•Including tagging data improved spatial assessments regardless of release design.•Periodic releases balanced tradeoffs between tag program cost and parameter bias.•Time-varying movement was ...estimable with informative periodic tagging data.•Violation of tagging assumptions increased parameter bias more than ignoring movement.•Estimating tag mixing parameters was feasible and eliminated associated bias.
The need for spatial stock assessment models that match the spatiotemporal management and biological structure of marine species is growing. Spatially explicit, tag-integrated models can emulate complex population structure, because they are able to estimate connectivity among population units by incorporating tag-recovery data directly into the combined objective function of the assessment. However, the limited scope of many small-scale tagging studies along with difficulty addressing major assumptions of tagging data has prevented more widespread utilization of tag-recovery data sets within tag-integrated models. A spatially explicit simulation-estimation framework that simulates metapopulation dynamics with two populations and time-varying connectivity was implemented for three life history (i.e., longevity) scenarios to explore the relative utility of tagging data for use in spatial assessment models across a range of tag release designs (e.g., annual, historical, periodic, and opportunistic tagging). Model scenarios also investigated the impacts of not accounting for incomplete tag mixing or assuming all fish were fully selected (i.e., that the age composition of tagged fish was unknown). Results demonstrated that periodic tagging (e.g., releasing tags every five years) may provide the best balance between tag program cost and parameter bias. For cost-effective tagging programs, tag releases should be spread over a longer time period instead of focusing on release events in consecutive years, while releasing tags in tandem with existing surveys could further improve the practicality of implementing tag-recovery experiments. However, care should be taken to fully address critical modeling assumptions (e.g., by estimating tag mixing parameters) before incorporating tagging data into an assessment model.
We present current concepts and evidence to optimize diagnosis and management of osteoarthritis in the thumb joints. Numerous options and controversies exist for surgical treatment of carpometacarpal ...joint arthritis. Fewer options exist for metacarpophalangeal joint arthritis. Surgical treatment for interphalangeal arthritis is mainly arthrodesis.
The purpose of this study was to explore the lived experiences of chief enrollment management officers in the state of Ohio. Using a constructivist phenomenological approach, the study was conducted ...to make meaning of the chief enrollment officer's lived experiences that have led them to serving as a chief enrollment officer at their respective institution. Data were collected from eight chief enrollment management officers from Ohio's various 4-year institutions through a semi-structured interview. The research led to 6 key findings related to research question 1, which was "What experiences have influenced chief enrollment management officers' ability to lead?" There were 8 key findings related to research question 2, which was "Through their experiences, what competencies are essential for chief enrollment management officers to be successful in this area of the country?" The 6 key findings related to RQ1 were: the need to take on more responsibility before the role, the impact of the COVID-19 pandemic, the technology revolution and push toward automation, CEMOs' professional development opportunities, CEMOs being mentored, and the length of time spent in their role. The 8 key findings related to RQ2 were: understanding enrollment management trends and practices, understanding and utilizing data, the ability to lead, successful supervising, being technologically savvy, having an ability to work with presidents, having an ability to work with campus partners, and recognizing your weaknesses. With a better understanding of these individuals, one can learn more about how to be successful recruiting students in the study's context. The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.
The field of research related to neurocritical care has grown significantly in recent years, and the clinical demands for current and dependable expertise has followed suit. It can be a challenge for ...the neurocritical practitioner to keep up with cutting-edge evidence-based research and best practices, especially regarding the role of pharmacotherapeutics.In the treatment of neurocritical disease states, pharmacotherapeutic strategies are increasingly relevant.Neuropharmacotherapy in Critical Illnessis the first book that provides this information in a high-yield format for the busy healthcare provider. Edited and authored by leading experts in the field, this book provides practitioners with clinical pearls on neuropharmacology, dosing strategies, monitoring, adverse events, drug interactions, and evidence-based pharmacotherapy.
