Search Results (53)

Global and regional climate change and their water-related impacts are a key component in future development scenarios to guide sustainable water management. Climatic changes may lead to an undesirable redistribution of water supplies and potentially harmful extremities in river flows throughout the year. If we add to this the uneven spatial distribution of water resources in Kazakhstan, the importance of assessment of the intra-annual distribution of river flows under historical and present climatic conditions becomes evident. The presented scientific study analyzes decadal regional trends from 1985 to 2022 in the intra-annual distribution of river runoff in selected catchments in Kazakhstan, including Buktyrma River, Zhabay River, and Ulken-Kobda River. The river basins were selected to cover diverse regions in terms of geographical features and hydrological conditions, significantly affected by climate change. We applied statistical analysis methods using multiyear values of mean monthly and mean annual river flows, mean monthly air temperatures, and mean monthly precipitation. To analyze the intra-annual distribution of annual river flow in the context of climate change, a computational method was used, in which the actual current river flow (modern river flow taking into account non-stationarity of climatic changes) was compared with the conditionally natural flow obtained by modeling and corresponding to the natural regime of the river. The long-term dynamics of flow-forming factors and runoff parameters with regard to phases of different water content (25%, 50%, and 75%) were considered. Statistical analysis of seasonal changes in water content of modeled and actual river flow, taking into account climatic non-stationarity, allowed us to identify significant trends of flow redistribution within the year: indicating a decrease in the volume of spring floods, an increase in winter flow and increase in seasonal variability, especially for the Ulken Kobda River. It appears that atmospheric circulation significantly affects annual and seasonal variations of water availability. The shift in western circulation type (W) contributes to increased average annual river flow, while the shift in eastern circulation type (E) is associated with amplification of extreme flood-type events. The results obtained are important for adapting sustainable water management practices under a changing climate, helping to anticipate the availability of water resources and allowing pro-active measures to mitigate hydrological extremes. Full article

Background/Objective: Identifying patterns of diagnostic imaging workflow parallel to the influence of certain variables, such as pathology guidelines over time, provides valuable insight for clinical decision making. This study presents a recurring trend of initial imaging orders and follow-ups, up to the diagnosis of pancreatic neuroendocrine tumors (pNETs), across two decades, with scans which led to pathological investigation. Methods: Three readers evaluated common conventional imaging among initial and follow-up studies for lesion detection and localization. Inter-reader and intra-reader analyses were controlled as contributing factors to the imaging diagnostic trend. Results: Our results show that CT was the prominent initial scan in pNET workup, likely due to their wide availability, high spatial resolution, and rapid acquisition, with a sufficient detection rate throughout both decades, regardless of technical advances. However, MRI scans also gained soaring popularity, especially among syndromic patients, likely due to follow-up and anatomical surgery precision. Conclusions: Newer modalities may be eventually useful and only requested for pNETs staging and further treatment. Full article

Inflammatory bowel diseases (IBDs), comprising Crohn’s disease (CD) and ulcerative colitis (UC), are chronic immune-mediated inflammatory diseases of the gastrointestinal (GI) tract with still-elusive etiopathogeneses and an increasing prevalence worldwide. Despite the growing availability of more advanced therapies in the last two decades, there are still a number of unmet needs. For example, the achievement of mucosal healing has been widely demonstrated as a prognostic marker for better outcomes and a reduced risk of dysplasia and cancer; however, the accuracy of endoscopy is crucial for both this aim and the precise and reproducible evaluation of endoscopic activity and the detection of dysplasia. Artificial intelligence (AI) has drastically altered the field of GI studies and is being extensively applied to medical imaging. The utilization of deep learning and pattern recognition can help the operator optimize image classification and lesion segmentation, detect early mucosal abnormalities, and eventually reveal and uncover novel biomarkers with biologic and prognostic value. The role of AI in endoscopy—and potentially also in histology and imaging in the context of IBD—is still at its initial stages but shows promising characteristics that could lead to a better understanding of the complexity and heterogeneity of IBDs, with potential improvements in patient care and outcomes. The initial experience with AI in IBDs has shown its potential value in the differentiation of UC and CD when there is no ileal involvement, reducing the significant amount of time it takes to review videos of capsule endoscopy and improving the inter- and intra-observer variability in endoscopy reports and scoring. In addition, these initial experiences revealed the ability to predict the histologic score index and the presence of dysplasia. Thus, the purpose of this review was to summarize recent advances regarding the application of AI in IBD endoscopy as there is, indeed, increasing evidence suggesting that the integration of AI-based clinical tools will play a crucial role in paving the road to precision medicine in IBDs. Full article

