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1.
Sci Total Environ ; 929: 172634, 2024 Jun 15.
Article in English | MEDLINE | ID: mdl-38643883

ABSTRACT

Chicken fillets, predominantly encased in disposable plastic packaging, represent a common perishable commodity frequently found in the shopping baskets of British consumers, with an annual slaughter exceeding 1.1 billion chickens. The associated environmental implications are of considerable significance. However, a noticeable gap exists concerning the household-level ramifications of chicken meat consumption, which remains a prominent driver (165 kg CO2eyr-1 per capita) of environmental impacts in the United Kingdom (UK). This study's primary objective is to integrate Life Cycle Assessment (LCA) methodology with insights derived from a spectrum of interventions simulated within the Household Simulation Model (HHSM). The interventions that are simulated are influenced by various consumer behaviours related to the purchase, consumption, storage and disposal of chicken fillets. The overarching aim is to provide a comprehensive understanding of the environmental consequences associated with each intervention. The research encompasses eight distinct household archetypes and the UK average, with a focus on discerning differences in their environmental influence. The introduction of shelf-life extension measures leads to a reduction in the overall environmental impacts (in µPt), with reductions ranging from 1 % to 18 %. Concurrently, waste treatment's environmental burdens can be curtailed by 9 % to 69 % for the UK average. Of the 12 interventions tested, the intervention that combines a one-day extension in the shelf life of open packs and a three-day extension for unopened packs leads to the greatest reduction in environmental impacts, at 18 % for the entire process and 69 % for the waste treatment. This intervention is estimated to yield annual reductions of 130,722 t of CO2 emissions across the entire process and 34,720 t of CO2 emissions from waste treatment, as compared to the default scenario. These findings demonstrate the importance of integrating consumer behaviour, food waste, and packaging considerations within the domain of food LCA research.


Subject(s)
Conservation of Natural Resources , United Kingdom , Animals , Conservation of Natural Resources/methods , Chickens , Environment , Consumer Behavior , Family Characteristics , Models, Theoretical
2.
Bone Jt Open ; 4(11): 873-880, 2023 Nov 17.
Article in English | MEDLINE | ID: mdl-37972634

ABSTRACT

Aims: Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of 'full-time bracing' versus 'night-time bracing' in adolescent idiopathic scoliosis (AIS). Methods: UK paediatric spine clinics will recruit 780 participants aged ten to 15 years-old with AIS, Risser stage 0, 1, or 2, and curve size (Cobb angle) 20° to 40° with apex at or below T7. Patients are randomly allocated 1:1, to either full-time or night-time bracing. A qualitative sub-study will explore communication and experiences of families in terms of bracing and research. Patient and Public Involvement & Engagement informed study design and will assist with aspects of trial delivery and dissemination. Discussion: The primary outcome is 'treatment failure' (Cobb angle progression to 50° or more before skeletal maturity); skeletal maturity is at Risser stage 4 in females and 5 in males, or 'treatment success' (Cobb angle less than 50° at skeletal maturity). The comparison is on a non-inferiority basis (non-inferiority margin 11%). Participants are followed up every six months while in brace, and at one and two years after skeletal maturity. Secondary outcomes include the Scoliosis Research Society 22 questionnaire and measures of quality of life, psychological effects of bracing, adherence, anxiety and depression, sleep, satisfaction, and educational attainment. All data will be collected through the British Spine Registry.

3.
J Am Vet Med Assoc ; 260(13): 1650-1652, 2022 05 12.
Article in English | MEDLINE | ID: mdl-35560126
4.
Sci Adv ; 7(3)2021 Jan.
Article in English | MEDLINE | ID: mdl-33523870

ABSTRACT

Projections of ice sheet behavior hinge on how ice flow velocity evolves and the extent to which marine-based grounding lines are stable. Ice flow and grounding line retreat are variably governed by the coupling between the ice and underlying terrain. We ask to what degree catchment-scale bed characteristics determine ice flow and retreat, drawing on paleo-ice sheet landform imprints from 99 sites on continental shelves worldwide. We find that topographic setting has broadly steered ice flow and that the bed slope favors particular styles of retreat. However, we find exceptions to accepted "rules" of behavior: Regional topographic highs are not always an impediment to fast ice flow, retreat may proceed in a controlled, steady manner on reverse slopes and, unexpectedly, the occurrence of ice streaming is not favored on a particular geological substrate. Furthermore, once grounding line retreat is under way, readvance is rarely observed regardless of regional bed characteristics.

