Reactive persistence, spatial management, and conservation of metapopulations: An application to seagrass restoration.

Assessing the conditions for persistence of spatially structured populations, especially those that are exploited by humans or threatened by global change, is of critical importance to inform management and conservation efforts. Observations for entire metapopulations are usually incomplete and rarely, if ever, sufficiently long to deduce population persistence from spatial patterns of abundance. Instead, insights based on metapopulation theory are often used for interpreting the demographic trajectories of real populations and for informing management decisions. The classical theoretical tool used to assess conditions for metapopulation persistence is the "invasibility criterion," which characterizes the asymptotic, or long-term, stability of a small colonizing population. Essentially, when the linear operator governing the metapopulation dynamics of an invasion event has a positive eigenvalue, recovery and resistance to extinction (resilience) are implied. The converse, however, is not necessarily the case-an invasion may grow over multiple generations, even when the eigenvalues indicate that extinction will eventually occur, a situation referred to here as "reactive persistence." For the management, restoration, and conservation of real metapopulations subject to continual disturbance, this transient behavior is often more relevant than the asymptotic behavior over long time scales. We develop the theoretical tools for assessing reactive persistence, demonstrating how the conditions for asymptotic and reactive persistence differ in both the patch-occupancy models suited to many terrestrial populations and those where local patch extinctions can be disregarded in the dynamics, often suited to marine species. After presenting the mathematical basis for generalizing the invasibility criterion to include reactive persistence, we illustrate how these concepts and tools can be applied in practice, using as a case study the population ecology and restoration of the seagrass Zostera muelleri (Irmisch ex Ascherson, 1867) in the Port of Gladstone in the Great Barrier Reef World Heritage Area Australia. It is shown how the analysis of the transient dynamics of the Z. muelleri metapopulation can be used to guide restoration efforts. Moreover, it is demonstrated that these reactive persistence concepts provide a more appropriate basis for site prioritization for restoration interventions than traditional stability analysis.

Trends in use of prostacyclin analogs for management of CDH-associated pulmonary hypertension.

PURPOSE: Off-label use of prostacyclins to manage congenital diaphragmatic hernia-associated pulmonary hypertension (CDH-PHTN) has been described over recent years, but use is not standardized across institutions. This study aims to describe trends in use of these medications in the CDH Study Group (CDHSG) patients. METHODS: The CDHSG was queried for all patients born from 2007 to 2019. Records were reviewed to describe the number of patients receiving prostacyclins, the day of life on which the agent was started, start time relative to ECLS, the duration of medication use, and continuation of the medication at the time of discharge. Finally, trends in use by year of birth were evaluated to assess for changes in use over time. RESULTS: There were 6439 patients identified from the registry who were born during the study period. 4372 (68%) patients received medications to treat pulmonary hypertension. Of these, 604 (14%) received a prostacyclin at some point during their care. The median start time for prostacyclins was 7.5 days of life (mean 16.9 days, SD 32.5 days), and the median duration was 12.5 days (mean 25.1 days, SD 49.1 days). Among patients who received prostacyclins, 340 patients required ECLS during care, 53 (15.5%) of whom started the prostacyclin prior to ECLS, and 159 (46.8%) of whom started prostacyclin therapy during their ECLS run. Only a small cohort (26/604, 4.3%) required continuation of the prostacyclin at the time of discharge. The proportion of patients receiving a prostacyclin remained relatively stable over the study period. CONCLUSIONS: While the proportion of patients receiving a prostacyclin for management of CDH-PHTN has remained relatively stable over the last 13 years, there is significant variation in timing of initiation and duration of use especially in the pre-ECLS period that warrants further investigation to describe optimal use in these patients.

Encouraging Gender Conformity or Sanctioning Nonconformity? Felt Pressure from Parents, Peers, and the Self.

Expectations regarding gendered behaviors are understood to emanate from many sources, including parents, peers, and the self but there has been little research directly comparing these three sources of pressure. The present study assessed felt pressure regarding masculine and feminine stereotypic behaviors and compared pressure from parents, peers, and the self and how these sources are associated with self-perceived gender typicality. Participants (N = 275; 53.09% female; grade 7 M = 12.35 years; grade 9 M = 14.3 years; 71% Anglo-Celtic) were recruited from independent schools in Sydney. Felt pressure from the self to engage in masculine behavior was greater than felt pressure from parents or peers. Male adolescents reported higher felt pressure to conform to gender conforming behavior from parents and the self and pressure to avoid gender nonconforming behavior was greatest from peers. Female adolescents reported felt pressure to conform to gender nonconforming behaviors and this pressure was the strongest from the self. Additionally, for both genders, felt pressure from the self was most consistently associated with gender typicality. These findings highlight the importance of self-expectations for gender cognitions relating to both masculine and feminine behaviors.

