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The savannah–forest mosaic of the Rupununi region of Guyana is a dispersal corridor between large tracts of intact Guiana Shield forests and a subsistence hunting ground for Indigenous Makushi and Wapichan communities. We conducted a camera-trap survey at 199 sites across four major forested habitat types and used multi-species occupancy modelling to determine regional-scale drivers of mammalian occupancy at both species and community levels, accounting for imperfect detection. We detected 47 savannah- and forest-dwelling mammal species, with the occupancy of medium- and large-bodied terrestrial mammal species (community occupancy) positively related to per cent forest cover and negatively to the presence of gallery forest habitat. The occupancy of 15 of 30 species was positively related to forest cover, suggesting the importance of maintaining forested habitat within the broader mosaic comprising savannahs and intermediate habitats for sustaining maximum mammal diversity. Jaguar Panthera onca occupancy was associated with the presence of livestock, and giant anteater Myrmecophaga tridactyla occupancy was negatively associated with distance to the nearest road, both results of concern in relation to potential human–wildlife conflict. The probability of detecting terrestrial mammal species (community detectability) increased away from villages, as did the detectability of two large-bodied, hunted species, the lowland tapir Tapirus terrestris and collared peccary Pecari tajacu, potentially indicating the negative effects of subsistence and commercial hunting in this savannah mosaic habitat. We use our findings to discuss how management strategies for hunting, fire, timber harvest and agriculture within Indigenous titled lands could help ensure the sustainability of these traditional livelihood activities.
Quality improvement programmes (QIPs) are designed to enhance patient outcomes by systematically introducing evidence-based clinical practices. The CONQUEST QIP focuses on improving the identification and management of patients with COPD in primary care. The process of developing CONQUEST, recruiting, preparing systems for participation, and implementing the QIP across three integrated healthcare systems (IHSs) is examined to identify and share lessons learned.
Approach and development:
This review is organized into three stages: 1) development, 2) preparing IHSs for implementation, and 3) implementation. In each stage, key steps are described with the lessons learned and how they can inform others interested in developing QIPs designed to improve the care of patients with chronic conditions in primary care.
Stage 1 was establishing and working with steering committees to develop the QIP Quality Standards, define the target patient population, assess current management practices, and create a global operational protocol. Additionally, potential IHSs were assessed for feasibility of QIP integration into primary care practices. Factors assessed included a review of technological infrastructure, QI experience, and capacity for effective implementation.
Stage 2 was preparation for implementation. Key was enlisting clinical champions to advocate for the QIP, secure participation in primary care, and establish effective communication channels. Preparation for implementation required obtaining IHS approvals, ensuring Health Insurance Portability and Accountability Act compliance, and devising operational strategies for patient outreach and clinical decision support delivery.
Stage 3 was developing three IHS implementation models. With insight into the local context from local clinicians, implementation models were adapted to work with the resources and capacity of the IHSs while ensuring the delivery of essential elements of the programme.
Conclusion:
Developing and launching a QIP programme across primary care practices requires extensive groundwork, preparation, and committed local champions to assist in building an adaptable environment that encourages open communication and is receptive to feedback.
This piece explores the parallel development of two fisheries management regimes in mid-twentieth-century Lake Malawi: one imposed by the British colonial government over the lake and the other by Senior Chief Makanjira focused on Mbenji Island. The parallel development of these regimes provides opportunity for close analysis of how fisheries management centred on different knowledge and practices led to distinctive legacies of governance legitimacy and efficacy. Given the increasing recognition that Indigenous knowledge is crucial to the future sustainability of fisheries globally, we contend that it is imperative to recognise the ways in which colonial pasts have embedded knowledge hierarchies and exclusionary decision-making processes within national fisheries governance regimes that continue to obstruct capacities to bring different knowledges, practices, and management approaches together effectively and appropriately.
Objectives/Goals: Professional coaching greatly enhances faculty personal and professional development through fostered empowerment and a culture of continuous growth within the academic environment. The UMN Clinical and Translational Science Institute (CTSI)’s coaching program provides a variety of coaching formats (1:1, group, special programs). Methods/Study Population: CTSI provides professional coaching to faculty in the KAP, K12, KL2, and K-R01 and NLITeS programs. Typically, coaching begins with a HoganLead™ assessment and debrief. Scholars may pursue further coaching through individual sessions (up to 6 sessions during or 1-year post CTSI award) or a monthly peer coaching group facilitated by certified coaches. New URM faculty hires in the Early Career Research Awards (ECRA) program receive monthly coaching support to problem solve and attend to wellbeing. The NLITeS leadership development program for senior and mid-career faculty includes the HoganLead debriefing and 1–2 individual coaching sessions. All sessions are confidential. Results/Anticipated Results: Since 2016/2017, 80 scholars have taken the HoganLead assessment (72 debriefs), and 23 scholars have made use of 217 individual coaching sessions (most use between 6 and 12). Since 2021, 10 Scholars have participated in the Peer Coaching Group with 7 continuing over multiple years. Since 2021, 12 ECRA scholars have been supported in monthly coaching. Frequent coaching topics include self-awareness, work-life balance, overwhelm, negotiation, and leaving academic medicine. Scholar comments include: “I initially approached this professional coaching with some curiosity but fairly minimal expectations that it would change much. It has reshaped the way I approach my academic career and its associated challenges for the better, giving me confidence that I can handle the unique challenges that this career presents…” Discussion/Significance of Impact: The UMN CTSI coaching programs are extensively used and highly valued by participating faculty. Professional coaching with Hogan assessments provides faculty scholars with support that complements the mentoring they receive by going beyond a teach and learn model.