5.
Sci Total Environ ; 775: 145788, 2021 Jun 25.
Article in English | MEDLINE | ID: mdl-33618305

ABSTRACT

Pollinator biodiversity loss occurs at unprecedented rates globally, with particularly sharp declines documented in the North Temperate Zone. There is currently no consensus on the main drivers of the decline. Although climate change is expected to drive biodiversity loss in the future, current warming is often suggested to have positive impacts on pollinator assemblages in higher latitudes. Consequently, pollinator conservation initiatives in Europe and the USA tend to lack climate adaptation initiatives, an omission of which may be risky if climate change has significant negative impacts on pollinators. To gain an understanding of the impacts of climate change on pollinator biodiversity in the Northern Hemisphere, we conducted a literature review on genetic, species and community level diversity. Our findings suggest that global heating most likely causes homogenization of pollinator assemblages at all levels of pollinator biodiversity, making them less resilient to future stochasticity. Aspects of biodiversity that are rarely measured (e.g. genetic diversity, ß-diversity, species evenness) tend to be most affected, while some dimensions of climate change, such as fluctuations in winter weather conditions, changes in the length of the vegetational season and increased frequency of extreme weather events, that seldom receive attention in empirical studies, tend to be particularly detrimental to pollinators. Negative effects of global heating on pollinator biodiversity are most likely exacerbated by homogenous and fragmented landscapes, widespread across Europe and the US, which limit opportunities for range-shifts and reduce micro-climatic buffering. This suggests the need for conservation initiatives to focus on increasing landscape connectivity and heterogeneity at multiple spatial scales.


Subject(s)
Climate Change , Pollination , Biodiversity , Europe
6.
Vet Pathol ; 57(5): 632-641, 2020 09.
Article in English | MEDLINE | ID: mdl-32812517

ABSTRACT

Equus caballus papillomavirus type 2 (EcPV-2) has been recognized as a potential cause of a subset of genital squamous cell carcinomas (SCCs) in horses. In the current study, we measured EcPV-2 seropositivity in 50 healthy horses from Western Canada, and these were compared to a herd of horses with known EcPV-2 exposure. Second, the presence of EcPV-2 DNA was measured using EcPV-2-specific PCR (polymerase chain reaction), performed on a variety of tissues collected at necropsy from 70 horses that lacked any history, gross, or histologic evidence of neoplasia or papillomavirus-associated disease. EcPV-2-specific RNA in situ hybridization (R-ISH) was performed on PCR-positive samples to identify the specific tissues infected. The prevalence of asymptomatic infection with EcPV-2 in Western Canadian horses was 20/70 (29%). Exposure to EcPV-2 as measured by seropositivity was 18/50 (36%). EcPV-2 positivity by anatomic location, as measured by R-ISH, was as follows: penis 10/29 (35%), vulva 5/34 (15%), eyelid 8/68 (12%), oral mucosa 7/65 (11%), skin from muzzle 7/68 (10%), and retropharyngeal lymph node 2/64 (3%). The youngest horses with EcPV-2 infection, based on PCR, were fetuses, suggesting for the first time that vertical transmission of EcPV-2 occurs in horses. The current study observed an increased prevalence of EcPV-2 as compared to previous studies. We suggest that this difference is due to our use of biopsies in place of superficial swabs. We propose that EcPV-2 infection in asymptomatic horses is more common than previously reported and that the virus' role in equine genital SCCs may be more complex than originally thought.


