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Theories of early cooperation in human society often draw from a small sample of ethnographic studies of surviving populations of hunter–gatherers, most of which are now sedentary. Borneo hunter–gatherers (Punan, Penan) have seldom figured in comparative research because of a decades-old controversy about whether they are the descendants of farmers who adopted a hunting and gathering way of life. In 2018 we began an ethnographic study of a group of still-nomadic hunter–gatherers who call themselves Punan Batu (Cave Punan). Our genetic analysis clearly indicates that they are very unlikely to be the descendants of neighbouring agriculturalists. They also preserve a song language that is unrelated to other languages of Borneo. Dispersed travelling groups of Punan Batu with fluid membership use message sticks to stay in contact, co-operate and share resources as they journey between rock shelters and forest camps. Message sticks were once widespread among nomadic Punan in Borneo, but have largely disappeared in sedentary Punan villages. Thus the small community of Punan Batu offers a rare glimpse of a hunting and gathering way of life that was once widespread in the forests of Borneo, where prosocial behaviour extended beyond the face-to-face community, facilitating successful collective adaptation to the diverse resources of Borneo's forests.
To assess experience, physical infrastructure, and capabilities of high-level isolation units (HLIUs) planning to participate in a 2018 global HLIU workshop hosted by the US National Emerging Special Pathogens Training and Education Center (NETEC).
An electronic survey elicited information on general HLIU organization, operating costs, staffing models, and infection control protocols of select global units.
Setting and participants:
The survey was distributed to site representatives of 22 HLIUs located in the United States, Europe, and Asia; 19 (86%) responded.
Data were coded and analyzed using descriptive statistics.
The mean annual reported budget for the 19 responding units was US$484,615. Most (89%) had treated a suspected or confirmed case of a high-consequence infectious disease. Reported composition of trained teams included a broad range of clinical and nonclinical roles. The mean number of HLIU beds was 6.37 (median, 4; range, 2–20) for adults and 4.23 (median, 2; range, 1–10) for children; however, capacity was dependent on pathogen.
Responding HLIUs represent some of the most experienced HLIUs in the world. Variation in reported unit infrastructure, capabilities, and procedures demonstrate the variety of HLIU approaches. A number of technical questions unique to HLIUs remain unanswered related to physical design, infection prevention and control procedures, and staffing and training. These key areas represent potential focal points for future evidence and practice guidelines. These data are important considerations for hospitals considering the design and development of HLIUs, and there is a need for continued global HLIU collaboration to define best practices.
Using existing data from clinical registries to support clinical trials and other prospective studies has the potential to improve research efficiency. However, little has been reported about staff experiences and lessons learned from implementation of this method in pediatric cardiology.
We describe the process of using existing registry data in the Pediatric Heart Network Residual Lesion Score Study, report stakeholders’ perspectives, and provide recommendations to guide future studies using this methodology.
The Residual Lesion Score Study, a 17-site prospective, observational study, piloted the use of existing local surgical registry data (collected for submission to the Society of Thoracic Surgeons-Congenital Heart Surgery Database) to supplement manual data collection. A survey regarding processes and perceptions was administered to study site and data coordinating center staff.
Survey response rate was 98% (54/55). Overall, 57% perceived that using registry data saved research staff time in the current study, and 74% perceived that it would save time in future studies; 55% noted significant upfront time in developing a methodology for extracting registry data. Survey recommendations included simplifying data extraction processes and tailoring to the needs of the study, understanding registry characteristics to maximise data quality and security, and involving all stakeholders in design and implementation processes.
Use of existing registry data was perceived to save time and promote efficiency. Consideration must be given to the upfront investment of time and resources needed. Ongoing efforts focussed on automating and centralising data management may aid in further optimising this methodology for future studies.
Sustainable invasive weed management must address treatment effects on desired vegetation. Our objective was to determine the influence of clopyralid plus 2,4-D, glyphosate, and fosamine, at various application rates and timing, on the density and biomass of Russian knapweed and desired plant groups growing in association with this invasive weed. In a randomized complete block design with four replications, three herbicides by three herbicide rates by three herbicide application timings and a nontreated control were factorially applied to two sites located along the Missouri River riparian corridor in Montana. Clopyralid plus 2,4-D, glyphosate, and fosamine were applied during the spring rosette stage of Russian knapweed (June), the bud to bloom stage of Russian knapweed (July), or the flowering stage of Russian knapweed (August). Herbicide rates were considered low, medium, and high based on label rates of clopyralid plus 2,4-D, glyphosate, or fosamine. Density and biomass of all species were sampled 3 yr after treatment. Russian knapweed biomass decreased from 125 to about 25 g/m2 using clopyralid plus 2,4-D, irrespective of rate or timing of application. Russian knapweed density was reduced by about half by this mixture of herbicides. Nonnative grass density and biomass were maintained, whereas native grasses increased using clopyralid plus 2,4-D at medium or high rates. Neither glyphosate nor fosamine provided substantial Russian knapweed control or increases in grasses. Too few forbs were present to analyze their response to the treatments. We believe that herbicides must be combined with revegetation in areas lacking a diverse mixture of desired species capable of capturing resources made available by controlling Russian knapweed.
