Factor Eight Inhibitor Bypass Activity use in cardiac surgery: A propensity matched analysis of safety outcomes.

BACKGROUND: Bleeding during cardiac surgery may be refractory to standard interventions. Off-label use of Factor Eight Inhibitor Bypass Activity (FEIBA) has been described to treat such bleeding. However, reports of safety, particularly thromboembolic outcomes, show mixed results and reported cohorts have been small. METHODS: Adult patients undergoing cardiac surgery on cardiopulmonary bypass between July 1, 2018 and June 30, 2023 at Stanford Hospital were reviewed (n=3335). Patients who received FEIBA to treat post-cardiopulmonary bypass bleeding were matched with those who did not by propensity scores in a 1:1 ratio using nearest neighbor matching (n= 352 per group). The primary outcome was a composite outcome of thromboembolic complications including any one of deep vein thrombosis (DVT), pulmonary embolism (PE), unplanned coronary artery intervention, ischemic stroke, and acute limb ischemia, in the postoperative period. Secondary outcomes included renal failure, reoperation, postoperative transfusion, ICU length of stay (LOS), and 30-day mortality. RESULTS: 704 encounters were included in our propensity matched analysis. The mean dose of FEIBA administered was 7.3 ±5.5 units/kg. In propensity matched multivariate logistic regression models there was no statistically significant difference in odds ratios for thromboembolic outcomes, ICU LOS, or mortality. Patients who received >750 units of FEIBA had an increased odds ratio for acute renal failure (OR 4.14; 95% CI 1.61 to 10.36, p <0.001). In multivariate linear regression, patients receiving FEIBA were transfused more plasma and cryoprecipitate postoperatively. However, only the dose range of 501-750 units was associated with an increase in transfusion of RBCs (ß 2.73; 95% CI 0.68 to 4.78; p=0.009), and platelets (ß 1.74; 95% CI 0.85 to 2.63; p <0.001). CONCLUSIONS: Low dose FEIBA administration during cardiac surgery does not increase risk of thromboembolic events, ICU LOS, or mortality in a propensity matched cohort. Higher doses were associated with increased acute renal failure and postoperative transfusion. Further studies are required to establish the efficacy of activated factor concentrates to treat refractory bleeding during cardiac surgery.

Sustained predation pressure may prevent the loss of anti-predator traits from havened populations.

Conservation havens free of invasive predators are increasingly relied upon for fauna conservation, although havened populations can lose anti-predator traits, likely making them less suitable for life 'beyond the fence'. Sustaining low levels of mammalian predator pressure inside havens may prevent the loss of anti-predator traits from havened populations. We opportunistically compared behavioural and morphological anti-predator traits between four woylie (Bettongia penicillata ogilbyi) populations- one haven isolated from all mammalian predators, one haven containing a native mammalian predator (chuditch; Dasyurus geoffroii), and their respective non-havened counterparts (each containing both chuditch and invasive predators). Havened woylies existing without mammalian predators were smaller (shorter hindfeet, smaller body weight) and less reactive (consumed more food from fox-treated and control feeding stations, less agitated during human handling) than a non-havened reference population. However, in the haven containing chuditch, we found no difference in behaviour or morphology compared to the adjacent non-havened population. Across populations, anti-predator responses tended to appear stronger at sites with higher predator activity, suggestive of an adaptive response across a gradient of predation pressure. Our findings suggest that maintaining mammalian predation pressure in conservation havens could be effective for preventing or slowing the loss of anti-predator traits from these populations.

Comprehensive overview of the anesthesiology research landscape: A machine Learning Analysis of 737 NIH-funded anesthesiology primary Investigator's publication trends.

