Species-specific traits affect bird species' susceptibility to global change.

The current ecological crisis has risen extinction rates to similar levels of ancient mass extinctions. However, it seems to not be acting uniformly across all species but affecting species differentially. This suggests that species' susceptibility to the extinction process is mediated by specific traits. Since understanding this response mechanism at large scales will benefit conservation effort around the world, we used the IUCN global threat status and population trends of 8281 extant bird species as proxies of the extinction risk to identify the species-specific traits affecting their susceptibility to extinction within the biogeographic regions and at the global scale. Using linear mixed effect models and multinomial models, we related the global threat status and the population trends with the following traits: migratory strategy, habitat and diet specialization, body size, and generation length. According to our results and independently of the proxy used, more vulnerable species are sedentary and have larger body size, longer generation time, and higher degree of habitat specialization. These relationships apply globally and show little variation across biogeographic regions. We suggest that such concordant patterns might be caused either by a widespread occurrence of the same threats such as habitat modification or by a uniform capacity of some traits to reflect the impact of different local threats. Regardless of the cause of this pattern, our study identified the traits that affect species' response capability to the current ecological crisis. Conservation effort should focus on the species with trait values indicating the limited response capacity to overcome this crisis.

Prescription medications with actionable pharmacogenomic recommendations in Veterans Health Administration patients.

Aim: To evaluate the prevalence of medications with actionable pharmacogenomic (PGx) safety and efficacy recommendations in patients receiving care from the Veterans Health Administration. Materials & methods: Outpatient prescription data from 2011 to 2021 and any documented adverse drug reactions (ADRs) were reviewed for those who received PGx testing at one Veterans Administration location between November 2019 and October 2021. Results: Among the reviewed prescriptions, 381 (32.8%) were associated with an actionable recommendation based on the Clinical Pharmacogenetics Implementation Consortium (CPIC) prescribing guidelines, with 205 (17.7%) for efficacy concerns and 176 (15.2%) for safety concerns. Among those with a documented ADR for a PGx-impacted medication, 39.1% had PGx results that aligned with CPIC recommendations. Conclusion: Medications with actionable PGx recommendations for safety and efficacy concerns are received with similar frequency, and most patients who have undergone PGx testing at the Phoenix Veterans Administration have received medications that may be impacted by PGx testing.

Initiation of Continuous Glucose Monitoring Is Linked to Improved Glycemic Control and Fewer Clinical Events in Type 1 and Type 2 Diabetes in the Veterans Health Administration.

OBJECTIVE: To determine the benefit of starting continuous glucose monitoring (CGM) in adult-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) with regard to longer-term glucose control and serious clinical events. RESEARCH DESIGN AND METHODS: A retrospective observational cohort study within the Veterans Affairs Health Care System was used to compare glucose control and hypoglycemia- or hyperglycemia-related admission to an emergency room or hospital and all-cause hospitalization between propensity score overlap weighted initiators of CGM and nonusers over 12 months. RESULTS: CGM users receiving insulin (n = 5,015 with T1D and n = 15,706 with T2D) and similar numbers of nonusers were identified from 1 January 2015 to 31 December 2020. Declines in HbA1c were significantly greater in CGM users with T1D (-0.26%; 95% CI -0.33, -0.19%) and T2D (-0.35%; 95% CI -0.40, -0.31%) than in nonusers at 12 months. Percentages of patients achieving HbA1c <8 and <9% after 12 months were greater in CGM users. In T1D, CGM initiation was associated with significantly reduced risk of hypoglycemia (hazard ratio [HR] 0.69; 95% CI 0.48, 0.98) and all-cause hospitalization (HR 0.75; 95% CI 0.63, 0.90). In patients with T2D, there was a reduction in risk of hyperglycemia in CGM users (HR 0.87; 95% CI 0.77, 0.99) and all-cause hospitalization (HR 0.89; 95% CI 0.83, 0.97). Several subgroups (based on baseline age, HbA1c, hypoglycemic risk, or follow-up CGM use) had even greater responses. CONCLUSIONS: In a large national cohort, initiation of CGM was associated with sustained improvement in HbA1c in patients with later-onset T1D and patients with T2D using insulin. This was accompanied by a clear pattern of reduced risk of admission to an emergency room or hospital for hypoglycemia or hyperglycemia and of all-cause hospitalization.

Improving Administration and Documentation of Enteral Nutrition Support Therapy in a Veteran Affairs Health Care System: Use of Medication Administration Record and Bar Code Scanning Technology.

