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Land use and precipitation are two major factors affecting phosphorus (P) pollution of watershed runoff. However, molecular characterization of dissolved organic phosphorus (DOP) in runoff under the joint influences of land use and precipitation remains limited. This study used Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR-MS) to study the molecular characteristics of DOP in a typical P-polluted watershed with spatially variable land use and precipitation. The results showed that low precipitation and intense human activity, including phosphate mining and associated industries, resulted in the accumulation of aliphatic DOP compounds in the upper reaches, characterized by low aromaticity and low biological stability. Higher precipitation and widespread agriculture in the middle and lower reaches resulted in highly unsaturated DOP compounds with high biological stability constituting a higher proportion, compared to in the upper reaches. While, under similar precipitation, more aliphatic DOP compounds characterized by lower aromaticity and higher saturation were enriched in the lower reaches due to more influence from urban runoff relative to the middle reaches. Photochemical and/or microbial processes did result in changes in the characteristics of DOP compounds during runoff processes due to the prevalence of low molecular weight and low O/C bioavailable aliphatic DOP molecules in the upper reaches, which were increasingly transformed into refractory compounds from the upper to middle reaches. The results of this study can increase the understanding of the joint impacts of land use and precipitation on DOP compounds in watershed runoff.
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Monitoreo del Ambiente , Fósforo , Contaminantes Químicos del Agua , Fósforo/análisis , Contaminantes Químicos del Agua/análisis , Lluvia/química , AgriculturaRESUMEN
The increased frequency and intensity of heavy rainfall events due to climate change could potentially influence the movement of nutrients from land-based regions into recipient rivers. However, little information is available on how the rainfall affect nutrient dynamics in subtropical montane rivers with complex land use. This study conducted high-frequency monitoring to study the effects of rainfall on nutrients dynamics in an agricultural river draining to Lake Qiandaohu, a montane reservoir of southeast China. The results showed that riverine total nitrogen (TN) and total phosphorus (TP) concentrations increased continuously with increasing rainfall intensity, while TN:TP decreased. The heavy rainfall and rainstorm drove more than 30% of the annual N and P loading in only 5.20% of the total rainfall period, indicating that increased storm runoff is likely to exacerbate eutrophication in montane reservoirs. NO3--N is the primary nitrogen form lost, while particulate phosphorus (PP) dominated phosphorus loss. The main source of N is cropland, and the main source of P is residential area. Spatially, forested watersheds have better drainage quality, while it is still a potential source of nonpoint pollution during rainfall events. TN and TP concentrations were significantly higher at sites dominated by cropland and residential area, indicating their substantial contributions to deteriorating river water quality. Temporally, TN and TP concentrations reached high values in May-August when rainfall was most intense, while they were lower in autumn and winter than that in spring and summer under the same rainfall intensities. The results emphasize the influence of rainfall-runoff and land use on dynamics of riverine N and P loads, providing guidance for nutrient load reduction planning for Lake Qiandaohu.
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Monitoreo del Ambiente , Nitrógeno , Fósforo , Lluvia , Ríos , Contaminantes Químicos del Agua , Fósforo/análisis , Nitrógeno/análisis , China , Ríos/química , Contaminantes Químicos del Agua/análisis , AgriculturaRESUMEN
ABSTRACT A patient presented with corneoscleral thinning five months after the treatment of suspected ocular squamous surface neoplasia with mitomycin-C and interferon. For tectonic and aesthetic purposes, we decided to perform lamellar corneoscleral transplantation. The approach used established new tectonic support and corneal homeostasis. This technique might be an option in similar cases.
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ABSTRACT Purpose: This study aimed to analyze variations in intraoperative corneal thickness during corneal cross-linking in patients with keratoconus and to investigate its possible correlation with presurgical maximal keratometry (Kmax) and pachymetry. Methods: This was a prospective case series. We used a method similar to the Dresden protocol, with the application of hydroxypropyl methylcellulose 0.1% hypo-osmolar riboflavin in corneas between 330 and 400 µm after epithelium removal. Corneal thickness was measured using portable calipers before and immediately after epithelium removal, and 30 and 60 min after the procedure. Results: The 30 patients in this study were followed up for one year. A statistically significant difference was observed in pachymetry values during the intraoperative period (p<0.0001) and an increase of 3.05 µm (95%C1: 0.56-5.54) for each diopter was seen after epithelium removal (p0.019). We found an average Kmax difference of —2.12 D between men and women (p0.013). One year after treatment, there was a statistically significant reduction in pachymetry (p<0.0001) and Kmax (p0.0170) values. Conclusions: A significant increase in pachymetry measurements was seen during the procedure, and most patients showed a regression in Kmax and pachymetry values one year after surgery.