Subject(s)
Carcinoma, Squamous Cell/veterinary , Horse Diseases/epidemiology , Infectious Disease Transmission, Vertical/veterinary , Papillomaviridae/immunology , Papillomavirus Infections/veterinary , Animals , Asymptomatic Diseases , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/virology , Female , Fetus , Horse Diseases/pathology , Horse Diseases/virology , Horses , In Situ Hybridization/veterinary , Male , Papillomaviridae/genetics , Papillomavirus Infections/epidemiology , Papillomavirus Infections/pathology , Papillomavirus Infections/virology , Penis/pathology , Penis/virology , Polymerase Chain Reaction/veterinary , Seroepidemiologic Studies , Vulva/pathology , Vulva/virology
7.
Vet Pathol ; 57(5): 623-631, 2020 09.
Article in English | MEDLINE | ID: mdl-32812522

ABSTRACT

Equus caballus papillomavirus type-2 (EcPV-2) has been proposed as a causal factor in equine genital squamous cell carcinoma (SCC). This study had 2 objectives: first, calculate the frequency of papillomavirus (PV) and EcPV-2 infection in papillomas, carcinomas in situ (CIS), and SCCs in Western Canadian horses; and second, determine if EcPV-2 status of equine SCCs is associated with overall survival (OS). EcPV-2 status of 115 archived tissue samples, spanning 6 years, was determined using broad spectrum (MY09/11) and EcPV-2-specific polymerase chain reaction (PCR) assays, EcPV-2-E6/E7 chromogenic RNA in situ hybridization (R-ISH), and amplicon sequencing. A retrospective survey gathered data on history, outcome, breeding, treatment, and rationales of referring veterinarians when managing PV-associated diseases. Histologic grade and completeness of surgical margins of SCCs were also considered. EcPV-2 DNA was identified in 10/58 (17%) SCC, 8/27 (30%) papillomas, 0/5 CIS, and 0/11 lesions identified as "other." Overall, 18/101 (18%) of these lesions were positive for EcPV-2. EcPV-2 was identified in 10/35 (29%) SCCs arising from genital tissues but in 0/22 SCCs from other locations. There was no association between breeding history and EcPV-2 status of genital SCCs. EcPV-2 status of genital SCCs was not associated with OS (P = .76). The strongest negative predictors of OS were a lack of treatment (P < .01) and recurrence post-treatment (P < .01). Weaker predictors of OS included older age at time of diagnosis (P = .02). Completeness of margins at surgical excision, concurrent disease, treatment type, anatomic location of the SCC (anogenital vs other), and histologic grade of the SCC did not influence OS (P > .1).


Subject(s)
Carcinoma, Squamous Cell/veterinary , Horse Diseases/diagnosis , Papillomaviridae/isolation & purification , Papillomavirus Infections/veterinary , Animals , Canada/epidemiology , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/epidemiology , Female , Genitalia/virology , Horse Diseases/epidemiology , Horse Diseases/virology , Horses , In Situ Hybridization/veterinary , Male , Papillomaviridae/genetics , Papillomavirus Infections/diagnosis , Papillomavirus Infections/epidemiology , Papillomavirus Infections/virology , Polymerase Chain Reaction/veterinary , Prevalence , Prognosis , Retrospective Studies , Survival Analysis
8.
Sci Total Environ ; 744: 140880, 2020 Nov 20.
Article in English | MEDLINE | ID: mdl-32693283

ABSTRACT

Pollinator biodiversity and biomass are in decline globally. This fact accompanied by shortage and collapses of domesticated pollinator colonies, puts human food security under unprecedented threat. Many countries worldwide have adopted or intend to introduce national pollinator conservation strategies. Decisions of policy makers and other involved stakeholders are often driven by pragmatic considerations, rather than biodiversity conservation per se. At the same time, different opinions exist in the literature on the role of pollinator biodiversity versus abundance of few dominant species in crop pollination. This article critically evaluates the literature in order to understand the importance of biodiversity over abundance and to examine the effectiveness of conservation strategies. Results of this review suggest that pollinator biodiversity is critical for crop pollination quality, magnitude and resilience. Most current national pollinator conservation strategies lack comprehensive measures for maintaining pollinator biodiversity at a landscape scale.


Subject(s)
Ecosystem , Pollination , Bees , Biodiversity , Humans
9.
Can Vet J ; 60(5): 485-489, 2019 05.
Article in English | MEDLINE | ID: mdl-31080260

ABSTRACT

A 10-month-old, domestic shorthaired, spayed female cat was presented to the Veterinary Medical Centre, Western College of Veterinary Medicine, for evaluation of an oral mucosal mass. Histopathology and polymerase chain reaction with sequencing allowed for a definitive diagnosis of bovine papillomavirus type-14-associated oral sarcoid. The mass resolved spontaneously following incisional biopsy and was still grossly absent 10 months later.


