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Attitudes are deemed critical psychological variables that can determine end users’ acceptance and adoption of robots. This study explored the heterogeneity of the Chinese public’s attitudes toward robots in healthcare and examined demographic characteristics associated with the derived profile membership. The data were collected from a sample of 428 Chinese who participated in an online survey. Latent profile analysis identified three distinct subgroups regarding attitudes toward robots—optimistic (36.9%), neutral (47.2%), and ambivalent (15.9%). Interestingly, although participants in the ambivalent attitude profile held more negative attitudes toward interaction with or social influence of healthcare robots, their attitudes tended to be positive when it came to emotional interactions with healthcare robots. All the respondents reported negative attitudes toward the social influence of healthcare robots. Multivariable regression analysis results showed that there were significant differences in age, education level, monthly income, experience with computers, experience with wearable devices, and whether to follow robot-related news or not. This study confirmed the heterogeneity of the Chinese public’s attitudes toward robots in healthcare and highlighted the importance of emotional interaction with and social influence of healthcare robots, which might facilitate a better understanding of the needs and expectations of potential end users for robots in healthcare to make them more acceptable in different situations.

To explore the relationships between clinical teaching behaviour and transition shock in newly graduated nurses and significant differences in the northwest and northeast China.A cross-sectional design.A total of 211 (nurses) and 925 (preceptors) were recruited in six Third-class different hospitals from July to August 2019.The transition shock is negatively correlated with the clinical teaching behaviour in northwest and northeast China, while the transition shock in the northwest is higher than that in the northeast for the behindhand economy and natural limit.The transition process of newly graduated nurses in northeast China with ethnic minorities and the behindhand economy is more difficult. For newly graduated nurses, personal health and a supportive environment need further improvement. Teaching strategies for preceptors need to be enhanced. Two-way feedback is more useful for both the newly graduated nurses and preceptors to improve quality care, and holistic care.

Aims To investigate the mental workload level of nurses aiding the most affected area during the Coronavirus disease 2019 (COVID-19) pandemic and explore the subtypes of nurses regarding their mental workload. Design Cross-sectional study. Methods A sample of 446 frontline nurses participated from March 8 to 19, 2020. A latent profile analysis was performed to identify clusters based on the six subscales of the Chinese version of the National Aeronautics and Space Administration Task Load Index. The differences among the classes and the variables including sociodemographic characteristics, psychological capital and coping style were explored. Results The level of mental workload indicates that the nurses had high self-evaluations of their performance while under extremely intensive task loads. The following three latent subtypes were identified: 'low workload & low self-evaluation' (8.6%); 'medium workload & medium self-evaluation' (35.3%) and 'high workload & high self-evaluation' (56.1%) (Classes 1, 2, and 3, respectively). Nurses with shared accommodations, fewer years of practice, junior professional titles, lower incomes, nonmanagement working positions, lower psychological capital levels and negative coping styles had a higher likelihood of belonging to Class 1. In contrast, senior nurses with higher psychological capital and positive coping styles were more likely to belong to Classes 2 and 3. Conclusion The characteristics of the 'low workload & low self-evaluation' subtype suggest that attention should be paid to the work pressure and psychological well-being of junior nurses. Further research on regular training program of public health emergency especially for novices is needed. Personnel management during public health events should be focused on the allocation between novice and senior frontline nurses. Impact This study addresses the level of mental workload of frontline nurses who aid in the most severe area of the COVID-19 pandemic in China and delineates the characteristics of the subtypes of these nurses.