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Introdução: O câncer de pulmão é uma doença grave, sendo a segunda maior causa de morte em todo o mundo, entretanto, em alguns países desenvolvidos, tornou-se já a primeira causa de morte. Cerca de 90% dos casos de neoplasia pulmonares são causados pela inalação da fumaça do cigarro. Objetivo: Correlacionar a prevalência de tabagismo e morbimortalidade por câncer de pulmão nos estados brasileiros, além de demonstrar a associação destes com sexo e faixa etária. Métodos: Estudo de caráter ecológico acerca da prevalência de tabagismo e morbimortalidade por câncer de pulmão nos estados brasileiros, nos períodos de 2013 e 2019, dividida por sexo e faixa etária. Foram utilizados bancos de coleta de dados como o Tabnet e Pesquisa Nacional de Saúde. Resultados: As maiores taxas de mortalidade e internações hospitalares foram do público masculino, em 2013, com taxa de 2,7 e 10, respectivamente, e em 2019 com 3,3 e 11,9, respectivamente. Ademais, a maior prevalência de tabagismo foi encontrada nos homens; entretanto seu índice tem caído, enquanto a quantidade de mulheres tabagistas tem aumentado. A Região Sul demonstrou maiores números de mortalidade em ambos os períodos estudados, com taxas de 4,9 e 5,8 por 100 mil habitantes, e morbidade hospitalar com 19,9 e 23,5 por 100 mil habitantes. Já a Região Norte se configurou com as menores prevalências: em 2013 apresentou taxa de óbito por câncer de pulmão de 1,0 e morbidade hospitalar de 3,5/100 mil habitantes, em 2019 apresentou taxa de mortalidade de 4,6 e internações de 1,6/100 mil habitantes. Os coeficientes de correlação de morbidade hospitalar e prevalência de tabagismo foram R2=0,0628, r=0,251 e p=0,042, enquanto os de mortalidade e prevalência de tabagismo foram R2=0,0337, r=0,183 e p=0,140. Conclusões: Na presente pesquisa, pode-se inferir que houve associação positiva na comparação entre taxa de morbidade hospitalar e prevalência de tabagismo; em contrapartida, não foi possível observar associação positiva na correlação da taxa de mortalidade por câncer de pulmão e prevalência de tabagismo.
Introduction: Lung cancer is a serious disease, being the second leading cause of death worldwide. Moreover, in some developed countries, it has already become the leading cause of death. About 90% of lung cancer cases are caused by cigarette smoking. Objective: To correlate the prevalence of smoking and lung cancer morbidity and mortality in Brazilian states, and to demonstrate their association with sex and age group as well. Methods: An ecological study on the prevalence of smoking and lung cancer morbidity and mortality in Brazilian states between 2013 and 2019, divided by sex and age group. The data collection databases Tabnet and National Health Survey were used. Results: The highest rates of mortality and hospital admissions were among men, in 2013 with a rate of 2.7 and 10, respectively, and in 2019 with 3.3 and 11.9, respectively. In addition, the highest prevalence of smoking was found in men, but this rate has fallen, while the number of women smokers has increased. The South region showed higher mortality rates in both periods studied, with rates of 4.9 and 5.8 per 100,000 inhabitants, and hospital morbidity with 19.9 and 23.5 per 100,000 inhabitants. The North region had the lowest prevalence, where in 2013, it had a death rate from lung cancer of 1.0 and hospital morbidity of 3.5/100 thousand inhabitants, and where in 2019, it had a mortality rate of 4.6 and hospitalizations of 1.6/100 thousand inhabitants. The correlation coefficients for hospital morbidity and smoking prevalence were R2=0.0628, r=0.251 and p=0.042, while for mortality and smoking prevalence, these were R2=0.0337, r=0.183 and p=0.140. Conclusions: In the present study, it can be inferred that there was a positive association between hospital morbidity rate and prevalence of smoking, while it was not possible to observe a correlation between lung cancer mortality rate and prevalence of smoking.
