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The transport sector accounts for about one quarter of worldwide anthropogenic carbon dioxide emissions. Since a robust growth in transport activity is expected over the coming decades, reducing associated emissions to mitigate human-caused climate change is a particular challenge. In order to achieve high-quality comparative monitoring, to develop scenarios for future emissions, and to enable a robust assessment of climate protection measures, the allocation of emissions to the subsector level is a necessary prerequisite. The DLR project ELK – EmissionsLandKarte (en.: emission map) contributes here in several respects: (1) requirements are specified in an application-based manner, i.e. compatibility with existing inventories, such as the ones generated for IPCC, is ensured and insufficiencies in spatial resolution and methodological detail are addressed, (2) an input database congruent with both statistical data and SSP scenarios is provided, and (3) bottom-up calculations are performed that allow attribution of climate impacts to specific transport services, as well as prospective analyses where, for example, activity levels change or alternative fuels affect regional emission factors. The resulting prototype global gas and particle emission inventories for land transport, aviation and shipping reflect the status quo as of 2019.For land transport, fine-grained activity and vehicle fleet data as well as technology-specific emission factors are applied. This allows emissions from passenger and freight transport to be disaggregated by mode and vehicle type. New approaches for spatial disaggregation of emissions will increase transparency of the methodology. For aviation, calculations are based on fleet composition and transport performance for both passenger and cargo traffic at the airport pair level, while real flight tracks serve as the foundation for spatial allocation. For both transport sectors, complementary analyses are performed to characterize particulate emissions in order to fill gaps in data availability. For shipping, transport performance on inland waterways and maritime routes are considered, including technical data describing propulsion and bunkering. Finally, all mode-specific results are subjected to an innovative uncertainty assessment aligned with the needs of other emission inventory creators through a detailed evaluation per uncertainty factor, as well as aggregated values for climate modelers and practitioners. The consistent assessment of uncertainty factors along the entire calculation chain, such as activity levels, emission factors, and proxy data used for spatial or temporal disaggregation, promotes comparability across all transport sectors. In this paper, we outline the new methodological approaches for mapping transport emissions and present first results.

Latar belakang: Benign prostatic hyperplasia atau pembesaran prostat jinak merupakan penyakit yang biasa terjadi pada pria usia tua, ditandai dengan kelainan histologis yang khas disyarati dengan proliferasi sel-sel prostat. Gejala saluran kemih bagian bawah atau lower urinary tract symptoms merupakan kombinasi gejala yang sangat umum didapatkan pada pasien dengan pembesaran prostat jinak. Terdapat banyak faktor yang dapat mempengaruhi kejadian benign prostatic hyperplasia, salah satunya adalah diabetes mellitus. Diabetes mellitus adalah kelompok penyakit metabolik yang ditandai dengan adanya hiperglikemia yang disebabkan oleh terjadinya gangguan sekresi insulin, gangguan kerja insulin ataupun mekanisme keduanya. International Diabetes Federation memperkirakan bahwa insidensi kejadian diabetes mellitus akan terus semakin tinggi hingga 700 juta orang di tahun 2045. Metode: Studi/kajian literatur dengan pendekatan systematic review, Sumber data yang digunakan adalah data sekunder yang diperoleh dari SpringerLink, ScienceDirect, ResearchGate, ProQuest, PERPUSNAS, Neliti, Microsoft Academic, GARUDA, Ebscohost, DOAJ, dan Google Scholar. Kata kunci yang digunakan adalah hubungan, diabetes mellitus, dan pembesaran prostat jinak. Didapatkan 41 literatur yang memenuhi kriteria. Sintesis data menggunakan metode SPIDER. Hasil: 41 jurnal internasional dan nasional yang di review terdapat 30 (73,17%) jurnal yang hasilnya menyatakan bahwa diabetes mellitus berhubungan dengan kejadian benign prostatic hyperplasia, hal ini didasari oleh mekanisme aktivitas saraf simpatis yang berlebihan, aterosklerosis, aktivitas IGF, perubahan metabolisme hormon seks, dan inflamasi. Kesimpulan: Terdapat hubungan antara diabetes mellitus dengan kejadian benign prostatic hyperplasia. Kata Kunci: Pembesaran prostat jinak, Diabetes mellitus, Hubungan

