Evaluate climate change and anthropogenic activities influencing geochemical variations in sediment between and within the avulsion period in the Lower Yellow River avulsion channels.

The geochemical data from sediments in avulsion channels provide historical evidence of climate change and human-induced alterations in river basin environments. The present study focused on the particle size of sediments in cores and the level of geochemical variation in avulsion channels of the Lower Yellow River Delta (YRD), China. The sediment samples were collected in a depth range of 20-400 cm in avulsion channels. The collected samples were analyzed for sediment particle size and geochemical composition using standard methods. The results demonstrated rapid increases in agriculture practices, rainfall pattern changes, and terrestrial sediment runoff reduction in river basins after the 1960s. The reduced sediment loads in the Sanmenxia Reservoir significantly changed the sediment grain size and geochemical levels in the avulsion channel from August 1960.8 to January -1961.1. In particular, TC, TN, and C/N levels decreased with increasing sediment depth. The C/N values of <12 denoted completely reduced terrestrial sources of organic matter in the channel during the August 1960-January 1961 period compared to the July 1953-August 1960 period. The two-way ANOVA p-values were (p <0.016-p<0.001) strong between the avulsion periods but had no significant variation within the avulsion periods. We emphasize that this study provides a close interplay of different historical periods of geochemical variation in avulsion channel sediments in the alluvial fan YRD, and we argue that the evolution of the middle upstream river basin was subjective by climate change and human developmental actions, which impacted the YRD. In particular, reservoir-interrupted water flow and sediment reduction impacts associated with geochemical fluctuations are documented in the YRD.

Trends in antidiabetic drug use and expenditure in public hospitals in Northwest China, 2012-21: a case study of Gansu Province.

BACKGROUND: Since the twenty-first century, the prevalence of diabetes has risen globally year by year. In Gansu Province, an economically underdeveloped province in northwest China, the cost of drugs for diabetes patients accounted for one-third of their total drug costs. To fundamentally reduce national drug expenditures and the burden of medication on the population, the relevant departments of government have continued to reform and improve drug policies. This study aimed to analyse long-term trends in antidiabetic drug use and expenditure in Gansu Province from 2012 to 2021 and to explore the role of pharmaceutical policy. METHODS: Data were obtained from the provincial centralised bidding and purchasing (CBP) platform. Drug use was quantified using the anatomical therapeutic chemistry/defined daily dose (ATC/DDD) method and standardised by DDD per 1000 inhabitants per day (DID), and drug expenditure was expressed in terms of the total amount and defined daily cost (DDC). Linear regression was used to analyse the trends and magnitude of drug use and expenditure. RESULTS: The overall trend in the use and expenditure of antidiabetic drugs was on the rise, with the use increasing from 1.04 in 2012 to 16.02 DID in 2021 and the expenditure increasing from 48.36 in 2012 to 496.42 million yuan in 2021 (from 7.66 to 76.95 million USD). Some new and expensive drugs changed in the use pattern, and their use and expenditure shares (as the percentage of all antidiabetic drugs) increased from 0 to 11.17% and 11.37%, but insulins and analogues and biguanides remained the most used drug class. The DDC of oral drugs all showed a decreasing trend, but essential medicines (EMs) and medical insurance drugs DDC gradually decreased with increasing use. The price reduction of the bid-winning drugs was over 40%, and the top three drugs were glimepiride 2mg/30, acarbose 50mg/30 and acarbose 100mg/30. CONCLUSIONS: The implementation of pharmaceutical policies has significantly increased drug use and expenditure while reducing drug prices, and the introduction of novel drugs and updated treatment guidelines has led to changes in use patterns.

Integrating work into life helps reduce residential greenhouse gas emissions.