Background: Anesthesiology plays a crucial role in perioperative care, critical care, and pain management, impacting patient experiences and clinical outcomes. However, our understanding of the anesthesiology research landscape is limited. Accordingly, we initiated a data-driven analysis through topic modeling to uncover research trends, enabling informed decision-making and fostering progress within the field. Methods: The easyPubMed R package was used to collect 32,300 PubMed abstracts spanning from 2000 to 2022. These abstracts were authored by 737 Anesthesiology Principal Investigators (PIs) who were recipients of National Institute of Health (NIH) funding from 2010 to 2022. Abstracts were preprocessed, vectorized, and analyzed with the state-of-the-art BERTopic algorithm to identify pillar topics and trending subtopics within anesthesiology research. Temporal trends were assessed using the Mann-Kendall test. Results: The publishing journals with most abstracts in this dataset were Anesthesia & Analgesia 1133, Anesthesiology 992, and Pain 671. Eight pillar topics were identified and categorized as basic or clinical sciences based on a hierarchical clustering analysis. Amongst the pillar topics, "Cells & Proteomics" had both the highest annual and total number of abstracts. Interestingly, there was an overall upward trend for all topics spanning the years 2000-2022. However, when focusing on the period from 2015 to 2022, topics "Cells & Proteomics" and "Pulmonology" exhibit a downward trajectory. Additionally, various subtopics were identified, with notable increasing trends in "Aneurysms", "Covid 19 Pandemic", and "Artificial intelligence & Machine Learning". Conclusion: Our work offers a comprehensive analysis of the anesthesiology research landscape by providing insights into pillar topics, and trending subtopics. These findings contribute to a better understanding of anesthesiology research and can guide future directions.

Income loss and gender-based violence during the COVID-19 pandemic among female entertainment workers in Cambodia: a cross-sectional phone survey.

BACKGROUND: In Cambodia, female entertainment workers (FEWs) are disproportionately affected by global and local disasters, such as the COVID-19 pandemic. To prevent the spread of COVID-19, the government imposed tight restrictions, including closures of entertainment venues, such as karaoke bars, beer gardens, nightclubs, or massage parlors, leading FEWs to face economic and social disruptions. This study aims to assess the relationship between income loss during the pandemic and gender-based violence (GBV) among FEWs in Cambodia to inform future disaster response programs. METHODS: We conducted a phone survey in August 2021 with 369 randomly sampled FEWs from a national organization's email list. We used a structured questionnaire to ask the participants about job and income loss, food security, mental health, access to health services, and GBV. We fit a linear regression model to examine the differences in GBV experience between FEWs who lost all their income and those who lost partial income due to the COVID-19 pandemic. Key covariables comprised the number of dependents, smartphone ownership, internet access, food security, and mental health. Multivariable linear regression analysis was conducted. RESULTS: The mean age (31.6 vs. 30.6), years of formal education (6.3 vs. 6.3), marital status (24.2 vs. 23.8 never married), and the number of children (1.3 vs. 1.1) of women reporting having lost all income were not significantly different from those who experienced partial income loss. Overall, GBV experiences were significantly higher in FEWs who lost all income than in those who lost partial income (62.9% vs. 47.4%, p = 0.03). Controlling for the number of dependents, smartphone ownership, and food security, the adjusted odds ratio for GBV was significant in the adjusted model (AOR = 1.23 (1.08-1.40), p = 0.001) indicating that those who experienced total income loss were more likely to experience GBV than those who experienced partial income loss. In addition, they were significantly less likely to be food secure (p = 0.04), less likely to own a smartphone (p = 0.02), and had more dependents (p < 0.001). CONCLUSION: Disaster response programs should consider the implications of safety measures and government support for both formal and informal workers regarding safety, food access, and mental health support. Food assistance programs should target the most vulnerable informal sector workers during crises.

Identifying the most effective behavioural assays and predator cues for quantifying anti-predator responses in mammals: a systematic review.

