Impacts of Multiple Environmental Changes on Long‐Term Nitrogen Loading From the Chesapeake Bay Watershed

Excessive nutrient inputs from land, particularly nitrogen (N), have been found to increase the occurrence of hypoxia and harmful algal blooms in coastal ecosystems. To identify the main contributors of increased N loading and evaluate the efficacy of water pollution control policies, it is essential to quantify and attribute the long‐term changes in riverine N export. Here, we use a state‐of‐the‐art terrestrial–aquatic interface model to examine how multiple environmental factors may have affected N export from the Chesapeake Bay watershed since 1900. These factors include changes in climate, carbon dioxide, land use, and N inputs (i.e., atmospheric N deposition, animal manure, synthetic N fertilizer use, and wastewater discharge). Our results estimated that ammonium (NH4+) and nitrate (NO3−) export increased substantially (66% for NH4+ and 123% for NO3−) from the 1900s to the 1990s and then declined (32% for NH4+ and 14% for NO3−) since 2000. The temporal trend of dissolved organic nitrogen (DON) export paralleled that of dissolved inorganic N, while particulate organic nitrogen export was relatively constant during 1900–2015. Precipitation was the primary driver of interannual variability in N export to the Bay. Wastewater discharge explained most of the long‐term change in riverine NH4+ and DON fluxes from 1900 to 2015. The changes in atmospheric deposition, wastewater, and synthetic fertilizer were responsible for the trend of riverine NO3−. In light of our model‐based attribution analysis, terrestrial non‐point source nutrient management will play an important role in achieving water quality goals

Impacts of Multiple Environmental Changes on Long‐Term Nitrogen Loading From the Chesapeake Bay Watershed

Excessive nutrient inputs from land, particularly nitrogen (N), have been found to increase the occurrence of hypoxia and harmful algal blooms in coastal ecosystems. To identify the main contributors of increased N loading and evaluate the efficacy of water pollution control policies, it is essential to quantify and attribute the long‐term changes in riverine N export. Here, we use a state‐of‐the‐art terrestrial–aquatic interface model to examine how multiple environmental factors may have affected N export from the Chesapeake Bay watershed since 1900. These factors include changes in climate, carbon dioxide, land use, and N inputs (i.e., atmospheric N deposition, animal manure, synthetic N fertilizer use, and wastewater discharge). Our results estimated that ammonium (NH4+) and nitrate (NO3−) export increased substantially (66% for NH4+ and 123% for NO3−) from the 1900s to the 1990s and then declined (32% for NH4+ and 14% for NO3−) since 2000. The temporal trend of dissolved organic nitrogen (DON) export paralleled that of dissolved inorganic N, while particulate organic nitrogen export was relatively constant during 1900–2015. Precipitation was the primary driver of interannual variability in N export to the Bay. Wastewater discharge explained most of the long‐term change in riverine NH4+ and DON fluxes from 1900 to 2015. The changes in atmospheric deposition, wastewater, and synthetic fertilizer were responsible for the trend of riverine NO3−. In light of our model‐based attribution analysis, terrestrial non‐point source nutrient management will play an important role in achieving water quality goals

A late 19th-Century British perspective on modern foreign language learning, teaching, and reform: the legacy of Prendergast’s “Mastery System”

The late 19th century saw a great rise in private foreign language learning and increasing provision of Modern foreign language teaching in schools. Evidence is presented to document the uptake of innovations in Thomas Prendergast’s (1807–1886) “Mastery System” by both individual language learners and educationalists. Although it has previously been suggested that Prendergast’s method failed to have much impact, this study clearly demonstrates the major influence he had on approaches to language learning and teaching in Britain and around the world both with his contemporaries and long after his death. This detailed case study illuminates the landscape of modern language pedagogy in Victorian Britain

Naproxen chemoprevention induces proliferation of cytotoxic lymphocytes in Lynch Syndrome colorectal mucosa

BackgroundRecent clinical trial data from Lynch Syndrome (LS) carriers demonstrated that naproxen administered for 6-months is a safe primary chemoprevention that promotes activation of different resident immune cell types without increasing lymphoid cellularity. While intriguing, the precise immune cell types enriched by naproxen remained unanswered. Here, we have utilized cutting-edge technology to elucidate the immune cell types activated by naproxen in mucosal tissue of LS patients.MethodsNormal colorectal mucosa samples (pre- and post-treatment) from a subset of patients enrolled in the randomized and placebo-controlled ‘Naproxen Study’ were obtained and subjected to a tissue microarray for image mass cytometry (IMC) analysis. IMC data was processed using tissue segmentation and functional markers to ascertain cell type abundance. Computational outputs were then used to quantitatively compare immune cell abundance in pre- and post-naproxen specimens.ResultsUsing data-driven exploration, unsupervised clustering identified four populations of immune cell types with statistically significant changes between treatment and control groups. These four populations collectively describe a unique cell population of proliferating lymphocytes within mucosal samples from LS patients exposed to naproxen.ConclusionsOur findings show that daily exposure of naproxen promotes T-cell proliferation in the colonic mucosa, which paves way for developing combination of immunoprevention strategies including naproxen for LS patients

Knowledge translation strategies to improve the use of evidence in public health decision making in local government: intervention design and implementation plan

Background:&nbsp;Knowledge translation strategies are an approach to increase the use of evidence within policy and practice decision-making contexts. In clinical and health service contexts, knowledge translation strategies have focused on individual behavior change, however the multi-system context of public health requires a multi-level, multi-strategy approach. This paper describes the design of and implementation plan for a knowledge translation intervention for public health decision making in local government. Methods: Four preliminary research studies contributed findings to the design of the intervention: a systematic review of knowledge translation intervention effectiveness research, a scoping study of knowledge translation perspectives and relevant theory literature, a survey of the local government public health workforce, and a study of the use of evidence-informed decision-making for public health in local government. A logic model was then developed to represent the putative pathways between intervention inputs, processes, and outcomes operating between individual-, organizational-, and system-level strategies. This formed the basis of the intervention plan. Results: The systematic and scoping reviews identified that effective and promising strategies to increase access to research evidence require an integrated intervention of skill development, access to a knowledge broker, resources and tools for evidence-informed decision making, and networking for information sharing. Interviews and survey analysis suggested that the intervention needs to operate at individual and organizational levels, comprising workforce development, access to evidence, and regular contact with a knowledge broker to increase access to intervention evidence; develop skills in appraisal and integration of evidence; strengthen networks; and explore organizational factors to build organizational cultures receptive to embedding evidence in practice. The logic model incorporated these inputs and strategies with a set of outcomes to measure the intervention\u27s effectiveness based on the theoretical frameworks, evaluation studies, and decision-maker experiences. Conclusion: Documenting the design of and implementation plan for this knowledge translation intervention provides a transparent, theoretical, and practical approach to a complex intervention. It provides significant insights into how practitioners might engage with evidence in public health decision making. While this intervention model was designed for the local government context, it is likely to be applicable and generalizable across sectors and settings.</div

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The cheats : a romantic fantasy /

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