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111.
Amir Sadri Peter Dacombe Edmund Ieong Jasvinder Daurka Beryl De Souza 《European journal of plastic surgery》2014,37(1):37-42
Background
Effective handover is vital to ensuring high care standards across numerous shift changes, so prevalent since the introduction of the European Working Time Directive (EWTD). Handover processes are rarely monitored and prone to error, with serious adverse events as a potential consequence. Our aim is to evaluate and improve handover quality in a plastic surgery tertiary referral centre.Methods
The handover process was audited against standards set by the Royal College of Surgeons. Data were collected over 21 days for both initial and re-audit. A simple proforma, the ABCD of Handover, was devised and implemented to improve the quality of handover prior to re-auditing.Results
Poor handover practice was demonstrated initially. Before the ABCD model, handovers took place in an appropriate non-clinical environment at 48 %, a senior clinician was present at 23 %, complete and accurate patient information was presented at 71.4 % of handovers and the total number of admissions of patients discussed was 69 %. These results were improved with the ABCD handover model. After re-auditing, 76 % of handovers took place in a non-clinical environment (p?=?0.30), 85.7 % of handovers had senior clinicians present, patient details were complete in 90.5 % handovers (p?<?0.05) and the number of admissions was discussed 100 % of the time.Conclusions
Good handover is vital in maintaining continuity of care and safety in the EWTD era. In this study, poor initial compliance with the Royal College guidelines was significantly improved through the use of a simple model—the ABCD of Handover. Level of evidence: Level III, risk/prognostic study 相似文献112.
Mingzhen Lu William J. Bond Efrat Sheffer Michael D. Cramer Adam G. West Nicky Allsopp Edmund C. February Samson Chimphango Zeqing Ma Jasper A. Slingsby Lars O. Hedin 《Proceedings of the National Academy of Sciences of the United States of America》2022,119(9)
Recent findings point to plant root traits as potentially important for shaping the boundaries of biomes and for maintaining the plant communities within. We examined two hypotheses: 1) Thin-rooted plant strategies might be favored in biomes with low soil resources; and 2) these strategies may act, along with fire, to maintain the sharp boundary between the Fynbos and Afrotemperate Forest biomes in South Africa. These biomes differ in biodiversity, plant traits, and physiognomy, yet exist as alternative stable states on the same geological substrate and in the same climate conditions. We conducted a 4-y field experiment to examine the ability of Forest species to invade the Fynbos as a function of growth-limiting nutrients and belowground plant–plant competition. Our results support both hypotheses: First, we found marked biome differences in root traits, with Fynbos species exhibiting the thinnest roots reported from any biome worldwide. Second, our field manipulation demonstrated that intense belowground competition inhibits the ability of Forest species to invade Fynbos. Nitrogen was unexpectedly the resource that determined competitive outcome, despite the long-standing expectation that Fynbos is severely phosphorus constrained. These findings identify a trait-by-resource feedback mechanism, in which most species possess adaptive traits that modify soil resources in favor of their own survival while deterring invading species. Our findings challenge the long-held notion that biome boundaries depend primarily on external abiotic constraints and, instead, identify an internal biotic mechanism—a selective feedback among traits, plant–plant competition, and ecosystem conditions—that, along with contrasting fire regime, can act to maintain biome boundaries.Recent findings (1) have demonstrated striking differences in plant rooting strategies across biomes worldwide, spawning the hypothesis that belowground competition for soil resources may be critical for maintaining biome boundaries (1, 2). This idea differs