A continuous record of organic carbon δ13C from a buried soil sequence in south-central Texas demonstrates: 1) strong coupling between marine and adjacent continental ecosystems in the late Pleistocene as a result of glacial meltwater entering the Gulf of Mexico and 2) ecosystem decoupling in the Holocene associated with a reduction of meltwater and a shift in global circulation patterns. In the late Pleistocene, reduction in C4 plant productivity correlates with two well-documented glacial meltwater pulses (∼15,000 and 12,000 14C yr B.P.), indicating a cooler-than-present adjacent continental environment. Increased C4 production between 11,000 and 10,000 14C yr B.P. suggests that the Younger Dryas was a warm interval responding to the diversion of glacial meltwater away from the Mississippi River. With waning meltwater flow, C4 productivity generally increased throughout the Holocene, culminating in peak warm intervals at ∼5000 and 2000 14C yr B.P. Shifts in the abundances of C3–C4 plants through the late Quaternary show no correlation to ecophysiological responses to atmospheric CO2 concentration.
Species richness and diversity are important indicators of ecosystem function and may be related to plant community resistance to invasion by nonindigenous species. Our specific objective was to determine the influence of clopyralid plus 2,4-D, glyphosate, and fosamine, at different application rates and timings, on richness and diversity of total species, total native species, and total nonnative species within a Russian knapweed–infested plant community. Twenty-eight treatments (3 herbicides by 3 rates by 3 application timings, and an untreated control) were applied to two sites located along the Missouri River riparian corridor in Montana. Clopyralid plus 2,4-D, glyphosate, and fosamine were applied in June (spring rosette stage of Russian knapweed), July (bud to bloom stage of Russian knapweed), and August (flowering stage of Russian knapweed). Herbicide rates were clopyralid plus 2,4-D at 0.08 (clopyralid) + 0.42 (2,4-D), 0.13 + 0.67, and 0.18 + 0.92 kg ai ha−1; glyphosate at 0.6, 1.2, and 1.8 kg ai ha−1; fosamine at 3.6, 7.2, and 10.8 kg ai ha−1. Density of each species was recorded during June and August of 2001 and 2002. Species richness and Simpson's Reciprocal Index (1/D) were calculated. By August 2002, only the glyphosate treatment (4.6 species m−2) yielded greater total richness over that of the control (3.5 species m−2). At that time, diversity after applying clopyralid plus 2,4-D remained similar to that of the control (1.4), but glyphosate (2.3) and fosamine (2.0) increased total species diversity. Nonnative grasses and forbs accounted for the increases in richness and diversity. Glyphosate may be appropriate for enhancing ecosystem function and possibly niche occupation to preempt reinvasion by Russian knapweed, but restoring native species seems unlikely using any of these herbicides alone.
A 5.4-m sequence of peat and marl overlying a basal clay in a northern Belize wetland was studied to assess salinity changes over the past 7000 yr. The distribution of ostracods, gastropods, and foraminifers revealed initially freshwater conditions in a terrestrial wetland, changing to at least mesohaline conditions by about 5600 yr B.P. The mesohaline conditions corresponded to the formation of an open-water lagoon (and precipitation of a lacustrine marl) that was contemporaneous with rapidly rising sea level in the area. A mangrove peat filled the lagoon by 4800 yr B.P. probably as a result of increasingly shallow waters as sea level rise slowed and marl precipitation continued. A new lagoon began to form sometime after 3400 yr B.P. Freshwater ostracods and gastropods found in the marl of this lagoon suggest that it formed under near-limnetic conditions. Freshwater input likely resulted from massive deforestation by the Maya that began by 4400 yr B.P. Subsidence of the mangrove peat likely permitted the formation of a lagoon. A peat has filled the lagoon since at least 500 yr B.P.
Fontan survivors have depressed cardiac index that worsens over time. Serum biomarker measurement is minimally invasive, rapid, widely available, and may be useful for serial monitoring. The purpose of this study was to identify biomarkers that correlate with lower cardiac index in Fontan patients.
