Hypogastric artery bypass to preserve pelvic circulation: improved outcome after endovascular abdominal aortic aneurysm repair

AbstractObjectiveThis study was carried out to compare the functional outcomes after hypogastric artery bypass and coil embolization for management of common iliac artery aneurysms in the endovascular repair of aortoiliac aneurysms (EVAR).MethodsBetween 1996 and 2002, 265 patients underwent elective or emergent EVAR. Data were retrospectively reviewed for 21 (8%) patients with iliac artery aneurysms 25 mm or larger that involved the iliac bifurcation. Patients underwent hypogastric artery bypass (n = 9) or coil embolization (n = 12). Interviews about past and current levels of activity were conducted. A disability score (DS) was quantitatively graded on a discrete scale ranging from 0 to 10, corresponding to “virtually bed-bound” to exercise tolerance “greater than a mile.” Worsening or improvement of symptoms was expressed as a difference in DS between two time points (-, worsening; +, improvement).ResultsThere was no difference in age (72.6 ± 7.3 years vs 73.1 ± 6.4 years), sex (male-female ratio, 8:1 vs 11:1), abdominal aortic aneurysm size (60.1 ± 5.9 mm vs 59.3 ± 7.0 mm), or number of preoperative comorbid conditions (1.9 ± 0.8 vs 2.1 ± 0.8) between hypogastric bypass and coil embolization groups, respectively. Mean follow-up was shorter after hypogastric bypass (14.8 vs 20.5 months; P < .05). There was no difference in the mean overall baseline DS between the bypass and the embolization groups (8.0 vs 7.8). Six (50%) of the 12 patients with coil embolization reported symptoms of buttock claudication ipsilateral to the occluded hypogastric artery. No symptoms of buttock claudication were reported after hypogastric bypass (P < .05). There was a decrease in the DS after both procedures; however, coil embolization was associated with a significantly worse DS compared with hypogastric artery bypass (4.5 vs 7.3; P < .001). In 4 (67%) of 6 patients with claudication after coil embolization symptoms improved, with a DS of 5.4 at last follow-up. This was significantly worse than in patients undergoing hypogastric artery bypass, with a DS of 7.8 at last follow-up (P < .001). There was no difference between the groups in duration of procedure, blood loss, length of hospital stay, morbidity, or mortality (0%).ConclusionsHypogastric artery bypass to preserve pelvic circulation is safe, and significantly decreases the risk for buttock claudication. Preservation of pelvic circulation results in significant improvement in the ambulatory status of patients with common iliac artery aneurysms, compared with coil embolization

Patterns of hospitalisation before and following initiation of haemodialysis: a 5 year single centre study

ABSTRACT Background The utilisation of healthcare resources by prevalent haemodialysis patients has been robustly evaluated with regard to the provision of outpatient haemodialysis; however, the impact of hospitalisation among such patients is poorly defined. Minimal information is available in the UK to estimate the health and economic burden associated with the inpatient management of prevalent haemodialysis patients. The aim of this study was to assess the pattern of hospitalisation among a cohort of haemodialysis patients, before and following their initiation of haemodialysis. In addition the study sought to assess the impact of their admissions on bed occupancy in a large tertiary referral hospital in a single region in the UK. Methods All admission episodes were reviewed and those receiving dialysis with the Belfast City Hospital Programme were identified over a 5 year period from January 2001 to December 2005. This tertiary referral centre provides dialysis services for a population of approximately 700 000 and additional specialist renal services for the remainder of Northern Ireland. The frequency and duration of hospitalisation, and contribution to bed day occupancy of haemodialysis patients, was determined and compared to other common conditions which are known to be associated with high bed occupancy. In addition, the pattern and timing of admissions in dialysis patients in relation to their dialysis initiation date was assessed. Results Over the 5 year study period, 798 haemodialysis patients were admitted a total of 2882 times. These accounted for 2.5% of all admissions episodes; the median number of admissions for these patients was 3 (2–5) which compared with 1 (1–2) for non-dialysis patients. The majority of first hospitalisations (54%) were within 100 days before or after commencement of maintenance dialysis therapy. In all clinical specialties the median length of stay for haemodialysis patients was significantly longer than for patients not on haemodialysis (p=0.004). In multivariate analysis with adjustment for age, gender, and other clinically relevant diagnostic codes, maintenance haemodialysis patients stayed on average 3.75 times longer than other patient groups (ratio of geometric means 3.75, IQR 3.46–4.06). Conclusions Maintenance haemodialysis therapy is an important risk factor for prolonged hospitalisation regardless of the primary reason for admission. Such patients require admission more frequently than the general hospital population, particularly within 100 days before and after initiation of their first dialysis treatment. </jats:sec

Northern spotted owl nesting habitat under high potential wildfire threats along the California Coastal Redwood Forest