Introducción: El cáncer de pulmón es una enfermedad grave, siendo la segunda causa de muerte en todo el mundo, sin embargo, en algunos países desarrollados, ya se ha convertido en la primera causa de muerte. Alrededor del 90% de los casos de neoplasias pulmonares están causados por la inhalación del humo del cigarrillo. Objetivo: Correlacionar la prevalencia de tabaquismo y la morbimortalidad por cáncer de pulmón en los estados brasileños, además de demostrar la asociación de estos con el género y el grupo de edad. Métodos: estudio ecológico sobre la prevalencia de tabaquismo y morbimortalidad por cáncer de pulmón en los estados brasileños, dentro de los períodos 2013 y 2019, divididos por sexo y grupo de edad. Se utilizaron bancos de recogida de datos como Tabnet y la Encuesta Nacional de Salud. Resultados: las mayores tasas de mortalidad e ingresos hospitalarios se dieron en el público masculino, en 2013 con una tasa de 2,7 y 10, respectivamente, y en 2019 con 3,3 y 11,9, respectivamente. Además, la mayor prevalencia del tabaquismo se encontró en los hombres, sin embargo, su tasa ha disminuido, mientras que la cantidad de mujeres fumadoras ha aumentado. La región Sur presentó cifras más altas de mortalidad en ambos periodos estudiados, con tasas de 4,9 y 5,8 por 100.000 habitantes, y de morbilidad hospitalaria con 19,9 y 23,5 por 100.000 habitantes. Mientras que la región Norte se configuró con las prevalencias más bajas, en 2013 presentó una tasa de mortalidad por cáncer de pulmón de 1,0 y una morbilidad hospitalaria de 3,5/100.000 habitantes, en 2019 presentó una tasa de mortalidad de 4,6 y hospitalizaciones de 1,6/100.000 habitantes. Los coeficientes de correlación para la morbilidad hospitalaria y la prevalencia del tabaquismo fueron R2=0,0628, r=0,251 y p=0,042, mientras que para la mortalidad y la prevalencia del tabaquismo fueron R2=0,0337, r=0,183 y p=0,140. Conclusiones: En la presente investigación se puede inferir que existe una asociación positiva en la comparación entre la tasa de morbilidad hospitalaria y la prevalencia de tabagismo, en contrapartida, no fue posible observar una asociación positiva en la correlación de la tasa de mortalidad por cáncer de pulmón y la prevalencia de tabagismo.
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Humanos , Tabaquismo , Carcinógenos , Productos de Tabaco , Neoplasias PulmonaresRESUMEN
Abstract Introduction: Aquatic birds (AB) are usually associated with wetlands, which provide refuge, food, and/or nesting sites for resident and migratory species. Despite their ecological importance, there is little knowledge on AB in some tropical environments, such as those found on the Colima coast. Objective: To investigate the spatial and temporal composition of the AB community in Juluapan Lagoon, Colima, Central Mexican Pacific. Methods: Monthly counts were conducted between June 2017 and May 2018 during low-tide conditions to record habitat use by AB. Species richness and bird counts were obtained to compare sampling areas; mean richness and number of individuals were compared between seasons. Results: We detected 53 species and 5 750 individuals. The highest species richness and relative abundance values were obtained in winter at the lagoon area farthest from the connection with the marine system, where anthropogenic activity is lower. Diversity was greater in zones 2 and 3 in spring, summer, and fall. Muddy flats were the most used environment, and the most frequent activity was resting. Nesting activity was only recorded in the middle of the lagoon at the mangrove during spring. "Shorebirds" and "waders" were the most dominant groups in the bird community of the Juluapan lagoon. Conclusions: This coastal wetland is a site of great biological importance for aquatic birds; thus, conservation measures should be implemented, and there should be a continuous study of the effects of anthropogenic pressure.
