Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 142
Filter
1.
Proc Natl Acad Sci U S A ; 120(29): e2301018120, 2023 Jul 18.
Article in English | MEDLINE | ID: mdl-37428924

ABSTRACT

The occurrence of sedimentary storm deposits around the Tethys Ocean during the early Toarcian hyperthermal (~183 Ma) suggests that intensified tropical cyclone (TC) activity occurred in response to CO2 rise and marked warming. However, this hypothesized linkage between extreme warmth and storm activity remains untested, and the spatial pattern of any changes in TCs is unclear. Here, model results show that there were two potential storm genesis centers over Tethys during the early Toarcian hyperthermal located around the northwestern and southeastern Tethys. The empirically determined doubling of CO2 concentration that accompanied the early Toarcian hyperthermal (~500 to ~1,000 ppmv) leads to increased probability of stronger storms over Tethys, in tandem with more favorable conditions for coastal erosion. These results match well with the geological occurrence of storm deposits during the early Toarcian hyperthermal and confirm that increased TC intensity would have accompanied global warming.

2.
JMIR Hum Factors ; 10: e42768, 2023 Jul 26.
Article in English | MEDLINE | ID: mdl-37494099

ABSTRACT

BACKGROUND: Major depressive disorder (MDD) is a leading cause of disability worldwide. Management of chronic conditions such as MDD can be improved by enhanced patient engagement, measurement-based care (MBC), and shared decision-making (SDM). A user-centered design approach can improve the understanding of the patient journey and care team workflows and thus aid the development of digital health care innovations optimized for the needs of patients living with MDD and their primary care teams. OBJECTIVE: This study aims to use qualitative research methods for the user-centered design of a digitally enabled MDD care platform, PathwayPlatform, intended to enhance patient engagement, MBC, and SDM. METHODS: Insights were gathered through 2 stages of qualitative interviews by a study team with expertise in qualitative research and user-centered design methods. Thematic analysis was used to generate an overarching understanding of a set of shared experiences, thoughts, or behaviors across a broad qualitative data set, including transcripts of interviews, to allow both inductive and deductive insights to emerge. Thematic analysis of interviews was supported by Dedoose (SocioCultural Research Consultants, LLC), a qualitative data analysis software tool that enables systematized coding. Findings and insights were presented based on code frequency, salience, and relevance to the research project. RESULTS: In stage 1, interviews were conducted with 20 patients living with MDD and 15 health care providers from September 2018 to January 2019 to understand the experiences with and perceptions about the initial functionality of the Pathway app while also exploring the perceptions about potential additional features and functionality. Feedback about care team workflows and treatment approaches was collected in stage-2 interviews with 36 health care providers at 8 primary care sites. Inductive and deductive thematic analyses revealed several themes related to app functionality, patient-provider engagement, workflow integration, and patient education. Both patients and their care teams perceived the remote tracking of patient-reported outcomes via digital tools to be clinically useful and reliable and to promote MBC and SDM. However, there was emphasis on the need to enhance the flow of real-time data shared with the care team, improve trend visualizations, and integrate the data within the existing clinical workflow and educational programs for patients and their care teams. User feedback was incorporated into the iterative development of the Pathway app. CONCLUSIONS: Ongoing communication with patients living with MDD and their care teams provided an opportunity for user-centric developmental iterations of the Pathway Platform. Key insights led to further development of the patient-facing and care team-facing visit preparation features, collaborative goal-setting and goal-tracking features, patient-reported outcome summaries, and trend visualizations. The result is an enhanced digital platform with the potential to improve treatment outcomes and provide patients living with MDD additional support throughout their treatment journey.