Objectives/Goals: In Fall 2024, we designed a collaborative scholar retreat model to create dialogue among our training programs. The purpose of the retreat was to foster collaboration and provide unique networking opportunity for our KL2, T32, and TL1 scholars to share their research across the translational spectrum and learn more about Clinical and Translational Science Institute (CTSI) resources and tools. Methods/Study Population: The CTSI Fall Scholar Retreat brought together a diverse group of 25 scholars who attended in-person a full-day program. The program included presentations on CTSI resources and Team Science on How to Become a Better Team Member in cross-disciplinary and cross-functional groups. The KL2 Scholars presented motivational talks on their career and professional development journeys. Mentoring roundtable included discussions on subthemes like characteristics of a good mentor/mentee, organizing your mentoring team, different mentor roles, and fears of approaching new mentor/mentee. TL1 and T32 scholars also presented posters describing their ongoing research project from the planning stages to initial observations to completed studies. Results/Anticipated Results: To measure the effectiveness and impact of the CTSI Fall Scholar Retreat, we conducted an evaluation using REDCap survey and received an 88% response rate. On the Likert scale of 1–5 (1 = not at all valuable, 2 = not very valuable, 3 = neutral, 4 = very valuable, and 5 = extremely valuable), 92% of the scholars found the sessions to be valuable. Net Promoter Score of 9.6 (scale of 1–10) was measured to collect the scholar feedback and most of them are likely to recommend the Scholar Retreat to other scholars. Discussion/Significance of Impact: The in-person retreat proved to be a unique platform to interact, collaborate, learn, and grow for all scholars at different levels of their career and research. Inclusion of HRSA-funded T32 post-doctoral program provided cross-level collaboration and helped promote a culture of continuous learning in clinical and translational science.
Many post-acute and long-term care settings (PALTCs) struggle to measure antibiotic use via the standard metric, days of therapy (DOT) per 1000 days of care (DOC). Our objective was to develop antibiotic use metrics more tailored to PALTCs.
Design:
Retrospective cohort study with a validation cohort.
Setting:
PALTC settings within the same network.
Methods:
We obtained census data and pharmacy dispensing data for 13 community PALTCs (January 2020–December 2023). We calculated antibiotic DOT/1000 DOC, DOT per unique residents, and antibiotic starts per unique residents, at monthly intervals for community PALTCs. The validation cohort was 135 Veterans Affairs Community Living Centers (VA CLCs). For community PALTCs only, we determined the DOT and antibiotics starts per unique residents cared for by individual prescribers.
Results:
For community PALTCs, the correlation between facility-level antibiotic DOT/1000 DOC and antibiotic DOT/unique residents and antibiotic courses/unique residents was 0.97 (P < 0.0001) and 0.84 (P < 0.0001), respectively. For VA CLCs, those values were 0.96 (P < 0.0001) and 0.85 (P < 0.0001), respectively. At community PALTCs, both novel metrics permitted assessment and comparison of antibiotic prescribing among practitioners.
Conclusion:
At the facility level, the novel metric antibiotic DOT/unique residents demonstrated strong correlation with the standard metric. In addition to supporting tracking and reporting of antibiotic use among PALTCs, antibiotic DOT/unique residents permits visualization of the antibiotic prescribing rates among individual practitioners, and thus peer comparison, which in turn can lead to actionable feedback that helps improve antibiotic use in the care of PALTC residents.
Although cognitive remediation (CR) improves cognition and functioning, the key features that promote or inhibit its effectiveness, especially between cognitive domains, remain unknown. Discovering these key features will help to develop CR for more impact.
Aim
To identify interrelations between cognition, symptoms, and functioning, using a novel network analysis approach and how CR affects these recovery outcomes.
Methods
A secondary analysis of randomized controlled trial data (N = 165) of CR in early psychosis. Regularized partial correlation networks were estimated, including symptoms, cognition, and functioning, for pre-, post-treatment, and change over time. Pre- and post-CR networks were compared on global strength, structure, edge invariance, and centrality invariance.
