•Apparent age of Florida spring discharge increased with time from 1997 to 2013.•Apparent age increase unaffected by pumping or recharge from Tropical Storm Debby.•Increase in apparent age caused by ...excess precipitation from ∼1960 to 1980.•Excess precipitation results from El Niño years during warm phase AMO.•Groundwater management should consider effects of global climate on recharge.
Water quantity and quality in karst aquifers may depend on decadal-scale variations in recharge or withdrawal, which we hypothesize could be assessed through time-series measurements of apparent ages of spring water. We tested this hypothesis with analyses of various age tracers (3H/3He, SF6, CFC-11, CFC-12, CFC-113) and selected solute concentrations dissolved oxygen (DO), NO3, Mg, and SO4 from 6 springs in a single spring complex (Ichetucknee springs) in northern Florida over a 16-yr period. These springs fall into two groups that reflect shallow short (Group 1) and deep long (Group 2) flow paths. Some tracer concentrations are altered, with CFC-12 and CFC-113 concentrations yielding the most robust apparent ages. These tracers show a 10–20-yr monotonic increase in apparent age from 1997 to 2013, including the flood recession that followed Tropical Storm Debby in mid-2012. This increase in age indicates most water discharged during the study period recharged the aquifer within a few years of 1973 for Group 2 springs and 1980 for Group 1 springs. Inverse correlations between apparent age and DO and NO3 concentrations reflect reduced redox state in older water. Positive correlations between apparent age and Mg and SO4 concentrations reflect increased water-rock reactions. Concentrated recharge in the decade around 1975 resulted from nearly 2m of rain in excess of the monthly average that fell between 1960 and 2014, followed by a nearly 4m deficit to 2014. This excess rain coincided with two major El Niño events during the maximum cool phase in the Atlantic Multidecadal Oscillation. Although regional water withdrawal increased nearly 5-fold between 1980 and 2005, withdrawals represent only 2–5% of Ichetucknee River flow and are less important than decadal-long variations in precipitation. These results suggest that groundwater management should consider climate cycles as predictive tools for future water resources.
The x-ray structure of the monotopic membrane protein (S)-mandelate dehydrogenase (MDH) from Pseudomonas putida reveals an inherent flexibility of its membrane binding segment that might be important ...for its biological activity. The surface of MDH exhibits a concentration of the positive charges on one side and the negative charges on the other side. The putative membrane binding surface of MDH has a concentric circular ridge, formed by positively charged residues, which projects away from the protein surface by ∼4 Å; this is an unique structural feature and not observed in other monotopic membrane proteins to our knowledge. There are three α-helixes in the membrane binding region. Based on the structure of MDH, it is possible to propose that the interaction of MDH with the membrane is stabilized by coplanar electrostatic interactions, between the positively charged concentric circular ridge and the negatively charged head-groups of the phospholipid bilayer, along with three α-helixes that provide additional stability by inserting into the membrane. The structure reveals the possible orientation of these helixes along with possible roles for the individual residues which form those helixes. These α-helixes may play a role in the enzyme's mobility. A detergent molecule, N-Dodecyl-β-maltoside, is inserted between the membrane binding region and rest of the molecule and may provide structural stability to intra-protein regions by forming hydrogen bonds and close contacts. From the average B-factor of the MDH structure, it is likely that MDH is highly mobile, which might be essential for its interaction in membrane and non-membrane environments, as its substrate (S)-mandelate, is from the cytoplasm, while its electron acceptor is a component of the membrane electron transport chain.
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•Membrane binding segment contains three α-helixes.•Three helixes provide stability in membrane interaction.•Formation of concentric circular positively charged ridge is unique.•Electrostatic interaction is the main force of stabilization in membrane interaction.
Background West Nile virus (WNV) is an emerging mosquito-borne pathogen in Serbia, where it has been detected as a cause of infection in humans since 2012. We analyzed and modelled WNV transmission ...patterns in the country between 2012 and 2023. Methods We applied a previously developed modelling approach to quantify epidemiological parameters of interest and to identify the most important environmental drivers of the force of infection (FOI) by means of statistical analysis in the human population in the country. Results During the study period, 1,387 human cases were recorded, with substantial heterogeneity across years. We found that spring temperature is of paramount importance for WNV transmission, as FOI magnitude and peak timing are positively associated with it. Furthermore, FOI is also estimated to be greater in regions with a larger fraction of older adult people, who are at higher risk to develop severe infections. Conclusion Our results highlight that temperature plays a key role in shaping WNV outbreak magnitude in Serbia, confirming the association between spring climatic conditions and WNV human transmission risk and thus pointing out the importance of this factor as a potential early warning predictor for timely application of preventive and control measures.