OBJECTIVES: The goal of this project was to evaluate and improve the ordering, administration, documentation, and monitoring of enteral nutrition therapies within the inpatient setting in a Veteran's Health Administration system. METHODS: An interdisciplinary team of clinicians reviewed the literature for best practices and revised the process for enteral nutrition support for hospitalized veterans. Interventions included training staff, revising workflows to include scanning patients and products, including enteral nutrition orders within the medication administration record (MAR), and using the existing bar code medication administration system for administration, documentation, and monitoring. Baseline and postprocess improvement outcomes over a year period were collected and analyzed for quality improvement opportunities. RESULTS: Before process change, only 60% (33/55) of reviewed enteral nutrition orders were documented and 40% (22/55) were not documented in the intake flowsheet of the electronic health record. In the year after adding enteral nutrition therapies to the MAR and using bar code scanning, a total of 3807 enteral nutrition products were evaluated. One hundred percent of patients were bar code scanned, 3106/3807 (82%) products were documented as given, 447/3807 (12%) were documented as held (with comments), 12/3807 (<1%) were documented as missing/unavailable, and 242/3807 (6%) were documented as refused. CONCLUSIONS: Inclusion of enteral nutrition order sets on the MAR and using bar code scanning technology resulted in sustained improvements in safety, administration, and documentation of enteral therapies for hospitalized veterans.

Traits and ecological space availability predict avian densities at the country scale of the Czech Republic.

Species' geographical distributions and abundances are a central focus of current ecological research. Although multiple studies have been conducted on their elucidation, some important information is still missing. One of them is the knowledge of ecological traits of species responsible for the population density variations across geographical (i.e., total physical area) and ecological spaces (i.e., suitable habitat area). This is crucial for understanding how ecological specialization shapes the geographical distribution of species, and provides key knowledge about the sensitivity of species to current environmental challenges. Here, we precisely describe habitat availability for individual species using fine-scale field data collected across the entire Czech Republic. In the next step, we used this information to test the relationships between bird traits and country-scale estimates of population densities assessed in both geographical and ecological spaces. We did not find any effect of habitat specialization on avian density in geographical space. But when we recalculated densities for ecological space available, we found a positive correlation with habitat specialization. Specialists occur at higher densities in suitable habitats. Moreover, birds with arboreal and hole-nesting strategies showed higher densities in both geographical and ecological spaces. However, we found no significant effects of morphological (body mass and structural body size) and reproductive (position along the slow-fast life-history continuum) traits on avian densities in either geographical or ecological space. Our findings suggest that ecological space availability is a strong determinant of avian abundance and highlight the importance of precise knowledge of species-specific habitat requirements. Revival of this classical but challenging ecological topic of habitat-specific densities is needed for both proper understanding of pure ecological issues and practical steps in the conservation of nature.

Evaluation of the Veterans Affairs Pharmacogenomic Testing for Veterans (PHASER) clinical program at initial test sites.

Aim: The first Plan-Do-Study-Act cycle for the Veterans Affairs Pharmacogenomic Testing for Veterans pharmacogenomic clinical testing program is described. Materials & methods: Surveys evaluating implementation resources and processes were distributed to implementation teams, providers, laboratory and health informatics staff. Survey responses were mapped to the Consolidated Framework for Implementation Research constructs to identify implementation barriers. The Expert Recommendation for Implementing Change strategies were used to address implementation barriers. Results: Survey response rate was 23-73% across personnel groups at six Veterans Affairs sites. Nine Consolidated Framework for Implementation Research constructs were most salient implementation barriers. Program revisions addressed these barriers using the Expert Recommendation for Implementing Change strategies related to three domains. Conclusion: Beyond providing free pharmacogenomic testing, additional implementation barriers need to be addressed for improved program uptake.

Veterans Affairs Pharmacogenomic Testing for Veterans (PHASER) clinical program.

In 2019, the Veterans Affairs (VA), the largest integrated US healthcare system, started the Pharmacogenomic Testing for Veterans (PHASER) clinical program that provides multi-gene pharmacogenomic (PGx) testing for up to 250,000 veterans at approximately 50 sites. PHASER is staggering program initiation at sites over a 5-year period from 2019 to 2023, as opposed to simultaneous initiation at all sites, to facilitate iterative program quality improvements through Plan-Do-Study-Act cycles. Current resources in the PGx field have not focused on multisite, remote implementation of panel-based PGx testing. In addition to bringing large scale PGx testing to veterans, the PHASER program is developing a roadmap to maximize uptake and optimize the use of PGx to improve drug response outcomes.

Longitudinally extensive transverse myelitis with AQP4 antibodies revealing ovarian teratoma.

Paraneoplastic myelitis is a rare inflammatory disorder most frequently associated with solid tumors or lymphoproliferative disorders. Patients often harbor onconeuronal antibodies and their prognosis is usually poor. Here we report a 42-year old woman with longitudinally extensive transverse myelitis and aquaporin-4 (AQP4) antibodies that led to the diagnosis of ovarian teratoma. After tumor removal and immune therapy (including corticosteroids, plasma exchange, intravenous immunoglobulins and rituximab) the patient progressively improved achieving complete recovery. Histological study of the teratoma demonstrated neural tissue containing AQP4 expressing cells and intense inflammatory infiltrates, providing evidence for a possible paraneoplastic link between both disorders.

Wunderlich syndrome as first manifestation of infective endocarditis.

Infective endocarditis (IE) presents with several signs and symptoms that are mainly heart-related and the result of bacteremia. We describe the case of a woman with severe renal hemorrhage due to a septic embolic cortical infarction, who was also receiving anticoagulation therapy because of cardiopathy, whose retroperitoneal hematoma was the first manifestation of IE.

