Dynamics of meteorological and hydrological drought: The impact of groundwater and El Niño events on forest fires in the Amazon.

Over recent decades, anthropogenic forest fires have significantly altered vegetation dynamics in the Amazon region. While human activities primarily initiate these fires, their escalation is intricately linked to climatic conditions, particularly droughts induced by the warm El Niño phase. This study investigates the impact of meteorological and hydrological drought on forest fires in the Amazon, focusing on the role of groundwater and El Niño events. Utilizing comprehensive drought indicators at various soil depths and standardized precipitation indexes, the research spans from 2004 to 2016, revealing a consistent decrease in humidity conditions across surface soil moisture, root zone soil moisture, and groundwater storage levels. With its slower response to precipitation changes, groundwater emerges as a crucial factor influencing hydrological drought patterns in the Amazon. The spatial distribution of drought conditions is explored, highlighting areas with lower humidity concentrations in the northeast and a correlation between forest fires and positive rates of change in burned area fraction during El Niño events. Notably, the study underscores the substantial increase in burned area during the 2015-2016, characterized by a very strong El Niño. This nuanced understanding of groundwater dynamics and its interplay with El Niño events provides critical insights for developing a tailored fire risk index in the ecologically significant and vulnerable Amazon basin, subsidizing strategies for mitigating fire risk and enhancing preparedness.

Appalachia - Bridging the Opioid Epidemic Amid the Fentanyl Crisis.

Although the opioid epidemic and fentanyl crisis are nationwide problems of immense proportions, calming the storm raging across the isolating geo-economic framework of Appalachia demonstrates the need for courageous, culturally effective programs that have the power to address and overcome the grave situation of addiction in this region. In the Appalachian region, unjust social structures are embedded in the communities' socio-economic conditions. As this reality poses even greater barriers to addressing the opioid epidemic in these communities, the restoration of social relationships within a community becomes vital to the development of a broader approach to social functioning and human flourishing. Faith traditions and faith communities can play an important role in helping to establish and support such social cohesion through attention to the individual, social, and spiritual needs of the community. This essay explores the complex problem of the opioid epidemic compounded by the fentanyl crisis. It considers the importance of public health research within the regional geo-economic framework of Appalachia to (a) inform policies that improve health inequities and promote social cohesion, (b) develop social solutions with a spiritual dimension, and (c) reveal remedies capable of informing moral norms in support of building a more just society. Reflecting on the virtue of solidarity, this essay also highlights the witness of the Catholic Church's response to the suffering experienced within the communities and the societies within the Appalachian mountains. While there may be considerable interest in viewing this article as a research document, foundationally, this essay utilizes a literary narrative approach through a Catholic lens to inform ethical deliberations, reasoning, and practice while supporting ethical reflection and consideration of the responses raised. Further, the reader is strongly encouraged to reference the comprehensive footnote system provided for extension and verification of the data presented.

Methodological evaluation of river discharges derived from remote sensing and land surface models.

This study assesses river discharges derived using remote sensing and hydrologic modeling approaches throughout the CONUS. The remote sensing methods rely on total water storage anomalies (TWSA) from the GRACE satellite mission and water surface elevations from altimetry satellites (JASON-2/3, Sentinel-3). Surface and subsurface runoff from two Land Surface Models (NOAH, CLSM) are routed using the Hillslope River Routing model to determine discharge. The LSMs are part of NASA's Global Land Data Assimilation System (GLDAS). Differences in key physical processes represented in each model, model forcings, and use of data assimilation provide an intriguing basis for comparison. Evaluation is performed using the Kling Gupta Efficiency and USGS stream gauges. Results highlight the effectiveness of both satellite-derived discharge methods, with altimetry generally performing well over a range of discharges and TWSA capturing mean flows. LSM-derived discharge performance varies based on hydroclimatic conditions and drainage areas, with NOAH generally outperforming CLSM. CLSM-derived discharges may be impacted by the use of data assimilation (GLDAS v2.2). Low correlation and high variability contribute to lower KGE values. GLDAS models tend to perform poorly in snow dominated, semi-arid and water-regulated systems where both the timing and magnitude of the simulated results are early and overestimated.

Evaluation of the Relationship between QT Interval in ECG and GRACE Score Amount of Hospitalized Patients with NSTEMI.

