Annual census data spanning seventy-five years document mortality and regeneration in a population of saguaro cactus (Carnegiea gigantea) in the Cactus Forest of the Rincon Mountain District of ...Saguaro National Park near Tucson, AZ. On 6 four-hectare plots, each saguaro was censused and a methodical search for new saguaros was conducted annually each year from 1942 through 2016, with the exception of 1955. Regeneration has been episodic with 828 plants established from 1959 through 1993 compared with 34 plants established between 1942 and 1958 and only three plants established after 1993. The years preceding 1959 and following 1993, include some of the driest decades in centuries in southern Arizona. While woodcutting and cattle grazing are believed to be among the causes of decades of failed regeneration prior to 1958, neither of these factors contributed to the failed regeneration following 1993. The height structure of the population from 1942 to 2016 shifted dramatically from a population dominated by large saguaros (> 5.4 m tall) in the first three decades of the study to a population dominated by small saguaros (< 1.8 m tall) in the most recent two decades. Mortality is shown to be strongly age dependent. In the year following the 2011 catastrophic freeze, 21 of 59 plants older than 80 years died compared with zero deaths in 270 plants between the ages of 29 and 80 years. Saguaros under 40 years old, growing under small shrubs or in the open, have a lower probability of survival than better protected saguaros. Long-term population monitoring is essential to understanding the complex impacts of human and environmental factors on the population dynamics of long-lived species.
As efforts to reduce the overpopulation and euthanasia of unwanted and unowned dogs and cats have increased, greater attention has been focused on spay-neuter programs throughout the United States. ...Because of the wide range of geographic and demographic needs, a wide variety of programs have been developed to increase delivery of spay-neuter services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, feral cat programs, and services provided through private practitioners. In an effort to ensure a consistent level of care, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. The guidelines consist of recommendations for preoperative care (eg, patient transport and housing, patient selection, client communication, record keeping, and medical considerations), anesthetic management (eg, equipment, monitoring, perioperative considerations, anesthetic protocols, and emergency preparedness), surgical care (eg, operating-area environment; surgical-pack preparation; patient preparation; surgeon preparation; surgical procedures for pediatric, juvenile, and adult patients; and identification of neutered animals), and postoperative care (eg, analgesia, recovery, and release). These guidelines are based on current principles of anesthesiology, critical care medicine, microbiology, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs.
This systematic analysis examines effectiveness research on online and blended learning from schools, particularly relevant during the Covid‐19 pandemic, and also educational games, ...computer‐supported cooperative learning (CSCL) and computer‐assisted instruction (CAI), largely used in schools but with potential for outside school. Eight research databases were searched. Studies which were non‐school, before 2000, not in English, without data and duplicates were removed, leaving 1355 studies: online 7%, blended 13%, CSCL 7%, games 26% and CAI 47%. Overall, digital technology was more effective (better) than regular instruction in 85% of studies, 8% the same and 3% worse. Blended learning was considerably better than online learning. CAI was the most effective, with games and CSCL coming after blended learning, but of course CAI was not searched for and these were not widely used outside of schools. Primary and early years/kindergarten were most effective (87% better) and secondary/high next (80%). Although science and mathematics were the most popular subjects, English as a foreign language interventions were the most effective, then writing and STEM, thinking, arts/music, humanities, health and science, reading and maths, foreign languages and English in that order. Overall, females did better than males. ‘Low ability’ children and second language learners did especially well. Disadvantaged and special educational needs/disabled students did slightly worse. Self‐efficacy was highly related to better outcomes. The limitations/strengths of the research were discussed and linked back to previous literature, a critical analysis made, and detailed implications for practitioners, policy makers and future researchers outlined. Digital technology's main advantage may be the possibility for enhanced task flexibility and learner autonomy, encouraging greater self‐regulation. However, this may not be an advantage for all students.
COPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms. The objective of this study was to evaluate, in a population-based sample, the ...relationship between subjective sleep quality and risk of COPD exacerbations.
