The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services

This paper discusses mathematical models of expressing severity of injury and probability of survival following trauma and their use in establishing clinical governance of a trauma system. There are five sections: (i) Historical overview of scoring systems—anatomical, physiological and combined systems and the advantages and disadvantages of each. (ii) Definitions used in official statistics—definitions of ‘killed in action’ and other categories and the importance of casualty reporting rates and comparison across conflicts and nationalities. (iii) Current scoring systems and clinical governance—clinical governance of the trauma system in the Defence Medical Services (DMS) by using trauma scoring models to analyse injury and clinical patterns. (iv) Unexpected outcomes—unexpected outcomes focus clinical governance tools. Unexpected survivors signify good practice to be promulgated. Unexpected deaths pick up areas of weakness to be addressed. Seventy-five clinically validated unexpected survivors were identified over 2 years during contemporary combat operations. (v) Future developments—can the trauma scoring methods be improved? Trauma scoring systems use linear approaches and have significant weaknesses. Trauma and its treatment is a complex system. Nonlinear methods need to be investigated to determine whether these will produce a better approach to the analysis of the survival from major trauma.     

Observer variation in field assessments of vegetation condition: Implications for biodiversity conservation

Summary   Uncertainty in assessments of vegetation condition that are used to inform land management and planning decisions for biodiversity conservation in Australia may lead to unexpected outcomes, including loss of biodiversity. This study investigates observer error in field estimates of vegetation attributes, one component of uncertainty in assessments of vegetation condition. Ten observers conducted vegetation condition assessments using two assessment protocols (BioMetric and Habitat Hectares) on 20 sites in a grassy woodland community. Observers' estimates varied substantially across multiple scoring categories for all vegetation attributes on almost all sites. Across all sites, the average coefficient of variation in total vegetation condition scores was 15–18% for both protocols, with a maximum of 60%. The primary cause of variation in total vegetation condition scores was random error in raw estimates of vegetation attributes, although sensitivity of some highly weighted attributes to error exacerbated variation in some cases. Observers generally agreed on the total scores and ranks of highly degraded (pasture) sites, but were less consistent on other sites. Rank correlations between pairs of observers were stronger for Habitat Hectares, suggesting BioMetric may be slightly more sensitive to observer error. It is recommended that: (i) research is undertaken into methods for reducing observer error; (ii) review is made of the sensitivity of index scoring structures to observer error; (iii) field observers estimate uncertainty around point estimates of vegetation condition; and, (iv) decision-makers explicitly incorporate uncertainty into the decision-making processes and aim for outcomes that are robust to this uncertainty.     

Strong observer effect on tree microhabitats inventories: A case study in a French lowland forest

Validating biodiversity indicators requires an analysis of their applicability, their range of validity and their degree of correlation with the biodiversity they are supposed to represent. In this process, assessing the magnitude of observer effect is an essential step, especially if non-specialist observers are involved. Tree microhabitats – woodpecker cavities, cracks and bark characteristics – are reputed to be easily detected by non-specialists as microhabitat observation does not require prior forestry or ecology knowledge. We therefore quantified the probabilities of true and false positive detections made by observers during inventories.Within two 0.5 ha plots in a forest reserve that has not been harvested for at least 150 years, 14 observers with various backgrounds visually inventoried microhabitats on 106 oak (Quercus petraea and Quercus robur) and beech (Fagus sylvatica) trees. We used parametric and Bayesian statistics to compare these observers’ recorded observations with results from an independent census.The mean number of microhabitats per tree varied widely among observers – from 1.4 to over 3. Only five observers reported a mean number of microhabitats per tree that was statistically equivalent to the reference census. The probability of true detection also varied among observers for each microhabitat (from to 0 to 1) as did the probability of false positive detection (from 0 to 0.7). These results show that microhabitat inventories are particularly prone to observer effects.Such strong observer effects weaken the usefulness of microhabitats as biodiversity indicators. If microhabitat inventories are to be developed, we recommend controlling for observer effects by (i) defining standard operating procedures and multiplying the number of observer training sessions and of consensual standardization censuses; (ii) using pairs of observers to record microhabitats whenever possible (though the efficiency of this method remains to be tested); (iii) planning fieldwork so that the factors of interest are not confused with observer effects; and (iv) integrating observer profiles into the statistical models used to analyze the data.     

