Marine wildlife faces a growing number of threats across the globe, and the survival of many species and populations will be dependent on conservation action. One threat in particular that has ...emerged over the last 4 decades is the pollution of oceanic and coastal habitats with plastic debris. The increased occurrence of plastics in marine ecosystems mirrors the increased prevalence of plastics in society, and reflects the high durability and persistence of plastics in the environment. In an effort to guide future research and assist mitigation approaches to marine conservation, we have generated a list of 16 priority research questions based on the expert opinions of 26 researchers from around the world, whose research expertise spans several disciplines, and covers each of the world's oceans and the taxa most at risk from plastic pollution. This paper highlights a growing concern related to threats posed to marine wildlife from microplastics and fragmented debris, the need for data at scales relevant to management, and the urgent need to develop interdisciplinary research and management partnerships to limit the release of plastics into the environment and curb the future impacts of plastic pollution.
To assess the impact of a proactive case finding approach to end-of-life care for critically ill patients experiencing global cerebral ischemia (GCI) after cardiopulmonary resuscitation and multiple ...organ system failure (MOSF) in comparison to historical control subjects.
Comparative study of retrospective and prospective cohorts.
Medical ICU of a university hospital.
Patterns of end-of life care for patients with MOSF and GCI obtained through a retrospective chart review were compared to proactive case finding facilitated by the inpatient palliative care service. Interventions included identification of patient's advance directives or preferences about end-of life care, if any; assistance with discussion of the prognosis and treatment options with patients or their surrogates; and implementation of palliative care strategies when treatment goals changed to a focus on comfort measures.
Although our retrospective data demonstrated a high percentage of do-not-resuscitate decisions for the patients under investigation, a considerable time lag elapsed between identification of the poor prognosis and the establishment of end-of-life treatment goals (4.7 ± 2.4 days and 3.5 ± 0.5 days for patients with MOSF and GCI, respectively mean ± SE). The proactive case finding approach decreased hospital length of stay (mean, 20.6 ± 4.1 days vs 15.1 ± 2.5 days and 8.6 ± 1.6 days vs 4.7 ± 0.6 days for MOSF and GCI patients, respectively; p = 0.063 and < 0.001, respectively). More importantly, a proactive palliative care intervention decreased the time between identification of the poor prognosis and the establishment of comfort care goals (7.3 ± 2.9 days vs 2.2 ± 0.8 days and 6.3 ± 1.2 days vs 3.5 ± 0.4 days for MOSF and GCI patients, respectively; p < 0.05 for both), decreased the time dying patients with MOSF remained in the ICU, and reduced the use of nonbeneficial resources, thus reducing the cost of care.
Proactive interventions from a palliative care consultant within this subset of patients decreased the use of nonbeneficial resources and avoided protracted dying.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
OBJECTIVES:To compare usual care with a proactive case-finding approach for critically ill patients with terminal dementia using an inpatient palliative care service.
DESIGN:Prospective comparison to ...historical control.
SETTING:Urban, university-affiliated hospital.
PATIENTS:Total of 52 men and women with end-stage dementia, 26 subjects in each control and intervention group.
INTERVENTIONS:Proactive case-finding by the palliative care service was done to offer early assistance to the intensive care unit staff about the treatment of patients with terminal dementia. Results were compared with data obtained retrospectively.
MEASUREMENTS AND MAIN RESULTS:Measurements included age, gender, Acute Physiology and Chronic Health Evaluation Score, Therapeutic Intervention Scoring System, mortality, intensive care unit and hospital lengths of stay, frequency, timing, and goals of do-not-resuscitate orders. The proactive, case-finding approach decreased hospital and medical intensive care unit length of stay. More important, a proactive palliative intervention decreased the time between identification of the poor prognosis and the establishment of do-not-resuscitate goals, decreased the time terminal demented patients remained in the intensive care unit, and reduced the use of nonbeneficial resources, thus reducing patient burden and the cost of care while having the potential to afford the patient and family increased comfort and psychoemotional support.
CONCLUSIONS:Proactive interventions from a palliative care consultant within this subset of patients improved end-of-life care and decreased use of superfluous resources.
Prenatal maternal stressful life events are associated with adverse neurodevelopmental outcomes in offspring. Biological mechanisms underlying these associations are largely unknown, but DNA ...methylation likely plays a role. This meta-analysis included twelve non-overlapping cohorts from ten independent longitudinal studies (N = 5,496) within the international Pregnancy and Childhood Epigenetics consortium to examine maternal stressful life events during pregnancy and DNA methylation in cord blood. Children whose mothers reported higher levels of cumulative maternal stressful life events during pregnancy exhibited differential methylation of cg26579032 in ALKBH3. Stressor-specific domains of conflict with family/friends, abuse (physical, sexual, and emotional), and death of a close friend/relative were also associated with differential methylation of CpGs in APTX, MyD88, and both UHRF1 and SDCCAG8, respectively; these genes are implicated in neurodegeneration, immune and cellular functions, regulation of global methylation levels, metabolism, and schizophrenia risk. Thus, differences in DNA methylation at these loci may provide novel insights into potential mechanisms of neurodevelopment in offspring.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
PURPOSE OF REVIEWDyspnea is a multidimensional response to an asphyxial threat that heralds respiratory failure. A clinicianʼs ability to treat dyspnea warrants understanding the prevalence, burden, ...trajectories, and measurement across chronic conditions and exacerbations. This review focuses on two contextsthe intensive care unit and the near death stage of illness.
