Assessing the impact of three biosphere reserves on the conservation of coastal ecosystems.

Biosphere Reserves (BR) manage large territories with diverse natural covers and land uses to preserve biodiversity, promote local development and preserve ecosystems. This study evaluated how their zoning (buffer and core) and policy timeframes (decree period, management plan period, and land planning period) influence four landscape management outcomes: deforestation, natural cover recovery, and anthropic and natural permanence. For three Mexican BR case studies, land use and cover transitions were calculated and compared to contrafactual sites. Observed rates of land cover change were marginal within all three BR zoning and across their policy timeframe (<0.02 % change rate), suggesting that BR effectively promote the permanence of both natural and anthropic covers. Nevertheless, the predicted probability of uncommon deforestation and recovery outcomes at local levels showed that the effect of a BR over its regulated landscape is not spatiotemporally static, contrasting the effect of individual allocation vs a group or network. Poverty, land tenure, agriculture aptitude and distance to markets adds to this dynamic and is modelled and discussed. This study shows that BR zoning schemes and its regulatory sequence influence the rates of land cover change and the predicted probability of landscape management outcomes across space and time.

Methodology for a preliminary assessment of water use sustainability in industries at sub-basin level.

The sustainability of industrial production, especially for highly water-demanding processes, is strictly related to water resource availability and to the dynamic interactions between natural and anthropogenic requirements over the spatial and temporal scales. The increase in industrial water demand raises the need to assess the related environmental sustainability, facing the occurrence of global and local water stress issues. The identification of reliable methodologies, based on simple indices and able to consider the impact on local water basins, may play a basilar role in water sustainability diagnosis and decision-making processes for water management and land use planning. The present work focalized on the definition of a methodology based on the calculation of indicators and indices in the view of providing a synthetic, simple, and site-specific assessment tool for industrial water cycle sustainability. The methodology was built starting from geo-referenced data on water availability and sectorial uses derived for Italian sub-basins. According to the data monthly time scale, the proposed indices allowed for an industrial water-related impacts assessment, able to take into account the seasonal variability of local resources. Three industrial factories, located in northern (SB1, SB2) and central (SB3) Italian sub-basins, were selected as case studies (CS1, CS2, CS3) to validate the methodology. The companies were directly involved and asked to provide some input data. The methodology is based on the calculation of three synthetic indexes: the Withdrawal and Consumption water Stress Index (WCSI) allowed for deriving a synthetic water stress level assessment at the sub-basin scale, also considering the spatial and temporal variations; the industrial water use sustainability assessment was achieved by calculating the Overall Factory-to-Basin Impact (OFBI) and the Internal Water Reuse (IWR) indices, which allowed a preliminary evaluation of the factories' impacts on the sub-basin water status, considering the related water uses and the overall pressures on the reference territorial context. The WCSI values highlighted significant differences between the northern sub-basins, characterised by limited water stress (WCSISB1 = 0.221; WCSISB2 = 0.047), and the central ones, more subjected to high stress (WCSISB3 = 0.413). The case studies CS1 and CS3 showed to exert a more significant impact on the local water resource (OFBICS1 = 0.18%; OFBICS2 = 0.192%) with respect to CS2 (OFBI = 0.002%), whereas the IWR index revealed the different company's attitude in implementing water reuse practices (IWRCS1 = 40%; IWRCS1 = 27%; IWRCS1 = 99%). The proposed methodology and the indices may also contribute to assessing the effectiveness of river basin management actions to pursue sustainable development goals.

Understanding health service quality in emergency department through the length of stay and its determinants.