Sarcoïde oral chez une chatte. Une chatte stérilisée âgée de 10 mois a été présentée au Veterinary Medical Centre du Western College of Veterinary Medicine, pour l'évaluation d'une masse orale. L'histopathologie et une amplification en chaîne par polymérase avec le séquençage ont permis de poser un diagnostic définitif de sarcoïde oral associé au papillomavirus bovin de type-14. La masse s'est résorbée spontanément après une biopsie incisionelle et n'était toujours pas visuellement détectable 10 mois plus tard.(Traduit par Isabelle Vallières).


Subject(s)
Cat Diseases , Skin Diseases/veterinary , Animals , Cats , Female , Polymerase Chain Reaction/veterinary
10.
Nat Commun ; 9(1): 3176, 2018 08 09.
Article in English | MEDLINE | ID: mdl-30093609

ABSTRACT

How ice sheets respond to changes in their grounding line is important in understanding ice sheet vulnerability to climate and ocean changes. The interplay between regional grounding line change and potentially diverse ice flow behaviour of contributing catchments is relevant to an ice sheet's stability and resilience to change. At the last glacial maximum, marine-based ice streams in the western Ross Sea were fed by numerous catchments draining the East Antarctic Ice Sheet. Here we present geomorphological and acoustic stratigraphic evidence of ice sheet reorganisation in the South Victoria Land (SVL) sector of the western Ross Sea. The opening of a grounding line embayment unzipped ice sheet sub-sectors, enabled an ice flow direction change and triggered enhanced flow from SVL outlet glaciers. These relatively small catchments behaved independently of regional grounding line retreat, instead driving an ice sheet readvance that delivered a significant volume of ice to the ocean and was sustained for centuries.

11.
Sci Rep ; 8(1): 6876, 2018 05 02.
Article in English | MEDLINE | ID: mdl-29720603

ABSTRACT

Peatlands in northern latitudes sequester one third of the world's soil organic carbon. Mineral dusts can affect the primary productivity of terrestrial systems through nutrient transport but this process has not yet been documented in these peat-rich regions. Here we analysed organic and inorganic fractions of an 8900-year-old sequence from Store Mosse (the "Great Bog") in southern Sweden. Between 5420 and 4550 cal yr BP, we observe a seven-fold increase in net peat-accumulation rates corresponding to a maximum carbon-burial rate of 150 g C m-2 yr-1 - more than six times the global average. This high peat accumulation event occurs in parallel with a distinct change in the character of the dust deposited on the bog, which moves from being dominated by clay minerals to less weathered, phosphate and feldspar minerals. We hypothesize that this shift boosted nutrient input to the bog and stimulated ecosystem productivity. This study shows that diffuse sources and dust dynamics in northern temperate latitudes, often overlooked by the dust community in favour of arid and semi-arid regions, can be important drivers of peatland carbon accumulation and by extension, global climate, warranting further consideration in predictions of future climate variability.

12.
Nature ; 552(7684): 183-184, 2017 12 14.
Article in English | MEDLINE | ID: mdl-29239370
13.
Glob Chang Biol ; 23(10): 4162-4176, 2017 10.
Article in English | MEDLINE | ID: mdl-28418105

ABSTRACT

Intense droughts combined with increased temperatures are one of the major threats to forest persistence in the 21st century. Despite the direct impact of climate change on forest growth and shifts in species abundance, the effect of altered demography on changes in the composition of functional traits is not well known. We sought to (1) quantify the recent changes in functional composition of European forests; (2) identify the relative importance of climate change, mean climate and forest development for changes in functional composition; and (3) analyse the roles of tree mortality and growth underlying any functional changes in different forest types. We quantified changes in functional composition from the 1980s to the 2000s across Europe by two dimensions of functional trait variation: the first dimension was mainly related to changes in leaf mass per area and wood density (partially related to the trait differences between angiosperms and gymnosperms), and the second dimension was related to changes in maximum tree height. Our results indicate that climate change and mean climatic effects strongly interacted with forest development and it was not possible to completely disentangle their effects. Where recent climate change was not too extreme, the patterns of functional change generally followed the expected patterns under secondary succession (e.g. towards late-successional short-statured hardwoods in Mediterranean forests and taller gymnosperms in boreal forests) and latitudinal gradients (e.g. larger proportion of gymnosperm-like strategies at low water availability in forests formerly dominated by broad-leaved deciduous species). Recent climate change generally favoured the dominance of angiosperm-like related traits under increased temperature and intense droughts. Our results show functional composition changes over relatively short time scales in European forests. These changes are largely determined by tree mortality, which should be further investigated and modelled to adequately predict the impacts of climate change on forest function.


