Courageous Conversations: The Teaching and Learning of Pastoral Supervision

Reviewed by C. George Fitzgeral

Forced Expiratory Volume in One Second Predicts Length of Stay and In-Hospital Mortality in Patients Undergoing Cardiac Surgery: A Retrospective Cohort Study

Objective: An aging population and increasing use of percutaneous therapies have resulted in older patients with more co-morbidity being referred for cardiac surgery. Objective measurements of physiological reserve and severity of co-morbid disease are required to improve risk stratification. We hypothesised that FEV1 would predict mortality and length of stay following cardiac surgery. Methods: We assessed clinical outcomes in 2,241 consecutive patients undergoing coronary artery bypass grafting and/or valve surgery from 2001 to 2007 in a regional cardiac centre. Generalized linear models of the association between FEV1 and length of hospital stay and mortality were adjusted for age, sex, height, body mass index, socioeconomic status, smoking, cardiovascular risk factors, long-term use of bronchodilators or steroids for lung disease, and type and urgency of surgery. FEV1 was compared to an established risk prediction model, the EuroSCORE. Results: Spirometry was performed in 2,082 patients (93%) whose mean (SD) age was 67 (10) years. Median hospital stay was 3 days longer in patients in the lowest compared to the highest quintile for FEV1, 1.35-fold higher (95% CI 1.20–1.52; p<0.001). The adjusted odds ratio for mortality was increased 2.11-fold (95% CI 1.45–3.08; p<0.001) per standard deviation decrement in FEV1 (800 ml). FEV1 improved discrimination of the EuroSCORE for mortality. Similar associations were found after excluding people with known pulmonary disease and/or airflow limitation on spirometry. Conclusions: Reduced FEV1 strongly predicted increased length of stay and in-hospital mortality following cardiac surgery. FEV1 is a widely available measure of physiological health that may improve risk stratification of complex patients undergoing cardiac surgery and should be evaluated for inclusion in new prediction tools

State of the California Current 2011–2012: Ecosystems Respond To Local Forcing as La Nina Wavers and Wanes

The state of the California Current System (CCS) since spring 2011 has evolved in response to dissipation of La Niña through spring and summer, resurgence of cooler La Niña conditions in fall and winter, and finally a transition towards ENSO-neutral conditions in spring 2012. The resurgence of La Niña was uneven, however, as indicated by variable responses in broad climate indices such as the Pacific Decadal Oscillation and the multivariate ENSO index, and by latitudinal variability in the timing, strength, and duration of upwelling relative to climatological means. Across the CCS, various measures of ecosystem productivity exhibited a general decline in 2011 relative to 2010, but the magnitude of these declines varied substantially among taxa. Available observations indicate regional variability in climate forcing and ecosystem responses throughout the CCS, continuing a pattern that has emerged with increasing clarity over the past several years. In 2011–12, regional variability was again a consequence of southern regions exhibiting a relatively mild response to climate forcing, in this case tending towards climatological means, while northern regions showed somewhat greater effects of delayed or weaker-than-normal upwelling. In addition to the effects of local and basin-scale forcing, long-term observations off southern California show declines in dissolved oxygen and increases in nutrient concentrations in waters below the mixed layer, trends that are consistent with recent predictions of how global warming will affect the characteristics of upwelling source waters in the CCS. Such trends must be accounted for more comprehensively in ongoing assessment of the state of the California Current and its responses to environmental forcing. At the time of writing, tropical conditions are ENSO neutral and forecast to transition into El Niño in late 2012. This, combined with unusually high abundances of diverse gelatinous taxa throughout much of the CCS during spring 2012, suggests that the ongoing evolution of the state of the California Current might take a particularly unusual path in the coming year.This is the publisher’s final pdf. The article is copyrighted by the California Cooperative Oceanic Fisheries Investigations (CalCOFI) in partnership with the California Department of Fish & Wildlife, NOAA Fisheries Service and Scripps Institution of Oceanography. The article can be found at: http://calcofi.org/publications/ccreports.htm

Restoring fire-prone Inland Pacific landscapes: seven core principles

© 2015 The Author(s) Context: More than a century of forest and fire management of Inland Pacific landscapes has transformed their successional and disturbance dynamics. Regional connectivity of many terrestrial and aquatic habitats is fragmented, flows of some ecological and physical processes have been altered in space and time, and the frequency, size and intensity of many disturbances that configure these habitats have been altered. Current efforts to address these impacts yield a small footprint in comparison to wildfires and insect outbreaks. Moreover, many current projects emphasize thinning and fuels reduction within individual forest stands, while overlooking large-scale habitat connectivity and disturbance flow issues. Methods: We provide a framework for landscape restoration, offering seven principles. We discuss their implication for management, and illustrate their application with examples. Results: Historical forests were spatially heterogeneous at multiple scales. Heterogeneity was the result of variability and interactions among native ecological patterns and processes, including successional and disturbance processes regulated by climatic and topographic drivers. Native flora and fauna were adapted to these conditions, which conferred a measure of resilience to variability in climate and recurrent contagious disturbances. Conclusions: To restore key characteristics of this resilience to current landscapes, planning and management are needed at ecoregion, local landscape, successional patch, and tree neighborhood scales. Restoration that works effectively across ownerships and allocations will require active thinking about landscapes as socio-ecological systems that provide services to people within the finite capacities of ecosystems. We focus attention on landscape-level prescriptions as foundational to restoration planning and execution