ABSTRACT
Nature's contributions to people (NCP) encompass both the beneficial and detrimental effects of living nature on human quality of life, including regulatory, material, and non-material contributions. Globally, vital NCPs have been deteriorating, accelerated by changes in both natural and anthropogenic drivers over recent decades. Despite the often inevitable trade-offs between NCPs due to their spatially and temporally uneven distributions, few studies have quantitatively assessed the impacts of different drivers on the spatial and temporal changes in multiple NCPs and their interrelationships. Here we evaluate the effects of precipitation, temperature, population, gross domestic product, vegetation restoration, and urban expansion on four key regulatory NCPs-habitat maintenance, climate regulation, water quantity regulation, and soil protection-in Nei Mongol at the county level. We observe increasing trends in climate regulation and soil protection from 2000 to 2019, contrasted with declining trends in habitat maintenance and water quantity regulation. We have identified the dominant positive and negative drivers influencing each NCP across individual counties, finding that natural drivers predominantly overpowered anthropogenic drivers. Furthermore, we discover significant spatial disparities in the trade-off or synergy relationships between NCPs across the counties. Our findings illustrate how the impacts of various drivers on NCPs and their interrelationships can be quantitatively evaluated, offering significant potential for application in various spatial scales. With an understanding of trade-offs and scale effects, these insights are expected to support and inform policymaking at both county and provincial levels.
ABSTRACT
Ecosystem services (ES) are the direct and indirect benefits people obtain from ecosystems, serving as a bridge linking ecological systems and social-economic systems. The quantitative assessment of the dynamic changes in ES and their relationships and the identification of the driving forces behind them have recently become a research hotspot. However, several research gaps remain challenging, such as the lack of an analytical framework for selecting relevant driving factors and the need for an innovative approach that integrally estimates the impacts of driving factors on the changes in ES and the relationships between ES. In this study, we modify the social-ecological system framework as the analytical basis and suggest a series of principles for selecting relevant driving factors, we then adopt the path analysis model to simultaneously and consistently quantify the contributions of driving factors to ES changes and their relationships. Using the West Liao River Basin (WLRB) as a case study, the results show the spatial-temporal variations in three ES and six driving factors from 2000 to 2020, divided into four periods. The estimation of path analysis model confirm two hypotheses that different driving factors exerted differential effects on changes in multiple ES in four periods for the whole WLRB and in three sub-basins for the period 2015-2020. In addition, the path analysis exhibits the quantitative relationships between food production, water yield, and soil conservation, which vary temporally and spatially in different periods and different sub-basins. The identification of driving factors is helpful for supporting policy-making to construct a coupled self-adjusted social-ecological for the benefit of the public.
ABSTRACT
Physicians in education often have poor experience in practice and assessment of ultrasonography on entering their profession, due to a deficiency of training offers during their study of medicine. Hence, a multimedia device for stepwise learning and training ultrasonography of the thyroid was developed. A software for a portable ultrasonography system was used to design a multimedia device for ultrasonography of the thyroid. It allows the user to illustrate texts and pictorial material simultaneously with ultrasound examination in order to compare own findings with examples from a database. The device was evaluated by 8 medical students and compared to a tutor-guided training. A structured, stepwise manual for ultrasonography of the thyroid with a large content of examples in different sectional images was designed for simultaneous reconstruction with the ultrasonography device. The informative content of the device and the replicability of the examination procedure were evaluated positively. Assessment respecting clarity, eligibility for users without experience and learning success was varying. The tutorial to learn and train ultrasonography of the thyroid is an instrument for self-learning and improving practical education in ultrasonography in medical education. In the next version, the manual for the examination will be structured in greater detail.