Background: Non-ST-elevation myocardial infarction (NSTEMI) is a significant component of acute coronary syndrome (ACS) and typically exhibits a relative incidence that is more than double that of ST-segment elevation myocardial infarction (STEMI). Data obtained from the International Long QT Syndrome Registry indicate that the risk of developing malignant arrhythmias in individuals with long QT syndrome is exponentially associated with the duration of the QTc interval. Therefore, the aim of this study was to assess the potential inclusion of prolonged QTc as a prognostic risk factor in NSTEMI patients. Methods: A cross-sectional study was conducted on patients with NSTEMI diagnosis admitted to the Bu-Ali Hospital of Qazvin between April 2021 and September 2021 by census method. The QT interval was measured in the electrocardiogram at admission. The documented grace score was calculated and its relationship with the corrected QTc interval was estimated using the Hodges formula. Finally, the relationship between QTc and GRACE score was investigated as a prognostic factor in ACS patients. Relationships were assessed by using both the T-test and the chi-square test. Results: A total of 60 patients (31.7% females, 63.8% males) with a mean age of 63 ± 12.7 years were evaluated. Most of the patients (68.3%) were at low risk regarding the Grace score category. In evaluating the relationship between QTc in the electrocardiogram at admission with total GRACE score, the Pearson correlation results were significant and there was a positive relationship between these two factors (r = 0.497, P < 0.001). Conclusion: This study revealed a significant relationship between the QTc interval of patients and the GRACE Score. It was shown patients' QTc can be a predictive factor of patients' mortality.

Application of GRACE-based satellite estimates in the assessment of flood potential: A case study of Gangetic-Brahmaputra basin, India.

The high frequency of flood occurrences and the uneven distribution of hydrological stations make it difficult to monitor large-scale floods. Emergence of the Gravity Recovery and Climate Experiment (GRACE) satellite system sets up a new era of large-scale flood monitoring without much reliance on in situ hydrological observations. The GRACE-derived flood potential index (FPI) exhibits its ability to monitor major events of 2003, 2004, 2007, and 2008 over the Indo-Gangetic-Brahmaputra Basin (IGBB). Precipitation and soil moisture are the major influencing factors of flood. However, the response of potential flooding to such parameters is little known. Pearson's lag correlation analysis is used to examine the response of the GRACE-based FPI to precipitation and soil moisture over the study region comparing seasonal time series of the variables. Results exhibited a 2-month lagged response of FPI to precipitation in the Upper Gangetic Yamuna Chambal Basin (UGYCB) and the Lower Gangetic Basin (LGB) and 1-month lagged response in the Lower Brahmaputra Basin (LBB). With context to soil moisture, a 1-month lag is observed in the Gangetic basins, and no lag is observed in the LBB. Event wise analysis of the lags portrays slightly varying lags for different events; however, it provides a picture on the interaction between these variables. This study also assesses the agreement between FPI and satellite-based river discharge, i.e. Dartmouth Flood Observatory (DFO) discharge. A good correlation (> 0.60) between the two is observed. Threshold values of FPI are determined for the LBB due to its annual flood frequency. The nearly similar accuracy of threshold FPI, determined using DFO discharge, in monitoring floods and the predictive skill measure of FPI for LBB to the previous studies demonstrates the utility of satellite-based discharge in the quantification of threshold FPI values for different percentile floods.

Monitoring terrestrial water storage changes using GNSS vertical coordinate time series in Amazon River basin.

Aiming at the Terrestrial Water Storage(TWS) changes in the Amazon River basin, this article uses the coordinate time series data of the Global Navigation Satellite System (GNSS), adopts the Variational Mode Decomposition and Bidirectional Long and Short Term Memory(VMD-BiLSTM) method to extract the vertical crustal deformation series, and then adopts the Principal Component Analysis(PCA) method to invert the changes of terrestrial water storage in the Amazon Basin from July 15, 2012 to July 25, 2018. Then, the GNSS inversion results were compared with the equivalent water height retrieved from Gravity Recovery and Climate Experiment (GRACE) data. The results show that (1) the extraction method proposed in this article has better denoising effect than the traditional method; (2) the surface hydrological load deformation can be well calculated using GNSS coordinate vertical time series, and then the regional TWS changes can be inverted, which has a good consistency with the result of GRACE inversion of water storage, and has almost the same seasonal variation characteristics; (3) There is a strong correlation between TWS changes retrieved by GNSS based on surface deformation characteristics and water mass changes calculated by GRACE based on gravitational field changes, but GNSS satellite's all-weather measurement results in a finer time scale compared with GRACE inversion results. In summary, GNSS can be used as a supplementary technology for monitoring terrestrial water storage changes, and can complement the advantages of GRACE technology.