Large and severe wildfires, exacerbated by climate change and human behavior, are occurring more frequently in many forests across the western United States. While wildfire is a natural part of most terrestrial ecosystems, rapidly changing fire regimes have the potential to alter habitat beyond the adaptive capabilities of species. Spatial assessments of wildfire risks to species habitat may allow managers to pinpoint locations for management activities. To illustrate this, we spatially assessed wildfire risk within habitat that supports the nesting activity of the federally threatened northern spotted owl (Strix occidentalis caurina) in the California redwood coast ecoregion. To accomplish this, we built a scale-optimized ensemble nesting habitat suitability model and identified habitat with the highest wildfire hazard potential. Percent canopy cover at 100-m scale, slope at 400-m scale, and January precipitation at 800-m scale were the most influential environmental covariates for predicting northern spotted owl nesting habitat. Nearly 60% of nesting habitat was predicted to be at high or very high (>1986 index value) wildfire risks. We identified three areas in the Maple Creek Area of Humboldt County, Jackson State Demonstration Forest in Mendocino County, and Point Reyes National Seashore in Marin County, California with a high concentration of nesting habitat that are at a very high risk of experiencing high severity wildfires. We recommend these areas be targeted for future research to understand the impact of wildfire on northern spotted owl as well as management attention

Narrative, identity and mental health: How men with serious mental illness re-story their lives through sport and exercise

Objectives: It has been suggested that mental illness threatens identity and sense of self when one's personal story is displaced by dominant illness narratives focussing on deficit and dysfunction. One role of therapy, therefore, is to allow individuals to re-story their life in a more positive way which facilitates the reconstruction of a meaningful identity and sense of self. This research explores the ways in which involvement in sport and exercise may play a part in this process. Design: Qualitative analysis of narrative. Method: We used an interpretive approach which included semi-structured interviews and participant observation with 11 men with serious mental illness to gather stories of participants' sport and exercise experiences. We conducted an analysis of narrative to explore the more general narrative types which were evident in participants' accounts. Findings: We identified three narrative types underlying participants' talk about sport and exercise: (a) an action narrative about "going places and doing stuff"; (b) an achievement narrative about accomplishment through effort, skill or courage; (c) a relationship narrative of shared experiences to talk about combined with opportunities to talk about those experiences. We note that these narrative types differ significantly from-and may be considered alternatives to-dominant illness narratives. Conclusion: This study provides an alternative perspective on how sport and exercise can help men with serious mental illness by providing the narrative resources which enabled participants to re-story aspects of their lives through creating and sharing personal stories through which they rebuilt or maintained a positive sense of self and identity. © 2007 Elsevier Ltd. All rights reserved

The physical activity experiences of men with serious mental illness: Three short stories

Objectives: Although a considerable amount of research has explored the effects of physical activity on mental health, the voices of people with mental illness have been largely excluded from published reports. Through this study we aim to foreground service users' voices in order to shed light on the personal and subjective nature of the relationship between physical activity and serious mental illness (SMI). Methods: An interpretive case study approach was used to explore in depth the physical activity experiences of three men with SMI. Creative analytic practice was used to write three creative non-fictions which, as first-person narratives, foreground the participants' voices. Results: We present three short stories in an effort to communicate participants' personal and subjective experiences of physical activity in an accessible, engaging, and evocative manner. We hope to: (i) provide potentially motivating physical activity success stories for others who live with SMI; (ii) increase awareness among mental health professionals of the possibilities of physical activity; and (iii) provide an empathetic understanding of possibilities and problems of living with SMI which may help challenge the stigma surrounding mental illness. Conclusions: For us, the stories communicate the diversity and difference inherent in the ways men with SMI experience physical activity. We reflect on how the short story form allows these differences to be preserved and respected. We resist making further interpretations of the stories preferring instead to encourage the reader to form her or his own conclusions. © 2007 Elsevier Ltd. All rights reserved

The practical implications of using standardized estimation equations in calculating the prevalence of chronic kidney disease