Results
Cognition, negative, and positive symptoms were separable constructs, with symptoms showing independent relationships with cognition. Negative symptoms were central to the CR networks and most strongly associated with change in functioning. Verbal and visual learning improvement showed independent relationships to improved social functioning and negative symptoms. Only visual learning improvement was positively associated with personal goal achievement. Pre- and post-CR networks did not differ in structure (M = 0.20, p = 0.45) but differed in global strength, reflecting greater overall connectivity in the post-CR network (S = 0.91, p = 0.03).
Conclusions
Negative symptoms influenced network changes following therapy, and their reduction was linked to improvement in verbal and visual learning following CR. Independent relationships between visual and verbal learning and functioning suggest that they may be key intervention targets to enhance social and occupational functioning.
The January 6th insurrection and its aftermath of obfuscation and denial were ostensibly racialized events. Under the guise of election fraud, white supremacists, white nationalists, and paramilitary groups attempted to overthrow established democratic procedures to retain a president who stoked racial antagonisms and racial divisions. African Americans, like many American citizens, watched in fear, anxiety, and foreboding as the groups most committed to their repression violently attacked and ransacked the Capitol.
We examine the extent to which the January 6th insurrection and its aftermath of denial and obfuscation influence African Americans’ racial resentment. Our results show how the racialized January 6th events were connected to heightened African American racial resentment. The most compelling result confirms that African Americans’ racial resentment stems from beliefs about justice and fairness.
In the early modern period, both legal and illegal maritime predation was a common occurrence, but the expansion of European maritime empires exacerbated existing and created new problems of piracy across the globe. This collection of original case studies addresses these early modern problems in three sections: first, states' attempts to exercise jurisdiction over seafarers and their actions; second, the multiple predatory marine practices considered 'piracy'; and finally, the many representations made about piracy by states or the seafarers themselves. Across nine chapters covering regions including southeast Asia, the Atlantic archipelago, the North African states, and the Caribbean Sea, the complexities of defining and criminalizing maritime predation is explored, raising questions surrounding subjecthood, interpolity law, and the impacts of colonization on the legal and social construction of ocean, port, and coastal spaces. Seeking the meanings and motivations behind piracy, this book reveals that while European states attempted to fashion piracy into a global and homogenous phenomenon, it was largely a local and often idiosyncratic issue.
This editorial considers the value and nature of academic psychiatry by asking what defines the specialty and psychiatrists as academics. We frame academic psychiatry as a way of thinking that benefits clinical services and discuss how to inspire the next generation of academics.
Recruitment of participants into research studies remains a major concern for investigators. Using clinical teams to identify potentially eligible patients can present a significant barrier. To overcome this, we implemented a process for using our patient portal, called MyChart, as a new institutional recruitment option utilizing our electronic health record’s existing functionality.
Methods:
To streamline the institutional approval process, we established a working group comprised of representatives from human subject protection, information technology, and privacy and vetted our process with many stakeholder groups. Our specific process for study approval is described and started with a consultation with our recruitment and retention function funded through our Clinical and Translational Science Award.
Results:
The time from consultation to the first message(s) sent ranged from 84 to 442 days and declined slightly over time. The overall patient response rate to MyChart messages about available research studies was 23% with one third of those saying they were interested in learning more. The response rate for Black and Hispanic patients was about 50% that of White patients.
Conclusions:
Many different types of studies from any medical specialty successfully identified interested patients using this option. Study teams needed support in defining appropriate inclusion/exclusion criteria to identify the relevant population in the electronic health records and they needed assistance writing study descriptions in plain language. Using MyChart for recruitment addressed a critical barrier and opened up the opportunity to provide a full recruitment consultation to identify additional recruitment channels the study teams would not have considered otherwise.
The hoary-throated spinetail and Rio Branco antbird are two bird species endemic to the Rio Branco drainage of Brazil and Guyana, currently listed as Critically Endangered on the IUCN Red List. Previous assessments of both species’ global populations focused on the Brazilian state of Roraima but did not include most of its border with Guyana, where significant areas of suitable habitat remain along the Ireng (Maú) and Takutu (Tacutu) Rivers. In July and August 2021, we conducted a survey to determine the extent of each species’ geographic range along the two rivers, and to estimate population sizes. We used playback surveys along 219 km of river to ascertain each species’ distribution and intensively sampled three forest blocks to determine densities. Both species were locally abundant on both sides of the international border. Rio Branco antbird occurred over a greater geographic range than hoary-throated spinetail, particularly along the Takutu River, but was confined to a narrower zone along the river edges. Both species appear to have retreated from habitat along the Ireng River that was occupied in the past, possibly due to habitat degradation from increasingly frequent fires. Nevertheless, our minimum estimates of 1147 antbirds and 851 spinetails in the study area represent, respectively, 7.5% and 17.8 % increases over current estimates of global population sizes, and indicate that the Guyana-Brazil border region may become a critical stronghold for both species if effective conservation measures are implemented. We propose establishment of a Key Biodiversity Area encompassing the core of both species’ distributions along the border; extensive follow-up work including stakeholder engagement to explore possibilities for habitat management and protection; and further field study to increase general ecological knowledge of these two bird species.