Objectives: To identify and analyse the determinants of emergency department length of stay. METHODS: The cross-sectional study was conducted from December 20 to 31, 2017, at the Centre of Referral Hospital after approval from the ethics review committee of Dr Soetomo General Hospital, Surabaya, Indonesia, and comprised patients of either gender aged 18 years or above who visited the emergency department who required follow-up after triage, such as diagnostics or hospitalisation. Emergency department length of stay, assessment time, review and consultation, and disposition or decision were the variables noted. Data was analysed using SPSS 18. RESULTS: Of the 172 patients, 95(57%) were men and 74(43%) were women. The largest age group was of those aged 45-59 years 61(34.4%). There were 48(27%) cases of surgery and 124(73%) of medicine. Mean emergency department length of stay was 575.94±306.402 minutes (range: 100-2215 minutes), and it was significantly associated with assessment time (p=0.001), review and consultation time (p=0.001) and disposition or decision time (p=0.002). CONCLUSIONS: The emergency department length of stay was found to be rather prolonged and needed to be improved.

Temporal Dynamics of Functional Brain States Underlie Cognitive Performance.

The functional organization of the human brain adapts dynamically in response to a rapidly changing environment. However, the relation of these rapid changes in functional organization to cognitive functioning is not well understood. This study used a graph-based time-frame modularity analysis approach to identify temporally recurrent functional configuration patterns in neural responses to an n-back working memory task during fMRI. Working memory load was manipulated to investigate the functional relevance of the identified brain states. Four distinct brain states were defined by the predominant patterns of activation in the task-positive, default-mode, sensorimotor, and visual networks. Associated with escalating working memory load, the occurrence of the task-positive state and the probability of transitioning into this state increased. In contrast, the occurrence of the default-mode and sensorimotor states and the probability of these 2 states transitioning away from the task-positive state decreased. The task-positive state occurrence rate and the probability of transitioning from the default-mode state back to the task-positive state explained a significant and unique portion of the variance in task performance. The results demonstrate that dynamic brain activities support successful cognitive functioning and may have heuristic value for understanding abnormal cognitive functioning associated with multiple neuropsychiatric disorders.

An Operational Definition of End-of-Life Healthcare: A Complex and Subjective Construct.

Comprehensively defining end-of-life healthcare is a challenge due to the diverse areas of healthcare involved, the various stakeholders, and the range of patient options. This qualitative study examined many areas of end-of-life healthcare including quality, areas for improvement, and healthcare policy in Tennessee, in which the definition of end-of-life healthcare was a focus. Data were collected using semi-structured interviews with 19 participants who included end-of-life healthcare experts and Tennessee legislators. Through this research an operational definition of end-of-life healthcare, encompassing five concepts, was developed. Concepts include: a diagnosis, a timeframe, type of care, location of care, and planning for the future. When considered together, they are the embodiment of what end-of-life healthcare encompasses. Not in a one-fits-all definition, but individually tailored. An understanding of what end-of-life healthcare denotes is essential to maintaining open communication, high quality standards of care, and the protection of patient autonomy.

The Limitations of Using the Pittsburgh Sleep Quality Index to Assess Athletes' Sleep Quality: Evidence from Reliability and Validity in Chinese Professional Athletes.

Purpose: This study aimed to assess the structural validity of the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) among Chinese professional athletes and examine its test-retest reliability and convergent validity across different timeframes. Methods: 581 Chinese professional athletes participated. Exploratory and confirmatory factor analyses were conducted on the Chinese version of the PSQI. Test-retest reliability was assessed over 2 weeks, 1 week, and 2-3 days within a 1-month timeframe. Additional reliability analysis over a 2-day interval was conducted within a 1-week timeframe. Convergent validity was assessed using Chinese versions of the Insomnia Severity Index (ISI), the Athlete Sleep Screening Questionnaire (ASSQ), and actigraphy. A 1-month tracking was conducted, with weekly completion of the PSQI using a one-week timeframe, supplemented by assessments in the second and fourth week using two-week and one-month timeframes. Relationships between weekly results and those over two weeks and one month examined, along with convergent validity, using sleep diary and actigraphy. Results: The PSQI exhibited a two-factor structure (sleep quality and sleep efficiency), with good model fit (CFI = 0.960, AGFI = 0.924, TLI = 0.925, RMSEA = 0.085). Test-retest reliability was satisfactory for intervals of one week or more (r = 0.721 ~ 0.753). Using a one-week timeframe, the total score and two dimensions exhibited good reliability (r = 0.769 ~ 0.881), but only the total score and sleep quality showed high correlations with ISI and ASSQ (r = 0.701 ~ 0.839). Throughout the tracking, monthly responses correlated well with the most recent weeks (r = 0.732 ~ 0.866). Conclusion: The PSQI demonstrates a two-factor structure in Chinese athletes, with sleep quality being predominant. Test-retest reliability within a one-month timeframe is unstable, suggesting a one-week timeframe performs better. Distinguishing between the two dimensions, employing shorter timeframes, and incorporating objective measures are recommended.

