Prevalence of traditional, complementary, and alternative medicine (TCAM) among adult cancer patients in Malawi.

PURPOSE: The objective of this study is to document the prevalence of traditional, complementary, and alternative medicine (TCAM) use by adult cancer patients at a national teaching hospital in Malawi. We aim to document the products/therapies used, the reason for use, as well as patient-reported satisfaction with TCAM practitioners and modalities. METHODS: We conducted investigator-administered interviews with adult cancer patients presenting to the Kamuzu Central Hospital (KCH) Cancer Clinic in Lilongwe, Malawi between January and July 2018. The KCH is a national teaching hospital in the capital of Lilongwe, which serves patients with cancer from the northern half of Malawi. Descriptive statistics were used to describe TCAM use and logistic regression was applied to identify predictors of TCAM. RESULTS: A total of 263 participants completed the survey, of which 70% (n = 183) were female and average age was 45 (SD 14) years old. The prevalence of overall TCAM use was 84% (n = 222), and 60% (n = 157) of participants reported combining TCAM with conventional cancer treatment. The majority of patients used TCAM to directly treat their cancer versus for symptom management. Patients reported using faith-based healing (64%, n = 168), herbal medicine (56%, n = 148), diet change (46%, n = 120), and vitamins/minerals (23%, n = 61). Participants reported the highest satisfaction for physicians among practitioners and diet change for modalities. Female gender was found to be a predictor of TCAM with conventional treatment use, no other significant predictors were observed. CONCLUSION: There is a high prevalence of TCAM use among an adult population with cancer in Malawi, and a wide variety in the TCAM modalities used among patients. Additional studies are needed to identify risks and benefits of TCAM use to assist with policy and public health, patient safety, and holistically address the global burden of cancer.

Effect of water temperature on the duration of the internesting interval across sea turtle species.

Sea turtles generally lay several clutches of eggs in a single nesting season. While a negative correlation between water temperatures and the time required between constitutive nesting events (termed the internesting interval) has been previously reported in loggerhead Caretta caretta and green turtles Chelonia mydas, it is not understood whether this relationship remains constant across other sea turtle species. Here, we expanded upon these previous studies on loggerhead and green turtles by using larger sample sizes and including data from species with a wider range of body-sizes; specifically: hawksbill Eretmochelys imbricata, leatherback Dermochelys coriacea, and olive ridley turtles Lepidochelys olivacea. In total, we compiled temperature data from biologgers deployed over internesting intervals on 23 loggerhead, 22 green, 7 hawksbill, 26 leatherback and 11 olive ridley turtles from nesting sites in 8 different countries. The relationship between the duration of the internesting interval and water temperatures in green and loggerhead turtles were statistically similar yet it differed between all other turtle species. Specifically, hawksbill turtles had much longer internesting intervals than green or loggerhead turtles even after controlling for temperature. In addition, both olive ridley and leatherback turtles exhibited thermal independence of internesting intervals presumably due to the large body-size of leatherback turtles and the unique capacity of ridley turtles to delay oviposition. The observed interspecific differences in the relationship between the length of the internesting interval and water temperatures indicate the complex and variable responses that each sea turtle species may exhibit due to environmental fluctuations and climate change.

Design and implementation of a clinical decision support tool for primary palliative Care for Emergency Medicine (PRIM-ER).

