The mortality of wildlife on roadways is a major conservation concern worldwide. Amphibians and reptiles are especially vulnerable to vehicular collisions, and this is of particular concern in the ...Frontenac Arch Biosphere Reserve (Ontario, Canada) where several species are near their geographic limits of distribution and designated as species-at-risk. We completed regular surveys (n = 270) of two major highways in the Reserve, each slightly less than 40 km in length. All observations of wildlife-vehicle collisions were documented for two years on each road, including 18,278 frogs, turtles, and snakes. We used kernel density estimation to map relative magnitude of this mortality and built a suite of regression tree models to assess the influence of landcover and other habitat factors on roadkill at two scales (1 ha and 20 ha). Sample size was large enough to conduct species-level analyses for Chrysemys picta marginata (midland painted turtle) and Nerodia sipedon (northern watersnake). Spatial clustering of roadkill was evident on both roads and for all taxa. However, the extent of clustering varied between the two roadways due to differences in landcover pattern and clustering was more discrete for frogs and turtles than for snakes. For frogs, turtles, and northern watersnakes we found that elevated levels of mortality were positively associated with the amount of wetland and open water in adjacent areas as well as the proximity of water features. However, mortality locations for other species of snakes were more closely associated with upland habitat types. While some generalities emerge from our study, the variation also suggests that caution be exercised when attempting to extend results to different taxa and roadways, especially since these results may vary with scale. Nonetheless, scale-related differences can be informative for identifying the location of roadkill mitigation efforts and we illustrate how such an approach could be implemented for snakes that exhibit less discrete clustering of mortality.
Abstract Background The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) has monitored discharge disposition, after total hip and knee arthroplasties, since inception in 2012 ...and found the standardized risk of extended care facility (ECF) placement to be highly variable between hospitals. Methods The variation in standardized risks of ECF placement among MARCQI member sites was reported to the collaborative. At the May 2, 2014 quarterly meeting, a quality initiative was started, emphasizing the wide variability between hospitals, the contribution of hospital and surgeon to that variability using median odds ratios, and the need for outlier hospitals to initiate quality improvement (QI) processes. Patients from 29 hospitals that were members of MARCQI before the intervention were included in this analysis. We compared standardized risks before and after the intervention in the entire cohort, and for 3 hospitals that implemented institution-specific QI projects. We report changes in ECF placement, length of stay, emergency room visits, and readmissions over time. Results This study includes 31,347 patients before and 20,879 patients after the implementation of the quality initiative. The range in standardized risk dropped from 9.4%-46.1% to 9.4%-32.4% and the average dropped from 23.0% to 19.6%. Three outlier hospitals decreased their absolute risk of ECF placement by 12.2%, 8.9%, and 12.4% after QI, without increases in adverse outcomes. Conclusion Discharge to ECF after primary hip and knee arthroplasties is highly variable and influenced by hospital and surgeon practices. Hospital-level QI measures can decrease ECF admissions.
A prospective cohort study of consecutive patients.
Determination of the quality of life (QoL) and prevalence of slip progression in patients with degenerative lumbar spondylolisthesis managed ...nonoperatively.
Lumbar spinal stenosis secondary to degenerative lumbar spondylolisthesis is a common radiographic diagnosis associated with chronic back pain and radicular symptoms. There is limited evidence as to the clinical course in terms of validated QoL measures, and the extent of slip progression in patients with this condition treated nonoperatively.
Validated disease-specific and generic QoL metrics including SF12 physical and mental scores SF12-physical component summary (PCS) and SF12-mental component summary (MCS), Oswestry Disability Index (ODI), and numeric scales for back and leg pain as well as radiographic assessment of slip extent were evaluated at initial consultation (baseline) and at a minimum of 5 years after the baseline assessment. Slip progression was defined by a >5% increase in slip percentage.
Thirty-nine of 160 (24.4%) patients elected to switch to operative management, despite no slip progression on preoperative radiographs. Seventy spondylolisthetic levels in 66 participants were assessed after a minimum of 5 years of nonoperative management. Twenty-one participants (31.8%) had slip progression. SF12-PCS, ODI, and leg pain improved similarly in both groups (P < 0.05). SF12-MCS did not change significantly in either group. Back pain improved only in the nonprogressing group.
The majority of cases of low-grade spondylolisthesis do not progress over 5 years with nonoperative management. Regardless of whether there was progression or not, the mean PCS, ODI, and leg pain improved from baseline, although symptoms remained and a significant number elected to switch to surgical management before 5 years. Back pain improved with nonoperative treatment only in those without progression.
2.
•Satellite-derived cyanobacteria and qualitative sampler responses had 94% agreement.•685 drinking water sources are observable with 300-m satellite imagery.•2019 temporal frequency of blooms ...averaged 2% across source waters, peaking at 100%.•Effect size of 10 years needed for observed trends to outweigh residual variability.•Only 5 source waters have sufficient data for a sustained trend from 2016 to 2020.