Serum Magnesium Levels and QTc Interval Prolongation As Prognostic Markers in Acute Myocardial Infarction: A Randomized Controlled Study.

Introduction Acute myocardial infarction (AMI) is frequently preceded by arrhythmias, which continue to be a prominent cause of abrupt fatality in AMI. Abnormal magnesium levels have been linked to the emergence of arrhythmia because it enhances myocardial metabolism and cardiac output and prevents calcium buildup and myocardial cell death by lowering arrhythmias. The objectives of this study were to evaluate serum magnesium levels and QTc interval as prognostic indicators in AMI patients during the initial 48 hours of hospital stay and to correlate these parameters with the Global Registry of Acute Coronary Events (GRACE) scoring. We studied AMI patients by dividing them into two groups: those with abnormal and those with normal serum magnesium levels. Methods After obtaining ethical approvals, patients were subjected to detailed history, which included sociodemographic details, drug history, clinical examination, and investigations such as creatine kinase myocardial band (CK-MB), CK-total, troponin-T, ECG (QTc interval), two-dimensional echocardiogram (2D-ECHO), serum creatinine and magnesium levels, heart rate, and blood pressure. We also calculated the GRACE score for all patients. Results We found that patients in the age group of 51-60 years were more prone to developing arrhythmias, and while AMI was more prevalent in males, the occurrence of arrhythmias was slightly higher in females with AMI. Anterior wall motion abnormality (AWMA) was the most predominant abnormality, and 12.3% of AWMA patients had arrhythmias. QTc interval was significantly longer in patients who developed arrhythmias. Interestingly, among patients with QTc prolongation, 35% patients had abnormal magnesium levels, while 65% had normal magnesium levels. In our study, of the 25 patients with hypermagnesemia, nine (36%) developed arrhythmias, while of the 75 patients with hypomagnesemia, 15 (20%) patients developed arrhythmias. Interestingly, we found that there was a positive correlation between GRACE score and serum magnesium as well as QTc interval prolongation. Lastly, among the six deaths reported, three (50%) patients had arrhythmias. Conclusion Overall, we conclude that serum magnesium levels play a pivotal role as a prognostic tool for arrhythmias and are a useful investigation during the initial 48 hours of admission in AMI patients.

The otherwise and grace: Exploring theopolitical connections.

Although they are not often in explicit conversation with each other, several scholarly contributions about the otherwise and grace, respectively, echo each other in striking ways. In this article, the author explores some of these echoes. Assembling theoretically various approaches to the otherwise and grace allows him to show that they both tread on similar theopolitical paths, and to identify three points on which they converge: excess, incarnation and turbulence. The article is structured around these three confluences. Each section begins with a description of a particular way of approaching the otherwise, which is then compared with a similar way of approaching grace. Each section concludes with reflections on the spaces of convergence thus identified, and it is argued that they constitute promising sites for the deployment of a 'theopolitical analytics' in anthropology.

Bien qu'elles ne soient pas souvent mises en conversation les unes avec les autres, de nombreuses contributions académiques traitant respectivement de l'autrement et de la grâce se font écho de façons surprenantes. Dans cet article, j'explore quelques-uns de ces échos. Ce rapprochement théorique de diverses façons de concevoir l'autrement et la grâce me permet de montrer qu'ils suivent tous deux des chemins théopolitiques similaires et d'identifier trois points vers lesquels ils convergent: l'excès, l'incarnation et la turbulence. L'article est structuré autour de ces trois confluences. Chaque section débute avec la description d'une façon particulière d'approcher l'autrement qui est par le suite comparée avec une approche similaire de la grâce. Je conclue chaque section avec des réflexions sur les espaces de convergence ainsi identifiés et soutiens qu'ils constituent des sites prometteurs pour le développement d'une analytique théopolitique en anthropologie.

