The systematic guideline review: method, rationale, and test on chronic heart failure

Background: Evidence-based guidelines have the potential to improve healthcare. However, their de-novo-development requires substantial resources-especially for complex conditions, and adaptation may be biased by contextually influenced recommendations in source guidelines. In this paper we describe a new approach to guideline development-the systematic guideline review method (SGR), and its application in the development of an evidence-based guideline for family physicians on chronic heart failure (CHF). Methods: A systematic search for guidelines was carried out. Evidence-based guidelines on CHF management in adults in ambulatory care published in English or German between the years 2000 and 2004 were included. Guidelines on acute or right heart failure were excluded. Eligibility was assessed by two reviewers, methodological quality of selected guidelines was appraised using the AGREE instrument, and a framework of relevant clinical questions for diagnostics and treatment was derived. Data were extracted into evidence tables, systematically compared by means of a consistency analysis and synthesized in a preliminary draft. Most relevant primary sources were re-assessed to verify the cited evidence. Evidence and recommendations were summarized in a draft guideline. Results: Of 16 included guidelines five were of good quality. A total of 35 recommendations were systematically compared: 25/35 were consistent, 9/35 inconsistent, and 1/35 un-rateable (derived from a single guideline). Of the 25 consistencies, 14 were based on consensus, seven on evidence and four differed in grading. Major inconsistencies were found in 3/9 of the inconsistent recommendations. We re-evaluated the evidence for 17 recommendations (evidence-based, differing evidence levels and minor inconsistencies) - the majority was congruent. Incongruity was found where the stated evidence could not be verified in the cited primary sources, or where the evaluation in the source guidelines focused on treatment benefits and underestimated the risks. The draft guideline was completed in 8.5 man-months. The main limitation to this study was the lack of a second reviewer. Conclusion: The systematic guideline review including framework development, consistency analysis and validation is an effective, valid, and resource saving-approach to the development of evidence-based guidelines

Behavioral Response of a Mobile Marine Predator to Environmental Variables Differs Across Ecoregions

Animal movement and habitat selection are in part a response to landscape heterogeneity. Many studies of movement and habitat selection necessarily use environmental covariates that are readily available over large‐scales, which are assumed representative of functional habitat features such as resource availability. For widely distributed species, response to such covariates may not be consistent across ecosystems, as response to any specific covariate is driven by its biological relevance within the context of each ecosystem. Thus, the study of any widely distributed species within a limited geographic region may provide inferences that are not widely generalizable. Our goal was to evaluate the response of a marine predator to a suite of environmental covariates across a wide ecological gradient. We identified two behavioral states (resident and transient) in the movements of shortfin mako sharks (Isurus oxyrinchus) tracked via satellite telemetry in two regions of the western North Atlantic Ocean: the tropical Caribbean/Gulf of Mexico marginal sea (CGM), and the temperate waters off the east coast of North America (OWA). We compared patterns of resident behavior between regions, and modeled relationships between oceanographic variables and resident behavior. We tracked 39 sharks during 2013 – 2015. Resident behavior was associated with shallow, continental shelf and slope waters in both regions. In the OWA resident behavior was associated with low sea surface temperature and high primary productivity, however, sharks exhibited no response to either variable in the CGM. There was a negative relationship between sea‐surface height gradient (a proxy for oceanic fronts) and resident behavior in the OWA, and a positive relationship in the CGM. Our observations likely reflect shark responses to regional variability in factors responsible for the distribution and availability of prey. Our study illustrates the importance of studying widely distributed species in a consistent manner over large spatial scales

Bayesian Estimation of Animal Movement from Archival and Satellite Tags

The reliable estimation of animal location, and its associated error is fundamental to animal ecology. There are many existing techniques for handling location error, but these are often ad hoc or are used in isolation from each other. In this study we present a Bayesian framework for determining location that uses all the data available, is flexible to all tagging techniques, and provides location estimates with built-in measures of uncertainty. Bayesian methods allow the contributions of multiple data sources to be decomposed into manageable components. We illustrate with two examples for two different location methods: satellite tracking and light level geo-location. We show that many of the problems with uncertainty involved are reduced and quantified by our approach. This approach can use any available information, such as existing knowledge of the animal's potential range, light levels or direct location estimates, auxiliary data, and movement models. The approach provides a substantial contribution to the handling uncertainty in archival tag and satellite tracking data using readily available tools

Seasonal Spatial Segregation in Blue Sharks (Prionace glauca) by Sex and Size Class in the Northeast Pacific Ocean