This study presents the first large-scale assessment of cyanobacterial frequency and abundance of surface water near drinking water intakes across the United States. Public water systems serve drinking water to nearly 90% of the United States population. Cyanobacteria and their toxins may degrade the quality of finished drinking water and can lead to negative health consequences. Satellite imagery can serve as a cost-effective and consistent monitoring technique for surface cyanobacterial blooms in source waters and can provide drinking water treatment operators information for managing their systems. This study uses satellite imagery from the European Space Agency's Ocean and Land Colour Instrument (OLCI) spanning June 2016 through April 2020. At 300-m spatial resolution, OLCI imagery can be used to monitor cyanobacteria in 685 drinking water sources across 285 lakes in 44 states, referred to here as resolvable drinking water sources. First, a subset of satellite data was compared to a subset of responses (n = 84) submitted as part of the U.S. Environmental Protection Agency's fourth Unregulated Contaminant Monitoring Rule (UCMR 4). These UCMR 4 qualitative responses included visual observations of algal bloom presence and absence near drinking water intakes from March 2018 through November 2019. Overall agreement between satellite imagery and UCMR 4 qualitative responses was 94% with a Kappa coefficient of 0.70. Next, temporal frequency of cyanobacterial blooms at all resolvable drinking water sources was assessed. In 2019, bloom frequency averaged 2% and peaked at 100%, where 100% indicated a bloom was always present at the source waters when satellite imagery was available. Monthly cyanobacterial abundances were used to assess short-term trends across all resolvable drinking water sources and effect size was computed to provide insight on the number of years of data that must be obtained to increase confidence in an observed change. Generally, 2016 through 2020 was an insufficient time period for confidently observing changes at these source waters; on average, a decade of satellite imagery would be required for observed environmental trends to outweigh variability in the data. However, five source waters did demonstrate a sustained short-term trend, with one increasing in cyanobacterial abundance from June 2016 to April 2020 and four decreasing.
Carbon 1s (C−R) → π*C C electronic transitions originating from the substituent-bonded carbon atom of a benzene ring show distinctive chemical shifts in their near-edge X-ray absorption fine ...structure (NEXAFS) spectra. We have systematically explored these chemical shifts through ab initio calculations and carefully calibrated experimental data for a wide range of molecules containing substituted benzene rings. The systematic disparity between experimental and calculated transition energies was used to develop a semiempirical correction for this class of transitions, allowing us to map calculated transition energies onto a corrected, experimental energy scale. The correction method was applied to a large set of calculated core C 1s (C−R) → π*C C transition energies, and used to prepare a chemically wide-ranging NEXAFS correlation diagram for the “C−R π* band”. We demonstrate the usefulness of this correlation diagram for the analytical application of NEXAFS spectroscopy and microscopy to organic materials.
Background
The roles of physical activity (PA) and exercise within the management of cystic fibrosis (CF) are recognised by their inclusion in numerous standards of care and treatment guidelines. ...However, information is brief, and both PA and exercise as multi-faceted behaviours require extensive stakeholder input when developing and promoting such guidelines.
Method
On 30th June and 1st July 2021, 39 stakeholders from 11 countries, including researchers, healthcare professionals and patients participated in a virtual conference to agree an evidence-based and informed expert consensus about PA and exercise for people with CF. This consensus presents the agreement across six themes: (i) patient and system centred outcomes, (ii) health benefits, iii) measurement, (iv) prescription, (v) clinical considerations, and (vi) future directions. The consensus was achieved by a stepwise process, involving: (i) written evidence-based synopses; (ii) peer critique of synopses; (iii) oral presentation to consensus group and peer challenge of revised synopses; and (iv) anonymous voting on final proposed synopses for adoption to the consensus statement.
Results
The final consensus document includes 24 statements which surpassed the consensus threshold (>80% agreement) out of 30 proposed statements.
Conclusion
This consensus can be used to support health promotion by relevant stakeholders for people with CF.
Data informing energy needs of people with spinal cord injury (SCI) and pressure injuries are scarce, the impact of surgical repair unknown, and the role of body composition in healing unexplored. ...The study aims were to investigate resting energy expenditure (REE) over the course of pressure injury surgical repair, compare with available energy prediction equations, and explore associations between body composition and wound healing.
Indirect calorimetry measured REE pre-surgery, post-surgery, at suture removal and hospital discharge. A clinically significant change was defined as +/-10% difference from pre-surgery. Eight SCI-specific energy prediction equations were compared to pre-surgery REE. Wound breakdown (Yes/No), weight, waist circumference (WC), and body composition (fat mass FM, fat-free mass FFM, bioimpedance spectroscopy) were measured.
Twenty people underwent pressure injury surgical repair (95% male, mean age 56 ± 12 years, 70% paraplegia). Between pre-surgery and discharge, mean REE increased (+118 kcal/d, p = 0.005), but with <10% change at any timepoint. An energy prediction equation incorporating FFM showed greatest agreement (r
= 0.779, 95% CI: 0.437, 0.924). Those with wound breakdown (65%) had a higher weight (12.7 kg, 95% CI: -4.0, 29.3), WC (17.8 cm, 95% CI: -5.1, 40.7), and FM % (36.0% IQR 31.8, 40.2 vs 26.0% IQR 15.6, 41.3) than those without wound breakdown, although statistical significance was not reached.
The presence of pressure injuries and subsequent surgical repair did not impact REE and energy prediction equations incorporating FFM performed best. While not statistically significant, clinically important differences in body composition were observed in those with wound breakdown.
Research on caregivers for children with intellectual disabilities, particularly those with autism spectrum disorder (ASD), has highlighted several obstacles to achieving better oral health. These ...include challenges with tolerating oral care, sensory processing differences, uncooperative behaviors, and communication impairments. There is limited understanding of what caregivers would consider "successful assistance" in improving oral health for these children.
This pilot study aimed to examine caregivers' and user's experiences with a Kids Smart Electric Toothbrush used by children with ASD.
It involved open-ended interviews and questionnaires with caregivers prior to utilization of the toothbrush and after 4 weeks of product use by the child.
Seventeen children with ASD, aged 5-12, participated. A total of 58.8% of caregivers said their child brushed more often, and all reported brushing at least twice a day by week 4. Caregivers reported that children became more independent while brushing their teeth and achieved better quality brushing. Caregivers' frustration with the brushing process, satisfaction with the device, and need to assist the child with brushing were improved. Caregivers did encounter some technical difficulties with the app.
This study will assist in exploring "smart" toothbrush technologies for oral hygiene in children with ASD.
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