Seagrass beds provide a wealth of ecosystem services that benefit society (e.g., habitat and feeding ground for juvenile fisheries species), but the Anthropocene has seen to a global decline of these ...productive habitats. Many temperate estuaries are becoming eutrophic due to horticultural, agricultural, and urban nutrient run off, but the role of this enrichment in seagrass decline is not fully understood. In a multi-site manipulative field experiment (Tauranga Harbour, New Zealand; 37°S, 176°E), we elevated pore water nitrogen (N) concentrations (mimicking the consequences of long-term eutrophication) to examine effects on seagrass meadows. At six intertidal seagrass sites with differing sediment properties and macrofaunal communities, slow release urea fertiliser (200 g N m−2) was buried in 1 m2 plots at the start of the peak growing season (early summer). After 60 d, we measured several seagrass morphological variables (cover, leaf length and width, and above and below ground biomass), sediment properties, and macrofauna community structure. Results demonstrate that the resilience of seagrass meadows to N enrichment is highly site-dependent. Two of the six sites showed significant declines in a multivariate indicator of seagrass morphology, driven by marked reductions in seagrass cover and leaf length (of up to 78%). Whereas, other sites appeared resilient to N enrichment. It was expected that these site-specific responses would be correlated with changes in sediment properties that alter nutrient processing capacity (permeability and biogeochemistry). However, site-specific responses were instead correlated with the ambient seagrass biomass and macrofaunal diversity. Sites with low ambient seagrass biomass and macrofaunal diversity were less resilient to enrichment. These results highlight that seagrass biomass could be a good indicator of resilience to nutrient enrichment, and the biomass where resilience is lost may lie between 140 and 285 g DW m−2. This study contributes knowledge that is required for predicting and mitigating future impacts of estuarine eutrophication on seagrass ecosystems.
•Estuary eutrophication enriches sediment pore water with bioavailable N.•Sediment pore water N was experimentally enriched in 6 seagrass meadows.•Seagrass morphological characteristics were measured 8 weeks after enrichment.•Enrichment negatively affected seagrass at 2 of the 6 sites.•Resilience to enrichment was attributed to high seagrass biomass.
Assessment literacy is increasingly recognized as an important concept to consider when developing assessment strategies for courses and programs. Assessment literacy approaches support students in ...their understanding of assessment expectations and help them both understand and optimize their performance in assessment. In this teaching tip, a model for assessment literacy that builds on the well-known Miller's Pyramid model for assessment in clinical disciplines is proposed and contextualized. The model progresses thinking from assessment methods themselves to consideration of the activities that need to be built into curricula to ensure that assessment literacy is addressed at each level of the pyramid. The teaching tip provides specific examples at each of the levels. Finally, the relevance of this work to overall curriculum design is emphasized.
Ex vivo kidney perfusion is an evolving platform that demonstrates promise in preserving and rehabilitating the kidney grafts. Despite this, there is little consensus on the optimal perfusion ...conditions. Hypothermic perfusion offers limited functional assessment, whereas normothermic perfusion requires a more complex mechanical system and perfusate. Subnormothermic machine perfusion (SNMP) has the potential to combine the advantages of both approaches but has undergone limited investigation. Therefore, the present study sought to determine the suitability of SNMP for extended kidney preservation.
SNMP at 22-25 °C was performed on a portable device for 24 h with porcine kidneys. Graft assessment included measurement of mechanical parameters and biochemical analysis of the perfusate using point-of-care tests. To investigate the viability of kidneys preserved by SNMP, porcine kidney autotransplants were performed in a donation after
death (DCD) model. SNMP was also compared with static cold storage (SCS). Finally, follow-up experiments were conducted in a subset of human kidneys to test the translational significance of findings in porcine kidneys.
In the perfusion-only cohort, porcine kidneys all displayed successful perfusion for 24 h by SNMP, evidenced by stable mechanical parameters and biological markers of graft function. Furthermore, in the transplant cohort, DCD grafts with 30 min of warm ischemic injury demonstrated superior posttransplant graft function when preserved by SNMP in comparison with SCS. Finally, human kidneys that underwent 24-h perfusion exhibited stable functional and biological parameters consistent with observations in porcine organs.
These observations demonstrate the suitability and cross-species generalizability of subnormothermic machine perfusion to maintain stable kidney perfusion and provide foundational evidence for improved posttransplant graft function of DCD kidneys after SNMP compared with SCS.
IntroductionSCALE-UP II aims to investigate the effectiveness of population health management interventions using text messaging (TM), chatbots and patient navigation (PN) in increasing the uptake of ...at-home COVID-19 testing among patients in historically marginalised communities, specifically, those receiving care at community health centres (CHCs).Methods and analysisThe trial is a multisite, randomised pragmatic clinical trial. Eligible patients are >18 years old with a primary care visit in the last 3 years at one of the participating CHCs. Demographic data will be obtained from CHC electronic health records. Patients will be randomised to one of two factorial designs based on smartphone ownership. Patients who self-report replying to a text message that they have a smartphone will be randomised in a 2×2×2 factorial fashion to receive (1) chatbot or TM; (2) PN (yes or no); and (3) repeated offers to interact with the interventions every 10 or 30 days. Participants who do not self-report as having a smartphone will be randomised in a 2×2 factorial fashion to receive (1) TM with or without PN; and (2) repeated offers every 10 or 30 days. The interventions will be sent in English or Spanish, with an option to request at-home COVID-19 test kits. The primary outcome is the proportion of participants using at-home COVID-19 tests during a 90-day follow-up. The study will evaluate the main effects and interactions among interventions, implementation outcomes and predictors and moderators of study outcomes. Statistical analyses will include logistic regression, stratified subgroup analyses and adjustment for stratification factors.Ethics and disseminationThe protocol was approved by the University of Utah Institutional Review Board. On completion, study data will be made available in compliance with National Institutes of Health data sharing policies. Results will be disseminated through study partners and peer-reviewed publications.Trial registration numberClinicalTrials.gov: NCT05533918 and NCT05533359.
