The role of ponds in pesticide dissipation at the catchment scale: The case of the Save agricultural catchment (Southwestern France).

Pesticides are a major source of pollution for ecosystems. In agricultural catchments, ponds serve as buffer areas for pesticide transfers and biogeochemical hotspots for pesticide dissipation. Some studies have highlighted the specific impact of ponds on the dynamics of pesticides, but knowledge of their cumulative effect at the watershed scale is scarce. Hence, using a modelling approach, we assessed the cumulative role of ponds in pesticide transfer in an agricultural basin (Southwest of France, 1110 km2). The Soil and Water Assessment Tool (SWAT) model was used to model the Save basin, including 197 ponds selected with a Multi-Criteria Decision Aiding Model based on their pesticide interception capacities. The daily discharge, the suspended sediment loads and two herbicide loads (i.e. S-metolachlor and aclonifen) in dissolved and particulate phases were accurately simulated from January 2002 to July 2014 at a daily time step. The presence of ponds resulted in a yearly mean reduction at the watershed outlet of respectively 61 % and 42 % of aclonifen and S-metolachlor fluxes compared to the simulations in the absence of ponds. Sediment-related processes were the most efficient for pesticide dissipation, leading to a mean dissipation efficiency by ponds of 51.0 % for aclonifen and 34.4 % for S-metolachlor. This study provides a first quantification of the cumulative role of ponds in pesticide transfer at the catchment scale in an intensive agricultural catchment.

Chronic Obstructive Lung Disease: Treatment Guidelines and Recommendations for Referral and Multidisciplinary Continuity of Care.

Chronic Obstructive Pulmonary Disease (COPD) constitutes a major public health problem, and it is anticipated that its prevalence will continue to increase in the future. Its progressive nature requires a continuous and well-coordinated care approach. The follow-up for COPD should primarily focus on disease screening and control, which includes monitoring of pulmonary function, prevention of exacerbations, identification of aggravating factors and comorbidities, as well as ensuring treatment adequacy and adherence. However, existing clinical practice guidelines and consensus documents offer limited recommendations for the follow-up. In this context, we undertake a review of COPD treatment and the continuity of care recommendations endorsed by several scientific societies. Moreover, we underscore the importance of the involvement of nursing and community pharmacy in this process, as well as the utilization of quality indicators in the provision of care for the disease.

Assessing fluvial organic carbon flux and its response to short climate variability and damming on a large-scale tropical Asian river basin.

Fluvial organic carbon (OC) transfer is an essential resource for downstream ecosystems. Multiple factors affect its transfer process, e.g., climate or anthropogenic activities. Quantifying OC fluxes with fine spatiotemporal resolution is challenging in anthropised catchments. This study aims to quantify daily OC dynamics and to assess the impacts of short climate variability and damming on OC spatiotemporal transfer processes in a large tropical Asian river basin (the Red River) for an extended period (2003-2013) by combining empirical equations with modelling outputs. Firstly, empirical equations for calculating dissolved (DOC) and particulate OC (POC) concentrations were calibrated based on in-situ sampling data. Then, simulated daily discharge (Q) and suspended sediment concentrations were used to quantify daily OC fluxes. Results show that the parameters of the DOC and POC equations well represent the subbasins characteristics, underlining the effects of soil OC content, mean annual Q and Chlorophyll a. DOC and POC exports reached 222 and 406 kt yr-1 at the basin outlet, accounting for 0.38 % of the total OC (TOC) exported by Asian rivers to the ocean. However, the specific yields of DOC (1.62 t km-2 yr-1) and POC (2.96 t km-2 yr-1) of the Red River basin were ~ 1.5 times those of other Asian basins. By comparing a reference scenario (without dams) to current conditions, we estimated 12 % and 88 % decreases in DOC and POC fluxes between 2008-2013 and 2003-2007, mainly due to damming. This study shows that climate variability may not impact OC dynamics in rivers as it explained <2 % of the variations. However, dam management, especially recent ones operating since 2008, deeply influences OC variations as the POC/TOC ratio decreased from 86 % to 47 %. Damming significantly decreased POC exports due to sediment retention, altering the equilibrium of OC cycling downstream, which may impact the food chain.