BACKGROUND: The emergency department is a critical juncture in the trajectory of care of patients with serious, life-limiting illness. Implementation of a clinical decision support (CDS) tool automates identification of older adults who may benefit from palliative care instead of relying upon providers to identify such patients, thus improving quality of care by assisting providers with adhering to guidelines. The Primary Palliative Care for Emergency Medicine (PRIM-ER) study aims to optimize the use of the electronic health record by creating a CDS tool to identify high risk patients most likely to benefit from primary palliative care and provide point-of-care clinical recommendations. METHODS: A clinical decision support tool entitled Emergency Department Supportive Care Clinical Decision Support (Support-ED) was developed as part of an institutionally-sponsored value based medicine initiative at the Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health. A multidisciplinary approach was used to develop Support-ED including: a scoping review of ED palliative care screening tools; launch of a workgroup to identify patient screening criteria and appropriate referral services; initial design and usability testing via the standard System Usability Scale questionnaire, education of the ED workforce on the Support-ED background, purpose and use, and; creation of a dashboard for monitoring and feedback. RESULTS: The scoping review identified the Palliative Care and Rapid Emergency Screening (P-CaRES) survey as a validated instrument in which to adapt and apply for the creation of the CDS tool. The multidisciplinary workshops identified two primary objectives of the CDS: to identify patients with indicators of serious life limiting illness, and to assist with referrals to services such as palliative care or social work. Additionally, the iterative design process yielded three specific patient scenarios that trigger a clinical alert to fire, including: 1) when an advance care planning document was present, 2) when a patient had a previous disposition to hospice, and 3) when historical and/or current clinical data points identify a serious life-limiting illness without an advance care planning document present. Monitoring and feedback indicated a need for several modifications to improve CDS functionality. CONCLUSIONS: CDS can be an effective tool in the implementation of primary palliative care quality improvement best practices. Health systems should thoughtfully consider tailoring their CDSs in order to adapt to their unique workflows and environments. The findings of this research can assist health systems in effectively integrating a primary palliative care CDS system seamlessly into their processes of care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03424109. Registered 6 February 2018, Grant Number: AT009844-01.

Surface Layer Matrix-Assisted Laser Desorption Ionization Mass Spectrometry Imaging: A Surface Imaging Technique for the Molecular-Level Analysis of Synthetic Material Surfaces.

Surface layer matrix-assisted laser desorption ionization mass spectrometry imaging (SL-MALDI-MSI) is a powerful new surface sensitive imaging technique to establish surface component localization of multicomponent polymer materials. This study demonstrates the ability of SL-MALDI-MSI to image defects from foreign materials, material absence, mechanical scribing, and solvent perturbation at the surface of low-molecular-weight poly(methyl methacrylate) and polystyrene thin films. The surface specificity of the SL-MALDI-MSI technique is validated by imaging polystyrene on poly(methyl methacrylate) bilayer films; only polystyrene ions are detected from the surface of the unperturbed polystyrene layer. A key process enabling SL-MALDI-MSI is the solvent-free sublimation of matrix and salt uniformly on the sample's surface.

Advancing patient-centered research practices in a pragmatic patient-level randomized clinical trial: A thematic analysis of stakeholder engagement in Emergency Medicine Palliative Care Access (EMPallA).

BACKGROUND: Involving patient and community stakeholders in clinical trials adds value by ensuring research prioritizes patient goals both in conduct of the study and application of the research. The use of stakeholder committees and their impact on the conduct of a multicenter clinical trial have been underreported clinically and academically. The aim of this study is to describe how Study Advisory Committee (SAC) recommendations were implemented throughout the Emergency Medicine Palliative Care Access (EMPallA) trial. EMPallA is a multi-center, pragmatic two-arm randomized controlled trial (RCT) comparing the effectiveness of nurse-led telephonic case management and specialty, outpatient palliative care of older adults with advanced illness. METHODS: A SAC consisting of 18 individuals, including patients with palliative care experience, members of healthcare organizations, and payers was convened for the EMPallA trial. The SAC engaged in community-based participatory research and assisted in all aspects from study design to dissemination. The SAC met with the research team quarterly and annually from project inception to dissemination. Using meeting notes and recordings we completed a qualitative thematic analysis using an iterative process to develop themes and subthemes to summarize SAC recommendations throughout the project's duration. RESULTS: The SAC convened 16 times between 2017 and 2020. Over the course of the project, the SAC provided 41 unique recommendations. Twenty-six of the 41 (63%) recommendations were adapted into formal Institutional Review Board (IRB) study modifications. Recommendations were coded into four major themes: Scientific, Pragmatic, Resource and Dissemination. A majority of the recommendations were related to either the Scientific (46%) or Pragmatic (29%) themes. Recommendations were not mutually exclusive across three study phases: Preparatory, execution and translational. A vast majority (94%) of the recommendations made were related to the execution phase. Major IRB study modifications were made based on their recommendations including data collection of novel dependent variables and expanding recruitment to Spanish-speaking patients. CONCLUSIONS: Our study provides an example of successful integration of a SAC in the conduct of a pragmatic, multi-center RCT. Future trials should engage with SACs in all study phases to ensure trials are relevant, inclusive, patient-focused, and attentive to gaps between health care and patient and family needs. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT03325985, 10/30/2017.