3.
JMIR Res Protoc ; 12: e43788, 2023 Jun 23.
Article in English | MEDLINE | ID: mdl-37351941

ABSTRACT

BACKGROUND: Major depressive disorder (MDD) is a serious public health concern worldwide. A treatment approach that incorporates measurement-based care (MBC) and shared decision-making between patients with MDD and their providers may foster patient engagement and improve clinical outcomes. While digital tools such as mobile apps show promise for expanding health interventions, these apps are rarely integrated into clinical practice. OBJECTIVE: The primary objective of this ongoing study is to determine whether implementation of a digital tool-the Pathway Platform-in primary care improves adherence to MBC practices; here, we present the study methods. METHODS: This large-scale, real-world implementation study is based on a pilot study of an earlier iteration of a mobile app (the Pathway app) that confirmed the feasibility of using the app in patients with MDD and showed a positive trend in patient engagement in the app arm. In addition, a user-centered design approach that included qualitative assessments from patients and providers was used to improve understanding of the patient journey and care team workflows. User feedback highlighted the need for enhanced features, education modules, and real-time data sharing via integration with the electronic health record. The current iteration of the Platform includes the newest version of the Pathway app, education modules for both patients and providers, and real-time patient-level data sharing with the electronic health record. The study takes place in primary care sites within the Advocate Aurora Health system in Illinois and includes adult patients with MDD who were recently prescribed monotherapy antidepressant medication (defined as a new start, medication switch, or dose change in the past 3 months). Clinical performance and selected patient outcomes will be compared before and after the implementation of the Platform. RESULTS: Patient recruitment was completed in July 2022, with initial results expected in mid-2023. CONCLUSIONS: This study will provide useful insights into real-world integration of a digital platform within a large health system. The methods presented here highlight the unique user-centric development of the Pathway Platform, which has resulted in an enhanced digital tool with the potential to foster MBC and shared decision-making, improve patient-provider communication, and ultimately lead to optimized treatment outcomes for patients with MDD. TRIAL REGISTRATION: ClinicalTrials.gov NCT04891224; https://clinicaltrials.gov/ct2/show/NCT04891224. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43788.

4.
Sci Adv ; 9(8): eadd1467, 2023 Feb 24.
Article in English | MEDLINE | ID: mdl-36827375

ABSTRACT

Antarctic bottom water (AABW) production is a key factor governing global ocean circulation, and the present disintegration of the Antarctic Ice Sheet slows it. However, its long-term variability has not been well documented. On the basis of high-resolution chemical scanning of a well-dated marine ferromanganese nodule from the eastern Pacific, we derive a record of abyssal ventilation spanning the past 4.7 million years and evaluate its linkage to AABW formation over this period. We find that abyssal ventilation was relatively weak in the early Pliocene and persistently intensified from 3.4 million years ago onward. Seven episodes of markedly reduced ocean ventilation indicative of AABW formation collapse are identified since the late Pliocene, which were accompanied by key stages of Northern Hemisphere glaciation. We suggest that the interpolar climate synchronization within these inferred seven collapse events may have intensified global glaciation by inducing poleward moisture transport in the Northern Hemisphere.

5.
JMIR Form Res ; 6(10): e34923, 2022 Oct 27.
Article in English | MEDLINE | ID: mdl-36301599

ABSTRACT

BACKGROUND: Enhanced patient-provider engagement can improve patient health outcomes in chronic conditions, including major depressive disorder (MDD). OBJECTIVE: We evaluated the impact of a digitally enabled care mobile app, Pathway, designed to improve MDD patient-provider engagement. Patients used a mobile interface to assess treatment progress and share this information with primary care providers (PCPs). METHODS: In this 52-week, real-world effectiveness and feasibility study conducted in primary care clinics, 40 patients with MDD who were recently prescribed antidepressant monotherapy were randomized to use a mobile app with usual care (20/40, 50%) or usual care alone (20/40, 50%). Patients in the app arm engaged with the app daily for 18 weeks; a report was generated at 6-week intervals and shared with the PCPs to facilitate shared treatment decision-making discussions. The patients discontinued the app at week 18 and were followed through year 1. Coprimary outcome measures, assessed via research visits, included change from baseline in the 13-item Patient Activation Measure (PAM-13) and 7-item Patient-Provider Engagement Scale scores at week 18. Additional outcome measures included depression severity (9-item Patient Health Questionnaire [PHQ-9]) and cognitive symptoms (5-item Perceived Deficits Questionnaire-Depression). RESULTS: All 37 patients (app arm: n=18, 49%; usual care arm: n=19, 51%) who completed the 18-week follow-up period (n=31, 84% female, mean age 36, SD 11.3 years) had moderate to moderately severe depression. Improvements in PAM-13 and PHQ-9 scores were observed in both arms. Increases in PAM-13 scores from baseline to 18 weeks were numerically greater in the app arm than in the usual care arm (mean 10.5, SD 13.2 vs mean 8.8, SD 9.4; P=.65). At 52 weeks, differences in PAM-13 scores from baseline demonstrated significantly greater improvements in the app arm than in the usual care arm (mean 20.2, SD 17.7 vs mean 1.6, SD 14.2; P=.04). Compared with baseline, PHQ-9 scores decreased in both the app arm and the usual care arm at 18 weeks (mean 7.8, SD 7.2 vs mean 7.0, SD 6.5; P=.73) and 52 weeks (mean 9.5, SD 4.0 vs mean 4.7, SD 6.0; P=.07). Improvements in 7-item Patient-Provider Engagement Scale and WHO-5 scores were observed in both arms at 18 weeks and were sustained through 52 weeks in the app arm. Improvements in WHO-5 scores at 52 weeks were significantly greater in the app arm than in the usual care arm (41.5 vs 20.0; P=.02). CONCLUSIONS: Patients with MDD will engage with a mobile app designed to track treatment and disease progression. PCPs will use the data generated as part of their assessment to inform clinical care. The study results suggest that an app-enabled clinical care pathway may enhance patient activation and benefit MDD management. TRIAL REGISTRATION: ClinicalTrials.gov NCT03242213; https://clinicaltrials.gov/ct2/show/NCT03242213.

