Search

Humanity is on a pathway of unsustainable loss of the natural systems upon which we, and all life, rely. To date, global efforts to deliver internationally-agreed goals to reduce carbon emissions, halt biodiversity loss, and retain essential ecosystem services, have been poorly integrated. All these goals rely in part on preserving natural (e.g. native, largely unmodified) and semi-natural (e.g. under some form of low intensity/sustainable human use) forests, woodlands and grasslands. Here, we show how to unify these goals by empirically deriving spatially explicit, quantitative area-based targets for the retention of natural and semi-natural (e.g. native) terrestrial vegetation. We found that at least 67 million km

ObjectiveTo summarise evidence of the effects of blood pressure (BP)-lowering interventions after acute spontaneous intracerebral haemorrhage (ICH).MethodsA prespecified systematic review of the Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE databases from inception to 23 June 2020 to identify randomised controlled trials that compared active BP-lowering agents versus placebo or intensive versus guideline BP-lowering targets for adults 6 mL) and proportional (>33%) haematoma growth at 24 hours. Meta-analysis used a one-stage approach, adjusted using generalised linear mixed models with prespecified covariables and trial as a random effect.ResultsOf 7094 studies identified, 50 trials involving 11 494 patients were eligible and 16 (32.0%) shared patient-level data from 6221 (54.1%) patients (mean age 64.2 [SD 12.9], 2266 [36.4%] females) with a median time from symptom onset to randomisation of 3.8 hours (IQR 2.6–5.3). Active/intensive BP-lowering interventions had no effect on the primary outcome compared with placebo/guideline treatment (adjusted OR for unfavourable shift in modified Rankin scale scores: 0.97, 95% CI 0.88 to 1.06; p=0.50), but there was significant heterogeneity by strategy (pinteraction=0.031) and agent (pinteraction6 ml, adjusted OR 0.75, 95%CI 0.60 to 0.92; p=0.0077) and relative (≥33%, adjusted OR 0.82, 95%CI 0.68 to 0.99; p=0.034) haematoma growth.InterpretationOverall, a broad range of interventions to lower BP within 7 days of ICH onset had no overall benefit on functional recovery, despite reducing bleeding. The treatment effect appeared to vary according to strategy and agent.PROSPERO registration numberCRD42019141136.

Numerous wellbore instability problems have been reported when drilling through laminated shale formations because of anisotropic (weak) strength along bedding layers. The anisotropic strength is defined through the analysis of stress distributions around wellbore and angle of intersection (AOI) between well trajectory and weak bedding plane. This paper presents a method to calibrate a wellbore stability model, design mud weight and control breakout width based on analysis of AOI and anisotropic strength. The proposed method includes four (4) steps as follows: AOI is calculated by using bedding plane data (dip angle and dip azimuth) and well trajectory information (well inclination and azimuth). Based on single plane of weakness theory, the stress distributions around deviated wellbores in laminated shales are analyzed to show that failure can occur either along or across bedding planes depending on AOI. The profile of collapse pressure for both isotropic and anisotropic strength model are calculated along with the AOI. Drilling data (mud weight, cuttings/cavings pictures etc.) combined with azimuthal density image are used to choose and calibrate the wellbore stability model. Lab strength test results with different angle to bedding plane are used to calibrate rock strength model and field data are collected and analyzed to define acceptable breakout width. Field data demonstrates that AOI can have a significant effect on wellbore stability. It is observed that severe borehole problems occurred in hole sections with low AOI ( The ‘zero breakout width’ criterion is recommended for AOI less than 30°, the ‘(90°-Inclination) breakout width’ criterion for AOI between 30° and 60°, and the ‘(90°-2/3*Inclination) breakout width’ criteria for AOI greater than 60°. If the mud weight window permits, then it would be beneficial to increase the mud weight by an extra 0.2 ppg to cover swab effects in shale formations that have an extremely low AOI (

The concept of God in human mind has been and will always be a diversified concept. To understand God one has to travel through his mind and its contents. The centuries of inheritance have cemented the beliefs, on which we stand today. The concept of God is different for every human but to understand the whole concept of God one has to put his inherited knowledge on bay and look what he perceives. As J. Krishnamurti says- We have to completely come out of our psychological conditioning only then there is a possibility of understanding the immense named as God. Since, primitive time till today’s modern world this one word ‘God’ has played a major role in human living. It has travelled through the ages in human mind and to clearly understand this concept of God we have to look at our journey as mankind, without this neither we should accept nor reject the concept of God.