Detection Probabilities for Ground-Based Breeding Waterfowl Surveys

ABSTRACT Current methods for conducting ground-based surveys of breeding waterfowl pairs make the unlikely assumption that detection probabilities are constant and approach 100%. To test this assumption, we conducted independent double-observer pair surveys in North Dakota, USA, to evaluate sources of variation in detection probabilities for 8 common species of prairie-nesting ducks. An experienced observer had 0.911 detection probability averaged over all 8 species (range = 0.866-0.944) versus 0.790 (range = 0.537-0.890) for a novice observer. Detection probabilities also varied substantially among species, but patterns were not consistent between observers. Detection probabilities declined as number of ducks per wetland increased, presumably due to difficulty in identifying large numbers of flushing ducks. Other covariates affecting detection probabilities included size of social groups, precipitation, survey methodology (roadside vs. walk-up), cloud cover, time of day, and amount of wetland vegetation, but these covariates only affected detection probabilities by 2–5%. Our results demonstrated that the assumption of 100% detection probabilities for ground-based waterfowl counts was clearly false and surveys based on this erroneous assumption underestimated population size by 10–29%. We recommend that future investigators measure detection probabilities explicitly by using double-observer methodologies.     

Effectiveness of a regional trauma system in reducing mortality from major trauma: before and after study.

OBJECTIVE: To assess the effect of the development of an experimental trauma centre and regional trauma system on the survival of patients with major trauma. DESIGN: Controlled before and after study examining outcomes between 1990 and 1993, spanning the introduction of the system in 1991-2. SETTING: Trauma centre in North Staffordshire Royal Infirmary and five associated district general hospitals in the North West Midlands regional trauma system, and two control regions in Lancashire and Humberside. SUBJECTS: All trauma patients taken by the ambulance services serving the regions or arriving other than by ambulance with injury severity scores > 15, whether or not they had vital signs on arrival at hospital. MAIN OUTCOME MEASURES: Survival rates standardised for age, severity of injury, and revised trauma score. RESULTS: In 1990, 33% of major trauma patients in the experimental region were taken to the trauma centre, and by 1993 this had risen to only 39%. Crude death rates changed by the same amount in the control regions (46.5% in 1990-1 to 44.4% in 1992-3) as in the experimental region (44.8% to 41.3%). After standardisation, the estimated change in the probability of dying in the experimental region compared with the control regions was -0.8% per year (95% confidence interval -3.6% to 2.2%); for out of hours care, the change was 1.6% per year (-2.3% to 5.6%), and, for multiply injured patients, the change was -1.6% (-6.1% to 2.6%). CONCLUSION: Any reductions in mortality from regionalising major trauma care in shire areas of England would probably be modest compared with reports from the United States.     

CyberKnife MLC-based treatment planning for abdominal and pelvic SBRT: Analysis of multiple dosimetric parameters,overall scoring index and clinical scoring

PurposeThis study evaluated the plan quality of CyberKnife MLC-based treatment planning in comparison to the Iris collimator for abdominal and pelvic SBRT. Multiple dosimetric parameters were considered together with a global scoring index validated by clinical scoring.Methods and materialsIris and MLC plans were created for 28 liver, 15 pancreas and 13 prostate cases including a wide range of PTV sizes (24–643 cm³). Plans were compared in terms of coverage, conformity (nCI), dose gradient (R50%), homogeneity (HI), OAR doses, PTV gEUD, MU, treatment time both estimated by TPS (t_TPS) and measured. A global plan quality score index was calculated for IRIS and MLC solutions and validated by a clinical score given independently by two observers.ResultsCompared to Iris, MLC achieved equivalent coverage and conformity without compromising OAR sparing and improving R50% (p < 0.001). MLC gEUD was slightly lower than Iris (p < 0.05) for abdominal cases. MLC reduced significantly MU (−15%) and t_TPS (−22%). Time reduction was partially lost when measured. The global score index was significantly higher for MLC solutions which were selected in 73% and 64% of cases respectively by the first and second observer.ConclusionIris and MLC comparison was not straightforward when based on multiple dosimetric parameters. The use of a mathematical overall score index integrated with a clinical scoring was essential to confirm MLC plans advantages over Iris solutions.     