Knowledge of vegetation dynamics in relation to climatic changes and human activities is essential for addressing the terrestrial carbon cycle in the context of global warming. Scientific detection and quantitative attribution of vegetation dynamic changes in different climatic zones and human activities are the focus and challenge of the relevant research. Taking the Poyang Lake basin as the research area, this study aimed to reveal how climate and land use drive changes in net primary productivity (NPP) in the subtropical humid basin. Change patterns of vegetation NPP and their relationships with meteorological factors across the basin were first investigated based on the estimation of 18 year (2000–2017 year) NPP by using a typical light energy utilization model, the Carnegie-Ames-Stanford Approach (CASA) model. Quantitative analysis was then conducted to explicitly distinguish the driving effects of climate change and land-use change on NPP dynamics in two different periods. Results show that annual NPP and total production (TP) of the Poyang Lake basin increased significantly from 2000 to 2017. During this period, land-use change in the basin was driven by the process of urbanization expansion and the efforts of ecological protection. Climatically, the temperature is the major influencing climatic factor in determining vegetation productivity in the subtropical humid basin, followed by precipitation and solar radiation. In addition, our investigation also revealed that with comparison to the period of 2000s, the increased TP of the Poyang Lake basin due to climate change in 2010s was much bigger than the decreased TP due to land-use change. However, in the areas where the land-use change occurred, the decreased TP was mainly attributed to the impact of land-use change, even though climate change showed a positive effect of increasing productivity.

Background:Doctors should disclose the diagnosis to patients according to the principle of autonomy. However, not disclosing the diagnosis and prognosis to cancer patients remains common in mainland China.Objective:The study explored the experiences and attitudes of patients with cancer, family members, and the medical staff in truth-telling.Research design:A quantitative survey with three closed-ended questionnaires was conducted.Participants:In all, 137 patients with cancer, 134 family members caring for cancer cases, and 54 medical staff were surveyed. Descriptive statistics were used to summarize all characteristics, and the chi-square test was performed to analyze group differences in attitudes toward cancer disclosure.Ethical considerations:This study was approved by the Committee on Ethics of Biomedicine Research, at the Second Military Medical University (HJEC-2018-YF-001). Informed consent was obtained from all participants prior to study commencement.Findings:A total of 59.8% of patients were informed about their diagnosis within 1 week, and 19.7% inferred theirs. The medical staff preferred to prioritize family members in informing about patient diagnosis while 77.4% of patients preferred to be told the whole truth at the time of initial diagnosis. More patients than family members and medical staff wanted the patients to be informed about the diagnosis ( p < 0.001). A significant difference was found between the patients and family members regarding who should tell the patients.Discussion:The willingness of patients in knowing the truth was underestimated by their family members as well as the medical staff. Guessing the truth indirectly may exert negative effects on the patients, and not telling the truth is inappropriate in patients who want to be informed.Conclusion:Disclosure of a cancer diagnosis is a complex process involving medical practice, as well as a range of cultural, ethical, and legal factors. The medical staff should first assess each patient’s willingness in truth-telling and inform about disease diagnosis with respect. Emotional support and comfort from family members are encouraged. Anyone in the patient’s care team, especially nurses, could be integrated in the process of truth-telling.

Characterized by increasing surface air temperature, global warming has altered the hydrological cycle at global and regional scales. In order to adapt water resources management under the context of global warming, attribution analysis on regional differentiation of water resources in the Yangtze River basin (YRB) was conducted in this study. Meteoro-hydrological variations across the basin were examined for the period 1960&ndash, 2013, and then a statistic-based method was applied in quantifying the contributions of climate variability and human activities on annual runoff variations in different tributary sub-basins in the YRB. Our observation indicates that both the annual increasing rate and the inter-annual fluctuations of temperature in China and in the YRB were higher than that of the global average since the turn of the century. Climate change analysis indicates that the YRB experienced a hot-wet period during 1994&ndash, 2002 and a hot-dry period during 2003&ndash, 2013, since the step change of temperature in 1993. Contributions of climate change and human activities on runoff variations varied spatially in the basin. With reference to the baseline period of 1960&ndash, 1993, the contribution of climate change played a dominant role in most regions of the basin, especially in those upstream sub-basins. The effect of human activities in the basin was quite complicated, not only its regional differentiation, but also its contribution were opposite during the hot-wet period and the hot-dry period in some sub-basins. The result of this study is helpful in understanding the impacts of climate change and human activities on water resources variation in both temporal and spatial scales.

