Subsequent Management Recommendations Research Articles

Perilous state of critically endangered Northwest African cheetah (Acinonyx jubatus hecki) across the Sudano‐Sahel

AbstractNorthwest African cheetah populations have declined precipitously, with expert opinion estimating that <420 individuals persist across parts of Algeria, Benin, Burkina Faso, Chad, Niger and Mali. However, no reliable density estimates exist in the remaining subspecies strongholds throughout the Sudano‐Sahel Zone, including the W‐Arly‐Pendjari Complex and Greater Zakouma Ecosystem within the Bahr/Salamat landscape. Camera trap surveys were combined with spatially explicit capture–recapture methodologies in both regions to estimate the cheetah density and detectable demographic composition of these populations. Following 15 429 camera trap nights, we detected nine individuals during the dry season and four individuals during the wet season in Pendjari (2021), nine individuals (dry season; 2023) in Zakouma and none in Siniaka Minia. Cheetah densities were thus estimated at 0.17–0.24 and 0.37 cheetah per 100 km2 in Pendjari and Zakouma, respectively. While marginally higher than predicted, such low‐density estimates are concerning in the last remaining habitats harbouring this critically endangered subspecies. Considering the substantial contraction of regional cheetah distribution, we estimate an overall population size of 68 ± 29 individuals across the studied areas. These novel estimates are among the lowest formally determined densities throughout cheetah range in Africa, where a high frequency of people and livestock detected on camera traps highlight the ongoing risks to large carnivores in these protected areas. Subsequent management recommendations include implementation of the established regional conservation strategies that encompass the distributional range of these cheetah, continuous monitoring of populations, genetic analyses to inform management, curbing illegal trade and increasing international awareness around the plight of the subspecies.

Association of patient gender and gastroenterologists' diagnosis and management choices in gastroesophageal reflux disease.

Symptom severity and prevalence of erosive disease in gastroesophageal reflux disease (GERD) differ between genders. It is not known how gastroenterologists incorporate patient gender in their decision-making process. We aimed to evaluate how gender influences the diagnosis and management recommendations for patients with GERD. We invited a nationwide sample of gastroenterologists via voluntary listservs to complete an online survey of fictional patient scenarios presenting with different GERD symptoms and endoscopic findings. Patient gender for each case was randomly generated. Study participants were asked for their likelihood of a diagnosis of GERD and subsequent management recommendations. Results were analyzed using chi-square tests, Fisher Exact tests, and multivariable logistic regression. Of 819 survey invitations sent, 135 gastroenterologists responded with 95.6% completion rate. There was no significant association between patient gender and prediction for the likelihood of GERD for any of the five clinical scenarios when analyzed separately or when all survey responses were pooled. There was also no significant association between gender and decision to refer for fundoplication, escalate PPI therapy, or start of neuromodulation/behavioral therapy. Despite documented symptomatic and physiologic differences of GERD between the genders, patient gender did not affect respondents' estimates of GERD diagnosis or subsequent management. Further outcomes studies should validate whether response to GERD treatment strategies differ between women and men.

3303Classification of patients with acute chest pain by analytical benchmarks and subsequent management recommendations - A comparison of three highly-sensitivity troponin assays in the ROMICAT trials

