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Tropical cyclones are an important cause of forest disturbance, and major storms caused severe structural damage and elevated tree mortality in coastal tropical forests. Model capabilities that can be used to understand post-hurricane forest recovery are still limited. We use a vegetation demography model, the Functionally Assembled Terrestrial Ecosystem Simulator, coupled with the Energy Exascale Earth System Model Land Model (ELM-FATES) to study the processes and the key factors regulating post-hurricane forest recovery. We implemented hurricane-induced forest damage, including defoliation, structural biomass reduction, and tree mortality, performed ensemble model simulations, and used random forest feature importance. For the simulation in the Luquillo Experimental Forest, Puerto Rico, we identified factors controlling the post-hurricane forest recovery, and quantified the sensitivity of key model parameters to the post-hurricane forest recovery. The results indicate a tendency for the Bisley forests to shift toward the light demanding plant functional type (PFT) when the pre-hurricane biomass between the light demanding and shade tolerant PFTs is nearly equal and forests experience hurricane disturbance with mortality >60% for both the two PFTs. Under more realistic conditions where the shade tolerant PFT is initially dominant, mortality >80% is required for a shift toward dominance of the light demanding PFT at Bisley. Hurricane mortality and background mortality are the two major factors regulating post-hurricane forest recovery in simulations. This research improves understanding of the ELM-FATES model behavior associated with hurricane disturbance and provides guidance for dynamic vegetation model development in representing hurricane induced forest damage with varied intensities.

Tropical forest dynamics play a crucial role in the global carbon, water, and energy cycles. However, realistically simulating the dynamics of competition and coexistence between different plant functional types (PFTs) in tropical forests remains a significant challenge. This study aims to improve the modeling of PFT coexistence in the Functionally Assembled Terrestrial Ecosystem Simulator (FATES), a vegetation demography model implemented in the Energy Exascale Earth System Model (E3SM) land model (ELM), ELM-FATES. Specifically, we explore (1) whether plant trait relationships established from field measurements can constrain ELM-FATES simulations and (2) whether machine learning (ML)-based surrogate models can emulate the complex ELM-FATES model and optimize parameter selections to improve PFT coexistence modeling. We conducted three ensembles of ELM-FATES experiments at a tropical forest site near Manaus, Brazil. By comparing the ensemble experiments without (Exp-CTR) and with (Exp-OBS) consideration of observed trait relationships, we found that accounting for these relationships slightly improves the simulations of water, energy, and carbon variables when compared to observations but degrades the simulation of PFT coexistence. Using ML-based surrogate models trained on Exp-CTR, we optimized the trait parameters in ELM-FATES and conducted another ensemble of experiments (Exp-ML) with these optimized parameters. The proportion of PFT coexistence experiments significantly increased from 21 % in Exp-CTR to 73 % in Exp-ML. After filtering the experiments that allow for PFT coexistence to agree with observations (within 15 % tolerance), 33 % of the Exp-ML experiments were retained, which is a significant improvement compared to the 1.4 % in Exp-CTR. Exp-ML also accurately reproduces the annual means and seasonal variations in water, energy, and carbon fluxes and the field inventory of aboveground biomass. This study represents a reproducible method that utilizes machine learning to identify parameter values that improve model fidelity against observations and PFT coexistence in vegetation demography models for diverse ecosystems. Our study also suggests the need for new mechanisms to enhance the robust simulation of coexisting plants in ELM-FATES and has significant implications for modeling the response and feedbacks of ecosystem dynamics to climate change.