Process evaluation of a systemic intervention to identify and support partner violence survivors in a multi-specialty health system.

BACKGROUND: Intimate partner violence (IPV) is highly prevalent in the United States and impacts the physical and mental health and social well-being of those who experience it. Healthcare settings are important intervention points for IPV screening and referral, yet there is a wide range of implementation of IPV protocols in healthcare settings in the U.S., and the evidence of the usefulness of IPV screening is mixed. This process evaluation investigates the facilitators and barriers to implementing Coordinated Care for IPV Survivors through the M Health Community Network ("M Health Network"), an intervention that aimed to standardize IPV screening and referral in a multi-specialty clinic and surgery center (CSC). Two validated IPV screens were introduced and mandated to be done by rooming staff at least once every 3 months with all clinic patients regardless of gender; the Humiliation Afraid Rape Kick (HARK) for presence of IPV and the shortened Danger Assessment (DA-5) for lethality of IPV. Upon a positive screen, the patient was offered immediate informational resources and, if willing, was referred to a social worker for care coordination with a community organization. METHODS: Semi-structured, individual and group process interviews with clinic managers and clinic staff at 8 CSC clinics (N = 24) were undertaken at 3,12, and 27 months after intervention start. Semi-structured interviews were undertaken with the research team (N = 3) post-implementation. A Consolidated Framework for Implementation Research (CFIR) codebook was used to code data in two rounds. After each round, thick description was used to write detailed and contextual descriptions of each code. Facilitators and barriers to implementation were identified during the second round of thick description. RESULTS: Facilitators to implementation were clinic staff support, dedication, and flexibility and research team engagement. Barriers were lack of prioritization, loss of intervention champions, lack of knowledge about intervention protocol and resources, staff and patient discomfort discussing IPV, and operational issues with screen technology. CONCLUSIONS: The IPV protocol was implemented, but faced common barriers. CFIR is a complex, but comprehensive, tool to guide process evaluation for IPV screening and referral interventions in health systems in the U.S.

Students and brides: a qualitative analysis of the relationship between girls' education and early marriage in Ethiopia and India.

BACKGROUND: Early marriage (< 18 years) is associated with education cessation among girls. Little research has qualitatively assessed how girls build resiliency in affected contexts. This study examines these issues in Oromia, Ethiopia and Jharkhand, India among girls and their decision-makers exposed to early marriage prevention programs. METHODS: Qualitative interviews were conducted with girls who received the intervention programs and subsequently either a) married prior to age 18 or b) cancelled/postponed their proposed early marriage. Girls also selected up to three marital decision-makers for inclusion in the study. Participants (N = 207) were asked about the value and enablers of, and barriers to, girls' education and the interplay of these themes with marriage, as part of a larger in-depth interview on early marriage. Interviews were transcribed, coded, and analyzed using latent content analysis. RESULTS: Participants recognized the benefits of girls' education, including increased self-efficacy and life skills for girls and opportunity for economic development. A girl's capacity and desire for education, as well as her self-efficacy to demand it, were key psychological assets supporting school retention. Social support from parents and teachers was also important, as was social support from in-laws and husbands to continue school subsequent to marriage. Post-marriage education was nonetheless viewed as difficult, particularly subsequent to childbirth. Other noted barriers to girls' education included social norms against girls' education and for early marriage, financial barriers, and poor value of education. CONCLUSION: Social norms of early marriage, financial burden of school fees, and minimal opportunity for girls beyond marriage affect girls' education. Nonetheless, some girls manifest psychological resiliency in these settings and, with support from parents and teachers, are able to stay in school and delay marriage. Unfortunately, girls less academically inclined, and those who do marry early, are less supported by family and existing programs to remain in school; programmatic efforts should be expanded to include educational support for married and childbearing girls as well as options for women and girls beyond marriage.

Beyond the statistic: exploring the process of early marriage decision-making using qualitative findings from Ethiopia and India.