Assessing terrestrial water storage dynamics and multiple factors driving forces in China from 2005 to 2020.

In the context of global warming, comprehending the dynamics of terrestrial water storage (TWS) and its responses to natural and anthropogenic factors is paramount for hydrological research and the management of water resources in China. This study utilized GRACE (Gravity Recovery and Climate Experiment)/GRACE-Follow On (GRACE-FO) satellite data to analyze terrestrial water storage across nine basins in China from 2005 to 2020 at multiple temporal and spatial scales. Subsequently, employing a Geographic detector model, potential influencing factors were identified, and an enhanced Geographically Weighted Regression (GWR) method was proposed for attributing changes in TWS in China. The findings reveal a consistent declining trend in TWS based on GRACE/GRACE-FO data across different temporal scales, with the most pronounced decreases observed in August and September. Geographic Detector analysis unveils significant interactions among various environmental factors, with climate variables playing a pivotal role in modulating hydrological characteristics of major river basins, where rising temperatures can exacerbate the severity of precipitation events, thus increasing the risk of floods and droughts. Moreover, analysis of the primary influencing factors indicates significant impacts of population density and topography on water resources in the southeastern and southwestern regions, particularly amidst increasing human activities and urbanization expansion. The results of this study are crucial for comprehending the dynamic changes and mechanisms of TWS in China, as well as for formulating water resource management strategies.

Bridging the gap between GRACE and GRACE Follow-On by combining high-low satellite-to-satellite tracking data and satellite laser ranging.

The satellite missions GRACE and GRACE Follow-On have undoubtedly been the most important sources to observe mass transport on global scales. Within the Combination Service for Time-Variable Gravity Fields (COST-G), gravity field solutions from various processing centers are being combined to improve the signal-to-noise ratio and further increase the spatial resolution. The time series of monthly gravity field solutions suffer from a data gap of about one year between the two missions GRACE and GRACE Follow-On among several smaller data gaps. We present an intermediate technique bridging the gap between the two missions allowing (1) for a continued and uninterrupted time series of mass observations and (2) to compare, cross-validate and link the two time series. We focus on the combination of high-low satellite-to-satellite tracking (HL-SST) of low-Earth orbiting satellites by GPS in combination with satellite laser ranging (SLR), where SLR contributes to the very low degrees and HL-SST is able to provide the higher spatial resolution at an lower overall precision compared to GRACE-like solutions. We present a complete series covering the period from 2003 to 2022 filling the gaps of GRACE and between the missions. The achieved spatial resolution is approximately 700 km at a monthly temporal resolutions throughout the time period of interest. For the purpose of demonstrating possible applications, we estimate the low degree glacial isostatic adjustment signal in Fennoscandia and North America. In both cases, the location, the signal strength and extend of the signal coincide well with GRACE/GRACE-FO solutions achieving 99.5% and 86.5% correlation, respectively.

Serum BAFF level is associated with the presence and severity of coronary artery disease and acute myocardial infarction.

OBJECTIVE: The aim of this study was to investigate the relationship between circulating levels of B cell activating factor (BAFF) and the presence and severity of coronary artery disease (CAD) and acute myocardial infarction (AMI) in humans, as its biological functions in this context remain unclear. METHODS: Serum BAFF levels were measured in a cohort of 723 patients undergoing angiography, including 204 patients without CAD (control group), 220 patients with stable CAD (CAD group), and 299 patients with AMI (AMI group). Logistic regression analyses were used to assess the association between BAFF and CAD or AMI. RESULTS: Significantly elevated levels of BAFF were observed in patients with CAD and AMI compared to the control group. Furthermore, BAFF levels exhibited a positive correlation with the SYNTAX score (r = 0.3002, P < 0.0001) and the GRACE score (r = 0.5684, P < 0.0001). Logistic regression analysis demonstrated that increased BAFF levels were an independent risk factor for CAD (adjusted OR 1.305, 95% CI 1.078-1.580) and AMI (adjusted OR 2.874, 95% CI 1.708-4.838) after adjusting for confounding variables. Additionally, elevated BAFF levels were significantly associated with a high GRACE score (GRACE score 155 to 319, adjusted OR 4.297, 95% CI 1.841-10.030). BAFF exhibited a sensitivity of 75.0% and specificity of 71.4% in differentiating CAD patients with a high SYNTAX score, and a sensitivity of 75.5% and specificity of 72.8% in identifying AMI patients with a high GRACE score. CONCLUSION: Circulating BAFF levels serve as a valuable diagnostic marker for CAD and AMI. Elevated BAFF levels are associated with the presence and severity of these conditions, suggesting its potential as a clinically relevant biomarker in cardiovascular disease.

