Riparian woodland condition in relation to lippia (Phyla canescens (Kunth) Greene) and fire management, southern Queensland

The implementation of inappropriate management regimes encourages alien species invasion into native ecosystems. Disturbances, such as fire, flooding and grazing, create a unique window of opportunity for invasive species to colonise areas not previously invaded. Fire regimes can be changed through the introduction of foreign species and may induce detrimental ecosystem effects including increased tree mortality, an increase in bare ground and further invasion by foreign species. Phyla canescens (lippia) is an invasive introduced species covering over 5.3 million hectares of the Murray-Darling Basin. Many potential control methods have been attempted. However, the response of lippia to fire as a potential management tool has not previously been studied. The general question of this research was: what is the effect of a prescribed fire on lippia, the vegetation structural components and the soil seed bank of a vegetation remnant in a highly modified agricultural landscape? This research examined the following specific hypotheses: that there is no difference in the abundance of lippia between burnt and unburnt treatments, six months after a prescribed burn; that there is no difference in the abundance of other vegetative structural components between burnt and unburnt woodlands, six months after a prescribed burn; that the fire has resulted in no change in the seedling emergence of lippia seeds stores in the soil seed bank; and, that the fire has resulted in no change of pseudo-species (not taxonomically identified species) richness within the seed bank. Ten sites, (5 burnt, 5 unburnt) were sampled within each of the two woodlands: Eucalyptus camaldulensis and Eucalyptus populnea, six months after a prescribed burn. At each site, a 500 m2 quadrat was established to determine general disturbance measures (using a 0–4 scoring method) and the abundance and percentage cover of vegetative structural components. Within each 500 m2 quadrat, the density of the following vegetative structural components were measured: trees > 20 m; trees 10–20 m; trees 20 m; standing stags 10–20 m; standing stags < 10 m; stumps; logs 6–13 cm; logs 13–35 cm; logs 35–90 cm; and logs 90–150 cm. The percent cover of each of the following vegetative structural components was also measured: trees; stags; stumps; logs; grasses/sedges; herbs/forbs; lippia; lippia litter; fine litter; bare ground. Within each 500 m2 quadrat, eight 70 cm2 sub-quadrats were placed along a 16 m transect to determine the cover abundance of lippia, grasses and forbs at a finer scale. Soil samples were also collected at each site for the glasshouse seed germination trial. Samples were kept in the glasshouse for 14 weeks to determine total germination and pseudo-species richness of each site and treatment. Independent T-tests determined whether there were any significant differences of variables between treatments. The Levene’s Test for Homogeneity was used to determine homogeneity. There were no significant differences in the abundance and cover of lippia or vegetation structural components between burnt and unburnt woodlands, six months after a prescribed burn at either the broad (500 m2) or finer scale (70 cm2) (T-test, p > 0.05). The only exception to this finding was a significant difference in forb cover between burnt and unburnt Eucalyptus populnea woodlands (T-test, p < 0.05). There were no significant differences in seedling emergence or pseudo-species richness between burnt and unburnt treatments within each woodland (T-test, p > 0.05). This research shows that fire may not be a suitable control method for lippia invasion. The results found for structural components and the seedling germination trial were consistent with previous literature. Lippia’s response to fire in this study and the lack of positive effect that fire had on the invasive weed at St Ruth Reserve, has begun to fill an identified knowledge gap in the control methods for lippia. This study shows that fire may not be a useful management tool for lippia

Lippia (Phyla canescens) and its response to fire

Lippia (Phyla canescens), a significant invasive weed, is a recognized threat to floodplain woodlands in Australia, particularly in the Murray-Darling Basin. Current control methods include the use of herbicides, which can be costly and environmentally harmful, particularly in riparian areas. 'Environmentally friendly' control mechanisms are yet to be found, with the potential for biological control still being researched. This research explores the use of fire as a potential control method to help slow the expansion and growth of lippia. Lippia response to fire and the effect of fire in lippia-invaded landscapes has not previously been investigated. Half of the St. Ruth Reserve south of Dalby in Southern Queensland was subject to a control burn in November 2013 by the Western Downs Regional Council in an attempt to reduce lippia abundance in this remnant riparian woodland. This research investigates the response of lippia to the burn. The study will compare the cover abundance of lippia and major functional plant groups between burnt and unburnt (control) sites within the reserve; it will also investigate the impact of fire on lippia germination rates in soil samples from burnt and unburnt sites. Additional studies testing lippia seed viability, using tetrazolium staining, will also be conducted after a range of fire mimicking treatments have been applied to seeds and compared to controls from an unburnt area. This research will contribute to evidence-based decision-making for improved management of lippia-invaded remnant ecosystems

High Risk of Unexpected Late Fetal Death in Monochorionic Twins Despite Intensive Ultrasound Surveillance: A Cohort Study