Data were obtained from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants with COPD who had completed 18 months of follow-up were included. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a three-factor analysis. Symptom-based (dyspnea or sputum change ≥ 48 h) and event-based (symptoms plus medication or unscheduled health services use) exacerbations were assessed. Association of PSQI with exacerbation rate was assessed by using negative binomial regression. Exacerbation-free survival was also assessed.
A total of 480 participants with COPD were studied, including 185 with one or more exacerbations during follow-up and 203 with poor baseline sleep quality (PSQI score > 5). Participants with subsequent symptom-based exacerbations had higher median baseline PSQI scores than those without (6.0 interquartile range, 3.0-8.0 vs 5.0 interquartile range, 2.0-7.0; P = .01), and they were more likely to have baseline PSQI scores > 5 (50.3% vs 37.3%; P = .01). Higher PSQI scores were associated with increased symptom-based exacerbation risk (adjusted rate ratio, 1.09; 95% CI, 1.01-1.18; P = .02) and event-based exacerbation risk (adjusted rate ratio, 1.10; 95% CI, 1.00-1.21; P = .048). The association occurred mainly in those with undiagnosed COPD. Strongest associations were with Factor 3 (sleep disturbances and daytime dysfunction). Time to symptom-based exacerbation was shorter in participants with poor sleep quality (adjusted hazard ratio, 1.49; 95% CI, 1.09-2.03).
Higher baseline PSQI scores were associated with increased risk of COPD exacerbation over 18 months' prospective follow-up.
There is limited data on the risk factors and phenotypical characteristics associated with spirometrically confirmed COPD in never-smokers in the general population.
To compare the characteristics ...associated with COPD by gender and by severity of airway obstruction in never-smokers and in ever-smokers.
We analysed the data from 5176 adults aged 40 years and older who participated in the initial cross-sectional phase of the population-based, prospective, multisite Canadian Cohort of Obstructive Lung Disease study. Never-smokers were defined as those with a lifetime exposure of <1/20 pack year. Logistic regressions were constructed to evaluate associations for 'mild' and 'moderate-severe' COPD defined by FEV1/FVC <5th centile (lower limits of normal). Analyses were performed using SAS V.9.1 (SAS Institute, Cary, North Carolina, USA).
The prevalence of COPD (FEV1/FVC<lower limits of normal) in never-smokers was 6.4%, constituting 27% of all COPD subjects. The common independent predictors of COPD in never-smokers and ever-smokers were older age, self reported asthma and lower education. In never-smokers a history of hospitalisation in childhood for respiratory illness was discriminative, while exposure to passive smoke and biomass fuel for heating were discriminative for women. COPD in never-smokers and ever-smokers was characterised by increased respiratory symptoms, 'respiratory exacerbation' events and increased residual volume/total lung capacity, but only smokers had reduced DLCO/Va and emphysema on chest CT scans.
The study confirmed the substantial burden of COPD among never-smokers, defined the common and gender-specific risk factors for COPD in never-smokers and provided early insight into potential phenotypical differences in COPD between lifelong never-smokers and ever-smokers.
NCT00920348 (ClinicalTrials.gov); study ID number: IRO-93326.
OBJECTIVE To define learning curves for fourth-year veterinary students performing ovariohysterectomy procedures in dogs and cats and castration in dogs. DESIGN Retrospective study. SAMPLE 3,196 ...ovariohysterectomies or castrations performed in dogs and cats by 88 veterinary students during a spay-neuter surgery and animal shelter rotation (n = 3,056) or by 1 experienced general practitioner (n = 140). PROCEDURES Data collected from medical records included patient signalment, type and duration of procedure, and sequence (by date and time) of the procedure within a list of procedures of the same type generated for each student. For each procedure type, geometric mean surgery time and 95% confidence intervals were determined for each number of surgeries completed by ≥ 10 students. Median surgery times for the same procedure types were determined for the experienced practitioner. The learning curve for each procedure was modeled with nonlinear (3-factor exponential equation with a nonzero asymptote) and linear regression. For each procedure, the asymptote (optimal surgery time) for students was compared with the experienced practitioner's median surgery time. RESULTS 2,945 surgeries (mean, 33/student) performed by ≥ 10 students were analyzed. Surgery time decreased in a nonlinear manner as student experience increased for castration of adult or pediatric dogs and ovariohysterectomy of pediatric dogs and adult or pediatric cats. Surgery time decreased in a linear manner as experience increased for ovariohysterectomy of adult dogs. CONCLUSIONS AND CLINICAL RELEVANCE To the authors' knowledge, this was the first study to map surgery times for common surgical procedures consecutively performed by veterinary students. Results clearly indicated the value of repetition to improve surgical skills (as measured by surgery time) during a 3-week period.