Functional Outcome of Forearm Fractures Managed With Screw Nails vs. Dynamic Compression Plates: A Prospective Study.

Background Fractures of the forearm are very frequently encountered in day-to-day practice. These fractures have a bimodal age distribution. The forearm fractures are considered intra-articular and need absolute stability for adequate healing. The current treatment modalities include using intramedullary devices such as a square nail, locking intramedullary nail, or using a plate for fixation. In this study, we aim to determine the functional outcome of forearm fractures managed with a screw nail used as an intramedullary device as compared to a locking plate using the Grace-Eversmann criteria. Methodology Patients with forearm fractures were divided into two groups and treated with a screw nail and a dynamic compression plate. Patients were followed up at one month, three months, six months, and one year postoperatively and assessment was done using the Grace-Eversmann criteria. Results The study included a total of 30 subjects, ranging in age from 18 to 65. The majority of the patients had encountered a road traffic accident, following which they incurred a forearm fracture. Grace-Eversmann criteria was used for these patients at follow-up, and a total of 13 patients (86.6%) had good to excellent scores, which was similar when compared to the plate osteosynthesis group (86.6%). A significant difference in the amount of blood loss was noted in the screw nail osteosynthesis group as compared to the plate osteosynthesis group (p<0.05). Conclusions Though a dynamic compression plate is considered a standard method for fixation of the forearm fractures, the use of an intramedullary screw nail as a fixation device gives a similar result with excellent functional outcomes (Grace-Eversmann criteria). It also gives an added benefit of reduced blood loss and preservation of fracture biology.

Grace, too: the sense of agency and Jeremy Safran's relational vision.

The sense of agency, our felt sense of authorship for our actions, is a difficult concept to define, yet its faltering stands at the heart of psychopathology. Historically undertheorized by psychoanalysis and typically positioned opposite relatedness by clinical psychology, Jeremy Safran conceived of agency and relatedness as paradoxically related. This paper pays tribute to Safran's ideas by taking his writings on agency as a starting point to elaborate how agency forms, and goes awry, in the relational crucible of early life. In doing so, the paper draws on the developmental theory of Winnicott, empirical research on embodied agency from adjacent fields of study, and Safran's clinical phenomenology.

Grace periods and exposure misclassification in self-controlled case-series studies of drug-drug interactions.

The self-controlled case-series (SCCS) research design is increasingly used in pharmacoepidemiologic studies of drug-drug interactions (DDIs), with the target of inference being the incidence rate ratio (IRR) associated with concomitant exposure to the object plus precipitant drug versus the object drug alone. While day-level drug exposure can be inferred from dispensing claims, these inferences may be inaccurate, leading to biased IRRs. Grace periods (periods assuming continued treatment impact after days' supply exhaustion) are frequently used by researchers, but the impact of grace period decisions on bias from exposure misclassification remains unclear. Motivated by an SCCS study examining the potential DDI between clopidogrel (object) and warfarin (precipitant), we investigated bias due to precipitant or object exposure misclassification using simulations. We show that misclassified precipitant treatment always biases the estimated IRR toward the null, whereas misclassified object treatment may lead to bias in either direction or no bias, depending on the scenario. Further, including a grace period for each object dispensing may unintentionally increase the risk of misclassification bias. To minimize such bias, we recommend 1) avoiding the use of grace periods when specifying object drug exposure episodes; and 2) including a washout period following each precipitant exposed period.

Long-term trends in human-induced water storage changes for China detected from GRACE data.

