Whales as marine ecosystem engineers Roman, Joe; Estes, James A; Morissette, Lyne ...
Frontiers in ecology and the environment,
September 2014, Letnik:
12, Številka:
7
Journal Article
Recenzirano
Odprti dostop
Baleen and sperm whales, known collectively as the great whales, include the largest animals in the history of life on Earth. With high metabolic demands and large populations, whales probably had a ...strong influence on marine ecosystems before the advent of industrial whaling: as consumers of fish and invertebrates; as prey to other large-bodied predators; as reservoirs of and vertical and horizontal vectors for nutrients; and as detrital sources of energy and habitat in the deep sea. The decline in great whale numbers, estimated to be at least 66% and perhaps as high as 90%, has likely altered the structure and function of the oceans, but recovery is possible and in many cases is already underway. Future changes in the structure and function of the world's oceans can be expected with the restoration of great whale populations.
Enhanced recovery pathways have been shown to reduce length of stay without increasing readmission or complications in numerous areas of surgery. Uptake of gynecologic oncology ERAS guidelines has ...been limited. We describe the effect of ERAS guideline implementation in gynecologic oncology on length of stay, patient outcomes, and economic impact for a province-wide single-payer system.
We compared pre- and post-guideline implementation outcomes in consecutive staging and debulking patients at two centers that provide the majority of surgical gynecologic oncology care in Alberta, Canada between March 2016 and April 2017. Clinical outcomes and compliance were obtained using the ERAS Interactive Audit System. Patients were followed until 30 days after discharge. Negative binomial regression was employed to adjust for patient characteristics.
We assessed 152 pre-ERAS and 367 post-ERAS implementation patients. Mean compliance with ERAS care elements increased from 56% to 77.0% after implementation (p < 0.0001). Median length of stay for all surgeries decreased from 4.0 days to 3.0 days post-ERAS (p < 0.0001), which translated to an adjusted LOS decrease of 31.4% (95% CI = 21.7% - 39.9%, p < 0.0001). In medium/high complexity surgery median LOS was reduced by 2.0 days (p = 0.0005). Complications prior to discharge decreased from 53.3% to 36.2% post-ERAS (p = 0.0003). There was no significant difference in readmission (p = 0.6159), complications up to 30 days (p = 0.6274), or mortality (p = 0.3618) between the cohorts. The net cost savings per patient was $956 (95%CI: $162 to $1636).
Systematic implementation of ERAS gynecologic oncology guidelines across a healthcare system improves patient outcomes and saves resources.
•Implementation of ERAS gynecologic oncology guidelines results in significant clinical improvements and cost savings.•Use of an audit system allows measurement of compliance to the individual ERAS recommendations.•ERAS teams should strive to improve compliance to guidelines as this translates into improved outcomes.
This review comprises the most extensive literature search and evidence evaluation to date on the most important international BLS interventions, diagnostics, and prognostic factors for cardiac ...arrest victims. It reemphasizes that the critical lifesaving steps of BLS are (1) prevention, (2) immediate recognition and activation of the emergency response system, (3) early high-quality CPR, and (4) rapid defibrillation for shockable rhythms. Highlights in prevention indicate the rational and judicious deployment of search-and-rescue operations in drowning victims and the importance of education on opioid-associated emergencies. Other 2015 highlights in recognition and activation include the critical role of dispatcher recognition and dispatch-assisted chest compressions, which has been demonstrated in multiple international jurisdictions with consistent improvements in cardiac arrest survival. Similar to the 2010 ILCOR BLS treatment recommendations, the importance of high quality was reemphasized across all measures of CPR quality: rate, depth, recoil, and minimal chest compression pauses, with a universal understanding that we all should be providing chest compressions to all victims of cardiac arrest. This review continued to focus on the interface of BLS sequencing and ensuring high-quality CPR with other important BLS interventions, such as ventilation and defibrillation. In addition, this consensus statement highlights the importance of EMS systems, which employ bundles of care focusing on providing high-quality chest compressions while extricating the patient from the scene to the next level of care. Highlights in defibrillation indicate the global importance of increasing the number of sites with public-access defibrillation programs. Whereas the 2010 ILCOR Consensus on Science provided important direction for the “what” in resuscitation (ie, what to do), the 2015 consensus has begun with the GRADE methodology to provide direction for the quality of resuscitation. We hope that resuscitation councils and other stakeholders will be able to translate this body of knowledge of international consensus statements to build their own effective resuscitation guidelines.
Testing for a Semilattice Term Freese, Ralph; Nation, J. B.; Valeriote, Matt
Order (Dordrecht),
15/3, Letnik:
36, Številka:
1
Journal Article
Recenzirano
This paper investigates the computational complexity of deciding if a given finite algebra is an expansion of a semilattice. In general this problem is known to be EXP-TIME complete, and we show that ...even for idempotent algebras, this problem remains hard. This result is in contrast to a series of results that show that similar decision problems turn out to be tractable.
We present results inspired by the study of closure systems with unique critical sets. Many of these results, however, are of a more general nature. Among those is the statement that every optimum ...basis of a finite closure system, in D. Maier’s sense, is also right-side optimum. New parameters for the size of the binary part of a closure system are established. We introduce the K-basis of a closure system, which is a refinement of the canonical basis of V. Duquenne and J.L. Guigues, and discuss a polynomial algorithm to obtain it.
The main part of the paper is devoted to closure systems with unique critical sets, and some subclasses of these where the K-basis is unique. A further refinement in the form of the E-basis is possible for closure systems without D-cycles. There is a polynomial algorithm to recognize the D-relation from a K-basis. Consequently, closure systems without D-cycles can be effectively recognized. While the E-basis achieves an optimum in one of its parts, the optimization of the others is an NP-complete problem.
We introduce a new generalization of Alan Day’s doubling construction. For ordered sets
ℒ
and
K
and a subset
E
⊆
≤
ℒ
we define the ordered set
ℒ
⋆
E
K
arising from inflation of
ℒ
along
E
by
K
. Under ...the restriction that
ℒ
and
K
are finite lattices, we find those subsets
E
⊆
≤
ℒ
such that the ordered set
ℒ
⋆
E
K
is a lattice. Finite lattices that can be constructed in this way are classified in terms of their congruence lattices.
A finite lattice is binary cut-through codable if and only if there exists a 0−1 spanning chain
𝜃
i
:
0
≤
i
≤
n
in
Con
(
ℒ
)
such that the cardinality of the largest block of
𝜃
i
/
𝜃
i
−1
is 2 for every
i
with 1≤
i
≤
n
. These are exactly the lattices that can be constructed by inflation from the 1-element lattice using only the 2-element lattice. We investigate the structure of binary cut-through codable lattices and describe an infinite class of lattices that generate binary cut-through codable varieties.
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