Objectives
To compare predictive significance of sarcopenia and clinical frailty scale (CFS) in terms of postoperative mortality in patients undergoing emergency laparotomy
Methods
In compliance with ...STROCSS statement standards, a retrospective cohort study with prospective data collection approach was conducted. The study period was between January 2017 and January 2022. All adult patients with non-traumatic acute abdominal pathology who underwent emergency laparotomy in our centre were included. The primary outcome was 30-day mortality and secondary outcomes were in-hospital mortality and 90-day mortality. The predictive value of sarcopenia and CFS were compared using the receiver operating characteristic (ROC) curve analysis and multivariable binary logistic regression analysis.
Results
A total of 1043 eligible patients were included. The risk of 30-day mortality, in-hospital mortality, and 90-day mortality were 8%, 10%, and 11%, respectively. ROC curve analysis suggested that sarcopenia is a significantly stronger predictor of 30-day mortality (AUC: 0.87 vs. 0.70,
P
<0.0001), in-hospital mortality (AUC: 0.79 vs. 0.67,
P
=0.0011), and 90-day mortality (AUC: 0.79 vs. 0.67,
P
=0.0009) compared with CFS. Moreover, multivariable binary logistic regression analysis identified sarcopenia as an independent predictor of mortality coefficient: 4.333, OR: 76.16 (95% CI 37.06–156.52),
P
<0.0001 but not the CFS coefficient: 0.096, OR: 1.10 (95% CI 0.88–1.38),
P
=0.4047.
Conclusions
Sarcopenia is a stronger predictor of postoperative mortality compared with CFS in patients undergoing emergency laparotomy. It cancels out the predictive value of clinical frailty scale in multivariable analyses; hence among the two variables, sarcopenia deserves to be included in preoperative predictive tools.
Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is associated with significant pain and prolonged hospitalization. There is evidence that early mobilization and multimodal ...analgesia can accelerate functional recovery and reduced length of stay (LOS). Using these principles, we implemented a quality improvement initiative to enable earlier functional recovery in our AIS-PSF population.
We designed and implemented a standardized rapid recovery pathway (RRP) with evidence-based management recommendations for children aged 10 to 21 years undergoing PSF for AIS. Our primary outcome, functional recovery, was assessed using statistical process control charts for LOS and average daily pain scores. Our process measures were medication adherence and order set utilization. The balancing measure was 30-day readmission rate.
We included 322 patients from January 1, 2011 to June 30, 2015 with 134 (42%) serving as historical controls, 104 (32%) representing our transition population, and 84 (26%) serving as our RRP population. Baseline average LOS was 5.7 days and decreased to 4 days after RRP implementation. Average daily pain scores remained stable with improvement on postoperative day 0 (3.8 vs 4.9 days) and 1 (3.8 vs 5 days) after RRP implementation. In the second quarter of 2015, gabapentin (91%) and ketorolac (95%) use became routine and order set utilization was 100%. Readmission rates did not increase as a result of this pathway.
Implementation of a standardized RRP with multimodal pain management and early mobilization strategies resulted in reduced LOS without an increase in reported pain scores or readmissions.
Purpose
This study sought to delineate whether total hip arthroplasty (THA) or hip hemiarthroplasty (HHA) had more complication rates following the treatment of femoral neck fractures (FNF) in ...chronic obstructive pulmonary disease (COPD) patients.
Materials and methods
The ACS-NSQIP database was queried for all patients with a history of COPD who had undergone THA and HHA with FNFs, isolated by CPT codes and ICD-9/ICD-10 codes. Propensity score matching without replacement in a 1:1 manner was done to control for patient demographics/preoperative comorbidities. Multivariate logistic regression models were utilized to assess the independent effect of HHA in comparison to THA.
Results
The propensity-matched (PM) HHA cohort was significantly older (76.14 years vs. 73.33 years,
p
= 0.001) and had significantly higher rates of pneumonia (
p
= 0.017), extended length of stay (LOS) (
p
= 0.017), and mortality (
p
= 0.002), but lower rates of blood transfusions (
p
= 0.016) and reoperation (
p
= 0.020). HHA was independently associated with an increased risk of pneumonia (
p
= 0.043), extended LOS (
p
= 0.050), and death (
p
= 0.044) but a decreased risk for blood transfusions (
p
= 0.008) and reoperation (
p
= 0.028) when compared to THA.
Discussion
Patients with more comorbidities are more likely to receive HHA than THA, which may explain some of the increased complications and mortality associated with HHA for FNFs compared to THA. Patients undergoing THA were at increased risk for blood transfusion and reoperation. THA does not appear to result in increased morbidity in this population compared to HHA. While THA should be considered in these patients given improved functional outcomes, further prospective studies are needed to establish superiority.
Level of evidence
III.
Abstract
We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths ...taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60
$\to$
–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.
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