Assessment of compliance with a color code protocol for non-elective cesarean section and its impact on time to delivery interval and neonatal outcomes.

INTRODUCTION: We set out to assess the compliance with a cesarean section color code protocol and its impact on maternal and neonatal outcomes since its implementation in our maternity ward. METHODS: This was a retrospective study including a sample of 200 patients per year who underwent a non-elective cesarean section delivery in Rennes University Hospital from January 1, 2015 to December 31, 2018. Patients were grouped by year and by color code (red, orange or green). The main outcome was compliance with the protocol (color code in accordance with indication for cesarean section) and compliance with the corresponding decision-delivery interval. Secondary outcomes were maternal and neonatal outcomes. RESULTS: Eight hundred patients were included during the study period. There was no significant difference in patient characteristics over the years. There was a significant improvement in protocol compliance: full compliance increased from 22.4% in 2015 to 76.5% in 2018 (p < 0.0001). The respect of the 15 min decision-delivery interval in red code protocol increased between 2015 and 2018 (p = 0.0020). CONCLUSION: We observed a significant improvement in compliance with the color code protocol between 2015 and 2018 and in the 15 min decision-delivery deadline for the red code.

Health care-associated infections studies project: An American journal of infection control and national healthcare safety network data quality collaboration case study - Chapter 2 Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance case study vignettes.

This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) surveillance definitions. This specific case study focuses on the application of three of the surveillance concepts included in the Patient Safety Component, Chapter 2 - Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance. The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions and encourage accurate HAI event determination among Infection Preventionists (IPs).

Immobilization and Hand Therapy After Carpometacarpal Arthroplasty: A Systematic Review.

Purpose: We provide a systematic review of the current literature regarding best practices in postoperative care following carpometacarpal arthroplasty, and compare these findings to current practices via reported survey data. Methods: The PubMed, Cochrane, Cumulative Index to Nursing and Allied Health Literature, Science Direct, and Google Scholar databases were searched for relevant studies. English-language articles were included that assessed any aspect of postoperative care, including the immobilization time or rehabilitation strategy. In addition, studies were included that surveyed surgeons and hand therapists on current practices regarding this topic. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. Results: The initial search yielded 3,899 hits. Two systematic reviews were found, along with 5 studies that specifically tested the desired variables of the immobilization duration and type following carpometacarpal arthroplasty. Three relevant surveys were also found. Using the Oxford Centre for Evidence-Based Medicine Level of Evidence guidelines, we found moderate-quality evidence that (1) there is no additional benefit for extended cast immobilization (>6 weeks); and (2) a semirigid orthosis performs as well as a rigid orthosis. We found a lack of evidence regarding formal therapy versus no therapy, and a lack of evidence comparing therapy regimens. When analyzing the survey data, we found wide variation in practices among surgeons and therapists. Conclusions: Longer immobilization times (>6 weeks) and rigid orthotic devices provide no additional benefit over earlier immobilization and semirigid orthotic devices. There is a lack of evidence for the use of formal hand therapy or any specific rehabilitation protocol. Current practices in these areas vary widely among hand surgeons. Clinical relevance: Practices following carpometacarpal arthroplasty are widely variable, and guidance has previously been lacking. This review compiles the most recent data, as well as identifies gaps in the literature for future studies.