The hydrological regime of a lake is largely dependent on its bathymetry. A dramatic water level reduction has occurred in Poyang Lake in recent years, coinciding with significant bed erosion. Few studies have focused on the influence of bathymetric changes on the hydrological regime in such a complex river-lake floodplain system. This study combined hydrological data and a physically based hydrodynamic model to quantify the influence of the bathymetric changes (1998–2010) on the water level spatiotemporal distribution in Poyang Lake, based on a dry year (2006), a wet year (2010) and an average year (2000–2010). The following conclusions can be drawn from the results of this study: (1) The bed erosion of the northern outlet channel averaged 3 m, resulting in a decrease in the water level by 1.2–2 m in the northern channels (the most significantly influenced areas) and approximately 0.3 m in the central lake areas during low-level periods. The water levels below 16 m and 14 m were significantly affected during the rising period and recession period, respectively. The water level reduction was enhanced due to lower water levels. (2) The water surface profiles adjusted, and the rising and recession rates of the water level increased by 0.5–3.1 cm/d at the lake outlet. The bathymetric influence extended across the entire lake due to the emptying effect, resulting in a change in the water level distribution. The average annual outflow increased by 6.8%. (3) The bathymetric changes contributed approximately 14.4% to the extreme low water level in autumn 2006 and enhanced the drought in the dry season. This study quantified the impact of the bathymetric changes on the lake water levels, thereby providing a better understanding of the potential effects of continued sand mining operations and providing scientific explanations for the considerable variations in the hydrological regimes of Poyang Lake. Moreover, this study attempts to provide a reference for the assessment of similarly dramatic bathymetric changes in complex floodplain lakes.

In this study, 11 extreme precipitation indices were selected to examine the spatiotemporal variation of extreme precipitation in the Poyang Lake Basin during 1960–2017. The responses of extreme precipitation indices to El Nino/Southern Oscillation (ENSO) events of different Pacific Ocean areas were further investigated. The results show that the temperature in the Poyang Lake Basin has increased significantly since the 1990s, and the inter-decadal precipitation fluctuated. Most extreme precipitation indices showed an increasing trend with abrupt changes occurring around 1991. Spatially, most of the extreme precipitation indices decreased from northeast to southwest. The increasing trend of most indices in the center and south of the basin was relatively prominent. The linear correlations between the extreme precipitation indices and Nino 1 + 2 were the most significant. On the timescale of 2–6 years, a common oscillation period between the extreme precipitation of the basin and the four ENSO indices can be observed. After 2010, the positive correlation between the precipitation of the Poyang Lake Basin and the SST (sea surface temperature) anomalies in the equatorial Pacific increased significantly. Additionally, annual total wet–day precipitation in most areas of the Poyang Lake Basin increased with varying degrees in warm ENSO years. The results of this study will improve the understanding of the complex background and driving mechanism of flood disasters in the Poyang Lake Basin.

In recent years, dramatic decline in China’s largest freshwater lake, Poyang Lake, has raised wide concerns about water supply and ecological crises in the middle–lower Yangtze River reaches. To assist in resolving the debates regarding the low water regime of the lake, the current study quantitatively assessed the enhanced water level decline from the changing underlying surface in the Poyang Lake region. It is the first time that the magnitude, temporal–spatial difference, trend development and background mechanism of lake water level variation and its causes are studied comprehensively. The results revealed that the changing underlying surface in the lake region has caused an average decline of annual water level of 0.26 m ~ 0.75 m across the lake during 2000–2014, which shows great seasonal and spatial differences. The enlarged outflow cross–section due to extensive sand mining was the major reason for the effect on water level decline in the northern lake. While, increased water surface gradient should be attributed to water level decline in the southern lake. The long–term increasing trend of annual lake water level decline reflects the cumulative effects of lake bottom topography change caused by the continuous south movement of sand mining activities.

