Diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients:A mini review for clinicians

Among critically ill patients,severe pulmonary and extrapulmonary tuberculosis has high morbidity and mortality.Yet,it is a diagnostic challenge given its nonspecific clinical symptoms and signs in early stages of the disease.In addition,management of severe pulmonary and extrapulmonary tuberculosis is complicated given the high risk of drug-drug interactions,drug-disease interactions,and adverse drug reactions.To help clinicians acquire an up-to-date approach to severe tuberculosis,this paper will provide a narrative review of contemporary diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients.

Impact of interleukin 6 levels on acute lung injury risk and disease severity in critically ill sepsis patients

BACKGROUND Sepsis is a life-threatening condition characterized by a dysregulation of the host response to infection that can lead to acute lung injury(ALI)and multiple organ dysfunction syndrome(MODS).Interleukin 6(IL-6)is a pro-inflammatory cytokine that plays a crucial role in the pathogenesis of sepsis and its complications.AIM To investigate the relationship among plasma IL-6 levels,risk of ALI,and disease severity in critically ill patients with sepsis.METHODS This prospective and observational study was conducted in the intensive care unit of a tertiary care hospital between January 2021 and December 2022.A total of 83 septic patients were enrolled.Plasma IL-6 levels were measured upon admission using an enzyme-linked immunosorbent assay.The development of ALI and MODS was monitored during hospitalization.Disease severity was evaluated by Acute Physiology and Chronic Health Evaluation II(APACHE II)and Sequential Organ Failure Assessment(SOFA)scores.RESULTS Among the 83 patients with sepsis,38(45.8%)developed ALI and 29(34.9%)developed MODS.Plasma IL-6 levels were significantly higher in patients who developed ALI than in those without ALI(median:125.6 pg/mL vs 48.3 pg/mL;P<0.001).Similarly,patients with MODS had higher IL-6 levels than those without MODS(median:142.9 pg/mL vs 58.7 pg/mL;P<0.001).Plasma IL-6 levels were strongly and positively correlated with APACHE II(r=0.72;P<0.001)and SOFA scores(r=0.68;P<0.001).CONCLUSIONElevated plasma IL-6 levels in critically ill patients with sepsis were associated with an increased risk of ALI andMODS.Higher IL-6 levels were correlated with greater disease severity,as reflected by higher APACHE II andSOFA scores.These findings suggest that IL-6 may serve as a biomarker for predicting the development of ALI anddisease severity in patients with sepsis.

面向Critical MTC的无连接传输

关键机器类通信(Critical MTC)对时延和可靠性都有极高的要求。支持海量Critical MTC的终端是一个巨大挑战。提出了一种面向海量Critical MTC终端的无连接传输方案。为了降低时延,提出了基于竞争的无连接单次传输方案;为了实现高可靠性,设计了具有极低导频碰撞概率的稀疏正交多导频。进一步利用大规模多输入多输出(MIMO)的增益来提高可靠性以及在空域复用大量用户。仿真结果表明,提出的方案可以支持海量Critical MTC终端,同时满足低时延和高可靠的严格要求。

Mental health status among COVID-19 patients survivors of critical illness in Saudi Arabia:A 6-month follow-up questionnaire study