BACKGROUND: Early marriage of girls (marriage < 18 years) is a pervasive abuse of rights that compromises maternal and child health. The common conceptualization of this practice as an outcome undermines the nuanced and sometimes protracted decision-making process of whom and when to marry. METHODS: This paper uses qualitative data from semi-structured interviews with females aged 13-23 years who participated in child marriage prevention programs and either married early or cancelled/postponed early marriage, and their key marital decision-makers in Oromia, Ethiopia (n = 105) and Jharkhand, India (n = 100). RESULTS: Social norms and the loss of a parent were stressors sustaining early marriage across contexts. Participants described three stages of early marriage: initiation, negotiation and final decision-making. Girls were infrequently involved in the initiation of early marriage proposals, though their decision-making autonomy was greater in groom-initiated proposals. The negotiation phase was most open to extra-familial influences such as early marriage prevention program staff and teachers. Across settings, fathers were the most important final decision-makers. CONCLUSIONS: The breadth and number of individual and social influences involved in marital decision-making in these settings means that effective early marriage prevention efforts must involve girls, families and communities. While underlying norms need to be addressed, programs should also engage and enable the choice, voice and agency of girls. Empowerment was important in this sample, but generally required additional social resources and support to have impact. Girls with greater social vulnerability, such as those without a male caretaker, had more compromised voice, choice and agency with regards to early marriage. Understanding early marriage decision-making as a process, rather than an endpoint, will better equip programs and policies that aim to eliminate early marriage to address the underlying norms that perpetuate this practice, and is an important lens through which to support the health and human rights of women and girls globally.

Making the middle classes on shifting ground? Residential status, performativity and middle-class subjectivities in contemporary London.

This paper argues that shifts in access to housing - both in relation to rental and ownership - disrupt middle-class reproduction in ways that fundamentally influence class formation. While property ownership has had a long association with middle-class identities, status and distinction, an increasingly competitive rental market alongside inflated property prices has impacted on expectations and anxieties over housing futures. In this paper, we consider two key questions: (1) What happens to middle-class identities under the conditions of this wider structural change? (2) How do the middle classes variously manoeuvre within this? Drawing on empirical research conducted in London, we demonstrate that becoming an owner-occupier may be fractured along lines of class but also along the axes of age, wealth and timing, particularly as this relates to the housing market. It builds on understandings of residential status and place as central to the formation of class, orienting this around the recognition of both people and place as mutable, emphasizing that changing economic and social processes generate new class positionalities and strategies for class reproduction. We argue that these processes are writ large in practices of belonging and claims to place, with wider repercussions within the urban landscape.

Use of a seagrass residency index to apportion commercial fishery landing values and recreation fisheries expenditure to seagrass habitat service.

Where they dominate coastlines, seagrass beds are thought to have a fundamental role in maintaining populations of exploited species. Thus, Mediterranean seagrass beds are afforded protection, yet no attempt to determine the contribution of these areas to both commercial fisheries landings and recreational fisheries expenditure has been made. There is evidence that seagrass extent continues to decline, but there is little understanding of the potential impacts of this decline. We used a seagrass residency index, that was trait and evidence based, to estimate the proportion of Mediterranean commercial fishery landings values and recreation fisheries total expenditure that can be attributed to seagrass during different life stages. The index was calculated as a weighted sum of the averages of the estimated residence time in seagrass (compared with other habitats) at each life stage of the fishery species found in seagrass. Seagrass-associated species were estimated to contribute 30%-40% to the value of commercial fisheries landings and approximately 29% to recreational fisheries expenditure. These species predominantly rely on seagrass to survive juvenile stages. Seagrass beds had an estimated direct annual contribution during residency of €58-91 million (4% of commercial landing values) and €112 million (6% of recreation expenditure) to commercial and recreational fisheries, respectively, despite covering <2% of the area. These results suggest there is a clear cost of seagrass degradation associated with ineffective management of seagrass beds and that policy to manage both fisheries and seagrass beds should take into account the socioeconomic implications of seagrass loss to recreational and commercial fisheries.

Learning the lessons from banding appeals: evidence based guidance for running junior doctor rotas.