The relative timing of peak flows (RTPF) from tributaries has significant influence on flood occurrence at their confluence. This study is aimed at 1) analyzing the characteristics of the RTPF of the five recharging rivers in the Poyang Lake catchment and the Yangtze River during the period of 1960–2012, and 2) employing a physically-based hydrodynamic model (MIKE 21) to quantify the effects of RTPF on flood behavior in the Poyang Lake (the largest freshwater lake in China). The results show that short RTPF, or close occurrence of peak flows, triggers flood in the Poyang Lake more easily. More than 75% of total flood events in the study period occurred with RTPF less than 60 days, and more than 55% of the events occurred with RTPF less than 30 days. The hydrodynamic simulation revealed that the date of flood peak in the lake was postponed by 4−7 days and the flood stage raised by 0.69 m because of the delay of peak flows from the upstream rivers/tributaries. On the other hand, earlier start of the Yangtze River peak flow led to flood peak in the lake 6−13 days earlier . Additionally, the duration of high lake water levels was extended by 9−12 days when the RTPF shortened, and the flood hydrograph of the Poyang Lake changed from a flat to a flashy type. These results indicate that an enlarged RTPF between the upstream rivers and the Yangtze River could be an effective way to prevent flood disasters in the Poyang Lake, a method apparently being adopted in the operation of the Three Gorges Dam. The RTPF should be considered and integrated when developing flood prevention and management plans in the Poyang Lake, as well as in other similar regions in the world.

The inherent regularities of hydrological processes will not be stationary under the changing environment, making the evaluation of hydrological characteristics and trend forecasting face great uncertainty. Based on the observed streamflow series in the Poyang Lake catchment during the period 1960–2013, this study investigated the evolution characteristics and future trend of water resources. The extracted trend component by wavelet decomposition and the reliability of trend forecasting by rescaled range analysis (R/S analysis) were verified and assessed by a non-parametric statistical test. Results indicate a change point at 1995 when the trend of annual streamflows across the catchment changed. Periodic components indicated that the lake basin seems to enter into an increasing process under inter-decadal scale, while decreasing under inter-annual scale in the near future. R/S analysis revealed that annual streamflow series of most stations in Poyang Lake show ‘weaker’ or ‘very weak’ persistence. For the whole study period, Hurst exponents of most stations are less than 0.5 (0.224–0.339), therefore, opposite from the increasing trend of historical series, decreasing trend is forecasted for the basin. However, due to the effect of intensified human activities in the Fuhe sub-basin, the reliability of R/S analysis on trend forecasting is disturbed at Lijiadu station.

The occurrence of flood and drought frequency is highly correlated with the temporal fluctuations of streamflow series; understanding of these fluctuations is essential for the improved modeling and statistical prediction of extreme changes in river basins. In this study, the complexity of daily streamflow fluctuations was investigated by using multifractal detrended fluctuation analysis (MF-DFA) in a large heterogeneous lake basin, the Poyang Lake basin in China, and the potential impacts of human activities were also explored. Major results indicate that the multifractality of streamflow fluctuations shows significant regional characteristics. In the study catchment, all the daily streamflow series present a strong long-range correlation with Hurst exponents bigger than 0.8. The q-order Hurst exponent h(q) of all the hydrostations can be characterized well by only two parameters: a (0.354 ≤ a ≤ 0.384) and b (0.627 ≤ b ≤ 0.677), with no pronounced differences. Singularity spectrum analysis pointed out that small fluctuations play a dominant role in all daily streamflow series. Our research also revealed that both the correlation properties and the broad probability density function (PDF) of hydrological series can be responsible for the multifractality of streamflow series that depends on watershed areas. In addition, we emphasized the relationship between watershed area and the estimated multifractal parameters, such as the Hurst exponent and fitted parameters a and b from the q-order Hurst exponent h(q). However, the relationship between the width of the singularity spectrum (Δα) and watershed area is not clear. Further investigation revealed that increasing forest coverage and reservoir storage can effectively enhance the persistence of daily streamflow, decrease the hydrological complexity of large fluctuations, and increase the small fluctuations.