A Network Meta-Analysis on the Surgical Management of Thoracolumbar Burst Fractures: Anterior, Posterior, and Combined.

Background: Thoracolumbar burst fractures (BFs) are traumatic lesions instigated by compression forces. Canal compression and compromise may lead to neurological deficits. Optimal surgical management is yet to be fully defined since various approaches such as anterior, posterior, or combined exist. This study aims to determine the operative performance of these three treatment modalities. Methods: In accordance with the PRISMA guidelines, a systematic review was performed, identifying studies comparing anterior, posterior, and/or combined surgical approaches in patients with thoracolumbar BFs. To analyze available evidence, a Bayesian network meta-analysis framework was utilized. Results: In this study, 16 studies were included. The shortest operative times and lowest operative blood losses were found for a posterior approach. The length of stay (LoS) was shorter with the posterior approach compared with the other two modalities. Return to work, postoperative kyphotic angle (PKA), and complications all favored the posterior approach. The visual analog scale score was similar between groups. Conclusions: This study suggests that the posterior approach has significant advantages in terms of operative time, blood loss, LoS, PKA, return to work, and complication rates when compared to the other approaches. Treatment should remain an individualized process, and before choosing an approach, factors such as patient characteristics, surgeon experience, and hospital settings should be considered.

Aeroallergen immunotherapy associated with reduced risk of severe COVID-19 in 1095 allergic patients.

Introduction: Allergen immunotherapy (AIT) brings along changes in the immune system, restoring dendritic cell function, reducing T2 inflammation and augmenting the regulatory cell activation. Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, interferes with the immune system causing immune suppression during the first phase and over-activation in more advanced disease. We decided to explore the interaction of both in a real-world observational trial. Methods: We registered COVID-19 outcomes in patients with allergic disorders in Latin America, treated with and without AIT. The registry was conducted during the first 1.3 years of the pandemic, with most of the data collected before COVID-19 vaccination was concluded in most countries. Data collection was anonymous via a web-based instrument. Ten countries participated. Results: 630/1095 (57.6%) of the included patients received AIT. Compared to patients without AIT, those treated with AIT had a reduced risk ratio (RR) for COVID-19 lower respiratory symptoms (RR 0.78, 95% CI: 0.6703-0.9024; p = 0.001662) and need for oxygen therapy (RR 0.65, 95% CI: 0.4217-0.9992; p = 0.048). In adherent patients on maintenance sublingual immunotherapy/subcutaneous immunotherapy (SLIT/SCIT) the RR reduction was larger [RR = 0.6136 (95% CI 0.4623-0.8143; p < 0.001) and RR: 0.3495 (95% CI 0.1822-0.6701; p < 0.005), respectively]. SLIT was slightly more effective (NS). We excluded age, comorbidities, level of health care attendance, and type of allergic disorder as confounders, although asthma was related to a higher frequency of severe disease. When analyzing patients with allergic asthma (n = 503) the RR reduction favoring AIT was more pronounced with 30% for lower respiratory symptoms or worse (RR 0.6914, 95% CI 0.5264 to 0.9081, p = 0.0087) and 51% for need of oxygen therapy or worse (RR 0.4868, 95% CI 0.2829-0.8376, p = 0.0082). Among severe allergic patients treated with biologics (n = 24) only 2/24 needed oxygen therapy. There were no critical cases among them. Conclusion: In our registry AIT was associated with reduced COVID-19 severity.

Identification of critical effect factors for prediction of spatial and intra-annual variability of shallow groundwater nitrate in agricultural areas.