Attention deficit hyperactivity disorder (ADHD) is an inheritable neurodevelopmental condition, often coexisting with other psychiatric conditions and learning difficulties. This exploratory qualitative investigation sought to explore and advance knowledge on mental health recovery–oriented principles and practices for young people and their families. We examined factors identified by parents as promoting and enabling young people living with ADHD to lead an engaged and meaningful life despite experiencing the challenges of their condition. The study was guided by grounded theory with purposeful sampling deployed to recruit 11 parents (8 mothers and 3 fathers) of children with ADHD. Two focus groups adopting a semi-structured interview format were convened to collect data. The interviews were audio recorded and transcribed verbatim. Thematic analysis was employed and focused on the identification and organization of common themes and patterns observed across the dataset. Nine primary themes were identified as captured by the acronym THRIVESSS (Time, Having a plan, Routine and structure, Identity, Valued social supports, Educating and collaborating, Self-awareness, Self-acceptance, and Symptom control) and explicated by 22 subthemes. Results showed that personal recovery for young people with ADHD is a specific and definable construct which offers a conceptual and applied alternative to the deficit-focused view of ADHD. Our findings provide support for the pressing need to develop a novel lexicon to represent a mental health personal recovery pathway specific for young people and their families predicated upon a strength-based foundation.

To evaluate the epidemiology, management and outcome of acute mastoiditis (AM) in children and to improve strategies for antimicrobial stewardship.We conducted a retrospective observational study of children aged6 months to ≤18 years of age admitted to a tertiary care hospital with AM over an 8-year period (2011-2019). Electronic medical records were reviewed to collect data.A total of 129 patients met inclusion criteria for AM during this time period. Eighty-one (63 %) were males with 110 (81 %) White and 67 (52 %) non-Hispanic. The median age at presentation was 6.4 years (3-10.1 years). Ear protrusion was associated with reduced odds of having AM with intracranial extension (ICE) (OR 0.307, 95 % CI = 0.107-0.883) whereas presence of headaches and/or neck pain increased the odds of having AM with ICE (OR = 3.96, 95%CI 1.29-12.1). The most common etiologies were Streptococcus pyogenes (n = 23, 19.2 %), Pseudomonas aeruginosa (n = 20, 17 %), and Streptococcus pneumoniae (n = 15, 12.5 %). Empiric antibiotic selection and duration of therapy was highly variable. The most common empiric antibiotic used was intravenous vancomycin with a third generation cephalosporin (n = 45, 34.8 %). Majority completed course (n = 92; 73 %) with an oral antibiotic. Shorter (≤10 and ≤14 days) versus longer courses (10 and14 days) did not affect readmission rates for AM without ICE.There is high variability of treatment of AM in children. Broad spectrum antibiotics, especially vancomycin were used most frequently despite low rates of Methicillin Resistant Staphylococcus aureus. The use of antibiotic stewardship is essential for judicious antibiotic use.

Climate change and the energy transition are long-term challenges that could occur in a chaotic and uncertain way. The potential and varied impacts of these phenomena on existing human systems is leading to a rethinking of the ability of organisations to adapt life-sustaining services and business supply chains. However, the different scenarios surrounding these two phenomena are not always well understood by the public, by those who manage critical infrastructure, businesses, key institutions and organisations and sometimes even by risk managers. In order to assess whether current risk management strategies are able to cope with these two phenomena, it is important to understand the knowledge and perceptions of risk managers of the impacts of climate change and energy transition. This research investigates the perception of climate change and energy transition by risk managers in order to (i) assess their understanding of the impact of the energy transition and climate change on current lifeline services and business supply chains, (ii) evaluate the needs of risk managers to integrate these phenomena into risk management strategies. Results of ongoing semi-structured interviews and questionnaires will be shared. Overall, the aim of this research is to improve cross-sectoral risk management strategies by integrating a systemic approach into risk management methodology and risk reduction strategies. The research has been conducted in Chile, which is a country critical to the global energy transition. Chile is the world's primary producer of copper (30%) and ranks second in global lithium production (20%), two minerals coveted by different economic sectors and necessary for the global energy transition. In addition the region is exposed to numerous natural hazards, including climate related phenomena and associated extreme weather and temperature events. The integration of risk management strategies that incorporate both climate change and a change in energy supply is crucial in order to avoid significant disruptions and cascading effects in the supply chains of these increasingly sought-after minerals.

