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To evaluate the association between novel pre- and post-operative biomarker levels and 30-day unplanned readmission or mortality after paediatric congenital heart surgery.
Children aged 18 years or younger undergoing congenital heart surgery (n = 162) at Johns Hopkins Hospital from 2010 to 2014 were enrolled in the prospective cohort. Collected novel pre- and post-operative biomarkers include soluble suppression of tumorgenicity 2, galectin-3, N-terminal prohormone of brain natriuretic peptide, and glial fibrillary acidic protein. A model based on clinical variables from the Society of Thoracic Surgery database was developed and evaluated against two augmented models.
Unplanned readmission or mortality within 30 days of cardiac surgery occurred among 21 (13%) children. The clinical model augmented with pre-operative biomarkers demonstrated a statistically significant improvement over the clinical model alone with a receiver-operating characteristics curve of 0.754 (95% confidence interval: 0.65–0.86) compared to 0.617 (95% confidence interval: 0.47–0.76; p-value: 0.012). The clinical model augmented with pre- and post-operative biomarkers demonstrated a significant improvement over the clinical model alone, with a receiver-operating characteristics curve of 0.802 (95% confidence interval: 0.72–0.89; p-value: 0.003).
Novel biomarkers add significant predictive value when assessing the likelihood of unplanned readmission or mortality after paediatric congenital heart surgery. Further exploration of the utility of these novel biomarkers during the pre- or post-operative period to identify early risk of mortality or readmission will aid in determining the clinical utility and application of these biomarkers into routine risk assessment.
The purpose of this study was to examine whether vehicle type based on size (car vs. other = truck/van/SUV) had an impact on the speeding, acceleration, and braking patterns of older male and female drivers (70 years and older) from a Canadian longitudinal study. The primary hypothesis was that older adults driving larger vehicles (e.g., trucks, SUVs, or vans) would be more likely to speed than those driving cars. Participants (n = 493) had a device installed in their vehicles that recorded their everyday driving. The findings suggest that the type of vehicle driven had little or no impact on per cent of time speeding or on the braking and accelerating patterns of older drivers. Given that the propensity for exceeding the speed limit was high among these older drivers, regardless of vehicle type, future research should examine what effect this behaviour has on older-driver road safety.
Understanding why ecological communities contain the species they do is a long-standing question in ecology. Two common mechanisms that affect the species found within communities are dispersal limitation and environmental filtering. Correctly identifying the relative influences of these mechanisms has important consequences for our understanding of community assembly. Here variable selection was used to identify the environmental variables that best predict tropical forest primate community similarity in four biogeographic regions: the Neotropics, Afrotropics, Madagascar and the island of Borneo in South-East Asia. The environmental variables included net primary productivity and altitude, as well as multiple temperature, precipitation and topsoil variables. Using the best environmental variables in each region, Mantel and partial Mantel tests were used to reanalyse data from a previously published study. The proportion of variance explained increased for each region. Despite increases, much of the variation remained unexplained for all regions (R2: Africa = 0.45, South America = 0.16, Madagascar = 0.28, Borneo = 0.10), likely due to different evolutionary and biogeographic histories within each region. Nonetheless, substantial variation among regions in the environmental variables that best predicted primate community similarity were documented. For example, none of the 14 environmental variables was included for all four regions, yet each variable was included for at least one region. Contrary to prior results, environmental filtering was an important assembly mechanism for primate communities in tropical forests worldwide. Geographic distance more strongly predicted African and South American communities whereas environmental distance more strongly predicted Malagasy and Bornean communities. These results suggest that dispersal limitation structures primate communities more strongly than environmental filtering in Africa and in South America whereas environmental filtering structures primate communities more strongly than dispersal limitation in Madagascar and Borneo. For communities defined by genera, environmental distance more strongly predicted primate communities than geographic distance in all four regions, which suggests that environmental filtering is a more influential assembly mechanism at the genus level. Therefore, a more nuanced consideration of environmental variables affects conclusions about the influences of environmental filtering and dispersal limitation on primate community structure.