BACKGROUND: Mammals, globally, are facing population declines. Protecting and breeding threatened populations inside predator-free havens and translocating them back to the wild is commonly viewed as a solution. These approaches can expose predator-naïve animals to predators they have never encountered and as a result, many conservation projects have failed due to the predation of individuals that lacked appropriate anti-predator responses. Hence, robust ways to measure anti-predator responses are urgently needed to help identify naïve populations at risk, to select appropriate animals for translocation, and to monitor managed populations for changes in anti-predator traits. Here, we undertake a systematic review that collates existing behavioural assays of anti-predator responses and identifies assay types and predator cues that provoke the greatest behavioural responses. METHODS: We retrieved articles from academic bibliographic databases and grey literature sources (such as government and conservation management reports), using a Boolean search string. Each article was screened against eligibility criteria determined using the PICO (Population-Intervention-Comparator-Outcome) framework. Using data extracted from each article, we mapped all known behavioural assays for quantifying anti-predator responses in mammals and examined the context in which each assay has been implemented (e.g., species tested, predator cue characteristics). Finally, with mixed effects modelling, we determined which of these assays and predator cue types elicit the greatest behavioural responses based on standardised difference in response between treatment and control groups. REVIEW FINDINGS: We reviewed 5168 articles, 211 of which were eligible, constituting 1016 studies on 126 mammal species, a quarter of which are threatened by invasive species. We identified six major types of behavioural assays: behavioural focals, capture probability, feeding station, flight initiation distance, giving-up density, and stimulus presentations. Across studies, there were five primary behaviours measured: activity, escape, exploration, foraging, and vigilance. These behaviours yielded similar effect sizes across studies. With regard to study design, however, studies that used natural olfactory cues tended to report larger effect sizes than those that used artificial cues. Effect sizes were larger in studies that analysed sexes individually, rather than combining males and females. Studies that used 'blank' control treatments (the absence of a stimulus) rather than a treatment with a control stimulus had higher effect sizes. Although many studies involved repeat measures of known individuals, only 15.4% of these used their data to calculate measures of individual repeatability. CONCLUSIONS: Our review highlights important aspects of experimental design and reporting that should be considered. Where possible, studies of anti-predator behaviour should use appropriate control treatments, analyse males and females separately, and choose organic predator cues. Studies should also look to report the individual repeatability of behavioural traits, and to correctly identify measures of uncertainty (error bars). The review highlights robust methodology, reveals promising techniques on which to focus future assay development, and collates relevant information for conservation managers.

Affordable RFID loggers for monitoring animal movement, activity, and behaviour.

Effective conservation management strategies require accurate information on the movement patterns and behaviour of wild animals. To collect these data, researchers are increasingly turning to remote sensing technology such as radio-frequency identification (RFID). RFID technology is a powerful tool that has been widely implemented in ecological research to identify and monitor unique individuals, but it bears a substantial price tag, restricting this technology to generously-funded disciplines and projects. To overcome this price hurdle, we provide detailed step-by-step instructions to source the components for, and construct portable RFID loggers in house, at a fraction of the cost (~5%) of commercial RFID units. Here, we assess the performance of these RFID loggers in the field and describe their application in two studies of Australian mammal species; monitoring nest-box use in the Northern quolls (Dasyurus hallucatus) and observing the foraging habits of quenda (Isoodon fusciventer) at feeding stations. The RFID loggers performed well, identifying quenda in >80% of visits, and facilitating the collection of individual-level behavioural data including common metrics such as emergence time, latency to approach, and foraging effort. While the technology itself is not novel, by lowering the cost per unit, our loggers enabled greater sample sizes, increasing statistical power from 0.09 to 0.75 in the quoll study. Further, we outline and provide solutions to the limitations of this design. Our RFID loggers proved an innovative method for collecting accurate behavioural and movement data. With their ability to successfully identify individuals, the RFID loggers described here can act as an alternative or complementary tool to camera traps. These RFID loggers can also be applied in a wide variety of projects which range from monitoring animal welfare or demographic traits to studies of anti-predator responses and animal personality, making them a valuable addition to the modern ecologists' toolkit.

Causative mechanisms and functional correlates of MTT reduction in stallion spermatozoa.