Clinical research should involve patient and community stakeholder perspectives to make sure the study addresses questions important to the studied population. One way to do this is by creating a group of stakeholders who can advise on the conduct of a study. We assembled a Study Advisory Committee (SAC) for the Emergency Medicine Palliative Care Access (EMPallA) trial. The purpose of this clinical trial is to compare the effectiveness of nurse-led telephonic case management and specialty, outpatient palliative care of older adults with advanced illness. This paper describes how the SACs involvement translated into direct impacts on the EMPallA trial. The trial research team held regular meetings with the SAC throughout the trial process. Their involvement led to many significant changes in the trial, such as  expanding recruitment inclusion criteria (Spanish-speaking patients), and including survey instruments to measure lonelines and caregiver burden. The SAC also devised strategies to overcome patient and caregiver recruitment and retention challenges, including the creation of patient-friendly materials and training for research coordinators. This study provides a successful example of how actively engaging patient and community stakeholders, through committee engagement, can promote patient priorities in all phases of a trial while facilitating patient recruitment and retention.

Spatial ecology of translocated raccoons.

Raccoons (Procyon lotor) are routinely translocated both legally and illegally to mitigate conflicts with humans, which has contributed to the spread of rabies virus across eastern North America. The movement behavior of translocated raccoons has important ramifications for disease transmission yet remains understudied and poorly quantified. To examine the spatial ecology of raccoons following experimental translocation, we performed reciprocal 16 km-distance translocations of 30 raccoons between habitats of high and low raccoon density (bottomland hardwood and upland pine, respectively) across the Savannah River Site (SRS) in Aiken, South Carolina, USA (2018-2019). Translocation influenced patterns of raccoon space use, with translocated animals exhibiting a 13-fold increase in 95% utilization distributions (UDs) post- compared to pre-translocation (mean 95% UD 35.8 ± 36.1 km2 vs 1.96 ± 1.17 km2). Raccoons originating from upland pine habitats consistently had greater space use and larger nightly movement distances post-translocation compared to raccoons moved from bottomland hardwood habitats, whereas these differences were generally not observed prior to translocation. Estimated home ranges of male raccoons were twice the area as estimated for female raccoons, on average, and this pattern was not affected by translocation. After a transient period lasting on average 36.5 days (SD = 30.0, range = 3.25-92.8), raccoons often resumed pre-experiment movement behavior, with 95% UD sizes not different from those prior to translocation (mean = 2.27 ± 1.63km2). Most animals established new home ranges after translocation, whereas three raccoons moved > 16 km from their release point back to the original capture location. Four animals crossed a 100-m wide river within the SRS post-translocation, but this behavior was not documented among collared raccoons prior to translocation. Large increases in space use combined with the crossing of geographic barriers such as rivers may lead to elevated contact rates with conspecifics, which can heighten disease transmission risks following translocation. These results provide additional insights regarding the potential impacts of raccoon translocation towards population level risks of rabies outbreaks and underscore the need to discourage mesocarnivore translocations to prevent further spread of wildlife rabies.

Raccoon spatial ecology in the rural southeastern United States.