Background: High comorbidity rates among emotional disorders have led researchers to examine transdiagnostic factors that may contribute to shared psychopathology. Bifactor models provide a unique method for examining transdiagnostic variables by modelling the common and unique factors within measures. Previous findings suggest that the bifactor model of the Depression Anxiety and Stress Scale (DASS) may provide a method for examining transdiagnostic factors within emotional disorders. Aims: This study aimed to replicate the bifactor model of the DASS, a multidimensional measure of psychological distress, within a US adult sample and provide initial estimates of the reliability of the general and domain-specific factors. Furthermore, this study hypothesized that Worry, a theorized transdiagnostic variable, would show stronger relations to general emotional distress than domain-specific subscales. Method: Confirmatory factor analysis was used to evaluate the bifactor model structure of the DASS in 456 US adult participants (279 females and 177 males, mean age 35.9 years) recruited online. Results: The DASS bifactor model fitted well (CFI = 0.98; RMSEA = 0.05). The General Emotional Distress factor accounted for most of the reliable variance in item scores. Domain-specific subscales accounted for modest portions of reliable variance in items after accounting for the general scale. Finally, structural equation modelling indicated that Worry was strongly predicted by the General Emotional Distress factor. Conclusions: The DASS bifactor model is generalizable to a US community sample and General Emotional Distress, but not domain-specific factors, strongly predict the transdiagnostic variable Worry.
On August 25, 2017, Hurricane Harvey made landfall near Corpus Christi, Texas. The ensuing unprecedented flooding throughout the Texas coastal region affected millions of individuals.1 The statewide response in Texas included the sheltering of thousands of individuals at considerable distances from their homes. The Dallas area established large-scale general population sheltering as the number of evacuees to the area began to amass. Historically, the Dallas area is one familiar with “mega-sheltering,” beginning with the response to Hurricane Katrina in 2005.2 Through continued efforts and development, the Dallas area had been readying a plan for the largest general population shelter in Texas. (Disaster Med Public Health Preparedness. 2019;13:33–37)
Background: Standardized data collection for traumatic brain injury (TBI) (including concussion) using common data elements (CDEs) has strengthened clinical care and research capacity in the United States and Europe. Currently, Ontario healthcare providers do not collect uniform data on adult patients diagnosed with concussion. Objective: The Ontario Concussion Care Strategy (OCCS) is a collaborative network of multidisciplinary healthcare providers, brain injury advocacy groups, patient representatives, and researchers with a shared vision to improve concussion care across the province, starting with the collection of standardized data. Methods: The International Framework of Functioning Disability and Health was selected as the conceptual framework to inform the selection of CDEs. The CDEs recommended by the OCCS were identified using key literature, including the National Institute of Neurological Disorders and Stroke–Zurich Consensus Statements for concussion in sport and the Ontario Neurotrauma Foundation Concussion/mTBI clinical guidelines. Results: The OCCS has recommended and piloted CDEs for Ontario that are readily available at no cost, clinically relevant, patient friendly, easy to interpret, and recognized by the international scientific community. Conclusions: The implementation of CDEs can help to shift Ontario toward internationally recognized standard data collection, and in so doing yield a more comprehensive evidence-based approach to care while also supporting rigorous research.
We use numerical simulations from the Community Coordinated Modeling Center to provide, for the first time, a coherent temporal description of the magnetic reconnection process of two dayside Electron Diffusion Regions (EDRs) identified in Magnetospheric Multiscale Mission data. The model places the MMS spacecraft near the separator line in these most intense and long-lived events. A listing of 31 dayside EDRs identified by the authors is provided to encourage collaboration in analysis of these unique encounters.
Introduction: We characterised tobacco use, cessation patterns, and patient satisfaction with a cessation support program at an NCI Designated Comprehensive Cancer Center following a mandatory tobacco assessment and automatic referral.
Methods: A 3-month follow-up survey (via web, paper, or telephone) was administered between March 2013 and November 2013 for all patients referred to and contacted by a cessation support service, and who consented to participation three months prior to administration. Patients were asked about their perceived importance and self-efficacy to quit smoking, quit attempts, and satisfaction with the cessation service.
