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While constant change characterises ecology, subtidal ecologists seem set to take a deep dive in to the biological processes that accelerate and compensate for environmental change. Similar to the technological and collaborative progress that benefited the present generation of authors, continuing progress may assist future generations of subtidal ecologists to figure out why kelp forests are characterised by global mosaics of long-term loss, gain and stasis. Where and how might kelp decline or flourish or simply persist future ocean change? Our review takes a biogeographic perspective to synthesise ecological patterns and the processes that create them. On this basis, we consider the modification of ecological processes by oceans undergoing physical and chemical change and, as a result, consider their future ecology. We find that future oceans will make life beyond the capacity of kelp to exist on many coasts, but not all coasts will be beyond the capacity of a kelp’s life. Consequently, this review provides a sign post for future research into the future decline or persistence or even increase of kelp forests.
Babysbreath or perennial babysbreath (Gypsophila paniculata L.) is an aggressive invasive plant in large parts of southern Canada and the northern and western United States. It reproduces and disperses by seed, so the phenology of seed maturation is important in designing management programs. The present study provides the first quantitative assessment of G. paniculata seed-maturation phenology in a field population, as well as the first quantitative assessment of how the efficacy of herbicide treatment in preventing production of germinable seeds depends on the timing of treatment in relation to this phenology. Seeds were collected from untreated plants on five dates during July and August in both 2016 and 2017 and tested for germinability. Percent germination increased from 20% to 81% between July 22 and 28 and exceeded 90% by August 4, 2016. The seed-maturation phenology in 2017 was similar but delayed by about 4 d. On a growing degree-day scale, seed-maturation phenologies for the 2 yr were nearly identical. We also tested germinability of seeds from plants sprayed with glyphosate (23.4 ml ae L−1) on July 11, 18, and 25, 2016 (one date per plant). Percent germination increased from 0% to 13% to 20% over successive treatment dates, highlighting the importance of completing treatment early in the growing season.
There is a long history of exploitation of the South American river turtle Podocnemis expansa. Conservation efforts for this species started in the 1960s but best practices were not established, and population trends and the number of nesting females protected remained unknown. In 2014 we formed a working group to discuss conservation strategies and to compile population data across the species’ range. We analysed the spatial pattern of its abundance in relation to human and natural factors using multiple regression analyses. We found that > 85 conservation programmes are protecting 147,000 nesting females, primarily in Brazil. The top six sites harbour > 100,000 females and should be prioritized for conservation action. Abundance declines with latitude and we found no evidence of human pressure on current turtle abundance patterns. It is presently not possible to estimate the global population trend because the species is not monitored continuously across the Amazon basin. The number of females is increasing at some localities and decreasing at others. However, the current size of the protected population is well below the historical population size estimated from past levels of human consumption, which demonstrates the need for concerted global conservation action. The data and management recommendations compiled here provide the basis for a regional monitoring programme among South American countries.
As the number of older immigrants in Europe rises, dementia within minority ethnic populations warrants attention as a significant public health problem. Equitable health and care services constitute a prioritised health policy aim on both supranational and national levels in Europe and is formulated in the Norwegian health legislation. Through interviews and focus groups with older immigrants, relatives of immigrants with dementia and health personnel, we explored the perceptions of dementia among ethnically diverse groups in Norway. The findings show that many interpret symptoms such as memory loss and disorientation as a natural part of ageing. Others consider dementia symptoms to have a psycho-social origin, deriving from social isolation. Some describe symptoms as an expression of a potentially transient sign of madness, while others point to destiny and God's will, representing basic and unalterable causes. However, another pattern of perception includes viewing dementia as a potentially transient physical illness, including a belief in a medical cure. By investigating how people with dementia and their families understand and manage the condition, one may facilitate access to relevant and adapted information. Furthermore, by exploring how people relate to their illness, health personnel may challenge explanatory models that create unrealistic expectations of cure, as well as models that, due to stigma or normalisation of symptoms, prevent the use of public care.