6.
AMA J Ethics ; 24(8): E773-780, 2022 08 01.
Article in English | MEDLINE | ID: mdl-35976935

ABSTRACT

Many regard iatrogenic injuries as consequences of diagnosis or intervention actions. But inaction-not offering indicated major surgery-can also result in iatrogenic injury. This article explores some surgeons' overestimations of operative risk based on patients' race and socioeconomic status as unduly influential in their decisions about whether to perform major cancer or cardiac surgery on some patients with appropriate clinical indications. This article also considers artificial intelligence and machine learning-based clinical decision support systems that might offer more accurate, individualized risk assessment that could make patient selection processes more equitable, thereby mitigating racial and ethnic inequity in cancer and cardiac disease.


Subject(s)
Decision Support Systems, Clinical , Neoplasms , Artificial Intelligence , Humans , Iatrogenic Disease , Patient Selection
7.
J Appl Physiol (1985) ; 133(3): 721-731, 2022 09 01.
Article in English | MEDLINE | ID: mdl-35861522

ABSTRACT

Weightlessness induces a cephalad shift of blood and cerebrospinal fluid that may increase intracranial pressure (ICP) during spaceflight, whereas lower body negative pressure (LBNP) may provide an opportunity to caudally redistribute fluids and lower ICP. To investigate the effects of spaceflight and LBNP on noninvasive indicators of ICP (nICP), we studied 13 crewmembers before and after spaceflight in seated, supine, and 15° head-down tilt postures, and at ∼45 and ∼150 days of spaceflight with and without 25 mmHg LBNP. We used four techniques to quantify nICP: cerebral and cochlear fluid pressure (CCFP), otoacoustic emissions (OAE), ultrasound measures of optic nerve sheath diameter (ONSD), and ultrasound-based internal jugular vein pressure (IJVp). On flight day 45, two nICP measures were lower than preflight supine posture [CCFP: mean difference -98.5 -nL (CI: -190.8 to -6.1 -nL), P = 0.037]; [OAE: -19.7° (CI: -10.4° to -29.1°), P < 0.001], but not significantly different from preflight seated measures. Conversely, ONSD was not different than any preflight posture, whereas IJVp was significantly greater than preflight seated measures [14.3 mmHg (CI: 10.1 to 18.5 mmHg), P < 0.001], but not significantly different than preflight supine measures. During spaceflight, acute LBNP application did not cause a significant change in nICP indicators. These data suggest that during spaceflight, nICP is not elevated above values observed in the seated posture on Earth. Invasive measures would be needed to provide absolute ICP values and more precise indications of ICP change during various phases of spaceflight.NEW & NOTEWORTHY The current study provides new evidence that intracranial pressure (ICP), as assessed with noninvasive measures, may not be elevated during long-duration spaceflight. In addition, the acute use of lower body negative pressure did not significantly reduce indicators of ICP during weightlessness.