BACKGROUND Psychological assessment after intensive care unit(ICU)discharge is increasingly used to assess patients'cognitive and psychological well-being.However,few studies have examined those who recovered from coronavirus disease 2019(COVID-19).There is a paucity of data from the Middle East assessing the post-ICU discharge mental health status of patients who had COVID-19.AIM To evaluate anxiety and depression among patients who had severe COVID-19.METHODS This is a prospective single-center follow-up questionnaire-based study of adults who were admitted to the ICU or under ICU consultation for>24 h for COVID-19.Eligible patients were contacted via telephone.The patient’s anxiety and depression six months after ICU discharge were assessed using the Hospital Anxiety and Depression Scale(HADS).The primary outcome was the mean HADS score.The secondary outcomes were risk factors of anxiety and/or depression.RESULTS Patients who were admitted to the ICU because of COVID-19 were screened(n=518).Of these,48 completed the questionnaires.The mean age was 56.3±17.2 years.Thirty patients(62.5%)were male.The main comorbidities were endocrine(n=24,50%)and cardiovascular(n=21,43.8%)diseases.The mean overall HADS score for anxiety and depression at 6 months post-ICU discharge was 11.4(SD±8.5).A HADS score of>7 for anxiety and depression was detected in 15 patients(30%)and 18 patients(36%),respectively.Results from the multivariable ordered logistic regression demonstrated that vasopressor use was associated with the development of anxiety and depression[odds ratio(OR)39.06,95% confidence interval:1.309-1165.8;P<0.05].CONCLUSION Six months after ICU discharge,30% of patients who had COVID-19 demonstrated a HADS score that confirmed anxiety and depression.To compare the psychological status of patients following an ICU admission(with vs without COVID-19),further studies are warranted.

Semi-analytical solution for drained expansion analysis of a hollow cylinder of critical state soils

The expansion of a thick-walled hollow cylinder in soil is of non-self-similar nature that the stress/deformation paths are not the same for different soil material points.As a result,this problem cannot be solved by the common self-similar-based similarity techniques.This paper proposes a novel,exact solution for rigorous drained expansion analysis of a hollow cylinder of critical state soils.Considering stress-dependent elastic moduli of soils,new analytical stress and displacement solutions for the nonself-similar problem are developed taking the small strain assumption in the elastic zone.In the plastic zone,the cavity expansion response is formulated into a set of first-order partial differential equations(PDEs)with the combination use of Eulerian and Lagrangian descriptions,and a novel solution algorithm is developed to efficiently solve this complex boundary value problem.The solution is presented in a general form and thus can be useful for a wide range of soils.With the new solution,the non-self-similar nature induced by the finite outer boundary is clearly demonstrated and highlighted,which is found to be greatly different to the behaviour of cavity expansion in infinite soil mass.The present solution may serve as a benchmark for verifying the performance of advanced numerical techniques with critical state soil models and be used to capture the finite boundary effect for pressuremeter tests in small-sized calibration chambers.

Shock index and its variants as predictors of mortality in severe traumatic brain injury

BACKGROUND The increase in severe traumatic brain injury(sTBI)incidence is a worldwide phenomenon,resulting in a heavy disease burden in the public health systems,specifically in emerging countries.The shock index(SI)is a physiological parameter that indicates cardiovascular status and has been used as a tool to assess the presence and severity of shock,which is increased in sTBI.Considering the high mortality of sTBI,scrutinizing the predictive potential of SI and its variants is vital.AIM To describe the predictive potential of SI and its variants in sTBI.METHODS This study included 71 patients(61 men and 10 women)divided into two groups:Survival(S;n=49)and Non-survival(NS;n=22).The responses of blood pressure and heart rate(HR)were collected at admission and 48 h after admission.The SI,reverse SI(rSI),rSI multiplied by the Glasgow Coma Score(rSIG),and Age multiplied SI(AgeSI)were calculated.Group comparisons included Shapiro-Wilk tests,and independent samples t-tests.For predictive analysis,logistic regression,receiver operator curves(ROC)curves,and area under the curve(AUC)measurements were performed.RESULTS No significant differences between groups were identified for SI,rSI,or rSIG.The AgeSI was significantly higher in NS patients at 48 h following admission(S:26.32±14.2,and NS:37.27±17.8;P=0.016).Both the logistic regression and the AUC following ROC curve analysis showed that only AgeSI at 48 h was capable of predicting sTBI outcomes.CONCLUSION Although an altered balance between HR and blood pressure can provide insights into the adequacy of oxygen delivery to tissues and the overall cardiac function,only the AgeSI was a viable outcome-predictive tool in sTBI,warranting future research in different cohorts.