Terrestrial Water Storage (TWS) plays a pivotal role in water resource management by providing a comprehensive measure of both surface water and groundwater availability. This study investigates changes in TWS driven by human activities from 2003 to 2023, and forecasts future TWS trends under various climate change and development scenarios. Our findings reveal a continuous decline in China's TWS since 2003, with an average annual decrease of approximately 1.36 mm. This reduction is primarily attributed to the combined effects of climate change and human activities, including irrigation, industrial water use, and domestic water consumption. Notably, TWS exhibits significant seasonal and annual fluctuations, with variations ranging ±10 mm. For the future period (2024-2030), we project greater disparities between water resource supply and demand in specific years for the Songliao, Southwest, and Yangtze basins. Consequently, future water resource management must prioritize water conservation during wet seasons, particularly in years when supply-demand conflicts for limited water resources intensify. This study is valuable for effective planning and sustainable utilization of water resources.

Watching the Grand Ethiopian Renaissance Dam from a distance: Implications for sustainable water management of the Nile water.

Increased demands for sustainable water and energy resources in densely populated basins have led to the construction of dams, which impound waters in artificial reservoirs. In many cases, scarce field data led to the development of models that underestimated the seepage losses from reservoirs and ignored the role of extensive fault networks as preferred pathways for groundwater flow. We adopt an integrated approach (remote sensing, hydrologic modeling, and field observations) to assess the magnitude and nature of seepage from such systems using the Grand Ethiopian Renaissance Dam (GERD), Africa's largest hydropower project, as a test site. The dam was constructed on the Blue Nile within steep, highly fractured, and weathered terrain in the western Ethiopian Highlands. The GERD Gravity Recovery and Climate Experiment Terrestrial Water Storage (GRACETWS), seasonal peak difference product, reveals significant mass accumulation (43 ± 5 BCM) in the reservoir and seepage in its surroundings with progressive south-southwest mass migration along mapped structures between 2019 and 2022. Seepage, but not a decrease in inflow or increase in outflow, could explain, at least in part, the observed drop in the reservoir's water level and volume following each of the three fillings. Using mass balance calculations and GRACETWS observations, we estimate significant seepage (19.8 ± 6 BCM) comparable to the reservoir's impounded waters (19.9 ± 1.2 BCM). Investigating and addressing the seepage from the GERD will ensure sustainable development and promote regional cooperation; overlooking the seepage would compromise hydrological modeling efforts on the Nile Basin and misinform ongoing negotiations on the Nile water management.

Prediction of Major Adverse Cardiac Events After Transcatheter Aortic Valve Implantation: A Machine Learning Approach with GRACE Score.

Objectives: Predictive risk scores have a significant impact on patient selection and assessing the likelihood of complications following interventions in patients with severe aortic stenosis (AS). This study aims to explore the utility of machine learning (ML) techniques in predicting 30-day major adverse cardiac events (MACE) by analyzing parameters, including the Global Registry of Acute Coronary Events (GRACE) score. Methods: This retrospective, multi-center, observational study enrolled 453 consecutive patients diagnosed with severe AS who underwent transcatheter aortic valve implantation (TAVI) from April 2020 to January 2023. The primary outcome was defined as a composition of MACE comprising periprocedural myocardial infarction (MI), cerebrovascular events (CVE), and all-cause mortality during the 1-month follow-up period after the procedure. Conventional binomial logistic regression and ML models were utilized and compared for prediction purposes. Results: The study population had a mean age of 76.1, with 40.8% being male. The primary endpoint was observed in 7.5% of cases. Among the individual components of the primary endpoint, the rates of all-cause mortality, MI, and CVE were reported as 4.2%, 2.4%, and 1.9%, respectively. The ML-based Extreme Gradient Boosting (XGBoost) model with the GRACE score demonstrated superior discriminative performance in predicting the primary endpoint, compared to both the ML model without the GRACE score and the conventional regression model [Area Under the Curve (AUC)= 0.98 (0.91-0.99), AUC= 0,87 (0.80-0.98), AUC= 0.84 (0.79-0.96)]. Conclusion: ML techniques hold the potential to enhance outcomes in clinical practice, especially when utilized alongside established clinical tools such as the GRACE score.

Short- and long-term performance of risk calculation tools for mortality in patients with acute coronary syndrome.