Introduction: The radiological and clinical follow-up of patients with a mild traumatic brain injury (mTBI) and an intracranial hemorrhage (ICH) is often heterogeneous, as there is no official guideline for CT scan control. Furthermore, public sector health expenditure has increased significantly as the number of MRI and CT scan almost doubled in Canada in the last decade. Therefore, the main objective of this study was to describe the current management practices of mTBI patients with intracranial hemorrhage at two level-1 trauma centers. Methods: Design: An historical cohort was created at the CHU de Québec – Hôpital de l'Enfant-Jésus (Québec City) and Hôpital du Sacré-Coeur (Montréal). Consecutive medical records were reviewed from the end of 2017 backwards until sample saturation using a standardized checklist. Participants: mTBI patients aged ⩾16 with an ICH were included. Measures: The main and secondary outcomes were the presence of a control CT scan and neurosurgical consultation/admission. Analyses: Univariate descriptive analyses were performed. Inter-observer measures were calculated. Results: Two hundred seventy-four patients were included, of which 51.1% (n = 140) came from a transfer. Mean age was 60.8 and 68.9% (n = 188) were men. Repeat CT scan was performed in 73.6% (n = 201) of our patients as 12.5% showed a clinical deterioration. The following factors might have influenced clinician decision to proceed to a repeat scan: anticoagulation (association of 87.1% with scanning; n = 27), antiplatelet (84.1%; 58), GCS of 13 (94.1%; 16), GCS of 14 (75%; 72) and GCS of 15 (70.2%; 111). 93.0% (n = 254) of patients had a neurosurgical consultation and only 6.7% (17) underwent a neurosurgical intervention. Conclusion: The management of mild traumatic brain injury with hemorrhage uses a lot of resources that might be disproportionate with regards to risks. Further research to identify predictive factors of deterioration is needed.
Introduction: Upper gastrointestinal bleeding (UGIB) is a common presentation to the emergency department (ED). Early endoscopy within 24 hours has been shown to reduce re-bleeding rates and lower mortality. However, low-risk patients can often be managed through outpatient follow-up. The aim of this study was to compare the timing and appropriateness of endoscopy and proton pump inhibitor (PPI) use in a tertiary care ED setting for low- and high-risk patients determined using the Glasgow Blatchford Score (GBS). Methods: Retrospective chart review was conducted to examine the management of patients presenting with an UGIB in 2016 to the University of Alberta Hospital ED. TANDEM and Emergency Department Information System (EDIS) databases were used to identify patients using specific ICD-10 codes and the CEDIS presenting complaints of vomiting blood or blood in stool/melena. Patients with GBS 0-3 were categorized as low-risk and those with GBS > 3 were considered high-risk with appropriateness of and time to endoscopy, disposition of patient at 24 hours, and use of PPIs determined for each group. Results: A total of 400 patients were included. A total of 319/400 patients (80%) underwent esophagogastroduodenoscopy (EGD). EGD was performed within 24 hours in 37% of patients (29/78) with GBS 0 to 3 and in 77% (248/322) with GBS greater than 3. Of the remaining high-risk patients, 11% (36/322) underwent EGD after 24 hours and 12% (38/322) did not undergo EGD. The endoscopic diagnoses were peptic ulcer disease (PUD) in 41% of patients (130/319), esophagitis in 18% (56/319), and varices in 14% (45/319). PPIs (data available 375/400) were administered (mainly intravenously) to 93% (279/300) of high-risk and 79% (59/75) of low-risk patients. Data on patient disposition showed 60/322 (19%) high-risk patients were discharged from the ED within 24 hours and only 31/60 (52%) of these underwent EGD before discharge. Of 29 low-risk patients undergoing EGD within 24 hours, 9 (31%) were admitted, 17 (59%) were discharged from ED, and 3 (10%) were kept for observation in the ED greater than 24 hours. Of low-risk patients, 76% (59/78) were discharged from the ED within 24 hours. Conclusion: A majority of patients presenting with UGIB appropriately received endoscopy within 24 hours. 19% of high-risk patients were discharged from the ED. Earlier discharge for low-risk patients can be improved as only 76% of low-risk patients were discharged from the ED within 24 hours. As expected, PPI use was high in these patients.