Abstract Background Concordance of different highly-sensitive troponin (hsTn) assays in stratifying acute chest pain (ACP) patients according to analytical benchmarks and subsequent emergency department (ED) management recommendations are unknown. Methods We included patients enrolled in the ROMICAT (Rule Out Myocardial Infarction/Ischemia Using Computer-Assisted Tomography) I and II trials (n=624; 39.1% female; 52.8±10.0 years), who presented to the ED and were referred to further non-invasive diagnostic testing. In ROMICAT I, blood was obtained at 4 hours, and in ROMICAT II at ED presentation, and at 2 and 4 hours and was tested with three state-of-the-art hsTn assays (Roche Diagnostics, Elecsys 2010; Abbott ARCHITECT i2000SR; Siemens Diagnostics, HsVista). In a per sample analysis, we compared the concordance of assays for analytic benchmarks (below the level of detection (LOD)/LOD to 99th percentile/99th percentile to myocardial infarction (<LOD], ><LOD], >MI)/above MI). In a per patient analysis of serial hsTn testing in ROMICAT II, we determined concordance of management recommendations (rule out/observe/rule in) based on 2015ESC guidelines, results of coronary CT angiography and stress myocardial perfusion, and adjudicated endpoints of ACS. Results Overall, only 34.4% (353/1027) of samples were classified into the same benchmark category by all assays (table 1). In a per patient analysis, all assays agreed on the same of management recommendation in 25.3% (49/242) patients after the 1st hsTn, mostly driven by differences in discharge (6.6%, 21.1%, and 61.2%; respectively; all p<0.001). The concordance of management recommendations improved significantly to 67.4% (163/242; p<0.001) after the 2nd hsTn measurement but the final agreement for “observe” and “rule in” remained limited (13/90 and 5/18). Among patients in whom discharge was recommended, at least 18.8% (range: 18.8–21.0% across assays) had a positive imaging/stress test and at least 2.9% (range: 2.9–3.4%) had ACS. Table 1. Classification of measurements from three hsTn assays in 1027 samples of patients with ACP according to analytical benchmarks <LOD LOD – 99th %tile* 99th %tile* – AMI** AMI**< Roche Elecsys, n (%) 578 (56.3) 328 (31.9) 95 (9.3) 26 (2.5) Abbott ARCHITECT, n (%) 176 (17.1) 788 (76.7) 14 (1.7) 49 (4.8) Siemens Vista, n (%) 96 (9.4) 861 (83.9) 33 (3.2) 37 (3.6) *Assay specific 99th percentiles; **as per ESC 2015 guidelines. Conclusion Differences in hsTn assay concordance for analytical benchmarks and subsequent ED management recommendations in patients with ACP are substantial raising concerns about the lack of uniform management. Acknowledgement/Funding Fulbright Visiting Student Researcher Grant

Managing Moist Forests of the Pacific Northwest United States for Climate Positive Outcomes

The moist forests of the Pacific Northwest United States (PNW) are among the most naturally carbon rich ecoregions in the world. However, regional in-forest carbon storage levels are currently well below ecological potential. Recent climate policy proposals have renewed and deepened debates over forest sector climate strategies. This paper begins with a review of regionally applicable forest carbon life cycle assessments (LCAs) in an effort to provide some clarity around how these studies are conducted, and why their results may vary. The review highlights the importance of assumptions made during carbon accounting across the wood product lifespan and how the inclusion or exclusions of variables, such as product substitution and leakage, influence study results and subsequent management recommendations. Next we discuss the influence of climate change on forest management and planning. We conclude with a review of regional-specific factors to consider when developing optimal forest climate strategies in the moist forests of the PNW. These strategies include, but are not limited to; extending harvest rotations, shelterwood and select tree harvests (in lieu of full harvest), and managing forests for increased structural, age, and species complexity.

Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicentre European study.

To investigate whether knowledge of fetal outcome influences retrospective interpretation of cardiotocographic tracings and subsequent management recommendations. Prospective online study. Seven university hospitals in five European countries. Forty-two intrapartum tracings from women with singleton pregnancies and uneventful antepartum courses. Using an online questionnaire, 123 healthcare professionals interpreted 42 tracings without any knowledge of fetal outcome and provided management recommendations according to the National Institute of Clinical Excellence guidelines (intrapartum care). Two months later, 93 of the 123 participants re-interpreted the same re-ordered tracings, this time with information on the newborn's umbilical artery pH. Comparison of the evaluation of tracing features, overall tracing classification, and management recommendations between the initial analysis and re-interpretation. In newborns with umbilical artery pH ≤ 7.05, knowledge of the pH value led to significant changes in the evaluation of all basic tracing features. In this group, classification of tracings as 'normal' decreased 76% (8.8-2.1%, P < 0.001), whereas classification as 'pathologic' increased 51% (44.7-67.5%, P < 0.001). In newborns with pH 7.06-7.19, classification of tracings as 'normal' decreased 36% (22.4-14.4%, P < 0.001), and in those with pH ≥ 7.20, classification of tracings as 'pathologic' decreased 40% (23.4-14.1%, P < 0.001). In the group of newborns with umbilical artery pH ≤ 7.05, the recommendations 'no attention needed' decreased 75% (10.2-2.6%, P < 0.001), and the number of recommendations 'rapid reversal of hypoxic cause or immediate delivery' increased 70.3% (42.1-71.7%, P < 0.001). When provided with information on adverse fetal outcome, healthcare professionals provide a more pessimistic evaluation of basic tracing features, overall classification, and clinical management recommendations. Knowledge of adverse fetal outcome leads to more pessimistic CTG evaluation and management recommendations.