Kidney transplantation is currently the treatment of choice for patients with end-stage kidney diseases. Although significant advancements in kidney transplantation have been achieved over the past decades, the host’s immune response remains the primary challenge, often leading to potential graft rejection. Effective management of the immune response is essential to ensure the long-term success of kidney transplantation. To address this issue, immunosuppressives have been developed and are now fully integrated into the clinical management of transplant recipients. However, the considerable inter- and intra-patient variability in pharmacokinetics (PK) and pharmacodynamics (PD) of these drugs represents the primary cause of graft rejection. This variability is primarily attributed to the polymorphic nature (genetic heterogeneity) of genes encoding xenobiotic-metabolizing enzymes, transport proteins, and, in some cases, drug targets. These genetic differences can influence drug metabolism and distribution, leading to either toxicity or reduced efficacy. The main objective of the present review is to report an historical overview of the pharmacogenetics of immunosuppressants, shedding light on the most recent findings and also suggesting how relevant is the research and investment in developing validated NGS-based commercial panels for pharmacogenetic profiling in kidney transplant recipients. These advancements will enable the implementation of precision medicine, optimizing immunosuppressive therapies to improve graft survival and kidney transplanted patient outcomes. Full article

Cuticular hydrocarbons (CHCs) are long-chain lipids found on the exoskeletons of insects, serving primarily as a protective barrier against water loss and environmental factors. In the last few decades, the qualitative and quantitative analysis of CHCs, particularly in blow flies, has emerged as a valuable tool in forensic entomology, offering promising potential for species identification and age estimation of forensically important insects. This review examines the current application of CHC analysis in forensic investigations and highlights the significant advancements in the field over the past few years. Studies have demonstrated that CHC profiles vary with insect development, and while intra-species variability exists due to factors such as age, sex, geographical location, and environmental conditions, these variations can be harnessed to refine post-mortem interval (PMI) estimations and improve the accuracy of forensic entomological evidence. Notably, CHC analysis can also aid in distinguishing between multiple generations of insects on a body, providing insights into post-mortem body movement and aiding in the interpretation of PMI in complex cases. Furthermore, recent studies have investigated the variability and degradation of CHCs over time, revealing how environmental factors—such as temperature, humidity, UV light exposure, and toxicological substances—affect CHC composition, providing valuable insights for forensic investigations. Despite the promise of CHC profiling, several challenges remain, and this review also aims to highlight future research directions to enhance the reliability of this technique in forensic casework. Full article

To understand the impact of climate change on water resources, this research investigates long-term rainfall trends and anomalies across Northeastern India (NEI), covering Assam and Meghalaya (A&M); Nagaland, Manipur, Mizoram, and Tripura (NMMT); and Sub-Himalayan West Bengal and Sikkim (SHWB&S) using different statistical tests including innovative trend analysis (ITA). The study scrutinizes 146 years of rainfall statistics, trend analyses, variability, and probability distribution changes to comprehend its implications. Furthermore, the change in the assured rainfall probabilities was also worked out to understand the impact on rainfed agriculture of Northeastern India. Comparative analysis between all India (AI) and NEI reveals that NEI receives nearly double the annual rainfall compared to AI (2051 mm and 1086 mm, respectively). Despite resembling broad rainfall patterns, NEI displays intra-regional variations, underscoring the necessity for region-specific adaptation strategies. Statistical characteristics like the coefficient of skewness (CS) and coefficient of kurtosis indicate skewed rainfall distributions, notably during the winter seasons in NMMT (CS~1.6) and SHWB&S (CS~1.5). Trend analyses reveal declining rainfall trends, especially conspicuous in NEI’s winter (−1.88) and monsoon (−2.9) seasons, where the rate of decrease was higher in the last three decades. The return periods of assured rainfall at 50% and 75% probability levels also increased sharply during the winter and monsoon seasons by over 30% during the recent half, posing challenges for rainfed upland hill farming. Furthermore, this study highlights increasing variability and negative anomalies in monsoon rainfall over NEI, exacerbating decreasing rainfall trends and significantly impacting agricultural productivity. These findings underscore the urgency for adaptive measures tailored to evolving rainfall patterns, ensuring sustainable agricultural practices and efficient water resource management. Full article