Methods and results
This study was a multi-centre case series assessing the correlations between biomarkers and cardiac magnetic resonance-derived cardiac index in Fontan patients ⩾6 years of age with biochemical and haematopoietic biomarkers obtained ±12 months from cardiac magnetic resonance. Medical history and biomarker values were obtained by chart review. Spearman’s Rank correlation assessed associations between biomarker z-scores and cardiac index. Biomarkers with significant correlations had receiver operating characteristic curves and area under the curve estimated. In total, 97 cardiac magnetic resonances in 87 patients met inclusion criteria: median age at cardiac magnetic resonance was 15 (6–33) years. Significant correlations were found between cardiac index and total alkaline phosphatase (−0.26, p=0.04), estimated creatinine clearance (0.26, p=0.02), and mean corpuscular volume (−0.32, p<0.01). Area under the curve for the three individual biomarkers was 0.63–0.69. Area under the curve for the three-biomarker panel was 0.75. Comparison of cardiac index above and below the receiver operating characteristic curve-identified cut-off points revealed significant differences for each biomarker (p<0.01) and for the composite panel [median cardiac index for higher-risk group=2.17 L/minute/m2 versus lower-risk group=2.96 L/minute/m2, (p<0.01)].
Higher total alkaline phosphatase and mean corpuscular volume as well as lower estimated creatinine clearance identify Fontan patients with lower cardiac index. Using biomarkers to monitor haemodynamics and organ-specific effects warrants prospective investigation.
Clinical databases in congenital and paediatric cardiac care provide a foundation for quality improvement, research, policy evaluations and public reporting. Structured audits verifying data integrity allow database users to be confident in these endeavours. We report on the initial audit of the Pediatric Cardiac Critical Care Consortium (PC4) clinical registry.
Materials and methods
Participants reviewed the entire registry to determine key fields for audit, and defined major and minor discrepancies for the audited variables. In-person audits at the eight initial participating centres were conducted during a 12-month period. The data coordinating centre randomly selected intensive care encounters for review at each site. The audit consisted of source data verification and blinded chart abstraction, comparing findings by the auditors with those entered in the database. We also assessed completeness and timeliness of case submission. Quantitative evaluation of completeness, accuracy, and timeliness of case submission is reported.
We audited 434 encounters and 29,476 data fields. The aggregate overall accuracy was 99.1%, and the major discrepancy rate was 0.62%. Across hospitals, the overall accuracy ranged from 96.3 to 99.5%, and the major discrepancy rate ranged from 0.3 to 0.9%; seven of the eight hospitals submitted >90% of cases within 1 month of hospital discharge. There was no evidence for selective case omission.
Based on a rigorous audit process, data submitted to the PC4 clinical registry appear complete, accurate, and timely. The collaborative will maintain ongoing efforts to verify the integrity of the data to promote science that advances quality improvement efforts.
Chemoradiotherapy followed by monthly temozolomide (TMZ) is the standard of care for patients with glioblastoma multiforme (GBM). Case reports have identified GBM patients who experienced transient radiological deterioration after concurrent chemoradiotherapy which stabilized or resolved after additional cycles of adjuvant TMZ, a phenomenon known as radiographic pseudoprogression. Little is known about the natural history of radiographic pseudoprogression.
We retrospectively evaluated the incidence of radiographic pseudoprogression in a population-based cohort of GBM patients and determined its relationship with outcome and MGMT promoter methylation status.
Out of 43 evaluable patients, 25 (58%) exhibited radiographic progression on the first MRI after concurrent treatment. Twenty of these went on to receive adjuvant TMZ, and subsequent investigation demonstrated radiographic pseudoprogression in 10 cases (50%). Median survival (MS) was better in patients with pseudoprogression (MS 14.5 months) compared to those with true radiologic progression (MS 9.1 months, p=0.025). The MS of patients with pseudoprogression was similar to those who stabilized/responded during concurrent treatment (p=0.31). Neither the extent of the initial resection nor dexamethasone dosing was associated with pseudoprogression.
These data suggest that physicians should continue adjuvant TMZ in GBM patients when early MRI scans show evidence of progression following concurrent chemoradiotherapy, as up to 50% of these patients will experience radiologic stability or improvement in subsequent treatment cycles.