As one of the fastest developing regions in China, the middle-lower Yangtze River (MLYR) is vulnerable to floods and droughts. With obtained time series of annual highest water level (HWL), annual lowest water level (LWL) and the corresponding river discharges from three gauging stations in MLYR that covering the period 1987–2011, the current study evaluated the change characteristics of annual extreme water levels and the correlation with river discharges by using the methods of trend test, Mann-Whitney-Pettitt (MWP) test and double mass analysis. Major result indicated a decreasing/increasing trend for annual HWL/LWL of all stations in MLYR during the study period. A change point in 1999 was identified for annual HWL at the Hankou and Datong stations. The year 2006 was found to be the critical year that the relationship between annual extreme water levels and river discharges changed in the MLYR. With contrast to annual LWL in MLYR, further investigation revealed that the change characteristics of annual HWL were highly consistent with regional precipitation in the Yangtze River Basin, while the linkage with Three Gorges Dam (TGD) operation is not strong. Our observation also pointed out that the effect of serious down cutting of the riverbed and the enlargement of the cross-section area during the initial period of TGD operation caused the downward trend of the relationship between annual LWL and river discharge. Whereas, the relatively raised river water level before the flood season due to TGD regulation since 2006 explained for the changing upward trend of the relationship between annual HWL and river discharge.

Reference evapotranspiration (ETr) is one of the important parameters in the hydrological cycle. The spatio-temporal variation of ETr and other meteorological parameters that influence ETr were investigated in the Jialing River Basin (JRB), China. The ETr was estimated using the CROPWAT 8.0 computer model based on the Penman–Montieth equation for the period 1964–2014. Mean temperature (MT), relative humidity (RH), sunshine duration (SD), and wind speed (WS) were the main input parameters of CROPWAT while 12 meteorological stations were evaluated. Linear regression and Mann–Kendall methods were applied to study the spatio-temporal trends while the inverse distance weighted (IDW) method was used to identify the spatial distribution of ETr. Stepwise regression and partial correlation methods were used to identify the meteorological variables that most significantly influenced the changes in ETr. The highest annual ETr was found in the northern part of the basin, whereas the lowest rate was recorded in the western part. In the autumn, the highest ETr was recorded in the southeast part of JRB. The annual ETr reflected neither significant increasing nor decreasing trends. Except for the summer, ETr is slightly increasing in other seasons. The MT significantly increased whereas SD and RH were significantly decreased during the 50-year period. Partial correlation and stepwise regression methods found that the impact of meteorological parameters on ETr varies on an annual and seasonal basis while SD, MT, and RH contributed to the changes of annual and seasonal ETr in the JRB.

Under the background of climate variability and anthropogenic stresses, changes of the runoff and sediment processes have drawn increasing concerns during the past decades. Analyzing the evolution characteristics and causes of runoff and sediment load is critical for the sustainable development of water resource and terrestrial ecosystems of river basins. This study presents an integrated approach for analyzing the evolution characteristics of the annual runoff and sediment load, including the trend, periodicity, change point and their correlations in the Wujiang River basin (WRB) –a typical mountainous river system in southwest China, based on the observed data during the period 1970–2016. On this basis, the contributions of climate variability and human activities on runoff change were first distinguished by using a widely applied Budyko-based hydrological sensitivity method, and then the quantified result was further applied in the attribution analysis of river sediment load change. Research results revealed that the change patterns of runoff and sediment processes, such as the trend, periodicity and potential change point, as well as the relationships of precipitation-runoff and runoff-sediment load are quite different in the WRB. Quantitative assessment revealed that climate variability contributes to 71.5%–85.6% changes of mean annual runoff in 1985–1994, 1995–2004 and 2005–2016 with reference to the baseline period of 1970–1984. In contrary, human activities dominate the reduction of sediment load in the river, and the contribution rate ranged in 67.2%–107.5%. Variations of annual runoff in the WRB was the direct result of climate variability, while land use change played a secondary role. The construction of cascade hydropower reservoirs, particularly in the upper and middle reaches of the Wujiang River is fundamentally responsible for the significant decreasing and the weakened periodicity of sediment load as well as the changed runoff-sediment load correlation at Wulong station in recent years. However, this influence was not big enough to modify the regime of annual runoff.

