As the global temperature continues to increase, the sea level continues to rise at a rapid rate that has never been seen before. This becomes an issue for many facets of life but one of the most impacted is the trans...As the global temperature continues to increase, the sea level continues to rise at a rapid rate that has never been seen before. This becomes an issue for many facets of life but one of the most impacted is the transportation infrastructure. Many people living in low elevation coastal areas can become trapped by flooding with no way in or out. With Delaware being a coastal state, this would affect a large portion of the population and will have detrimental effects over time if nothing is done to combat sea level rise. The issue with sea level rise in transportation is that once the roads become flooded, they become virtually unusable and detour routes would be needed. If all the roads in a coastal area were to be affected by sea level rise, the options for detours would become limited. This article looks at direct solutions to combat sea level rise and indirect solutions that would specifically help transportation infrastructure and evacuation routes in Delaware. There is not one solution that can fix every problem, so many solutions are laid out to see what is applicable to each affected area. Some solutions include defense structures that would be put close to the coast, raising the elevation of vulnerable roads throughout the state and including pumping stations to drain the water on the surface of the road. With an understanding of all these solutions around the world, the ultimate conclusion came in the form of a six-step plan that Delaware should take in order to best design against sea level rise in these coastal areas.展开更多
Background: Heart failure (HF) is a rising global health problem. Patients with HF tend to use several therapies obtained via different treatment routes to relieve their symptoms. It is rampant in sub-Saharan Africa (...Background: Heart failure (HF) is a rising global health problem. Patients with HF tend to use several therapies obtained via different treatment routes to relieve their symptoms. It is rampant in sub-Saharan Africa (SSA), leading to poor health-seeking behaviours and worsened HF health outcomes. We aimed to describe the different therapeutic routes of HF patients from the onset of their first symptom until treatment in a specialised cardiology centre to identify and rebuke harmful therapeutic routes. Materials and Methods: This was a cross-sectional study at the Yaoundé Central Hospital in Cameroon between December 2018 to July 2019. Patients were recruited by consecutive convenient sampling. Adult patients aged above 18 years with confirmed HF were included using the Framingham criteria. Variables relating to socio-demographic and clinical data and the health-seeking behaviours of HF patients were studied. Results: We included 132 patients with a mean age of 62.90 years (62.88% women). Very few patients (0.90%) followed an ideal route;60.71% of subjects had a pseudo-ideal route, 19.64% accessed a specialised facility directly, and 21.42% used an erratic route. At the arrival time in a cardiology unit, 49.24% and 35.61% of our subjects were in NYHA stage III and IV HF compared to 15.15% for stage II. None of them was in Stage I. Conclusion: Most heart failure patients in Cameroon have resorted to non-specialised care, which worsens their clinical presentation. There is an urgent need for health education of HF patients in our context.展开更多
Long-distance migratory birds travel more rapidly in spring than in autumn,as they face temporal breeding constraints.However,several species travel slower in spring owing to environmental influences,such as food avai...Long-distance migratory birds travel more rapidly in spring than in autumn,as they face temporal breeding constraints.However,several species travel slower in spring owing to environmental influences,such as food availability and wind conditions.GPS trackers were attached to 17 Whooper Swans(Cygnus cygnus) inhabiting northeastern Mongolia,to determine their migration routes and stopover sites in spring and autumn.Differences between spring and autumn migrations,migration-influencing parameters,and the effect of spring stopover site temperatures were analyzed.Six swans completed perfect tours between their wintering and breeding sites,and these data were used for analysis.Spring migration lasted 57 days,with 49.2 days spent at 3.7 stopover sites.Autumn migration lasted 21.5 days,with 17.5 days spent at 1.0 stopover sites.Thus,the swans traveled more rapidly in autumn than in spring.Migration distance,number of stopovers,migration speed,and straightness were important migration determinants in both spring and autumn.Migration distance,stopover duration,number of stopovers,daily travel speed,travel duration,and migration speed differed significantly between spring and autumn.During spring migration,the temperature at the current stopover sites and that at the future stopover sites displayed significant variations(t=1585.8,df=631.6,p <0.001).These findings are critical for the conservation and management of Whooper Swans and their key habitats in East Asian regions,and the data are anticipated to make a particularly significant contribution toward developing detailed management plans for the conservation of their key habitats.展开更多
