National-scale detection of reservoir impacts through hydrological signatures

Reservoirs play a vital role in the supply and management of water resources and their operation can significantly alter downstream flow. Despite this, reservoirs are frequently excluded or poorly represented in large-scale hydrological models, which can be partly attributed to a lack of open-access data describing reservoir operations, inflow and storage. To help inform the development of reservoir operation schemes, we collate a suite of hydrological signatures designed to detect the impacts of reservoirs on the flow regime at large-scales from downstream flow records only. By removing the need for pre-and-post-reservoir flow timeseries (a requirement of many pre-existing techniques), these signatures facilitate the assessment of flow alteration across a much wider range of catchments. To demonstrate their application, we calculate the signatures across Great Britain in 111 benchmark (i.e., near-natural) catchments and 186 reservoir catchments (where at least one upstream reservoir is present). We find that abstractions from water resource reservoirs induce deficits in the water balance, and that pre-defined flow releases (e.g., the compensation flow) reduce variability in the downstream flow duration curve and in intra-annual low flows. By comparing signatures in benchmark and reservoir catchments, we define thresholds above which the influence of reservoirs can be distinguished from natural variability and identify 40 catchments significantly impacted by the presence of reservoirs. The signatures also provide insights into local reservoir operations, which can inform the development of tailored reservoir operation schemes, and identify locations where current modeling practices (which lack reservoir representation) will be insufficient

Knowledge and attitude of nursing students regarding older adults' sexuality: a cross-sectional study

Background: Although older adults are sexual, sexuality is infrequently discussed with them by health care professionals. Nursing students, as future professionals, can make an important contribution by developing competences in discussing intimacy and sexuality with older adults to increase quality of life and to prevent sexual problems. In order to improve these competences, current levels of knowledge and attitude need to be explored.Objectives: To investigate i) knowledge and attitudes of nursing students regarding intimacy and sexuality of older adults, ii) the difference in knowledge and attitudes of nursing students in different years of study and iii) frequency of discussing intimacy and sexuality with older adults. Design: Cross-sectional.Settings: A University of Applied Sciences in the Netherlands.Participants: Nursing students, >= 16 years who were able to read and write in Dutch.Methods: The Ageing Sexual Knowledge and Attitudes Scale was used among nursing students. Furthermore, demographic information and frequencies were collected. Data was analyzed using SPSS.Results: In total, 732 students participated. The mean knowledge-score was 43.9 (SD = 8.9), the mean attitudescore 64.3 (SD = 16.0). Unlike attitude, the level of knowledge differed significantly per year of study: first year students had the lowest and third year students the highest knowledge. Most students stated they 'never' (54.1%) or 'once' (13.2%) discussed intimacy and sexuality with older adults. Reasons to avoid talking about intimacy and sexuality were feelings of 'not being the right person' (17.3%) and 'incompetence' (14.0%).Conclusions: Nursing students had moderate knowledge and positive attitudes toward older adults' intimacy and sexuality. The knowledge-level differed per year of study, the attitude level did not. Only a minority discussed intimacy and sexuality with older adults. Moderate knowledge and positive attitudes do not mean that intimacy and sexuality is discussed. To ensure students feel responsible and competent, interventions should focus on continuous knowledge dissemination, role clarification and role modelling.Neuro-urology: functional disorders in male and female urogenital trac

The Clinical Translation Gap in Child Health Exercise Research: A Call for Disruptive Innovation

In children, levels of play, physical activity, and fitness are key indicators of health and disease and closely tied to optimal growth and development. Cardiopulmonary exercise testing (CPET) provides clinicians with biomarkers of disease and effectiveness of therapy, and researchers with novel insights into fundamental biological mechanisms reflecting an integrated physiological response that is hidden when the child is at rest. Yet the growth of clinical trials utilizing CPET in pediatrics remains stunted despite the current emphasis on preventative medicine and the growing recognition that therapies used in children should be clinically tested in children. There exists a translational gap between basic discovery and clinical application in this essential component of child health. To address this gap, the NIH provided funding through the Clinical and Translational Science Award (CTSA) program to convene a panel of experts. This report summarizes our major findings and outlines next steps necessary to enhance child health exercise medicine translational research. We present specific plans to bolster data interoperability, improve child health CPET reference values, stimulate formal training in exercise medicine for child health care professionals, and outline innovative approaches through which exercise medicine can become more accessible and advance therapeutics across the child health spectrum

Value of long-term streamflow forecasts to reservoir operations for water supply in snow-dominated river catchments