Marine fishes are heterogeneously distributed across their ranges according to population dynamics governed by complex spatiotemporal relationships between ontogenetic habitat usage, species ...interactions, environmental variability, and harvest patterns. However, few stock assessments incorporate spatial population structure in the determination of population status and sustainable catch limits. A small number of generalized stock assessment software platforms are utilized worldwide to assess a large number of marine fish populations. Although each platform relies on similar underlying population dynamics, the spatial capabilities and functionality often differ among them. We catalogue spatial dynamics and capabilities across stock assessment platforms to leverage collective experiences and identify future needs for next generation assessment software packages. Despite commonalities across platforms (e.g., most models allow for a single population with spatial heterogeneity, apportionment of recruitment, and age-varying connectivity), no single platform is flexible enough to address the full breadth of spatial dynamics observed for managed marine fish species. Our review clarifies spatial assessment design and modeling ‘good practices’, while emphasizing the need for more generalizable and modular next generation assessment platforms that can account for the spatiotemporal complexity of marine resources (such as natal homing and spawning migrations, ontogenetic movement patterns, metapopulation structure, and complex fleet dynamics). Generalized, spatially-integrated assessment platforms will be key decision-tools to account for spatiotemporal species and fishery interactions, particularly as managers attempt to address climate change and implement ecosystem-based fisheries management.
•Changing distributions and other scale-dependent management challenges require advancements to stock assessment software tools.•Despite some commonalities across assessment platforms, none were flexible enough for the full extent of observed spatial population dynamics.•Population structure, recruitment, and connectivity parameterization options were the most varied and are areas for cross-collaboration.•Challenges include multiple population structure hypotheses, parameter dimension constraints, and efficient management and review systems.•Spatial layers (partitions or strata) should be a foundational feature of any future generalizable, modular software development approach.
Despite evidence associating inflammatory biomarkers with worse outcomes in hospitalized adults with COVID-19, trials of immunomodulatory therapies have met with mixed results, likely due in part to ...biological heterogeneity of participants. Latent class analysis (LCA) of clinical and protein biomarker data has identified two subtypes of non-COVID acute respiratory distress syndrome (ARDS) with different clinical outcomes and treatment responses. We studied biological heterogeneity and clinical outcomes in a multi-institutional platform randomized controlled trial of adults with severe COVID-19 hypoxemic respiratory failure (I-SPY COVID).
Clinical and plasma protein biomarker data were analyzed from 400 trial participants enrolled from September 2020 until October 2021 with severe COVID-19 requiring ≥ 6 L/min supplemental oxygen. Seventeen hypothesis-directed protein biomarkers were measured at enrollment using multiplex Luminex panels or single analyte enzyme linked immunoassay methods (ELISA). Biomarkers and clinical variables were used to test for latent subtypes and longitudinal biomarker changes by subtype were explored. A validated parsimonious model using interleukin-8, bicarbonate, and protein C was used for comparison with non-COVID hyper- and hypo-inflammatory ARDS subtypes.
Average participant age was 60 ± 14 years; 67% were male, and 28-day mortality was 25%. At trial enrollment, 85% of participants required high flow oxygen or non-invasive ventilation, and 97% were receiving dexamethasone. Several biomarkers of inflammation (IL-6, IL-8, IL-10, sTNFR-1, TREM-1), epithelial injury (sRAGE), and endothelial injury (Ang-1, thrombomodulin) were associated with 28- and 60-day mortality. Two latent subtypes were identified. Subtype 2 (27% of participants) was characterized by persistent derangements in biomarkers of inflammation, endothelial and epithelial injury, and disordered coagulation and had twice the mortality rate compared with Subtype 1. Only one person was classified as hyper-inflammatory using the previously validated non-COVID ARDS model.
We discovered evidence of two novel biological subtypes of severe COVID-19 with significantly different clinical outcomes. These subtypes differed from previously established hyper- and hypo-inflammatory non-COVID subtypes of ARDS. Biological heterogeneity may explain inconsistent findings from trials of hospitalized patients with COVID-19 and guide treatment approaches.
Orthopedic and hand surgery implants for internal fixation of fractures have evolved substantially over the past 50 years. Newer metal compositions have been used, and new standards have been applied ...to older alloys, resulting in modern implants with unique physical properties and better clinical performances. Conventional wisdom has long dictated that implanting different metals should be avoided, but few guidelines exist regarding the safety of using in proximity implant systems of dissimilar metals. To better characterize the landscape of internal fixation implant metallurgy, we have compiled the recommendations and conclusions of the currently available and pertinent literature.