The use of tail chalk and estrus/heat expression scores (HEATSC) evaluation is instrumental in identifying cows with greater estrus expression and greater artificial insemination pregnancy rates (P/AI) in cows submitted to timed artificial insemination (TAI), and cows with low or no estrus expression present lower P/AI. It was intended in this study to improve the pregnancy rates in TAI for Bos indicus beef cows, and gonadotrophin-releasing hormone (GnRH) injection was hypothesized to increase pregnancy rates in a TAI program for cows submitted to progesterone–estradiol-based protocols with low or no estrus expression, evaluated by HEATSC. Cows (n= 2284) received a progesterone device and 2 mg estradiol benzoate, after 8 days the device was removed and 1 mg estradiol cypionate, 150 μg of d-cloprostenol and 300 IU equine chorionic gonadotropin was administered. All cows were marked with chalk and HEATSC evaluated (scales 1 to 3) at TAI performed on day 10. Animals with HEATSC1 and HEATSC2 (n= 937) received 100 μg de gonadorelin (GNRH group; n= 470), or 1 ml saline (Control group; n= 467), and cows with HEATSC3 (named HEAT group; n= 1347) received no additional treatment. The larger dominant follicle, evaluated on day 8and at TAI (day 10), was greater in HEAT group (P= 0.0145 and P <0.001, respectively). Corpus luteum (CL) area and progesterone concentration was evaluated on day 17, and CL area was larger in HEAT group, intermediary in Control and lower in GnRH group (Control= 2.68 cm2, GnRH= 2.37 cm2, HEAT group= 3.07 cm2, P <0.001). Greater progesterone concentrations were found in HEAT group than in Control and GnRH groups (Control= 4.74 ng/ml, GnRH= 4.29 ng/ml, HEAT group= 6.08 ng/ml, P<0.001). There was a difference in ovulation rate, greater in HEAT group than GnRH and Control groups (Control= 72.5%; GnRH= 81.25%; HEAT group= 90.71%; P= 0.0024). Artificial insemination pregnancy rates was greater in HEAT group (57.09% (769/1347) than in Control and GNRH groups, with positive effect of GnRH injection at the time of TAI in P/AI (Control= 36.18% (169/467), GnRH= 45.95% (216/470); P<0.0001). In conclusion, GnRH application in cows with low HEATSC (1 and 2) is a simple strategy, requiring no changes in TAI management to increase pregnancy rates in postpartum beef cows submitted to progesterone–estradiol-based TAI protocols, without reaching, however, the pregnancy rates of cows that demonstrate high estrus expression at the TAI.
Within international institutions such as the International Criminal Court (ICC), lawyers increasingly encounter managerial practices which are designed to improve organizational efficiency and cost-effectiveness. Charting this trend, scholars have analyzed these practices with a view to make them more legitimate. However, this scholarly focus overlooks the role of managerial practices in legitimizing and thus sustaining the institutions in which they are embedded. In this article, I ask how managerial practices operate to boost the ICC’s reputation among its global audience. I find the answer in the Court’s use of the juxtaposed images of bureaucracy and management, with all their negative and positive associations. The Court uses these images to narrate a story of its own internal evolution from inefficient bureaucracy to efficient and well-managed organization. This hidden narrative of institutional progress functions rhetorically to frame, focus and distract the attention of the Court’s global constituencies.
As vitamin B12 is only synthesized by bacteria, ruminant products, especially dairy products, are excellent sources of this vitamin. This study aims to identify if diet and cow characteristics could affect vitamin B12 concentration in milk of dairy cows. Information on 1484 first, 1093 second and 1763 third and greater parity Holstein cows in 100 herds was collected during three consecutive milkings. During the first morning milking, all dietary ingredients given to cows were sampled and quantities offered were recorded throughout the day. Nutrient composition of ingredients was obtained by wet chemistry to reconstitute nutrient composition of the ration. Milk samples were taken with in-line milk meters during the evening milking of the 1st day and the morning milking of the 2nd day and were analyzed for vitamin B12 concentration. Milk yields were recorded and milk components were separately analyzed for each milking. Daily vitamin B12 concentration in milk was obtained using morning and evening vitamin B12 concentrations weighted with respective milk yield, then divided by daily yield. To decrease the number of interdependent variables to include in the multivariable model, a principal component analysis was carried out. Daily milk concentration of vitamin B12 averaged 3809±80 pg/ml, 4178±79 pg/ml and 4399±77 pg/ml for first, second and third, and greater lactation cows. Out of 11 principal components, six were significantly related to daily milk concentration of vitamin B12 when entered in the multivariable model. Results suggested that vitamin B12 concentration in milk was positively related to percentage of fiber and negatively related to starch as well as energy of the diet. Negative relationships were noted between vitamin B12 concentration in milk and milk yield as well as milk lactose concentration and positive relationships were observed between vitamin B12 concentration in milk and milk fat as well as protein concentrations. The percentages of chopped mixed silage and commercial energy supplement in the diet as well as cow BW were positively related to vitamin B12 in milk and percentages of baled mixed silage, corn and commercial protein supplement in the ration were negatively related to vitamin B12 concentration in milk. The pseudo-R2 of the model was low (52%) suggesting that diet and cow characteristics have moderate impact on vitamin B12 concentration in milk. Moreover, when entering solely the principal component related to milk production in the model, the pseudo-R2 was 46%. In conclusion, it suggests that studied diet characteristics have a marginal impact on vitamin B12 concentration in milk variation.