Introduction: Culturally and linguistically diverse (CALD) communities are growing globally. Understanding patterns of cerebrovascular disease in CALD communities may improve health outcomes through culturally specific interventions. We compared rates of transient ischaemic attack (TIA)/stroke (ischaemic stroke, intracerebral haemorrhage) and stroke risk factor prevalence in overseas and Australian-born people in South Western Sydney (SWS) and New South Wales (NSW). Methods: This was a 10-year retrospective analysis (2011–2020) of SWS and NSW age-standardized rates per 100,000 person-years of TIA/stroke. Data were extracted from Health Information Exchange and Secure Analytics for Population Health Research and Intelligence systems. Rates of hypertension, type 2 diabetes mellitus (T2DM), atrial fibrillation (AF), smoking, and obesity were also calculated. Results: The SWS and NSW age-standardized rate of TIA/stroke for people born in Australia was 100 per 100,000 person-years (100/100,000/year). In SWS, 56.6% of people were overseas-born compared to 29.8% for NSW. The age-standardized rate of TIA/stroke for Polynesian-born people was more than double that of Australian-born people (p < 0.001). Hypertension (33 [SWS] vs. 27/100,000/year [NSW]) and T2DM (36 [SWS] vs. 26/100,000/year [NSW]) were the most common risk factors with rates >50/100,000/year (hypertension) and >80/100,000/year (T2DM) for people born in Polynesia, Melanesia, and Central America. Rates of T2DM, AF, and obesity for Polynesian-born people were over threefold greater than people born in Australia. Discussion/Conclusion: Greater rates of TIA/stroke were observed in specific CALD communities, with increased rates of cerebrovascular risk factors. Culturally specific, targeted interventions may bridge health inequalities in cerebrovascular disease.

Wellbore instability and lost circulation are two major sources of non-productive time (NPT) in drilling operations worldwide. Non-aqueous fluid (NAF) is often chosen to mitigate this and minimize the chemical effect on wellbore instability in reactive shales. However, it may inadvertently increase the risk of losses. A simple method to optimize internal phase salinity (IPS) of NAF is presented to improve wellbore stability and mitigate the increased possibility of losses. Field cases are used to demonstrate the effects of salinity on wellbore instability and losses, and the application of the proposed method. IPS is optimized by managing bidirectional water movement between the NAF and shale formation via semi-permeable membrane. Typically, higher shale dehydration is designed for shallow reactive shale formation with high water content. Whereas, low or no dehydration is desired for deep naturally fractured or faulted formation by balancing osmotic pressure with hydrostatic pressure difference between mud pressure and pore pressure. The simple approach to managing this is as follows: The water activity profile for the shale formation (aw,shale) is developed based on geomechanical and geothermal information The water activity of drilling fluid (aw,mud) is defined through considering IPS and thermal effects The IPS of NAF is manipulated to manage whether shale dehydration is a requirement or should be avoided If the main challenge is wellbore instability in a chemically reactive shale, then the IPS should be higher than the equivalent salinity of shale formation (or aw,shale > aw, mud) If the main challenge is losses into non-reactive, competent but naturally fractured or faulted shale, then IPS should be at near balance with the formation equivalent salinity (or aw, shale ≈ aw, mud) It is important that salt (e.g. calcium chloride – CaCl2) addition during drilling operations is done judiciously. The real time monitoring of salinity variations, CaCl2 addition, water evaporation, electric stability (ES), cuttings/cavings etc. will help determine if extra salt is required. The myth of the negative effects of IPS on wellbore instability and lost circulation is dispelled by analyzing the field data. The traditional Chinese philosophy: "following Nature is the only criteria to judge if something is right" can be applied in this instance of IPS optimization. A simple and intuitive method to manage IPS is proposed to improve drilling performance.