PURPOSE: Designing and running robust junior doctor rotas is a challenging task and much previous advice has been based on consensus or anecdote. This paper aims to discern the most frequently occurring problems with trainee working patterns and produce evidence-based guidance for implementing and running contract-compliant rotas. DESIGN/METHODOLOGY/APPROACH: A total of 35 secondary care trusts in North West England were invited to supply information on pay banding appeals requested under the New Deal junior doctor contract. Of these, 15 (43 per cent) participated with data from 35 appeals between 2004 and 2012. A thematic analysis was undertaken to discern the commonly occurring causes of contractual breaches. FINDINGS: A total of 83 per cent (n = 29/35) of appeals were based on data showing the rota to be non-compliant with the contract (band 3), with the remainder being compliant with the contract but not in keeping with the pay banding currently assigned. Inability to take adequate natural breaks was the most frequently cited cause of rota non-compliance. Where underlying reasons were given for breaches of hours/rest limits they clustered around 20 themes, the top four being poor or absent dialogue between HR and doctors, excessive workload, inappropriately timed ward rounds, and inadequate or non-existent bleep policies. ORIGINALITY/VALUE: This is the first analysis of banding appeals under the UK junior doctor contract. The findings show that problems with rotas cluster around specific themes. The authors provide recommendations to target these so as to avoid financially detrimental contract breaches and trainee dissatisfaction.

Conceptualizing transgender experiences in psychology: Do we have a 'true' gender?

Psychological research has acknowledged that the commonly accepted definitions of 'transgender', 'sex' and 'gender' within psychological research have resulted in limitations in accounting for the lived realities of transgender individuals. Such limitations include, but are not limited to, the continued pathologization of transgender experiences through idealizing sex and gender congruence and incapacity to account for non-normative and non-binary transition pathways. This paper provides a review of these limitations to first demonstrate how the incongruence definition of 'transgender' is reliant on the idea of a 'true' gender, and next suggest that problematising the idea of a 'true' gender allows new conceptions of transgender experiences to be advanced. To undertake this problematization, the work of Judith Butler and Sara Ahmed is used to consider how gender could be conceptualized otherwise in psychology and then applied to transgender experiences. In all, this paper theorizes transgender experiences without a reliance on the assertion of a true gender, to suggest instead a focus on contextualized transgender experiences. Last, the limitations and implications of this definition of transgender are briefly discussed. Overall, transgender experiences are conceptualized as those experiences that run counter to the dominant (re)production of binary sexed gender.

Direct prostacyclin transition in pediatric patients with pulmonary hypertension.

Pediatric patients with pulmonary arterial hypertension (PAH) are commonly treated with the prostacyclin analog treprostinil in IV, SQ, inhaled or oral form, or the prostacyclin receptor agonist selexipag. Patients who transition between these medications often follow recommendations for gradual up- and down-titrations that take place over several days in the hospital or several weeks as an outpatient. However, hospital resources are limited, and long transitions are inconvenient for patients and families. We report a case series of eight pediatric patients with PAH transitioned directly between prostacyclins with no overlapping doses. Direct medication transitions occurred in the cardiac intensive care unit (CICU), at home and in cardiology clinic. Equivalent doses for selexipag were estimated using information extrapolated from experience, published materials and selexipag study guidelines. All patients completed direct transition as planned and remained on transition dose for at least 1 week. In most cases selexipag was up-titrated at home after establishing initial transition dose. In select patients, direct prostacyclin transition in pediatric patients with PAH is safe, effective, convenient for families and reduces the use of hospital resources.

A review of the factors influencing spawning, early life stage survival and recruitment variability in the common cuttlefish (Sepia officinalis).

Global landings of cephalopods (cuttlefish, squid and octopus) have increased dramatically over the past 50 years and now constitute almost 5% of the total world's fisheries production. At a time when landings of many traditional fin-fish stocks are continuing to experience a global decline as a result of over-exploitation, it is expected that fishing pressure on cephalopod stocks will continue to rise as the fishing industry switch their focus onto these non-quota species. However, long-term trends indicate that landings may have begun to plateau or even decrease. In European waters, cuttlefish are among the most important commercial cephalopod resource and are currently the highest yielding cephalopod group harvested in the north-east Atlantic, with the English Channel supporting the main fishery for this species. Recruitment variability in this short-lived species drives large fluctuations in landings. In order to provide sustainable management for Sepia officinalis populations, it is essential that we first have a thorough understanding of the ecology and life history of this species, in particular, the factors affecting spawning, early life stage (ELS) survival and recruitment variability. This review explores how and why such variability exists, starting with the impact of maternal effects (e.g. navigation, migration and egg laying), moving onto the direct impact of environmental variation on embryonic and ELSs and culminating on the impacts that these variations (maternal and environmental) have at a population level on annual recruitment success. Understanding these factors is critical to the effective management of expanding fisheries for this species.

