Status of woodland caribou in western north America

A review of current population size and trends of woodland caribou (Rangifer tarandus caribou) in seven jurisdictions in western North America shows a wide range of situations. A total maximum population estimate of woodland caribou west of the Ontario/Manitoba border is 61 090. Of 44 herds or populations described in this review: 14 are stable; two are stable to slightly decreasing; four are decreasing; four are increasing; and 22 are of unknown status. Caribou are classified as a threatened species in Alberta and as an endangered species in Washington/Idaho. The decline of caribou in North America following settlement (Bergerud, 1974) has continued along the southern edge of woodland caribou distribution. Direct loss of habitat to logging, mines and dams continued throughout the I960s, 1970s and 1980s. The secondary effects of these habitat changes, (i.e. increased roads leading to increased hunting and poaching, and increased early succession habitat leading to increased alternate prey/predator densities) has led in some cases to the total loss or decreased size of local herds. Three ecotypes of woodland caribou are described and their relative distribution delineated. These ecotypes live under different environmental conditions and require different inventory and management approaches. Woodland caribou herds in northern B.C., Yukon and N.W.T. generally are of good numbers and viable (stable or increasing), and management primarily is directed at regulating human harvest and natural predation to prevent, herd declines. Land use activities such as logging or energy development are not extensive. Managers in southern caribou ranges stress the need for a better understanding of caribou population stability within mixed prey/predator regimes; how habitat changes (eg. through logging) affect these regimes; and how to develop effective land use guidelines for resource extraction that can sustian caribou populations and maintain resource industries. Caribou managers have suggested that herds may be priorized for research and management efforts. Unstable, remnant populations may be left to their own fate. The limited research dollars available and difficult management decisions should be applied to caribou herds that are apparently sustainable and provide the greatest potential for long-term viability

Successful and unsuccessful attempts to resolve caribou management and timber harvesting issues in west central Alberta

Research studies of woodland caribou in west central Alberta began in 1979 in response to proposed timber harvesting on their winter ranges. Using results from initial studies, timber harvest guidelines were developed. A recent review of these guidelines, and the assumptions on which they were based, has resulted in a renegotiation by government and industry of timber harvesting on caribou range in west central Alberta. Caribou range in west central Alberta overlaps many jurisdictional boundaries: federal and provincial lands, four Forest Management Agreement Areas, three Alberta Land and Forest Service Regions and two Alberta Fish and Wildlife Service Regions. This jurisdictional complexity in combination with other factors such as total allocation of the timber resources, high levels of petroleum, natural gas and coal extraction activities, a high level of concern by public groups for caribou conservation and recent understanding of woodland caribou needs for abundant space has made resolution of caribou/timber harvest conflicts exceedingly slow and often relatively unproductive. This paper reviews 10 years of trying to resolve conflicts between timber harvesting and caribou conservation through meetings, committees, integrated resource planning, policy papers and public consultation. We describe what might be learned by other jurisdictions that are trying to resolve similar caribou/timber harvesting issues. We conclude with an overview of recent timber harvest planning initiatives on caribou range in west central Alberta

The diet of woodland caribou populations in west-central Alberta

The diet of woodland caribou (Rangifer tarandus caribou) populations in the foothills and Rocky Mountains of west-central Alberta was estimated by microhistological analyses of feces collected in winter and summer. In winter, terrestrial lichens averaged 60-83% of fecal fragment densities in both areas. In the mountains, decreasing proportions of terrestrial lichens and increasing proportions of conifer needles and moss indicated decreasing accessibility of forage because of deeper/harder snow. Apparent diets in summer were dominated by Salix spp., sedges, and lichens. However, forb inflorescences and stems were largely undetected by the microhistological technique and results for summer samples must be interpreted accordingly. We conclude that the conservation and management of forest ecotypes of caribou must include options of lichen-rich habitats as a major component of management plans

Comparing neonatal morbidity and mortality estimates across specialty in periviable counseling