Background Strategies to improve the effectiveness and quality of health and care have predominantly emphasised the implementation of new research and evidence into service organisation and delivery. A parallel, but less understood issue is how clinicians and service leaders stop existing practices and interventions that are no longer evidence based, where new evidence supersedes old evidence, or interventions are replaced with those that are more cost effective. The aim of this evidence synthesis is to produce meaningful programme theory and practical guidance for policy makers, managers and clinicians to understand how and why de-implementation processes and procedures can work. Methods and analysis The synthesis will examine the attributes or characteristics that constitute the concept of de-implementation. The research team will then draw on the principles of realist inquiry to provide an explanatory account of how, in what context and for whom to explain the successful processes and impacts of de-implementation. The review will be conducted in four phases over 18 months. Phase 1: develop a framework to map the preliminary programme theories through an initial scoping of the literature and consultation with key stakeholders. Phase 2: systematic searches of the evidence to develop the theories identified in phase 1. Phase 3: validation and refinement of programme theories through stakeholder interviews. Phase 4: formulating actionable recommendations for managers, commissioners and service leaders about what works through different approaches to de-implementation. Discussion This evidence synthesis will address gaps in knowledge about de-implementation across health and care services and ensure that guidance about strategies and approaches accounts for contextual factors, which may be operating at different organisational and decision-making levels. Through the development of the programme theory, which explains what works, how and under which circumstances, findings from the evidence synthesis will support managers and service leaders to make measured decisions about de-implementation. Systematic review registration PROSPERO CRD42017081030

Background\ud \ud The influence of patient demographics and mode of admission on the ‘weekend effect’ remains unclear. This study examins the relationship between day of admission, patient demographics, mode of presentation and survival.\ud \ud \ud Methods\ud \ud Hospital admissions over a three-year period were studied. Patients with an inpatient stay less than 24 h and those who were discharged from the emergency department were excluded. In-hospital mortality was correlated with day of admission, age, gender and mode of presentation in a binary logistical regression analysis.\ud \ud \ud Results\ud \ud There were 448,827 admissions, of which 350,648 (85.7%) occurred during a weekday. 256,777 (62.7%) were emergency presentations, which was closely related to a weekend admission (92.3% vs 57.8%, p < 0.001). There were 8099 deaths of which 6336 (78.2%) related to a weekday admission and 1736 (21.4%) related a weekend admission. Mortality for elective admissions was 78 (0.05%) compared to 8021 (3.12%), p < 0.001 in emergency admissions. Univariable regression analysis revealed a weekend admission (Odds Ratio (OR) 1.68 (95% confidence interval (CI) 1.60–1.78, p < 0.001) and emergency presentation (OR 63.02 (95%CI 50.42–78.77), p < 0.011) were associated with weekend mortality. On multivariable analysis the OR for weekend admission reduced to 1.07 (95%CI 1.01–1.13), p = 0.013 and the OR for emergency presentation increased to 76.68 (95%CI 61.40–96.00), p < 0.001.\ud \ud \ud Conclusion\ud \ud This study highlights that higher weekend mortality rates are a consequence of a lower proportion of elective admissions. Extending the working week to seven days might reduce weekend mortality without reducing the total number of deaths.