BACKGROUND Incidence of cholangiocarcinoma(CCA)is rising,with overall prognosis remaining very poor.Reasons for the high mortality of CCA include its late presentation in most patients,when curative options are no lon...BACKGROUND Incidence of cholangiocarcinoma(CCA)is rising,with overall prognosis remaining very poor.Reasons for the high mortality of CCA include its late presentation in most patients,when curative options are no longer feasible,and poor response to systemic therapies for advanced disease.Late presentation presents a large barrier to improving outcomes and is often associated with diagnosis via mergency presentation(EP).Earlier diagnoses may be made by Two Week Wait(TWW)referrals through General practitioner(GP).We hypothesise that TWW referrals and EP routes to diagnosis differ across regions in England.AIM To investigate routes to diagnosis of CCA over time,regional variation and influencing factors.METHODS We linked patient records from the National Cancer Registration Dataset to Hospital Episode Statistics,Cancer Waiting Times and Cancer Screening Programme datasets to define routes to diagnosis and certain patient characteristics for patients diagnosed 2006-2017 in England.We used linear probability models to investigate geographic variation by assessing the proportions of patients diagnosed via TWW referral or EP across Cancer Alliances in England,adjusting for potential confounders.Correlation between the proportion of people diagnosed by TWW referral and EP was investigated with Spearman’s correlation coefficient.RESULTS Of 23632 patients diagnosed between 2006-2017 in England,the most common route to diagnosis was EP(49.6%).Non-TWW GP referrals accounted for 20.5%of diagnosis routes,13.8%were diagnosed by TWW referral,and the remainder 16.2%were diagnosed via an‘other’or Unknown route.The proportion diagnosed via a TWW referral doubled between 2006-2017 rising from 9.9%to 19.8%,conversely EP diagnosis route declined,falling from 51.3%to 46.0%.Statistically significant variation in both the TWW referral and EP proportions was found across Cancer Alliances.Age,presence of comorbidity and underlying liver disease were independently associated with both a lower proportion of patients diagnosed via TWW referral,and a higher proportion diagnosed by EP after adjusting for other potential confounders.CONCLUSION There is significant geographic and socio-demographic variation in routes to diagnosis of CCA in England.Knowledge sharing of best practice may improve diagnostic pathways and reduce unwarranted variation.展开更多
Road traffic conditions can have an important impact on the economic development of various regions.Under the background of rapid social and economic development,more and more expressway construction projects are init...Road traffic conditions can have an important impact on the economic development of various regions.Under the background of rapid social and economic development,more and more expressway construction projects are initiated in various regions,including both new expressways and expansion of old expressways,and interchange design plays an important role.Scientific and reasonable interchange design can not only realize energy saving and low carbon footprint,but also be people-oriented and promote regional economic development.Therefore,this paper mainly analyzes the highway route and its interchange design strategy for reference.展开更多
文摘As the global temperature continues to increase, the sea level continues to rise at a rapid rate that has never been seen before. This becomes an issue for many facets of life but one of the most impacted is the transportation infrastructure. Many people living in low elevation coastal areas can become trapped by flooding with no way in or out. With Delaware being a coastal state, this would affect a large portion of the population and will have detrimental effects over time if nothing is done to combat sea level rise. The issue with sea level rise in transportation is that once the roads become flooded, they become virtually unusable and detour routes would be needed. If all the roads in a coastal area were to be affected by sea level rise, the options for detours would become limited. This article looks at direct solutions to combat sea level rise and indirect solutions that would specifically help transportation infrastructure and evacuation routes in Delaware. There is not one solution that can fix every problem, so many solutions are laid out to see what is applicable to each affected area. Some solutions include defense structures that would be put close to the coast, raising the elevation of vulnerable roads throughout the state and including pumping stations to drain the water on the surface of the road. With an understanding of all these solutions around the world, the ultimate conclusion came in the form of a six-step plan that Delaware should take in order to best design against sea level rise in these coastal areas.
文摘Background: Heart failure (HF) is a rising global health problem. Patients with HF tend to use several therapies obtained via different treatment routes to relieve their symptoms. It is rampant in sub-Saharan Africa (SSA), leading to poor health-seeking behaviours and worsened HF health outcomes. We aimed to describe the different therapeutic routes of HF patients from the onset of their first symptom until treatment in a specialised cardiology centre to identify and rebuke harmful therapeutic routes. Materials and Methods: This was a cross-sectional study at the Yaoundé Central Hospital in Cameroon between December 2018 to July 2019. Patients were recruited by consecutive convenient sampling. Adult patients aged above 18 years with confirmed HF were included using the Framingham criteria. Variables relating to socio-demographic and clinical data and the health-seeking behaviours of HF patients were studied. Results: We included 132 patients with a mean age of 62.90 years (62.88% women). Very few patients (0.90%) followed an ideal route;60.71% of subjects had a pseudo-ideal route, 19.64% accessed a specialised facility directly, and 21.42% used an erratic route. At the arrival time in a cardiology unit, 49.24% and 35.61% of our subjects were in NYHA stage III and IV HF compared to 15.15% for stage II. None of them was in Stage I. Conclusion: Most heart failure patients in Cameroon have resorted to non-specialised care, which worsens their clinical presentation. There is an urgent need for health education of HF patients in our context.
