Multistakeholder Recommendations for Supporting Patients and Families Transitioning From Paediatric to Adult Congenital Heart Disease Care.

Background: Transitioning from paediatric to adult congenital heart disease (CHD) care is a high-risk time for being lost to follow-up. Existing CHD transition programmes have not included patients, caregivers, and health care providers as partners in their development. This study aimed to develop recommendations for a CHD transition programme driven by lived and clinical experiences. Methods: We used a multilevel participatory process that engaged adult and paediatric people living with CHD, their caregivers, and CHD health care providers as members of the research team. We also consulted members of these stakeholder groups through a series of 3 virtual workshops that culminated in the generation of recommendations for the essential components of a CHD transition programme. Results: The Transition Essentials recommendations inform what information, education, or support is required, who should provide it, and when and how it should be provided. Information, education, and support for self-management and knowledge are required for people living with CHD. Caregivers require information, education, and support to build capacity in people living with CHD and navigate their new role in their loved ones' life. The health care team should provide this information, education, and support with peer support options when people living with CHD are 15-22 years of age. This information, education, and support should be individualized, navigate limitations, build over time, have multimodal options, and be available virtually or in person. Conclusions: Engaging those with lived and clinical expertise to develop recommendations for the essential components of a CHD transition programme provides important insights missing from previous studies.

Contexte: La transition des personnes qui vivent avec une cardiopathie congénitale (CC) entre les soins pédiatriques et les soins destinés aux adultes constitue une période où le risque de perte de vue est élevé. Les programmes de transition existants n'ont pas été élaborés avec la participation des patients, des aidants ou des fournisseurs de soins de santé. La présente étude visait à mettre en place des recommandations fondées sur la réalité des personnes concernées et sur l'expérience clinique pour les programmes de transition en contexte de CC. Méthodologie: Nous avons fait appel à un processus participatif à plusieurs niveaux dans lequel des enfants et des adultes vivant avec la CC, des aidants et des fournisseurs de soins de santé du domaine de la CC ont été impliqués comme membres de l'équipe de recherche. Nous avons également mené des consultations auprès de ces groupes d'intervenants dans une série de trois ateliers virtuels qui ont mené à la rédaction de recommandations sur les composantes essentielles d'un programme de transition pour les personnes vivant avec une CC. Résultats: Les recommandations portant sur les impératifs d'une transition réussie énoncent les renseignements, la formation et le soutien nécessaires ainsi que les intervenants qui devraient les offrir, de quelle façon et à quel moment. Les personnes qui vivent avec une CC ont besoin de renseignements, de formation et de soutien pour l'autoprise en charge et l'accès aux connaissances. Quant aux aidants, ils ont aussi besoin de renseignements, de formation et de soutien pour mieux outiller les personnes qui vivent avec une CC et pour mieux comprendre leur nouveau rôle dans la vie de leur proche. Il conviendrait que les professionnels de la santé soient ceux qui offrent ces ressources, lesquelles devraient être personnalisées, tenir compte des lacunes à combler, être cumulatives, offrir des options multimodales et être accessibles en personne ou virtuellement. Les personnes de 15 à 22 ans qui vivent avec une CC devraient également avoir la possibilité de s'entraider. Conclusions: La participation des personnes qui ont une expertise ancrée dans la réalité et une expertise clinique afin de formuler des recommandations sur les éléments essentiels d'un programme de transition pour les personnes qui vivent avec une CC a permis d'obtenir des renseignements intéressants qui ne se trouvaient pas dans les études antérieures.

The Likelihood of Coliform Bacteria in NJ Domestic Wells Based on Precipitation and Other Factors.