Recent advances in satellite observations of solar-induced chlorophyll fluorescence (SIF) provide a new opportunity to constrain the simulation of terrestrial gross primary productivity (GPP). Accurate representation of the processes driving SIF emission and its radiative transfer to remote sensing sensors is an essential prerequisite for data assimilation. Recently, SIF simulations have been incorporated into several land surface models, but the scaling of SIF from leaf-level to canopy-level is usually not well-represented. Here, we incorporate the simulation of far-red SIF observed at nadir into the Community Land Model version 5 (CLM5). Leaf-level fluorescence yield was simulated by a parametric simplification of the Soil Canopy-Observation of Photosynthesis and Energy fluxes model (SCOPE). And an efficient and accurate method based on escape probability is developed to scale SIF from leaf-level to top-of-canopy while taking clumping and the radiative transfer processes into account. SIF simulated by CLM5 and SCOPE agreed well at sites except one in needleleaf forest (R 2 > 0.91, root-mean-square error  0.68). At the global scale, simulated SIF generally captured the spatial and seasonal patterns of satellite-observed SIF. Factors including the fluorescence emission model, clumping, bidirectional effect, and leaf optical properties had considerable impacts on SIF simulation, and the discrepancies between simulate d and observed SIF varied with plant functional type. By improving the representation of radiative transfer for SIF simulation, our model allows better comparisons between simulated and observed SIF toward constraining GPP simulations.

This paper summarized the practice of Traditional Chinese Medicine retention enema and nursing interventions on constipation symptoms in a patient with severe pneumonia. The nurses had carried out a comprehensive assessment on patient’s condition. Based on conventional interventions such as anti-infective therapy, enteral nutritional support, psychological care, Traditional Chinese Medicine retention enema by syndrome differentiation was conducted to improve the recovery of gastrointestinal function and relieve the constipation symptoms of the patient. (本文总结中药保留灌肠治疗1例重症肺炎患者便秘的护理经验。护理人员科学评估, 基于中医辨证, 在抗感染治疗、肠内营养支持、心理护理等常规治疗和护理的基础上, 开展中药保留灌肠干预, 在促进患者胃肠功能恢复的同时, 兼顾补中益气, 有效缓解患者便秘症状, 促进早期康复。)

Atmospheric humidity and soil moisture in the Amazon forest are tightly coupled to the region's water balance, or the difference between two moisture fluxes, evapotranspiration minus precipitation (ET-P). However, large and poorly characterized uncertainties in both fluxes, and in their difference, make it challenging to evaluate spatiotemporal variations of water balance and its dependence on ET or P. Here, we show that satellite observations of the HDO/H2O ratio of water vapor are sensitive to spatiotemporal variations of ET-P over the Amazon. When calibrated by basin-scale and mass-balance estimates of ET-P derived from terrestrial water storage and river discharge measurements, the isotopic data demonstrate that rainfall controls wet Amazon water balance variability, but ET becomes important in regulating water balance and its variability in the dry Amazon. Changes in the drivers of ET, such as above ground biomass, could therefore have a larger impact on soil moisture and humidity in the dry (southern and eastern) Amazon relative to the wet Amazon.

As a multifactorial geriatric syndrome in the elderly, urinary incontinence has a high prevalence and low rate of diagnosis and treatment. The pelvic floor muscle training is a low-risk and low-cost behavioral intervention in relieving symptoms of urinary incontinence. This paper analyzed the studies on influencing factors of pelvic floor muscle training compliance in elderly patients with urinary incontinence, summarized intervention strategies, and provided reference for further research on urinary incontinence in the elderly. (老年尿失禁是一种与多因素相关的老年综合征, 患病率高, 诊治率低。盆底肌训练是一种低风险、低耗费的, 有助于改善尿失禁症状的行为干预方法, 而影响其长期治疗效果的主要因素是坚持盆底肌锻炼的依从性较低。本文通过分析老年尿失禁患者盆底肌训练依从性欠佳的影响因素, 总结干预措施, 旨在为老年人尿失禁问题的研究提供参考。)