A Bayesian estimate of harbour seal survival using sparse photo-identification data

Survival rates have rarely been estimated for pinniped populations due to the constraints of obtaining unbiased sample data. In this paper, we present an approach for estimating survival probabilities from individual recognition data in the form of photographic documentation of pelage patterns. This method was applied to estimate adult (age 2+) survival for harbour seals in the Moray Firth, NE Scotland. An astronomical telescope was used to obtain digital images of individual seals, and high-quality images were used to document the annual presence or absence of individuals at a single haul-out site over a 4-year period. A total of 95 females, 10 males and 57 individuals of unknown sex were photographically documented during the study period. Survival and recapture probabilities were estimated using Jolly–Seber mark–recapture models in a Bayesian statistical framework. Computer-intensive Markov Chain Monte Carlo methods were used to estimate the probability distributions for the survival and recapture probabilities, conveying the full extent of the uncertainty resulting from unavoidably sparse observational data. The deviance information criterion was used to identify a best-fitting model that accounted for variation in the probability of capture between sexes, with constant survival. The model estimated adult survival as 0.98 (95% probability interval of 0.94–1.00) using our photo-identification data alone, and 0.97 (0.92–0.99) with the use of an informative prior distribution based on previously published estimates of harbour seal survival. This paper represents the first survival estimate for harbour seals in the UK, and the first survival estimate using photo-identification data in any species of pinniped.     

It counts who counts: an experimental evaluation of the importance of observer effects on spotlight count estimates

Spotlight surveys conducted by volunteers is a promising method to assess the abundance of nocturnally active mammals, but estimates are subject to bias if different observer groups differ in their ability to detect animals in the dark. We quantified the variation amongst volunteer spotlight observers with respect to their ability to detect and estimate distance to realistic animal silhouettes at different distances. Detection probabilities were higher for observers experienced in spotlighting mammals than for inexperienced observers, higher for observers with a hunting background compared with non-hunters and decreased as function of age but were independent of sex or educational background. If observer-specific detection probabilities were applied to real counting routes, point count estimates from inexperienced observers without a hunting background would only be 43 % (95 % CI, 39–48) of what inexperienced hunters with a hunting background would obtain and 29 % (25–33) of what experienced spotlight observers would detect. Mean estimated distances to objects did not deviate from true distances (no bias) but were highly imprecise. Female non-hunters estimated distances less precisely than other observers and precision increased with age. The study shows that observer effects may influence abundance estimates and underlines the importance of testing and accounting for observer effects when designing citizen science-based population survey programmes.     

Reducing accident death rates in children and young adults: the contribution of hospital care. Steering Committee of the Major Trauma Outcome Study Group.

OBJECTIVE: To assess the contribution of trauma care to the recent decline in accident death rates among children and young people. DESIGN: Logistic regression modelling of temporal trends in the probability of death in patients admitted to hospital for the treatment of severe injury. SETTING: Hospitals participating the United Kingdom major trauma outcome study. SUBJECTS: 3230 patients with an injury severity score of 16 or more, who were admitted for more than three days, transferred or admitted to intensive care, or died from their injuries. MAIN OUTCOME MEASURES: Death or survival in hospital within three months of injury. RESULTS: Over the seven year period 1989-95 there was a substantial decline in the probability of death among children and young adults admitted to hospital after severe injury. The overall estimate of the reduction in the odds of death was 16% per year (odds ratio for the yearly trend 0.84; 95% confidence interval 0.79 to 0.89). This decline did not differ significantly between age groups. (0-4 years 0.79; 5-14 years 0.87; 15-24 years 0.83). CONCLUSIONS: Reductions in hospital case fatality have made an important contribution to reaching the Health of the Nation targets. The contribution of hospital care in the reduction of accident mortality should be taken into account in decisions about the allocation of resources to preventive and curative services.     