As a large open lake that connects to the lower Yangtze River, the Poyang Lake, China, has persisted dramatic water level decline since 2003. For better management of lake water resources and ecosystem, this study quantitatively examined the contributions and spatiotemporal differences of compounding influencing factors to this hydrological change. Attempts were achieved through the reconstruction of lake water level series by two combined neural network models. The results indicate that with reference to the period 1980–1999, the average contributions to lake decline during 2003–2014 of lake-bottom topography change, the operation of the Three Gorges Dam (TGD), and climate change and other human activities over the Yangtze River basin were 50%, 18%, and 32%, respectively. The response of the lake water level to the three factors shows obvious spatiotemporal differences due to different influencing mechanisms. It is worth noting that the effect of lake-bottom topography change is still increasing across the lake. In addition, the reduction of precipitation in the Yangtze River basin should be highly correlated to the water level decline of the lake. From the perspective of maintaining a certain water level of the lake and preventing continuous decline and shrinkage, constructing the proposed water control structure would be an effective solution.

Understanding of the vegetation dynamics is essential for addressing the potential threats of terrestrial ecosystem. In recent years, the vegetation coverage of the Yangtze River Basin (YRB) has increased significantly, yet the spatio-temporal variations and potential driving meteorological factors of carbon use efficiency (CUE) under the context of global warming are still not clear. In this study, MODIS-based public-domain data during 2000–2015 was used to analyze these aspects in the YRB, a large river basin with powerful ecological functions in China. Spatio-temporal variations of CUE in different sub-basins and land cover types were investigated and the correlations with potential driving meteorological factors were examined. Results revealed that CUE in the YRB had strong spatiotemporal variability and varied remarkably in different land cover types. For the whole YRB, the average CUE of vegetated land was 0.519, while the long-term change trend of CUE was obscure. Along the rising altitude, CUE generally showed an increasing trend until the altitude of 3900 m and then followed by a decreasing trend. CUE of grasslands was generally higher than that of croplands, and then forest lands. The inter-annual variation of CUE in the YRB is likely to be driven by precipitation as a strong positive partial correlation between the inter-annual variability of CUE and precipitation was observed in most of sub-basins and land cover types in the YRB. The influence of temperature and relative humidity is also outstanding in certain regions and land cover types. Our findings are useful from the view point of carbon cycle and reasonable land cover management under the context of global warming.

Background Informed consent (IC) is a fundamental element of modern clinical medicine based on the spirit of individual autonomy. Patients’ comprehension of the key elements of clinical IC is often poor. Aims and Objectives This study aimed to explore patients’ perceptions and expectations of IC process in invasive and surgical procedures. Design A cross-sectional descriptive study was carried out in Shanghai, China. Methods A self-administered structured questionnaire was developed to evaluate patients’ perceptions and expectations of the IC process. In total, 317 individuals were included in the final analysis. Results Majority (73.8%) of the process was undertaken one day prior to the procedure and nearly half (47.6%) lasted less than 15 minutes. Most (96.8%) patients were given verbal explanation information by healthcare professionals. The nature of illness, potential risks and complications (74.1%) and the necessity of the procedure (69.4%) were mostly memorized while alternative treatments rarely (13.6%). Patients expected their family members involved in the decision making and could be provided more time to read the IC document and prepare for the decision-making. What the patients got was significantly different from what they expected in the following aspects, such as who participated in IC, where and when it took place, how long it lasted and main contents that should be discussed in IC (P

Drought–flood abrupt alternation (DFAA) is one of the remarkable manifestations of the summer monsoon anomaly at the subseasonal scale and can result in severe damage. This study identified and analyzed DFAA in terms of streamflow in the Poyang Lake catchment over the last 50 years based on a DFAA index (DFAAI). The study also investigated the intra-annual distribution characteristics and long-term tendencies associated with DFAA, as well as the relationship with precipitation patterns. A statistical analysis showed that drought-to-flood events in the Poyang Lake catchment generally occur in March and April, while flood-to-drought events occur in July and August. A Mann–Kendall test indicated a long-term decreasing trend in DFAAI in March and April and a slight increasing trend in July and August; however, the trends were not statistically significant. Flood-to-drought events occurred more frequently than did drought-to-flood events at the decadal scale, especially in the 1960s and 1970s. The particular distribution of precipitation in the Poyang Lake catchment mainly determined the occurrence patterns of DFAA events, but intensive human activities are also significant factors that have decreased and mitigated DFAA disasters since the 1980s in the Poyang Lake catchment.