Objective To describe and compare estimates of neonatal morbidity and mortality communicated by neonatologists and obstetricians in simulated periviable counseling encounters. Methods A simulation-based study of 16 obstetricians (OBs) and 15 neonatologists counseling standardized patients portraying pregnant women with ruptured membranes at 23 weeks gestation. Two investigators tabulated all instances of numerically-described risk estimates across individuals and by specialty. Results Overall, 12/15 (80%) neonatologists utilized numeric estimates of survival; 6/16 (38%) OBs did. OBs frequently deferred the discussion of “exact numbers” to neonatologists. The twelve neonatologists provided 13 unique numeric estimates, ranging from 3% to 50% survival. Half of those neonatologists provided 2-3 different estimates in a single encounter. By comparison, six OBs provided 4 unique survival estimates (“50%”, “30-40%”, “1/3-1/2”, “<10%”). Only 2/15 (13%) neonatologists provided numeric estimates of survival without impairment. None of the neonatologists used the term ‘intact’ survival, while 5 OBs did. Three neonatologists gave numeric estimates of long-term disability and one OB did. Conclusion We found substantial variation in estimates and noteworthy omissions of discussions related to long-term morbidity. Across specialties, we noted inconsistencies in the use and meaning of terms like ‘intact survival.’ More tools and training are needed to improve the quality and consistency of periviable risk-communication

A Pilot Study of Neonatologists' Decision-Making Roles in Delivery Room Resuscitation Counseling for Periviable Births

BACKGROUND: Relatively little is known about neonatologists' roles in helping families navigate the difficult decision to attempt or withhold resuscitation for a neonate delivering at the threshold of viability. Therefore, we aimed to describe the "decision-making role" of neonatologists in simulated periviable counseling sessions. METHODS: We conducted a qualitative content analysis of audio-recorded simulation encounters and post-encounter debriefing interviews collected as part of a single-center simulation study of neonatologists' resuscitation counseling practices in the face of ruptured membranes at 23 weeks gestation. We trained standardized patients to request a recommendation if the physician presented multiple treatment options. We coded each encounter for communication behaviors, applying an adapted, previously developed coding scheme to classify physicians into four decision-making roles (informative, facilitative, collaborative, or directive). We also coded post-simulation debriefing interviews for responses to the open-ended prompt: "During this encounter, what did you feel was your role in the management decision-making process?" RESULTS: Fifteen neonatologists (33% of the division) participated in the study; audio-recorded debriefing interviews were available for 13. We observed 9 (60%) take an informative role, providing medical information only; 2 (13%) take a facilitative role, additionally eliciting the patient's values; 3 (20%) take a collaborative role, additionally engaging the patient in deliberation and providing a recommendation; and 1 (7%) take a directive role, making a treatment decision independent of the patient. Almost all (10/13, 77%) of the neonatologists described their intended role as informative. CONCLUSIONS: Neonatologists did not routinely elicit preferences, engage in deliberation, or provide treatment recommendations-even in response to requests for recommendations. These findings suggest there may be a gap between policy recommendations calling for shared decision making and actual clinical practice

"Doctor, what would you do?": physicians' responses to patient inquiries about periviable delivery

OBJECTIVE: To qualitatively assess obstetricians' and neonatologists' responses to standardized patients (SPs) asking "What would you do?" during periviable counseling encounters. METHODS: An exploratory single-center simulation study. SPs, portraying a pregnant woman presenting with ruptured membranes at 23 weeks, were instructed to ask, "What would you do?" if presented options regarding delivery management or resuscitation. Responses were independently reviewed and classified. RESULTS: We identified five response patterns: 'Disclose' (9/28), 'Don't Know' (11/28), 'Deflect' (23/28), 'Decline' (2/28), and 'Ignore' (2/28). Most physicians utilized more than one response pattern (22/28). Physicians 'deflected' the question by: restating or offering additional medical information; answering with a question; evoking a hypothetical patient; or redirecting the SP to other sources of support. When compared with neonatologists, obstetricians (40% vs. 15%) made personal or professional disclosures more often. Though both specialties readily acknowledged the importance of values in making a decision, only one physician attempted to elicit the patient's values. CONCLUSION: "What would you do?" represented a missed opportunity for values elicitation. Interventions are needed to facilitate values elicitation and shared decision-making in periviable care. PRACTICE IMPLICATIONS: If physicians fail to address patients' values and goals, they lack the information needed to develop patient-centered plans of care

