Better survival after transcatheter aortic valve replacement by process improvements

ObjectiveThe aim of this study is to assess the effects on procedural, 30-day, and 1‑year all-cause mortality by a newly introduced quality improvement strategy in patients after transcatheter aortic valve replacement (TAVR).MethodsIn October 2015, a coherent set of quality improving interventions with respect to patient geriatric screening, general diagnostic examination and safety of the procedure was implemented at a single centre in the Netherlands. Patients undergoing TAVR in 2013–2018 were included for retrospective analysis. Mortality was assessed in the pre-quality improvement strategy cohort (January 2013 to October 2015; cohort A) and in the post-quality improvement strategy cohort (November 2015 to December 2018; cohort B). Logistic regression analysis was used to estimate the influence of patient and procedural characteristics on the results of the quality improvement strategy in terms of procedural, 30-day, and 1‑year all-cause mortality.ResultsIn total, 806 patients were analysed with 274 patients in cohort A and 532 patients in cohort B. After introduction of the quality improvement strategy, procedural (4.4% to 1.3%, p < 0.01), 30-day (8.4% to 2.7%, p < 0.01) and 1‑year (16.4% to 8.5%, p < 0.01) all-cause mortality significantly decreased. Multivariate regression analysis showed that the quality improvement strategy also significantly reduced 30-day (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.09–0.42) and 1‑year (OR 0.38, 95% CI 0.24–0.61) all-cause mortality if corrected for patient characteristics.ConclusionStructural meetings on evaluation of outcomes highlight potential areas for improvement and subsequent outcome-based quality improvement initiatives can result in lower procedural, 30-day, and 1‑year all-cause mortality.Electronic supplementary materialThe online version of this article (10.1007/s12471-020-01526-7) contains supplementary material, which is available to authorized users.     

Can indicator species predict restoration outcomes early in the monitoring process? a case study with peatlands

Success in ecological restoration is rarely assessed rigorously due to insufficient planning for post-restoration monitoring programs, limited funding and, especially, lack of scientifically validated evaluation criteria and protocols. In this article, we propose the use of the Indicator Value Index technique (IndVal), which statistically determines the association of species to one or several particular site types, to obtain indicators of success at the early stages of the recovery process in restoration projects. Peat bogs extracted by the vacuum method, subsequently restored by a moss-transfer technique and regularly monitored for ~10 years were used as a model system to test this approach. We first identified 34 restored sectors of ~10 ha from 4 to 11 years old in twelve eastern-Canadian bogs. These sectors were then classified according to their degree of success in recovering a typical sphagnum moss carpet (restoration goal). Then, we retrospectively reviewed vegetation communities recorded at the third year after restoration to identify indicator species of different categories of restoration success, using the IndVal methodology. By identifying early indicator species, our method provides a tool that guides intervention soon after restoration if a site is not on a desired successional trajectory. Typical bog species, namely the bryophytes S. rubellum and Mylia anomala and the tree Picea mariana, were indicative of successful restoration; while bare peat, lichens and one species of ericaceous shrubs (Empetrum nigrum), which cope better under drier conditions, indicated sites where restoration failed. A surprising finding was that the moss Polytrichum strictum, which is known to facilitate the colonization of sphagnum in disturbed peatlands, is an early indicator of unsuccessful restoration. This finding made us question the nursing role of P. strictum at a cover threshold above ca. 30%, when P. strictum could be outcompeting sphagnum and become dominant. We conclude that the IndVal method is an effective tool to identify early indicators of restoration success when combined with a thoughtful examination of species frequency and cover within each site type.     

Effects of smoking severity and moderate and severe periodontitis on serum C-reactive protein levels: an age- and gender-matched retrospective cohort study

Abstract

Background and purpose: C-reactive protein (CRP) which might affect cardiovascular events can be affected by chronic diseases and smoking. Since the effects of smoking dosage as well as the mutual effect of smoking and periodontitis on CRP levels have not been evaluated, we aimed to assess these.