Despite many advances in recent years for patients with critical paediatric and congenital cardiac disease, significant variation in outcomes remains across hospitals. Collaborative quality improvement has enhanced the quality and value of health care across specialties, partly by determining the reasons for variation and targeting strategies to reduce it. Developing an infrastructure for collaborative quality improvement in paediatric cardiac critical care holds promise for developing benchmarks of quality, to reduce preventable mortality and morbidity, optimise the long-term health of patients with critical congenital cardiovascular disease, and reduce unnecessary resource utilisation in the cardiac intensive care unit environment. The Pediatric Cardiac Critical Care Consortium (PC4) has been modelled after successful collaborative quality improvement initiatives, and is positioned to provide the data platform necessary to realise these objectives. We describe the development of PC4 including the philosophical, organisational, and infrastructural components that will facilitate collaborative quality improvement in paediatric cardiac critical care.
An enormous effort is underway worldwide to attempt to detect gravitational waves. If successful, this will open a new frontier in astronomy. An essential portion of this effort is being carried out in Australia by the Australian Consortium for Interferometric Gravitational Astronomy (ACIGA), with research teams working at the Australia National University, University of Western Australia, and University of Adelaide involving scientists and students representing many more institutions and nations. ACIGA is developing ultrastable high-power continuous-wave lasers for the next generation interferometric gravity wave detectors; researching the problems associated with high optical power in resonant cavities; opening frontiers in advanced interferometry configurations, quantum optics, and signal extraction; and is the world's leader in high-performance vibration isolation and suspension design. ACIGA has also been active in theoretical research and modelling of potential astronomical gravitational wave sources, and in developing data analysis detection algorithms. ACIGA has opened a research facility north of Perth, Western Australia, which will be the culmination of these efforts. This paper briefly reviews ACIGA's research activities and the prospects for gravitational wave astronomy in the southern hemisphere.
Extracorporeal cardiopulmonary resuscitation may be defined as the use of extracorporeal membrane oxygenation for the support of patients who do not respond to conventional cardiopulmonary resuscitation. Data from national and international paediatric databases indicate that the use of extracorporeal cardiopulmonary resuscitation is increasing. Guidelines from the American Heart Association suggest that any patient with refractory cardiopulmonary resuscitation and potentially reversible causes of cardiac arrest is a candidate for extracorporeal cardiopulmonary resuscitation. One possible framework for selection of patients for extracorporeal cardiopulmonary resuscitation includes dividing patients on the basis of favourable or unfavourable characteristics. Favourable characteristics include cardiac disease, witnessed event in the intensive care unit, ability to deliver effective cardiopulmonary resuscitation, active patient monitoring present, favourable arterial blood gases, and early institution of extracorporeal membrane oxygenation. Unfavourable characteristics potentially include non-cardiac disease, an unwitnessed cardiac arrest, ineffective cardiopulmonary resuscitation, and severely acidotic arterial blood gases. Considering the significant resources and cost involved in the use of extracorporeal cardiopulmonary resuscitation, its use needs to be critically examined to improve outcomes, assess neurological recovery and quality of life, and help identify populations and other factors that may help guide in the selection of patients for successful extracorporeal cardiopulmonary resuscitation.
The use of extracorporeal membrane oxygenation in infants and children with cardiac disease who develop refractory cardiogenic shock, cyanosis, or cardiac arrest is increasing. Early mortality in children with cardiac disease who require extracorporeal membrane oxygenation remains an important issue, as only 40% of cannulated patients survive to discharge from the hospital. However, it is encouraging that 90% children who are discharged alive from the hospital after extracorporeal membrane oxygenation are still alive at intermediate-term follow-up. Surviving patients are at risk for long-term dysfunction of multiple organ systems related to their underlying cardiac disease, non-cardiac comorbidities, treatment-related complications, and exposure to extracorporeal membrane oxygenation. Among the most important acute complications related to support with extracorporeal membrane oxygenation is injury to the central nervous system, which may contribute to adverse neurodevelopmental outcomes. All of these factors, in turn, influence quality of life. Many survivors remain medically complex related to their underlying cardiac disease, comorbidities, and sequelae of complications acquired over their lifetime. Neurological morbidity clearly plays an important role in approximately one-third of survivors, with significant deficits in approximately 10%. The limited data about quality of life data that are available for survivors of cardiac extracorporeal membrane oxygenation suggests that approximately 15–30% of survivors have at least moderately decreased quality of life. Overall, published data support the ongoing use of support with extracorporeal membrane oxygenation in children with acute cardiac failure, most of whom would die without it. However, programmatic efforts to improve the selection of patients and the preservation of the function of end organs during extracorporeal membrane oxygenation are clearly needed in order to improve long-term outcomes.