Investigating the Correlation Between LPR & Obesity

Objectives: To determine whether Drug-Induced Sleep Endoscopy (DISE) findings of Laryngopharyngeal Reflux (LPR) correlate with obesity, gender, Epworth Sleepiness scale, and OSA severity. Study design: Single center retrospective cohort study. Methods: Patients greater than 18 years of age who underwent DISE by one surgeon at a tertiary care center from July 2016 to July 2022 were included. DISE findings, patient characteristics, demographics, polysomnogram(s), and Epworth Sleepiness Scale(s) were extracted. Fisher’s exact test was used to compare categorical variables, and independent sample t-test was used to compare continuous variables. All statistical analyses were performed using IBM SPSS Statistics 28. Results: The study included 178 patients (60.87 years ± 11.54; 31.24 BMI ± 6.21). 38 patients had LPR, and 103 patients had a BMI\u3e30. LPR+ patients BMI was 33.11 ± 5.60, and LPR- patients BMI was 30.74 ± 6.28. There was a statistically significant relationship between obesity and LPR (p = 0.005). Additionally, obesity mild-moderately affected patients having LPR (d = .404). There was no statistically significant difference between LPR+ patients and ESS, AHI, and gender (p = .395, .174, & .302 respectively). Conclusion: DISE aids in the diagnosis and evaluation of Obstructive Sleep Apnea (OSA) by simulating natural sleep. Using this highly precise diagnostic procedure, our study shows a relationship between findings of LPR in obese patients with obesity playing a small-medium role. There was no difference between LPR and ESS, AHI, and gender

To burn or not to burn: Comparing reintroducing fire with cutting an encroaching conifer for conservation of an imperiled shrub‐steppe

Woody vegetation has increased on rangelands worldwide for the past 100– 200 years, often because of reduced fire frequency. However, there is a general aversion to reintroducing fire, and therefore, fire surrogates are often used in its place to reverse woody plant encroachment. Determining the conservation effectiveness of reintroducing fire compared with fire surrogates over different time scales is needed to improve conservation efforts. We evaluated the conservation effectiveness of reintroducing fire with a fire surrogate (cutting) applied over the last ~30 years to control juniper (Juniperus occidentalis Hook.) encroachment on 77 sagebrush‐steppe sites. Critical to conservation of this imperiled ecosystem is to limit juniper, not encourage exotic annual grasses, and promote sagebrush dominance of the overstory. Reintroducing fire was more effective than cutting at reducing juniper abundance and extending the period of time that juniper was not dominating the plant community. Sagebrush was reduced more with burning than cutting. Sagebrush, however, was predicted to be a substantial component of the overstory longer in burned than cut areas because of more effective juniper control. Variation in exotic annual grass cover was explained by environmental variables and perennial grass abundance, but not treatment, with annual grasses being problematic on hotter and drier sites with less perennial grass. This suggests that ecological memory varies along an environmental gradient. Reintroducing fire was more effective than cutting at conserving sagebrush‐steppe encroached by juniper over extended time frames; however, cutting was more effective for short‐term conservation. This suggests fire and fire surrogates both have critical roles in conservation of imperiled ecosystems

The Sage-Grouse Habitat Mortgage: Effective Conifer Management in Space and Time

AbstractManagement of conservation-reliant species can be complicated by the need to manage ecosystem processes that operate at extended temporal horizons. One such process is the role of fire in regulating abundance of expanding conifers that disrupt sage-grouse habitat in the northern Great Basin of the United States. Removing conifers by cutting has a beneficial effect on sage-grouse habitat. However, effects may last only a few decades because conifer seedlings are not controlled and the seed bank is fully stocked. Fire treatment may be preferred because conifer control lasts longer than for mechanical treatments. The amount of conservation needed to control conifers at large temporal and spatial scales can be quantified by multiplying land area by the time needed for conifer abundance to progress to critical thresholds (i.e., “conservation volume”). The contribution of different treatments in arresting conifer succession can be calculated by dividing conservation volume by the duration of treatment effect. We estimate that fire has approximately twice the treatment life of cutting at time horizons approaching 100 yr, but, has high up-front conservation costs due to temporary loss of sagebrush. Cutting has less up-front conservation costs because sagebrush is unaffected, but it is more expensive over longer management time horizons because of decreased durability. Managing conifers within sage-grouse habitat is difficult because of the necessity to maintain the majority of the landscape in sagebrush habitat and because the threshold for negative conifer effects occurs fairly early in the successional process. The time needed for recovery of sagebrush creates limits to fire use in managing sage-grouse habitat. Utilizing a combination of fire and cutting treatments is most financially and ecologically sustainable over long time horizons involved in managing conifer-prone sage-grouse habitat