ISS与APACHEⅡ评分对急诊多发伤患者伤情评估的价值分析

目的:探讨损伤严重程度计分法(Injuryseverityscore,ISS)和慢性健康评分(Acute physiology and chronic health evaluation scoreⅡ,APACHEⅡ)评分对急诊多发伤患者伤情评估的应用价值。方法:将我院自2016年6月至2019年6月急诊收治的多发伤患者85例作为研究对象,分别使用ISS和APACHEⅡ评分,追踪患者住院期间的伤情严重程度和预后情况。结果:急诊多发伤患者入院时ISS评分和APACHEⅡ评分越高,患者ICU收住率和死亡率越高,患者预后越差(P0.05);死亡的急诊多发伤患者ISS评分和APACHE-Ⅱ评分均明显高于存活组(P0.05)。ISS评分预测急诊多发伤患者死亡的灵敏度为87.06%,特异性为85.88%,APACHE-Ⅱ评分预测急诊多发伤患者死亡的灵敏度和特异性分别为88.24%和87.06%,差异无统计学意义(P0.05),两者联合预测急诊多发伤患者死亡的灵敏度为95.29%,特异性为94.12%,均优于单独预测(P0.05)。结论:ISS评分和APACHE-Ⅱ评分能够较为准确的评估急诊多发伤患者的病情严重程度,对患者预后具有较好的预测价值,两者结合使用的应用价值更高。     

Using soundscape recordings to estimate bird species abundance, richness, and composition

ABSTRACT Point counts are the most frequently used technique for sampling bird populations and communities, but have well‐known limitations such as inter‐ and intraobserver errors and limited availability of expert field observers. The use of acoustic recordings to survey birds offers solutions to these limitations. We designed a Soundscape Recording System (SRS) that combines a four‐channel, discrete microphone system with a quadraphonic playback system for surveying bird communities. We compared the effectiveness of SRS and point counts for estimating species abundance, richness, and composition of riparian breeding birds in California by comparing data collected simultaneously using both methods. We used the temporal‐removal method to estimate individual bird detection probabilities and species abundances using the program MARK. Akaike's Information Criterion provided strong evidence that detection probabilities differed between the two survey methods and among the 10 most common species. The probability of detecting birds was higher when listening to SRS recordings in the laboratory than during the field survey. Additionally, SRS data demonstrated a better fit to the temporal‐removal model assumptions and yielded more reliable estimates of detection probability and abundance than point‐count data. Our results demonstrate how the perceptual constraints of observers can affect temporal detection patterns during point counts and thus influence abundance estimates derived from time‐of‐detection approaches. We used a closed‐population capture–recapture approach to calculate jackknife estimates of species richness and average species detection probabilities for SRS and point counts using the program CAPTURE. SRS and point counts had similar species richness and detection probabilities. However, the methods differed in the composition of species detected based on Jaccard's similarity index. Most individuals (83%) detected during point counts vocalized at least once during the survey period and were available for detection using a purely acoustic technique, such as SRS. SRS provides an effective method for surveying bird communities, particularly when most species are detected by sound. SRS can eliminate or minimize observer biases, produce permanent records of surveys, and resolve problems associated with the limited availability of expert field observers.     