Work from home (WFH) creates work-life integration by moving work into traditional life at home, but its influence on residential greenhouse gas (GHG) emissions remains unclear. In this study, an activity-based bottom-up model was developed to analyze the time-use patterns (activity durations and timeline of a typical day) of participants under WFH and traditional home life and to quantify their residential GHG emissions. Under WFH, participants generated an average of 9.03 kg CO2e/person/day, primarily attributed to space heating and cooling, cooking, grooming, work, and watching TV and movies. Notably, the GHG footprints varied across groups (8.08-9.93 kg CO2e/person/day) due to different work and household responsibilities and leisure time and varied with climate region (4.99-10.63 kg CO2e/person/day) because of emission factors of electricity, space heating and cooling, and cooking. Compared with traditional life at home (10.06 kg CO2e/person/day), WFH participants spent less time on almost all major activities (especially sleeping and watching TV and movies) to focus on work, enabling an 11.34% (1.02 kg CO2e/person/day) mitigation of GHG emissions. The reductions also varied by group and climate region, mainly associated with laundry, cooking, and watching TV and movies. Opportunities to reduce GHG emissions under WFH lie in targeting key activities, balancing the time spent on various activities, and developing group- and spatial-specific strategies. This study provides a systematic and high-resolution estimation of residential GHG emissions under WFH and traditional home life, with a complete system boundary, activity-specific considerations, and countrywide understanding. The findings reveal the environmental impact of work-life integration from the residential perspective and can aid residents and policymakers in utilizing decarbonization opportunities to advance low-carbon living under WFH.

A Critical Review on the Factors that Influence Opportunistic Premise Plumbing Pathogens: From Building Entry to Fixtures in Residences.

Residential buildings provide unique conditions for opportunistic premise plumbing pathogen (OPPP) exposure via aerosolized water droplets produced by showerheads, faucets, and tubs. The objective of this review was to critically evaluate the existing literature that assessed the impact of potentially enhancing conditions to OPPP occurrence associated with residential plumbing and to point out knowledge gaps. Comprehensive studies on the topic were found to be lacking. Major knowledge gaps identified include the assessment of OPPP growth in the residential plumbing, from building entry to fixtures, and evaluation of the extent of the impact of typical residential plumbing design (e.g., trunk and branch and manifold), components (e.g., valves and fixtures), water heater types and temperature setting of operation, and common pipe materials (copper, PEX, and PVC/CPVC). In addition, impacts of the current plumbing code requirements on OPPP responses have not been assessed by any study and a lack of guidelines for OPPP risk management in residences was identified. Finally, the research required to expand knowledge on OPPP amplification in residences was discussed.

Buffer zone-based trace elements indicating the impact of human activities on karst urban groundwater.

The tanglesome allocation of landscape types at various spatial dimensions is an important component influencing the quality of groundwater environment in karst cities. Trace elements can be used as indicators of the extent of impact on groundwater which is an effective means of tracing groundwater contamination. In this study, we studied the influence of landscape patterns on trace elements in groundwater of typical karst cities in Southwest China (Guiyang City) on a multi-spatial scale by using multivariate statistical analysis. According to the sampling points, buffer zone scales with different radii (500 m, 1000 m, 1500 m, and 4000 m) were established to quantify the land use model. There are suburban and urban differences in trace element content. The city center has higher levels of trace elements compared to suburban areas, especially Li, Ni, Tl, Cu, Sr, Co, As, and Mn. In addition, the outcomes of the multiple linear regression had shown that the size effect of the association from landscape pattern to trace elements varies with different indicators and parameters. The results of redundancy analysis showed an overall change in trace elements was better interpreted by the landscape pattern of the 1500 m-scale buffer. At the same time, at the 1500 m scale, Ni, Tl, Cu, Co, As, Cr, Sr, Li, and Mn were positively correlated with the urban landscape index (4LPI, 4LSI), influenced by urban anthropogenic activities, while Cd, Zn, and Pb were positively correlated with the cropland landscape index (1AI, 1LPI), influenced by agricultural activities. This study indicates that trace elements are a reliable indicator for tracing groundwater contamination. The buffer zone can reflect the extent of urban impacts on groundwater and provide a new and effective analytical tool for groundwater management.

National-scale investigation of dual nitrate isotopes and chloride ion in South Korea: Nitrate source apportionment for stream water.