Subject(s)
Space Flight , Weightlessness , Head-Down Tilt/physiology , Intracranial Pressure/physiology , Space Flight/methods , Weightlessness Simulation
8.
J Chem Phys ; 155(11): 117101, 2021 Sep 21.
Article in English | MEDLINE | ID: mdl-34551551

ABSTRACT

Two-color (1 + 1') zero-electron-kinetic-energy (ZEKE) and photoionization efficiency (PIE) spectra are reported via different levels in the S1 ← S0 (Ã1A2←X̃1A1) one-photon transition of jet-cooled N-methylpyrrole. The laser radiation is produced using two dye lasers, one with an 1800 l/mm grating and one with 2400 l/mm. We report spectra where the excitation and ionization radiation are produced with both combinations of the dye lasers; these spectra differ markedly. This is attributed to Wood's anomalies with the 2400 l/mm grating: one aspect is a loss in light intensity over a range of wavelengths, attributed to a resonance anomaly. Another is the appearance of a "shadow" ZEKE spectrum and PIE curve at apparently higher ionization wavenumbers; under some conditions, a third ZEKE spectrum was observed-these latter observations arise from higher-order dispersion effects, likely caused by a Rayleigh anomaly. We comment on these observations and report more representative ZEKE and PIE spectra than those presented in a recent paper by our group [A. R. Davies, D. J. Kemp, and T. G. Wright, J. Chem. Phys. 154, 224305 (2021)] for four intermediate S1 levels.

9.
Nat Commun ; 12(1): 4694, 2021 08 04.
Article in English | MEDLINE | ID: mdl-34349121

ABSTRACT

Climate change is a critical factor affecting biodiversity. However, the quantitative relationship between temperature change and extinction is unclear. Here, we analyze magnitudes and rates of temperature change and extinction rates of marine fossils through the past 450 million years (Myr). The results show that both the rate and magnitude of temperature change are significantly positively correlated with the extinction rate of marine animals. Major mass extinctions in the Phanerozoic can be linked to thresholds in climate change (warming or cooling) that equate to magnitudes >5.2 °C and rates >10 °C/Myr. The significant relationship between temperature change and extinction still exists when we exclude the five largest mass extinctions of the Phanerozoic. Our findings predict that a temperature increase of 5.2 °C above the pre-industrial level at present rates of increase would likely result in mass extinction comparable to that of the major Phanerozoic events, even without other, non-climatic anthropogenic impacts.


Subject(s)
Climate Change , Extinction, Biological , Temperature , Animals , Biodiversity , Fossils , Models, Theoretical , Oceans and Seas
10.
J Chem Phys ; 154(22): 224305, 2021 Jun 14.
Article in English | MEDLINE | ID: mdl-34241223

ABSTRACT

The electronic spectrum associated with the S1 ← S0 (Ã1A2←X̃1A1) one-photon transition of jet-cooled N-methylpyrrole is investigated using laser-induced fluorescence (LIF) and (1 + 1) resonance-enhanced multiphoton ionization (REMPI) spectroscopy; in addition, the (2 + 2) REMPI spectrum is considered. Assignment of the observed bands is achieved using a combination of dispersed fluorescence (DF), two-dimensional LIF (2D-LIF), zero-electron-kinetic energy (ZEKE) spectroscopy, and quantum chemical calculations. The spectroscopic studies project the levels of the S1 state onto those of either the S0 state, in DF and 2D-LIF spectroscopy, or the ground state cation (D0 +) state, in ZEKE spectroscopy. The assignments of the spectra provide information on the vibrational, vibration-torsion (vibtor), and torsional levels in those states and those of the S1 levels. The spectra are indicative of vibronic (including torsional) interactions between the S1 state and other excited electronic states, deduced both in terms of the vibrational activity observed and shifts from expected vibrational wavenumbers in the S1 state, attributed to the resulting altered shape of the S1 surface. Many of the ZEKE spectra are consistent with the largely Rydberg nature of the S1 state near the Franck-Condon region; however, there is also some activity that is less straightforward to explain. Comments are made regarding the photodynamics of the S1 state.