The influence of precipitation on coliform bacteria detection rates in domestic wells was investigated using data collected through the New Jersey Private Well Testing Act. Measured precipitation data from the National Weather Service (NWS) monitoring stations was compared to estimated data from the Multisensor Precipitation Estimate (MPE) in order to determine which source of data to include in the analyses. A strong concordance existed between these two precipitations datasets; therefore, MPE data was utilized as it is geographically more specific to individual wells. Statewide, 10 days of cumulative precipitation prior to testing was found to be an optimal period influencing the likelihood of coliform detections in wells. A logistic regression model was developed to predict the likelihood of coliform occurrence in wells from 10 days of cumulative precipitation data and other predictive variables including geology, season, coliform bacteria analysis method, pH, and nitrate concentration. Total coliform (TC) and fecal coliform or Escherichia coli (FC/EC) were detected more frequently when the preceding 10 days of cumulative precipitation exceeded 34.5 and 54 mm, respectively. Furthermore, the likelihood of coliform detection was highest in wells located in the bedrock region, during summer and autumn, analyzed with the enzyme substrate method, with pH between 5 and 6.99, and (for FC/EC but not TC) nitrate greater than 10 mg/L. Thus, the likelihood of coliform presence in domestic wells can be predicted from readily available environmental factors including timing and magnitude of precipitation, offering outreach opportunities and potential changes to coliform testing recommendations.

Use of a Florida Gulf Coast Barrier Island by Spring Trans-Gulf Migrants and the Projected Effects of Sea Level Rise on Habitat Availability.

Barrier islands on the north coast of the Gulf of Mexico are an internationally important coastal resource. Each spring hundreds of thousands of Nearctic-Neotropical songbirds crossing the Gulf of Mexico during spring migration use these islands because they provide the first landfall for individuals following a trans-Gulf migratory route. The effects of climate change, particularly sea level rise, may negatively impact habitat availability for migrants on barrier islands. Our objectives were (1) to confirm the use of St. George Island, Florida by trans-Gulf migrants and (2) to determine whether forested stopover habitat will be available for migrants on St. George Island following sea level rise. We used avian transect data, geographic information systems, remote sensing, and simulation modelling to investigate the potential effects of three different sea level rise scenarios (0.28 m, 0.82 m, and 2 m) on habitat availability for trans-Gulf migrants. We found considerable use of the island by spring trans-Gulf migrants. Migrants were most abundant in areas with low elevation, high canopy height, and high coverage of forests and scrub/shrub. A substantial percentage of forest (44%) will be lost by 2100 assuming moderate sea level rise (0.82 m). Thus, as sea level rise progresses, less forests will be available for migrants during stopover. Many migratory bird species' populations are declining, and degradation of barrier island stopover habitat may further increase the cost of migration for many individuals. To preserve this coastal resource, conservation and wise management of migratory stopover areas, especially near ecological barriers like the Gulf of Mexico, will be essential as sea levels rise.

Underwater anesthesia of diamondback terrapins (Malaclemys terrapin) for measurement of auditory evoked potentials.

Investigations into the biology of aquatic and semiaquatic species, including those involving sensory specialization, often require creative solutions to novel questions. We developed a technique for safely anesthetizing a semiaquatic chelonian species, the diamondback terrapin (Malaclemys terrapin), for measurement of auditory evoked potentials while animals were completely submerged in water. Custom-modified endotracheal tubes were used to obtain a watertight seal on both sides of the glottis and prevent aspiration of water during testing. No adverse effects were seen after the procedures, and assessment of venous blood-gas partial pressures and lactate concentrations indicated that sufficient gas exchange was maintained under anesthesia through manual ventilation.

Recreational boats and turtles: behavioral mismatches result in high rates of injury.

Recreational boats are a dominant feature of estuarine waters in the United States. Boat strike injury and mortality may have a detrimental effect on populations of diamondback terrapins (Malaclemys terrapin), a keystone species in estuarine ecosystems. In Barnegat Bay, New Jersey, 11% of terrapins (n = 2,644) have scars consistent with injuries from boats. Conservative estimates of injury rates from boats increased from 2006 to 2011. When exposed to playback recordings of approaching boat engines of varying sizes and speeds in situ, terrapins did not significantly change their behavior in response to sounds of boat engines of different sizes. The lack of behavioral response of terrapins to boat sounds helps explain high rates of injury and mortality of terrapins and may threaten the viability of terrapin populations. Boater education courses that discuss impacts of boats to wildlife, combined with closure of areas of high terrapin densities to boating, are necessary to protect terrapins and other aquatic species from injury and mortality caused by motorized boats.