Eligibility of cardiac arrest patients for extracorporeal cardiopulmonary resuscitation and their clinical characteristics:a retrospective two-centre study

BACKGROUND AND IMPORTANCE: Sudden cardiac arrest has a high incidence and often leads to death. A treatment option that might improve the outcomes in refractory cardiac arrest is Extracorporeal Cardiopulmonary Resuscitation (ECPR).OBJECTIVES: This study investigates the number of in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients eligible to ECPR and identifies clinical characteristics that may help to identify which patients benefit the most from ECPR.DESIGN, SETTINGS AND PARTICIPANTS: A retrospective two-centre study was conducted in Rotterdam, the Netherlands. All IHCA and OHCA patients between 1 January 2017 and 1 January 2020 were screened for eligibility to ECPR. The primary outcome was the percentage of patients eligible to ECPR and patients treated with ECPR. The secondary outcome was the comparison of the clinical characteristics and outcomes of patients eligible to ECPR treated with conventional Cardiopulmonary Resuscitation (CCPR) vs. those of patients treated with ECPR.MAIN RESULTS: Out of 1246 included patients, 412 were IHCA patients and 834 were OHCA patients. Of the IHCA patients, 41 (10.0%) were eligible to ECPR, of whom 20 (48.8%) patients were actually treated with ECPR. Of the OHCA patients, 83 (9.6%) were eligible to ECPR, of whom 23 (27.7%) were actually treated with ECPR. In the group IHCA patients eligible to ECPR, no statistically significant difference in survival was found between patients treated with CCPR and patients treated with ECPR (hospital survival 19.0% vs. 15.0% respectively, 4.0% survival difference 95% confidence interval -21.3 to 28.7%). In the group OHCA patients eligible to ECPR, no statistically significant difference in-hospital survival was found between patients treated with CCPR and patients treated with ECPR (13.3% vs. 21.7% respectively, 8.4% survival difference 95% confidence interval -30.3 to 10.2%).CONCLUSION: This retrospective study shows that around 10% of cardiac arrest patients are eligible to ECPR. Less than half of these patients eligible to ECPR were actually treated with ECPR in both IHCA and OHCA.</p

State of wildfires 2023–24

Climate change is increasing the frequency and intensity of wildfires globally, with significant impacts on society and the environment. However, our understanding of the global distribution of extreme fires remains skewed, primarily influenced by media coverage and regional research concentration. This inaugural State of Wildfires report systematically analyses fire activity worldwide, identifying extreme events from the March 2023–February 2024 fire season. We assess the causes, predictability, and attribution of these events to climate change and land use, and forecast future risks under different climate scenarios. During the 2023–24 fire season, 3.9 million km2 burned globally, slightly below the average of previous seasons, but fire carbon (C) emissions were 16 % above average, totaling 2.4 Pg C. This was driven by record emissions in Canadian boreal forests (over 9 times the average) and dampened by reduced activity in African savannahs. Notable events included record-breaking wildfire extent and emissions in Canada, the largest recorded wildfire in the European Union (Greece), drought-driven fires in western Amazonia and northern parts of South America, and deadly fires in Hawai’i (100 deaths) and Chile (131 deaths). Over 232,000 people were evacuated in Canada alone, highlighting the severity of human impact. Our analyses revealed that multiple drivers were needed to cause areas of extreme fire activity. In Canada and Greece a combination of high fire weather and an abundance of dry fuels increased the probability of fires by 4.5-fold and 1.9–4.1-fold, respectively, whereas fuel load and direct human suppression often modulated areas with anomalous burned area. The fire season in Canada was predictable three months in advance based on the fire weather index, whereas events in Greece and Amazonia had shorter predictability horizons. Formal attribution analyses indicated that the probability of extreme events has increased significantly due to anthropogenic climate change, with a 2.9–3.6-fold increase in likelihood of high fire weather in Canada and a 20.0–28.5-fold increase in Amazonia. By the end of the century, events of similar magnitude are projected to occur 2.22–9.58 times more frequently in Canada under high emission scenarios. Without mitigation, regions like Western Amazonia could see up to a 2.9-fold increase in extreme fire events. For the 2024–25 fire season, seasonal forecasts highlight moderate positive anomalies in fire weather for parts of western Canada and South America, but no clear signal for extreme anomalies is present in the forecast. This report represents our first annual effort to catalogue extreme wildfire events, explain their occurrence, and predict future risks. By consolidating state-of-the-art wildfire science and delivering key insights relevant to policymakers, disaster management services, firefighting agencies, and land managers, we aim to enhance society’s resilience to wildfires and promote advances in preparedness, mitigation, and adaptation

Improving resampling-based ensemble in Churn prediction

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Conservation Agriculture in the Highlands of Tanzania under a Coffee-Banana-Agroforestry Farming System. Training Manual for Small Scale Farmers