Patients with occlusion myocardial infarction (OMI) and no ST-elevation on presenting ECG are increasing in numbers. These patients have a poor prognosis and would benefit from immediate reperfusion therapy, but we currently have no accurate tools to identify them during initial triage. Herein, we report the first observational cohort study to develop machine learning models for the ECG diagnosis of OMI. Using 7,313 consecutive patients from multiple clinical sites, we derived and externally validated an intelligent model that outperformed practicing clinicians and other widely used commercial interpretation systems, significantly boosting both precision and sensitivity. Our derived OMI risk score provided superior rule-in and rule-out accuracy compared to routine care, and when combined with the clinical judgment of trained emergency personnel, this score helped correctly reclassify one in three patients with chest pain. ECG features driving our models were validated by clinical experts, providing plausible mechanistic links to myocardial injury.

Pediatric prehospital encounters are proportionally low-frequency events. National pediatric readiness initiatives have targeted gaps in prehospital pediatric assessment and management. Regional studies suggest that pediatric vital signs are inconsistently obtained and documented. We aimed to assess national emergency medical services (EMS) data to evaluate completeness of assessment documentation for pediatric versus adult patients and to identify the documentation of condition-specific assessments. We performed a retrospective cross-sectional analysis of EMS encounters from the National Emergency Medical Services Information System for 2019, including all 9-1-1 encounters resulting in transport. Our primary outcome was the proportion of encounters with complete vital signs (heart rate, respiratory rate, and systolic blood pressure) documented by pediatric age category relative to adult encounters. Pediatric patients were considered as those less than 18 years old. Our secondary outcome was condition-specific assessments for encounters with respiratory emergencies, cardiac complaints, and trauma. We performed multivariable logistic regression to calculate odds ratios (OR) and 95% confidence intervals (95% CI) for vital signs documentation by age after adjusting for sex, injury status, transport type (advanced vs basic life support), census region, urbanicity, organization nonprofit status, and organization type. Of 18,918,914 EMS encounters, 6.4% involved pediatric patients. Documentation of complete vital signs was lowest in those

This study aimed to compare statewide emergency medical services protocols for the management of pediatric respiratory distress.We performed a descriptive study of emergency medical services protocols for the management of pediatric respiratory distress in the United States, excluding those without model or mandatory protocols. We compared medication recommendations for specific disease processes, including asthma, croup, epiglottitis, anaphylaxis, generalized respiratory distress, intubation, and drug assisted intubation.Thirty-four state protocols were included. All had protocols to address the management of pediatric respiratory distress. There was high agreement in albuterol use for bronchospasm and epinephrine use in anaphylaxis. Epinephrine was recommended in all anaphylaxis protocols, 27 croup protocols (79%), and 3 epiglottitis protocols (9%). Six states (18%) called for albuterol in patients with generalized respiratory distress. Steroid recommendations and indications had variance among states; 26 states (76%) allowed steroid use in patients with asthma, 19 states (56%) recommended steroid use in anaphylaxis, and 11 (32%) recommended steroid use in croup protocols. The route for steroid administration also varied among protocols. Five states (15%) allowed continuous positive airway pressure application in pediatric patients, whereas endotracheal intubation and rapid sequence intubations had varying requirements as well as recommendations for use. Twelve (35%) listed impending or current respiratory failure as an indication, whereas other states had specific markers, such as Glasgow Coma Scale or oxygen saturation, as indications.All included states had specific recommendations for the management of pediatric respiratory distress. There was consistency in recommendations for albuterol use for wheezing and epinephrine use for anaphylaxis. However, there was wide variability in other uses for epinephrine, steroid administration, continuous positive airway pressure use, and specific treatments for croup and epiglottitis. The findings of this study provide a base for important future evidence-based protocol developments and changes in prehospital pediatric respiratory distress treatment.