Nitrate sources in surface water have been identified using dual-isotope compositions of nitrate with various tools to efficiently manage the water quality at the local scale. Correlation between Cl and NO3 has also been used to identify NO3. In this study, we assess the reliability of the dual-isotope approach and Cl in terms of nitrate source apportionment. To this end, we collected stream water samples throughout South Korea to estimate nitrate sources in streams and determine whether the land-use pattern was closely related to nitrate sources. The δ15N-NO3 ranging from -1.3 to 14.8‰ showed a spatial distribution that was lower in mountain ranges (<7‰) than plain areas (>8‰). The Cl concentration in this national-scale distribution was also assessed. The relationship between the proportion of Cl and δ15N-NO3 classifies nitrate sources into areas characterized by three land-use patterns: (1) agricultural and business areas, (2) forests in highlands, and (3) lowland forests, of which (1) had proportions of Cl >50%, while (2) and (3) were <50%. The samples in (3) showed δ15N-NO3 values > 6‰, similar to those of (1). Deuterium excess of samples was negatively correlated (R2 = 0.53) with δ15N-NO3, accounting for the fact that δ15N-NO3 reflected land-use patterns. Samples were dominantly affected by agriculture-derived sources and domestic sewage showed NO3/Cl of <0.4 and δ15N-NO3 of >6‰. These results suggest that nitrate source apportionment should be comprehensively evaluated considering the dual-isotope approach, land-use patterns, and Cl proportions.

Differing Behaviors Around Adult Nonmedical Use of Prescription Stimulants and Opioids: Latent Class Analysis.

BACKGROUND: The availability of central nervous system stimulants has risen in recent years, along with increased dispensing of stimulants for treatment of, for example, parent-reported attention-deficit/hyperactivity disorder in children and new diagnoses during adulthood. Typologies of drug use, as has been done with opioids, fail to include a sufficient range of behavioral factors to contextualize person-centric circumstances surrounding drug use. Understanding these patterns across drug classes would bring public health and regulatory practices toward precision public health. OBJECTIVE: The objective of this study was to quantitatively delineate the unique behavioral profiles of adults who currently nonmedically use stimulants and opioids using a latent class analysis and to contrast the differences in findings by class. We further evaluated whether the subgroups identified were associated with an increased Drug Abuse Screening Test-10 (DAST-10) score, which is an indicator of average problematic drug use. METHODS: This study used a national cross-sectional web-based survey, using 3 survey launches from 2019 to 2020 (before the COVID-19 pandemic). Data from adults who reported nonmedical use of prescription stimulants (n=2083) or prescription opioids (n=6127) in the last 12 months were analyzed. A weighted latent class analysis was used to identify the patterns of use. Drug types, motivations, and behaviors were factors in the model, which characterized unique classes of behavior. RESULTS: Five stimulant nonmedical use classes were identified: amphetamine self-medication, network-sourced stimulant for alertness, nonamphetamine performance use, recreational use, and nondiscriminatory behaviors. The drug used nonmedically, acquisition through a friend or family member, and use to get high were strong differentiators among the stimulant classes. The latter 4 classes had significantly higher DAST-10 scores than amphetamine self-medication (P<.001). In addition, 4 opioid nonmedical use classes were identified: moderate pain with low mental health burden, high pain with higher mental health burden, risky behaviors with diverse motivations, and nondiscriminatory behaviors. There was a progressive and significant increase in DAST-10 scores across classes (P<.001). The potency of the opioid, pain history, the routes of administration, and psychoactive effect behaviors were strong differentiators among the opioid classes. CONCLUSIONS: A more precise understanding of how behaviors tend to co-occur would improve efficacy and efficiency in developing interventions and supporting the overall health of those who use drugs, and it would improve communication with, and connection to, those at risk for severe drug outcomes.

Integrating Ecosystem Health and Services for Assessing Ecological Risk and its Response to Typical Land-Use Patterns in the Eco-fragile Region, North China.

Changes in land-use patterns may increase the ecological risks faced by Eco-Fragile regions. It is vital for regional ecological restoration and management of Eco-Fragile regions to reasonably assess ecological risk and study its response to typical land-use patterns. Existing study on regional ecological risk largely ignored the internal representation of ecosystem health and ecosystem services to ecological risk, and also ignored the internal relationship between ecological risk and land use patterns. This study developed a regional ecological assessment model by describing the relationship between ecosystem health, ecosystem services and ecological risks. Among them, the ecosystem health assessment used the Net Primary Productivity, landscape index and ecosystem elasticity coefficient based on different land use patterns to build Vigor-Organization-Resilience (VOR) model, and the improved equivalent factor method was used to calculate the ecosystem service value. Taking the Fen River Basin (FRB), a typical Eco-Fragile region of the Loess Plateau, as a study region, spatial auto-correlation analysis was used to reveal the temporal and spatial changes and spatial clustering characteristics of regional ecological risk, and regression analysis was used to study the relationship between typical land use patterns and ecological risks, which was included in the consideration of ecological and environmental risk management strategies. The results show that the regions with high ecological risk are mainly distributed in the middle and southwest of the FRB; the regions with low ecological risk are mainly distributed in the north, east and west of the FRB. Both high-risk and low-risk areas show significant spatial clustering effects. The change of ecological risk in FRB is related to the land use patterns. The ecological risk is negatively related to the expansion of construction land and cultivated land at the county and patch scales. On this basis, the environmental management strategies at different scales are discussed. This study can helpful deepen the understanding of the impact of land use patterns on ecological risk, and can also provide important reference for regional ecological risk management and land use policies.