Maximum horizontal stress (SH) and stress path (change of SH and minimum horizontal stress with depletion) are the two most difficult parameters to define for an oilfield geomechanical model. Understanding these in-situ stresses is critical to the success of operations and development, especially when production is underway, and the reservoir depletion begins. This paper introduces a method to define them through the analysis of actual minifrac data. Field examples of applications on minifrac failure analysis and operational pressure prediction are also presented. It is commonly accepted that one of the best methods to determine the minimum horizontal stress (Sh) is the use of pressure fall-off analysis of a minifrac test. Unlike Sh, the magnitude of SH cannot be measured directly. Instead it is back calculated by using fracture initiation pressure (FIP) and Sh derived from minifrac data. After non-depleted Sh and SH are defined, their apparent Poisson's Ratios (APR) are calculated using the Eaton equation. These APRs define Sh and SH in virgin sand to encapsulate all other factors that influence in-situ stresses such as tectonic, thermal, osmotic and poro-elastic effects. These values can then be used to estimate stress path through interpretation of additional minifrac data derived from a depleted sand. A geomechanical model is developed based on APRs and stress paths to predict minifrac operation pressures. Three cases are included to show that the margin of error for FIP and fracture closure pressure (FCP) is less than 2%, fracture breakdown pressure (FBP) less than 4%. Two field cases in deep-water wells in the Gulf of Mexico show that the reduction of SH with depletion is lower than that for Sh.

Humanity is on a pathway of unsustainable loss of the natural systems upon which we, and all life, rely. To date, global efforts to achieve internationally-agreed goals to reduce carbon emissions, halt biodiversity loss, and retain essential ecosystem services, have been poorly integrated. However, these different goals all rely on preserving natural ecosystems. Here, we show how to unify these goals by empirically deriving spatially-explicit, quantitative area-based targets for the retention of natural terrestrial ecosystems. We found that at least 67 million km2of Earth’s natural terrestrial ecosystems (~79% of the area remaining) require retention – via a combination of strict protection but more prominently through sustainably managed land use regimes complemented by restoration actions – to contribute to biodiversity, climate, soil and freshwater objectives under four United Nations’ Resolutions. This equates to retaining natural ecosystems across ~50% of the total terrestrial (excluding Antarctica) surface of Earth. Our results show where retention efforts could be focussed to contribute to multiple goals simultaneously. The retention targets concept that we present explicitly recognises that such management can and should co-occur alongside and be driven by the people who live in and rely on places where natural and semi-natural ecosystems remain on Earth.

Lost circulation (LC) is extremely costly to many drilling operations due to loss of mud and productive time. Significant industry resources have been devoted to providing recommendations for both preventing and curing losses. These comprise bridging particles, settable pills and a focus on the better understanding, measurement and control of downhole pressures. The industry has also started to examine the relationship between downhole losses and fracture geometry. However, there has been very limited verification and utilization of such effort. Knowledge of the loss mechanism(s), location of the thief zone and fracture geometry is fundamental for understanding and treating losses effectively. The proposed method introduces a systematic approach for diagnosing lost circulation into potential root cause(s) by utilizing up to twenty-two diagnostic indicators. This allows the most appropriate treatments to be mapped to the suspected root cause. This technique supports the creation of preventative strategies during well planning. For example, if induced fractures are identified as the most likely root cause in the planning stage, then a wellbore strengthening formulation based on the fracture width estimation is recommended. A proper treatment can be designed based on the fracture width analysis as the data becomes invaluable in determining optimum sealing and effective treatment for losses into conductive natural fractures/faults. In case of loss events, the fracture width can be estimated based upon loss rate, the mud rheology, bottom hole pressure and pore pressure. Field experiences demonstrate that natural and induced fractures are the two most common root causes of losses. For induced fractures, fracture width usually develops beyond 3000-micron (µm) once losses have occurred and the preventive lost circulation materials (LCM) have not then worked effectively. If the bottom hole pressures can be kept below fracture propagation limits (or far-field minimum horizontal stress), then induced fractures will not cause significant volume of losses. The drilling induced fractures can be modelled by using in-situ stresses, well trajectory, bottom hole pressure, geothermal and mud temperature information.