Comparison of goals set by people with multiple sclerosis during two fatigue management interventions.

BACKGROUND: Identifying the meaningful goals of people with multiple sclerosis (PwMS) can facilitate tailored treatment plans. OBJECTIVES: To describe and compare the goals set by PwMS during two interventions, and explore the strategies used to meet their goals, the barriers and facilitators influencing goal achievement. METHODS: Data from 56 community-dwelling PwMS were used in this secondary analysis: 45 used an interactive fatigue self-management website (MS INFoRm), and 11 received MS INFoRm coupled with occupational performance coaching (OPC) for 3 months. The International Classification of Functioning, Disability and Health (ICF) was used to map and compare the goals, strategies, facilitators and obstacles to goal achievement between the groups. Goals were also evaluated for being Specific, Measurable, Attainable, Relevant and Timely (SMART). RESULTS: Most goals were related to 'looking after one's health' (n = 35) and 'recreation and leisure' (n = 17). Participants who received OPC set more SMART goals (75 vs. 24%, p < 0.01). Fatigue management strategies were identified. Personal and environmental factors were found as facilitators and obstacles to goal achievement. CONCLUSION AND SIGNIFICANCE: Coaching can help PwMS with goal setting, and to adapt strategies to achieve their goals. Increased awareness of goals set by PwMS may equip clinicians to better assess their clients' needs.

Simulated effects of tidal inundation and light reduction on Zostera muelleri flowering in seagrass nurseries.

Zostera muelleri is an abundant seagrass species distributed through intertidal and shallow subtidal waters on the subtropical coasts of Australia. The vertical distribution of Zostera is likely defined by tidal influences, particularly desiccation and light reduction stresses. These stresses were expected to affect the flowering of Z. muelleri; however, it is difficult to quantify the effects of tidal inundation with field studies due to multiple confounding environmental factors affecting flowering (e.g., water temperature, herbivory, nutrients). A laboratory aquarium experiment compared the effects of two levels of tidal height (intertidal and subtidal) and light intensity (shaded and unshaded) on flowering timing, abundance, the ratio between flowering shoots and vegetative shoots, the morphology and duration of flower development. The earliest and greatest flowering intensity was recorded in the subtidal-unshaded group, with no flowers observed in the intertidal-shaded group. Notably, the peak flowering time was the same across shaded and unshaded treatments. Shading prolonged the timing of the first flowering and reduced the density of flowering shoots and spathes, while tidal inundation had a more significant effect on the density of flowering shoots and the density of spathes. Results showed that Z. muelleri could flower under low light conditions or tidal stress but not when exposed to both stresses simultaneously in a laboratory 'nursery setting'. Therefore, applying subtidal-unshaded conditions appears to be beneficial for seagrass nurseries aimed at improved flower abundance despite the plants previously being collected from and adapted to intertidal meadows. Further studies that explore the suitable conditions for triggering and optimising the flowering will be beneficial in designing cost-effective seagrass nurseries.

A multidisciplinary approach to severe bronchopulmonary dysplasia is associated with resolution of pulmonary hypertension.

Objective: To describe our multidisciplinary bronchopulmonary dysplasia (BPD) consult team's systematic approach to BPD associated pulmonary hypertension (PH), to report our center outcomes, and to evaluate clinical associations with outcomes. Study design: Retrospective cohort of 60 patients with BPD-PH who were referred to the Seattle Children's Hospital BPD team from 2018 to 2020. Patients with critical congenital heart disease were excluded. Demographics, comorbidities, treatments, closure of hemodynamically relevant intracardiac shunts, and clinical outcomes including time to BPD-PH resolution were reviewed. Results: Median gestational age of the 60 patients was 25 weeks (IQR: 24-26). 20% were small for gestational age (SGA), 65% were male, and 25% received a tracheostomy. With aggressive cardiopulmonary management including respiratory support optimization, patent ductus arteriosus (PDA) and atrial septal defect (ASD) closure (40% PDA, 5% ASD, 3% both), and limited use of pulmonary vasodilators (8%), all infants demonstrated resolution of PH during the follow-up period, including three (5%) who later died from non-BPD-PH morbidities. Neither SGA status nor the timing of PH diagnosis (<36 vs. ≥36 weeks PMA) impacted the time to BPD-PH resolution in our cohort [median 72 days (IQR 30.5-166.5)]. Conclusion: Our multidisciplinary, systematic approach to BPD-PH management was associated with complete resolution of PH with lower mortality despite less sildenafil use than reported in comparable cohorts. Unique features of our approach included aggressive PDA and ASD device closure and rare initiation of sildenafil only after lack of BPD-PH improvement with respiratory support optimization and diagnostic confirmation by cardiac catheterization.

