Rehabilitation and outcomes after complicated vs uncomplicated mild TBI:results from the CENTER-TBI study

Background: Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods: Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles. Results: Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL. Conclusions: Patients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach. Trial registration: ClinicalTrials.gov NCT02210221.</p

Seasonal drought limits tree species across the Neotropics

Within the tropics, the species richness of tree communities is strongly and positively associated with precipitation. Previous research has suggested that this macroecological pattern is driven by the negative effect of water-stress on the physiological processes of most tree species. This process implies that the range limits of taxa are defined by their ability to occur under dry conditions, and thus in terms of species distributions it predicts a nested pattern of taxa distribution from wet to dry areas. However, this ‘dry-tolerance’ hypothesis has yet to be adequately tested at large spatial and taxonomic scales. Here, using a dataset of 531 inventory plots of closed canopy forest distributed across the Western Neotropics we investigated how precipitation, evaluated both as mean annual precipitation and as the maximum climatological water deficit, influences the distribution of tropical tree species, genera and families. We find that the distributions of tree taxa are indeed nested along precipitation gradients in the western Neotropics. Taxa tolerant to seasonal drought are disproportionally widespread across the precipitation gradient, with most reaching even the wettest climates sampled; however, most taxa analysed are restricted to wet areas. Our results suggest that the ‘dry tolerance’ hypothesis has broad applicability in the world's most species-rich forests. In addition, the large number of species restricted to wetter conditions strongly indicates that an increased frequency of drought could severely threaten biodiversity in this region. Overall, this study establishes a baseline for exploring how tropical forest tree composition may change in response to current and future environmental changes in this region

Technology-based Service Proposal Screening: Decision Making Effectiveness and Innovation Success

Contains fulltext : 86955.pdf (publisher's version ) (Open Access

Ecotype adaptation and acclimation of leaf traits to rainfall in 29 species of 16-year-old Eucalyptus at two common gardens

1. Relationships of leaf traits with rainfall at the place of origin of seed (RPO) are a function of acclimation and adaptation. To disentangle these effects we studied 29 species of 16-year-old Eucalyptus at a productive and an unproductive common garden (mean annual increments of above-ground stem volume = 21 ± 11 and 8 ± 5 m3 ha−1 years−1, respectively).We tested three hypotheses: (i) leaf traits vary between sites, but relation- ships among them do not; (ii) relationships of leaf traits with RPO do not vary between sites; and (iii) ecotypes originating from low-rainfall areas allocate a small fraction of nitrogen to thylakoid proteins and Rubisco, and have small SLA, small and narrow leaves, and large water-use efficiency (WUE). 2. Eleven leaf traits (leaf area, leaf thickness, leaf width/length, specific leaf area, fresh weight/dry weight, N, chlorophyll a/b, carotenoids/chlorophyll, thylakoid N%, Rubisco N%, WUE derived from 13C content) were measured in 1-year-old sun leaves. 3. Site had a large effect on not only the absolute values of leaf traits, but also relationships between pairs of traits. There were 20 significant correlations between pairs of traits. Three of the correlations had different slopes between sites, while a further nine had different intercepts. Hence the majority of significant correlations were not independent of site. 4. Leaf area and leaf width/length were the only traits related to RPO. There was no evidence that N allocation to Rubisco or thylakoid proteins was related to RPO, or that WUE was greater in ecotypes from dry areas. 5. For Eucalyptus, and perhaps other genera, physiological leaf traits may play a minor role in adaptation to water availability. There is large phenotypic plasticity in many leaf traits affecting not only the absolute values of traits, but also relationships among them