Venovenous collaterals are abnormal connections between the systemic and pulmonary venous systems. They are commonly seen in the Fontan circulation and may lead to significant hypoxaemia. Transcatheter closure of venovenous collaterals is a potential but controversial treatment as the long-term benefits and outcomes are not well understood.
Methods:
This retrospective cohort study utilised data from the Australian and New Zealand Fontan Registry. Patients who underwent transcatheter venovenous collateral occlusion for hypoxemia from the year 2000 onwards were included. Atriopulmonary and Kawashima-type Fontan circulations were excluded to reflect a more contemporary Fontan cohort.
Results:
Nineteen patients (age 19.3 ± 7.8 years, 53% female) underwent transcatheter venovenous collateral occlusion. Compared to baseline, mean oxygen saturation was improved at latest follow-up (90.5% vs 87.0%; p = 0.003). Nine patients achieved a clinically significant response (defined as an increase of at least 5% to 90% or greater), and this was associated with lower baseline Fontan pressures (12.9 v 15.6 mmHg; p = 0.02). No heart failure hospitalisations, arrhythmia, transplant referrals, or mortality were observed during the median follow-up period of 4 years. Two patients experienced thromboembolic events and five patients underwent re-intervention.
Conclusion:
Transcatheter occlusion of venovenous collaterals in Fontan patients with chronic hypoxaemia resulted in a modest increase in oxygenation over a median follow-up of 4 years and longer-term prognosis did not appear to be adversely affected. Lower Fontan pressures at baseline were associated with a greater improvement in oxygenation.
Background: Measuring and reporting antibiotic use are essential to antimicrobial stewardship activities. The most common metric to assess facility-level use is days of antibiotic therapy per 1000 days of care (DOT/1000 DOC). This metric may be difficult to calculate, not be readily comparable, or not provide actionable data to individual prescribers, particularly those that work in post-acute and long-term care (PALTC) settings. Here we use data from a centralized dispensing pharmacy to develop antibiotic use metrics suitable for offering individualized feedback to prescribers working in PALTC settings. Methods: We obtained medication dispensing data and resident census data for 13 PALTC settings within the same network. After omitting non-pharmacologic items and limiting the data to medications dispensed from 1/2020 – 12/2022, we determined the following metrics by month: days of antibiotic therapy (DOT), number of medications prescribed, number of antibiotic courses prescribed (antibiotic starts), and the number of individual residents issued a prescription for any medication (unique residents). These metrics were assessed for each facility (2020 – 2022) and for prescribers responsible for > 1% of prescriptions within that facility (2022 only). Prescriber-level unique residents was the number of residents issued a prescription by the given provider. We obtained facility-level census data to calculate antibiotic DOT/1000 resident days of care (DOC) as a standard to which we compared novel metrics. Results: During the 3-year study period, 1718 prescribers at 13 PALTC settings wrote for 672256 medications, including 31087 antibiotic courses. At the facility level, the correlation between monthly antibiotic starts (courses)/unique residents and antibiotic DOT/1000 DOC was 0.83 (p < 0 .0001). The correlation between monthly antibiotic DOT/unique residents and antibiotic DOT/1000 DOC was 0.98 (p < 0 .0001). Trends in monthly values of both novel metrics and DOT/1000 DOC were consistent across the examined period (Figure 1). For individual prescribers, both novel metrics permit assessment and comparison of antibiotic prescription rates over time (Figure 2). Conclusions: Pharmacy dispensing data can be used to determine antibiotic DOT/unique residents and antibiotic starts/unique residents at the facility level and for individual providers. The novel metric antibiotic DOT/unique residents demonstrated strong correlation with antibiotic DOT/1000 DOC at the facility level. In addition to supporting tracking and reporting of antibiotic use among PALTC settings, these new metrics permit visualization of the antibiotic prescribing rates of individuals prescribers, as well as peer comparison, which in turn can lead to actionable feedback that helps improve antibiotic use in the care of PALTC.
Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS).
Methods
The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COMET) database. Systematic literature review identified candidate items. Patient-centred items were identified via a qualitative study. Items and their definitions were refined by multidisciplinary stakeholders in a two-round Delphi exercise and subsequent consensus meeting.
Results
The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management.
Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology [does not have to be positive], histology [malignancy excluded], positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research.
Conclusion
The adoption of consensus-defined diagnostic criteria and COS facilitates standardised research reporting and robust data synthesis. Inclusion of patient and professional perspectives ensures best practice stakeholder engagement.