Subject(s)
Climate Change , Forests , Trees , Europe , Population Dynamics , Taiga
14.
Ecol Lett ; 20(4): 539-553, 2017 04.
Article in English | MEDLINE | ID: mdl-28220612

ABSTRACT

Drought events are increasing globally, and reports of consequent forest mortality are widespread. However, due to a lack of a quantitative global synthesis, it is still not clear whether drought-induced mortality rates differ among global biomes and whether functional traits influence the risk of drought-induced mortality. To address these uncertainties, we performed a global meta-analysis of 58 studies of drought-induced forest mortality. Mortality rates were modelled as a function of drought, temperature, biomes, phylogenetic and functional groups and functional traits. We identified a consistent global-scale response, where mortality increased with drought severity [log mortality (trees trees-1  year-1 ) increased 0.46 (95% CI = 0.2-0.7) with one SPEI unit drought intensity]. We found no significant differences in the magnitude of the response depending on forest biomes or between angiosperms and gymnosperms or evergreen and deciduous tree species. Functional traits explained some of the variation in drought responses between species (i.e. increased from 30 to 37% when wood density and specific leaf area were included). Tree species with denser wood and lower specific leaf area showed lower mortality responses. Our results illustrate the value of functional traits for understanding patterns of drought-induced tree mortality and suggest that mortality could become increasingly widespread in the future.


Subject(s)
Droughts , Ecosystem , Trees/physiology , Longevity , Plant Leaves/physiology , Wood/physiology
15.
Glob Chang Biol ; 23(9): 3742-3757, 2017 09.
Article in English | MEDLINE | ID: mdl-28135022

ABSTRACT

Ongoing climate change poses significant threats to plant function and distribution. Increased temperatures and altered precipitation regimes amplify drought frequency and intensity, elevating plant stress and mortality. Large-scale forest mortality events will have far-reaching impacts on carbon and hydrological cycling, biodiversity, and ecosystem services. However, biogeographical theory and global vegetation models poorly represent recent forest die-off patterns. Furthermore, as trees are sessile and long-lived, their responses to climate extremes are substantially dependent on historical factors. We show that periods of favourable climatic and management conditions that facilitate abundant tree growth can lead to structural overshoot of aboveground tree biomass due to a subsequent temporal mismatch between water demand and availability. When environmental favourability declines, increases in water and temperature stress that are protracted, rapid, or both, drive a gradient of tree structural responses that can modify forest self-thinning relationships. Responses ranging from premature leaf senescence and partial canopy dieback to whole-tree mortality reduce canopy leaf area during the stress period and for a lagged recovery window thereafter. Such temporal mismatches of water requirements from availability can occur at local to regional scales throughout a species geographical range. As climate change projections predict large future fluctuations in both wet and dry conditions, we expect forests to become increasingly structurally mismatched to water availability and thus overbuilt during more stressful episodes. By accounting for the historical context of biomass development, our approach can explain previously problematic aspects of large-scale forest mortality, such as why it can occur throughout the range of a species and yet still be locally highly variable, and why some events seem readily attributable to an ongoing drought while others do not. This refined understanding can facilitate better projections of structural overshoot responses, enabling improved prediction of changes in forest distribution and function from regional to global scales.