Effect of land use and soil depth on the distribution of phyto-available nutrients and SOC pools of Vertisols in Central India.

A proper understanding of soil parameters under different production systems of the world is necessary for efficient soil management. We, therefore, carried out the present study to assess the status of some selected soil properties (soil pH and electrical conductivity (EC)), phyto-available nutrients (available nitrogen (AN), available potassium (AK), exchangeable calcium (Ex. Ca), exchangeable magnesium (Ex. Mg), available sulfur (AS), and soil organic carbon (SOC) pools (SOC, total organic carbon (TOC), very labile C, labile C, less labile C, and non-labile C) and to establish relationships among the measured soil parameters at different depths of Vertisols of India under various land uses. A total of 150 composite soil samples (from 25 plots including nine from agricultural land, nine from horticultural land, three from forest land, and four from grassland) were collected from 6 soil depths viz, 0-10, 10-20, 20-40, 40-60, 60-80, and 80-100 cm under agriculture, horticulture, forest, and grassland land uses present in Central India and analyzed. The values of soil pH, EC, AN, AK, Ex. Ca, Ex. Mg, and AS in various soil depths under different land uses varied widely. The values of SOC (0.19 to 1.00%), TOC (0.58 to 2.42%), very labile C (0.14 to 0.83%), labile C (0.05 to 0.25%), less labile C (0.05 to 0.26%) and non-labile C (0.23 to 1.42%) in various soil depths under different land uses also varied significantly. Forest and grassland land uses had higher levels of SOC, TOC, very labile, and non-labile C content in all the soil depths in comparison to SOC, TOC, very labile, and non-labile C content in different soil depths under agriculture and horticulture land use. The levels of SOC, TOC, very labile, and non-labile C content under all the land uses decreased with increasing soil depths. SOC was positively and significantly correlated with AN, AK, AS, and estimated SOC pools in surface soil layers. Principal component analysis (PCA) of soil parameters in different soil depths resulted in 5 principal components (PCs) with > 1 eigenvalue and accounting for > 75% variability. This information could be used for managing SOC status and phyto-available nutrients in Vertisols under different land uses.

Anthropogenic disturbances on distribution and sources of pharmaceuticals and personal care products throughout the Jinsha River Basin, China.

Pharmaceuticals and personal care products (PPCPs) are recognized as a group of emerging contaminants closely related to anthropogenic activities, which capture increasing attention worldwide. To evaluate the anthropogenic disturbances on PPCP distribution and sources, this study investigated the distribution and sources of 50 PPCPs along the 2300 km long Jinsha River and revealed different anthropogenic disturbances on PPCPs. Results showed that 40 out of the 50 PPCPs were ubiquitously detected among these river water samples, with the concentrations varied from less than 1 ng/L to more than 500 ng/L. Although most PPCPs concentrations were much lower in the Jinsha River than in highly developed rivers, the prevalence of PPCPs suggested the widespread use and improper disposal of PPCPs in the Jinsha River. The risk assessment also revealed that some PPCPs posed risks to aquatic organisms in the Jinsha River. Anthropogenic activities including human habitation and dam construction had different influence on PPCPs. PPCP distribution varied significantly across the "Hu Huanyong line", indicating human habitation significantly influenced PPCP distribution. Dam construction was insignificant in altering PPCP distribution throughout the Jinsha River. Moreover, the land use index indicated degradation level of multiple lands related to anthropogenic activities and represented the major sources of PPCPs in the Jinsha River. Most PPCPs were correlated with anthropogenic lands, for example, antibiotics, analgesics, and endocrine disrupting chemicals mainly originated from artificial surfaces, whereas other PPCPs mainly originated from cultivated lands. Together, this study indicates the disturbances of multiple anthropogenic activities on PPCP distribution and sources along the Jinsha River, which contributes to PPCP management in rural areas.