11.
Molecules ; 26(11)2021 May 27.
Article in English | MEDLINE | ID: mdl-34072134

ABSTRACT

The interest in utilizing food-derived compounds therapeutically has been rising. With the growing prevalence of systematic chronic inflammation (SCI), efforts to find treatments that do not result in the side effects of current anti-inflammatory drugs are underway. Bioactive peptides (BAPs) are a particularly promising class of compounds for the treatment of SCI, and the abundance of high-quality seafood processing byproducts (SPB) makes it a favorable material to derive anti-inflammatory BAPs. Recent research into the structural properties of anti-inflammatory BAPs has found a few key tendencies including they tend to be short and of low molecular weight (LMW), have an overall positive charge, contain hydrophobic amino acids (AAs), and be rich in radical scavenging AAs. SPB-derived anti-inflammatory BAPs have been observed to work via inhibition of the NF-κB and MAPK pathways by disrupting the phosphorylation of IκBα and one or more kinases (ERK, JNK, and p38), respectively. Radical scavenging capacity has also been shown to play a significant role in the efficacy of SPB-derived anti-inflammatory BAPs. To determine if SPB-derived BAPs can serve as an effective treatment for SCI it will be important to understand their properties and mechanisms of action, and this review highlights such findings in recent research.


Subject(s)
Anti-Inflammatory Agents/pharmacology , Peptides/chemistry , Amino Acids/chemistry , Animals , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Antioxidants/pharmacology , DNA Damage , Extracellular Signal-Regulated MAP Kinases/metabolism , Fishes , Hydrophobic and Hydrophilic Interactions , Inflammation , MAP Kinase Kinase 4/metabolism , Macrophages/metabolism , Molecular Weight , NF-KappaB Inhibitor alpha/metabolism , Oxidative Stress , Reproducibility of Results , Shellfish , Shellfish Proteins , p38 Mitogen-Activated Protein Kinases/metabolism
12.
J Appl Physiol (1985) ; 130(6): 1766-1777, 2021 06 01.
Article in English | MEDLINE | ID: mdl-33856253

ABSTRACT

Head-to-foot gravitationally induced hydrostatic pressure gradients in the upright posture on Earth are absent in weightlessness. This results in a relative headward fluid shift in the vascular and cerebrospinal fluid compartments and may underlie multiple physiological consequences of spaceflight, including the spaceflight-associated neuro-ocular syndrome. Here, we tested three mechanical countermeasures [lower body negative pressure (LBNP), venoconstrictive thigh cuffs (VTC), and impedance threshold device (ITD) resistive inspiratory breathing] individually and in combination to reduce a posture-induced headward fluid shift as a ground-based spaceflight analog. Ten healthy subjects (5 male) underwent baseline measures (seated and supine postures) followed by countermeasure exposure in the supine posture. Noninvasive measurements included ultrasound [internal jugular veins (IJV) cross-sectional area, cardiac stroke volume, optic nerve sheath diameter, noninvasive IJV pressure], transient evoked otoacoustic emissions (OAE; intracranial pressure index), intraocular pressure, choroidal thickness from optical coherence tomography imaging, and brachial blood pressure. Compared with the supine posture, IJV area decreased 48% with application of LBNP [mean ratio: 0.52, 95% confidence interval (CI): 0.44-0.60, P < 0.001], 31% with VTC (mean ratio: 0.69, 95% CI: 0.55-0.87, P < 0.001), and 56% with ITD (mean ratio: 0.44, 95% CI: 0.12-1.70, P = 0.46), measured at end-inspiration. LBNP was the only individual countermeasure to decrease the OAE phase angle (Δ -12.9 degrees, 95% CI: -25 to -0.9, P = 0.027), and use of combined countermeasures did not result in greater effects. Thus, LBNP, and to a lesser extent VTC and ITD, represents promising headward fluid shift countermeasures but will require future testing in analog and spaceflight environments.NEW & NOTEWORTHY As a weightlessness-induced headward fluid shift is hypothesized to be a primary factor underlying several physiological consequences of spaceflight, countermeasures aimed at reversing the fluid shift will likely be crucial during exploration-class spaceflight missions. Here, we tested three mechanical countermeasures individually and in various combinations to reduce a posture-induced headward fluid shift as a ground-based spaceflight analog.