Backflow, the temporary reversal of discharge at the outlet of a lake, is an important mechanism controlling flow and transport in many connected river–lake systems. This study used statistical methods to examine long-term variations and primary causal factors of backflow from the Yangtze River to a laterally connected, large floodplain lake (Poyang Lake, China). Additionally, the effects of backflow on the lake hydrology were explored using a physically based hydrodynamic model and a particle-tracking model. Although backflow into Poyang Lake occurs frequently, with an average of 16 backflow events per year, and varies greatly in magnitude between years, statistical analysis indicates that both the frequency and magnitude of backflow reduced significantly during 2001–2010 relative to the previous period of 1960–2000. The ratio of Poyang Lake catchment inflows to Yangtze River discharge can be used as an indication of the daily occurrence of backflow, which is most likely to occur during periods when this ratio is lower than 5%. Statistical analysis also indicates that the Yangtze River discharge is the main controlling factor of backflow during July to October, rather than catchment inflows to the lake. Hydrodynamic modelling reveals that, in general, backflow disturbs the normal northward water flow direction in Poyang Lake and transports mass ~20 km southward into the lake. The effects of backflow on flow direction, water velocities and water levels propagate to virtually its upstream extremity. The current study represents a first attempt to explore backflow and causal factors for a highly dynamic floodplain lake system. An improved understanding of Poyang Lake backflow is critical for guiding future strategies to manage the lake, its water quality and ecosystem value, given proposals to modify the lake–river connectivity. Copyright © 2016 John Wiley & Sons, Ltd.

Wetlands are thought to be the most unique ecosystem in the world which plays an important role in water and material circulation. However, investigation of ecosystem dynamics in those lake floodplain wetlands that suffering rapid and significant short-term water level fluctuation is quite a challenge. In this study, the short- and long-term characteristics of vegetation NPP (net primary productivity) and their driving mechanism were investigated in the Poyang Lake floodplain wetland, an important international wetland that listed in the Global Eco-region by the World Wildlife Fund (WWF). Attempts were achieved through validating the Carnegie-Ames-Stanford Approach (CASA) model based on observed biomasses of different vegetation types and reconstructed continuous high spatiotemporal resolution (30 m and 16 days) of NDVI data during 2000–2015 according to the fused Landsat and MODIS data. Major result indicates that the intra-annual variation of NPP of most vegetation types shows two peaks in a year due to combined effects of vegetation growth rhythm and seasonal exposure of the lake floodplain. Annual NPP of the lake floodplain ranges in 360.09–735.94 gC/m2 and shows an increasing trend during the study period. The change of NPP in space indicates that the distribution elevation of the major vegetation types decreased and evoluted toward the center lake floodplain. Different from the terrestrial ecosystem, inundation duration is the dominant factor that controls NPP dynamics in the lake floodplain, while the influences of other meteorological factors are much weakened. Recent decline of lake water level was the major reason for the spatio-temporal evolution of annual and seasonal vegetation NPP in the lake floodplain.

Case-based Learning was an effective and highly efficient teaching approach that was extensively applied in education systems across a variety of countries. Critical thinking ability is an important indicator for access the study ability for baccalaureate nursing education.The study aimed to explore the effect of "nursing case-based learning" course on the critical thinking ability of nursing student.A total of 80 students who were in Junior were included in this study. The experimental group included 40 students who selected "nursing case-based learning" course. The control group included 40 students who selected the traditional teaching course.The critical thinking disposition inventory (CTDI-CV) was used to evaluate the effects of the critical thinking abilities during the 1st week (pre-test), the 9th week (mid-test), and the 18th week (post-test).There are no statistically significant differences between two groups in the pre-test thinking abilities (P 0.05). After nine weeks, the critical thinking abilities of experimental group were significantly higher than control group (P 0.05). Three obtained time-points had statistically significant differences of control and experimental group (P 0.05).The "nursing case-based learning" was an effective course to develop the critical thinking abilities of nursing students. Strict instructional design was the guarantee for the smooth implementation of "nursing case-based learning" course.