Commencement of and Retention in Web-Based Interventions and Response to Prompts and Reminders: Longitudinal Observational Study Based on Two Randomized Controlled Trials.

BACKGROUND: Web-based interventions are effective for several psychological problems. However, recruitment, adherence, and missing data are challenges when evaluating these interventions. OBJECTIVE: This study aimed to describe the use patterns during the commencement phase, possible retention patterns (continuation of data provision), and responses to prompts and reminders among participants in 2 randomized controlled trials (RCTs) evaluating web-based interventions. METHODS: Data on use patterns logged in 2 RCTs aiming to reduce symptoms of anxiety and depression among adult patients recently diagnosed with cancer (AdultCan RCT) and patients with a recent myocardial infarction (Heart RCT) were analyzed. The web-based intervention in the AdultCan trial consisted of unguided self-help and psychoeducation and that in the Heart trial consisted of therapist-supported cognitive behavioral therapy. In total, 2360 participants' use patterns at first log-in, including data collection at baseline (ie, commencement) and at 2 follow-ups, were analyzed. Both the intervention and comparison groups were analyzed. RESULTS: At commencement, 70.85% (909/1283) and 86.82% (935/1077) of the participants in AdultCan and Heart RCTs, respectively, logged in and completed baseline data collection after receiving a welcome email with log-in credentials. The median duration of the first log-in was 44 minutes and 38 minutes in AdultCan and Heart RCTs, respectively. Slightly less than half of the participants' first log-ins were completed outside standard office hours. More than 80% (92/114 and 103/111) of the participants in both trials explored the intervention within 2 weeks of being randomized to the treatment group, with a median duration of 7 minutes and 47 minutes in AdultCan and Heart RCTs, respectively. There was a significant association between intervention exploration time during the first 2 weeks and retention in the Heart trial but not in the AdultCan trial. However, the control group was most likely to retain and provide complete follow-up data. Across the 3 time points of data collection explored in this study, the proportion of participants responding to all questionnaires within 1 week from the prompt, without a reminder, varied between 35.45% (413/1165) and 66.3% (112/169). After 2 reminders, up to 97.6% (165/169) of the participants responded. CONCLUSIONS: Most participants in both RCTs completed the baseline questionnaires within 1 week of receiving the welcome email. Approximately half of them answered questions at baseline data collection outside office hours, suggesting that the time flexibility inherent in web-based interventions contributes to commencement and use. In contrast to what was expected, the intervention groups generally had lower completion rates than the comparison groups. About half of the participants completed the questionnaires without a reminder, but thereafter, reminders contributed to both baseline and follow-up retention, suggesting they were effective. Strategies to increase commencement of and retention in eHealth interventions are important for the future development of effective interventions and relevant research.

Soil properties changes earthworm diversity indices in different agro-ecosystem.

BACKGROUND: Earthworm communities are generally very sensitive to physico-chemical properties of the soil in different agro-ecosystem i.e. cultivated or non-cultivated which directly or indirectly influence the earthworm survival. The difference in physico-chemical properties of soil at different sites contributed to the formation of population patches for earthworm species. Understanding the physico-chemical properties of soil at a particular site could facilitate the prediction of earthworm species at that site. The objective of the present study was to investigate the diversity, abundance, and distribution of earthworms in cultivated and non-cultivated agroecosystems and their physico-chemical properties affecting the earthworm diversity and abundance. RESULTS: Total 10 species of earthworms i.e. Amynthas alexandri, Amynthas morrisi, Eutyphoeus incommodus, Eutyphoeus waltoni, Metaphire birmanica, Metaphire houlleti, Metaphire posthuma, Octochaetona beatrix, Perionyx excavatus, and Polypheretima elongata, were reported. Out of all the reported species, Metaphire posthuma was found to be the most abundant earthworm species in both cultivated and non-cultivated agroecosystems with the occurrence at 56.81% sites. The Shannon-Wiener index (H), Margalef species richness index (DMg) and Pielou species evenness (E) was ranged from 0 to 0.86, 0 to 0.64 and 0.78 to 1 respectively. The principal component analysis resulted in four principal components i.e. PC1, PC2, PC3 and PC4 which contributing variance (%) of 22.96, 19.37, 14.23 and 10.10 respectively. The principal component analysis also showed that physico-chemical parameters of soil such as EC, pH, TDS, texture, OC, moisture, etc. play a critical role in earthworm distribution. CONCLUSION: The conventional farming system has a negative effect on the earthworm diversity in the soil while the physico-chemical properties of soil also have a determinant effect on the same. Earthworms abundance in the present study have significant direct relation with soil properties at a particular site and vice versa. The diversity indices also change due to the conventional farming system which directly affects the earthworm abundance.

