Ecotones are important landscape features where there is a transition between adjoining ecosystems. However, there are few generalized hypotheses about the response of communities to ecotones, except ...for a proposed increase in species richness that receives varying empirical support. Based on the assumption that transport of abiotic material and dispersal of organism propagules across ecotones are independent processes, we propose the new hypothesis that ecotones decouple community-environment relationships, increasing the importance of spatial structure that is independent of the environment. We tested this hypothesis by examining the effects of ecotones on relationships between trees and soil properties in a temperate deciduous forest. The study area included different landforms defined by topography, hydrology, and geomorphology, which we designated upland, bottomland, and riparian forests. The site also included a mowed herbaceous corridor. We found that soil properties and tree community composition significantly differed among landforms, and thus they could be treated as differing ecosystem types. However, inclusion of plots near ecotones significantly reduced the variance explained by landform due to introduction of increased noise, increased similarity of ecotone plots in different landforms, or both. To examine tree community-soil environment relationships, factorial kriging analysis was used to decompose variation in soil properties into structures associated with differing spatial scales, which were then used as predictors of tree composition using redundancy analysis. In agreement with the ecotone-decoupling hypothesis, we found that ecotones introduced significant unexplained variation into correlations between tree community composition and soil properties. In addition, spatial variation in tree community composition that was independent of soil properties was only detected when ecotones were included in the analysis, and little variation in tree community composition was attributed to small-scale soil property structures. Together, these results indicate that dispersal limitation and mass effects in the tree community take on increased importance near ecotones. We found no consistent changes in tree species richness associated with ecotones, and we suggest that the ecotone-decoupling hypothesis may correspond with a more general community-level pattern that warrants further testing. Decoupling of community-environment relationships near ecotones also has important implications for accuracy of models predicting community distributions from abiotic information.
Summary
Background
Clinical evidence shows that pediatric anesthesia patients are subject to a higher rate of life‐threatening medical errors than their adult counterparts. Medication error in adult ...anesthesia is estimated to occur to 1 in 133 anesthetic administrations, but such a figure has not been determined for pediatric anesthesia patients. Individual studies of medication error in pediatric anesthesia have ranged from rates of 0.01% to 1.92% of anesthetic uses. The present study is a systematic review that employs a meta‐analytic estimate to determine the rate of medication error in pediatric anesthesia.
Methods
A systematic review of the literature on pediatric anesthesia medication error was conducted using Medline, Cochrane Database, PROSPERO, and Clinicaltrials.gov. A meta‐analytic estimate was used to determine the medication error rate for all of the included studies. Subgroup sensitivity analysis was used to evaluate possible sources of heterogeneity in included studies.
Results
Of the 433 initially screened records, 13 studies met inclusion criteria. Meta‐analytic estimate of medication error rate across all studies was 0.08% (95% CI 0.05%‐0.10%), or 1 out of 1250 anesthetics. Ten different countries were represented in the studies. Sample size of anesthetics reported on ranged from 296 to 2 316 635. Data collecting periods ranged from 3 months to 15 years. Six included studies individually reported higher rates of medication error in patients under 1 year of age.
Conclusion
The present systematic review revealed a medication error rate of 1 per 1250 anesthetic administrations in pediatric anesthesia. This result is significantly lower than would be expected given reported rates of medication error in adult anesthesia, which raises questions regarding the validity of research methods and reporting of medication error in pediatric anesthesia. Future investigations of medication error should employ methodologies other than self‐reporting of error, such as retrospective chart review.
Nontuberculous mycobacteria (NTM) are essentially ubiquitous and can infect both immunocompetent and immunocompromised hosts. However, NTM infection is surprisingly uncommon in reports from ...allogeneic hematopoietic stem cell transplant (alloSCT) centers that do not routinely perform allograft T-cell depletion. We reviewed medical records for all adult patients who underwent alloSCT at our center between January 1993 and December 2001. American Thoracic Society and Centers for Disease Control and Prevention guidelines Were used to define definite, probable, and possible NTM infection. Of 571 patients, 36 of 372 (9.7%) T-cell depleted and 14 of 199 (7.0%) conventional alloSCT recipients (P=0.26) had a positive culture for NTM after alloSCT. Of the 50 patients with NTM infection, 16 had definite infection and 34 had probable or possible infection. Rates of NTM infection were 5 to 20-fold higher than rates reported by other centers. Of the 16 definite infections, nine were caused by Mycobacterium haemophilum. Two patients had disseminated M. avium complex (MAC) infection and one had a vascular catheter infected by MAC. Three patients died from complications of NTM infection. Patients with probable or possible NTM infection had markedly different epidemiology, risk factors, site and species of NTM infection, and prognosis than patients with definite NTM infection.
Informed consent for procedures in the emergency department (ED) challenges practitioners to navigate complex ethical and medical ambiguities. A patient's altered mental status or emergent medical ...problem does not negate the importance of his or her participation in the decision-making process but, rather, necessitates a nuanced assessment of the situation to determine the appropriate level of participation. Given the complexities involved with informed consent for procedures in the ED, it is important to understand the experience of key stakeholders involved.
For this review, we searched Medline, the Cochrane database, and Clinicaltrials.gov for studies involving informed consent in the ED. Inclusion and exclusion criteria were designed to select for studies that included issues related to informed consent as primary outcomes. The following data was extracted from included studies: Title, authors, date of publication, study type, participant type (i.e. adult patient, pediatric patient, parent of pediatric patient, patient's family, or healthcare provider), number of participants, and primary outcomes measured.