Subject(s)
Space Flight , Weightlessness , Fluid Shifts , Humans , Intracranial Pressure , Lower Body Negative Pressure , Male , Weightlessness/adverse effects
13.
Nat Commun ; 11(1): 6012, 2020 11 26.
Article in English | MEDLINE | ID: mdl-33243971

ABSTRACT

Humans are primary agents of geomorphic change, and rates of anthropogenic landscape change likely far exceed the pace of change expected from natural geologic processes. Nevertheless, our understanding of the impact of humans on the natural landscape is limited by difficulties in accurately comparing past and present rates of change across wide spatial and temporal scales. Here, we present a compilation of  >4000 rates of alluvial sediment accumulation that provide an indirect record of North American erosion, mass transfer and sediment storage from the late Pleistocene to the present day. Continent-wide rates of alluvium accumulation were broadly stable for ~40,000 years, but increased 10-fold during the rapid expansion of agriculture and river system modification associated with European colonization. Interpreted in terms of mass transfer, humans have moved as much sediment in North America in the past century as natural processes can transfer in 700-3000 years.

14.
Palaeogeogr Palaeoclimatol Palaeoecol ; 560: 110017, 2020 Dec 15.
Article in English | MEDLINE | ID: mdl-32934423

ABSTRACT

A high-precision geologic time scale is the essential key for understanding the Earth's evolutionary history and geologic processes. Astronomical tuning of orbitally forced stratigraphic records to construct high-resolution Astronomical Time Scales (ATS) has led to a progressive refinement of the geologic time scale over the past two decades. In turn, these studies provide new insights regarding the durations and rates of major Earth events, evolutionary processes, and climate changes, all of which provide a scientific basis for contextualizing and predicting future global change trends. South China hosts some of the best-exposed and well-dated Neoproterozoic through Mesozoic stratigraphic sections in the world; many of which are suitable for cyclostratigraphy and calibrating the geologic time scale. In North China, several Cenozoic oil-bearing basins have deep boreholes with continuous sampling and/or well logging that enable derivation of astronomically tuned time scales for an improved understanding of basin evolution and hydrocarbon generation. This Special Issue focuses on case studies of astrochronology and applied cyclostratigraphy research using reference sections within China. In this introductory overview, we: (1) summarize all existing astrochronology studies of the Neoproterozoic through Cenozoic sections within China that have been used to enhance the international geologic time scale, (2) examine briefly the astronomically forced paleoclimate information recorded in various depositional systems and the modern techniques employed to analyze the periodicity of these signals encoded within the sedimentary record, and (3) summarize the 20 contributions to this Special Issue of Palaeogeography, Palaeoclimatology, Palaeoecology on 'Cyclostratigraphy and Astrochronology: Case studies from China'.

16.
J Chem Phys ; 152(21): 214303, 2020 Jun 07.
Article in English | MEDLINE | ID: mdl-32505141

ABSTRACT

We investigate Duschinsky rotation/mixing between three vibrations for both m-fluorotoluene (mFT) and m-chlorotoluene (mClT), during electronic excitation and ionization. In the case of mFT, we investigate both the S1 → S0 electronic transition and the D0 + ← S1 ionization, by two-dimensional laser-induced fluorescence (2D-LIF) and zero-electron-kinetic energy (ZEKE) spectroscopy, respectively; for mClT, only the D0 + ← S1 ionization was investigated, by ZEKE spectroscopy. The Duschinsky mixings are different in the two molecules, owing to shifts in vibrational wavenumber and variations in the form of the fundamental vibrations between the different electronic states. There is a very unusual behavior for two of the mFT vibrations, where apparently different conclusions for the identity of two S1 vibrations arise from the 2D-LIF and ZEKE spectra. We compare the experimental observations to the calculated Duschinsky matrices, finding that these successfully pick up the key geometric changes associated with each electronic transition and so are successful in qualitatively explaining the vibrational activity in the spectra. Experimental values for a number of vibrations across the S0, S1, and D0 + states are reported and found to compare well to those calculated. Assignments are made for the observed vibration-torsion ("vibtor") bands, and the effect of vibrational motion on the torsional potential is briefly discussed.