Abnormal shoot growth in Korean red pine as a response to microclimate changes due to urbanization in Korea.

Impacts of climate change (e.g., abnormal growth in plants, early flowering, and shifting vegetation zones) are being detected throughout the world. Urban land use and its resulting microclimates work in conjunction with the impacts of climate change. Among the principal environmental signals that modulate bud flush, only temperature has changed significantly in recent years. Throughout South Korea, abnormal shoots (usually known as lammas shoots) in Korean red pine (Pinus densiflora), which were once a rare phenomenon, have become notably more common in recent years. The phenomenon is prominent in urban site of each local area. These abnormal shoots appear at a higher frequency and grow to longer lengths in Seoul's hotter urban center than in suburban sites and showed a close positive correlation with urban density and a close negative correlation with vegetation cover expressed as NDVI. Differences in temperature among the urban center, urban edge, and suburban greenbelt were significantly correlated with land-use intensity. Korean red pines planted in urban parks at sites in urban centers showed a lower frequency of abnormal shoots, and the length of the shoots was shorter, compared with those at the other urban sites. Furthermore, the phenology of Korean red pines in an urban park with a fountain showed a spatial difference, depending upon the distance from the fountain: pine trees close to the fountain did not produce abnormal shoots, but abnormal shoot growth increased with the distance from the fountain. These results are noteworthy because they are related to the cooling effects of evapotranspiration from vegetated landscapes and evaporation from a water body. From the results of this study, we could confirm that microclimate change due to urbanization accelerates the impacts of climate change on plant phenology. Furthermore, we identified the possibility that judicious land-use planning could contribute to minimizing the adverse effects of climate change.

Changes in drug use behaviors coinciding with the emergence of illicit fentanyl among people who use drugs in Vancouver, Canada.

Background: With the emergence of illicitly-manufactured fentanyl, drug overdose deaths have risen in unprecedented numbers. In this context, there is an urgent need to characterize potential changes in drug use behaviors among people who use drugs (PWUD). Objective: To examine changes in drug use behaviors following the emergence of illicit fentanyl among people who use drugs (PWUD). Methods: Data for this cross-sectional analysis was derived from three prospective cohorts of PWUD between December 2016 and May 2017 in Vancouver, Canada. Multivariable logistic regression was used to determine factors associated with self-reported behavior changes (binary variable "yes" or "no") following the emergence of illicit fentanyl. Results: Among 999 participants [363 (36.3%) females], 388 (38.8%) reported some behavior change. The remaining 611 (61.2%) reported no change in behavior; 240 (39.3%) of these individuals had recently been exposed to fentanyl. In multivariable analyses, factors independently associated with behavior change included recent non-fatal overdose (Adjusted Odds Ratio [AOR] = 2.28), active injection drug use (AOR = 1.96), being on opioid agonist therapy (AOR = 1.80), and urine drug screen positive for fentanyl (AOR = 1.45), (all p < .05). Conclusion: The majority of PWUD in our sample did not change their drug use behavior despite a high prevalence of fentanyl exposure, indicating a need for targeted behavior change messaging and overdose prevention efforts such as naloxone and addiction treatment for this sub-population of PWUD. Further, the high fentanyl exposure observed in our sample suggests a need to address upstream structural factors shaping the overdose risk in addition to individual behavioral change.

Multiscale land use impacts on water quality: Assessment, planning, and future perspectives in Brazil.