Analgesia postoperatoria con buprenorfina en aplicación preanestésica / Postoperative analgesia with buprenorphine applied preoperatively

El presente estudio tiene por objeto evaluar el dolor postquirúrgico, por medio de la Escala Visual Análoga, utilizando la buprenorfina como analgésico durante el transanestésico. Se estudiaron 30 pacientes del sexo femenino, con edades entre 20 y 60 años, ASA I,II,III, para cirugía electiva y de urgencia, asignados al azar a uno de los dos grupos de 15 pacientes. En el grupo A la medicación preanestésica fue buprenorfina, mientras que el grupo B fue con placebo (Solución fisiológica al 0.9 por ciento). El mantenimiento de la anestesia y la medicación complementaria fue en ambos grupos con Halotano. Se observó que en el grupo A, la concentración Alveolar Mínima del halogenado disminuyó hasta un 50 por ciento, se obtuvo una gran estabilidad hemodinámica, tanto en el transanestésico, como en el postquirúrgico (primeras 6 hrs.), no provocando disminución en la saturación de oxígeno en los pacientes de este grupo, y se obtuvo analgesia satisfactoria (leve a moderada), por lo menos durante las primeras 6 horas. Se consluye que la buprenorfina ofrece además de una analgesia postoperatoria adecuada, una mejor estabilidad hemodinámica en el transoperatorio

Pseudoquistes multiples en pacientes hemofílicos: reporte de dos casos / Multiple pseudocysts in haemophilic patients: presentation of case

Se presentan dos casos de pacientes hemofílicos tipo A, que presentaron pseudoquistes múltiples, lo cuales fueron tratados quirúrgicamente con drenaje percutáneo del quiste y relleno con cola de fibrina. La importancia de ambos casos radica en la peculariedad de ser bilaterales y múltiples

Pautas de la cirugía del pie-espástico / Surgical ptocedures of the spactic foot

Se hace una evaluación de las indicaciones de la cirugía en el pie efecto de parálisis espástica. Se evaluaron 200 pies operados de los que fueron posible revisar 189 operaciones. Se exponen los resultados y se hacen recomendaciones sobre las pautas seguidas en el Hospital San Juan de Dios

Patología de tronco y miembros superiores en músicos profesionales / Pathology of trunk and upper limb in professional musician

Se presenta un estudio de la patología de Tronco y Miembros Superior en 41 músicos profesionales durante un período de 8 años. El hallazgo clínico más frecuente fue el dolor cervical con contractura de los músculos trapecios (34,1 por ciento), seguido de quistes sinoviales (gangliones) en el dorso de la muñeca (19.5 por ciento), Escoliosis toracolumbar postural menor de 25º(17 por ciento), Bursitis en el Hombro (14.6 por ciento), Tendinitis Bicipital (4.8 por ciento), y Epicondilitis en el codo (4.8 por ciento). En todos la sintomatología mejoró con tratamiento médico conservador, en algunas ocasiones infiltraarticulares con esteroides y con un programa de rehabitación progresiva que incluyó ejercicios postulares, cambios en la técnica y acondicionamiento físico

Uso de la placa ancha DCP en las fracturas del fémur / Use of the DC plate on fractures of the femur

Se presenta una serie de veinte pacientes con fracturas de la diálisis femoral tratados quirúrgicamente con colocación de la placa ancha DCP, implante diseñado por el grupo AO/ASIF para la fijación interna de este tipo de fracturas. Al utilizar este método hay que tomar en cuenta aspectos mecánicos y biológicos, así como seguir una técnica que amerita gran precisión. Se discuten las ventajas y desventajas de este método de fijación interna

El obenque en cirugía traumatológica / The obenque in osteo-articular lesivus surgery

Se realizó un estudio retrospectivo de 22 casos intervenidos en el Centro Médico de Caracas por lesiones osteo-articulares en las cuales se empleó la técnica del Obenque y Tirante. Dentro de estas lesiones se encontraban algunas para las cuales este método quirúrgico no fue concebido originalmente. Se analizaron los resultados en base a las complicaciones encontradas y el tiempo de inmovilización. Observamos que la complicación más frecuente fue la prominencia subcutánea de los alambres, la cual ocurrió en lugares anatómicos donde la cantidad de tejido subcutáneo es escasa. En cuanto al tiempo de inmovilización, fue similar o menor al observado con las técnicas tradicioanles. Con esto queda evidenciado la utilidad de la técnica de Pauwels en el tratamiento de lesiones para las que originalmente no fue concebida

Sobre un caso raro de tumor de clavícula / About of a rare case in clavide tumour

Se trata de una paciente pre-escolar, de 4 años de edad con diagnóstico anatomo-patológico de displasia fibrosa, en una localización no descrita hasta ahora, por lo menos en la literatura revisada, la cual fue tratada quirúrgicamente en 2 ocasiones, obteniéndose magníficos resultados con el sistema de encolado de fibrina y el factor XIII para acelerar los procesos de crecimiento celular y obtener una mayor y mejor cicatrización, en nuestro caso, una completa y total osificación