Results: Fifty-two percent (257/499) of patients who participated in the cessation support service, and consented to be contacted again, completed a follow-up survey. Of those who participated, 9.7% were referred to the service as having recently quit tobacco (in the past 30 days) and 23.6% reported having quit at the time of first contact. At the 3-month follow-up, 48.1% reported being smoke-free for the previous seven days. When patients were asked about their experience with the cessation service, 86.4% reported being very or mostly satisfied with the service, and 64.3% reported that their experience with the service increased their satisfaction with the care received at the cancer centre.
Conclusions: Our findings suggest that recently diagnosed cancer patients are aware that quitting tobacco is important, are making attempts to quit, and are amenable to an opt-out automatic referral cessation support service as part of their cancer care.
Millions of people living in poverty depend on non-timber forest products (NTFPs), yet forest protection causes displacement, replacement or reduction of NTFP extraction activities, with implications for human welfare. Here, we assess the impact of forest protection on a novel measure of wellbeing that incorporates both objective and subjective components of people's lives. In five villages near forests with mixed protection status in Tanzania, household perceived need for firewood is compared with actual consumption in order to provide a simple metric of firewood sufficiency. Firewood sufficiency varied with forest protection status, with non-compliance inferred by household ability to meet firewood needs despite forest access restrictions. Fuel-efficient stove ownership improved the perceived ability to meet firewood needs; however, actual consumption remained unchanged. Firewood sufficiency was significantly lower for those sourcing firewood outside forests, and increased household awareness of the management authority significantly reduced firewood consumption. In a forest landscape of mixed protection status, pressure will likely be displaced to the forest with the least active management authority, affecting their efficiency as non-extractive reserves. Our findings reinforce the need for a landscape approach to forest management planning that accounts for local needs, to avoid leakage to other less well-protected forests and detriment to household welfare.
Epiphytes represent keystone resources for many arthropod and vertebrate species, however their ecology remains poorly explored, especially within the palaeotropics. Several recent studies have examined relationships between epiphyte richness and characteristics of local habitats, although these have all focused on neotropical forests. Here, we aim to determine whether predictors of neotropical epiphyte richness are consistent at a palaeotropical site. A total of 44 host trees (dbh range 25–288 cm) were sampled at two study sites on Buton Island, Indonesia. For each tree, epiphyte richness and seven variables relating to characteristics of the host tree and surrounding habitats were recorded: site (a proxy value for disturbance level and water availability), host above-ground biomass (agb), altitude, bark texture, exposure, emergence and crown area. Gaussian GLM analyses indicated that the percentage deviance explained in epiphyte richness per host was greatest for agb (20.9%), crown area (19.6%) and site (15.5%); similar to previous findings from the neotropics. Results therefore suggest that high epiphyte diversity within palaeotropical forests is most likely to be found in large tracts of undisturbed forest, supporting large, broad-crowned trees.
The appearance of the distinctive ‘Beaker package’ marks an important horizon in British prehistory, but was it associated with immigrants to Britain or with indigenous converts? Analysis of the skeletal remains of 264 individuals from the British Chalcolithic–Early Bronze Age is revealing new information about the diet, migration and mobility of those buried with Beaker pottery and related material. Results indicate a considerable degree of mobility between childhood and death, but mostly within Britain rather than from Europe. Both migration and emulation appear to have had an important role in the adoption and spread of the Beaker package.
Medullosa stands apart from most Paleozoic seed plants in its combination of large leaf area, complex vascular structure, and extremely large water-conducting cells. To investigate the hydraulic consequences of these anatomical features and to compare them with other seed plants, we have adapted a model of water transport in xylem cells that accounts for resistance to flow from the lumen, pits, and pit membranes, and that can be used to compare extinct and extant plants in a quantitative way. Application of this model to Medullosa, the Paleozoic coniferophyte Cordaites, and the extant conifer Pinus shows that medullosan tracheids had the capacity to transport water at volume flow rates more comparable to those of angiosperm vessels than to those characteristic of ancient and modern coniferophyte tracheids. Tracheid structure in Medullosa, including the large pit membrane area per tracheid and the high ratio of tracheid diameter to wall thickness, suggests that its xylem cells operated at significant risk of embolism and implosion, making this plant unlikely to survive significant water stress These features further suggest that tracheids could not have furnished significant structural support, requiring either that other tissues supported these plants or that at least some medullosans were vines. In combination with high tracheid conductivity, distinctive anatomical characters of Medullosa such as the anomalous growth of vascular cambium and the large number of leaf traces that enter each petiole base suggest vascular adaptations to meet the evapotranspiration demands of its large leaves. The evolution of highly efficient conducting cells dictates a need to supply structural support via other tissues, both in tracheid-based stem seed plants and in vessel-bearing angiosperms.