Subject(s)
Education, Medical/methods , Multimedia , Thyroid Diseases/diagnostic imaging , Thyroid Gland/diagnostic imaging , Ultrasonography , Curriculum , Germany , Humans , Software , Ultrasonography/instrumentationABSTRACT
Changes in performance parameters over four consecutive maximal incremental cycling tests were investigated to determine how many tests can be performed within one single day without negatively affecting performance. Sixteen male and female subjects (eight trained (T): 25 ± 3 yr, BMI 22.6 ± 2.5 kg·m(-2), maximal power output (P(max)) 4.6 ± 0.5 W·kg(-1); eight untrained (UT): 27 ± 3 yr, BMI 22.3 ± 1.2 kg·m(-2), P(max) 2.9 ± 0.3 W·kg(-1)) performed four successive maximal incremental cycling tests separated by 1.5 h of passive rest. Individual energy requirements were covered by standardised meals between trials. Maximal oxygen uptake (VO(2max)) remained unchanged over the four tests in both groups (P = 0.20 and P = 0.33, respectively). P(max) did not change in the T group (P = 0.32), but decreased from the third test in the UT group (P < 0.01). Heart rate responses to submaximal exercise were elevated from the third test in the T group and from the second test in the UT group (P < 0.05). The increase in blood lactate shifted rightward over the four tests in both groups (P < 0.001 and P < 0.01, respectively). Exercise-induced net increases in epinephrine and norepinephrine were not different between the tests in either group (P ≥ 0.15). If VO(2max) is the main parameter of interest, trained and untrained individuals can perform at least four maximal incremental cycling tests per day. However, because other parameters changed after the first and second test, respectively, no more than one test per day should be performed if parameters other than VO(2max) are the prime focus.
Subject(s)
Athletic Performance/physiology , Exercise Test , Exercise/physiology , Heart Rate , Lactic Acid/blood , Oxygen Consumption , Physical Endurance/physiology , Adult , Bicycling/physiology , Female , Humans , Male , Physical Exertion/physiology , Young AdultABSTRACT
El reemplazo valvular aórtico por estenosis es notoriamente alto, hasta un 30% en poblaciones estudiadas, lo cual implica en determinados grupos un riesgo quirúrgico elevado. En este artículo se describe la implantación transapical de la válvula, un procedimiento miniinvasivo y en principio sin circulación extracorpórea. Se indica preferentemente en pacientes ancianos con alto riesgo operatorio, en aquellos con aortas gravemente calcificadas y en otros con revascularizaciones coronarias previas. El estudio de la geometría aórtica es esencial: la ecocardiografía transesofágica da la mejor medida del diámetro de la raíz aórtica y la tomografía computarizada determina exactamente el diámetro del anillo y tiene la posibilidad agregada de medir la distancia desde el anillo a los ostia coronarios. Se debe contar con la posibilidad de circulación extracorpórea en carácter de stand-by. Por una pequeña toracotomía anterolateral se accede a la punta del corazón donde se cateteriza el ventrículo hacia la posición aórtica con control radioscópico. La valvuloplastia, la inserción de la vaina transapical y el posicionamiento de la prótesis son las maniobras siguientes. El posicionamiento de la válvula constituye el paso más crítico, pero con esta técnica es más eficaz. En los últimos casos, mediante el software denominado DYNA CT, se han logrado mejores perspectivas en un punto crucial para el desarrollo definitivo. Desde febrero de 2006 hasta diciembre 2008 se implantaron 192 válvulas por vía transapical en pacientes con una edad media de 82,5 ± 5,7 años. La mortalidad a los 30 días fue del 8,9% y en el seguimiento alejado a 256 ± 213 días fue del 12,8%. Esta técnica debe ser realizada en un quirófano híbrido por un equipo especializado y debidamente entrenado de cirujanos, cardiólogos y anestesistas para obtener resultados óptimos.
Almost 30% of aortic valve replacements are due to aortic stenosis; therefore, certain groups of patients present high operative risk. This article describes transapical aortic valve implantation, a minimally invasive off-pump procedure. This technique represents a new alternative for patients with advanced age and increased operative risk, severe calcifications of the aorta, or previous coronary revascularization. Delineation of the aortic root geometry is essential. Transesophageal echocardiography is the most reliable tool to measure the diameter of the aortic root. Computerized tomography is another method of determining the width of the aortic annulus and it has the added ability of measuring the distance from the aortic annulus to the coronary ostia. Cardiopulmonary bypass should be available as a stand-by during all the procedure, which consists of an anterolateral mini-thoracotomy for direct antegrade surgical access through the apex of the left ventricle; then a catheter is inserted and placed in the aortic position under fluoroscopic guidance. Balloon valvuloplasty is performed thereafter, followed by transapical sheath insertion and prosthetic valve positioning. Exact valve positioning is the most critical step. The use of DYNA CT imaging software has improved the perspectives for the definite development of this technique. From February 2006 to December 2008, 192 aortic valves have been implanted transapically; mean age of patients was 82.5±5.7 years. Mortality 30 days after the procedure was 8.9% and 12.8% at long-term follow-up (256±213 days). Implantations are optimally performed in a hybrid operating room by an experienced team of cardiac surgeons, cardiologists, and anesthetists.