The Community Land Model (CLM) is the land component of the Community Earth System Model (CESM) and is used in several global and regional modeling systems. In this paper, we introduce model developments included in CLM version 5 (CLM5), which is the default land component for CESM2. We assess an ensemble of simulations, including prescribed and prognostic vegetation state, multiple forcing data sets, and CLM4, CLM4.5, and CLM5, against a range of metrics including from the International Land Model Benchmarking (ILAMBv2) package. CLM5 includes new and updated processes and parameterizations: (1) dynamic land units, (2) updated parameterizations and structure for hydrology and snow (spatially explicit soil depth, dry surface layer, revised groundwater scheme, revised canopy interception and canopy snow processes, updated fresh snow density, simple firn model, and Model for Scale Adaptive River Transport), (3) plant hydraulics and hydraulic redistribution, (4) revised nitrogen cycling (flexible leaf stoichiometry, leaf N optimization for photosynthesis, and carbon costs for plant nitrogen uptake), (5) global crop model with six crop types and time-evolving irrigated areas and fertilization rates, (6) updated urban building energy, (7) carbon isotopes, and (8) updated stomatal physiology. New optional features include demographically structured dynamic vegetation model (Functionally Assembled Terrestrial Ecosystem Simulator), ozone damage to plants, and fire trace gas emissions coupling to the atmosphere. Conclusive establishment of improvement or degradation of individual variables or metrics is challenged by forcing uncertainty, parametric uncertainty, and model structural complexity, but the multivariate metrics presented here suggest a general broad improvement from CLM4 to CLM5.

This paper summarized the nursing management of a patient with chronic obstructive pulmonary disease (COPD)complicated with acute respiratory failure and plaque psoriasis. Comprehensive nursing interventions such as airway clearance techniques, facial skin care, psoriasis skin care, psychological care and discharge preparation services were carried out to relieve the symptoms, prevent the complications and improve the quality of life of the patient (本文总结1例慢性阻塞性肺疾病(COPD)合并急性呼吸衰竭伴斑块状银屑病患者的护理经验。通过综合护理干预, 如气道廓清技术、面部皮肤护理、银屑病皮肤护理、心理护理及出院准备服务等措施, 预防并发症, 改善患者症状, 有效提高患者生活质量。)

Background The needs of outpatient services, a key accessible health resource, are increasing in an increasingly aging population in China. So rational allocation of outpatient service resources to meet older people's health needs is a key to improving their health level. Objective To explore the factors affecting the utilization of outpatient services in the elderly, to provide feasible suggestions for improving older people's health level and the allocation of medical resources. Methods This study was conducted in 2021 using the data of older people (≥60 years old) attending the CHARLS 2018. The number of using outpatient services in these people in the past month prior to the CHARLS 2018 and associated factors were studied using a system developed based on the framework of Anderson's Behavioral Model of Health Services Use, with sex, age, marital status, the type of hukou (rural or urban), education level, smoking and drinking were classified as predisposing factors, health insurance, monthly household income per capita and the average distance from home to medical institutions as enabling factors, and chronic disease prevalence and self-rated health as need factors. The zero-inflated negative binomial regression (ZINB) was used to identify factors associated with the use of outpatient services. Results In all, 9 551 older people were included for analysis. Among them, non-users of outpatient services in the past month numbered 8 038 (84.16%), and one-time, two-time, and three or more-time users numbered 749 (7.84%), 367 (3.84%), and 397 (4.16%), respectively. The number of using outpatient services differed statistically by the type of hukou, education level, smoking, drinking, health insurance prevalence, monthly household income per capita, chronic disease prevalence, and self-rated health status (P

Evapotranspiration (ET) is a pivotal component in catchment-scale water balance and is essential for informed watershed management. Nevertheless, uncertainties in ET observation or modeling have been hindering effective water resources management. This study addresses this gap by establishing a robust, generalized linear relationship between ET and gross primary productivity (GPP) at the catchment scale. We test the linearity of the relationships between monthly GPP and ET data at 380 near-natural catchments across various climatic and landscape conditions in the contiguous US, yielding Pearson's r≥0.6 for 97% of the 380 catchments. We then develop a regionalization strategy to parameterize this GPP-ET relationship at the catchment scale by identifying and using the linkages between the parameter values and extensively available hydroclimatic and landscape data. We demonstrate the efficacy of the proposed GPP-ET relationship and parameter regionalization strategy by their combined predictive capacity, where the predicted monthly GPP matches well with remote-sensing–based GPP product, achieving Kling-Gupta efficiency (KGE) values ≥0.5 for 92% of the catchments. In addition, we verify the relationship and its parameter regionalization at 35 AmeriFlux sites with KGE ≥0.5 for 25 sites, suggesting that the new relationship is transferable across the site, catchment, and regional scales. Our findings are valuable for improving remote-sensing–based estimation of monthly ET and diagnosing coupled water-carbon simulations in land surface and Earth system models. [ABSTRACT FROM AUTHOR]