BACKGROUND Impaired facial emotion expression recognition (FEER) has typically been considered a correlate of Autism Spectrum Disorder (ASD). Now, the alexithymia hypothesis is suggesting that this emotion processing problem is instead related to alexithymia which frequently co-occurs with ASD. By combining predictive coding theories of ASD and simulation theories of emotion recognition, it is suggested that facial mimicry may improve the training of FEER in ASD and alexithymia. OBJECTIVE The current study aims to evaluate a novel mimicry task to improve FEER in adults with, and without ASD and alexithymia. Additionally, this study will aim to determine the contributions of alexithymia and ASD to FEER ability and assess which of these two populations benefit from this training task. METHODS Recruitment will primarily take place through an ASD community group with emphasis put on snowball recruiting. Included will be N=64 consenting adults equally divided between participants without an ASD, and participants with an ASD. Participants will be screened online using the K-10 (cut off score of 22), ASQ-10 and TAS-20 followed by a clinical interview with a provisional psychologist at the Federation University psychology clinic. The clinical interview will include assessment of ability, anxiety and depression as well as discussion of past ASD diagnosis and confirmatory administration of the Autism Mental Status Exam (AMSE). Following the clinical interview, the participant will complete the Bermond-Vorst Alexithymia Questionnaire (BVAQ) and then undertake a baseline assessment of FEER. Consenting participants will then be assigned using a permuted blocked randomisation method into either the control task condition or the mimicry task condition. A brief measure of satisfaction of the task and a debriefing session will conclude the study. RESULTS The study has Federation University Human Research Ethics Committee approval and is registered with the Australian New Zealand Clinical Trials. Participant recruitment is predicted to begin in quarter one of 2021. CONCLUSIONS This study will be the first to evaluate the use of a novel facial mimicry task condition to increase FEER in adults with ASD and alexithymia. If efficacious, this task could prove useful as a cost-effective adjunct intervention which could be used at home and thus remove barriers to entry. This study will also explore the unique effectiveness of this task in people without an ASD, with an ASD and with alexithymia. CLINICALTRIAL Registration: Australian New Zealand Clinical Trial Registry (ACTRN: ACTRN12619000705189, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377455).

Loss of habitats or ecosystems arising from development projects (e.g., infrastructure, resource extraction, urban expansion) are frequently addressed through biodiversity offsetting. As currently implemented, offsetting typically requires an outcome of “no net loss” of biodiversity, but only relative to a baseline trajectory of biodiversity decline. This type of “relative” no net loss entrenches ongoing biodiversity loss, and is misaligned with biodiversity targets that require “absolute” no net loss or “net gain.” Here, we review the limitations of biodiversity offsetting, and in response, propose a new framework for compensating for biodiversity losses from development in a way that is aligned explicitly with jurisdictional biodiversity targets. In the framework, targets for particular biodiversity features are achieved via one of three pathways: Net Gain, No Net Loss, or (rarely) Managed Net Loss. We outline how to set the type (“Maintenance” or “Improvement”) and amount of ecological compensation that is appropriate for proportionately contributing to the achievement of different targets. This framework advances ecological compensation beyond a reactive, ad‐hoc response, to ensuring alignment between actions addressing residual biodiversity losses and achievement of overarching targets for biodiversity conservation.

A global goal of no net loss of natural ecosystems or better has recently been proposed, but such a goal would require equitable translation to country-level contributions. Given the wide variation in ecosystem depletion, these could vary from net gain (for countries where restoration is needed), to managed net loss (in rare circumstances where natural ecosystems remain extensive and human development imperative is greatest). National contributions and international support for implementation also must consider non-area targets (for example, for threatened species) and socioeconomic factors such as the capacity to conserve and the imperative for human development.

Enhanced aerobic/anoxic Downflow Hanging Sponge (DHS) bioreactors were assessed for carbon (C) and total nitrogen (TN) removal for decentralised domestic wastewater treatment applications. The initial design included upper aerobic and lower anoxic sponge layers, and effluent recirculation, and achieved >80% CODs and >90% NH4-N removal. However, effluent TN was higher. It was concluded the anoxic layer was C-limited for denitrification, therefore an influent bypass was added to the anoxic layer to provide supplemental C. Differed bypass ratios were compared, including 0%, 10%, 20% and 30% (% of total influent), and effluent TN declined with increasing bypass; i.e., 50.1±23.3mg-N/L, 49.9±27.8mg-N/L, 31.9±18.4mg-N/L and 10.7±5.8mg-N/L, respectively, and all reactors removed >80% CODs. This design has potential because it uses limited energy, tolerates variable flows, and simultaneously removes C and TN; all key for effective decentralised treatment applications.