The macro-eco-evolutionary interplay between dispersal, competition and landscape structure in generating biodiversity.

Theory links dispersal and diversity, predicting the highest diversity at intermediate dispersal levels. However, the modulation of this relationship by macro-eco-evolutionary mechanisms and competition within a landscape is still elusive. We examine the interplay between dispersal, competition and landscape structure in shaping biodiversity over 5 million years in a dynamic archipelago landscape. We model allopatric speciation, temperature niche, dispersal, competition, trait evolution and trade-offs between competitive and dispersal traits. Depending on dispersal abilities and their interaction with landscape structure, our archipelago exhibits two 'connectivity regimes', that foster speciation events among the same group of islands. Peaks of diversity (i.e. alpha, gamma and phylogenetic), occurred at intermediate dispersal; while competition shifted diversity peaks towards higher dispersal values for each connectivity regime. This shift demonstrates how competition can boost allopatric speciation events through the evolution of thermal specialists, ultimately limiting geographical ranges. Even in a simple landscape, multiple intermediate dispersal diversity relationships emerged, all shaped similarly and according to dispersal and competition strength. Our findings remain valid as dispersal- and competitive-related traits evolve and trade-off; potentially leaving identifiable biodiversity signatures, particularly when trade-offs are imposed. Overall, we scrutinize the convoluted relationships between dispersal, species interactions and landscape structure on macro-eco-evolutionary processes, with lasting imprints on biodiversity.This article is part of the theme issue 'Diversity-dependence of dispersal: interspecific interactions determine spatial dynamics'.

Paleoenvironments shaped the exchange of terrestrial vertebrates across Wallace's Line.

Faunal turnover in Indo-Australia across Wallace's Line is one of the most recognizable patterns in biogeography and has catalyzed debate about the role of evolutionary and geoclimatic history in biotic interchanges. Here, analysis of more than 20,000 vertebrate species with a model of geoclimate and biological diversification shows that broad precipitation tolerance and dispersal ability were key for exchange across the deep-time precipitation gradient spanning the region. Sundanian (Southeast Asian) lineages evolved in a climate similar to the humid "stepping stones" of Wallacea, facilitating colonization of the Sahulian (Australian) continental shelf. By contrast, Sahulian lineages predominantly evolved in drier conditions, hampering establishment in Sunda and shaping faunal distinctiveness. We demonstrate how the history of adaptation to past environmental conditions shapes asymmetrical colonization and global biogeographic structure.

Temperature-Dependent Evolutionary Speed Shapes the Evolution of Biodiversity Patterns Across Tetrapod Radiations.

Biodiversity varies predictably with environmental energy around the globe, but the underlaying mechanisms remain incompletely understood. The evolutionary speed hypothesis predicts that environmental kinetic energy shapes variation in speciation rates through temperature- or life history-dependent rates of evolution. To test whether variation in evolutionary speed can explain the relationship between energy and biodiversity in birds, mammals, amphibians, and reptiles, we simulated diversification over 65 myr of geological and climatic change with a spatially explicit eco-evolutionary simulation model. We modeled four distinct evolutionary scenarios in which speciation-completion rates were dependent on temperature (M1), life history (M2), temperature and life history (M3), or were independent of temperature and life-history (M0). To assess the agreement between simulated and empirical data, we performed model selection by fitting supervised machine learning models to multidimensional biodiversity patterns. We show that a model with temperature-dependent rates of speciation (M1) consistently had the strongest support. In contrast to statistical inferences, which showed no general relationships between temperature and speciation rates in tetrapods, we demonstrate how process-based modeling can disentangle the causes behind empirical biodiversity patterns. Our study highlights how environmental energy has played a fundamental role in the evolution of biodiversity over deep time. [Biogeography; diversification; machine learning; macroevolution; molecular evolution; simulation.].

Randomised comparison of needle aspiration and chest tube drainage in spontaneous pneumothorax.

Guidelines on spontaneous pneumothorax are contradictory as to intervention between needle aspiration (NA) and chest tube drainage (CTD). Studies show poor adherence to guidelines.Three Norwegian hospitals included patients with primary (PSP) and secondary (SSP) spontaneous pneumothorax. Patients underwent NA or CTD as the primary intervention. The main outcome was duration of hospital stay. Secondary outcomes were immediate- and 1-week success rates and complications.127 patients were included, including 48 patients with SSP. 65 patients underwent NA, 63 patients CTD. Median (interquartile range) hospital stay was significantly shorter for NA: 2.4 days (1.2-4.7 days), compared with CTD: 4.6 days (2.3-7.8 days) (p<0.001). The corresponding figures for the SSP subgroup were 2.54 days (1.17-7.79 days) compared with 5.53 days (3.65-9.21 days) (p=0.049) for NA and CTD, respectively. Immediate success rates were 69% for NA compared with 32% for CTD (p<0.001). The positive effect of NA remained significant in sub-analyses for SSP. There was no significant difference in 1-week success rates. Complications occurred only during the CTD-treatment.Our study shows shorter hospital stay and higher immediate success rates for NA compared with CTD. Subgroup analyses also show clear benefits for NA for both PSP and SSP.