The movement ecology of raccoons varies widely across habitats with important implications for the management of zoonotic diseases such as rabies. However, the spatial ecology of raccoons remains poorly understood in many regions of the United States, particularly in the southeast. To better understand the spatial ecology of raccoons in the southeastern US, we investigated the role of sex, season, and habitat on monthly raccoon home range and core area sizes in three common rural habitats (bottomland hardwood, upland pine, and riparian forest) in South Carolina, USA. From 2018-2022, we obtained 264 monthly home ranges from 46 raccoons. Mean monthly 95% utilization distribution (UD) sizes ranged from 1.05 ± 0.48 km2 (breeding bottomland females) to 5.69 ± 3.37 km2 (fall riparian males) and mean monthly 60% UD sizes ranged from 0.25 ± 0.15 km2 (breeding bottomland females) to 1.59 ± 1.02 km2 (summer riparian males). Males maintained home range and core areas ~2-5 times larger than females in upland pine and riparian habitat throughout the year, whereas those of bottomland males were only larger than females during the breeding season. Home ranges and core areas of females did not vary across habitats, whereas male raccoons had home ranges and core areas ~2-3 times larger in upland pine and riparian compared to bottomland hardwood throughout much of the year. The home ranges of males in upland pine and riparian are among the largest recorded for raccoons in the United States. Such large and variable home ranges likely contribute to elevated risk of zoonotic disease spread by males in these habitats. These results can be used to inform disease mitigation strategies in the southeastern United States.

RACCOONS (PROCYON LOTOR) SHOW HIGHER TRYPANOSOMA CRUZI DETECTION RATES THAN VIRGINIA OPOSSUMS (DIDELPHIS VIRGINIANA) IN SOUTH CAROLINA, USA.

Chagas disease, a significant public health concern in the Americas, is caused by a protozoan parasite, Trypanosoma cruzi. The life cycle of T. cruzi involves kissing bugs (Triatoma spp.) functioning as vectors and mammalian species serving as hosts. Raccoons (Procyon lotor) and opossums (Didelphis virginiana) have been identified as important reservoir species in the life cycle of T. cruzi, but prevalence in both species in the southeastern US is currently understudied. We quantified T. cruzi prevalence in these two key reservoir species across our study area in South Carolina, US, and identified factors that may influence parasite detection. We collected whole blood from 183 raccoons and 126 opossums and used PCR to detect the presence of T. cruzi. We then used generalized linear models with parasite detection status as a binary response variable and predictor variables of land cover, distance to water, sex, season, and species. Our analysis indicated that raccoons experienced significantly higher parasite detection rates than Virginia opossums, with T. cruzi prevalence found to be 26.5% (95% confidence interval [CI], 20.0-33.8) in raccoons and 10.5% (95% CI, 5.51-17.5) in opossums. Overall, our results concur with previous studies, in that T. cruzi is established in reservoir host populations in natural areas of the southeastern US.

Healthcare Professionals' Perspectives on Improving Dietary Supplement Documentation in the Electronic Medical Record: Current Challenges and Opportunities to Enhance Quality of Care and Patient Safety.

Background: Around half the US population uses dietary supplements (DS), and concomitant use with medications is common. Many DS include bioactive substances that can interact with medications; therefore, accurate tracking is critical for patient safety. Unfortunately, documentation of patients' DS use is often missing or incomplete in the electronic medical record (EMR), leaving patients susceptible to potential adverse events. Novel approaches to assist healthcare professionals (HCPs) in capturing patients' DS use are needed. Objective: To assess HCPs' perspectives on challenges and facilitators of DS documentation in the EMR and their opinions on a proposed mHealth application (app) to aid in DS capture. Methods: HCPs, recruited from professional networks, largely in North Carolina, using purposive sampling, took part in semi-structured interviews. We inquired about HCPs' experiences with DS documentation in the EMR and their opinions about our proposed mHealth app. Interviews were recorded, transcribed, and coded. Thematic analysis included deductive codes based on the interview guide, and inductive codes that emerged during transcript review. Results: HCPs (N = 30) included 60% females, mean age 46 ± 10; 70% White. Pharmacists (20%), nurses (17%), and physicians (17%) were the most represented professions. Years in practice ranged from 3-35 years. Most HCPs were concerned about DS safety and potential supplement-drug interactions, and cited several barriers to accurate EMR DS documentation including time constraints, database inconsistencies, and poor patient-HCP communication about DS. HCPs' views on our proposed mHealth app were generally positive. They expressed that our proposed mHealth app could streamline documentation processes and enhance patient-provider communication. HCPs expressed desire for a high-quality mHealth app that includes access to evidence-based DS information, integrates with the EMR, and does not increase time burdens. Conclusion: HCPs believe documentation of patients' DS use is important but not accurately captured in the EMR. Support was expressed for our proposed barcode-scanning DS mHealth app.