Evaluation of the Care of Children Aged 0 to 10 Years Hospitalized for Severe Malaria at the Tambacounda Health Center, Senegal

Introduction: Malaria remains a public health priority in Senegal, particularly in Tambacounda, where it is one of the main causes of child mortality. The objective of this work was to evaluate the care of children under 10 years of age hospitalized at the Tambacounda Health Center and the factors associated with recovery. Methods: An analytical, retrospective, and descriptive cross-sectional study with exhaustive recruitment of children 0 to 120 months hospitalized at the Tambacounda reference health center for severe malaria (according to WHO criteria) between 1 January 2018 and 31 December 2021 was performed. Data collection was done through a questionnaire. Records, hospitalization records, and treatment records were the sources of collection. Data entry and analysis were performed on Epi Info 7.2 and R. Results: A total of 481 children hospitalized with severe malaria were recruited. The highest number of cases was recorded in 2018 (33.05%). In the four years of the study, peaks were always observed between October and November and the highest peak in November 2020 with 95 cases. The mean age was 65.64 months with a standard deviation of 29.28 months and a predominance of male (53.43%). The majority of people were admitted from the outpatient clinic (57.79%) and the rest (42.21%) on the recommendation of a peripheral health post. All hospitalized patients had a positive RDT and/or a positive thick drop. However, the sharp decline at admission or during hospitalization was positive in 93.80% of patients in our series, negative in 5.20% and not achieved in 1.00%. Seizures and severe anemia topped the list of signs of severity with 45.94% and 8.11%, respectively. In terms of evolution, for all hospitalized patients, there were 81.29% recovery, 10.19% referral to the Tambacounda regional hospital center for hospitalization, 4.99% death, 0.83% discharge and 2.70% unknown evolution. There was a statistically significant association between recovery without referral from a health post (OR = 1.85), absence of 2 or more signs of severity (OR = 1.82), absence of seizures (OR = 1.51), prostration (OR = 2.78), cardiovascular shock (OR = 6.67), coma (OR = 7.69), lack of evidence of biological severity (OR = 3.70), and hypoglycemia with blood glucose less than 0.4 g/L (OR = 5.88). Conclusion: In addition to the routine malaria prevention and management strategies implemented in Tambacounda, and the early referral of cases of severe malaria from health posts to the health center, all children hospitalized for severe malaria with certain symptomatology such as coma, prostration, cardiovascular shock, etc. Seizures and/or hypoglycemia should be systematically referred to the regional hospital to increase their chance of recovery.

Enhancing Critical Path Problem in Neutrosophic Environment Using Python

In the real world,one of the most common problems in project management is the unpredictability of resources and timelines.An efficient way to resolve uncertainty problems and overcome such obstacles is through an extended fuzzy approach,often known as neutrosophic logic.Our rigorous proposed model has led to the creation of an advanced technique for computing the triangular single-valued neutrosophic number.This innovative approach evaluates the inherent uncertainty in project durations of the planning phase,which enhances the potential significance of the decision-making process in the project.Our proposed method,for the first time in the neutrosophic set literature,not only solves existing problems but also introduces a new set of problems not yet explored in previous research.A comparative study using Python programming was conducted to examine the effectiveness of responsive and adaptive planning,as well as their differences from other existing models such as the classical critical path problem and the fuzzy critical path problem.The study highlights the use of neutrosophic logic in handling complex projects by illustrating an innovative dynamic programming framework that is robust and flexible,according to the derived results,and sets the stage for future discussions on its scalability and application across different industries.