Introduction Out of hospital cardiac arrest (OHCA) patients are often transported to the closest emergency department (ED) or cardiac center for initial stabilization and may be transferred for further care. We investigated the effects of delay to transfer on in hospital mortality at a receiving facility. Methods We included OHCA patients transported from the ED by a single critical care transport service to a quaternary care facility between 2010 and 2018. We calculated dwell time as time from arrest to critical care transport team contact. We abstracted demographics, arrest characteristics, and interventions started prior to transport arrival. For the primary analysis, we used logistic regression to determine the association of dwell time and in-hospital mortality. As secondary outcomes we investigated for associations of dwell time and mortality within 24 h of arrival, proximate cause of death among decedents, arterial pH and lactate on arrival, sum of worst SOFA subscales within 24 h of arrival, and rearrest during interfacility transport. Results We included 572 OHCA patients transported from an outside ED to our facility. Median dwell time was 113 (IQR = 85–159) minutes. Measured in 30 min epochs, increasing dwell time was not associated with in-hospital mortality, 24-h mortality, cause of death and initial pH, but was associated with lower 24-h SOFA score (p = 0.01) and lower initial lactate (p = 0.03). Rearrest during transport was rare (n = 29, 5%). Dwell time was associated with lower probability of rearrest during transport (OR = 0.847, (95% CI 0.68–1.01), p = 0.07). Conclusions Dwell time was not associated with in-hospital mortality. Rapid transport may be associated with risk of rearrest. Prospective data are needed to clarify optimal patient stabilization and transport strategies.

BACKGROUND: The 12-lead ECG plays an important role in triaging patients with symptomatic coronary artery disease, making automated ECG interpretation statements of “Acute MI” or “Acute Ischemia” crucial, especially during prehospital transport when access to physician interpretation of the ECG is limited. However, it remains unknown how automated interpretation statements correspond to adjudicated clinical outcomes during hospitalization. We sought to evaluate the diagnostic performance of prehospital automated interpretation statements to four well-defined clinical outcomes of interest: confirmed ST- segment elevation myocardial infarction (STEMI); presence of actionable coronary culprit lesions, myocardial necrosis, or any acute coronary syndrome (ACS). METHODS: An observational cohort study that enrolled consecutive patients with non-traumatic chest pain transported via ambulance. Prehospital ECGs were obtained with the Philips MRX monitor from the medical command center and re-processed using manufacturer-specific diagnostic algorithms to denote the likelihood of >>>Acute MI<<< or >>>Acute Ischemia<<

To protect water resources, halt waterborne diseases, and prevent future water crises, photocatalytic degradation of water pollutants arouse worldwide interest. However, considering the low degradation efficiency and risk of secondary pollution displayed by most metal-based photocatalysts, highly efficient and environmentally friendly photocatalysts with appropriate band gap, such as carbon dots (CDs), are in urgent demand. In this study, the photocatalytic activity of gel-like CDs (G-CDs) was studied using diverse water pollution models for photocatalytic degradation. The degradation rate constants demonstrated a remarkably enhanced photocatalytic activity of G-CDs compared with most known CD species and comparability to graphitic carbon nitride (g-C3N4). In addition, the rate constant was further improved by 1.4 times through the embedment of g-C3N4 in G-CDs to obtain CD-C3N4. Significantly, the rate constant was also higher than that of g-C3N4 alone, revealing a synergistic effect. Moreover, the use of diverse radical scavengers suggested that the main contributors to the photocatalytic degradation with G-CDs alone were superoxide radicals (O2-) and holes that were, however, substituted by O2- and hydroxyl radicals (OH) due to the addition of g-C3N4. Furthermore, the photocatalytic stabilities of G-CDs and CD-C3N4 turned out to be excellent after four cycles of dye degradation were performed continuously. Eventually, the nontoxicity and environmental friendliness of G-CDs and CD-C3N4 were displayed with sea urchin cytotoxicity tests. Hence, through various characterizations, photocatalytic degradation and cytotoxicity tests, G-CDs proved to be an environmentally friendly and highly efficient future photocatalyst.