Resumen Introducción: Las aves acuáticas (AA) son usualmente relacionadas a los humedales debido a que éstos funcionan como sitios de refugio, alimentación y anidación de diferentes especies residentes y migratorias. Sin embargo, el conocimiento sobre las aves acuáticas en algunos humedales es nulo. Objetivo: Investigar la composición espacio-temporal de la comunidad de AA en la laguna Juluapan, Colima, en el Pacífico Central Mexicano. Métodos: Entre junio de 2017 y mayo de 2018 se llevaron a cabo conteos mensuales en condiciones de marea baja para registrar el uso de hábitat de las AA. Se obtuvieron valores de riqueza de especies y número de individuos para realizar comparaciones entre zonas de muestreo, así como el promedio del número de especies y número de individuos para comparaciones entre temporadas. Resultados: Se registraron un total de 53 especies y 5 750 individuos. Los valores de riqueza de especies y densidad de individuos fueron más altos durante invierno, en la zona más alejada al ambiente marino, donde la actividad antropogénica es menor. La diversidad tuvo valores más altos en la zona 2 y 3, durante primavera, verano y otoño. El ambiente más explotado por las aves fueron las planicies lodosas; y el descanso fue la actividad más frecuente. Asimismo, la actividad de anidación sólo se registró en el manglar de la zona media durante primavera. Las "aves playeras" y "aves zancudas" fueron los grupos más predominantes en la comunidad de aves de la laguna Juluapan. Conclusiones: Este humedal costero es un sitio de gran importancia biológica para aves acuáticas, por lo que resulta necesario la implementación de medidas de conservación, así como el estudio de los efectos por la presión antropogénica.
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Animales , Aves/clasificación , Fauna Acuática , Muestreo , MéxicoRESUMEN
BACKGROUND: Alcohol use disorder is associated with a variety of complications, including alcohol withdrawal syndrome (AWS), which may occur in those who decrease or stop alcohol consumption suddenly. AWS is associated with a range of signs and symptoms, which are most commonly treated with GABAergic medications. CLINICAL QUESTION: Is phenobarbital an effective treatment for AWS? EVIDENCE REVIEW: Studies retrieved included two prospective, randomized, double-blind studies and three systematic reviews. These studies provided estimates of the effectiveness and safety of phenobarbital for treatment of AWS. CONCLUSIONS: Based on the available literature, phenobarbital is reasonable to consider for treatment of AWS. Clinicians must consider the individual patient, clinical situation, and comorbidities when selecting a medication for treatment of AWS.
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Treatment of opioid use disorder (OUD) faces several challenges, including restricted access to medications, geographical and logistical barriers, and variability in treatment availability across different communities. This article outlines several strategies aimed at improving access to medications. Pharmacy-based care could potentially extend access to medications but would require regulatory changes to empower pharmacists. In addition, telemedicine has shown promise in improving access by mitigating geographic and transportation barriers. Mobile health clinics also offer a direct approach to delivering medication-based treatments to underserved communities. Furthermore, integrating OUD treatment into primary care settings could facilitate early detection and treatment. Policy changes have increased access to take-home medications and buprenorphine initiation at home. Community engagement would be crucial for tackling the social determinants of health to offer equitable care for patients. The implementation of these strategies has the potential to significantly enhance the accessibility and delivery of effective, timely and equitable treatment to patients with OUD.
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BACKGROUND: The global lack of suitable formulations for children leads to off-label and unlicensed medicine use, posing significant risks of adverse effects. Understanding this usage on a national level can help guide interventions for better formulations. This study aimed to measure the prevalence of off-label and unlicensed medicines among children in South Africa's private sector. METHODS: The study used a point prevalence methodology to review medicine use in children aged 0-2 years enrolled in a selected pharmaceutical benefit management company in South Africa from January to June 2022. A sample size of 1055 prescriptions was calculated using a 90% confidence interval, 50% prevalence rate, and 5% error margin. A systematic random sampling approach selected every seventh entry from 91,973 total entries, resulting in a final sample size of 13,139. Data included patient age, number and characteristics of medicines, quantity, and indications. Descriptive statistics analysed and reported the prevalence of unlicensed and off-label medicine use. RESULTS: Among the 13,139 prescribed medicines, 40% (5,246) were off-label or unlicensed, and 60% (7,893) were on-label. Of the off-label/unlicensed medicines, 16.85% (2,214) were unlicensed, and 23.08% (3,032) were off-label. Methylprednisolone was the top off-label medicine, probiotics were the top unlicensed, and the ICD10 code Z76.9 was the top diagnosis. CONCLUSION: The study found that 40% of children aged 0-2 years were prescribed unlicensed or off-label medicines in South Africa's private healthcare sector between January and June 2022. This suggests a widespread practice of off-label or unlicensed prescriptions in paediatric treatment in the South African private sector.