Evaluating Shared Decision Making in Trial of Labor After Cesarean Counseling Using Objective Structured Clinical Examinations

Introduction Although shared decision making (SDM) is optimal for trial of labor after cesarean (TOLAC) counseling, resources to assess residents' clinical competency and communication skills are lacking. We addressed this gap by developing and testing an objective structured clinical examination (OSCE) to evaluate whether learners were able to use SDM in TOLAC counseling. Methods We created three simulation scenarios with increasing complexity to assess the skills of residents in their first, second, or third postgraduate year in using SDM in TOLAC counseling. All cases involved a standardized patient requesting a TOLAC consultation. Residents were provided with a medical history and instructed to counsel and develop a care plan. A 10-item scoring rubric was used, and each item was rated 0 (absent), 1 (partial), or 2 (complete). Three coders independently rated the encounters; discrepancies were resolved by consensus. Results Over 3 years, 39 residents participated in 60 OSCE encounters. The majority provided complete discussions of the clinical issue (93%), chances of success (72%), and maternal and fetal risks (100% and 85%, respectively) but obtained partial assessments of understanding (78%). Discussions of benefits were typically absent, with the exception of the maternal benefits (47%). More than 40% of residents did not discuss the patient's goals, 53% lacked discussion of uncertainties related to TOLAC, and half failed to explore the patient's preference, with most deferring a decision to a future encounter. Discussion Residents consistently discussed diagnosis, prognosis, and maternal risks yet infrequently addressed goals and preferences—two critical elements of SDM

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Status of woodland caribou in western north America

A review of current population size and trends of woodland caribou (Rangifer tarandus caribou) in seven jurisdictions in western North America shows a wide range of situations. A total maximum population estimate of woodland caribou west of the Ontario/Manitoba border is 61 090. Of 44 herds or populations described in this review: 14 are stable; two are stable to slightly decreasing; four are decreasing; four are increasing; and 22 are of unknown status. Caribou are classified as a threatened species in Alberta and as an endangered species in Washington/Idaho. The decline of caribou in North America following settlement (Bergerud, 1974) has continued along the southern edge of woodland caribou distribution. Direct loss of habitat to logging, mines and dams continued throughout the I960s, 1970s and 1980s. The secondary effects of these habitat changes, (i.e. increased roads leading to increased hunting and poaching, and increased early succession habitat leading to increased alternate prey/predator densities) has led in some cases to the total loss or decreased size of local herds. Three ecotypes of woodland caribou are described and their relative distribution delineated. These ecotypes live under different environmental conditions and require different inventory and management approaches. Woodland caribou herds in northern B.C., Yukon and N.W.T. generally are of good numbers and viable (stable or increasing), and management primarily is directed at regulating human harvest and natural predation to prevent, herd declines. Land use activities such as logging or energy development are not extensive. Managers in southern caribou ranges stress the need for a better understanding of caribou population stability within mixed prey/predator regimes; how habitat changes (eg. through logging) affect these regimes; and how to develop effective land use guidelines for resource extraction that can sustian caribou populations and maintain resource industries. Caribou managers have suggested that herds may be priorized for research and management efforts. Unstable, remnant populations may be left to their own fate. The limited research dollars available and difficult management decisions should be applied to caribou herds that are apparently sustainable and provide the greatest potential for long-term viability

Mitigating Depressive and Anxiety Symptoms with Healthier Dieting

Undergraduate Theoretical Proposa