fundamentally from the historical notion that biomes primarily are delineated by extrinsic abiotic factors such as climate, geological parent material, or topography (3–8), or the more recent recognition that aboveground plant adaptations can promote fire-determined plant communities (9, 10).Belowground competition introduces a biotic mechanism that is intrinsic to the plant community, emerges from plant–plant contest for resources, and may help explain the puzzling observation that biome boundaries can persist independent of climate–geological factors (4, 10).Of central importance is Ma et al.’s (1) recent observation that root traits that are associated with resource uptake appear to differ across biomes with differing soil resource dynamics. Specifically, Ma et al. hypothesized that thin-rooted plant strategies may be favored in biomes with permanently or seasonally low soil resources. They reasoned that, in those conditions, natural selection would favor absorptive roots [i.e., first-order roots (1, 11)] with low diameter and high specific root length (i.e., root length per unit photosynthetic carbon invested), which, in turn, are traits that allow high root surface area and efficient exploration of resource-poor soils. Conversely, thick roots and low specific root length may remain competitive traits in biomes with abundant soil resources, despite reduced root surface area and less efficient soil exploration.Here we test Ma et al.’s hypothesis (1) using a unique study of root traits and plant–plant resource competition across the boundary of two distinct biomes within the Cape Floristic Region of South Africa: Fynbos and Afrotemperate Forest. We show in Fig. 1 and 12, 13), by slow decomposition and nutrient recycling (14), and by low stores of soil organic matter (15). In contrast, the Afrotemperate Forest biome is defined by a substantial accumulation of soil organic matter and organic-bound nutrients, which, in turn, supports high rates of plant–soil–nutrient recycling. Based on Ma et al.’s hypothesis, we would expect that these sharp differences in soil resource conditions would result in divergent belowground root traits across the biome boundary.Open in a separate windowFig. 1.Sharp differences in biodiversity, aboveground plant traits, and ecosystem properties across the South African Fynbos–Forest boundary. (A) Two neighboring biomes of the Cape Floristic Region—the Fynbos (62) and the Afrotemperate Forest (63)—form a sharp boundary despite perching on the same geological parent material (39). (B) Biodiversity: The hyperdiverse Fynbos harbors >7,000 plant species, of which the majority are endemic to South Africa (64). The Afrotemperate Forest, on the other hand, contains >450 species with less endemism (63). (C) Aboveground plant traits: Fynbos species generally possess thick and small leaves with a high carbon-to-nitrogen (C:N) ratio while Afrotemperate Forest species display thinner and larger leaves with a lower C:N ratio. In addition, Fynbos plant species possess traits that either enhance (e.g., waxes) or resist (e.g., thick bark) fire. For example, Fynbos vegetation contains high concentrations of flammable organic compounds (e.g., crude fat content) that can facilitate very hot fires (65). In contrast, Afrotemperate Forest species tend to be sensitive to fire and possess traits that suppress fire (e.g., high water content). (D) Ecosystem properties: Fynbos soils are exceedingly poor in soil carbon, nitrogen, and phosphorus contents. In contrast, the Afrotemperate Forest soil is characterized by a developed layer rich in carbon, nitrogen, and phosphorus, which facilitates active cycling of nutrients between plant and soil pools (66, 67).Table 1.Comparison of neighboring Fynbos and Afrotemperate Forest