Emergency and post-emergency care of older adults with Alzheimer's disease/Alzheimer's disease related dementias.

BACKGROUND: The emergency department (ED) is a critical juncture in the care of persons living with dementia (PLwD), as they have a high rate of hospital admission, ED revisits, and subsequent inpatient stays. We examine ED disposition of PLwD compared with older adults with non-dementia chronic disease as well as healthcare utilization and survival. METHODS: Medicare claims data were used to identify community-dwelling older adults 66+ years old from 34 hospitals with either Alzheimer's disease/Alzheimer's disease related dementias (AD/ADRD) or a non-AD/ADRD chronic condition between January 1, 2014, and December 31, 2018. We compared ED disposition at the index visit, as well as healthcare utilization and mortality in the 12 months following an index ED visit, and adjusted for age, gender, and risk of mortality. RESULTS: There were 29,626 patients in the AD/ADRD sample, and 317,046 in the comparison sample. The AD/ADRD sample was older (82.4 years old [SD: 8.2] vs. 76.0 years old [SD: 7.7]) and had more female patients (59.9% vs. 54.7%). The AD/ADRD sample was more likely to experience ED disposition to acute care (OR 1.039, p < 0.001, 95% CI 1.029-1.050), to have an ED revisit (OR 1.077, p < 0.001, 95% CI 1.066-1.087), and an inpatient stay in the subsequent 12 months (OR 1.085, p < 0.001, 95% CI 1.075-1.095). ED disposition to hospice was low in both samples (0.2%). AD/ADRD patients had a higher risk of mortality (OR 1.099, p < 0.001, 95% CI 1.091-1.107) and high short-term mortality (31.9% within 12 months) than those without AD/ADRD (15.3% within 12 months). CONCLUSIONS: PLwD who visit the ED have high short-term mortality. Despite this, disposition to acute care, ED revisits, and inpatient stays, rather than hospice, remain the predominant mode of care delivery. Transition directly from the ED to hospice for PLwD is rare.

Patient Perspectives on the Development of a Novel Mobile Health (mHealth) Application for Dietary Supplement Tracking and Reconciliation-A Qualitative Focus Group Study.

BACKGROUND: More than 170 million adults use dietary supplements (DS) in the United States, which can have both benefit and harm to patient health. DS use is often poorly documented in the medical record and can pose health risks if not properly communicated with providers. Reasons for poor DS documentation include low disclosure rates, time constraints of clinical encounters, and providers' failure to inquire about DS use. This study was conducted to assess patients' views on the facilitators and barriers to using a mobile health (mHealth) application (app) to collect and share DS information with their healthcare providers. METHODS: Utilizing a theory-based conceptual model, we conducted 7 patient focus groups (FGs) to assess opinions on DS safety, provider communication, comfort with technology use, and our proposed mHealth app. Participants were recruited from the general public and through patient advisory groups. Patient views will inform the creation of an mHealth app to improve DS patient-provider communication and tracking and reconciliation in the electronic medical record (EMR). RESULTS: Overall, participants believe their DS information is inaccurately represented in the EMR, leading to safety concerns and negatively impacting overall quality of care. Participants desired an app designed with (1) Health Insurance Portability and Accountability Act (HIPAA) compliance; (2) ease of use for a variety of technical efficacy levels; (3) access to reliable DS information, including a DS-drug interaction checker; and (4) integration with the EMR. CONCLUSION: An app to simplify and improve DS entry and reconciliation was of interest to patients, as long as it maintained health autonomy and privacy and possessed key valuable features.