Shallow groundwater nitrate nitrogen (NO3--N) concentrations in agricultural areas usually show high spatial and intra-annual variability. It is hard to predict such concentrations due to the complexity of influencing factors (e.g., different forms of N in soil, vadose zone characteristics, and groundwater physiochemical conditions). Here, a large number of groundwater and soil samples were collected monthly over two years at 14 sites to analyze the soil and groundwater physiochemical properties and the stable isotopes of δ15N and δ18O of groundwater NO3--N in agricultural areas. Based on field observations, a random forest (RF) model was used to predict the groundwater NO3--N concentrations and reveal the importance of effect factors. The results show that there are large spatiotemporal variations in NO3--N, δ15N-NO3-, and δ18O-NO3- in groundwater. NO3--N is the major dominant specie of inorganic N in groundwater, and the groundwater NO3--N concentration in 24 % of the samples failed to meet the drinking water standard of the WHO (10 mg L-1). The RF model satisfactorily predicted groundwater NO3--N concentrations with R2 of 0.90-0.94, RMSE of 4.54-5.07, and MAE of 2.17-3.38. Groundwater nitrite and ammonium are the most important factors related to NO3--N consumption and production, respectively, in groundwater. Denitrification and nitrification were further identified by the relationships among δ15N-NO3-, δ18O-NO3-, and NO3--N, and by the ranges of δ15N-NO3-, δ18O-NO3-, temperature, pH, DO, and ORP in groundwater. Soil-soluble organic nitrogen (S-SON) and the depth of groundwater table were identified as vital factors related to N sourcing and leaching. Overall, as a first approach to adopting a RF model for high spatiotemporal-resolution prediction of groundwater NO3--N variations, the findings of this study enable a better understanding of groundwater N pollution in agricultural areas. Optimizing management of irrigation and N inputs is anticipated to reduce S-SON accumulation and mitigate the threat to groundwater quality in agricultural areas.

Experiences of first year undergraduate nursing students using Instagram in their clinical practicum during COVID-19 pandemic: A qualitative study.

BACKGROUND: Social media provides us with easy access to information. For students, it is an additional learning resource used in different types of theoretical and practical teaching methodologies. OBJECTIVES: The aim of this paper was to describe the perspective of undergraduate nursing students on the use of Instagram during their clinical practicums in the midst of the COVID-19 pandemic. DESIGN: A qualitative descriptive and exploratory study based on an interpretative framework. SETTINGS AND PARTICIPANTS: First-year undergraduate nursing students at the Universidad Europea de Madrid were included. METHODS: In-depth interviews and researchers' field notes were used to collect the data. Purposive sampling and inductive thematic analysis were applied. During the interviews, themes such as accompaniment during practicums or training opportunities were identified. RESULTS: The use of Instagram helped students to feel closer to professors, identifying it as an opportunity to remedy the possible lack of connection between theory and practice. Moreover, Instagram helped them build an image of nursing in clinical practicum environments. By using Instagram, undergraduate nursing students were able to better integrate and apply the knowledge acquired at university during their clinical practicums in hospitals. CONCLUSIONS: Our results can be applied to future studies on the use of social media platforms as teaching tools in clinical practicum settings and to observe the evolution of the image and role of nursing and its relationship with social media.

Internal Sulphate Attack in Masonry Mortars with Thaumasite Formation.

The present paper focuses on the study of mortar samples where expansions with thaumasite formation occur as a consequence of sulphate attack. The samples correspond to a masonry mortar used in a rural construction located in the Spanish province of Toledo made of cement with limestone filler addition CEM II/AL. Composition and microstructure of the mortars have been analysed by means of scanning electron microscopy (SEM) using secondary and backscattered electrons (BSE) and X-ray diffraction (XRD). The results show that aggregates are contaminated with gypsum, which is the source of the sulphates for the internal attack. It seems that thaumasite is formed through an ettringite transformation where aluminium atoms are replaced with silicon atoms by means of a solid solution. The study highlights that thaumasite can be formed in warm weather through an internal sulphate attack due to gypsum contamination of aggregates.

Under-graduate nursing students working during the first outbreak of the COVID-19 pandemic: A qualitative study of psychosocial effects and coping strategies.

BACKGROUND: The first wave of the COVID-19 pandemic caused a shortage of health care staff, forcing the hiring of senior nursing students. AIMS: To describe the psychosocial impact and coping strategies used by nursing students during the first outbreak of the COVID-19 pandemic and to understand the coping strategies they employed. METHOD: A qualitative exploratory study was conducted, based on Sandelowski's proposal. Purposive sampling was carried out to recruit 18 students hired during the pandemic. The students were interviewed between 18 March and 15 June 2020. Semi-structured interviews were conducted using a digital platform. An inductive thematic analysis was performed. FINDINGS: The students lived alone and isolated during their contract to protect their cohabitants from possible contagion. The impact of working during the pandemic leads to experiences of stress, insomnia, nightmares and anxiety. Nursing students coped with the emotional burden through mental disconnection and the support of co-workers and family members. CONCLUSION: Psychological support and tutoring should be provided by health centres. In addition, in these special circumstances, universities should adapt the training provided.