Nutritional strategies to mitigate the negative effects of heat stress on animal welfare and productivity often involve changes in ration formulation. However, cattle commonly sort their ration in favour of certain components, and it is not clear how feed sorting responds to heat stress. This study investigated the association between heat stress and feed sorting behaviour. Lactating Holstein dairy cows (n = 32; parity = 2.8±1.2; mean±SD) were housed in a free stall barn and milked 3×/day. Cows were fed individually using the Calan Broadbent Feeding System and offered ad libitum access to a total mixed ration (containing on a dry matter basis: 3.3% ryegrass hay, 16.5% ryegrass baleage, 24.7% corn silage, 11.1% brewers grains, 19.7% ground corn, 19.8% concentrate and 4.9% protein/mineral supplement), provided 1×/day. Beginning at 186±60 days in milk, cows were exposed to either: heat stress conditions (HT; n = 15) (average temperature–humidity index: 77.6), or evaporative cooling (CL; n = 17), consisting of misters and fans over the freestall and feed bunks. Data were collected during a 4-day baseline period, and two 4-day experimental periods: starting at 10 days after implementing treatments (defined as acute heat stress for HT cows), and at 62 days after implementing treatments (defined as chronic heat stress for HT cows). Daily feed intake and physiological responses to heat stress (body temperature, respiration rate) were recorded. Samples of fresh and refused feed were collected daily from individual cows for particle size analysis. The particle size separator had three screens (19, 8 and 1.18 mm) and a bottom pan, resulting in 4 fractions (long, medium, short and fine particles). Feed sorting was calculated as the actual intake of each particle size fraction expressed as a percentage of the predicted intake of that fraction. During both heat stress periods, HT cows sorted for long particles more than CL cows (105.0% v. 100.6%; SE = 1.1). During acute heat stress, HT cows sorted to a greater extent than CL cows against medium and short particles, whereas sorting of these fractions did not differ during chronic heat stress. Body temperature and respiration rate were associated across treatments with the extent of sorting for long particles and against short particles during acute heat stress. These results suggest that feed sorting is particularly influenced during acute heat stress, and that sorting for longer particles may increase in heat stress.
To study potentially modifiable factors associated with the severity of agitation or aggression (A/A) symptoms among Alzheimer’s disease (AD) patients.
Data from the Impact of Cholinergic Treatment Use (ICTUS) study, European longitudinal prospective observational study.
Community dwelling outpatients included in 29 European memory clinics.
1375 participants with probable AD (Mini-Mental State Examination score of 10–26) with an informal caregiver.
At baseline and twice yearly over the two-year follow-up, patients underwent comprehensive clinical and neuropsychological assessments: sociodemographic data, cognitive status, functional impairment, and assessment of neuropsychiatric symptoms based on Neuro-Psychiatric Inventory (NPI). The ZARIT scale assessed the caregiver’s burden. The variable of interest was the severity of the item of A/A of the NPI. To study factors associated to the severity of A/A symptoms six months later, a multivariate mixed regression model was used.
Frequency of A/A symptom varied from 30% to 34% at each visit. Two factors were found to be independently associated with the severity of A/A: (1) the presence of affective disorder (anxiety, depression, and/or irritability) that increased the severity of the A/A by 0.89 point (coefficient:0.89; 95% Confidence Interval (CI) = [0.48,1.30], p < 0.001), and (2) a severe caregiver burden that increased the severity of the A/A by 1.08 point (coefficient:1.08; 95% CI = [0.69,1.47], p < 0.001).
Research should evaluate whether the identification and treatment of an affective disorder along with the evaluation and optimal management of the caregiver would have a positive impact on the course of A/A in mild to moderate AD patients.
On December 1, 2017, the Fuji factory of Arakawa Chemical Industries exploded. Dust that formed as a byproduct from the crushing and packing process of the resin for ink exploded at the facility. The Fuji City Fire Department requested the dispatch of 2 physician-staffed helicopters (known as a doctor helicopter [DH] in Japan). The first party of emergency services established a headquarters and first-aid station. However, this area was feared to be at risk of a second explosion. Physicians performed re-triage for all 11 burned patients. Three severely injured patients were transported to emergency medical service centers either by ground ambulance or the DH without undergoing any decontamination. The physician who escorted the patient by ground ambulance complained of a headache. One of the severely injured patients was treated at a local hospital and then transported to an emergency medical service center after undergoing decontamination and intubation. Fortunately, all patients who were transported to medical facilities obtained a survival outcome. Chemical, biological, radiological, nuclear, and explosive incidents are rare but can be fatal for responders to these types of disaster. Therefore, all who work in these settings should be prepared and trained adequately to ensure that they have the knowledge and skill to both manage patients and protect themselves from harm. (Disaster Med Public Health Preparedness. 2018;page 1 of 7)
We show that professional management began to emerge in UK companies during the first half of the twentieth century, a development which was widely theorised and accepted. However, the managerially-led enterprise was accommodated rather than protected by company law, making it vulnerable to changes in the law. The Cohen Report of 1945 paid no attention to these developments, and led to the introduction, in the Companies Act 1948, of important, but previously little appreciated, changes in the name of enhancing the accountability of directors to shareholders. The shareholders’ statutory right to remove the directors by simple majority overturned existing structures overnight and was an important driver of the hostile takeover, which emerged shortly afterwards. This deprived management of the necessary autonomy to balance the competing interests at stake in the enterprise and to foster innovation. The emergence of the current system of shareholder primacy can be traced back to these developments.