Emergency provider perspectives on facilitators and barriers to home and community services for older adults with serious life limiting illness: A qualitative study.

BACKGROUND: Older adults account for a large proportion of emergency department visits, but those with serious life-limiting illness may benefit most from referral to home and community services instead of hospitalization. We aim to document emergency provider perspectives on facilitators and barriers to accessing home and community services for older adults with serious life-limiting illness. METHODS: We conducted interviewer-administered semi-structured interviews with emergency providers from health systems across the United States to obtain provider perspectives on facilitators and barriers to accessing home and community services. We completed qualitative thematic analysis using an iterative process to develop themes and subthemes to summarize provider responses. RESULTS: We interviewed 8 emergency nurses and 10 emergency physicians across 11 health systems. Emergency providers were familiar with local home and community services. Facilitators to accessing these services include care management and social workers. Barriers include services that are not accessible full-time to receive referrals, insurance/payment, and the busy nature of the emergency department. The most helpful reported services were hospice, physical therapy, occupational therapy, and visiting nursing services. Home-based palliative care and full-time emergency department-based care management and social work were the services most desired by providers. Providers expressed support for improving access to home and community services in the hopes of decreasing unnecessary emergency visits and inpatient admissions, and to provide patients with greater options for supportive care. CONCLUSION: Obtaining the perspective of emergency providers highlights important considerations to accessing HCS for older-adults with serious life-limiting illness from the emergency department. This study provides foundational information for futures studies and initiatives for improving access to home and community services directly from the emergency department.

Quantifying anthropogenic wolf mortality in relation to hunting regulations and landscape attributes across North America.

Understanding the types and magnitude of human-caused mortality is essential for maintaining viable large carnivore populations. We used a database of cause-specific mortality to examine how hunting regulations and landscape configurations influenced human-caused mortality of North American gray wolves (Canis lupus). Our dataset included 21 studies that monitored the fates of 3564 wolves and reported 1442 mortalities. Human-caused mortality accounted for 61% of mortality overall, with 23% due to illegal harvest, 16% due to legal harvest, and 12% the result of management removal. The overall proportion of anthropogenic wolf mortality was lowest in areas with an open hunting season compared to areas with a closed hunting season or mixed hunting regulations, suggesting that harvest mortality was neither fully additive nor compensatory. Proportion of mortality from management removal was reduced in areas with an open hunting season, suggesting that legal harvest may reduce human-wolf conflicts or alternatively that areas with legal harvest have less potential for management removals (e.g., less livestock depredation). Proportion of natural habitat was negatively correlated with the proportion of anthropogenic and illegal harvest mortality. Additionally, the proportion of mortality due to illegal harvest increased with greater natural habitat fragmentation. The observed association between large patches of natural habitat and reductions in several sources of anthropogenic wolf mortality reiterate the importance of habitat preservation to maintain wolf populations. Furthermore, effective management of wolf populations via implementation of harvest may reduce conflict with humans. Effective wolf conservation will depend on holistic strategies that integrate ecological and socioeconomic factors to facilitate their long-term coexistence with humans.

Factors influencing lion movements and habitat use in the western Serengeti ecosystem, Tanzania.

Protected areas that restrict human activities can enhance wildlife habitat quality. Efficacy of protected areas can be improved with increased protection from illegal activities and presence of buffer protected areas that surround a core protected area. Habitat value of protected areas also can be affected by seasonal variation in anthropogenic pressures. We examined seasonal space use by African lions (Panthera leo) within a core protected area, Serengeti National Park, Tanzania, and surrounding buffer protected areas with varying protection strengths. We used lion locations in logistic regression models during wet and dry seasons to estimate probability of use in relation to protection strength, distance to protected area edge, human and livestock density, distance to roads and rivers, and land cover. Lions used strongly protected buffer areas over the core protected area and unprotected areas, and moved away from protected area boundaries toward the core protected area when buffer protected areas had less protection. Lions avoided high livestock density in the wet season and high human density in the dry season. Increased strength of protection can decrease edge effects on buffer areas and help maintain habitat quality of core protected areas for lions and other wildlife species.