Enantioselective Synthesis and Pharmacological Evaluation of Aza-CGP37157-Lipoic Acid Hybrids for the Treatment of Alzheimer's Disease.

Hybrids based on an aza-analogue of CGP37157, a mitochondrial Na+/Ca2+ exchanger antagonist, and lipoic acid were obtained in order to combine in a single molecule the antioxidant and NRF2 induction properties of lipoic acid and the neuroprotective activity of CGP37157. The four possible enantiomers of the hybrid structure were synthesized by using as the key step a fully diastereoselective reduction induced by Ellman's chiral auxiliary. After computational druggability studies that predicted good ADME profiles and blood-brain permeation for all compounds, the DPPH assay showed moderate oxidant scavenger capacity. Following a cytotoxicity evaluation that proved the compounds to be non-neurotoxic at the concentrations tested, they were assayed for NRF2 induction capacity and for anti-inflammatory properties and measured by their ability to inhibit nitrite production in the lipopolysaccharide-stimulated BV2 microglial cell model. Moreover, the compounds were studied for their neuroprotective effect in a model of oxidative stress achieved by treatment of SH-SY5Y neuroblastoma cells with the rotenone-oligomycin combination and also in a model of hyperphosphorylation induced by treatment with okadaic acid. The stereocenter configuration showed a critical influence in NRF2 induction properties, and also in the neuroprotection against oxidative stress experiment, leading to the identification of the compound with S and R configuration as an interesting hit with a good neuroprotective profile against oxidative stress and hyperphosphorylation, together with a relevant anti-neuroinflammatory activity. This interesting multitarget profile will be further characterized in future work.

Ethical challenges during the COVID-19 pandemic: Perspectives of nursing students.

BACKGROUND: The first wave of the COVID-19 pandemic caused a shortage of qualified nurses in Spain. As a result, the government authorized the hiring of senior students. OBJECTIVES: To explore the ethical dilemmas and ethical conflicts experienced by final-year nursing students who worked during the first outbreak of the COVID-19 pandemic in Spain. RESEARCH DESIGN: A qualitative exploratory study was conducted using purposive sampling. Semi-structured interviews were carried out using a question guide. Interviews took place via a private video chat room platform. A thematic, inductive analysis was performed of the information gathered. PARTICIPANTS AND RESEARCH CONTEXT: Eighteen nursing students were recruited from two universities of Madrid, aged between 18 and 65 years old, enrolled in the fourth year of nursing studies and who were hired under a relief contract for health professionals during the pandemic. ETHICAL CONSIDERATIONS: The present study was carried out in accordance with the Declaration of Helsinki, and the study was approved by the Local Ethics Committee of Universidad Rey Juan Carlos. RESULTS: Three specific themes emerged: (a) coping with patient triage, (b) difficulties in providing end-of-life care, and (c) coping with patient death. Nursing students participated in the process of patient selection for resource allocation and ICU bed occupancy. They were shown how to care for patients who were not admitted to the ICU, in their last moments and were faced with the difficulties of applying end-of-life care. Finally, the nursing students were confronted with the death of their patients, in overwhelming numbers and under adverse conditions. CONCLUSIONS: These findings can help shed light on the ethical dilemmas and ethical conflicts faced by novice nursing students, incorporated into the workforce during the COVID-19 pandemic. Moreover, it was described that students may normalize the death due to the exhaustion and overwhelmed routine.

Global carbon sequestration through continental chemical weathering in a climatic change context.

This study simulates carbon dioxide (CO2) sequestration in 300 major world river basins (about 70% of global surface area) through carbonates dissolution and silicate hydrolysis. For each river basin, the daily timescale impacts under the RCP 2.6 and RCP 8.5 climate scenarios were assessed relative to a historical baseline (1969-1999) using a cascade of models accounting for the hydrological evolution under climate change scenarios. Here we show that the global temporal evolution of the CO2 uptake presents a general increase in the annual amount of CO2 consumed from 0.247 ± 0.045 Pg C year-1 to 0.261 and 0.273 ± 0.054 Pg C year-1, respectively for RCP 2.6 and RCP 8.5. Despite showing a general increase in the global daily carbon sequestration, both climate scenarios show a decrease between June and August. Such projected changes have been mapped and evaluated against changes in hydrology, identifying hot spots and moments for the annual and seasonal periods.

