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This digital database is the product of collaboration between the U.S. Geological Survey,

Bioclimates are syntheses of climatic variables into biologically relevant categories that facilitate comparative studies of biotic responses to climate conditions. Isobioclimates, unique combinations of bioclimatic indices (continentality, ombrotype, and thermotype), were constructed for northern California coastal ranges based on the Rivas-Martinez worldwide bioclimatic classification system for the end of the 20th century climatology (1971–2000) and end of the 21st century climatology (2070–2099) using two models, Geophysical Fluid Dynamics Laboratory (GFDL) model and the Parallel Climate Model (PCM), under the medium-high A2 emission scenario. The digitally mapped results were used to 1) assess the relative redistribution of isobioclimates and their magnitude of change, 2) quantify the loss of isobioclimates into the future, 3) identify and locate novel isobioclimates projected to appear, and 4) explore compositional change in vegetation types among analog isobioclimate patches. This study used downscaled climate variables to map the isobioclimates at a fine spatial resolution −270 m grid cells. Common to both models of future climate was a large change in thermotype. Changes in ombrotype differed among the two models. The end of 20th century climatology has 83 isobioclimates covering the 63,000 km2 study area. In both future projections 51 of those isobioclimates disappear over 40,000 km2. The ordination of vegetation-bioclimate relationships shows very strong correlation of Rivas-Martinez indices with vegetation distribution and composition. Comparisons of vegetation composition among analog patches suggest that vegetation change will be a local rearrangement of species already in place rather than one requiring long distance dispersal. The digitally mapped results facilitate comparison with other Mediterranean regions. Major remaining challenges include predicting vegetation composition of novel isobioclimates and developing metrics to compare differences in climate space.

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The COVID-19 pandemic reached the United States in early 2020 and spread rapidly across the country. This retrospective study describes the demographic and clinical characteristics of 308 children presenting to an Arkansas Children’s emergency department (ED) or admitted to an Arkansas Children’s hospital with COVID-19 in the first 10 months of the COVID-19 pandemic, prior to the emergence of clinically significant variants and available vaccinations. Adolescents aged 13 and older represented the largest proportion of this population. The most common presenting symptoms were fever, gastrointestinal symptoms, and upper respiratory symptoms. Patients with multisystem inflammatory syndrome in children (MIS-C) had a longer length of stay (LOS) than patients with acute COVID-19. Children from urban zip codes had lower odds of admission but were more likely to be readmitted after discharge. Nearly twenty percent of the study population incidentally tested positive for COVID-19. Despite lower mortality in children with COVID than in adults, morbidity and resource utilization are significant. With many Arkansas children living in rural areas and therefore far from pediatric hospitals, community hospitals should be prepared to evaluate children presenting with COVID-19 and to determine which children warrant transport to pediatric-specific facilities.

Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17⋅7 per cent) had SBO due to hernia. Surgery was performed in 312 (75⋅2 per cent) of the 415 patients; small bowel resection was required in 198 (63⋅5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32⋅1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9⋅4 per cent (39 of 415), and was highest in patients with a groin hernia (11⋅1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16⋅3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1⋅05, 95 per cent c.i. 1⋅01 to 1⋅10; P = 0⋅009) and complications (odds ratio 1⋅05, 95 per cent c.i. 1⋅02 to 1⋅09; P = 0⋅001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group. *Members of the National Audit of Small Bowel Obstruction (NASBO) Steering Group and NASBO Collaborators are co-authors of this study and are listed in Appendix S1 (supporting information) Funding information

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