Open in a separate windowThough sharing similar climatic and geological conditions, the Fynbos and Afrotemperate Forest biomes differ in their ecosystem properties and plant traits. Values in parentheses identify the sample size and SE from our study. n.a., not applicable.*Estimate from ref. 68†Soil total carbon, total nitrogen, and available phosphorus were derived from five pairs of Forest–Fynbos sites immediately neighboring each other at the Orange Kloof site in the Table Mountain National Park of Cape Town (Materials and Methods).‡Zero- to 10-cm soil of sandplain lowland Fynbos of Cape Province (69).§Direct comparison of neighboring Forest and Fynbos across four sites in Swartboskloof (42).¶Based on a 3-y field incubation study using the common species Leucospermum parile (70).#Based on a 2.5-y field incubation study using the common species P. repens (71).∥Based on the evergreen tree Pterocelastrus tricuspidatus (50).**Plant traits compiled by our group.††Mean (95% CI) digitizer from figure 1a of ref. 72 and rounded to double significant digits. Five Forest species (D. whyteana, K. africana, Olea capensis, Olea europaea, and Rapanea melanophloeos) and four Fynbos species (Berzelia lanuginosa, Erica versicolor, Phylica ericoides, and Searsia lucida) were used.‡‡Crude oil includes oils, fats, waxes, and terpenes that are extracted using the Soxhlet extraction approach (65). For both crude fat content and fuel moisture content, we derived the Fynbos value from the simple mean of the dominant Fynbos species (P. neriifolia, Cliffortia cuneata, B. nodiflora, and Erica plukenetii) and derived the Forest values from six Forest species (C. capensis, Ilex mitis, K. africana, Maytenus oleoides, Brachylaena neriifolia, and Brabejum stellatifolium) (65).§§The first value is derived from table 3 of ref. 73 using the simple mean of four Fynbos elements (proteoid, ericoid, restioid, and other sclerophylls) across coastal and mountain habitats. The second value is the average C:N ratio of the dominant canopy proteoid species.¶¶The simple mean leaf nitrogen concentration of 107 Afrotemperate Forest species across South Africa from ref. 74 is first calculated (25.95 mg/g). Assuming the average carbon concentration is equal to the global average leaf carbon content [476 mg/g (75)], the average C:N ratio is derived.##Bark thickness data of Fynbos species standardized at 5-cm trunk diameter are from woody Protea species that are resistant to fire (76). Restioids, ericoids, grass growth forms, and non–fire-resistant Protea species are pyrophilic. (Forest bark thickness data of Afromontane Forest from Knysna area are from unpublished data.)We further hypothesize that these differences in root traits, when combined with plant–plant competition for belowground resources, may offer a mechanism that acts to reinforce the boundary between the Fynbos and Afrotemperate Forest biomes. Central to such a mechanism is the emergence of a trait-by-resource feedback (2, 16), in which a plant species possesses traits that can impact the local conditions and recycling of soil resources. A biotic feedback can emerge if, in turn, the resulting resource regime acts to promote the resident plant species and/or to prohibit the invasion by nonresident species. In this way, a trait-by-resource feedback can in theory (16) maintain a biome boundary independent of differences in geological parent material or climate factors.An important (but not sufficient) part of this trait-by-resource feedback is that plant root traits must be systematically coupled to plant characteristics that can influence resource dynamics at the ecosystem scale. A notable example is the Fynbos biome (Fig. 1), in which plant species possess traits that promote fires at return times of ∼10 to 40+ y (17, 18). These fires, in turn, are hot enough to induce severely nutrient-poor soil conditions by volatilizing soil and plant organic nitrogen (19, 20) and by increasing the likelihood that phosphorus can leach from the soil profile following rain events (21). However, the feedback can only function if aboveground fire-adapted traits are systematically coupled with belowground traits that allow Fynbos plant species to outcompete any invading plants from the nearby Afrotemperate Forest. Conversely, the Afrotemperate Forest plant community depends on conditions that favor the significant accumulation of an organic soil nutrient pool (Fig. 1), which, in turn, can facilitate the active cycling of