Predicted Critical State Based on Invariance of the Lyapunov Exponent in Dual Spaces

Critical states in disordered systems,fascinating and subtle eigenstates,have attracted a lot of research interests.However,the nature of critical states is difficult to describe quantitatively,and in general,it cannot predict a system that hosts the critical state.We propose an explicit criterion whereby the Lyapunov exponent of the critical state should be 0 simultaneously in dual spaces,namely the Lyapunov exponent remains invariant under the Fourier transform.With this criterion,we can exactly predict a one-dimensional quasiperiodic model which is not of self-duality,but hosts a large number of critical states.Then,we perform numerical verification of the theoretical prediction and display the self-similarity of the critical state.Due to computational complexity,calculations are not performed for higher dimensional models.However,since the description of extended and localized states by the Lyapunov exponent is universal and dimensionless,utilizing the Lyapunov exponent of dual spaces to describe critical states should also be universal.Finally,we conjecture that some kind of connection exists between the invariance of the Lyapunov exponent and conformal invariance,which can promote the research of critical phenomena.

Anisotropic s-Wave Gap in the Vicinity of a Quantum Critical Point in Superconducting BaFe_(2)(As_(1-x)P_(x))_(2) Single Crystals:A Study of Point-Contact Spectroscopy

We report on soft c-axis point-contact Andreev reflection(PCAR)spectroscopy combining with resistivity measurements on BaFe_(2)(As_(0.7)P_(0.3))_(2),to elucidate the superconducting gap structure in the vicinity of the quantum critical point.A double peak at the gap edge plus a dip feature at zero-bias has been observed on the PCAR spectra,indicative of the presence of a nodeless gap in BaFe_(2)(As_(0.7)P_(0.3))_(2).Detailed analysis within a sophisticated theoretical model reveals an anisotropic gap with deep gap minima.The PCARs also feature additional structures related to the electron-bosonic coupling mode.Using the extracted superconducting energy gap value,a characteristic bosonic energy Ω_(b) and its temperature dependence are obtained,comparable with the spin-resonance energy observed in neutron scattering experiment.These results indicate a magnetism-driven quantum critical point in the BaFe_(2)(As_(1-x)P_(x))_(2) system.

Engineering Quantum Criticality for Quantum Dot Power Harvesting

Coupling of quantum-dot circuits to microwave photons enables us to investigate photon-assisted quantum transport.Here,we revisit this typical circuit quantum electrodynamical setup by introducing the Kerr nonlinearity of photons.By exploiting quantum critical behavior,we propose a powerful scheme to control the power-harvesting efficiency in the microwave regime,where the driven-dissipative optical system acts as an energy pump.It drives electron transport against a load in the quantum-dot circuit.The energy transfer and,consequently,the harvesting efficiency are enhanced near the critical point.As the critical point moves towards to low input power,high efficiency within experimental parameters is achieved.Our results complement fundamental studies of photon-to-electron conversion at the nanoscale and provide practical guidance for designs of integrated photoelectric devices through quantum criticality.

Unlocking hypoglycemia–associated brain microvascular dysfunction:critical insights from proteomic analysis

Hypoglycemia-a critical complication linked to worsened brain function in diabetic subjects:Hypoglycemia is characterized by a decline in circulatory glucose levels below sta nda rd physiological thresholds.Mild hypoglycemia,classified as level 1 hypoglycemia,is defined by blood glucose levels below 70 mg/dL and can be effectively addressed through carbohydrate intake.Severe hypoglycemia,denoted by blood glucose levels less than 54 mg/dL,poses a life-threatening risk if left untreated.Individuals with type 1 and type 2 diabetes undergoing insulin treatment are particularly susceptible to hypoglycemia due to impaired counterregulatory mechanisms.