Saving the sagebrush sea: An ecosystem conservation plan for big sagebrush plant communities

Vegetation change and anthropogenic development are altering ecosystems and decreasing biodiversity. Successful management of ecosystems threatened by multiple stressors requires development of ecosystem conservation plans rather than single species plans. We selected the big sagebrush (Artemisia tridentata Nutt.) ecosystem to demonstrate this approach. The area occupied by the sagebrush ecosystem is declining and becoming increasingly fragmented at an alarming rate because of conifer encroachment, exotic annual grass invasion, and anthropogenic development. This is causing rangewide declines and localized extirpations of sagebrush associated fauna and flora. To develop an ecosystem conservation plan, a synthesis of existing knowledge is needed to prioritize and direct management and research. Based on the synthesis, we concluded that efforts to restore higher elevation conifer-encroached, sagebrush communities were frequently successful, while restoration of exotic annual grass-invaded, lower elevation, sagebrush communities often failed. Overcoming exotic annual grass invasion is challenging and needs additional research to improve the probability of restoration and identify areas where success would be more probable. Management of fire regimes will be paramount to conserving sagebrush communities, as infrequent fires facilitate conifer encroachment and too frequent fires promote exotic annual grasses. Anthropogenic development needs to be mitigated and reduced to protect sagebrush communities and this probably includes more conservation easements and other incentives to landowners to not develop their properties. Threats to the sustainability of sagebrush ecosystem are daunting, but a coordinated ecosystem conservation plan that focuses on applying successful practices and research to overcome limitations to conservation is most likely to yield success

Restoring North America’s Sagebrush Steppe Ecosystem Using Seed Enhancement Technologies

Rangelands occupy over a third of global land area, and in many cases are in less than optimum condition as a result of past land use, catastrophic wildfire and other disturbance, invasive species, or climate change. Often the only means of restoring these lands involves seeding desirable species, yet there are few cost effective seeding technologies, especially for the more arid rangeland types. The inability to consistently establish desired plants from seed may indicate that the seeding technologies being used are not successful in addressing the primary sources of mortality in the progression from seed to established plant. Seed enhancement technologies allow for the physical manipulation and application of materials to the seed that can enhance germination, emergence, and/or early seedling growth. In this article we examine some of the major limiting factors impairing seedling establishment in North America’s native sagebrush steppe ecosystem, and demonstrate how seed enhancement technologies can be employed to overcome these restoration barriers. We discuss specific technologies for: (1) increasing soil water availability; (2) enhancing seedling emergence in crusting soil; (3) controlling the timing of seed germination; (4) improving plantability and emergence of small seeded species; (5) enhancing seed coverage of broadcasted seeds; and (6) improving selectivity of pre-emergent herbicide. Concepts and technologies in this paper for restoring the sagebrush steppe ecosystem may apply generally to semi-arid and arid rangelands around the globe

Of Grouse and Golden Eggs: Can Ecosystems Be Managed Within a Species-Based Regulatory Framework?