Subject(s)
Climate Change , Droughts , Trees/growth & development , Ecosystem , Forests
16.
Glob Chang Biol ; 20(12): 3756-66, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25141823

ABSTRACT

Altitudinal treelines are typically temperature limited such that increasing temperatures linked to global climate change are causing upslope shifts of treelines worldwide. While such elevational increases are readily predicted based on shifting isotherms, at the regional level the realized response is often much more complex, with topography and local environmental conditions playing an important modifying role. Here, we used repeated aerial photographs in combination with forest inventory data to investigate changes in treeline position in the Central Mountain Range of Taiwan over the last 60 years. A highly spatially variable upslope advance of treeline was identified in which topography is a major driver of both treeline form and advance. The changes in treeline position that we observed occurred alongside substantial increases in forest density, and lead to a large increase in overall forest area. These changes will have a significant impact on carbon stocking in the high altitude zone, while the concomitant decrease in alpine grassland area is likely to have negative implications for alpine species. The complex and spatially variable changes that we report highlight the necessity for considering local factors such as topography when attempting to predict species distributional responses to warming climate.


Subject(s)
Altitude , Forests , Models, Biological , Temperature , Trees/growth & development , Carbon Sequestration/physiology , Computer Simulation , Geography , Population Density , Taiwan
17.
Can J Occup Ther ; 81(4): 226-236, 2014 10.
Article in English | MEDLINE | ID: mdl-29898504

ABSTRACT

BACKGROUND: Participation in occupations is vital for learning and development. Children with disabilities are at risk for decreased participation. PURPOSE: The purpose of this study is to examine peer-reviewed literature about the participation-based experiences of children and youth with disabilities in activities outside of formal preschool and school academics. METHOD: A scoping review was conducted to examine research studies published between 1990 and 2012. Studies included participants from 2 to 18 years who had at least one physical or intellectual/cognitive disability. FINDINGS: Forty-nine articles discussing 32 studies and three systematic reviews met the inclusion criteria. Perceptions of and influences on participation were important emerging themes about direct impacts on patterns of participation. A child or youth's level of functioning, activity level, level of enjoyment, and contextual factors were found to influence their level of successful participation. IMPLICATIONS: Occupational therapists can use the findings from this review to consider supports and barriers within interventions to enhance participation in meaningful life situations.

18.
J Palliat Care ; 29(4): 217-24, 2013.
Article in English | MEDLINE | ID: mdl-24601072

ABSTRACT

AIM: The purpose of this study was to determine whether the Edmonton Symptom Assessment Scale (ESAS) or the Palliative Performance Scale (PPS) are associated with traditionally used scores for heart failure patients -- specifically, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), an overall health visual analog scale (VAS), and the Seattle Heart Failure Model (SHFM). Furthermore, we sought to determine whether the PPS or the ESAS provided additional information on quality of life, symptom severity, or prognosis above that provided by the traditional scores for patients with heart failure. METHODS: We administered the ESAS, MLHFQ, VAS, PPS, and SHFM in a shuffled manner to 78 New York Heart Association Functional Classification (NYHA-FC) Ill-IV ambulatory heart failure patients. Pearson's r correlation was used to determine whether the scores from the ESAS and PPS correlated with the scores from the MLHFQ, VAS, and SHFM. RESULTS: The sample was predominately male (62.8 percent), mean age 60.1 +/- 13 years, with a diagnosis of idiopathic cardiomyopathy (45 percent). Moderate correlations were found between the ESAS and MLHFQ (r = 0.483, p < 0.01), the ESAS and VAS (r = -0.345, p < 0.01), the PPS and MLHFQ (r = -0.54, p < 0.01), and the PPS and VAS (r = 0.53, p < 0.01). There was no significant correlation between the PPS and SHFM. CONCLUSION: The results of this study suggest that administration of the ESAS and PPS provides additional information on symptom severity and functional decline for patients with heart failure. Standardized administration of these scales may aid in the assessment and evaluation of heart failure patients.