A sampling design and model for estimating abundance of Nile crocodiles while accounting for heterogeneity of detectability of multiple observers

As part of the development of a management program for Nile crocodiles in Lake Nasser, Egypt, we used a dependent double-observer sampling protocol with multiple observers to compute estimates of population size. To analyze the data, we developed a hierarchical model that allowed us to assess variation in detection probabilities among observers and survey dates, as well as account for variation in crocodile abundance among sites and habitats. We conducted surveys from July 2008–June 2009 in 15 areas of Lake Nasser that were representative of 3 main habitat categories. During these surveys, we sampled 1,086 km of lake shore wherein we detected 386 crocodiles. Analysis of the data revealed significant variability in both inter- and intra-observer detection probabilities. Our raw encounter rate was 0.355 crocodiles/km. When we accounted for observer effects and habitat, we estimated a surface population abundance of 2,581 (2,239–2,987, 95% credible intervals) crocodiles in Lake Nasser. Our results underscore the importance of well-trained, experienced monitoring personnel in order to decrease heterogeneity in intra-observer detection probability and to better detect changes in the population based on survey indices. This study will assist the Egyptian government establish a monitoring program as an integral part of future crocodile harvest activities in Lake Nasser. © 2012 The Wildlife Society.     

The Mouse Grimace Scale: A Clinically Useful Tool?

Medical research has a heavy and continuing demand for rodent models across a range of disciplines. Behavioural assessment of pain in such models is highly time consuming, thus limiting the number of models and analgesics that can be studied. Facial expressions are widely used to assess pain in human infants. Recently the mouse grimace scale (MGS) has been developed and shown to be accurate and reliable, requiring only a short amount of training for the observer. This system therefore has the potential to become a highly useful tool both in pain research and clinical assessment of mouse pain. To date, the MGS has only been used as a research tool, however there is increasing interest in its use in cage-side clinical assessment. It is often wrongly assumed that MGS scores of animals not in pain (i.e. at baseline) are zero. Here, we aimed to assess the variability in baseline MGS scores between cohorts, sexes and strains of mice. Establishing the presence of a consistent baseline MGS score could lead to a valuable clinical pain assessment tool for mice when baseline information from the individual mouse may not be available as a comparator. Results demonstrated a significant difference in baseline MGS scores between both sexes (males > females) and strains of mice. The method used to score the facial action units (Live vs. retrospectively from still images) demonstrated significant differences in scores with live scores being significantly lower than retrospective scoring from images. The level of variation shown demonstrates the need for further research to be undertaken with regard to establishing baseline MGS scores for specific strains and sexes of mice, taking into account the method of scoring, prior to considering clinical implementation of this method in pain assessment.     

North Atlantic climate variation influences survival in adult fulmars

There is increasing evidence that large scale climate variation influences reproductive parameters of seabirds, but fewer studies have investigated possible effects on adult survival. Previous work has shown that climate variation reflected by the winter North Atlantic oscillation (WNAO) influences reproductive success in northern fulmars. Here, we use a 34 year long (1962–1995) individual‐based data set to investigate inter‐annual and inter‐individual variation in adult survival in this species. Breeding success in the previous and current seasons, and both the WNAO and one‐year lagged WNAO indexes, were considered as potential sources of inter‐annual variation in survival and recapture probabilities. Sex and an index of body size were considered as potential sources of inter‐individual variation in survival and recapture probabilities. Body size effects were not significant, but males and females differed in both their survival and recapture probabilities. Probability of recapture of females was positively correlated with breeding success in both the current and previous breeding seasons, whereas male recapture probabilities were correlated only with previous breeding success. Male and female survival decreased over the study period, suggesting that there had been a degradation of environmental conditions. This hypothesis was supported by the detection of a negative correlation between survival and the WNAO, which, in turn, showed a positive increase over this period. The negative correlation between female adult survival and WNAO did not result only from the long term behaviour of the two time series, but persisted for higher frequency fluctuations. In contrast, the correlation between male survival and WNAO seemed to result only from the long term behaviour of the two time series. Despite uncertainties over causal mechanisms, these findings add to the body of evidence that large scale climate variation could dramatically affect seabird population dynamics. Furthermore our results suggest that climate variation can differentially influence individuals with distinct phenotypic characteristics.     

Reduction of postoperative adhesions by N,O-carboxymethylchitosan and spermine NONOate in rats.