Age-related Eye Disease Study 2

This review provides a perspective on the Age-related Eye Disease Study 2 (AREDS2) including a summary of the goals and rationale of the study, major findings, subsequent management recommendations, and questions that remain to be answered. The primary goal of the AREDS2 was to evaluate the efficacy and safety of lutein plus zeaxanthin and/or omega-3 long-chain polyunsaturated acid supplementation in reducing the risk of developing advanced age-related macular degeneration (AMD). AREDS2 also investigated the effects of omitting β-carotene and reducing the concentration of zinc from the original AREDS formulation. Although primary analysis from the AREDS2 did not reveal a benefit of daily supplementation with lutein/zeaxanthin on AMD progression, secondary exploratory analyses suggested that lutein/zeaxanthin were helpful in reducing this risk. Comparison of low-dose to higher-dose zinc showed no significant benefit. The overall evidence on the beneficial and adverse effects from AREDS2 and other studies suggests that lutein/zeaxanthin could be more appropriate than β-carotene in AREDS-type supplements. Questions remain regarding the AREDS2 study results such as: whether the findings are generalizable to the population as a whole, what is the long-term safety profile of lutein/zeaxanthin supplementation, should other carotenoids be included in AREDS-type supplements, and at what optimal doses?

Greater Focus Needed on Alien Plant Impacts in Protected Areas

AbstractAlien plants pose significant threats to protected areas worldwide yet many studies only describe the degree to which these areas have become invaded. Research must move toward a better understanding of alien plant impacts since managers urgently require an appropriate evidence base to prioritize control/eradication targets. We analyze a global database of quantitative studies of alien plant impacts to evaluate existing knowledge of alien plant impacts within and outside protected areas. Although protected areas are a significant focus for quantitative impact studies, the biogeographic emphasis of most research effort does not coincide with the global distribution of protected areas nor the plant species or life‐forms recognized to have greatest impacts on ecosystems. While impacts were often as significant within protected areas as outside, only a minority of studies provide any subsequent management recommendations. There is therefore considerable scope to improve the evidence base on alien plant management in protected areas.

Does my bottom line look big in this?

Purpose – This paper discerns key fashion and beauty advertising strategies pertaining to model selection in order to best attract North American and Chinese women.Design/methodology/approach – Recommendations are based on survey and focus group research of over 3,500 Canadian, Chinese and American women between the ages of 14 and 65.Findings – Advertisers targeting North American women are advised to cast models who mirror the size, age and race traits of their target market. Conversely, advertisers targeting younger Chinese women are suggested to hire idealized Western models, whereas those targeting older women are advised to hire thin Chinese models. Exceptions and emerging trends are also discussed and subsequent management recommendations are made.Originality/value – This paper provides the first comprehensive managerial guidelines for model casting in fashion and beauty advertising that targets North American and Chinese women.