As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the ...provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs.
COPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms. The objective of this study was to evaluate, in a population-based sample, the ...relationship between subjective sleep quality and risk of COPD exacerbations.
Data were obtained from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants with COPD who had completed 18 months of follow-up were included. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a three-factor analysis. Symptom-based (dyspnea or sputum change ≥ 48 h) and event-based (symptoms plus medication or unscheduled health services use) exacerbations were assessed. Association of PSQI with exacerbation rate was assessed by using negative binomial regression. Exacerbation-free survival was also assessed.
A total of 480 participants with COPD were studied, including 185 with one or more exacerbations during follow-up and 203 with poor baseline sleep quality (PSQI score > 5). Participants with subsequent symptom-based exacerbations had higher median baseline PSQI scores than those without (6.0 interquartile range, 3.0-8.0 vs 5.0 interquartile range, 2.0-7.0; P = .01), and they were more likely to have baseline PSQI scores > 5 (50.3% vs 37.3%; P = .01). Higher PSQI scores were associated with increased symptom-based exacerbation risk (adjusted rate ratio, 1.09; 95% CI, 1.01-1.18; P = .02) and event-based exacerbation risk (adjusted rate ratio, 1.10; 95% CI, 1.00-1.21; P = .048). The association occurred mainly in those with undiagnosed COPD. Strongest associations were with Factor 3 (sleep disturbances and daytime dysfunction). Time to symptom-based exacerbation was shorter in participants with poor sleep quality (adjusted hazard ratio, 1.49; 95% CI, 1.09-2.03).
Higher baseline PSQI scores were associated with increased risk of COPD exacerbation over 18 months’ prospective follow-up.
Emergency department procedural sedation practices for children have been reported for pediatric tertiary care centers. This report describes these same practice patterns and outcomes for community ...hospital-based general emergency physicians (EPs) in their treatment of pediatric patients.
The Procedural Sedation in the Community Emergency Department registry is a prospective observational database composed of consecutive EP-directed procedural sedation cases in community hospitals. Information on sedation cases is collected at the time of the patient encounter and entered into an Internet-accessed database.
A total of 1028 procedural sedations were performed on 977 patients at 14 study sites, with 341 procedures performed in 339 patients younger than 21 years. The most common specified pediatric procedures performed included laceration repairs (n = 86, 25%), shoulder relocations (n = 78, 23%), and fracture care of the upper extremity (n = 56, 16%). Medications used included ketamine (n = 141, 41%), midazolam (n = 10, 32%), etomidate (n = 54, 16%), fentanyl (n = 51, 15%), and propofol (n = 47, 14%). Complications were reported in 2 cases (0.6%), 1 episode of apnea requiring a reversal agent and 1 episode of hypoxia responsive to supplemental oxygen. Of procedures attempted, 339 (99.4%) were successfully completed. Emergency physicians both directed the sedation and performed the procedure in 252 cases (74%), whereas in another 69 cases (20%), they directed the sedation for another physician performing the procedure. In 20 cases (5.8%), the EP directed sedation for a painless diagnostic study.
Community EPs in the Procedural Sedation in the Community Emergency Department registry deliver safe and effective pediatric sedation using a broad selection of agents.
School-based efforts need to embrace a continuum of care model that moves beyond solely primary prevention to address the needs of students who are identified as substance dependent. The extent of ...this problem and barriers to program implementation are presented. Efforts to offer services through Student Assistance Programs, School-based for-credit programs, and Alternative/Recovery Schools are described. Suggestions are made for ways in which schools can better participate in a service continuum for their substance dependent students through familiarity with knowledge-based research, tailoring programs to their students and their community, fighting for funding, and improving school-community collaboration.
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