Brazil contains the largest volume of freshwater of any nation in the world; however, this essential natural resource is threatened by rapid increases in water consumption and water quality degradation, mainly as a result of anthropogenic pressures. Declining water quality has become an increasingly more significant global concern as economic activities and human populations expand and climate change markedly alters hydrological cycles. Changes in land-use/land-cover (LULC) pattern have been recognized as a major driver of water quality degradation, however different LULC types and intensities affect water quality in different ways. In addition, the relationships between LULC and water quality may differ for different spatial and temporal scales. The increase in deforestation, agricultural expansion, and urban sprawl in Brazil highlights the need for water quality protection to ensure immediate human needs and to maintain the quality of water supplies in the long-term. Thus, this manuscript provides an overview of the relationships between LULC and water quality in Brazil, aiming at understanding the effects of different LULC types on water quality, how spatial and temporal scales contribute to these effects, and how such knowledge can improve watershed management and future projections. In general, agriculture and urban areas are the main LULCs responsible for water quality degradation in Brazil. However, although representing a small percentage of the territory, mining has a high impact on water quality. Water quality variables respond differently at different spatial scales, so spatial extent is an important aspect to be considered in studies and management. LULC impacts on water quality also vary seasonally and lag effects mean they take time to occur. Forest restoration can improve water quality and multicriteria evaluation has been applied to identify priority areas for forest restoration and conservation aiming at protecting water quality, but both need further exploration. Watershed modelling has been applied to simulate future impacts of LULC change on water quality, but data availability must be improved to increase the number, locations and duration of studies. Because of the international nature of watersheds and the consistent relationships between land use and water quality in Brazil, we believe our results will also aid water management in other countries.

Tramadol use in Norway: A register-based population study.

PURPOSE: Increasing use of tramadol for chronic non-cancer pain is concerning since tramadol users may be at risk of developing recurrent opioid use with increasing opioid consumption and co-medication. Therefore, we investigated a complete national cohort of tramadol users. METHODS: The study population (154 042 adult individuals in Norway, who redeemed ≥ one tramadol prescription in 2012) was stratified into four groups according to their opioid use 2 years before their first tramadol prescription in 2012 and followed until 2016. Information on all dispensed opioid analgesics, benzodiazepines (BZDs), and BZD-related Z-hypnotics were retrieved from the Norwegian Prescription Database. RESULTS: Six percent of opioid naïve tramadol users (no opioid use 2 years before tramadol use in 2012) became recurrent users (received opioids annually during 4-year follow-up), almost doubled their mean opioid consumption (66 to 108 defined daily doses [DDD]). One-quarter proceeded to strong opioids or was co-medicated with BZDs, one-third with Z-hypnotics. Among former weak opioid users, 39.8% became recurrent users, 18.7% proceeded to strong opioids, mean opioid consumption increased slightly, one-third used BZDs, or Z-hypnotics concurrently. Among former strong opioid and users in palliative care; 61%, 70% became recurrent users and developed a similar prescription pattern (high and increasing mean opioid consumption, 301 to 318, 413 to 430 DDD); half of them proceeded to strong opioids and/or used BZDs or Z-hypnotics concurrently. CONCLUSIONS: Many patients who developed recurrent opioid use received prescriptions which substantially conflicted with existing guidelines and might lead to problematic opioid use.

Distinct kratom user populations across the United States: A regional analysis based on an online survey.

OBJECTIVE: Kratom preparations have raised concerns of public health and safety in the United States. This paper analyzed the patterns and predictors of kratom use by four U.S. regions according to the U.S. Census. METHOD: An anonymous cross-sectional online survey yielded 8,049 valid responses. The data were categorised by regions (Northeast, South, Midwest, and West) and analyzed for the following predictors: age, gender, marital status, ethnicity, employment status, insurance coverage, education, and household income. RESULTS: After adjusting for state population, the survey response rates were highest from Oregon, Idaho, and Florida. Kratom use was significantly lower for both prescription drug dependency and acute or chronic pain in the Northeast region than the rest of the country. Multiple logistic regression models found that gender, employment, and education were significant on the regional level. Higher education was associated with lower kratom use for an illicit drug dependency (p = .002) independent of region whereas men were less likely to use kratom for acute or chronic pain in the Northeast (p < .001) but more likely in the Midwest (p = .041). CONCLUSIONS: The regional pattern of kratom use differed from opioid use data in both demographics and trend direction warranting further investigation.

Evaluation of the Implementation of Hospital Antibiotic Policy in Oncosurgery Ward: A Six-Year Experience.

