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Estimating vegetation sensitivity during the Holocene will improve the predictions of future vegetation dynamics. We compiled 52 pollen sequences from the monsoon-influenced northern China to reconstruct the Holocene dynamics of three forest types dominated respectively by Pinus, Quercus and Betula, as well as steppe and desert indicated respectively by Artemisia and Chenopodiaceae. The sensitivities of these vegetation types to changes in intensity of the East Asian monsoon were calculated according to the elevation, temperature and precipitation groupings of sites. Our results show that the Holocene vegetation dynamics differed across vegetation types, with Pinus and Quercus at lower elevations more sensitive to monsoon-induced precipitation changes and Betula at higher elevations more sensitive to temperature changes at the beginning of the Holocene. We also found an increasing sensitivity for forests and steppe within different groups following evident reduction in monsoon intensity since 5 ka BP, caused most probably by climate drying in this drought-determined forest-steppe in northern China. Besides regional scale forest retreat caused by climate drying, elevational movement as well as site expansion and decline are also suggested to explain low vegetation sensitivities in some site-groups. Our study provides insights into the mechanisms of individualistic responses of plant taxa as well as the asymmetrical response of ecotonal vegetation to the Holocene monsoon development in China. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the process and the comprehensiveness of advance care planning (ACP), we designed a national ACP-OSCE (Objective Structured Clinical Examination) program., Methods: The program was designed as a 40-minute OSCE test. Participants were categorized as different ACP team members to illustrate realistic scenarios. Preceptors were asked to observe ACP professionals' actions, responses, and communication skills during ACP with standardized patients (SP) through a one-way mirror. Participants' communication skills, medical expertise, legal knowledge, empathetic response and problem-solving skills of ACP were also self-evaluated before and after OSCE. Thematic analysis was used for qualitative analysis., Results: In Nov 2019, a total of 18 ACP teams with 38 ACP professionals completed the ACP-OSCE program, including 15 physicians, 15 nurses, 5 social workers, and 3 psychologists. After the ACP-OSCE program, the average score of communication skills, medical expertise, legal knowledge, empathetic response, ACP problem-solving all increased. Nurses felt improved in medical expertise, legal knowledge, and problem-solving skills, psychologists and social workers felt improved in legal knowledge, while physicians felt no improved in all domain, statistically. Thematic analysis showed professional skills, doctoral-patient communication, benefit and difficulties of ACP were the topics which participants care about. Meanwhile, most participants agreed that ACP-OSCE program is an appropriate educational tool., Conclusion: This is the first national ACP-OSCE program in Asia. We believe that this ACP-OSCE program could be applied in other countries to improve the ACP process and quality., (© 2024. The Author(s).)

Continuous atmospheric CO2 monitoring data indicate an increase in the amplitude of seasonal CO2 -cycle exchange (SCANBP) in northern high latitudes. The major drivers of enhanced SCANBP remain unclear and intensely debated, with land-use change, CO2 fertilization and warming being identified as likely contributors. We integrated CO2 -flux data from two atmospheric inversions (consistent with atmospheric records) and from 11 state-of-the-art land-surface models (LSMs) to evaluate the relative importance of individual contributors to trends and drivers of the SCANBP of CO2 fluxes for 1980–2015. The LSMs generally reproduce the latitudinal increase in SCANBP trends within the inversions range. Inversions and LSMs attribute SCANBP increase to boreal Asia and Europe due to enhanced vegetation productivity (in LSMs) and point to contrasting effects of CO2 fertilization (positive) and warming (negative) on SCANBP. Our results do not support land-use change as a key contributor to the increase in SCANBP. The sensitivity of simulated microbial respiration to temperature in LSMs explained biases in SCANBP trends, which suggests that SCANBP could help to constrain model turnover times. [ABSTRACT FROM AUTHOR]

Forests around the world are subject to risk of high rates of tree growth decline and increased tree mortality from combinations of climate warming and drought, notably in semi-arid settings. Here, we assess how climate warming has affected tree growth in one of the world's most extensive zones of semi-arid forests, in Inner Asia, a region where lack of data limits our understanding of how climate change may impact forests. We show that pervasive tree growth declines since 1994 in Inner Asia have been confined to semi-arid forests, where growing season water stress has been rising due to warming-induced increases in atmospheric moisture demand. A causal link between increasing drought and declining growth at semi-arid sites is corroborated by correlation analyses comparing annual climate data to records of tree-ring widths. These ring-width records tend to be substantially more sensitive to drought variability at semi-arid sites than at semi-humid sites. Fire occurrence and insect/pathogen attacks have increased in tandem with the most recent (2007-2009) documented episode of tree mortality. If warming in Inner Asia continues, further increases in forest stress and tree mortality could be expected, potentially driving the eventual regional loss of current semi-arid forests. [ABSTRACT FROM AUTHOR]