The study of ancient biodiversity trends is confounded by biases of the paleontologic record, but standardizing sampling intensity among time intervals can ameliorate sample-size biases. We show that several existing standardization methods are intimately linked to the spatial components of diversity (alpha, the within-assemblage diversity; and beta, the between-assemblage diversity). The subsampling curves generated by these methods can also be generated by various manipulations of alpha and beta, so that one can predict the responses of the methods to specific changes in alpha or beta diversity. The responses of the subsampling methods to changes in total diversity depend on whether measured alpha or measured beta diversity changed. Like biodiversity, sampling consists of a within-sample component (the number of specimens collected per locality) and a between-sample component (the number of localities). Several subsampling methods (rarefaction, OW, O2W) attempt to standardize sampling effort at both levels, although they use no direct information on the former. Instead, they alter sampling intensity at the beta level to compensate for perceived biases at the alpha level. We show that alpha and beta diversity are not so easily interchangeable and that the accuracy of the subsampling methods depends critically on the spatial characteristics of diversity in a data set. Current methods are calibrated only to the abundance-richness characteristics of individual collections, but the amount of beta diversity and the degree to which the rareness/commonness of taxa correlates among samples also strongly affect the accuracy of the subsampling methods. We offer new calibrations based on empirical data sets that account for these factors. Our findings do not support Alroy et al.'s (2001) tentative claim that the taxonomic radiation in the Cenozoic marine realm is an artifact of biased sampling intensity. Their diversity curves that most strongly contradict Sepkoski's traditional Phanerozoic curve are based on a method that overcorrects for local sample-size biases, whereas the remaining curves are either consistent with the traditional curve or ambiguous because of the limited temporal and taxonomic coverage of the analysis. Other factors may bias Sepkoski's curve, but there is insufficient evidence to claim that variations in sampling intensity are the major determinant of its long-term trajectory.
The purpose of this study was to determine if season or weather affected the objectively measured trip distances of older drivers (≥ 70 years; n = 279) at seven Canadian sites. During winter, for all trips taken, trip distance was 7 per cent shorter when controlling for site and whether the trip occurred during the day. In addition, for trips taken within city limits, trip distance was 1 per cent shorter during winter and 5 per cent longer during rain when compared to no precipitation when controlling for weather (or season respectively), time of day, and site. At night, trip distance was about 30 per cent longer when controlling for season and site (and weather), contrary to expectations. Together, these results suggest that older Canadian drivers alter their trip distances based on season, weather conditions, and time of day, although not always in the expected direction.
The whale shark Rhincodon typus is a popular focal species in the marine tourism industry. We analysed 689 encounters with at least 142 individual sharks during 2008–2010 to assess their behaviour in the presence of swimmers at Tofo Beach, Mozambique. Sharks varied in size (estimated 3.0–9.5 m total length) and the majority (74%) were males. The sharks displayed avoidance behaviours during 64.7% of encounters. Encounter duration decreased significantly, from 12 minutes 37 s with undisturbed sharks to 8 minutes 25 s when sharks expressed avoidance behaviours, indicating that interactions with tourists affected the sharks’ short-term behaviour. However, during the 2.5-year study period we found no trend in the mean encounter duration, the overall expression of avoidance behaviour or the likelihood of an individual shark exhibiting avoidance behaviours. Potential effects of tourism may be mitigated by the non-breeding status and transient behaviour of sharks at this aggregation site.