Validity, reliability, and responsiveness of daily monitoring visual analog scales in MASK-air®.

BACKGROUND: MASK-air® is an app that supports allergic rhinitis patients in disease control. Users register daily allergy symptoms and their impact on activities using visual analog scales (VASs). We aimed to assess the concurrent validity, reliability, and responsiveness of these daily VASs. METHODS: Daily monitoring VAS data were assessed in MASK-air® users with allergic rhinitis. Concurrent validity was assessed by correlating daily VAS values with those of the EuroQol-5 Dimensions (EQ-5D) VAS, the Control of Allergic Rhinitis and Asthma Test (CARAT) score, and the Work Productivity and Activity Impairment Allergic Specific (WPAI-AS) Questionnaire (work and activity impairment scores). Intra-rater reliability was assessed in users providing multiple daily VASs within the same day. Test-retest reliability was tested in clinically stable users, as defined by the EQ-5D VAS, CARAT, or "VAS Work" (i.e., VAS assessing the impact of allergy on work). Responsiveness was determined in users with two consecutive measurements of EQ-5D-VAS or "VAS Work" indicating clinical change. RESULTS: A total of 17,780 MASK-air® users, with 317,176 VAS days, were assessed. Concurrent validity was moderate-high (Spearman correlation coefficient range: 0.437-0.716). Intra-rater reliability intraclass correlation coefficients (ICCs) ranged between 0.870 (VAS assessing global allergy symptoms) and 0.937 (VAS assessing allergy symptoms on sleep). Test-retest reliability ICCs ranged between 0.604 and 0.878-"VAS Work" and "VAS asthma" presented the highest ICCs. Moderate/large responsiveness effect sizes were observed-the sleep VAS was associated with lower responsiveness, while the global allergy symptoms VAS demonstrated higher responsiveness. CONCLUSION: In MASK-air®, daily monitoring VASs have high intra-rater reliability and moderate-high validity, reliability, and responsiveness, pointing to a reliable measure of symptom loads.

Use and Significance of Nursing Diagnosis in Hospital Emergencies: A Phenomenological Approach.

Background: Professional nursing organizations recommend the use of nursing diagnosis to enhance and facilitate the standardization of care and the development of a common language used by nursing practitioners. In the clinical reality of hospital emergency departments, however, its use is controversial. The objectives of the research are (a) to explore the use of nursing diagnosis in hospital emergency departments, and (b) to describe the meaning of nursing diagnosis for hospital emergency nurses. Methods: A qualitative phenomenological study was conducted. A purposeful sampling and snowball technique were used. Data were collected using in-depth interviews, researchers' field notes, and documental analysis. An inductive analysis based on Giorgi´s proposal was used to identify significant emerging themes from interviews and field notes. Seventeen participants with a mean age of 40 were recruited. Results: Three themes were identified. The results showed how the use of nursing diagnosis in hospital emergency departments depends on nurses to apply a working methodology in their practice, along with other dimensions such as the characteristics of emergency care, the type of health problems, and the complexity of care. Conclusions: The use of standardized language in emergency departments is complex due to the overcrowded nature of care in these settings.

Evolution of N-balance with qualitative expert evaluation approach.