BackgroundProgression of chronic lung disease often leads to the requirement for a lung transplant (LTX). Despite improvements in short-term survival after LTX, chronic lung allograft dysfunction (CLAD) remains a critical challenge for long-term survival. This study investigates the relationship between the metabolome of bronchoalveolar lavage fluid (BALF) from subjects post-LTX with underlying lung disease and CLAD severity.MethodsUntargeted LC-MS/MS metabolomics was performed on 960 BALF samples collected over 10 years from LTX recipients with alpha-1-antitrypsin disease (AATD, n=22), cystic fibrosis (CF, n=46), chronic obstructive pulmonary disease (COPD, n = 79) or pulmonary fibrosis (PF, n=47). Datasets were analyzed using machine learning and multivariate statistics for associations with underlying disease and final CLAD severity.ResultsBALF metabolomes varied by underlying disease state, with AATD LT recipients being particularly distinctive (PERMANOVA,p=0.001). We also found a significant association with the final CLAD severity score (PERMANOVA,p=0.001), especially those with underlying CF. Association with CLAD severity was driven by changes in phosphoethanolamine (PE) and phosphocholine lipids that increased and decreased, respectively, and metabolites from the bacterial pathogenPseudomonas aeruginosa. P. aeruginosasiderophores, quorum-sensing quinolones, and phenazines were detected in BALF, and 4-hydroxy-2-heptylquinoline (HHQ) was predictive of the final CLAD stage in samples from CF patients (R=0.34;p≤0.01). Relationships between CLAD stage andP. aeruginosametabolites were especially strong in those with CF, where 61% of subjects had at least one of these metabolites in their first BALF sample after transplant.ConclusionsBALF metabolomes after LTX are distinctive based on the underlying disease and reflect final CLAD stage. In those with more severe outcomes, there is a lipid transition from PC to predominantly PE phospholipids. The association ofP. aeruginosametabolites with CLAD stages in LTX recipients with CF indicates this bacterium and its metabolites may be drivers of allograft dysfunction.Key messagesDespite the high prevalence of CLAD among LTX recipients, its pathology is not well understood, and no single molecular indicator is known to predict disease onset. Our machine learning metabolomic-based approach allowed us to identify patterns associated with a shift in the lipid metabolism and bacterial metabolites predicting CLAD onset in CF. This study provides a better understanding about the progression of allograft dysfunction through the molecular transitions within the transplanted lung from the host and bacterial pathogens.

Bile acids (BAs) are steroid detergents in bile that contribute to the absorption of fats and fat-soluble vitamins while shaping the gut microbiome due to their antimicrobial properties. Recently, a novel mechanism of BA metabolism by the gut microbiota was identified involving conjugation with various amino acids. Here, we show this unique biochemistry is mediated by bile salt hydrolase acting as an aminoacyltransferase or transpeptidase (BSH/T). Clostridium perfringens BSH/T rapidly performed acyl-transfer when provided various amino acids and taurocholate, glycocholate or cholate, with an optimum at approximately pH 5.3. Amino acids selected for incorporation by CpBSH/T were pH-dependent and broad in range, though proline and aspartic acid conjugates were not observed. BA conjugation was widespread among gut bacteria but showed unique amino acid preferences depending on the organism. Members of the family Lachnospiraceae had closely related BSH/T amino acid sequences and exhibited similar amino acid conjugation profiles, while horizontal gene transfer of bsh in some species increased conjugation diversity. Tertiary structure mapping of BSH/T from different gut bacteria implicates active site structure in amino acid selectivity. The products of BSH/T aminoacyltransferase activity were potent antimicrobials but this depended on the amino acid conjugated, with phenylalanine and leucine-conjugates acting as the best inhibitors of other gut commensals and known pathogens. This inhibitory property translated in vivo, as oral gavage of mice with different microbially conjugated bile acids altered the cecal and fecal microbiomes. This study shows that transpeptidase activity of BSH/T is a widespread and common property of the enzyme that greatly diversifies the bile acid pool, with the potential to shape the human microbiome.