Characterization of bright betatron radiation generated by direct laser acceleration of electrons in plasma of near critical density

Directed x-rays produced in the interaction of sub-picosecond laser pulses of moderate relativistic intensity with plasma of near-critical density are investigated. Synchrotron-like (betatron) radiation occurs in the process of direct laser acceleration (DLA) of electrons in a relativisticlaser channel when the electrons undergo transverse betatron oscillations in self-generated quasi-static electric and magnetic fields. In anexperiment at the PHELIX laser system, high-current directed beams of DLA electrons with a mean energy ten times higher than the ponderomotive potential and maximum energy up to 100 MeV were measured at 10^(19) W/cm^(2)laser intensity. The spectrum of directed x-raysin the range of 5–60 keV was evaluated using two sets of Ross filters placed at 0°and 10°to the laser pulse propagation axis. The differential x-ray absorption method allowed for absolute measurements of the angular-dependent photon fluence. We report 10^(13) photons/sr withenergies >5 keV measured at 0°to the laser axis and a brilliance of 10^(21) photons s^(−1) mm^(−2) mrad−2(0.1%BW)−1. The angular distributionof the emission has an FWHM of 14°–16°. Thanks to the ultra-high photon fluence, point-like radiation source, and ultra-short emissiontime, DLA-based keV backlighters are promising for various applications in high-energy-density research with kilojoule petawatt-class laserfacilities.

21st century critical care medicine:An overview

Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units(ICUs).This abstract provides a concise summary of the latest developments in critical care,highlighting key areas of innovation.Recent advancements in critical care include Precision Medicine:Tailoring treatments based on individual patient characteristics,genomics,and biomarkers to enhance the effectiveness of therapies.The objective is to describe the recent advancements in Critical Care Medicine.Telemedicine:The integration of telehealth technologies for remote patient monitoring and consultation,facilitating timely interventions.Artificial intelligence(AI):AI-driven tools for early disease detection,predictive analytics,and treatment optimization,enhancing clinical decision-making.Organ Support:Advanced life support systems,such as Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy provide better organ support.Infection Control:Innovative infection control measures to combat emerging pathogens and reduce healthcare-associated infections.Ventilation Strategies:Precision ventilation modes and lung-protective strategies to minimize ventilatorinduced lung injury.Sepsis Management:Early recognition and aggressive management of sepsis with tailored interventions.Patient-Centered Care:A shift towards patient-centered care focusing on psychological and emotional wellbeing in addition to medical needs.We conducted a thorough literature search on PubMed,EMBASE,and Scopus using our tailored strategy,incorporating keywords such as critical care,telemedicine,and sepsis management.A total of 125 articles meeting our criteria were included for qualitative synthesis.To ensure reliability,we focused only on articles published in the English language within the last two decades,excluding animal studies,in vitro/molecular studies,and non-original data like editorials,letters,protocols,and conference abstracts.These advancements reflect a dynamic landscape in critical care medicine,where technology,research,and patient-centered approaches converge to improve the quality of care and save lives in ICUs.The future of critical care promises even more innovative solutions to meet the evolving challenges of modern medicine.

Exploring Critical Thinking Dispositions among Fourth Year BSc Nursing Students of Various Colleges of Nursing, Pakistan

Background: Critical Thinking (CT) dispositions in nursing are prominent predictors of competence in delivering high-quality care, and of professionalism, in newly graduated nurses. CT skills, in isolation of CT dispositions, do not guarantee success in the workplace, because Critical Thinking Dispositions (CTD) are important elements of intellectual reasoning that simulate a person towards using the CT skills. Therefore, nursing educational programs should promote lifelong learning rather than focusing on transferring the content of nursing knowledge only. And for this purpose, quality education is the key. Education should focus on teaching from diverse perspectives, incorporating various teaching learning strategies that are congruent with the modern era. Purpose: The purpose of this study is to explore critical thinking dispositions among final year Baccalaureate Nursing students of various military colleges of nursing, in Pakistan. Methodology: A descriptive qualitative exploratory study design was used to investigate the CTD of BSc final year nursing students. The study population included twelve willing nursing students, from six military colleges across the country. Demographic information and consent was taken from the participants of the study. In-depth interviews, through a semi structured interview guide, and probes were used to obtain data related to personal experiences of CTD amongst the nursing students. Results: Data analysis showed two broad themes: 1) Perceptions of CT, and 2) Experiences of CT dispositions. In theme one, the emerging category was: Clarity of CT;whereas in theme two, the categories that emerged were: a) Truth Seeking, b) Open Mindedness, c) Inquisitiveness, and d) Self Organization. Conclusion: The findings of the study revealed positive dispositions towards truth seeking, open mindedness, and self-organization, whereas disposition towards inquisitiveness was weak. Self-confidence and maturity also emerged as positive factors that the students possessed. This study recommends that faculty and learners should extend their concept of CTD, and emphasizes its application in daily routine. Additionally, faculty should modify their instructional strategies and focus on the cultivation of dispositions of inquisitiveness, curiosity, and allow questioning by students in the class.