Predictors of Comprehension during Surgical Informed Consent Fink, Aaron S., MD, FACS; Prochazka, Allan V., MD, MSc; Henderson, William G., PhD ...
Journal of the American College of Surgeons,
06/2010, Letnik:
210, Številka:
6
Journal Article
Recenzirano
Background Patient comprehension during surgical informed consent remains problematic. Using data from our randomized trial of methods to improve informed consent comprehension, we performed an ...additional analysis to define independent factors associated with improved patient understanding. Study Design Patients scheduled for 1 of 4 elective operations (total hip arthroplasty n = 137, carotid endarterectomy n = 178, laparoscopic cholecystectomy n = 179, or radical prostatectomy n = 81) at 7 Department of Veterans Affairs (VA) medical centers were enrolled. All informed consent discussions were performed using iMedConsent (Dialog Medical), the VA's computerized informed consent platform. Using a unique module within iMedConsent, we randomized patients to repeat back (RB), requiring correct reiteration of procedure-specific facts, or standard (STD) iMedConsent. Patient comprehension was tested after the informed consent discussion using procedure-specific questionnaires. Time spent completing the informed consent process was measured using time stamps within iMedConsent. Multiple linear regression identified factors independently associated with improved comprehension. Results We enrolled 575 patients (276 RB, 299 standard); 93% were male, 74% were Caucasian, and 89% had at least a high school education. Independent factors associated with improved comprehension included race (p < 0.01), ethnicity (p < 0.05), age (p < 0.02), operation type (p < 0.01), group assignment (± RB; p < 0.05), and total consent time (p < 0.0001). Patient comprehension was maximized when informed consent took between 15 and 30 minutes. RB's positive impact on patient comprehension was weaker in the analysis including consent time. Conclusions Comprehension during informed consent discussions may be limited in individuals with potential language difficulty due to ethnicity or education. Total consent time was the strongest predictor of patient comprehension. Affording adequate time for informed consent discussions and using informed consent adjuncts such as RB may enhance comprehension in such individuals.
Purpose To determine if a slight modification of the 1987 Eaton-Glickel staging and interpreting 4 standardized radiographs for trapeziometacarpal (TMC) osteoarthritis (OA) improved analysis, to ...determine if a quantifiable index measurement from a single Robert (pronated anteroposterior) view enhanced reproducibility, and to examine whether improved radiographic staging correlated to clinically relevant disease and thus support validity. Methods We analyzed 4 thumb radiographs (posteroanterior, lateral, Robert, and stress views) in 60 consecutive subjects representing an adult population spectrum of asymptomatic to advanced disease. Two experienced hand surgeons (A.L.L. and A.P.C.W.), 1 chief resident (A.J.B.), and 1 medical student (J.M.M.) performed the analysis on each subject’s radiographs. We analyzed all 4 radiographs for Eaton and modified Eaton staging and then later analyzed only the Robert view for the thumb osteoarthritis (ThOA) index measurement. The radiographs were randomized and reread a week later for each classification at separate times. Surgically excised trapeziums from 20/60 subjects were inspected for first metacarpal surface disease and correlated to the 3 classifications. Results All 3 staging classifications demonstrated high reproducibility, with the intraclass correlation coefficient averaging 0.73 for the Eaton, 0.83 for the modified Eaton, and 0.95 for the ThOA index. Articular wear and metacarpal surface eburnation correlated highest to the ThOA index, with advanced disease 1.55 or greater correlating to Eaton III/IV and modified Eaton stage 3/4 in a linear relationship. Conclusions The ThOA index based on a Robert view provided a measurable alternative to Eaton staging and correlated to severity of surgically relevant thumb TMC OA. Clinical relevance A simple reproducible radiographic measurement may enhance TMC OA classification and provide a reliable means to predict clinical disease. Type of study/level of evidence Diagnostic II.
PDF