Based on long-term observations of the water discharge (WD) from 1878 to 2018, the main trends and patterns of its change in the basin of one of the largest rivers in the east of the East European Plain, the Vyatka River, were revealed using a set of standard statistical procedures and a graphical analysis of the WD probability curves. Three main phases of the annual river WD were identified, corresponding to the periods 1878–1929, 1930–1977, and 1978–2018. The first and third periods were characterized by increased WD (by 22–23%) relative to the medium period, and the differences in the average annual WD characteristics between these periods were statistically significant. It is also noteworthy that the difference in the average annual WD between the first and last periods of increased WD was very small and statistically insignificant. A gradual increase in the share of the so-called normal annual WD and a decrease in the abnormal (including extreme) annual WD were noted from 1878–1929 to 1978–2018 in the predominantly northern half of the river basin. At the same time, in the predominantly southern half of the basin, according to the analysis of only the periods 1930–1977 and 1978–2018, the so-called normal and abnormal WD remained almost unchanged; only a slight increase in positive anomalies of the WD was noted. Increased intra-annual variability in the WD was characteristic of the period of its reduced average annual value. Between the three identified periods, a gradual reduction in the water runoff coefficient was observed during the warm (mainly summer) season in the Vyatka River basin. The specified long-term variability in the water discharge of the Vyatka River was chiefly due to long-term changes in climatic factors, primarily the ratio of the air temperature and precipitation, expressed as the De Martonne aridity index. The duration of the principal cycle of these changes was 82 years. An additional contribution could also have been made by the widespread reduction in cropland in the study region in recent decades. The obtained results can be preliminarily considered representative of the entire southern sector of the boreal forest zone (taiga zone) of the east of the East European Plain. Full article

Forests are critical source regions of high-quality drinking water but forest disturbances such as harvesting can alter stream dissolved organic carbon (DOC) concentrations and influence source water treatability. Most stream DOC-centric forest harvesting impact studies report on effects <10 years post-harvest; less is known about the legacy effects of forest harvesting on stream DOC. Here, inter- and intra-catchment variability in stream DOC concentration and export were evaluated in two northern hardwood-dominated headwater catchments (unharvested reference and 24 years post-clearcut). The relationship between stream DOC and the concentration, spatial distribution, and hydrologic connectivity of hillslope solute pool DOC was investigated. Stream DOC concentrations in the legacy clearcut catchment exceeded those in the reference catchment for all flow conditions. Inter-catchment differences in DOC export were inconsistent. Hillslope solute pool DOC concentrations decreased with soil depth but were not significantly different between catchments. Concentration–discharge regression analysis indicated that DOC was primarily transport-limited (flushing) in both catchments. Aqueous potassium silica molar ratio data indicate the influence of groundwater on stream chemistry and streamflow was similar in both catchments. Results suggest that while clearcut harvesting can have detectable decadal-scale effects on stream DOC concentrations in northern hardwood-dominated headwater catchments, the effects are limited and likely do not pose a reasonable threat to downstream drinking water treatment operations. Full article

This study investigates the long-term trends (1992–2022) of nitrogen and phosphorus loadings exported by the River Po to the Adriatic Sea, to better analyse how changes in hydrology are affecting the timing and magnitude of river nutrient loads. We used 30 years of monitoring data in order to (a) identify the main temporal patterns and their interactions at a decadal, annual and seasonal scale, (b) estimate precipitation effects on load formation and evaluate whether and to which extent the hydrological regime affects nutrient export across the years and (c) analyse the nutrient export regime at a monthly scale and the main transport dynamic of N and P chemical species (hydrological vs. biogeochemical control). The long-term analysis shows a general decrease of both P and N loadings, but the trends are different between the elements and their chemical species, as well as undergoing different seasonal variations. We found a statistically significant relationships between precipitation and loads, which demonstrates that precipitation patterns drive the exported load at the intra- and interannual time scales considered in this study. Precipitation-induced load trends trigger seasonal changes in nutrient deliveries to the sea, peaking in spring and autumn. The nitrogen decrease is mainly concentrated in the summer dry period, while total phosphorus diminishes mainly in spring and autumn. This mismatch of N and P results in variable molar N:P ratios within the year. The effects of extreme drought and flood events, along with the progressive decrease in the snowmelt contribution to water fluxes, are expected to exacerbate the variability in the N and P loadings, which in turn is expected to perturbate the biodiversity, food webs and trophic state of the Northern Adriatic Sea. Full article