Climate change is one of the big challenges of our time. A better understanding of how individuals form their evaluation of the risk related to climate change seems to be key to win broad support for climate change mitigation efforts. Extant research indicates that biospheric values (BV) are an important antecedent of individuals' perception of the risk and consequences related to climate change. However, risk perception scholars have only recently started to study how BV relate to individuals' climate change risk perception (CCRP) and much is still to be learned about this relationship. The present study contributes to this growing literature by studying the BV-CCRP relationship in a multinational context. The results suggest that the BV - CCRP relationship varies in strength between different countries. These differences can be explained in part by societies' cultural leanings (i.e., individualism vs. collectivism) and societies' wealth. The present research adds to our understanding of why individuals in different countries perceive climate change related risk differently and how this perception is shaped differently by biospheric values in different countries. In this way, the findings help to build a more nuanced theory of how CCRP are formed. The presented results also have implications for policymakers and NGOs who wish to increase individuals' engagement with climate change and its consequences in different populations. In particular, the findings suggests that it might be necessary to use different strategies in different societies to achieve a greater awareness of climate change related risks.

In his introductions to the encyclopaedic Philosophy of Nature and to the Lectures on the Philosophy of Nature, Hegel distinguishes between three ‘attitudes’ (Verhaltensweisen, Einstellungen) towards nature—the theoretical, the practical and the philosophical attitude. According to him there is a certain ‘contradiction’ or tension between our theoretical attitude towards nature, which makes it an object of scientific inquiry, and the practical attitude that we assume as living rational beings who intervene in nature and shape it according to our purposes. This article focuses on how exactly to pinpoint that tension and on how it is resolved in what Hegel calls the ‘philosophical’ or ‘comprehending’ attitude towards nature.

Modern public transit systems are often run with automated fare collection (AFC) systems in combination with smart cards. These systems passively collect massive amounts of detailed spatio-temporal trip data, thus opening up new possibilities for public transit planning and management as well as providing new insights for urban planners. We use smart card trip data from Taipei, Taiwan, to perform an in-depth analysis of spatio-temporal station-to-station metro trip patterns for a whole week divided into several time slices. Based on simple linear regression and line graphs, days of the week and times of the day with similar temporal passenger flow patterns are identified. We visualize magnitudes of passenger flow based on actual geography. By comparing flows for January to March 2019 and for January to March 2020, we look at changes in metro trips under the impact of the coronavirus pandemic (COVID-19) that caused a state of emergency around the globe in 2020. Our results show that metro usage under the impact of COVID-19 has not declined uniformly, but instead is both spatially and temporally highly heterogeneous., Public transport;Bd 14. 2022, H. 2, S. 343 - 366

Background: Research networks need access to EMS data to conduct pilot studies and determine feasibility of prospective studies. Combining data across EMS agencies is complicated and costly. Leveraging the National EMS Information System (NEMSIS) to extract select agencies’ data may be an efficient and cost-effective method of providing network-level data. Objective: Describe the process of creating a Pediatric Emergency Care Applied Research Network (PECARN) specific NEMSIS data set and determine if these data were nationally representative. Methods: We established data use agreements (DUAs) with EMS agencies participating in PECARN to allow for agency identification through NEMSIS. Using 2019 NEMSIS version 3.4.0 data for EMS events with patients 18 years old and younger, we compared PECARN NEMSIS data to national NEMSIS data. Analyzed variables were selected for their ability to characterize events. No statistical analyses were utilized due to the large sample, instead, differences of ±5% were deemed clinically meaningful. Results: DUAs were established for 19 EMS agencies, creating a PECARN data set with 305,188 EMS activations of which 17,478 (5.7%) were pediatric. Of the pediatric activations, 17,140 (98.1%) were initiated through 9-1-1 and 9,487 (55.4%) resulted in transport by the documenting agency. The national data included 36,288,405 EMS activations of which 2,152,849 (5.9%) were pediatric. Of the pediatric activations 1,704,141 (79.2%) were initiated through 9-1-1 and 1,055,504 (61.9%) were transported by the documenting agency. Age and gender distributions were similar between the two groups, but the PECARN-specific data under-represents Black and Latinx patients. Comparison of EMS provider primary impressions revealed that three of the five most common were similar with injury being the most prevalent for both data sets along with mental/behavioral health and seizure. Conclusion: We demonstrated that NEMSIS can be leveraged to create network specific data sets. PECARN’s EMS data were similar to the national data, though racial/ethnic minorities and some primary impressions may be under-represented. Additionally, more EMS activations in PECARN study areas originated through 9-1-1 but fewer were transported by the documenting agency. This is likely related to the type of participating agencies, their ALS response level, and the diversity of the communities they serve.