BILL Strategy:Points to Consider During the Performance and Interpretation of Critical Care Echocardiography

The growing utilization of critical care echocardiography(CCE)by clinicians necessitates a meticulous review of clinical conditions in critically ill patients,both before and during the examination.The reviewing process of clinical conditions minimizes the risk of overlooking or misinterpreting crucial findings.This article proposes a comprehensive strategy,namely BILL strategy to integrated into the CCE protocol,where“B”represents baseline respiratory and hemodynamic support,“I”signifies information gleaned from invasive monitoring,including central venous pressure and thermodilution-derived cardiac output,the first“L”denotes laboratory results such as central venous oxygen saturation,troponin,and brain natriuretic peptide,and the second“L”refers to lung ultrasound data.xx Combining the BILL strategy with CCE enhances a more comprehensive understanding of critical illness,potentially leading to improved diagnostic accuracy and patient outcomes.

Superplasticity of fine-grained Mg-10Li alloy prepared by severe plastic deformation and understanding its deformation mechanisms

The superplastic behavior and associated deformation mechanisms of a fine-grained Mg-10.1 Li-0.8Al-0.6Zn alloy(LAZ1011)with a grain size of 3.2μm,primarily composed of the BCCβphase and a small amount of the HCPαphase,were examined in a temperature range of 473 K to 623 K.The microstructural refinement of this alloy was achieved by employing high-ratio differential speed rolling.The best superplasticity was achieved at 523 K and at strain rates of 10^(-4)-5×10^(-4)s^(-1),where tensile elongations of 550±600%were obtained.During the heating and holding stage of the tensile samples prior to tensile loading,a significant increase in grain size was observed at temperatures above 573 K.Therefore,it was important to consider this effect when analyzing and understanding the superplastic deformation behavior and mechanisms.In the investigated strain rate range,the superplastic flow at low strain rates was governed by lattice diffusion-controlled grain boundary sliding,while at high strain rates,lattice diffusion-controlled dislocation climb creep was the rate-controlling deformation mechanism.It was concluded that solute drag creep is unlikely to occur.During the late stages of deformation at 523 K,it was observed that grain boundary sliding led to the agglomeration of theαphase,resulting in significant strain hardening.Deformation mechanism maps were constructed forβ-Mg-Li alloys in the form of 2D and 3D formats as a function of strain rate,stress,temperature,and grain size,using the constitutive equations for various deformation mechanisms derived based on the data of the current tests.

A novel framework to intercept GPS-denied,bomb-carrying,nonmilitary,kamikaze drones:Towards protecting critical infrastructures

Protection of urban critical infrastructures(CIs)from GPS-denied,bomb-carrying kamikaze drones(G-BKDs)is very challenging.Previous approaches based on drone jamming,spoofing,communication interruption and hijacking cannot be applied in the case under examination,since G-B-KDs are uncontrolled.On the other hand,drone capturing schemes and electromagnetic pulse(EMP)weapons seem to be effective.However,again,existing approaches present various limitations,while most of them do not examine the case of G-B-KDs.This paper,focuses on the aforementioned under-researched field,where the G-B-KD is confronted by two defensive drones.The first neutralizes and captures the kamikaze drone,while the second captures the bomb.Both defensive drones are equipped with a net-gun and an innovative algorithm,which,among others,estimates the locations of interception,using a real-world trajectory model.Additionally,one of the defensive drones is also equipped with an EMP weapon to damage the electronics equipment of the kamikaze drone and reduce the capturing time and the overall risk.Extensive simulated experiments and comparisons to state-of-art methods,reveal the advantages and limitations of the proposed approach.More specifically,compared to state-of-art,the proposed approach improves:(a)time to neutralize the target by at least 6.89%,(b)maximum number of missions by at least 1.27%and(c)total cost by at least 5.15%.