MTT is a commonly used cell vitality probe, due to its ability to form insoluble formazan deposits at cellular locations of intense oxidoreductase activity. Although this response is considered a reflection of mitochondrial redox activity, extra-mitochondrial sites of MTT reduction have been recognized within the spermatozoa of several mammalian species. Therefore, the aim of this study was to determine the major sites and causative mechanisms of MTT reduction in stallion spermatozoa. Our results show that stallion spermatozoa displayed substantial mitochondrial formazan deposition, as well as a single extra-mitochondrial formazan deposit in various locations on the sperm head in approximately 20% of cells. The quality and capacitation status of stallion spermatozoa were positively correlated with the presence of an extra-mitochondrial formazan granule. Additionally, extra-mitochondrial formazan deposition was suppressed by the presence of an NADPH oxidase (NOX) inhibitor (VAS2870; active against NOX2, NOX4 and NOX5), MnTMPyP (SOD mimetic) and zinc (NOX5 inhibitor) suggesting that extra-mitochondrial MTT reduction may be facilitated by NOX-mediated ROS generating activity, conceivably NOX5 or NOX2. When comparing MTT to resazurin, another well-known probe used to detect metabolically active cells, MTT reduction had a higher correlation with sperm concentration and motility parameters (R2= 0.91), than resazurin reduction (R2 = 0.76). We conclude that MTT reduction in stallion spermatozoa follows a species-specific pattern due to a high dependence on oxidative phosphorylation and a degree of NOX activity. As such, MTT reduction is a useful diagnostic tool to assess extra-mitochondrial redox activity, and therefore, the functional qualities of stallion spermatozoa.

Behavioural change during dispersal and its relationship to survival and reproduction in a cooperative breeder.

The ability of dispersing individuals to adjust their behaviour to changing conditions is instrumental in overcoming challenges and reducing dispersal costs, consequently increasing overall dispersal success. Understanding how dispersers' behaviour and physiology change during the dispersal process, and how they differ from resident individuals, can shed light on the mechanisms by which dispersers increase survival and maximise reproduction. By analysing individual behaviour and concentrations of faecal glucocorticoid metabolites (fGCM), a stress-associated biomarker, we sought to identify the proximate causes behind differences in survival and reproduction between dispersing and resident meerkats Suricata suricatta. We used data collected on 67 dispersing and 108 resident females to investigate (a) which individual, social and environmental factors are correlated to foraging and vigilance, and whether the role of such factors differs among dispersal phases, and between dispersers and residents; (b) how time allocated to either foraging or vigilance correlated to survival in dispersers and residents and (c) the link between aggression and change in fGCM concentration, and their relationship with reproductive rates in dispersing groups and resident groups with either long-established or newly established dominant females. Time allocated to foraging increased across dispersal phases, whereas time allocated to vigilance decreased. Time allocated to foraging and vigilance correlated positively and negatively, respectively, with dispersers' group size. We did not find a group size effect for residents. High proportions of time allocated to foraging correlated with high survival, and more so in dispersers, suggesting that maintaining good physical condition may reduce mortality during dispersal. Furthermore, while subordinate individuals rarely reproduced in resident groups, the conception rate of subordinates in newly formed dispersing groups was equal to that of their dominant individuals. Mirroring conception rates, in resident groups, fGCM concentrations were lower in subordinates than in dominants, whereas in disperser groups, fGCM concentrations did not differ between subordinates and dominants. Our results, which highlight the relationship between behavioural and physiological factors and demographic rates, provide insights into some of the mechanisms that individuals of a cooperative species can use to increase overall dispersal success.

Curriculum development: Preparing trainees to care for children and adolescents with psychiatric disorders.

Family physicians provide care for about one-third of the children and adolescents in the United States, many of whom present with psychological concerns. Family physicians often do not recognize these psychological disorders and therefore do not diagnose or treat them. This report describes the implementation of a curriculum designed to increase family medicine trainees' level of awareness that children/adolescents experience psychiatric conditions. This goal is achieved through the addition of a clinical child/adolescent psychologist faculty member, resident self-assessment of training needs and subsequent development of didactic presentations to address these needs. The curriculum relies on the acquisition of child/adolescent psychiatric screeners, development of child/adolescent-focused bibliotherapy materials, and the development of a longitudinal behavioral sciences curriculum. To facilitate the screening of child/adolescent psychiatric disorders, a comprehensive collection of age-appropriate psychiatric screeners were compiled and made readily available in all precepting areas. To assist with the identification of specific child/adolescent psychiatric deficit areas, family medicine resident physicians were presented with an inventory of child/adolescent psychiatric, psychosocial, and behavioral topics, based upon American Academy of Family Practice guidelines and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition psychiatric disorders, and self-selected training deficiencies.