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BACKGROUND: Co-use of stimulants and opioids is often deliberate. However, the possibility remains that some people are unintentionally consuming fentanyl. To advance understanding of overdose risk, we examined the rate of concordance between self-reported fentanyl use and corresponding urine toxicology screen results. METHODS: Between August 2022-August 2023, 411 participants (adults who reported any non-medical drug use in the past three months) in Nevada and New Mexico completed a cross-sectional survey, of whom 64% (n = 270; the analytical sample) also completed a urine toxicology screen, which detects fentanyl use in the past three days. Positive predictive value, negative predictive value, sensitivity, and specificity were calculated using self-reported past three-day fentanyl use (yes/no) and urine toxicology screen results for the presence of fentanyl (positive/negative). RESULTS: Of the 270 participants who provided a urine sample, 268 are included in the descriptive statistics (two with inconclusive urine toxicology screen results were excluded). Of the 268 participants, 146 (54.5%) had a fentanyl-positive urine toxicology screen result, 122 (45.5%) had a fentanyl-negative urine toxicology screen result, 137 (51.1%) reported past three-day fentanyl use, and 130 (48.5%) reported no past three-day fentanyl use. Only 6.9% of those with a fentanyl-positive urine toxicology screen did not report recent fentanyl use. The sensitivity of self-reported fentanyl use was 93%, specificity was 97%, positive predictive value was 97%, and negative predictive value was 92%. DISCUSSION: The rate of unanticipated exposure to fentanyl (that is, positive urine screen and negative self-report) in this sample was low, at 6.9%. This runs counter to the national narrative that there is widespread unknown contamination of fentanyl in the drug supply. CONCLUSION: Future research is needed to further explore how people who use multiple substances interpret their overdose risk and what harm reduction methods they employ.
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Although psychological symptoms are broadly considered to be risk factors for substance use, internalizing symptoms may be associated with lower risk for adolescent substance use after controlling for co-occurring externalizing symptoms. The present study explored two potential mediators of this protective association between internalizing symptoms and adolescent substance use: popularity and harm avoidance. The study used data from the Colorado Longitudinal Twin Study (LTS) and Colorado Adoption Project (CAP). Annual assessments of internalizing and externalizing symptoms and social competence were completed by parents and teachers at participant ages 7 to 16. Harm avoidance and substance use were assessed at age 17. In this sample, internalizing symptoms were associated with less frequent substance use, controlling for externalizing symptoms. We did not find evidence that popularity or harm avoidance accounts for the protective association of internalizing symptoms with adolescent substance use. Teacher-reported popularity was associated with less frequent substance use, suggesting that social connectedness in the school context may be a protective factor for adolescent substance use. Harm avoidance was not associated with substance use after accounting for internalizing and externalizing symptoms.
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Adverse childhood experiences and workplace trauma exposure are associated with poor health. However, their differential impacts by gender are difficult to assess in studies of organizations with gender imbalances (e.g., law enforcement officers are more likely men whereas social workers are more likely women). Using a community-based participatory research framework, this study examines trauma exposure, mental and physical health, and substance use in an occupationally diverse sample (n = 391). Trauma exposure was high and associated with poor health. Even though women experienced more adversity, they were often more resilient than men. Implications for trauma-informed workplaces are discussed.
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Novel brominated flame retardants (NBFRs) have emerged as an alternative to traditional brominated flame retardants (BFRs) and may pose risks to the environment and human health. However, the distribution pattern of NBFRs in urbanized zones and their association with multiple socioeconomic variables have not been adequately explored. Herein, seven NBFRs were investigated in surface soil samples from Tianjin, China, a typical urbanized area. The ∑7NBFRs ranged from n.d. to 101 ng/g, dry weight (dw) (mean: 12.6 ± 17.6 ng/g dw), which exhibited a relatively elevated level compared to NBFRs in soils from other regions worldwide. Decabromodiphenylethane (DBDPE) was the main contaminant, and its concentration ranged from 0.378 to 99 ng/g, dry weight (dw) (mean: 11.4 ± 17.0 ng/g dw), accounting for 81 % of the ∑7NBFRs. Notably, NBFRs exhibited peak concentrations within residential zones, significantly surpassing those recorded in the remaining four regions (green, farmland, water environment and other) (p < 0.05). Furthermore, the concentration of NBFRs in the soil of the Binhai New District within Tianjin was the highest, significantly exceeding that of other administrative areas, which was closely related to the intensive industrial activities in this region. The above results indicate that human activities are a key factor affecting the concentration of NBFRs in the soil. Moreover, a variety of statistical methods were employed to investigate the correlation between socioeconomic variables and the distribution of NBFRs. The concentration of NBFRs showed a significant correlation with population density and the gross domestic product (GDP) (p < 0.05), and the incorporation of administrative regional planning into structural equation models demonstrated an indirect influence on the spatial distribution of NBFRs concentration, mediated by its impact on population density. These results emphasize the association between NBFRs contamination and the degree of urbanization, thereby providing valuable insights for assessing the exposure risk of NBFRs among urban residents.