Pollution of rivers by nitrate is a major issue. Many land use units are considered as net nitrate producers when the input dominates the uptake (e.g. agricultural areas), or in the opposite, net consumers (e.g. wetlands), but the role of their spatial organization and temporal dynamics together across the watershed is unclear. Here, we used a Nitrate-related Ecological Functions (NEF) concept, together with an expert-based analysis in a Geographical Information System, to investigate the role of two opposite landscape types in the nitrate regulation across the Garonne river watershed (France). At any point in a watershed, there is nitrate production (NP) and nitrate removal (NR). The nitrate net balance (NNB) between NP and NR functions can be neutral (NB, Neutral Balance) when nitrate fluxes balance over space and time. The first landscape type, called Actual, was obtained using a set of 7 actual environmental variables, as land cover types, soil organic matter content and wetlands presence. The second landscape type, called Natural, described a non-anthropized landscape, using the same layer types as the Actual landscape. Potentials in NP and NR for each class in each map layer were rated by a set of experts according to their scientific knowledge. NP, NR and by difference, NNB maps were obtained, overlaid and compared to provide an evaluation of the potential for each landscape. In both landscapes, NNB were largely balanced (Actual = 48% and Natural = 67%). In the Actual landscape, NNB were secondly dominated by an imbalance toward NP (43%) and in the Natural landscape secondly imbalanced toward NR (32%). We constructed 'maps of disagreement' between both landscapes to provide a spatially explicit assessment of NNB evolution caused by changing land cover. We found that 67% of the agricultural areas and 60% of the artificial areas of the watershed had been subjected to a loss of nitrate ecological functions from Natural to Actual landscapes. Some management practices able to modify these factors may improve ecological functions and diminish the NEF disagreement of the watershed.

The challenges of "learning on the go": A qualitative study of final-year Spanish nursing students incorporated to work during the first Covid-19 pandemic.

BACKGROUND: The first wave of the COVID-19 pandemic caused a shortage of qualified nurses in Spain. As a result, the government authorized the hiring of senior students. OBJECTIVES: To explore the perspectives of a group of final-year nursing students who were hired on the basis of a relief contract for health professionals during the first COVID-19 outbreak, regarding their learning process and their mixed role as students and novice nurses. DESIGN: A qualitative exploratory study was conducted. SETTINGS: The Nursing Department of the European University of Madrid, and the Red Cross College of Nursing. PARTICIPANTS: Eighteen nursing students were recruited, aged between 18 and 65 years old, enrolled in the fourth year of Nursing Studies and who were hired under a relief contract for health professionals during the pandemic. METHODS: Purposive sampling was used. Semi-structured, in-depth interviews were carried out using a question guide. Interviews were conducted in a private video chat room platform. Also, a thematic, inductive analysis was performed. This study was conducted according to the Consolidated Criteria for Reporting Qualitative Research and the Standards for Reporting Qualitative Research. RESULTS: Four specific themes emerged: a) The students' role during the relief contract; b) The learning process during the pandemic; c) Barriers to learning; and d) A unique learning opportunity. The students had an undefined mixed role, which hindered their skills and activities. Learning was self-directed, sometimes through trial and error, and through experiencing critical events. Time constraints and having to learn under pressure were experienced as difficulties for learning. Nevertheless, this was a unique professional learning opportunity. The students learned to be organized and effective, acknowledge their limitations, gain confidence, face their fears, and mature. CONCLUSIONS: These results can help inform nurse training programs and improve the organization and incorporation of nurses in health care facilities during the COVID-19 pandemic.

A pilot agreement study of a new classification system for Peri-implant femoral fractures.

BACKGROUND: Peri-implant fractures occur in association with an implant, used to treat a previous injury that is still attached to the bone. We recently published a proposal for a classification system for peri-implant femoral fractures [Videla-Cés, Injury,2019]. AIM: To assess the agreement of our classification system for peri-implant femoral fractures among a group of future users of said classification system. METHODS: A prospective, multicentre, international agreement pilot study was conducted among a group of independent traumatologists/orthopaedic surgeons (evaluators): senior (a minimum of 10 years' experience) and junior (in fourth or fifth training year). A set of 30 radiographs of peri-implant femoral fractures were selected (stratified into 3 levels of difficulty: low, medium and high). Each evaluator interpreted the radiographs on 2 different occasions separated by a period of one month and in a different order each time. The level of difficulty was masked from the evaluators and they had one week to classify the radiographs each time. Logistic regression and Cohen's kappa coefficient (κ) and its 95% confidence interval (95%CI) were used to assess the accuracy and agreement, both intra- and inter-evaluator. Between senior and junior surgeons was performed an exploratory analysis. RESULTS: 35 traumatologists/orthopaedic surgeons (17 senior and 18 junior) from 16 tertiary hospitals from 4 countries acted as evaluators. The accuracy, percentage of correct classifications (2 digits and 3 letters), in the first and second evaluation was: 56% (95%CI: 53-59%) and 55% (95%CI: 51-57%), respectively. (insert space) Negligible differences were found between junior and senior evaluators (first evaluation, OR: 1.46, 95%CI: 0.82-2.61, p-value: 0.199; second evaluation, OR: 1.06, 95%CI: 0.56-2.00, p-value: 0.860). (insert space) Both medium and low radiograph difficulty were associated with a lower probability of an incorrect classification compared with those of high difficulty (first evaluation, OR: 7.60, 95%CI: 5.24-11.05, p-value: <0.001; OR: 14.15, 95%CI: 9.12-21.96, p-value: <0.001, respectively; second evaluation, OR: 7.11, 95%CI: 4.88-10.38, p-value: <0.001, OR: 15.28, 95%CI: 9.77-23.89, p-value: <0.001). (insert space) The kappa for intra-observer agreement between the first and second evaluation was: 0.66, 95%CI: 0.63, 0.69. The kappa for inter-observer agreement considering all 30 radiographs was: 0.40, 95%CI: 0.40, 0.41 in the first evaluation and 0.39, 95%CI: 0.39, 0.40 in the second evaluation. CONCLUSION: The proposed classification for peri-implant femoral fractures may be useful and user-friendly. Future studies are needed to assess the how clinically useful this classification system may be (the third phase in the validation process).