Introduction: Cardiac arrests are traditionally classified according to the setting in which they occur, including out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). However, cardiac arrests that occur in the emergency department (EDCA) could constitute a third category, due to the peculiar characteristics of the emergency department (ED). In recent years, the need to study EDCAs separately from other intra-hospital events has emerged. The aim of this study was to describe the characteristics and outcomes of a cohort of patients experiencing EDCA in an Italian hospital over a 14-year period. Methods: This was a single-centre retrospective observational study conducted in the ED of the Santa Croce e Carle Hospital in Cuneo, Italy. All adult patients who experienced EDCA between 1 January 2010 and 30 June 2023 were included. OHCA patients, those arriving in the ED with on-going resuscitation measures, patients with EDCA not undergoing resuscitation, and patients with post-traumatic cardiac arrest were excluded from the study. The main outcome of the study was survival at hospital discharge with a favourable neurological outcome. Results: 350 cases of EDCA were included. The median age was 78 (63–85) years, and the median Charlson Comorbidity Index score was 5 (3–6). A total of 35 patients (10%) survived to hospital discharge with a cerebral performance category (CPC) Score of 1–2; survival in the ED was 28.3%. The causes of cardiac arrests were identified in 212 cases (60.6%) and included coronary thrombosis (35%), hypoxia (22%), hypovolemia (17%), pulmonary embolism (11%), metabolic (8%), cardiac tamponade (4%), toxins (2%) and hypothermia (1%). Variables associated with survival with a favourable neurological outcome were young age, a lower Charlson Comorbidity Index, coronary thrombosis as the primary EDCA cause, and shockable presenting rhythm; however, only the latter was associated with the outcome in a multivariate age-weighted model. Conclusions: In a cohort of patients with EDCA over a period of more than a decade, the most frequent cause identified was coronary thrombosis; 10% of patients survived with a good neurological status, and the only factor associated with the best prognosis was presenting a shockable rhythm. EDCA should be considered an independent category in order to fully understand its characteristics and outcomes. Full article

Freshwater availability in Pacific equatorial atolls is highly variable because of the influence of El Niño–Southern Oscillation (ENSO) on rainfall. IPCC projections for the central and western tropical Pacific suggest annual rainfall (P_a) will increase as sea surface temperature (SST) rises. Future changes in ENSO frequency and intensity and in hydrological droughts, however, are uncertain. Here, trends in monthly, seasonal, annual, annual maximum, and minimum rainfall in two equatorial atolls in the eastern and central tropical Pacific are compared with trends in the SST of the surrounding Nino regions from 1951 to 2023. Significant increasing trends in the warm season, annual, and annual maximum SST in the Nino1 + 2, Nino3, and Nino4 regions were of order +1.0 °C/100 y. There were no significant trends in the cool season or annual minimum SST. Despite ocean warming, there were no significant trends in atoll P_a, in intra-annual or interannual variability over 7 decades for either SST or P_a, or in the relative strengths of warm/cool and wet/dry seasons. Extreme, large P_a only occurred after 1987, indicative of ocean warming. Extreme, small P_a happened throughout the period, suggesting no change in drought frequency. Correlations between 12-month P and SST were very strong, with historic rates of increases in P_a of around 1200 mm/y/°C, consistent with projections. The results indicate that the recharge of atoll groundwater will increase as oceans warm, but droughts will remain a major challenge. Full article

This study assesses the variability of coastal extreme sea levels globally by utilizing nearly three decades of along-track, multi-mission satellite altimetry data. An altimetry-based global coastal database of the non-tidal residual sea level component has been produced. The climate variability of extremes is modeled through a parametric, non-stationary statistical model. This model captures intra-annual, inter-annual and long-term variations in non-tidal residual return levels. Comparisons with tide gauge data demonstrate the ability of altimetry data to capture the variability of coastal extreme sea levels. Our findings reveal a greater complexity in the monthly variability patterns of non-tidal residual extremes in tropical latitudes, often exhibiting multiple storm periods, contrasting with coasts in extratropical latitudes, which are mostly controlled by a winter–summer pattern. This study also highlights the significant influence of established climate circulation patterns on sea level extremes. The positive phase of the Arctic Oscillation pattern leads to increases of over 25% in non-tidal residual return levels in Northwestern Europe with respect to a neutral phase. Furthermore, return levels in the western coast of Central America could be 50% higher during El Niño compared to La Niña. Our results show a robust increasing trend in non-tidal residual return levels along most global coastlines. A comparative analysis shows that variations during the 1995–2020 period were primarily driven by intra-annual variations. Full article