Metabolic processes of the submerged aquatic community (photosynthesis and respiration) play important roles in regulating diel cycles of dissolved inorganic carbon (DIC) and sequestering carbon in a ...karst stream. However, little is known of whether diel DIC cycling occurs during rainfall in a karst groundwater-fed stream, even though this question is critical for the accurate estimation of what may be a major terrestrial carbon sink. Here, we measured diel variations of water chemical composition in a small karst groundwater-fed stream in southwest China during a rainfall event to assess the influences of rainfall and rising discharge on DIC diel cycling and the potential carbon sink produced by in-stream metabolism. Our results show that water chemical composition at the source spring (CK site) is relatively stable due to chemostatic behavior during rising discharge after a rainfall period. This site lacked submerged aquatic vegetation and, thus, had no diel variations in water chemistry. However, diel cycles of all hydrochemical parameters occurred at a site 1.3 km downstream (LY site). Diel variations in pH, DO, and δ
13
C
DIC
were inversely related to diel changes in SpC, DIC, Ca
2+
, and
p
CO
2
. These results indicated that diel cycling of DIC due to in-stream metabolism of submerged aquatic community was still occurring during elevated discharge from rainfall. We estimate the carbon sink through the in-stream metabolism of the submerged aquatic community to be 5.6 kg C/day during the studied rainfall event. These results imply that submerged aquatic communities in a karst stream can significantly stabilize carbon originating from the carbonate rock weathering processes in karst areas.
•Normal haemodynamics in the absence of major trauma rules out the need for PCCD.•If based on haemodynamics alone, 20% of serious pelvic injuries would not have received a PCCD.•Motor vehicle and ...motorcycle accidents were the most common mechanisms of injury requiring urgent pelvic intervention.
Pelvic ring fractures are common following high-energy blunt trauma and can lead to substantial haemorrhage, morbidity and mortality. Pelvic circumferential compression devices (PCCDs) improve position and stability of open-book type pelvic fracture, and can improve haemodynamics in patients with hypovolaemic shock. However, PCCDs may cause adverse outcomes including worsening of lateral compression fracture patterns and routine use is associated with high costs. Controversy regarding indication of PCCDs exists with some centres recommending PCCD in the setting of hypovolaemic shock compared to placement for any suspected pelvic injury.
To assess the need for PCCD application based on pre-hospital vital signs and mechanism of injury.
A retrospective cohort study was conducted in a single adult major trauma centre examining a 2-year period. Patients were sub-grouped based on initial pre-hospital and emergency department observations as haemodynamically normal (heart rate <100 bpm, systolic blood pressure ≥100 mmHg and Glasgow Coma Scale ≥13) or abnormal. Diagnostic accuracy of pre-hospital haemodynamics as a predictor of pelvic fracture requiring intervention within 24 h was assessed.
There were 376 patients with PCCD in-situ on hospital arrival. Pelvic fractures were diagnosed in 137 patients (36.4%). Of these, 39 (28.5%) were haemodynamically normal and 98 (71.5%) were haemodynamically abnormal.
The most common mechanisms of injury were motor vehicle collision (57.7%) and motorcycle collision (13.8%). Of those with fractures, 40 patients (29.2%) required pelvic intervention within 24 h of admission; of these, 8 (20%) were haemodynamically normal and 32 (80%) were haemodynamically abnormal. As a test for pelvic fracture requiring intervention within 24 h, abnormal pre-hospital haemodynamics had a sensitivity of 0.80 (95% CI 0.64-0.91), specificity of 0.32 (95% CI 0.27-0.38) and negative predictive value (NPV) of 0.93 (95% CI 0.88-0.96). Combined with absence of a major mechanism of injury, normal haemodynamics had a sensitivity 1.00, specificity 0.51 (95% CI 0.36-0.66) and NPV of 1.00 for pelvic intervention within 24 h.
Normal haemodynamic status, combined with absence of major mechanism of injury can rule out requirement for urgent pelvic intervention. Ongoing surveillance is recommended to monitor for any adverse effects of this change in practice.