Denitrification in wetlands: A review towards a quantification at global scale.

Research to understand the nitrogen cycle has been thriving. The production of reactive nitrogen by humans exceeds the removal capacity through denitrification of any natural ecosystem. The surplus of reactive nitrogen is also a significant pollutant that can shift biological diversity and distribution, promotes eutrophication in aquatic ecosystems, and affects human health. Denitrification is the microbial respiration in anoxic conditions and is the main process that removes definitively nitrates from the ecosystem by returning of reactive nitrogen (Nr) to the atmosphere as N2 and N2O emissions. This process occurs in the oceans, aquatic ecosystems and temporary flooded terrestrial ecosystems. Wetlands ecosystems are rich in organic matter and they have regular anoxic soil conditions ideal for denitrification to occur. In the current paper, we provide a meta-analysis that aims at exploring how research around global nitrogen, denitrification and wetlands had evolved in the last fifty years. Back in the time, wetland ecosystems were seen as non-exploitable elements of the landscape, and now they are being integrated as providers of ecosystem services. A significant improvement of molecular biology techniques and genetic extraction have made the denitrification process fully understood allowing constructed wetlands to be more efficient and popular. Yet, large uncertainties remain concerning the dynamic quantification of the global denitrification capacity of natural wetland ecosystems. The contribution of the current investigation is to provide a way forward for reducing these uncertainties by the integration of satellite-based Earth Observation (EO) technology with parsimonious physical based models.

Applications of a SWAT model to evaluate the contribution of the Tafna catchment (north-west Africa) to the nitrate load entering the Mediterranean Sea.

An elevated nitrogen concentration in water is one of the main problems affecting water quality in Mediterranean rivers. The objectives of this study were (1) to evaluate the contribution of the Tafna catchment to the nitrate load entering the Mediterranean Sea, (2) to quantify the impact of agriculture on the nitrate concentration in water bodies, (3) to evaluate nitrate loads entering groundwater, and (4) to quantify the role of reservoirs in nitrate retention. A SWAT model was applied during the period 2003 to 2011. The discharge calibration was based on a previous study by Zettam et al. (2017). NSE efficiencies ranged from 0.421 to 0.75, R2 ranged from 0.25 to 0.84, and PBIAS ranged from 3.68 to 39.42. The simulations of monthly nitrate loads were satisfactory in the upstream sampling stations, with NSE between 0.48 and 0.65 and R2 between 0.63 and 0.68. The PBIAS was satisfactory in all the sampling stations (- 36.30 to 10.42). In the downstream sampling stations, the calibration of the monthly nitrate loads was unsatisfactory (NSE ranged from - 0.26 to 0.21 and R2 ranged from 0.02 to 0.25). Fertilisation was the main N input in the catchment, while the main N output was plant uptake. The Tafna River carried an annual average of 37 to 85.5 t N year-1 into the Mediterranean Sea. The simulation also showed that reservoirs in the Tafna basin contain a large quantity of nitrates, i.e. 62% on average of the total amount of nitrates transported annually by the Tafna River.