Remembered preoperative Quick disabilities of the arm, shoulder and hand (QuickDASH) scores.

The Quick disabilities of the arm, shoulder and hand (QuickDASH) patient-reported outcome measure is frequently used to assess disabilities and symptoms of the upper extremity. This study compares real preoperative QuickDASH scores and remembered preoperative QuickDASH scores. Remembered preoperative QuickDASH scores were obtained 45 months (39-67) after surgery. Patient material consisted of 160 patients operated for Dupuytren's contracture, carpal tunnel syndrome, thumb basal joint arthrosis, and shoulder pain. All patients had completed QuickDASH questionnaires before surgery. Paired T-tests, linear mixed models, and limits of agreement were used for analyses. There was a significant difference between remembered and real preoperative scores (mean 7.6, SD 15.6; SEM 1.2). Neither diagnosis, age, gender, nor time between surgery and review influenced the difference significantly. A linear mixed model was constructed to investigate the ability to retrospectively predict preoperative QuickDASH scores. Remembered preoperative QuickDASH cannot be used in individual patients because of the high inaccuracy. LEVEL OF EVIDENCE: III.

Dynamic variables and fluid responsiveness in patients for aortic stenosis surgery.

BACKGROUND: Aortic stenosis is the most common valvular disease in developed countries, but it carries an increased mortality during non-cardiac surgery underscoring the importance of adequate hemodynamic management. Further, haemodynamic management of patients immediately after surgery for aortic stenosis can be challenging. Prediction of fluid responsiveness using dynamic variables has not been sufficiently studied in patients for aortic stenosis surgery. METHODS: Observational study evaluating fluid responsiveness on 32 (31 analysed) patients scheduled for aortic valve replacement due to aortic stenosis on mechanical ventilation before and after valve replacement. Increase in stroke volume (oesophagus Doppler) ≥ 15% to a fluid challenge defined fluid responders. RESULTS: Before surgery (31 fluid loads performed in 31 patients), areas under receiver operating characteristics curves (95% confidence intervals) were stroke volume variation (from arterial pulse contour analysis) 0.77 (0.58-0.90), pulse pressure variation 0.75 (0.54-0.90) and Pleth variability index 0.51 (0.31-0.69). After aortic valve replacement (31 fluid loads performed in 23 patients) the values were stroke volume variation 0.90 (0.74-0.98), pulse pressure variation 0.95 (0.80-1.0) and Pleth variability index 0.72 (0.52-0.87). CONCLUSIONS: The arterial pressure-based variables had moderate predictive values before valve replacement, but it predicted fluid responsiveness well postoperatively. Pleth variability index did not predict fluid responsiveness preoperatively, and it had a moderate predictive value postoperatively. These results indicate that arterial pressure-based dynamic variables have limited potential to guide fluid therapy in patients with aortic stenosis. Their ability to guide fluid therapy after aortic valve replacement seems better.

Handgrip strength measurement as a predictor for successful dry powder inhaler treatment: application in older individuals with COPD.

BACKGROUND: More than 10% of elderly people suffer from chronic obstructive pulmonary disease (COPD). Drug treatment for COPD involves inhalants. Dry powder inhalers (DPIs) have proven easiest for the elderly to use. Their effectiveness is dependent, however, on the inspiratory flow which can be generated, and it is unclear which geriatric assessment parameter permits inspiratory flow to be assessed. METHODS: In a randomly generated group of geriatric hospital patients, manual strength was measured as a complement to basic geriatric assessment and inspiratory flow assessed using a Turbohaler trainer. RESULTS: A total of 87 (27%) men (mean age 81 ± 7 years) and 231 (73%) women (mean age 82 ± 8 years) were included in the study. The threshold value of 40 l/min for minimum inspiratory flow was achieved by 194 (61%) of the patients. Manual strength was the only assessment parameter to correlate with the minimum inspiratory flow achieved. ROC analysis produced a threshold value for manual strength of 10 kg. The sensitivity and specificity for this threshold value were 70% each, while the positive and negative predictive values were 79% and 84%, respectively. CONCLUSION: A threshold value of 10 kg for manual strength enables the inspiratory flow achievable by elderly patients to be predicted satisfactorily. This is the only parameter which correlates sufficiently with inspiratory flow. Manual strength should be measured in all geriatric patients with COPD and should be taken into account when deciding whether or not to initiate differential treatment.