Materials and methods: This retrospective age- and gender-matched study was performed on 120 dental patients. Clinical attachment loss, pocket probing depth (PPD), bleeding on probing (BoP), O’Leary plaque index and serum CRP were recorded. Patients were divided into one control and five cohort groups (n?=?20 each) according to smoking severity [pack years (PY) below or above 30] and periodontal condition (healthy periodontium and moderate/severe periodontitis). The effects of clinical measurements, age, gender, smoking and periodontitis on CRP were assessed using one- and two-way analyses of variance, Tukey and Bonferroni post hoc tests, and multiple linear regression (α?=?0.05).

Results: CRP concentrations were 0.07255?±?0.009539, 0.09645?±?0.010625, 0.122235?±?0.018442, 0.3758?±?0.187369, 0.81595?±?0.0410299 and 1.8717?±?0.652728?mg/l, respectively, in the control (PY?≤?30 with healthy periodontium), cohort 1 (PY?>?30 with healthy periodontium), cohort 2 (PY?≤?30 with moderate periodontitis), cohort 3 (PY?>?30 with moderate periodontitis), cohort 4 (PY?≤?30 with severe periodontitis) and cohort 5 (PY?>?30 with severe periodontitis). The positive effects of age, smoking severity, periodontitis and PPD, on CRP increase were significant (Regression p?<?0.02). BoP had a negative effect (p?=?0.015).

Conclusions: Clinicians should warn the patients, especially the older ones, about the effects of their gingival health and smoking on their cardiovascular condition.     

Nutrigenomics-based personalised nutritional advice: in search of a business model?

Nutritional advice has mainly focused on population-level recommendations. Recent developments in nutrition, communication, and marketing sciences have enabled potential deviations from this dominant business model in the direction of personalisation of nutrition advice. Such personalisation efforts can take on many forms, but these have in common that they can only be effective if they are supported by a viable business model. The present paper takes an inventory of approaches to personalised nutrition currently available in the market place as its starting point to arrive at an identification of their underlying business models. This analysis is presented as a unifying framework against which the potential of nutrigenomics-based personalised advice can be assessed. It has uncovered nine archetypical approaches to personalised nutrition advice in terms of their dominant underlying business models. Differentiating features among such business models are the type of information that is used as a basis for personalisation, the definition of the target group, the communication channels that are being adopted, and the partnerships that are built as a part of the business model. Future research should explore the consumer responses to the diversity of “archetypical” business models for personalised nutrition advice as a source of market information on which the delivery of nutrigenomics-based personalised nutrition advice may further build.     

雄性核不育水稻育性转换的光周期效应指数值(PE)和温度效应指数值(TE)的遗传性初步研究

对比考察了农垦５８ｓ与７００１ｓ、８９０２ｓ与培矮６４ｓ及８９０２ｓ与安农Ｓ１等３个光（温）敏核不育水稻杂交组合的双亲、Ｆ１、Ｂ１、Ｂ２和Ｆ２世代的样本及每一个体的ＰＥ和ＴＥ的变异。无论双亲核不育基因的等位程度及栽培环境的光、温周期如何,在多数情况下都显示了如下的规律：（１）后代样本ＰＥ、ＴＥ的大小虽然形形色色,但都取决于其双亲。Ｆ１表示完全显性甚至超显性。（２）Ｆ２个体的ＰＥ或ＴＥ、尤其同一个体ＰＥ与ＴＥ的集成类型发生有规律的分离和超亲分离,产生形形色色的育性转换类型。在纯粹由雄性不育个体组成的Ｆ２不育分样本中也发生同样分离。（３）ＰＥ或ＴＥ的广义遗传力的估值都大于５０％。据此推断ＰＥ、ＴＥ是两个可遗传并可供选择的独立性状;并对育性转换现象的遗传机制也进行了讨论。     