nitrogen and phosphorus between the plant and soil components of the ecosystem.We experimentally tested the belowground component of this Fynbos trait-by-resource feedback idea, using a 4-y field experiment in which we manipulated 1) the supply of the potentially growth-limiting resources nitrogen and phosphorus, and 2) the ability of plants to compete for nitrogen and phosphorus belowground. Specifically, we asked whether Afrotemperate Forest tree species could successfully invade the Fynbos plant community, across differing conditions of soil resources and belowground competition. In the field, we established a full factorial manipulation of nitrogen and phosphorus across 40 plots in two separate locations within the native Fynbos plant community (Materials and Methods and SI Appendix, Fig. S2). We transplanted forest tree seedlings into all experimental plots and evaluated their ability to grow across the different soil nutrient and competition scenarios (SI Appendix, Fig. S3).Overall, our project was designed to evaluate whether Fynbos plants possess root traits that are consistent with a high capacity to compete for scarce nutrients and, in turn, whether these traits translate into the ability to outcompete plant species that seek to invade the Fynbos plant community—as predicted by the trait-by-resource feedback mechanism. 相似文献
| Properties and traits | Fynbos | Afrotemperate Forest |
| Ecosystem properties | ||
| Fire return interval, y | 12∼20* | n.a. |
| Soil carbon, mg/g | 23.5(5, 4.9),† 9.2(1.4)‡ | 49.3(5, 4.4)† |
| Soil nitrogen, mg/g | 1.07(5, 0.29),† 0.15(0.01),‡ 1.3(0.6)§ | 3.24(5, 0.26),† 3.9(0.8)§ |
| Soil phosphorus, mg/kg | 6.8(5, 2.8),† 4.8(0.9)§ | 28.4(5, 2.5), 22.5(8.6)§ |
| Litter decomposition rate, y−1 | 0.07,¶ 0.05# | 0.24∥ |
| Litter half-life time, y | 10,¶ 14# | 2.9∥ |
| Canopy cover, % | 20(360, 0.76)** | 81(9, 0.03)** |
| Aboveground plant traits | ||
| Maximal height, m | 0.84(309, 0.05)** | 17(26, 0.92)** |
| Leaf thickness, mm | 0.44(309, 0.15)** | 0.19(143, 0.005)** |
| Leaf size, cm2 | 7.5(309, 1.7)** | 20.4(143, 1.7)** |
| Specific leaf area, cm2/g | 60(309, 2.2)** | 105(143, 8.1)** |
| Amax, μmol CO2⋅m−2⋅s−1 | 18(16–20)†† | 8.6(7.5–9.8)†† |
| Crude fat content, % | 4.3–6.7‡‡ | 2.6–4.0‡‡ |
| Fuel moisture content, % | 86–15‡‡ | 139–229‡‡ |
| C:N ratio | 66,§§ 95§§ | 18¶¶ |
| Bark thickness, mm | 7.2## | ∼3∥∥ |
113.
Edmund J.S. Sonuga-Barke 《Journal of child psychology and psychiatry, and allied disciplines》2020,61(1):1-3
How is practical progress possible in child psychology and psychiatry? How does science advance to promote therapeutic innovation? The importance of the exciting stuff – new insights and ideas, studied using cutting edge and innovative technologies – is self-evident. However, the philosophy of science has shown us that less obvious and more mundane elements are also essential. This is because scientific progress is only possible where attempts to break new ground are solidly anchored in a stable shared framework of assumptions – a metatheory – about the general nature of the phenomenon being studied. This framework defines what questions are considered ‘scientific’ – questions that it ‘makes sense’ to ask from a scientific point of view and those that are considered out of bounds (scientists with less subtle minds even considering such to be nonquestions rather than different sorts of questions). Kuhn called this framework a paradigm and the research activity that originates from it, normal science (Kuhn, 1962, The Structure of Scientific Revolutions; Princeton, NJ: Princeton University Press). These frameworks also serve a vital regulatory function because they contain common concepts that embody shared points of reference that allow scientists to communicate with each other to share their ideas, hypotheses and findings (Habermas, 1979, Communication and the evolution of society; Boston: Beacon Press). 相似文献
114.
Brain Imaging and Behavior - The anatomical structure of the human brain varies widely, as does individual cognitive behavior. It is important and interesting to study the relationship between... 相似文献
115.
116.