The hospital antibiotic policy should be implemented to rationalize the antibiotic use and to decrease the risk of spread of resistant bacteria. The aim of this study was to describe the antibiotic consumption patterns in a single oncosurgery ward before and after the implementation of hospital antibiotic policy. We conducted a retrospective analysis of the antibiotic use at the oncosurgery ward in Warsaw, Poland, in the years 2011-2016. Calculations were based on daily defined doses (DDD), DDD/100 hospitalizations, and DDD/100 person-days. Drug utilization rates (DU 90% and DU 100%) were also analyzed. After the implementation of hospital antibiotic policy, a total antibiotic consumption increased (365.35 DDD in 2011 vs. 1359.22 DDD in 2016). A significant change was observed in the antibiotic consumption patterns: the use of amoxicillin clavulanate and carbapenems or glycopeptides decreased significantly (p < 0.05), while the use of ciprofloxacin and aminoglycosides increased (p < 0.05). The DU100% rate varied from 6 in 2011 to 12 in 2016; while DU 90% rate varied from 2 in 2011 to 3-5 in 2013-2016. Although the implementation of hospital antibiotic policy did not result in a decrease in the antibiotic consumption, it seems to provide a favorable change into the antibiotic consumption pattern.

Balancing volume and duration of information consumption by physicians: The case of health information exchange in critical care.

BACKGROUND: The realization of the potential benefits of health information exchange systems (HIEs) for emergency departments (EDs) depends on the way these systems are actually used. The attributes of volume of information and duration of information processing are important for the study of HIE use patterns in the ED, as cognitive load and time constraints may result in a trade-off between these attributes. Experts and non-experts often use different problem-solving strategies, which may be consequential for their system use patterns. Little previous research focuses on the trade-off between volume and duration of system use or on the factors that affect it, including user expertise. OBJECTIVES: This study aims at exploring the trade-off of volume and duration of use, examining whether this relationship differs between experts and non-experts, and identifying factors that are associated with use patterns characterized by volume and duration. METHODS: The research objectives are pursued in the context of critically-ill patients, treated at a busy ED in the period 2010-2012. The primary source of internal and external data is an HIE linked to 14 hospitals, over 1300 clinics, and other clinical facilities. We define four use profiles based on the attributes of duration and volume: quick and basic, quick and deep, slow and basic, and slow and deep. The volume and duration of use are computed using HIE log files as the number of screens and the time per screen, respectively. Each session is then classified into a specific profile based on distances from predefined profile centroids. Experts are physicians that are board-certified in emergency medicine. We test the distribution of use profiles and their associations with multiple variables that describe the patient, physician, situation, information available in the HIE system, and use dynamics within the encounter. RESULTS: The quick and basic profile is the most prevalent. While available admission summaries are associated with quick and basic use, lab and imaging results are associated with slower or deeper use. Physicians who are the first to use the system or are sole users during an encounter are less inclined to quick and deep use. These effects are intensified for experts. DISCUSSION: A trade-off between volume and duration is identified. While system use is overall similar for experts and non-experts, the circumstances in which a certain profile is more likely to be observed vary across these two groups. Information availability and multiple-physician dynamics within the encounter emerge as important for the prediction of use profiles. The findings of this study provide implications for the design, implementation, and research of HIE use.

Electronic Cigarettes in Germany: Patterns of Use and Perceived Health Improvement.

AIMS: The aim of the study was to characterize e-cigarette users in terms of their consumption patterns, motives, and the perceived health benefits they experience from using e-cigarettes. DESIGN: The study was a cross-sectional online survey in 2015. A total of 3,320 German e-cigarette users were enrolled. A total of 91.5% were former tobacco smokers, 7.5% used both e-cigarettes and tobacco products, 1.0% were never-smokers. RESULTS: No differences were found between ex-smokers and dual users with regard to sociodemographic and smoking history (mean age 40.8 years, 81% men, 45% with a high school degree or above). Both groups had smoked 26.4 tobacco cigarettes a day for 22 years, had unsuccessfully tried to quit smoking using various other nicotine replacement products, and had used e-cigarettes for an average of 2 years. Ex-smokers consumed lower nicotine strength and more liquid per month, experienced more positive health changes, and had made vaping their hobby. Never-smokers were about 5 years younger, used liquid without nicotine and without tobacco flavor, and had no physical dependency. CONCLUSIONS: E-cigarettes were primarily used as an alternative to smoking and a substitute for nicotine. More dual users than ex-smokers used e-cigarettes in places where smoking is forbidden. Positive health changes were more pronounced in ex-smokers than dual users.