Based on the estimation of standardized precipitation–evapotranspiration index (SPEI) and standardized runoff index (SRI), this study investigated the variability and correlation of hydrological drought and meteorological drought in a humid climate region – the Poyang Lake catchment in China. Results indicate that the occurrences of hydrological droughts in the catchment are different from those of meteorological drought on both a seasonal and annual basis. However, annual variability of both indices showed the same periodic variation characteristics during the study period. With comparison of the performance of SPEI and SRI time series at different timescales, our observation reveals that the two drought indices show a higher degree of similarity and correlation as timescales increased. In addition, SRI is found to be less variable than SPEI at shorter timescales and it shows an obvious hydrologic delay of about 1–2 months in response to SPEI at timescales >12 months. Due to hydrologic detention of subsurface soil moisture, shallow groundwater and perhaps reservoir storage, a 2-month timescale of SPEI is found to be more appropriate for river discharge monitoring, especially for those rivers with similar drainage area, climate and geographical conditions as in this study region.

The dry-wet abrupt transition (DWAT) is a typical anomaly of precipitation at the subseasonal scale and may result in a severer and greater hydro-meteorological hazard. This paper identified and examined the DWAT events in terms of precipitation in Poyang Lake basin, including both from dry to wet (DTW) and from wet to dry (WTD), during the period of 1960–2010 and analyzed its characteristics of temporal and spatial distribution and intra- and inter-annual tendencies based on the Mann–Kendall (M–K) test. The results revealed that the DTW was inclined to occur in March, but WTD in July and September, the inter-annual variation of the DWAT index showed a feeble long-term increasing trend in July and a decreasing trend in September with a Z-statistic of 1.81 and −1.44, respectively, although none of these trends achieved the statistical significance level (α = 0.05), the north parts of Poyang Lake basin experienced more DWAT events during the last 50 years in which the occurrence of WTD is more frequent than that of DTW. The outcomes of the study will help mitigate and regulate the flood and drought in Poyang Lake basin, as well as in other regions.

In recent years, a dramatic decline in Poyang Lake water levels and a shrinking water surface have raised concerns about water security and the wetland ecosystem. Changes in bottom topography due to sand mining activities in the lake was supposed to be one of the influencing factors of these changes. In response to this issue, the current study analyzed the change of lake bottom topography from observed digital elevation model (DEM) data, and quantitatively assessed the spatial and temporal responses of lake hydrology based on the framework of the neural network and the sediment effect was examined afterward. Results showed a total volume of 11.54 &times, 108 m3/year (about 0.96 &times, 108 m3/year or 1.58 &times, 108 t/year sediment) in net change of lake bottom topography in recent years, among which 97% was directly exported by commercial sand mining. During the study period, 2000&ndash, 2011, intensive sand mining extended the central part of Poyang Lake and widened and deepened the outflow channel of the northern lake. This great change of lake bottom topography caused an average annual increase of 182.74 m3/s of lake outflow and a decline of 0.23 m&ndash, 0.61 m in water levels across the lake. However, lake water levels are not consistent and show remarkable spatial and seasonal differences. The effects of changes in lake bottom topography on lake hydrological processes continue to grow as sand mining activities in the lake continue. More research on the environmental impacts is required for sustainable management of the lake ecosystem.

This paper presents a quantitative investigation of the variability of meteorological dry/wet conditions of the Poyang Lake catchment during 1960–2010 by using the standardized precipitation-evapotranspiration index (SPEI) based on daily observations of 14 meteorological stations across the catchment. Extending from previous studies, the background of the encounter and overlap of multitimescales of meteorological dry/wet episodes for several severe drought and flood events were discussed. In addition, the possible impacts of temperature changes on dry/wet variability were also examined by the comparison of SPEI and standardized precipitation index (SPI) variations at multitimescales during the study period. Major results show that the occurrence of dry/wet condition has become increasingly frequent in the recent two decades, especially the extreme wet episodes in 1990s and the extreme dry episodes in 2000s. Historically, the encounter and overlap of multitimescales of meteorological dry/wet episodes plays an important role in the occurrence of several severe drought and flood events. The study concluded that the impact of temperature anomaly to the dry/wet variability cannot be neglected.