基金the National Institute of Bio-logical Resources,funded by the Ministry of Environment,Republic of Korea(grant numbers NIBR202216101 and NIBR202223101).
文摘Long-distance migratory birds travel more rapidly in spring than in autumn,as they face temporal breeding constraints.However,several species travel slower in spring owing to environmental influences,such as food availability and wind conditions.GPS trackers were attached to 17 Whooper Swans(Cygnus cygnus) inhabiting northeastern Mongolia,to determine their migration routes and stopover sites in spring and autumn.Differences between spring and autumn migrations,migration-influencing parameters,and the effect of spring stopover site temperatures were analyzed.Six swans completed perfect tours between their wintering and breeding sites,and these data were used for analysis.Spring migration lasted 57 days,with 49.2 days spent at 3.7 stopover sites.Autumn migration lasted 21.5 days,with 17.5 days spent at 1.0 stopover sites.Thus,the swans traveled more rapidly in autumn than in spring.Migration distance,number of stopovers,migration speed,and straightness were important migration determinants in both spring and autumn.Migration distance,stopover duration,number of stopovers,daily travel speed,travel duration,and migration speed differed significantly between spring and autumn.During spring migration,the temperature at the current stopover sites and that at the future stopover sites displayed significant variations(t=1585.8,df=631.6,p <0.001).These findings are critical for the conservation and management of Whooper Swans and their key habitats in East Asian regions,and the data are anticipated to make a particularly significant contribution toward developing detailed management plans for the conservation of their key habitats.
文摘BACKGROUND Incidence of cholangiocarcinoma(CCA)is rising,with overall prognosis remaining very poor.Reasons for the high mortality of CCA include its late presentation in most patients,when curative options are no longer feasible,and poor response to systemic therapies for advanced disease.Late presentation presents a large barrier to improving outcomes and is often associated with diagnosis via mergency presentation(EP).Earlier diagnoses may be made by Two Week Wait(TWW)referrals through General practitioner(GP).We hypothesise that TWW referrals and EP routes to diagnosis differ across regions in England.AIM To investigate routes to diagnosis of CCA over time,regional variation and influencing factors.METHODS We linked patient records from the National Cancer Registration Dataset to Hospital Episode Statistics,Cancer Waiting Times and Cancer Screening Programme datasets to define routes to diagnosis and certain patient characteristics for patients diagnosed 2006-2017 in England.We used linear probability models to investigate geographic variation by assessing the proportions of patients diagnosed via TWW referral or EP across Cancer Alliances in England,adjusting for potential confounders.Correlation between the proportion of people diagnosed by TWW referral and EP was investigated with Spearman’s correlation coefficient.RESULTS Of 23632 patients diagnosed between 2006-2017 in England,the most common route to diagnosis was EP(49.6%).Non-TWW GP referrals accounted for 20.5%of diagnosis routes,13.8%were diagnosed by TWW referral,and the remainder 16.2%were diagnosed via an‘other’or Unknown route.The proportion diagnosed via a TWW referral doubled between 2006-2017 rising from 9.9%to 19.8%,conversely EP diagnosis route declined,falling from 51.3%to 46.0%.Statistically significant variation in both the TWW referral and EP proportions was found across Cancer Alliances.Age,presence of comorbidity and underlying liver disease were independently associated with both a lower proportion of patients diagnosed via TWW referral,and a higher proportion diagnosed by EP after adjusting for other potential confounders.CONCLUSION There is significant geographic and socio-demographic variation in routes to diagnosis of CCA in England.Knowledge sharing of best practice may improve diagnostic pathways and reduce unwarranted variation.
文摘Road traffic conditions can have an important impact on the economic development of various regions.Under the background of rapid social and economic development,more and more expressway construction projects are initiated in various regions,including both new expressways and expansion of old expressways,and interchange design plays an important role.Scientific and reasonable interchange design can not only realize energy saving and low carbon footprint,but also be people-oriented and promote regional economic development.Therefore,this paper mainly analyzes the highway route and its interchange design strategy for reference.