RECENT FINDINGSDyspnea is the most distressing symptom experienced by critically ill patients at risk for dying. New longitudinal studies reveal varying dyspnea trajectories over time and by diagnosis. Patients with noncancer diagnoses, particularly chronic obstructive pulmonary disease, experience severe dyspnea for months before death, whereas patients with cancer even without apparent cardiorespiratory disease have an escalation of dyspnea near death. The sickest patients and those who are cognitively impaired or unconscious are not represented because self-report measures are used. Thus, dyspnea is underrepresented in most end-of-life cohorts. In most data, the Numeric Rating Scale for the intensity of breathlessness, while unidimensional, is the most valid measure for palliative care because of its simplicity. Use of the Respiratory Distress Observation Scale in future studies will permit the inclusion of patients who are unable to self-report dyspnea.
SUMMARYIn summary, new evidence is demonstrating the high prevalence and distress associated with dyspnea among critically ill patients and patients near death.
Port Phillip Bay (PPB) is a large (1,930 km²), temperate embayment in southern Victoria, Australia. Extensive bay-wide surveys of PPB have occurred since 1840. In 1995/1996 the Commonwealth ...Scientific and Industrial Research Organization (CSIRO) Centre for Research on Introduced Marine Pests (CRIMP) undertook an intensive evaluation of the region with the aims of developing a comprehensive species list of native and introduced biota and contrasting previous bay-wide assessments with a current field survey in order to detect new incursions and discern alterations to native communities. Two methods were used to meet these aims: a re-evaluation of regional museum collections and published research in PPB to identify and determine the timing of introductions; and field surveys for benthic (infauna, epifauna and encrusting) organisms between September 1995 to March 1996. One hundred and sixty introduced (99) and cryptogenic (61) species were identified representing over 13% of the recorded species of PPB. As expected, the majority of these are concentrated around the shipping ports of Geelong and Melbourne. Invasions within PPB appear to be increasing, possibly due to an increase in modern shipping traffic and an increase in aquaculture (historically associated with incidental introductions); however the records of extensive biological surveys suggest that this may, in part, be an artefact of sampling effort. In contrast to Northern Hemisphere studies, PPB (and Southern Hemisphere introductions in general) have significantly different suites of successfully invading taxa. PPB is presented as one of the most invaded marine ecosystems in the Southern Hemisphere.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Dyspnea is a subjective experience that can be reported by the patient. Respiratory distress is an observable corollary, and represents the physical or emotional suffering that results from the ...experience of dyspnea. Recognizing and understanding this subjective phenomenon poses a challenge to intensive care unit (ICU) clinicians when caring for the patient who is dying in the ICU. Dyspnea and cognitive impairment are highly prevalent in the terminally ill ICU patient. A Respiratory Distress Observation Model may provide a theoretical foundation for the assessment of this phenomenon that is grounded in emotional and autonomic domains of neurologic function. Treatment of dyspnea and respiratory distress relies on nonpharmacologic interventions and opioids and sedatives. As with pain, the treatment of dyspnea and respiratory distress relies on close evaluation of the patient and treatment to satisfactory effect. Empirical evidence suggests that quality care with control of distressing symptoms does not hasten death. Withholding opioids or sedatives in the face of unrelieved dyspnea or respiratory distress has no moral foundation.
The tools available for incursion response in the marine environment are limited, both in number and in situations where they can be appropriately applied. The ability to make decisions as to when ...and where a response should occur is limited by knowledge of the efficacy and costs. We undertook an evaluation of manual removal of Undaria pinnatifida sporophytes in a new incursion in the Tinderbox Marine Reserve in Tasmania over a 2.5 year study period. Plants were removed, from a 800 m^sup 2^ area, on a monthly basis to minimise the likelihood of maturation of sporophytes and subsequent release of zoospores. While manual removal appears to have significantly reduced the number of developing sporophytes, the persistence of 'hot spots' through time suggests that either microscopic stages (zoospores, gametophytes or sporelings) create a 'seed bank' that persists for longer than 2.5years or selective gametophyte survival in microhabitats occurs. In order for manual removal of Undaria to be effective a long-term commitment to a removal activity needs to be coupled with vector management and education initiatives to reduce the chances of re-inoculation and spread, with monitoring (and response) on a larger spatial scale for the early detection of other incursion sites, and with a treatment to remove persistent microscopic stages.PUBLICATION ABSTRACT
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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