Access to Home and Community Health Services for Older Adults With Serious, Life-Limiting Illness: A Study Protocol.

OBJECTIVES: The objective of this study is to identify contextual access factors to home and community health services for end-of-life support for older adults with serious life-limiting illness, as well as determine if access to home and community services is associated with health-care utilization. DESIGN: This study includes an environmental scan, grey literature review, qualitative interviews, and health-care utilization analysis. This study is a subproject of the Grudzen et al. Primary Palliative Care for Emergency Medicine (PRIM-ER) study. SETTINGS/LOCATION: Analysis will include data collection from 17 health systems implementing the PRIM-ER intervention. PARTICIPANTS: For the qualitative interviews, one emergency medicine (EM) physician and one EM nurse will be interviewed from each of the 17 participating health systems. For the health-care utilization analysis, we will use the Senior Care Services Scale (SCSS), American Hospital Association Annual Survey of Hospitals (AHA-ASH), and Medicare claims for all emergency department (ED) visits for serious illness who present at each participating health system. OUTCOME MEASURES: The contextual analysis will obtain data on home and community services, such as hospice, home health services, assisted living, integrative medicine services, etc., available around each health system's highest volume ED, federal and state regulations influencing access to services, as well as EM provider perspectives on access to services. The health-care utilization analysis will determine if SCSS scores, which measure service availability, are associated with health-care usage. High or low SCSS scores are determined by comparing health system service availability on the AHA-ASH to the national median SCSS value.

Landscape transformations produce favorable roosting conditions for turkey vultures and black vultures.

Recent increases in turkey vulture (Cathartes aura) and black vulture (Coragyps atratus) populations in North America have been attributed in part to their success adapting to human-modified landscapes. However, the capacity for such landscapes to generate favorable roosting conditions for these species has not been thoroughly investigated. We assessed the role of anthropogenic and natural landscape elements on roosting habitat selection of 11 black and 7 turkey vultures in coastal South Carolina, USA using a GPS satellite transmitter dataset derived from previous research. Our dataset spanned 2006-2012 and contained data from 7916 nights of roosting. Landscape fragmentation, as measured by land cover richness, influenced roosting probability for both species in all seasons, showing either a positive relationship or peaking at intermediate values. Roosting probability of turkey vultures was maximized at intermediate road densities in three of four seasons, and black vultures showed a positive relationship with roads in fall, but no relationship throughout the rest of the year. Roosting probability of both species declined with increasing high density urban cover throughout most of the year. We suggest that landscape transformations lead to favorable roosting conditions for turkey vultures and black vultures, which has likely contributed to their recent proliferations across much of the Western Hemisphere.

Carolina critters: a collection of camera-trap data from wildlife surveys across North Carolina.

Camera trap surveys are useful to understand animal species population trends, distribution, habitat preference, behavior, community dynamics, periods of activity, and species associations with environmental conditions. This information is ecologically important, because many species play important roles in local ecosystems as predators, herbivores, seed dispersers, and disease vectors. Additionally, many of the larger wildlife species detected by camera traps are economically important through hunting, trapping, or ecotourism. Here we present a data set of camera-trap surveys from 6,043 locations across all 100 counties of North Carolina, USA from 2009 to 2019. These data come from 26 survey initiatives and contain 215,108 records of 36 mammal species and three species of terrestrial birds. This large data set increases the geographical distribution data for these 39 mammal and bird species by >500% over what is available for North Carolina in the Global Biodiversity Information Facility (GBIF). These data can be used to conduct inquiries about species, populations, communities, or ecosystems, and to produce useful information on wildlife behavior, distribution, and interactions. There are no copyright restrictions. Please cite this paper when using the data for publication.

Primary Palliative Care for Emergency Medicine (PRIM-ER): Applying form and function to a theory-based complex intervention.