Animal domestication was a major step forward in human prehistory, contributing to the emergence of more complex societies. At the time of the Neolithic transition, zebu cattle (Bos indicus) were ...probably the most abundant and important domestic livestock species in Southern Asia. Although archaeological evidence points toward the domestication of zebu cattle within the Indian subcontinent, the exact geographic origins and phylogenetic history of zebu cattle remains uncertain. Here, we report evidence from 844 zebu mitochondrial DNA (mtDNA) sequences surveyed from 19 Asiatic countries comprising 8 regional groups, which identify 2 distinct mitochondrial haplogroups, termed I1 and I2. The marked increase in nucleotide diversity (P < 0.001) for both the I1 and I2 haplogroups within the northern part of the Indian subcontinent is consistent with an origin for all domestic zebu in this area. For haplogroup I1, genetic diversity was highest within the Indus Valley among the three hypothesized domestication centers (Indus Valley, Ganges, and South India). These data support the Indus Valley as the most likely center of origin for the I1 haplogroup and a primary center of zebu domestication. However, for the I2 haplogroup, a complex pattern of diversity is detected, preventing the unambiguous pinpointing of the exact place of origin for this zebu maternal lineage. Our findings are discussed with respect to the archaeological record for zebu domestication within the Indian subcontinent.
We mapped tidal wetland gross primary production (GPP) with unprecedented detail for multiple wetland types across the continental United States (CONUS) at 16‐day intervals for the years 2000–2019. ...To accomplish this task, we developed the spatially explicit Blue Carbon (BC) model, which combined tidal wetland cover and field‐based eddy covariance tower data into a single Bayesian framework, and used a super computer network and remote sensing imagery (Moderate Resolution Imaging Spectroradiometer Enhanced Vegetation Index). We found a strong fit between the BC model and eddy covariance data from 10 different towers (r2 = 0.83, p < 0.001, root‐mean‐square error = 1.22 g C/m2/day, average error was 7% with a mean bias of nearly zero). When compared with NASA's MOD17 GPP product, which uses a generalized terrestrial algorithm, the BC model reduced error by approximately half (MOD17 had r2 = 0.45, p < 0.001, root‐mean‐square error of 3.38 g C/m2/day, average error of 15%). The BC model also included mixed pixels in areas not covered by MOD17, which comprised approximately 16.8% of CONUS tidal wetland GPP. Results showed that across CONUS between 2000 and 2019, the average daily GPP per m2 was 4.32 ± 2.45 g C/m2/day. The total annual GPP for the CONUS was 39.65 ± 0.89 Tg C/year. GPP for the Gulf Coast was nearly double that of the Atlantic and Pacific Coasts combined. Louisiana alone accounted for 15.78 ± 0.75 Tg C/year, with its Atchafalaya/Vermillion Bay basin at 4.72 ± 0.14 Tg C/year. The BC model provides a robust platform for integrating data from disparate sources and exploring regional trends in GPP across tidal wetlands.
Key Points
We created the Blue Carbon (BC) model, which mapped the Gross Primary Production (GPP) of all tidal wetlands within the continental United States
The BC model provides maps of tidal wetland GPP at sub‐250 m scales and at 16‐day intervals for the years 2000‐2019
The average daily GPP per m2 was 4.32 ± 2.45 g C/m2/day, and the total annual GPP for the continental United States was 39.65 ± 0.89 Tg C/year
Summary
What is known and objective
Patients admitted to general medical units and emergency short‐stay units are often complex with multiple comorbidities, polypharmacy and at risk for drug‐related ...problems associated with increased morbidity and mortality. The aim of this study was to evaluate the effectiveness of a partnered pharmacist charting model completed at the time of admission to prevent medication errors.
Methods
We conducted an unblinded cluster randomized controlled trial comparing partnered pharmacist charting to standard medical charting among patients admitted to general medical units and emergency short‐stay units with complex medication regimens or polypharmacy. This trial was conducted at an adult major referral hospital in metropolitan Melbourne, Australia, with an annual emergency department attendance of approximately 60 000 patients. The evaluation included patients’ medication charts written in the period of 16 March 2015 to 27 July 2015. Patients randomized to the intervention were managed using the partnered pharmacist charting model. The primary outcome variable was a medication error identified by an independent assessor within 24 h of admission, who was not part of the patient's admission process.
Results
Of the 473 patients who received standard medical staff charting during the study period, 372 (78·7%) had at least one medication error identified compared to 15 patients (3·7%) on the partnered pharmacist charting arm (P < 0·001). The relative risk of an error with standard medical charting was 21·4 (95% CI: 13·0–35·0) with a number needed to treat (NNT) to prevent one error of 1·3 (95% CI: 1·3–1·4), and the relative risk of a high or extreme risk error with standard medical charting was 150·9 (95% CI: 21·2–1072·9) with a NNT to prevent one high or extreme error of 2·7 (95% CI 2·4–3·1).