Creontiades dilutus (green mirid) and C. pacificus (brown mirid) are major hemipteran pests of transgenic (Bt) cotton in Australia. Current integrated pest management (IPM) guidelines for mirids in Australian cotton, based on economic thresholds and sampling recommendations, were developed and disseminated to industry at the start of the 2005–06 growing season and have remained largely unchanged since then. However, adoption of mirid IPM guidelines by industry has been highly variable and generally well below expectation. Annual surveys of crop protection practices across the Australian cotton industry, from 2010 to 2017, indicate that a third of all mirid sprays are applied below the recommended thresholds each year. More than half of all survey respondents in the 2017 survey indicated lack of confidence in the mirid thresholds due to highly variable and disproportionate damage, a phenomenon best described as the ‘mirid enigma’. A critical review of RD&E outputs since 1998 shows that potential contributors to the mirid enigma include but are not limited to biological, ecological and methodological factors. Mirid feeding damage is likely to vary with developmental stage, gender and reproductive status. Ecological factors including trophic effects and multiple host plant usage are potential modifiers of mirid feeding damage. Methodological and technological constraints and shortcomings are evident in the threshold research done to date. Inadequate commercial sampling that results in unreliable estimates of pest density in the crop is a major contributor to the mirid enigma. Failure to account for the complexity of factors that can influence the nature and severity of mirid damage to cotton often results in fruit loss due to non-mirid related factors being incorrectly attributed to mirids. An alternative approach to mirid management based on modelling the dynamics of net fruit load (production–loss) proposed over 15 years ago is discussed.
This article, by Claire Fox, is designed to share tools and techniques to help with business planning. It will focus on sharing real life knowledge and experience, with practical tips for developing your own business plan. It will lead to a better understanding of why a formal business plan process is crucial to helping teams prepare for the future and remain relevant and necessary to their organisations.
Recovery rates in schizophrenia remain suboptimal with up to one-third resistant to standard treatments, a population prevalence of 0.2%. Clozapine is the only evidenced-based treatment for treatment resistant schizophrenia (TRS), yet there are significant delays in its use or it may not be trialled, potentially impacting the chance of recovery. Better outcomes with earlier use of clozapine may be possible. There is emerging evidence that early treatment resistance is not uncommon from the earliest stages of psychosis. In this review, we provide an update on TRS, its epidemiology and its management, with a specific focus on the optimal use and timing of clozapine and augmentation strategies for the one-third of patients who do not respond to clozapine.
This paper addresses the process towards the integration of subsurface knowledge into urban planning for three cities – Rotterdam, Glasgow and Oslo – participating in the European Cooperation in Science and Technology (COST) Action TU1206 Sub-Urban. These cities each have unique challenges in managing conflicts and opportunities in the subsurface in the planning process. The COST Sub-Urban Action has enabled a unique interaction between subsurface specialists and urban planners across over 20 European cities, and has laid the foundations for a new understanding between experts who develop subsurface knowledge and those who can benefit most from it – urban planners and decision makers. Common challenges identified include: improving planning policies, enhancing the level of awareness of the subsurface in city development and the modification of legislation to include the subsurface. The paper provides a review of the current status of subsurface planning in the three cities, each of whom are aiming to adapt their urban planning practice and legislation in light of emerging subsurface knowledge, and the current major knowledge gaps. In our opinion, there are two main routes to raise awareness that lead to improved understanding and the use of subsurface information in urban planning processes: (1) the development of a subsurface policy and (2) providing subsurface information. These measures should enable subsurface knowledge to be widely disseminated in order to manage risks and opportunities, and maximise the economic, social and environmental benefits of the urban subsurface and its services on which cities depend.