The terminal phase of life as a team-based clinical global judgment: prevalence and associations in an acute geriatric unit.

BACKGROUND: In most elderly people, the final-terminal-phase of life is characterized by permanent dependency and a complete inability to perform activities of daily living. Treatment targets usually switch from rehabilitation to palliation. However, the prevalence of the clinical judgment "last phase of life" and its association with in-hospital death is unknown in geriatric patients. PATIENTS AND METHODS: We retrospectively analyzed GEMIDAS data from two geriatric units. Patients without cancer and an in-hospital stay of at least 1 week were included in our study. Prevalence of the terminal phase of life was clinically assessed according to the proposals made by M. Gillick. This clinical judgment was pronounced by the geriatric team after a stay in the hospital of at least 1 week. The clinical judgment took into account all available assessment parameters, as well as the impact of a geriatric treatment trial. In addition, the association between the clinical judgment and the risk of in-hospital mortality was analyzed. RESULTS: Records from 2,433 (56%) patients in hospital A and from 1,912 (44%) patients in hospital B were analyzed. The frequency of a terminal phase of life was 30% and 9% (p<0.01), respectively. The frequency depended on the manner of admission to the hospital. In both hospitals, mortality was significantly higher in terminal patients (27% and 37%) than in other patients (0-8% and 0-6%). In both hospitals, the risk of in-hospital mortality was significantly associated with the clinical judgment (OR 3.1 and 2.7), heart failure (OR 2.2 and 2.1), and dementia (OR 2.0 and 1.8). Age, residency in a nursing home, and the Barthel Index on admission were all without relevant impact. CONCLUSION: The frequency of the clinical construct "terminal phase of life" varies in geriatric units between 9% and 30%. This clinical construct is significantly associated with increased in-hospital mortality. Therefore, this construct possesses external validity. Further studies are needed in order to assess the significance of such a clinical judgment, the associations with clinical burdens of symptoms, and the supply structure required to cover the needs of patients and their families.

Complications in 2200 consecutive laparoscopic radical prostatectomies: standardised evaluation and analysis of learning curves.

BACKGROUND: Laparoscopic radical prostatectomy (LRP) represents an established treatment modality for localised prostate cancer. OBJECTIVE: To report standardised complication rates for LRP, evaluate the development of complication rates over time, and show changes within the learning curves of laparoscopic surgeons. DESIGN, SETTING, AND PARTICIPANTS: We conducted a standardised analysis of 2200 consecutive patients who underwent LRP between 1999 and 2008 at a single institution. INTERVENTION: LRP was performed using a transperitoneal (n=871) or extraperitoneal (n=1329) retrograde Heilbronn technique. Five surgeons operated on 96% of the patients. MEASUREMENTS: Complications were classified according to the modified Clavien system. Total complication rates and changes over time were analysed. Three generations of surgeons were defined for evaluation of learning curves. RESULTS AND LIMITATIONS: Minor complications occurred in 21.7% of patients (Clavien 1: 6.8%; Clavien 2: 14.9%); anaemia requiring transfusion (10.4%) dominated. Early reinterventions were necessary in 6.7% of patients (Clavien 3a: 3.6%; Clavien 3b: 1.5%; Clavien 4a: 1.5%; Clavien 4b: 0.1%). Late Clavien 3b complications occurred in 4.7% of patients-most of them anastomotic strictures. Mortality was 0.1% (Clavien 5). There was a significant decrease in overall complication rates over time, resulting predominantly from decreasing Clavien 1-2 events. Learning curves of third-generation surgeons plateaued earlier compared to the first generation (250 vs 700 cases). The limitation of this study is that data concerning comorbidity were not included. CONCLUSIONS: LRP is a safe procedure characterised by an acceptable profile of complications. Specifically, few major complications are reported. According to the complication rates, the learning curve of third-generation surgeons is significantly shorter compared to first- and second-generation surgeons.

Blue-dye intraoperative sentinel lymph node mapping in early non-small cell lung cancer.