17.
J Am Coll Surg ; 230(6): 1111-1113, 2020 06.
Article in English | MEDLINE | ID: mdl-32278727

ABSTRACT

This article proposes systems for the fair distribution of scarce resources to healthcare providers. It builds on classic ethical structures and adapts them to the equitable distribution of personal protective equipment (PPE) to clinicians at risk of contracting novel corona virus-19 (COVID-19). The article also defines systems of allocation that are generally considered unethical and are to be avoided. We emphasize that policies must be transparent, collaborative, applied equally, and have a system of accountability. It is recognized that unless the supply of PPE is quickly replenished, or viable alternatives to traditional equipment are devised in the coming days to weeks, hospitals and healthcare systems will face the difficult task of rationing PPE to at-risk clinicians. This paper suggests an ethical framework for that process.


Subject(s)
Ethics, Medical , Health Care Rationing/ethics , Pandemics/ethics , Personal Protective Equipment/supply & distribution , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Humans , Infection Control/instrumentation , Morals , Personal Protective Equipment/ethics , Pneumonia, Viral/epidemiology , SARS-CoV-2
18.
J Chem Phys ; 152(6): 064303, 2020 Feb 14.
Article in English | MEDLINE | ID: mdl-32061214

ABSTRACT

Zero-electron-kinetic-energy (ZEKE) spectra are presented for m-chlorotoluene (mClT), employing different low-lying torsional and vibration-torsional ("vibtor") levels of the S1 state as intermediates. The adiabatic ionization energy is determined to be 71 319 cm-1 ± 5 cm-1 (8.8424 ± 0.0006 eV). It is found that the activity in the ZEKE spectra varies greatly for different levels and is consistent with the assignments of the S1 levels of m-fluorotoluene (mFT) deduced in the recent fluorescence study of Stewart et al. [J. Chem. Phys. 150, 174303 (2019)] and the ZEKE study from Kemp et al. [J. Chem. Phys. 151, 084311 (2019)]. As with mFT, the intensities in the ZEKE spectra of mClT are consistent with a phase change in the torsional potential upon ionization, allowing a large number of torsions and vibtor levels to be observed for the cation. Vibration-induced modifications of the torsional potential are discussed. Calculated vibrational wavenumbers for the S0, S1, and D0 + states are also presented.

19.
Sci Bull (Beijing) ; 65(16): 1405-1414, 2020 Aug 30.
Article in English | MEDLINE | ID: mdl-36659220

ABSTRACT

Grazing exclusion using fences is a key policy being applied by the Chinese government to rehabilitate degraded grasslands on the Tibetan Plateau (TP) and elsewhere. However, there is a limited understanding of the effects of grazing exclusion on alpine ecosystem functions and services and its impacts on herders' livelihoods. Our meta-analyses and questionnaire-based surveys revealed that grazing exclusion with fences was effective in promoting aboveground vegetation growth for up to four years in degraded alpine meadows and for up to eight years in the alpine steppes of the TP. Longer-term fencing did not bring any ecological and economic benefits. We also found that fencing hindered wildlife movement, increased grazing pressure in unfenced areas, lowered the satisfaction of herders, and rendered substantial financial costs to both regional and national governments. We recommend that traditional free grazing should be encouraged if applicable, short-term fencing (for 4-8 years) should be adopted in severely degraded grasslands, and fencing should be avoided in key wildlife habitat areas, especially the protected large mammal species.

20.
J Chem Phys ; 151(15): 154302, 2019 Oct 21.
Article in English | MEDLINE | ID: mdl-31640374

ABSTRACT

A deceptively simple feature in the S1 ← S0 spectrum of p-fluorotoluene (pFT), 1013 cm-1 above the origin, is studied using both zero-electron-kinetic-energy (ZEKE) and two-dimensional laser-induced fluorescence (2D-LIF) spectroscopy. It is found to consist of a cornucopia of overlapped transitions to eigenstates that arise from numerous interacting levels. A significant variation in the activity is seen employing both the ZEKE and 2D-LIF techniques. Detailed insight into the complicated spectra can be achieved, owing to the large number of vibrational wavenumbers that have been previously determined for the S0, S1, and D0 + states, summarized herein. It is found that the activity is dominated by two overtones, which are individually interacting with other levels, so providing largely independent routes for vibrational energy flow at the same internal energy. Additionally, other weak features located 900-1050 cm-1 above the origin are examined.

SELECTION OF CITATIONS
SEARCH DETAIL
...