Subject(s)
Heart Failure/therapy , Palliative Care , Referral and Consultation , Adult , Aged , Aged, 80 and over , Decision Making , Female , Humans , Male , Middle Aged , Prognosis , Quality of Life , Severity of Illness Index , Surveys and Questionnaires
19.
J Paediatr Child Health ; 48(7): 588-95, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22452621

ABSTRACT

AIM: The aim of this article was to evaluate the Revised Clinical Risk Index for Babies' (CRIB-II) severity of illness score as a predictor of moderate to severe functional disability (FD) in very premature infants. METHODS: Population study of infants born <29 weeks' gestation cared for in all Neonatal Intensive Care Unit in New South Wales and the Australian Capital Territory between 1998 and 2003. FD at 2-3 years corrected age was defined as developmental delay (quotient < 2 standard deviation), non-ambulatory cerebral palsy (needing aids to walk), blindness (acuity <6/60 in better eye) or deafness (hearing aids). Sensitivity and specificity of CRIB-II scores to predict FD were performed by receiver operating characteristic curve analysis. RESULTS: Of study population of 2210, 480 (21.7%) died before hospital discharge. Among 1328 infants assessed, 217 (16.3%) had FD, 109 (8.2%) developmental delay, 75 (5.6%) cerebral palsy and 54 (4.1%) blindness or deafness. CRIB-II performed significantly better than gestation or birthweight (BW) alone in predicting mortality (area under the curve (AUC) ± standard error 0.83 ± 0.01, vs. 0.78 ± 0.01 and 0.76 ± 0.01, respectively). CRIB-II scores were significantly higher in FD than non-FD children (11.9 ± 2.9 vs. 10.1 ± 2.6), but the AUC for CRIB-II (0.68 ± 0.02) did not significantly differ from that of gestation (0.65 ± 0.02) and BW (0.65 ± 0.02). CONCLUSION: CRIB-II improved prediction of mortality but did not perform better than gestational age or BW in predicting FD. We would caution clinicians against using the infant's condition at admission to predict long-term outcome.


Subject(s)
Developmental Disabilities/epidemiology , Disability Evaluation , Infant Mortality , Infant, Premature, Diseases/epidemiology , Severity of Illness Index , Australia , Female , Humans , Infant , Infant, Newborn , Infant, Premature , Infant, Very Low Birth Weight , Intensive Care Units, Neonatal , Longitudinal Studies , Male , Patient Admission , Pregnancy , Risk Assessment , Risk Factors
20.
Can J Cardiol ; 27(3): 376-81, 2011.
Article in English | MEDLINE | ID: mdl-21514785

ABSTRACT

BACKGROUND: The increasing prevalence of heart failure and its unpredictable trajectory highlight the need for patients to make their end-of-life care wishes known using advanced care directives (ACDs). The paucity of literature addressing heart failure patients' decision-making processes and knowledge of ACDs underscores the need for investigation. The purposes of this study were to (1) determine patients' awareness, comprehension, and utilization of ACDs and (2) determine their knowledge of the process of cardiopulmonary resuscitation and their current resuscitation preference. METHODS: A prospective, single-centre study was designed to collect quantitative data addressing patients' understanding of ACDs and cardiopulmonary resuscitation as well as their current resuscitation preference. Patients who consented were interviewed using a semistructured questionnaire. Data were analyzed using descriptive statistics. RESULTS: Of the 41 participants, 76% did not know what ACDs were and fewer recalled discussing them with their physician. Nearly 80% of the 37 queried participants would have preferred to discuss ACDs. More than 75% of participants wanted full resuscitation if they were to require it at this time. Most participants had not documented their resuscitation preference, and only slightly over half said their substitute decision maker was aware of their preference. Among the 19 with an implantable cardioverter-defibrillator, nearly half would want it deactivated should their condition worsen. Only 2 participants recalled having discussed this option with their physician. CONCLUSIONS: There remains a lack of knowledge and utilization of ACDs among this heart failure population. Participants' preferences highlight the importance of discussing ACDs and exploring resuscitation preferences early and often in heart failure.


Subject(s)
Advance Directives , Health Knowledge, Attitudes, Practice , Heart Failure/mortality , Heart Failure/therapy , Adult , Advance Care Planning , Aged , Attitude to Death , Cardiopulmonary Resuscitation/statistics & numerical data , Critical Illness/mortality , Cross-Sectional Studies , Decision Making , Defibrillators, Implantable/statistics & numerical data , Female , Heart Failure/diagnosis , Humans , Male , Middle Aged , Needs Assessment , Ontario , Physician-Patient Relations , Prospective Studies , Severity of Illness Index , Surveys and Questionnaires , Young Adult
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