AIMS: The blue-dye staining method of sentinel lymph node identification in lung cancer patients has been scarcely reported. The study was designed to assess the sensitivity, accuracy and negative predictive value (NPV) of intraoperative sentinel lymph node mapping in patients with non-small cell lung cancer by means of staining with colloid or water solution of blue dye. PATIENTS AND METHODS: One hundred and ten patients with clinically confirmed NO non-small cell lung cancer were enrolled into prospective study of intraoperative sentinel node identification. Four quadrants of the peritumoral tissue were injected with 4 ml of blue dye. After complete lymphadenectomy, all resected lymph nodes were examined with conventional hematoxylin-eosine staining. All negative sentinel nodes were searched for metastatic deposits with both serial sections and immunohistochemistry for cytokeratines. RESULTS: The blue-dye technique was characterized by unacceptably low sentinel node identification rate (IR) and low sensitivity (27% and 67% respectively). No significant differences were found in either the sensitivity or NPV among the colloid or water solutions of the blue dye applied. Although patent blue (colloid) was superior to water solution of methylene blue in identifying sentinel lymph node (identification rate 36% and 22% respectively) the sensitivity and NPV were lower (63% and 80% for patent blue and 75% and 92% for methylene blue respectively). CONCLUSION: The blue-dye staining method of sentinel node identification in non-small cell lung cancer patients is inadequate and should not be recommended for clinical use.

The CarboMedics supraannular top hat valve improves prosthesis size in the aortic root.

BACKGROUND AND AIM OF THE STUDY: Aortic valve replacement can result in patient-valve mismatch and attenuated left ventricular remodeling. Using CarboMedics mechanical valves, we examined if the supraannular Top Hat prosthesis provided a size advantage over the intraannular valve. METHODS: Seventeen patients with aortic stenosis and aortic root < or = 23 mm were randomized to receive a CarboMedics supraannular Top Hat valve (n = 7) or an intraannular valve (n = 10). Doppler echocardiography was performed preoperatively, and after three months. RESULTS: There was no difference in aortic annulus size, but mean prosthesis size was significantly larger in the Top Hat group than in the intraannular group (25.00 mm versus 21.60 mm); the mean size improvement for Top Hat patients was 3.14 mm. After three months, all patients had excellent functional improvement and low transvalvular pressure gradients, with slightly higher effective valve opening area in the Top Hat group. CONCLUSION: The supraannular Top Hat valve provides an advantage of one to two sizes over the intraannular valve, and improves the effective valve opening area. Both valves offer favorable hemodynamic performance and functional improvement.

[Mitral valve plasty. A 12-year material]. / Mitralklaffeplastikk. Et 12-årsmateriale.

46 patients underwent mitral valve repair at the Regional Hospital in Trondheim/St. Elisabeth Heart Clinic, during the period 1983-95. There were 20 female patients. The valve pathology was ischemic in 40%, rheumatic in 10% and other or unknown in 50%. The surgical technique included commissurotomy (n = 9), ring annuloplasty (n = 18), resection of posterior leaflet (n = 12), Kay annuloplasty (n = 10), shortening of chordae (n = 3) and other techniques (n = 2). Postoperative complications included wound infection (n = 1), pneumonia (n = 1), mediastinitis (n = 1), pleural effusion (n = 5), renal failure (n = 1) and multi-organ failure (n = 1). One patient required re-exploration for postoperative bleeding. Three (6.5%) patients died within 30 days of surgery due to low cardiac output (n = 2) and multi-organ failure (n = 1). Nine patients (21%) died later. At follow up, within one year of surgery, marked functional improvement was registered, with only one patient in NYHA class III and none in class IV.

Cognitive function and time-of-day variation in serum carbamazepine concentration in epileptic patients treated with monotherapy.

Different parameters of antiepileptic drug (AED) treatment have been shown to affect cognitive function. The drug, dose, and duration of treatment have been studied. The present study assessed cognitive function in relation to time-of-day variation in serum carbamazepine (CBZ) concentration in epileptic patients treated with monotherapy. We studied 10 males and 12 females with a mean age of 36 years and a mean duration of CBZ-therapy of 4.4 years. Patients had been seizure-free for at least 1 month and took two daily CBZ doses. The test battery included tests of motor speed, reaction time, attention, and memory. In the experimental design, the subjects were tested twice at times close to expected daily maximum and minimum serum CBZ concentration. They were studied in two balanced blocks (block 1 tested at 8 a.m. and noon, block 2 tested at noon and 8 p.m.). Blood samples were collected every 2 hr from 8 a.m. to 8 p.m. The subjects showed significant differences in serum CBZ concentration between testing times, with suggested maximum concentration between 10 a.m. and noon. The test battery showed no consistent differences between performance at times of high versus low serum concentration. A supplementary analysis of correlations between mean performance level on cognitive tests and variables related to CBZ treatment did not show consistent trends.