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Cocoa farmers in Nigeria adopt crop diversification to safeguard the food security of their households. Although credit and land are thought to play a vital role in crop diversification, they continue to have limited access to credit and land. This study investigated the linkages between access to credit, land use, crop diversification, and food security with a focus on cocoa farming households. A multistage sampling procedure was used to obtain data for the study. Data were analyzed with the aid of descriptive statistics, the Heifindahl index, the Tobit regression model, the food consumption score, and the ordered Logit regression model. The results for the entire respondents showed mean values of 55 years for age, 31 years for farming experience, 6 people for household size, and 5 ha for farm size. Heifindahl index shows 38.67 % of the respondents had low crop diversification in the study area. Tobit regression model reveals that access to credit, farming experience, cooperative organization, access to extension service, farm size, distance to farms, and labour are the main albeit significant factors that determine crop diversification among cocoa farming households. Food consumption score revealed that 46.67 % were poor, 30.67 % were at the borderline and about 27.67 % were within the acceptable threshold. The ordered logit model revealed that crop diversification index, formal education, access to credit, farm size, land use, and farming experience have a significant influence on the food security of households. The study concluded that there is a positive relationship between access to credit, land use, crop diversification, and food security. Therefore, the government and financial institutions should make credit facilities accessible to cocoa farmers to improve their livelihood.
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This research investigates the future dynamics of water yield services in the Gorgan River Basin in the North of Iran by analyzing land cover changes from 1990 to 2020, using Landsat images and predicting up to 2040 with the Land Change Modeler and InVEST model under three scenarios: continuation, conservation, and mitigation. The results indicate significant shifts in agricultural land impacted water yields, which fluctuated from 324.7 million cubic meters (MCM) in 1990 to 279.7 MCM in 2010, before rising to 320.1 MCM by 2020. The study uniquely assesses the effects of land use changes on water yields, projecting a 13.6 % increase in water yield by 2040 under the continuation scenario, a 3.9 % increase under conservation, and a 1.6 % decrease under mitigation, which limits changes on steep slopes to prevent soil erosion and floods. This underscores the interplay between land use, vegetation cover, and water yield, emphasizing strategic land management for water resource preservation and effective watershed management in the GRB.
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Given the increasing utilization of forest components in integration systems worldwide, coupled with the growing demand for food in regions facing water restrictions, this study aims to evaluate how physiological and biochemical parameters contribute to the diversification of adaptive mechanisms among native species and eucalyptus genotypes intercropped with soybean or corn. The native tree species Anadenanthera macrocarpa and Dipteryx alata, and the eucalyptus genotypes Urograndis I-144 and Urocam VM01, were grown in soybean and corn intercropping areas and evaluated in fall, winter, spring, and summer. The study evaluated morning water potential, chloroplast pigment concentration, gas exchange, cell damage, and antioxidant enzyme activity. Intercropped with soybean, development the of A. macrocarpa improved through instantaneous water use efficiency, energy use by the electron transport chain, chloroplast pigments, and catalase enzyme activity. On the other hand, A. macrocarpa when, intercropped with corn, despite increasing energy absorption by the reaction center, there is a need for non-photochemical dissipation and in the activity of the enzymes superoxide dismutase and ascorbate peroxidase in response to water and oxidative deficits. In D. alata, the physiological and biochemical responses were not influenced by intercropping but by seasons, with increased chloroplast pigments in fall and electron transport in summer. However, in corn intercropping, the dissipation of excess energy allowed leaf acclimatization. The I-144 and VM01 genotypes also showed no significant differences between intercrops. The results describe photosynthetic and biochemical challenges in the native species A. macrocarpa intercropped with corn, such as a greater need for enzymatic and non-enzymatic defense mechanisms in response to more negative water potential. In D. alata, the challenges are present in both intercrops due to improved mechanisms to protect the photosynthetic apparatus. The survival of the I-144 genotype may be inefficient in both intercrops under prolonged drought conditions, as it modifies the photosystem; in contrast, genotype VM01 was the most adapted to the system for using captured energy, reducing water loss and being resilient.