Eugene H. Chung David E. McNeely III Anil K. Gehi Thomas Brickner Sharon Evans Edmund Pryski Kelly Waicus Harry Stafford J. Paul Mounsey Jennifer D. Schwartz Sihong Huang Irion Pursell Mario Ciocca 《Journal of electrocardiology》2014
Background
Displacement of ECG leads can result in unwarranted findings. We assessed the frequency of Brugada-type patterns in athletes when precordial leads were purposely placed upward.Methods
Four hundred ninety-one collegiate athletes underwent two ECGs: one with standard leads, one with V1 and V2 along the 2nd intercostal space. A positive Brugada-type pattern was defined as ST elevation in V1 or V2 consistent with a Type 1, 2, or 3 pattern in the high-lead ECG. A control group was comprised of 181 outpatients.Results
No Type 1 patterns were seen. In 58 athletes (11.8%), a Brugada-type 2 or 3 pattern was observed. Those with Brugada-type 2 or 3 patterns were more likely male, taller, and heavier. In the control group, 18 (9.9%) had Brugada-type 2 or 3 patterns and were more likely male.Conclusions
Proper lead positioning is essential to avoid unwarranted diagnosis of a Brugada-type ECG, especially in taller, heavier male athletes. 相似文献117.
Noguti AS Jarmy-Di Bella ZI de Oliveira E Castro RA Lima GR Baracat EC Sartori MG Girão MJ 《European journal of obstetrics, gynecology, and reproductive biology》2008,141(2):183-185
Objective
We aimed to study the cross-sectional area of levator ani muscle and the doppler velocimetric parameters of vessels its in premenopausal and postmenopausal women.Study design
Sixty-four patients, divided into 3 groups, were assessed: group I (20 women—average age 28 years) premenopausal and nulliparous (control); group II (24 women—average age 38 years, vaginal delivery 1–4) premenopausal with vaginal deliveries; group III (20 women—average age 55 years, parity 0–4) postmenopausal without hormonal therapy. Doppler velocimetry of levator ani muscle vessels through resistance and pulsatility indices was used and the means of the groups compared by adjusting the weighed variance model with multiple comparisons, according to Tukey's method. Similarly, we measured the cross-sectional area of the muscle using ultrasonography.Results
There was a significant increase in resistance and pulsatility indices in postmenopausal patients as compared to the other two groups. We also observed a significant decrease in the cross-sectional area of the muscle of postmenopausal patients when compared to those in premenopausal.Conclusion
The obtained results allow us to conclude that levator ani muscle vascularization significantly decreases after menopause (age and/or hipoestrogenism) and that it can be assumed that vaginal delivery does not promote long-term alterations in levator ani muscle vascularization. We also observed a significant decrease in the cross-sectional area of the muscle in postmenopausal women when compared to those in premenopausal. 相似文献118.
Lim SS Tan PC Sockalingam JK Omar SZ 《The Australian & New Zealand journal of obstetrics & gynaecology》2008,48(1):71-77
OBJECTIVE: To compare oral celecoxib with oral diclofenac as pain reliever after perineal repair following normal vaginal birth. METHODS: One hundred and sixty-four and 165 women, respectively, were randomised to 200 mg celecoxib or to 100 mg diclofenac orally 12 hourly for 24 h after perineal repair. A ten-point visual analog scale (VAS) for pain recorded at one, two, four, eight, 12 and 24 hours at rest and when mobilising was the primary outcome. RESULTS: Repeated measures analysis of variance showed a larger reduction of VAS pain score at rest with celecoxib compared to diclofenac (P = 0.044). Mean VAS pain score at rest was 2.2 versus 2.7, 2.1 versus 2.5, 1.8 versus 2.2, 1.6 versus 1.6, 1.3 versus 1.4 at one, two, four, eight, 12 and 24 hours, respectively, for celecoxib versus diclofenac. The difference in pain score when mobilising was not significant (P = 0.75). Univariate analyses with the Student's t-test indicated significantly lower pain score at rest only at one, two and four hours with celecoxib. Randomisation to celecoxib was associated with less upper gastrointestinal symptoms reported: 38 of 163 (23.3%) versus 57 of 165 (34.5%) (relative risk 0.67 95% CI 0.48-0.96: P = 0.029) but additional analgesia for breakthrough pain was not significantly different eight of 161 (5.0%) versus 18 of 165 (10.9%) (relative risk 0.46 95% CI 0.20-1.01: P = 0.065). CONCLUSION: Celecoxib was associated with a slightly lower VAS pain score at rest and less upper gastrointestinal symptoms were reported when compared to diclofenac. 相似文献
119.