Fifteen articles were included for final review. Commonly addressed themes included medical education (7 of 15 studies), surrogate decision-making (5 of 15 studies), and patient understanding (4 of 15 studies). The least common theme addressed in the literature was community notification (1 of 15 studies).
Studies of informed consent for procedures in the ED span many aspects of informed consent. The aim of the present narrative review is to summarize the work that has been done on informed consent for procedures in the ED.
Within academic medicine, residency programs in a range of specialties have utilized social media for a variety of purposes like showcasing program features, highlighting research, disseminating ...information during conferences, and providing educational tools for medical students, residents, or the general public 2–4. Future research may also focus on characterizing the content posted on social media by residency programs in order to develop a further understanding of social media use.Author contributions Max M. Feinstein conceived of the study idea, conducted data analysis, interpretation of results, and drafted the manuscript. Rank Program name Instagram account # of followers Posts/week 1 Brigham and Women's Hospital Program brighamanesthesia 2832 2.42 2 Massachusetts General Hospital Program mghanesthesia 2656 1.44 3 Stanford Health Care-Sponsored Stanford University Program stanfordanesthesia 2573 1.28 4 UCLA David Geffen School of Medicine/UCLA Medical Center Program ucla_anesthesiology_reslife 2266 4.67 5 Icahn School of Medicine at Mount Sinai (Mount Sinai Hospital) Program mountsinaianesthesiology 1904 4.29 6 University of California (San Francisco) Program ucsfanesthesia 1880 1.67 7 Mayo Clinic College of Medicine and Science (Rochester) Program mayoanesthesia 1520 0.67 8 University of Miami/Jackson Health System Program umanesthesia 1437 0.61 9 University of Pennsylvania Health System Program pennanesthesia 1367 1.55 10 Duke University Hospital Program dukeanes 1359 0.26 11 Stony Brook Medicine/University Hospital Program stonybrookanesthesia 1306 1.60 12 University of Virginia Medical Center Program uvaanesthesiology 1263 0.92 13 Washington University/B-JH/SLCH Consortium Program washu.anest.residency 1237 0.64 14 New York Presbyterian Hospital (Columbia Campus) Program columbiaanesthesia 1198 1.39 15 Temple University Hospital Program templeanesthesia 1169 0.90 16 University of Chicago Program uchicago_anesthesia_residency 1148 2.75 17 University of California Davis Health Program ucdavisanesthesiology 1138 1.20 18 University of North Carolina Hospitals Program unc_anesthesia_residency 1134 1.05 19 University of Texas Southwestern Medical Center Program utswanesthesiologyresidents 1131 0.99 20 New York Presbyterian Hospital (Cornell Campus) Program cornell.anesthesia 1053 0.67 Table 1 Top 20 most popular anesthesiology residency programs on Instagram.
•We assessed racial/ethnic minority enrollment in perioperative clinical research.•A total of 12,773 patients from 38 studies were evaluated.•Participation rates were 48.8% (black), 51.5% (white), ...and 46.1% (other).
Program-level information on total number of residency positions and geographic region was part of this data licensing agreement. Additionally, the R2 values of the statistical models (0.375 in 2020 ...and 0.397 in 2021) suggest that other important predictors of FREIDA pageviews were not included in this study.IRB status Exempt.Funding source Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.Author contributions Max M. Feinstein conceived of the study idea, collected data, conducted data analysis, interpreted results, and drafted the manuscript. Daniel Katz and Marc Sherwin conceived of the study idea, interpreted results, and drafted the manuscript.Declaration of Competing Interest None. n (%) Median IQR p Instagram posts 2020 3.5 15.8 Instagram posts 2021 4 10 0.032a Tweets 2020 0 15 0.448a Tweets 2021 0 6 0.508a FREIDA pageviews (unique) 2020 146 70.5 N/A FREIDA pageviews (unique) 2021 464 207 N/A Residency positions (total) 39 36 0.023a Program age 56.5 36.5 0.275a Geographic region 0.106b East North Central 26 (16.0%) East South Central 7 (4.3%) Mid Atlantic 34 (21.0%) Mountain 6 (3.7%) New England 15 (9.3%) Pacific 17 (10.5%) South Atlantic 29 (17.9%) Territory 1 (0.6%) West North Central 10 (6.2%) West South Central 17 (10.5%) Table 1 Summary data and univariate analyses. β Point Estimate 95% Confidence Interval p 2020 Instagram posts 0.017 −0.55 - 0.59 0.952 Twitter posts 0.335 −0.02 - 0.68 0.061 Residency positions 0.974 0.50–1.45 < 0.001 Doximity rank −0.039 −0.33 - 0.25 0.794 Program age −0.389 −0.81 - 0.03 0.071 2021 Instagram posts 2.396 0.03–4.76 0.047 Twitter posts −0.365 −1.01 - 0.28 0.265 Residency positions 2.250 1.14–3.36 < 0.001 Doximity rank −0.226 −0.92 - 0.47 0.518 Program age −0.670 −1.65 - 0.31 0.178 Table 2 Logistic regression models.
To identify pediatric age groups, medical subject headings (MeSH) categories for “Child”, “Infant”, and “Adolescent” were used with Boolean operators (Fig. 1). Across clinical topic areas for ...“Infant” RCTs, gastroenterology/hepatology, cardiology, pulmonary medicine, neurology, and obstetrics/gynecology had more yearly publications compared to other specialties, whereas psychiatry and neurology had substantially more RCTs for “Children” (Fig. 2A–B). Efforts to mandate trial reporting, to address barriers to high-quality research, and to ensure focus on RCTs to inform appropriate SRMAs require further attention.CRediT authorship contribution statement Joshua D. Niforatos: Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Writing - original draft, Writing - review & editing.
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