Regeneration in windthrow areas in hemiboreal forests: the influence of microsite on the height growths of different tree species

Natural regeneration of windthrow areas is an important issue when planning forestry measures after forest disturbances. Seedling recruitment was investigated in storm-damaged hemiboreal mixed forests in eastern Estonia. The establishment and growth of seedlings from natural regeneration was registered for tree species in soil pits and in mounds of uprooted trees in stands that were either heavily or moderately damaged. Seedling growth is expected to be better in large but shallow soil pits created by uprooted Norway spruce [Picea abies (L.) Karst.] and poorer in small but deep pits created by the hardwoods in the area, silver birch (Betula pendula Roth.) and European aspen (Populus tremula L.). The most abundant regenerating species was birch. Pits hosted larger seedling numbers than mounds, due to soil instability in mounds. Rowan (Sorbus aucuparia L.) showed significantly faster growth than the other seedling species. Norway spruce pits were preferred to pits of other species by both birch and spruce seedlings. Black alder [Alnus glutinosa (L.) J. Gaertn.] did not show a preference for pits of a certain species of uprooted tree. Both spruce and rowan preferred hardwood mounds over spruce mounds. Storm severity also affected species composition: birch predominantly occurred on pits and mounds in heavily disturbed areas, while spruce was more abundant in the moderately damaged areas. The effects of advance regeneration and surrounding stands on seedling microsite preferences should be considered in future research and subsequent management recommendations.

Recognition, diagnosis and management of obesity after myocardial infarction

We investigated the documentation of obesity as a medical problem, and subsequent management recommendations, in patients after myocardial infarction (MI). We performed a cross-sectional analysis of a randomly selected sample of 627 patients discharged after an MI, from five US teaching hospitals between 1/1/01 and 12/31/02. Information was extracted from clinical notes using standardized definitions. Mean body mass index (BMI) was 31+/-13 kg/m2, which was documented in only 14% of patients and had to be calculated post hoc in the rest. Waist circumference and waist/hip ratio were not documented at all; 83% of patients were overweight, 55% obese, and 8% morbidly obese. In only 20% of patients with BMI> or =30 kg/m2 was the diagnosis of obesity documented either as a current medical problem, as part of past medical history or as a final diagnosis. A dietary counseling was carried out in 61% of patients with BMI> or =25 kg/m2 and in 61% of patients with BMI<25 kg/m2, P=0.96. Weight loss was described as part of the goals/plan at discharge in 7% of overweight and 9% of obese patients. There was no change in either the level of recognition of obesity (22 vs 19%, P=0.3) or in the proportion of obese patients for whom weight loss was described as part of the goals/plan at discharge (8 vs 10%, P=0.7) before (n=301) compared to after (n=326) the Call to Action in Obesity by the Surgeon General in December 2001. Obesity is underecognized, underdiagnosed and undertreated in persons with acute MI.

Effect of tillage and corn on pigweed (Amaranthusspp.) seedling emergence and density

We studied the effect of no-till, chisel, and moldboard plow and the presence or absence of corn on soil temperature, moisture and, subsequently, the emergence phenology and density of pigweed seedlings at 2 sites from 1993 to 1995 inclusively. Tillage significantly affected the phenology of pigweed seedling emergence only during a June drought at one site in 1994. Soil temperature and moisture, measured at 2.5-cm depths, also were unaffected by tillage. Weed phenology is usually earlier in no-till because more seeds are located closer to the surface (&lt; 5 cm deep) in no-till, thereby reducing the delay in penetrating through the soil, and because soil temperatures and moisture are nearer the germination and emergence optima. However, pigweed seedlings are already physiologically restricted to germination depths of less than 2.5 cm regardless of tillage; therefore, this prior constraint eliminated any potential differences in emergence phenologies caused by tillage. The presence or absence of corn also did not affect soil temperatures, soil moisture, or pigweed seedling emergence phenologies. Pigweed seedling density was significantly higher in no-till; this may have been caused by increased numbers of seeds near the soil surface in no-till. The presence or absence of corn did not affect pigweed seedling density; the lack of a significant effect probably reflects high variances in density. Although necessary for most weed species, tillage may be a less important factor to consider in predicting pigweed population dynamics and subsequent management recommendations.