Declining greater sage-grouse populations are causing concern for the future of this species across the western United States. Major ecosystem issues, including exotic annual grass invasion and conifer encroachment, threaten vast acreages of sagebrush rangeland and are primary threats to sage-grouse. We discuss types of problems facing sage-grouse habitat and argue that complex ecosystem problems may be difficult to address under the Endangered Species Act as currently applied. Some problems, such as anthropogenic development, can be effectively regulated to produce a desired outcome. Other problems that are complex and involve disruption of ecosystem processes cannot be effectively regulated and require ongoing commitment to adaptive management. We believe that historical inertia of the regulatory paradigm is sufficient to skew management toward regulatory mechanisms, even though complex ecosystem problems impact large portions of the sage-grouse range. To overcome this situation, we suggest that the regulatory approach embodied in the Endangered Species Act be expanded to include promoting management trajectories needed to address complex ecosystem problems. This process should begin with state-and-transition models as the basis for a conceptual framework that outlines potential plant communities, their value as sage-grouse habitat, and their ecological status. Desired management trajectories are defined by maintenance of an ecologically resilient state that is of value as sage-grouse habitat, or movement from a less desired to a more desired state. Addressing complex ecosystem problems will involve shifting conservation roles. Under the regulatory approach, programmatic scales define regulatory policies, and local scales focus on implementing those policies. With complex ecosystem problems, programmatic scales empower local conservationists to make decisions necessary to adaptively manage problems. Putting ecosystem management on par with traditional regulatory actions honors obligations to provide regulatory protections while maintaining the capacity of the ecosystem to produce habitat and greatly expands the diversity of stakeholders willing to participate in sage-grouse conservation.Keywords: Sage-grouse, Endangered Species Act, State-and-transition, Sagebrus

Applying diagnosis and pharmacy-based risk models to predict pharmacy use in Aragon, Spain: The impact of a local calibration

<p>Abstract</p> <p>Background</p> <p>In the financing of a national health system, where pharmaceutical spending is one of the main cost containment targets, predicting pharmacy costs for individuals and populations is essential for budget planning and care management. Although most efforts have focused on risk adjustment applying diagnostic data, the reliability of this information source has been questioned in the primary care setting. We sought to assess the usefulness of incorporating pharmacy data into claims-based predictive models (PMs). Developed primarily for the U.S. health care setting, a secondary objective was to evaluate the benefit of a local calibration in order to adapt the PMs to the Spanish health care system.</p> <p>Methods</p> <p>The population was drawn from patients within the primary care setting of Aragon, Spain (n = 84,152). Diagnostic, medication and prior cost data were used to develop PMs based on the Johns Hopkins ACG methodology. Model performance was assessed through r-squared statistics and predictive ratios. The capacity to identify future high-cost patients was examined through c-statistic, sensitivity and specificity parameters.</p> <p>Results</p> <p>The PMs based on pharmacy data had a higher capacity to predict future pharmacy expenses and to identify potential high-cost patients than the models based on diagnostic data alone and a capacity almost as high as that of the combined diagnosis-pharmacy-based PM. PMs provided considerably better predictions when calibrated to Spanish data.</p> <p>Conclusion</p> <p>Understandably, pharmacy spending is more predictable using pharmacy-based risk markers compared with diagnosis-based risk markers. Pharmacy-based PMs can assist plan administrators and medical directors in planning the health budget and identifying high-cost-risk patients amenable to care management programs.</p

The development of a network for community-based obesity prevention: the CO-OPS Collaboration

Background: Community-based interventions are a promising approach and an important component of a comprehensive response to obesity. In this paper we describe the Collaboration of COmmunity-based Obesity Prevention Sites (CO-OPS Collaboration) in Australia as an example of a collaborative network to enhance the quality and quantity of obesity prevention action at the community level. The core aims of the CO-OPS Collaboration are to: identify and analyse the lessons learned from a range of community-based initiatives aimed at tackling obesity, and; to identify the elements that make community-based obesity prevention initiatives successful and share the knowledge gained with other communities.Methods: Key activities of the collaboration to date have included the development of a set of Best Practice Principles and knowledge translation and exchange activities to promote the application (or use) of evidence, evaluation and analysis in practice.Results: The establishment of the CO-OPS Collaboration is a significant step toward strengthening action in this area, by bringing together research, practice and policy expertise to promote best practice, high quality evaluation and knowledge translation and exchange. Future development of the network should include facilitation of furtherevidence generation and translation drawing from process, impact and outcome evaluation of existing communitybased interventions.Conclusions: The lessons presented in this paper may help other networks like CO-OPS as they emerge around the globe. It is important that networks integrate with each other and share the experience of creating these networks.<br /