Introduction: The designer benzodiazepine (DBZD) market continues to expand whilst evading regulatory controls. The widespread adoption of social media by pro-drug use communities encourages positive discussions around DBZD use/misuse, driving demand. This research addresses the evolution of three popular DBZDs, etizolam (E), flubromazepam (F), and pyrazolam (P), available on the drug market for over a decade, comparing the quantitative chemical analyses of tablet samples, purchased from the internet prior to the implementation of the Psychoactive Substances Act UK 2016, with the thematic netnographic analyses of social media content. Method: Drug samples were purchased from the internet in early 2016. The characterisation of all drug batches were performed using UHPLC-MS and supported with ¹H NMR. In addition, netnographic studies across the platforms X (formerly Twitter) and Reddit, between 2016–2023, were conducted. The latter was supported by both manual and artificial intelligence (AI)-driven thematic analyses, using numerous.ai and ChatGPT, of social media threads and discussions. Results: UHPLC-MS confirmed the expected drug in every sample, showing remarkable inter/intra batch variability across all batches (E = 13.8 ± 0.6 to 24.7 ± 0.9 mg; F = 4.0 ± 0.2 to 23.5 ± 0.8 mg; P = 5.2 ± 0.2 to 11.5 ± 0.4 mg). ¹H NMR could not confirm etizolam as a lone compound in any etizolam batch. Thematic analyses showed etizolam dominated social media discussions (59% of all posts), with 24.2% of posts involving sale/purchase and 17.8% detailing new administration trends/poly-drug use scenarios. Artificial intelligence confirmed three of the top five trends identified manually. Conclusions: Purity variability identified across all tested samples emphasises the increased potential health risks associated with DBZD consumption. We propose the global DBZD market is exacerbated by surface web social media discussions, recorded across X and Reddit. Despite the appearance of newer analogues, these three DBZDs remain prevalent and popularised. Reporting themes on harm/effects and new developments in poly-drug use trends, demand for DBZDs continues to grow, despite their potent nature and potential risk to life. It is proposed that greater controls and constant live monitoring of social media user content is warranted to drive active regulation strategies and targeted, effective, harm reduction strategies. Full article

Unprovoked shark bites have increased over the last three decades, yet they are still relatively rare. Bull sharks are globally distributed throughout rivers, estuaries, nearshore areas and continental shelf waters, and are capable of making long distance movements between tropical and temperate regions. As this species is implicated in shark bites throughout their range, knowledge of the environmental drivers of bull shark movements are important for better predicting the likelihood of their occurrence at ocean beaches and potentially assist in reducing shark bites. Using the largest dataset of acoustically tagged bull sharks in the world, we examined the spatial ecology of 233 juvenile and large (including sub-adult and adult) bull sharks acoustically tagged and monitored over a 5.5-year period (2017–2023) using an array of real-time acoustic listening stations off 21 beaches along the coast of New South Wales, Australia. Bull sharks were detected more in coastal areas of northern NSW (<32° S) but they travelled southwards during the austral summer and autumn. Juveniles were not detected on shark listening stations until they reached 157 cm and stayed north of 31.98° S (Old Bar). Intra-specific diel patterns of occurrence were observed, with juveniles exhibiting higher nearshore presence between 20:00 and 03:00, whilst the presence of large sharks was greatest from midday through to 04:00. The results of generalised additive models revealed that large sharks were more often found when water temperatures were higher than 20 °C, after >45 mm of rain and when swell heights were between 1.8 and 2.8 m. Understanding the influence that environmental variables have on the occurrence of bull sharks in the coastal areas of NSW will facilitate better education and could drive shark smart behaviour amongst coastal water users. Full article

In the past decade, there has been a considerable increase in the recognition of antimicrobial resistance in equine practice. The objective of this study was to survey the current clinical use of antimicrobials for a commonly performed surgical procedure (exploratory celiotomy) with the goal of understanding how recent literature and changes in microbial resistance patterns may have impacted antimicrobial selection practices. An electronic survey was distributed to veterinary professionals within the American College of Veterinary Internal Medicine (ACVIM) and the American College of Veterinary Surgery (ACVS). A total of 113 completed surveys were returned. Practitioners reported antimicrobials were most frequently given 30–60 min preoperatively (63.1%). Two antimicrobial classes were typically administered (95.5%), with gentamicin (98.2%) and potassium penicillin (74.3%) being the most common. Antimicrobials were typically not re-dosed intraoperatively (78.6%). Factors that affected overall treatment length postoperatively included resection (81.4%), bloodwork (75.2%), enterotomy (74.3%), fever (85.0%), incisional complications (76.1%), and thrombophlebitis (67.3%). The most common duration of antimicrobial use was 1–3 d for non-strangulating lesions (54.4% of cases) and inflammatory conditions such as enteritis or peritonitis (50.4%), and 3–5 d for strangulating lesions (63.7%). Peri-incisional and intra-abdominal antimicrobials were used by 24.8% and 11.5% of respondents, respectively. In summary, antimicrobial usage patterns were highly variable among practitioners and, at times, not concordant with current literature. Full article