What is new and conclusion
Partnering between medical staff and pharmacists to jointly chart initial medications on admission significantly reduced inpatient medication errors (including errors of high and extreme risk) among general medical and emergency short‐stay patients with complex medication regimens or polypharmacy.
Polypharmacy has the potential to influence many aspects of safe prescribing, including adverse drug reactions, risk of medication interactions, and adherence. Managing patients with polypharmacy can be time consuming, with complex cases requiring careful balancing of competing clinical priorities and conflicting guidelines, and are often associated with errors in prescribing. Partnered pharmacist charting, with collaboration between a pharmacist and a medical officer on admission, significantly reduced medication errors (including high and extreme risk) on admission for general medical and emergency short stay patients with complex medication regimens or polypharmacy
Abstract Objectives The contribution of chemical bonding of the polycarboxylic acid in classical powder/liquid conventional glass ionomers (GI) and resin-modified glass-ionomers (RMGI) has been ...attributed to the excellent long-term bond strengths and clinical retention. RMGIs have been recently introduced as paste/liquid systems for convenience of clinical usage. The objective of this study was to investigate the long-term bond strengths and mechanism of adhesion of paste-liquid RMGI in order to ascertain whether similar characteristics are retained. Methods Long-term shear adhesion to dentin and enamel was measured on two paste-liquid RMGIs and one powder/liquid RMGI. Scanning electron microscopy (SEM), Fourier-transformed infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopy (XPS) analyses were carried out on the paste-liquid RMGI Vitrebond Plus (VBP) and compared with the classical powder/liquid RMGI Vitrebond (VB). Results VBP maintains adhesion to dentin and enamel over long times; its long-term adhesive performance is equivalent to VB. FTIR data confirm that VBP exhibits the carboxylate crosslinking reaction of a true glass ionomer. SEM images show evidence of micromechanical bonding at the interface between VBP and the tooth. XPS and FTIR data show that the methacrylated copolyalkenoic acid component present in VB and VBP chemically bonds to the calcium in HAP. Significance The new paste-liquid RMGI liner, VBP, shows equivalent adhesion to its powder-liquid predecessor, VB. The adhesion mechanism was attributed to micromechanical and chemical bonding. This chemical bond is a significant factor in the excellent long-term adhesion of these materials.
•This study assessed the utility of a structured reporting template in improving the accuracy of CTB interpretation by emergency clinicians.•A pre- and post-intervention cohort study was conducted ...using a population of emergency medicine trainees.•320 CTBs were reported on by 26 participants and the concordance of participant reports with the radiology report evaluated.•The concordance of participant reports improved from 76% pre-intervention to 92% post-intervention (p<0.01).•A CTB reporting template may represent an effective strategy for improving CTB interpretation by emergency clinicians.
Computed tomography of the brain (CTB) has a fundamental role in the diagnosis and management of traumatic brain injury (TBI). There may be substantial discordance between initial CTB interpretation by emergency clinicians and the final radiology report. This study aimed to assess the utility of a structured reporting template in improving the accuracy of CTB interpretation by emergency clinicians.
A prospective pre- and post-intervention cohort study was undertaken using a study population of emergency medicine trainees. The CTB reporting template was created with consultation from radiology, emergency medicine and trauma specialists. Participants reported on a set of randomly selected trauma CTBs first without, and then with, the reporting template. Each case was independently assessed for concordance with the radiology report by two blinded assessors (including a radiologist) and the proportion of concordant reports in each phase calculated.
There were 26 participants recruited to the study who reported on a total of 320 CTBs. In the pre-intervention phase, 121 (76%) cases were concordant with the radiology report compared to 147 (92%) post-intervention (p<0.01). The AUROC was 0.84 (95% CI: 0.78–0.89) pre-intervention and improved to 0.94 (95% CI: 0.88–0.99) with the intervention (p=0.01). A higher level of baseline accuracy was observed in advanced trainees (78%) compared to basic trainees (72%), but both improved to a similar level of 92% with the use of the CTB reporting template. There was a marked reduction in false negative errors, with increased identification of critical diagnoses such as cerebral herniation and diffuse axonal injury.
The use of the CTB reporting template significantly increased the accuracy of emergency medicine trainees and reduced the number of missed critical diagnoses. Reporting templates may represent an effective strategy to improve CTB interpretation and enhance the initial care of head injured patients.
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