The paper focused on the Xining marginal area, providing the concept of land use competitive advantage, employing the PLUS and PFCI model to simulate production–living–ecological (PLE) land in 2030, and revealing the relationship between regional land interactions and sustainable land allocation. The results indicate that the following: (1) By 2030, the land use of the Xining marginal area is primarily production and ecological land, with approximately 0.1% of living land; however, living and production land will increase while ecological land will decrease in general, and the growth momentum of urban and other living space in government-seated regions is stronger. (2) The PLE land does not exhibit a piecemeal expansion pattern, as it is influenced by mountains and rivers. Agricultural production land and grassland ecological land have advantages for development, whereas urban living land has just development potential. (3) Developing the corresponding lands in the dominant regions can result in sustainable land allocation, and five nexus approaches are proposed for the sustainable allocation of PLE land in the Xining marginal region. The study addresses the interaction of different land use types across regions rather than examining them separately, and we provide significant insight into whether the Qinghai Tibet Plateau should be urbanized. [ABSTRACT FROM AUTHOR]

Large spatio‐temporal gradients in the Congo basin vegetation and rainfall are observed. However, its water‐balance (evapotranspiration minus precipitation, or ET − P) is typically measured at basin‐scales, limited primarily by river‐discharge data, spatial resolution of terrestrial water storage measurements, and poorly constrained ET. We use observations of the isotopic composition of water vapor to quantify the spatio‐temporal variability of net surface water fluxes across the Congo Basin between 2003 and 2018. These data are calibrated at basin scale using satellite gravity and total Congo river discharge measurements and then used to estimate time‐varying ET − P over four quadrants representing the Congo Basin, providing first estimates of this kind for the region. We find that the multi‐year record, seasonality, and interannual variability of ET − P from both the isotopes and the gravity/river discharge based estimates are consistent. Additionally, we use precipitation and gravity‐based estimates with our water vapor isotope‐based ET − P to calculate time and space averaged ET and net river discharge within the Congo Basin. These quadrant‐scale moisture flux estimates indicate (a) substantial recycling of moisture in the Congo Basin (temporally and spatially averaged ET/P > 70%), consistent with models and visible light‐based ET estimates, and (b) net river outflow is largest in the Western Congo where there are more rivers and higher flow rates. Our results confirm the importance of ET in modulating the Congo water cycle relative to other water sources. Plain Language Summary: Rainfall and vegetation vary substantially across the Congo Basin. However, the spatial variations, seasonality, and interannual variability of the net water balance, (the difference between evapotranspiration and rainfall) is not well quantified. Atmospheric observations of the isotopic composition of water vapor are sensitive to the balance of evapotranspiration (ET) and precipitation (P). We calibrate new observations of the isotopic composition of water vapor to ET − P that is based on satellite gravity measurements and ground‐based river discharge measurements to quantify ET − P across four quadrants of the Congo basin. When combined with satellite measurements of rainfall, we show that ET is the largest source of Congo basin water vapor. As ET is about 70% of observed rainfall, vegetation therefore plays an outsized role on the Congo water cycle. Additionally, when combined with satellite measurements of gravity, we show that river discharge is higher in the western part of the basin, where there are more rivers and stronger flows. Key Points: Water vapor isotopes provide a reliable proxy for evapotranspiration (ET) minus precipitation (P) in the Congo BasinET contributes over 70% to P within the four quadrants of the Congo BasinRiver discharge is highest in the western part of the basin, where there are more rivers and higher flow [ABSTRACT FROM AUTHOR]