BACKGROUND: Kidney Disease Outcomes Quality Initiative (KDOQI) chronic kidney disease (CKD) guidelines have focused on the utility of using the modified four-variable MDRD equation (now traceable by isotope dilution mass spectrometry IDMS) in calculating estimated glomerular filtration rates (eGFRs). This study assesses the practical implications of eGFR correction equations on the range of creatinine assays currently used in the UK and further investigates the effect of these equations on the calculated prevalence of CKD in one UK regionMETHODS: Using simulation, a range of creatinine data (30-300 micromol/l) was generated for male and female patients aged 20-100 years. The maximum differences between the IDMS and MDRD equations for all 14 UK laboratory techniques for serum creatinine measurement were explored with an average of individual eGFRs calculated according to MDRD and IDMS &lt; 60 ml/min/1.73 m(2) and 30 ml/min/1.73 m(2). Similar procedures were applied to 712,540 samples from patients &gt; or = 18 years (reflecting the five methods for serum creatinine measurement utilized in Northern Ireland) to explore, graphically, maximum differences in assays. CKD prevalence using both estimation equations was compared using an existing cohort of observed data.RESULTS: Simulated data indicates that the majority of laboratories in the UK have small differences between the IDMS and MDRD methods of eGFR measurement for stages 4 and 5 CKD (where the averaged maximum difference for all laboratory methods was 1.27 ml/min/1.73 m(2) for females and 1.59 ml/min/1.73 m(2) for males). MDRD deviated furthest from the IDMS results for the Endpoint Jaffe method: the maximum difference of 9.93 ml/min/1.73 m(2) for females and 5.42 ml/min/1.73 m(2) for males occurred at extreme ages and in those with eGFR &gt; 30 ml/min/1.73 m(2). Observed data for 93,870 patients yielded a first MDRD eGFR &lt; 60 ml/min/1.73 m(2) in 2001. 66,429 (71%) had a second test &gt; 3 months later of which 47,093 (71%) continued to have an eGFR &lt; 60 ml/min/1.73 m(2). Estimated crude prevalence was 3.97% for laboratory detected CKD in adults using the MDRD equation which fell to 3.69% when applying the IDMS equation. Over 95% of this difference in prevalence was explained by older females with stage 3 CKD (eGFR 30-59 ml/min/1.73 m(2)) close to the stage 2 CKD (eGFR 60-90 ml/min/1.73 m(2)) interface.CONCLUSIONS: Improved accuracy of eGFR is obtainable by using IDMS correction especially in the earlier stages of CKD 1-3. Our data indicates that this improved accuracy could lead to reduced prevalence estimates and potentially a decreased likelihood of onward referral to nephrology services particularly in older females.</p

The use of a vortex insertion technique to simulate the extratropical transition of Hurricane Michael (2000)

On 19 October 2000, Hurricane Michael merged with an approaching baroclinic trough over the western North Atlantic Ocean south of Nova Scotia. As the hurricane moved over cooler sea surface temperatures (SSTs; less than 25°C), it intensified to category-2 intensity on the Saffir–Simpson hurricane scale [maximum sustained wind speeds of 44 m s−1 (85 kt)] while tapping energy from the baroclinic environment. The large “hybrid” storm made landfall on the south coast of Newfoundland with maximum sustained winds of 39 m s−1 (75 kt) causing moderate damage to coastal communities east of landfall. Hurricane Michael presented significant challenges to weather forecasters. The fundamental issue was determining which of two cyclones (a newly formed baroclinic low south of Nova Scotia or the hurricane) would become the dominant circulation center during the early stages of the extratropical transition (ET) process. Second, it was difficult to predict the intensity of the storm at landfall owing to competing factors: 1) decreasing SSTs conducive to weakening and 2) the approaching negatively tilted upper-level trough, favoring intensification. Numerical hindcast simulations using the limited-area Mesoscale Compressible Community model with synthetic vortex insertion (cyclone bogus) prior to the ET of Hurricane Michael led to a more realistic evolution of wind and pressure compared to running the model without vortex insertion. Specifically, the mesoscale model correctly simulates the hurricane as the dominant circulation center early in the transition process, versus the baroclinic low to its north, which was the favored development in the runs not employing vortex insertion. A suite of experiments is conducted to establish the sensitivity of the ET to various initial conditions, lateral driving fields, domain sizes, and model parameters. The resulting storm tracks and intensities fall within the range of the operational guidance, lending support to the possibility of improving numerical forecasts using synthetic vortex insertion prior to ET in such a model

Social support for and through exercise and sport in a sample of men with serious mental illness.

Social support is important for people experiencing serious mental illness and is also important during the initiation and maintenance of exercise. In this article we draw on interpretive research into the experiences of 11 men with serious mental illness to explore four dimensions of social support both for and through exercise. Our findings suggest that informational, tangible, esteem, and emotional support were both provided for and given by participants through exercise. We conclude that experiences of both receiving and giving diverse forms of support in this way are significant for some people living with and recovering from serious mental illness

Cover-based allometric estimate of aboveground biomass of a non-native, invasive annual grass (Bromus tectorum L.) in the Great Basin, USA

Cheatgrass (Bromus tectorum L.) presence in the Great Basin is associated with an increase in fire frequency andsize, likely due to increased spatial continuity of fine fuel biomass. Measurements of the extent and cover ofcheatgrass are steadily improving, but the strength of the relationship between cover and aboveground biomass(AGB) is unclear. An allometric equation that can reliably convert cover to AGB of cheatgrass would allow forimproved incorporation of regional estimates of cover into models of fire activity, carbon storage, and net pri&shy;mary productivity, all of which rely on biomass. We measured cover and AGB of cheatgrass at 60 locations in thenorth-central Great Basin and used these measurements to model the relationship. We found a strong, linearrelationship between the percent cover and AGB, which was improved after square root transformation of bothcover and AGB, and after incorporating the number of days after peak NDVI that the biomass and cover weremeasured. These results show that AGB of cheatgrass can be reliably estimated from cover. It is likely thatallometric equations based on cover will be effective for other grass species, but care must be taken to account forphenology (e.g., peak NDVI) in the estimation.</p