Management of Severely Malnourished Children Aged 6 - 59 Months Hospitalized in the Pediatric Ward of Kayanza Hospital/Burundi

The implementation of WHO guidelines has significantly reduced hospital mortality due to severe malnutrition. Nevertheless, severe acute malnutrition in children under five remains a major public health problem in all low-income countries and is little studied. The study aimed to assess the nutritional status and quality of management of severe acute malnutrition in children aged 06 to 59 months hospitalized in the pediatric ward of Kayanza Hospital. This is a prospective study with descriptive and analytical aims over 6 months from February 10 to July 9, 2023. All children aged 6 to 59 months admitted for severe acute malnutrition are included in this study. The results show that the most affected age group is 12 to 23 months (42.55%). Marasmus is the most common clinical form, at 70.2%. Housewives and mothers from rural areas are the most affected, with rates ranging from 69.14% to 91.49%. The study shows that the reasons for consultation are respectively: edema (29.78%), diarrhea (26.59%), vomiting (19.14%), and fever (14.89%). Dehydration and hypothermia were the main complications observed in 45.74% and 22.34% respectively. Medical treatment was provided by antibiotics (44.68%), artesunate (31.91%), and resomal (21.27%). Nutritional treatment consisted of F75 100% milk and F100 100% milk. Pathologies observed were: anemia 38.29%, malaria 37.23%, urinary tract infection 12.7%, measles 11.7%. The national protocol for integrated management of acute malnutrition (PCIMA) was followed. This study shows that 72.3% of children were successfully treated, with 9.5% dropping out and dying, and 8.5% not responding. We found that malnutrition remains a public health problem, affecting mostly children aged 12 to 24 months. The main complications or pathologies associated with malnutrition are diarrhea, malaria, and fever, and the majority of children suffer from marasmus.

Radial growth in Qinghai spruce is most sensitive to severe drought in the Qilian Mountains of Northwest China

Global warming and frequent extreme drought events lead to tree death and extensive forest decline,but the underlying mechanism is not clear.In drought years,cambial development is more sensitive to climate change,but in different phenological stages,the response rela-tionship is nonlinear.Therefore,the dynamic relationship between tree radial growth and climatic/environmental fac-tors needs to be studied.We thus continuously monitored radial growth of Qinghai spruce(Picea crassifolia Kom.)and environmental factors from January 2021 to November 2022 using point dendrometers and portable meteorological weather stations in the central area of the Qilian Mountains.The relationship and stability between the radial growth of Qinghai spruce and environmental factors were compared for different levels of drought in 2021 and 2022.The year 2022 had higher temperatures and less precipitation and was drier than 2021.Compared with 2021,the growing period in 2022 for Qinghai spruce was 10 days shorter,maximum growth rate(Grmax)was 4.5μm·d^(-1) slower,and the initiation of growth was 6 days later.Growth of Qinghai spruce was always restricted by drought,and the stem radial increment(SRI)was more sensitive to precipitation and air relative humidity.Seasonal changes in cumulative radial growth were divided into four phenological stages according to the time of growth onset,cessation,and maximum growth rate(Grmax)of Qinghai spruce.Stability responses of SRI to climate change were stronger in Stage 3 and Stage 4 of 2021 and stronger in Stage 1(initiation growth stage)and Stage 3 of 2022.The results provide important information on the growth of the trees in response to drought and for specific managing forests as the climate warms.