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Effectiveness OF Mulching Under Miraba in Controlling Soil Erosion, Fertility Restoration and Crop Yield in the Usambara Mountains, Tanzania

Soil erosion is a major threat to food security in rural areas of Africa. Field experiments were conducted from 2011 to 2014 in Majulai and Migambo villages with contrasting climatic conditions in Usambara Mountains, Tanzania. The aim was to investigate the effectiveness of mulching in reducing soil erosion and restoring soil fertility for productivity of maize (Zea mays) and beans (Phaseolus vulgaris) under miraba, a unique indigenous soil conservation measure in the area. Soil loss was significantly higher (p<0·05) under miraba sole than under miraba with mulching, for example, 35 versus 20 and 13 versus 8Mg ha1 y1 for Majulai and Migambo villages, respectively, in 2012. Soil fertility status was significantly higher (p<0·05) under miraba with Tughutu mulching than under miraba sole, for example, 0·35 versus 0·25% total N, 37 versus 22 mg kg1 P and 0·6 versus 0·2 cmol(+) kg1K for the Majulai village; and 0·46 versus 0·38 total N, 17·2 versus 10·2 mg kg1 P and 0·50 versus 0·2 cmol(+) kg1K for the Migambo village. Maize and bean yields (Mg ha1) were significantly higher (p<0·05) under miraba with Tughutu mulching than under miraba sole, 2·0 versus 1·3 for maize and 0·9 versus 0·8 for beans in Majulai; and 3·8 versus 2·6 for maize and 1·0 versus 0·8 for beans in the Migambo village in 2012. This implies that Tughutu mulching is more effective in improving crop yield than Tithonia, although both could potentially protect the arable land from degradation caused by water erosion under miraba.status: publishe

Boulder-Faced Log Dams and other Alternatives for Gabion Check Dams in First-Order Ephemeral Streams with Coarse Bed Load in Ethiopia

© 2016 American Society of Civil Engineers. Although thousands of gabion check dams have been installed to control gully erosion in Ethiopia, several challenges still remain, such as the issue of gabion failure in ephemeral streams with coarse bed load, which abrades at the chute step. As an alternative for gabion check dams in torrents with coarse bed load, boulder-faced log dams were conceived, installed transversally across torrents, and tested (n=30). For this, logs (22-35 cm across) were embedded in the banks of torrents, 0.5-1 m above the bed, and their upstream sides were faced with boulders (0.3-0.7 m across). Similar to gabion check dams, boulder-faced log dams lead to temporary ponding, spreading of peak flow over the entire channel width, and sediment deposition. The results of testing under extreme flow conditions (including two storms with return periods of 5.6 and 7 years) show that 18 dams resisted strong floods. Beyond certain flood thresholds (represented by proxies such as Strahler's stream order, catchment area, D95, or channel width), 11 log dams were completely destroyed. Smallholder farmers see much potential in this type of structure to control first-order torrents with coarse bed load because the technique is cost-effective and can be easily installed.status: publishe

Boulder-Faced Log Dams as an Alternative for Gabion Check Dams in First-Order Ephemeral Streams with Coarse Bed Load in Ethiopia

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The Influence of Selected Soil Conservation Practices on Soil Properties and Crop Yieldsin the Usambara Mountains, Tanzania

The Usambara Mountains in Tanzania are severely affected by soil erosion which has led to deterioration of soil properties and reduced crop productivity. Indigenous soil erosion control measures such as miraba which are widely practised in the area have yielded little success. Field plot experiments were laid down in Majulai and Migambo villages from 2011 – 2014 on typical soils of the area (Acrisols). The aim was to single out soil properties developed under the studied soil conservation practices and their impact on crop productivity with reference to maize (Zea mays) and beans (Phaseolus vulgaris). Results showed that total N, OC, available P, Ca2+, Mg2+, K+ and Ph were powerful (P = .05) attributes that discriminated conservation measures. Magnitudes of the discriminating attributes followed the trend: miraba with Tughutu (Vernonia myriantha) mulching >miraba with Tithonia (Tithonia diversifolia) mulching > miraba sole > cropl and with no ‘Soil and Water Conservation’ (SWC) measures (control). Contents ofmicro-nutrients did not differ significantly with SWC measures except for Zn which was significantly (P = .05) lowin the control. Bulk density and available moisture content (AMC) were also strong discriminators of conservation measures. Maize and bean grain yields differed significantly (P = .05)with the trend: miraba with Tughutu > miraba with Tithonia > miraba sole > control in both villages. Crop yields under miraba were a function of AMC and pH (R2= 0.71); AMC, available P, Ca2+ and K+ (R2= 0.89) under miraba with Tithonia mulching; AMC, available P, Ca2+ and K+ (R2= 0.90) under miraba with Tughutu mulching. These findings imply that miraba with Tughutu mulching had greater potential in improving soil properties and crop yields than miraba with Tithonia mulching and miraba sole.status: publishe