BACKGROUND: Postsurgical adhesions can occur following virtually all types of surgery, resulting in serious clinical complications. Therefore, prevention of adhesions is an important goal of surgical practice. A rat uterine horn model was used to investigate the efficacy of N,O-carboxymethylchitosan (NOCC) and spermine NONOate (SPER/NO) alone and in combination in preventing adhesion formation. METHODS: Sixty Wistar albino rats underwent bilateral uterine horn injury with a unipolar cautery. Study groups were as follows: (i) control group, no adjuvant therapy; and those with adjuvant applied, (ii) normal saline group, 2 ml of normal saline was given; (iii) NOCC group, 2 ml of 2% NOCC gel was given; (iv) SPER/NO group, 2 ml of SPER/NO (0.5 mg/ml) was given, and (v) NOCC plus SPER/NO group, 2 ml of 2% NOCC gel including SPER/NO (0.5 mg/ml) was given. After 14 days, all animals were euthanatized, and a standard adhesion scoring system including extent and severity scores was applied by a blinded examiner. RESULTS: The extent score in NOCC plus SPER/NO group was significantly lower than those of control and normal saline groups (p < 0.05). The extent score in NOCC group was significantly lower than that of normal saline group (p < 0.05). The extent score in NOCC plus SPER/NO group was significantly lower than that of SPER/NO group (p < 0.05). The severity score was significantly lower in NOCC plus SPER/NO and NOCC groups than that of control group (p < 0.05). The severity score was significantly lower in NOCC plus SPER/NO group than that of SPER/NO group (p < 0.05). CONCLUSIONS: Postoperative administration of NOCC gel and SPER/NO alone and especially in combination to the site of peritoneal injury reduces the formation of adhesions in the rat uterine horn model.     

Interactive effects of senescence and natural disturbance on the annual survival probabilities of snail kites

Individuals in wild populations face risks associated with both intrinsic (i.e. aging) and external (i.e. environmental) sources of mortality. Condition‐dependent mortality occurs when there is an interaction between such factors; however, few studies have clearly demonstrated condition‐dependent mortality and some have even argued that condition‐dependent mortality does not occur in wild avian populations. Using large sample sizes (2084 individuals, 3746 re‐sights) of individual‐based longitudinal data collected over a 33 year period (1976–2008) on multiple cohorts, we used a capture–mark–recapture framework to model age‐dependent survival in the snail kite Rostrhamus sociabilis plumbeus population in Florida. Adding to the growing amount of evidence for actuarial senescence in wild populations, we found evidence of senescent declines in survival probabilities in adult kites. We also tested the hypothesis that older kites experienced condition‐dependent mortality during a range‐wide drought event (2000–2002). The results provide convincing evidence that the annual survival probability of senescent kites was disproportionately affected by the drought relative to the survival probability of prime‐aged adults. To our knowledge, this is the first evidence of condition‐dependent mortality to be demonstrated in a wild avian population, a finding which challenges recent conclusions drawn in the literature. Our study suggests that senescence and condition‐dependent mortality can affect the demography of wild avian populations. Accounting for these sources of variation may be particularly important to appropriately compute estimates of population growth rate, and probabilities of quasi‐extinctions.     

Long term survival after intensive care.