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Technology integration is becoming pervasive in the polytechnic institutes of Bangladesh. Many institutions opted for a blended learning approach to deliver their education. This approach drives the transformation of education towards more digitalization and obliges students to thrive in using technology in the learning process. However, many students lack technical competency and more importantly are deprived of having modern devices in their households. In particular, how students perceive technology and how it affects their learning experience and satisfaction is crucial for effective learning. This area of research is still unexplored in the context of TVET Bangladesh. This study attempts to investigate what are the factors that affect the students' perceived satisfaction with the usage of technology and to what extent students are satisfied with the way technology is being used in their learning process. A quantitative research method using an online survey was conducted across Bangladesh and a total of 847 polytechnic students from 16 polytechnic institutes were recruited through non-probability convenience sampling technique. A structural equation modelling (SEM) and independent multivariate analysis of variance (MANOVA) were employed for the data analysis. The results revealed that self-efficacy positively influenced attitude, and attitude positively influenced social interaction. In contrast, attitude negatively influenced perceived satisfaction. This study can help educators implement strategies such as providing scaffolding, promoting self-directed learning, and commemorating student successes to build self-efficacy and a positive attitude towards technology acceptance.
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Background: Longer treatment time has been shown to be associated with lower crime recidivism among forensic psychiatric patients, but it is not known if this applies also to mortality. In this study, we aim to research whether treatment time is associated with risk of post-discharge mortality in Finnish forensic psychiatric patients. Materials and methods: The study population consisted of 989 patients committed to compulsory forensic psychiatric hospital treatment in Finland from 1980 to 2009 who were released from care by the end of 2018. Each patient included in the cohort was linked with the Statistics Finland register, which includes all data on dates and causes of deaths in Finland. Crude cumulative rate of mortality were estimated using Kaplan-Meier method and compared using logrank-test. Adjusted cumulative rate analyzed using Cox regression model. A possible nonlinear relationship between the treatment time and the hazard of death was assessed by using 3-knot-restricted cubic spline regression. Adjusted models included age, sex, and SUD (substance use disorder) as covariates. Results: The mean duration of care was 7.1 (SD 6) years. The duration of treatment variable was divided into tertiles of treatment duration less than 3.5 years, 3.5-7.9 years and equal or more than 8 years. The risk of mortality was highest in the first tertile, and lowest in the last tertile. The risk of mortality was higher for patients suffering from SUD, for patients of male sex and for those released at younger age. Conclusions: Longer treatment time is associated with reduced post-discharge mortality in forensic psychiatric patients in Finland. Especially males and individuals with SUD are at higher mortality risk after release, but longer treatment duration may mitigate these risks. Longer periods of hospitalization have to be, however, viewed against the backdrop of institutionalization and loss of self-determination.
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BACKGROUND: Although several digital health interventions (DHIs) have shown promise in the care of skin diseases their uptake in Germany has been limited. To fully understand the reasons for the low uptake, an in-depth analysis of patients' and health care providers' barriers and facilitators in dermatology is needed. OBJECTIVE: The objective of this study was to explore and compare attitudes, acceptability, barriers, and facilitators of patients, dermatologists, and nurses toward DHIs in dermatology. METHODS: We conducted 6 web-based focus groups each with patients (n=34), dermatologists (n=30), and nurses (n=30) using a semistructured interview guide with short descriptions of DHIs described in the literature. A content analysis was performed using deductive constructs, following the unified theory of acceptance and use of technology framework, and inductive categories. RESULTS: Patients identified many positive performance expectancies, such as reduced travel times and improvement in follow-up appointments. Dermatologists also stated positive effects (eg, promotion of standardized care), but also negative implications of health care digitalization (eg, increased workload). All stakeholders reported that a DHI should bring additional value to all stakeholders. A lack of digital competence among patients was identified as the major barrier to adoption by all 3 groups. Nurses and dermatologists want apps that are easy to use and easy to implement into their daily routines. Trust in selected institutions, colleagues, and physicians was identified as a facilitator. Patients reported their dependence on the dermatologists' acceptance. All groups expressed concerns about data privacy risks and dermatologists stated insecurities toward data privacy laws. CONCLUSIONS: To ensure successful digitalization in dermatology, apps should be user-friendly, adapted to users' skill levels, and beneficial for all stakeholders. The incorporation of dermatologists' perspectives is especially important as their acceptance may impact use among patients and nurses. DHIs should ensure and be transparent about data privacy. The found barriers and facilitators can be used for implementation strategies.