Background: The mortality rate of acute coronary syndrome (ACS) remains high. Therefore, patients with ACS should undergo early risk stratification, for which various risk calculation tools are available. However, it remains uncertain whether the predictive performance varies over time between risk calculation tools for different target periods. This study aimed to compare the predictive performance of risk calculation tools in estimating short- and long-term mortality risks in patients with ACS, while considering different observation periods using time-dependent receiver operating characteristic (ROC) analysis. Methods: This study included 404 consecutive patients with ACS who underwent coronary angiography at our hospital from March 2017 to January 2021. The ACTION and GRACE scores for short-term risk stratification purposes and CRUSADE scores for long-term risk stratification purposes were calculated for all participants. The participants were followed up for 36 months to assess mortality. Using time-dependent ROC analysis, we evaluated the area under the curve (AUC) of the ACTION, CRUSADE, and GRACE scores at 1, 6, 12, 24, and 36 months. Results: Sixty-six patients died during the observation periods. The AUCs at 1, 6, 12, 24, and 36 months of the ACTION score were 0.942, 0.925, 0.889, 0.856, and 0.832; those of the CRUSADE score were 0.881, 0.883, 0.862, 0.876, and 0.862; and those of the GRACE score 0.949, 0.928, 0.888, 0.875, and 0.860, respectively. Conclusions: The ACTION and GRACE scores were excellent risk stratification tools for mortality in the short term. The prognostic performance of each risk score was almost similar in the long term, but the CRUSADE score might be a superior risk stratification tool in the longer term than 3 years.

Comparison of groundwater storage changes over losing and gaining aquifers of China using GRACE satellites, modeling and in-situ observations.

Groundwater depletion in intensively exploited aquifers of China has been widely recognized, whereas an overall examination of groundwater storage (GWS) changes over major aquifers remains challenging due to limited data and notable uncertainties. Here, we present a study to explore GWS changes over eighteen major aquifers covering an area of 1,680,000 km2 in China using data obtained from the Gravity Recovery and Climate Experiments (GRACE), global models, and in-situ groundwater level observations. The analysis aims to reveal the discrepancy in annual trends, amplitudes, and phases associated with GWS changes among different aquifers. It is found that GWS changes in the studied aquifers represent a spatial pattern of 'Wet-gets-more, Dry-gets-less'. An overall decreasing trend of -4.65 ± 0.34 km3/yr is observed by GRACE from 2005 to 2016, consisting of a significant (p < 0.05) increase of 47.28 ± 3.48 km3 in 7 aquifers and decrease of 103.56 ± 2.4 km3 (∼2.6 times the full storage capacity of the Three Gorges Reservoir) in 10 aquifers summed over the 12 years. The annual GWS normally reaches a peak in late July with an area-weighted average annual amplitude of 19 mm, showing notable discrepancy in phases and amplitudes between the losing aquifers (12 mm in middle August) in northern China and gaining aquifers (28 mm in early July) mostly in southern China. GRACE estimates are generally comparable, but can be notably different, with the results obtained from model simulations and in-situ observations at aquifer scale, with the area-weighted average correlation coefficients of 0.6 and 0.5, respectively. This study highlights different GWS changes of losing and gaining aquifers in response to coupled impacts of hydrogeology, climate and human interventions, and calls for divergent adaptions in regional groundwater management.

The Predictive Value of Geriatric Nutritional Risk Index Combined with the GRACE Score in Predicting the Risk of One Year Poor Prognosis in Elderly Patients with Non-ST Segment Elevation Myocardial Infarction After PCI.

Background: As a nutritional indicator, a lower level of geriatric nutritional risk index (GNRI) has been suggested as a predictor for poor prognosis in acute coronary syndrome (ACS). However, whether GNRI could improve the predictive value of the Global Registry of Acute Coronary Events (GRACE) score for the prognosis in elderly patients with non-ST segment elevation myocardial infarction (NSTEMI) after PCI remains unclear. Methods: A total of 446 elderly patients with NSTEMI after percutaneous coronary intervention (PCI) were consecutively enrolled. Patients were divided into major adverse cardiovascular and cerebrovascular events (MACCE) group and control group according to the occurrence of MACCE during one year follow up. The clinical parameters including GNRI were compared to investigate the predictors for MACCE. The performance after the addition of GNRI to the GRACE score for predicting MACCE was determined. Results: A total of 68 patients developed MACCE. In unadjusted analyses, the rate of MACCE was significantly higher in the 93.8