Guoyang Luo Morgan T Bahtiyar MO Snegovskikh VV Schatz F Kuczynski E Funai EF Dulay AT Huang ST Buhimschi CS Buhimschi IA Fortunato SJ Menon R Lockwood CJ Norwitz ER 《Reproductive sciences (Thousand Oaks, Calif.)》2008,15(2):147-155
Progesterone supplementation can prevent preterm birth in some high-risk women. Progesterone binds to progesterone receptor (PR) and modulates the expression of target genes. This study investigates the association between single nucleotide polymorphisms (SNPs) in the PR gene and spontaneous preterm birth. DNA was extracted from consecutive patients with preterm birth (n = 78) and term controls (n = 415), and genotyping was performed for 3 PR SNPs (+331[G>A], + 770[C>T], +660[G>T]) using Sequenom matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Data were analyzed by chi(2) test and logistic regression analysis. Multivariate analysis showed no association between maternal carriage of minor + 331T, +770T, and/or +660T alleles and preterm birth when controlled for maternal age, ethnicity, gravidity, parity, prior preterm birth, route of delivery, or neonatal outcome. Carriage of +770T and +660T (but not +331T) was associated with preterm birth in women with a body mass index <18.5 kg/m(2) (relative risk, 10.8; 95% confidence interval, 1.4-82.6; P = .02). Maternal carriage of minor alleles of +331(G>A), +770(C>T), and +660(G> T) SNPs in the PR gene is not associated with spontaneous preterm birth. 相似文献
120.
Buhimschi CS Turan OM Funai EF Azpurua H Bahtiyar MO Turan S Zhao G Dulay A Bhandari V Copel JA Buhimschi IA 《Obstetrics and gynecology》2008,111(3):715-722
OBJECTIVE: Fetal adaptation to stress is regulated in part by the pituitary-adrenocortical system. The stress hormones dehydroepiandrosterone sulfate (DHEAS) and cortisol have opposing effects: cortisol suppresses while DHEAS enhances immune functions. We sought to estimate the impact of intraamniotic inflammation on fetal adrenal gland volume and cortisol-to-dehydroepiandrosterone sulfate ratio (fetal stress ratio) in pregnancies complicated by preterm birth. METHODS: Fifty-one consecutive singleton fetuses of mothers who had an indicated amniocentesis to rule out infection were analyzed. Intraamniotic inflammation was assessed by proteomic profiling of amniotic fluid for the biomarkers of the Mass Restricted score. The Mass Restricted score ranges from 0 (biomarkers absent) to 4 (all biomarkers present), with Mass Restricted scores of 3 or 4 indicating severe intraamniotic inflammation. Fetal adrenal gland volume was assessed by three-dimensional ultrasonography and corrected for estimated fetal weight. Interleukin-6 (IL-6), cortisol, and DHEAS were measured by immunoassay. RESULTS: Women with intraamniotic inflammation delivered earlier (27.8+/-3.4 weeks, n=16, compared with 32.3+/-3.0 weeks, n=35, P<.001), and their fetuses had higher cord blood IL-6 (P=.011) and higher corrected adrenal gland volumes (P=.027). Cord blood IL-6 levels were in direct relationship with corrected adrenal volume (r=0.372, P=.019), fetal cortisol (r=0.428, P=.010), and DHEAS (r=0.521, P<.001). However, fetuses exposed to intraamniotic inflammation had an overall lower fetal stress ratio (P=.034). These results maintained after adjusting for gestational age, uterine contractions, and steroid exposure. CONCLUSION: Fetuses exposed to intraamniotic inflammation have higher adrenal gland volumes and lower cortisol-to-DHEAS ratios, suggesting that the fetal adrenocortical axis plays a role in the intrauterine adaptation to inflammation. 相似文献