BACKGROUND: Emergency departments are seeing an increase in acute exacerbations of chronic disease in the older-adult population. The delivery of palliative care in the emergency department can increase goal-concordant care at the end-of-life for this population. New interventions in palliative care for emergency medicine require large, pragmatic, complex health interventions due to the heterogeneous and dynamic environment of emergency departments. These complex interventions must balance fidelity with adaptability, while being rooted in theory, to produce an intervention that can be applied in a variety of contexts. METHODS: Primary Palliative Care for Emergency Medicine (PRIM-ER) is a large, pragmatic, complex health intervention. This paper outlines the conceptual theory-based design as well as the study form and functions of PRIM-ER to exemplify how this complex intervention has balanced fidelity with adaptability. RESULTS: A form and function matrix was created to highlight the key objectives and tailored intervention components of PRIM-ER. Each intervention component was also linked to one or more elements of the Theory of Planned Behavior to support provider behavior change and the delivery of palliative care services and referrals. CONCLUSION: The application of theory and delineation of forms and functions, as well prospective adaptation monitoring of large complex interventions can support the balance of fidelity with adaptability to encourage successful interventions among a variety of clinical environments.

Responses of sympatric canids to human development revealed through citizen science.

Measuring wildlife responses to anthropogenic activities often requires long-term, large-scale datasets that are difficult to collect. This is particularly true for rare or cryptic species, which includes many mammalian carnivores. Citizen science, in which members of the public participate in scientific work, can facilitate collection of large datasets while increasing public awareness of wildlife research and conservation. Hunters provide unique benefits for citizen science given their knowledge and interest in outdoor activities. We examined how anthropogenic changes to land cover impacted relative abundance of two sympatric canids, coyote (Canis latrans), and red fox (Vulpes vulpes) at a large spatial scale. In order to assess how land cover affected canids at this scale, we used citizen science data from bow hunter sighting logs collected throughout New York State, USA, during 2004-2017. We found that the two species had contrasting responses to development, with red foxes positively correlated and coyotes negatively correlated with the percentage of low-density development. Red foxes also responded positively to agriculture, but less so when agricultural habitat was fragmented. Agriculture provides food and denning resources for red foxes, whereas coyotes may select forested areas for denning. Though coyotes and red foxes compete in areas of sympatry, we did not find a relationship between species abundance, likely a consequence of the coarse spatial resolution used. Red foxes may be able to coexist with coyotes by altering their diets and habitat use, or by maintaining territories in small areas between coyote territories. Our study shows the value of citizen science, and particularly hunters, in collection of long-term data across large areas (i.e., the entire state of New York) that otherwise would unlikely be obtained.

CauseSpec: a database of global terrestrial vertebrate cause-specific mortality.

As wildlife populations continue to decline worldwide, human-caused mortality of terrestrial vertebrates is of increasing importance. However, there is a limited understanding of how direct anthropogenic mortality compares in magnitude to natural mortality. Here, we present CauseSpec, a database of global terrestrial vertebrate cause-specific mortality. We compiled studies that used telemetry to monitor terrestrial vertebrates and determine cause of death. We distinguished between anthropogenic and natural mortality and also documented the specific mortality source where possible (e.g., harvest, vehicle collision, predation, and starvation). This database consists of 1,134 studies that collectively monitored the fates of 123,747 individual animals. From this, there are 43,998 deaths of known cause among 307 species. It is an updated version of the data set used in Hill et al. (2019) and will continue to be updated in the future. These data can be combined with data on species morphology and behavior to examine how species attributes influence susceptibility to various mortality sources. Our database also includes the geographic coordinates of the study site so that site attributes can be included in analyses. We also distinguish between adults and juveniles where possible, allowing for age-specific mortality analyses. Study start and end dates are available as well so that analyses of temporal changes in mortality are possible. Last, users can select all cause-specific mortality studies from a single species to perform a species-level analysis. The data set will allow users to circumvent a literature search, facilitating more rapid publication of large-scale vertebrate mortality studies and elucidating mortality patterns of terrestrial vertebrates around the world. There are no copyright or proprietary restrictions. We would like researchers to cite this paper if the associated database is used to find studies of interest for analysis.