BACKGROUND: The rationale for fetal surveillance in monochorionic twin pregnancies is timely intervention to prevent the increased fetal/perinatal morbidity and mortality attributed to twin–twin transfusion syndrome and intrauterine growth restriction. We investigated the residual risk of fetal death after viability in otherwise uncomplicated monochorionic diamniotic twin pregnancies. METHODS AND FINDINGS: We searched an electronic database of 480 completed monochorionic pregnancies that underwent fortnightly ultrasound surveillance in our tertiary referral fetal medicine service between 1992 and 2004. After excluding pregnancies with twin–twin transfusion syndrome, growth restriction, structural abnormalities, or twin reversed arterial perfusion sequence, and monoamniotic and high-order multiple pregnancies, we identified 151 uncomplicated monochorionic diamniotic twin pregnancies with normal growth, normal liquor volume, and normal Doppler studies on fortnightly ultrasound scans. Ten unexpected intrauterine deaths occurred in seven (4.6%) of 151 previously uncomplicated monochorionic diamniotic pregnancies, within 2 wk of a normal scan, at a median gestational age of 34(+1) wk (weeks(+days); range 28(+0) to 36(+3)). Two of the five cases that underwent autopsy had features suggestive of acute late onset twin–twin transfusion syndrome, but no antenatal indicators of transfusional imbalance or growth restriction, either empirically or in a 1:3 gestation-matched case–control comparison. The prospective risk of unexpected antepartum stillbirth after 32 wk was 1/23 monochorionic diamniotic pregnancies (95% confidence interval 1/11 to 1/63). CONCLUSION: Despite intensive fetal surveillance, structurally normal monochorionic diamniotic twin pregnancies without TTTS or IUGR are complicated by a high rate of unexpected intrauterine death. This prospective risk of fetal death in otherwise uncomplicated monochorionic diamniotic pregnancies after 32 wk of gestation might be obviated by a policy of elective preterm delivery, which now warrants evaluation

A multi-center population-based case–control study of ovarian cancer in African-American women: the African American Cancer Epidemiology Study (AACES)

Abstract: Background: Ovarian cancer (OVCA) is the leading cause of death from gynecological cancer, with poorer survival for African American (AA) women compared to whites. However, little is known about risk factors for OVCA in AA. To study the epidemiology of OVCA in this population, we started a collaborative effort in 10 sites in the US. Here we describe the study and highlight the challenges of conducting a study of a lethal disease in a minority population. Methods: The African American Cancer Epidemiology Study (AACES) is an ongoing, population-based case–control study of OVCA in AA in 10 geographic locations, aiming to recruit 850 women with invasive epithelial OVCA and 850 controls age- and geographically-matched to cases. Rapid case ascertainment and random-digit-dialing systems are in place to ascertain cases and controls, respectively. A telephone survey focuses on risk factors as well as factors of particular relevance for AAs. Food-frequency questionnaires, follow-up surveys, biospecimens and medical records are also obtained. Results: Current accrual of 403 AA OVCA cases and 639 controls exceeds that of any existing study to date. We observed a high proportion (15%) of deceased non-responders among the cases that in part is explained by advanced stage at diagnosis. A logistic regression model did not support that socio-economic status was a factor in advanced stage at diagnosis. Most risk factor associations were in the expected direction and magnitude. High BMI was associated with ovarian cancer risk, with multivariable adjusted ORs and 95% CIs of 1.50 (0.99-2.27) for obese and 1.27 (0.85- 1.91) for morbidly obese women compared to normal/underweight women. Conclusions: AACES targets a rare tumor in AAs and addresses issues most relevant to this population. The importance of the study is accentuated by the high proportion of OVCA cases ascertained as deceased. Our analyses indicated that obesity, highly prevalent in this population (>60% of the cases), was associated with increased OVCA risk. While these findings need to be replicated, they suggest the potential for an effective intervention on the risk in AAs. Upon completion of enrollment, AACES will be the largest epidemiologic study of OVCA in AA women

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Healthcare Providers' Perspectives on Genetic Counselors

Background: As the genetic counseling profession expands, it is increasingly important for healthcare providers to understand genetic counselors’ scope of practice, and their role in patient care and within the multidisciplinary team. Little is currently known about the level of knowledge healthcare providers have about genetic counselors’ scope of practice, role, and skill set. This study aims to address this gap in the literature. Methods: Healthcare providers in direct patient care roles at UPMC Magee Womens Hospital and UPMC Children’s Hospital of Pittsburgh were surveyed through a twenty-question survey that covered scope of practice, facilitation of patient care, reasons for referring patients for genetic counseling and the demographics of the respondents. For the second part of the study providers were interviewed to further explore these areas. At the end of the survey, respondents could opt into a thirty-minute interview. The survey results were analyzed by Fisher’s exact test, and the interview transcripts were analyzed using thematic analysis. Results: Forty-nine surveys were utilized for data analysis, and two interviews were conducted with three total participants. Providers had a good understanding of genetic counselors’ scope of practice and were significantly more likely to know the degree held by a genetic counselor if they themselves had a medical degree (p-value: 0.004). However, providers did not have a clear understanding of whether Pennsylvanian genetic counselors are permitted by their licensure to order genetic testing. Most respondents referred frequently to genetic counselors, with 68% referring at least monthly. Interview participants reported high levels of positive regard for genetic counselors and their understanding of scope of practice was dependent on the interactions they had with genetic counselors. Conclusion: This study shows that providers in Pennsylvania need to be educated about Pennsylvanian genetic counselor scope of practice, particularly the provision related to who can serve as the ordering provider of genetic testing. This research is critical to understanding how genetic counselors are viewed by healthcare providers and is significant for public health as a referral to a genetic counselor is often part of the appropriate application of many national guidelines for individuals with genetic conditions