极化与固化:转基因“科普”的困境分析与路径选择

从中国转基因科普的实践入手,结合国内外经验研究,从传播学、心理学和社会学的维度,辨析了当前转基因科普面临的困境,梳理了公众转基因态度极化和固化的原因。科学知识与转基因接受度的相关度弱,信任、价值和科学体制等诸多因素影响着大众对转基因的态度。据此,提出了中国转基因科学传播的五点可能路径。     

MEWS系统在指导院前急性脑血管意外急救的临床应用

目的 探讨应用改良早期预警（MEWS）评分指导急性脑血管意外院前急救的临床价值.方法 将院前急救中临床诊断为急性脑血管意外的患者分为常规病情评估急救组（对照组）和进行现场MEWS评分指导急救组（实验组）,并比较两组患者的病死率及好转出院率.结果 对照组病死率为17.23%,好转出院率为82.77%;实验组病死率为8.76%,好转出院率为91.24%.两组比较,差异有统计学意义（P＜0.05）.结论 急性脑血管意外患者院前应用MEWS评分进行病情评估和指导急救,能降低患者的病死率及提高好转出院率,具有较好的应用价值,值得在院前脑血管意外急救中推广应用.     

The value of harmful algal bloom predictions to the nearshore commercial shellfish fishery in the Gulf of Maine

In this study, we develop a framework for measuring the value of harmful algal bloom (HAB) predictions. The framework captures the effects of both private and public responses to HABs. Using data from the New England nearshore commercial shellfish fishery and impact estimates for a large-scale HAB event in 2005, we illustrate how the potential value of HAB forecasts may be estimated. The results of our study suggest that the long-term value of a HAB prediction and tracking system for the Gulf of Maine is sensitive to the frequency of HAB events, the accuracy of predictions, the choice of HAB impact measures, and the effectiveness of public and private responses.     

山西珍稀野生花卉种质资源与利用

本文论述了山西珍稀野生花卉种质资源的种类、观赏特性和应用前景,并进一步分析了其生态特点和开发利用途径,为今后山西珍稀野生花卉的研究和开发利用提参考.     

Impact of landscape patterns on ecological vulnerability and ecosystem service values: An empirical analysis of Yancheng Nature Reserve in China

In this study, an ecological vulnerability assessment indicator system was constructed using the “exposure–climate sensitivity–adaptive capacity” framework according to the theory of ecological vulnerability. An improved ecosystem service value calculation model was proposed based on empirical parameters. Using Yancheng Nature Reserve in China as an example, we employed remote sensing data to conduct an empirical analysis of the changes in the spatiotemporal pattern, ecological vulnerability, and ecosystem services of typical landscape types over the period from 1987 to 2013. The statistical results derived from landscape pattern indices (LPIs) showed that during the investigation period, three natural wetland landscape types (i.e., Spartina alterniflora, Suaeda glauca, and Phragmites australis) showed gradually increased fragmentation in the study area. The ecological vulnerability scores of the major landscape types (in descending order) were P. australis (0.053), farmland (0.047), S. alterniflora (0.042), S. glauca (0.031), and bare mud flat (0.002). The results derived from the ecosystem service value fluctuation index (ESVFI) showed that from 1987 to 1997, the value of the ecosystem services provided by S. glauca and P. australis wetlands decreased, whereas that of S. alterniflora wetlands increased continuously. From 2002 to 2013, the value of the ecosystem services provided by all three types of natural wetland showed a downward trend. In conclusion, the combined effects of human and natural factors, including the expansion of farmland and the invasion of S. alterniflora, and changes in seawater erosion and deposition led to changes in the landscape patterns, ecological vulnerability, and ecosystem services of the Yancheng Nature Reserve during the investigation period. The results indicate that a “dual adaptive” management system based on natural succession and supplemented by appropriate manual intervention should be implemented, and the management efficiency and flexibility should be improved to meet the common needs of biodiversity conservation and economic development.