Effective Endotoxin Removal from Chitosan That Preserves Chemical Structure and Improves Compatibility with Immune Cells.

Chitosan is one of the most researched biopolymers for healthcare applications, however, being a naturally derived polymer, it is susceptible to endotoxin contamination, which elicits pro-inflammatory responses, skewing chitosan's performance and leading to inaccurate conclusions. It is therefore critical that endotoxins are quantified and removed for in vivo use. Here, heat and mild NaOH treatment are investigated as facile endotoxin removal methods from chitosan. Both treatments effectively removed endotoxin to below the FDA limit for medical devices (<0.5 EU/mL). However, in co-culture with peripheral blood mononuclear cells (PBMCs), only NaOH-treated chitosan prevented TNF-α production. While endotoxin removal is the principal task, the preservation of chitosan's structure is vital for the synthesis and lysozyme degradation of chitosan-based hydrogels. The chemical properties of NaOH-treated chitosan (by FTIR-ATR) were significantly similar to its native composition, whereas the heat-treated chitosan evidenced macroscopic chemical and physical changes associated with the Maillard reaction, deeming this treatment unsuitable for further applications. Degradation studies conducted with lysozyme demonstrated that the degradation rates of native and NaOH-treated chitosan-genipin hydrogels were similar. In vitro co-culture studies showed that NaOH hydrogels did not negatively affect the cell viability of monocyte-derived dendritic cells (moDCs), nor induce phenotypical maturation or pro-inflammatory cytokine release.

Association Between Early Prostacyclin Therapy and Extracorporeal Life Support Use in Patients With Congenital Diaphragmatic Hernia.

Importance: Prostacyclin (PGI2) is a therapeutic option to treat congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension in neonates. Its use may decrease the need for extracorporeal life support (ECLS). Objective: To evaluate the association of early PGI2 therapy with ECLS use and outcomes among patients with CDH. Design, Setting, and Participants: This was a cohort study from the CDH Study Group (CDHSG) registry of patients born from January 2007 to December 2019. Patients were from 88 different tertiary pediatric referral centers worldwide that contributed data to the CDHSG. Patients were included in the study if they were admitted within the first week of life. Propensity score matching was performed using estimated gestational age, birth weight, transfer status, 1-minute and 5-minute Apgar scores, highest and lowest partial pressure of arterial carbon dioxide in the first 24 hours of life, and degree of pulmonary hypertension as covariates to generate a matched cohort of exposed and unexposed patients. Data were analyzed from January 2021 to December 2022. Exposures: Early PGI2 therapy was defined as initiation of PGI2 within the first week of life. Patients who received ECLS were included in the early PGI2 group if PGI2 was started prior to ECLS. Main Outcomes and Measures: The primary outcome of the study was the proportion of patients receiving ECLS in the exposed and unexposed groups. Results: Of 6227 patients who met inclusion criteria (mean [SD] gestational age, 37.4 [2.36] weeks; 2618 [42%] female), 206 (3.3%) received early PGI2 therapy. ECLS was used in 46 of 206 patients who received PGI2 (22.2%) and 1682 of 6021 who did not (27.9%). After propensity score matching, there were 147 patients in the treatment and control groups. Thirty-four patients who received PGI2 (23.3%) and 63 who did not (42.9%) received ECLS. Those who received PGI2 were less likely to receive ECLS (adjusted odds ratio, 0.39; 95% CI, 0.22-0.68) and had shorter mean (SD) duration of ECLS (8.6 [3.73] days vs 12.6 [6.61] days; P < .001), although there was no significant difference in in-hospital mortality. Conclusions and Relevance: In this study, there was decreased use of ECLS and decreased ECLS duration among patients with CDH who started PGI2 therapy during the first week of life. These results identify a potential advantage of early prostacyclin therapy in this population.