OBJECTIVE--To examine the long term survival of critically ill patients admitted to an intensive therapy unit and to ascertain the effects of age, severity of illness, and diagnostic category at admission on survival. DESIGN--Retrospective observational study with prospectively gathered data on all patients admitted to the unit between June 1985 and July 1987 and followed up until 1 January 1989. SETTING--Regional intensive therapy unit. PATIENTS--513 critically ill adult patients, 16 of whom were excluded because measurements on severity of illness scoring were not available. MAIN OUTCOME MEASURES--Age, severity of illness (determined with the acute physiology and chronic health evaluation (APACHE) II score), and diagnostic category on admission; deaths in the unit; and long term survival after discharge. Details of the survivors were sent to the Registrar General for Scotland, who issued copies of death certificates for the patients who had died between discharge and 1 January 1989. RESULTS--Of 497 patients, 119 (24%) died in the intensive therapy unit and 120 (24%) after discharge, leaving 258 (52%) who were still alive at two years. The median (APACHE II) score was 13 and about half of the patients were aged 55 years or more. A wide range of critical illnesses, except neurosurgical emergencies, were treated. Survival analysis showed that only 41 (34%) of 122 patients with an APACHE II score of greater than or equal to 20 were alive at one year (95% confidence interval 25 to 42) compared with 124 (80%) of 155 patients with a score of less than 10 (73 to 87). Of the 144 patients aged 65 or more, only 68 (47%) survived to one year (39 to 55) but 90 (83%) of the 109 patients aged between 18 and 34 survived a similar period (76 to 71). Mortality was also related to diagnostic category; 71% of trauma victims survived to one year compared with only 41% of those admitted with gastrointestinal pathology. Univariate analysis of the results showed that age, severity of illness, and diagnosis were all predictors of long term survival. Multivariate analysis, however, showed that only age and severity of illness were independent prognostic factors. CONCLUSIONS--Long term survival of patients treated in an intensive therapy unit is related to severity of illness and to age. The outcome from critical illness in the elderly population is poor.     

Capture–recapture models with heterogeneity to study survival senescence in the wild

Detecting senescence in wild populations and estimating its strength raise three challenges. First, in the presence of individual heterogeneity in survival probability, the proportion of high‐survival individuals increases with age. This increase can mask a senescence‐related decrease in survival probability when the probability is estimated at the population level. To accommodate individual heterogeneity we use a mixture model structure (discrete classes of individuals). Second, the study individuals can elude the observers in the field, and their detection rate can be heterogeneous. To account for detectability issues we use capture–mark–recapture (CMR) methodology, mixture models and data that provide information on individuals’ detectability. Last, emigration to non‐monitored sites can bias survival estimates, because it can occur at the end of the individuals’ histories and mimic earlier death. To model emigration we use Markovian transitions to and from an unobservable state. These different model structures are merged together using hidden Markov chain CMR models, or multievent models. Simulation studies illustrate that reliable evidence for survival senescence can be obtained using highly heterogeneous data from non site‐faithful individuals. We then design a tailored application for a dataset from a colony of black‐headed gull Chroicocephalus ridibundus. Survival probabilities do not appear individually variable, but evidence for survival senescence becomes significant only when accounting for other sources of heterogeneity. This result suggests that not accounting for heterogeneity leads to flawed inference and/or that emigration heterogeneity mimics survival heterogeneity and biases senescence estimates.     

Definition and Application of a Histopathological Scoring Scheme for an Animal Model of Acute Mycoplasma pneumoniae Pulmonary Infection

A histopathological scoring system was developed to assess the pathology of acute Mycoplasma pneumoniae pulmonary infection in a hamster model. A final score per animal (ranging 0–26) is obtained by averaging scores from each lung which have been accumulated by the addition of subscores from the assessments of quantity and quality of peribronchiolar and peribronchial infiltrates, luminal exudates, perivascular infiltrates, and parenchymal pneumonia. The scoring scheme was then applied to test the ability of a heat-killed inoculum to induce pulmonary pathology and to the trial of a 43 kDa protein-associated antigen as a vaccine immunogen. A heat-killed inoculum delivered by both intratracheal and intranasal routes did not induce pulmonary pathology compared to a live inoculum (respective mean scores 0.1, 6.7; P<0.01). Animals prevaccinated with the 43 kDa antigen developed an accentuated pathological response after live challenge compared to those unvaccinated (respective mean scores 16.8, 5.8; P=0.00007). Hypersensitization to growth medium components may, however, have contributed to the accentuated disease since the lungs of vaccinated animals challenged with culture-negative media also were affected (mean score 5.4). Reproducibility of the scoring system was measured by duplicate reading of histology slides which were randomized to the observer upon the second reading (r=0.93; P=0.000009). The scoring system has the ability to differentiate disease severity in small groups of animals.