We present a forecast-based adaptive management framework for water supply reservoirs and evaluate the contribution of long-term inflow forecasts to reservoir operations. Our framework is developed for snow-dominated river basins that demonstrate large gaps in forecast skill between seasonal and inter-annual time horizons. We quantify and bound the contribution of seasonal and inter-annual forecast components to optimal, adaptive reservoir operation. The framework uses an Ensemble Streamflow Prediction (ESP) approach to generate retrospective, one-year-long streamflow forecasts based on the Variable Infiltration Capacity (VIC) hydrology model. We determine the optimal sequence of daily release decisions using the Model Predictive Control (MPC) optimization scheme. We then assess the forecast value by comparing system performance based on the ESP forecasts with the performances based on climatology and perfect forecasts. We distinguish among the relative contributions of the seasonal component of the forecast versus the inter-annual component by evaluating system performance based on hybrid forecasts, which are designed to isolate the two contributions. As an illustration, we first apply the forecast-based adaptive management framework to a specific case study, i.e., Oroville Reservoir in California, and we then modify the characteristics of the reservoir and the demand to demonstrate the transferability of the findings to other reservoir systems. Results from numerical experiments show that, on average, the overall ESP value in informing reservoir operation is 35% less than the perfect forecast value and the inter-annual component of the ESP forecast contributes 20–60% of the total forecast value.</p

Semantic mapping of discourse and activity, using Habermas’s theory of communicative action to analyze process

Our primary objective is evaluation of quality of process. This is addressed through semantic mapping of process. We note how this is complementary to the primacy of output results or products. We use goal-oriented discourse as a case study. We draw benefit from how social and political theorist, Jürgen Habermas, uses what was termed “communicative action”. An orientation in Habermas’s work, that we use, is analysis of communication or discourse. For this, we take Twitter social media. In our case study, we map the discourse semantically, using the Correspondence Analysis platform for such latent semantic analysis. This permits qualitative and quantitative analytics. Our case study is a set of eight carefully planned Twitter campaigns relating to environmental issues. The aim of these campaigns was to increase environmental awareness and behaviour. Each campaign was launched by an initiating tweet. Using the data gathered in these Twitter campaigns, we sought to map them, and hence to track the flow of the Twitter discourse. This mapping was achieved through semantic embedding. The semantic distance between an initiating act and the aggregate semantic outcome is used as a measure of process effectiveness

Racemic epinephrine compared to salbutamol in hospitalized young children with bronchiolitis; a randomized controlled clinical trial [ISRCTN46561076]

BACKGROUND: Bronchiolitis is the most common cause of lower respiratory tract illness in infancy, and hospital admission rates appear to be increasing in Canada and the United States. Inhaled beta agonists offer only modest short-term improvement. Trials of racemic epinephrine have shown conflicting results. We sought to determine if administration of racemic epinephrine during hospital stay for bronchiolitis improved respiratory distress, was safe, and shortened length of stay. METHODS: The study was a randomized, double-blind controlled trial of aerosolized racemic epinephrine compared to salbutamol every one to 4 hours in previously well children aged 6 weeks to ≤ 2 years of age hospitalized with bronchiolitis. The primary outcome was symptom improvement as measured by the Respiratory Distress Assessment Instrument (RDAI); secondary outcomes were length of stay in hospital, adverse events, and report of symptoms by structured parental telephone interview one week after discharge. RESULTS: 62 children with a mean age of 6.4 months were enrolled; 80% of children had Respiratory Syncytial Virus (RSV). Racemic epinephrine resulted in significant improvement in wheezing and the total RDAI score on day 2 and over the entire stay (p < 0.05). The mean LOS in the epinephrine arm was 2.6 days (95% CI 2, 3.2) v. 3.4 days in those in the salbutamol group (95% CI 2.6, 4.2) (p > 0.05). Adverse events were not significantly different in the two arms. At one week post-discharge, over half of parents reported that their child still had a respiratory symptom and 40% had less than normal feeding. CONCLUSION: Racemic epinephrine relieves respiratory distress in hospitalized infants with bronchiolitis and is safe but does not abbreviate hospital stay. Morbidity associated with bronchiolitis as identified by parents persists for at least one week after hospital discharge in most infants

Seasonal influenza vaccination of healthcare workers : Systematic review of qualitative evidence

Background Most countries recommend that healthcare workers (HCWs) are vaccinated seasonally against influenza in order to protect themselves and patients. However, in many cases coverage remains low. A range of strategies have been implemented to increase uptake. Qualitative evidence can help in understanding the context of interventions, including why interventions may fail to achieve the desired effect. This study aimed to synthesise evidence on HCWs’ perceptions and experiences of vaccination for seasonal influenza. Methods Systematic review of qualitative evidence. We searched MEDLINE, EMBASE and CINAHL and included English-language studies which reported substantive qualitative data on the vaccination of HCWs for seasonal influenza. Findings were synthesised thematically. Results Twenty-five studies were included in the review. HCWs may be motivated to accept vaccination to protect themselves and their patients against infection. However, a range of beliefs may act as barriers to vaccine uptake, including concerns about side-effects, scepticism about vaccine effectiveness, and the belief that influenza is not a serious illness. HCWs value their autonomy and professional responsibility in making decisions about vaccination. The implementation of interventions to promote vaccination uptake may face barriers both from HCWs’ personal beliefs and from the relationships between management and employees within the targeted organisations. Conclusions HCWs’ vaccination behaviour needs to be understood in the context of HCWs’ relationships with each other, with management and with patients. Interventions to promote vaccination should take into account both the individual beliefs of targeted HCWs and the organisational context within which they are implemented