Aim: Animal tracking can provide unique insights into the ecology and conservation of marine species, such as the partitioning of habitat, including differences between life history stages or sexes, and can inform fisheries stock assessments, bycatch reduction and spatial management such as dynamic management. Location: Northeast Pacific Ocean. Methods: We used satellite tracking data from 47 blue sharks (Prionace glauca) from the Northeast Pacific to determine movements and home range along the west coast of North America, and sex–size class (immature females, mature males) specific habitat preferences using boosted regression trees. Using a suite of static and dynamic environmental variables, we determined distribution and habitat preferences across summer and fall for each sex–size class. Results: We found that there was spatial segregation between sex–size classes particularly in the summer months with immature females found largely north of 33°N, and males south of 35°N. In fall, females travelled south, resulting in an overlap in distributions south of 37°N. Sea surface temperature (SST), latitude and longitude were top predictors. However, immature females and adult males demonstrated unique habitat preferences including SST, with immature females preferring cooler temperatures (SST \u3c 15°C) than adult males in summer, and a broader band of SST than adult males in fall. All models performed well, explaining 50%–67% of deviance, and 23%–41% of deviance when predictions were cross‐validated. Main conclusions: We provide first insights into coastal movements and habitat preferences of blue sharks in the Northeast Pacific. We found that immature females undergo a seasonal southward migration in this more coastal habitat, similar to patterns observed in the North Atlantic. We also found some overlap between adult males and immature females in fall months, suggesting the importance of more coastal habitat in managing this species, particularly in determining population structure for blue shark stock assessments, and reducing blue shark bycatch

Uniting statistical and individual-based approaches for animal movement modelling

<div><p>The dynamic nature of their internal states and the environment directly shape animals' spatial behaviours and give rise to emergent properties at broader scales in natural systems. However, integrating these dynamic features into habitat selection studies remains challenging, due to practically impossible field work to access internal states and the inability of current statistical models to produce dynamic outputs. To address these issues, we developed a robust method, which combines statistical and individual-based modelling. Using a statistical technique for forward modelling of the IBM has the advantage of being faster for parameterization than a pure inverse modelling technique and allows for robust selection of parameters. Using GPS locations from caribou monitored in Québec, caribou movements were modelled based on generative mechanisms accounting for dynamic variables at a low level of emergence. These variables were accessed by replicating real individuals' movements in parallel sub-models, and movement parameters were then empirically parameterized using Step Selection Functions. The final IBM model was validated using both k-fold cross-validation and emergent patterns validation and was tested for two different scenarios, with varying hardwood encroachment. Our results highlighted a functional response in habitat selection, which suggests that our method was able to capture the complexity of the natural system, and adequately provided projections on future possible states of the system in response to different management plans. This is especially relevant for testing the long-term impact of scenarios corresponding to environmental configurations that have yet to be observed in real systems.</p></div

Obstacles to researching the researchers: A case study of the ethical challenges of undertaking methodological research investigating the reporting of randomised controlled trials

<p>Abstract</p> <p>Background</p> <p>Recent cohort studies of randomised controlled trials have provided evidence of within-study selective reporting bias; where statistically significant outcomes are more likely to be more completely reported compared to non-significant outcomes. Bias resulting from selective reporting can impact on meta-analyses, influencing the conclusions of systematic reviews, and in turn, evidence based clinical practice guidelines.</p> <p>In 2006 we received funding to investigate if there was evidence of within-study selective reporting in a cohort of RCTs submitted to New Zealand Regional Ethics Committees in 1998/99. This research involved accessing ethics applications, their amendments and annual reports, and comparing these with corresponding publications. We did not plan to obtain informed consent from trialists to view their ethics applications for practical and scientific reasons.</p> <p>In November 2006 we sought ethical approval to undertake the research from our institutional ethics committee. The Committee declined our application on the grounds that we were not obtaining informed consent from the trialists to view their ethics application. This initiated a seventeen month process to obtain ethical approval. This publication outlines what we planned to do, the issues we encountered, discusses the legal and ethical issues, and presents some potential solutions.</p> <p>Discussion and conclusion</p> <p>Methodological research such as this has the potential for public benefit and there is little or no harm for the participants (trialists) in undertaking it. Further, in New Zealand, there is freedom of information legislation, which in this circumstance, unambiguously provided rights of access and use of the information in the ethics applications. The decision of our institutional ethics committee defeated this right and did not recognise the nature of this observational research.</p> <p>Methodological research, such as this, can be used to develop processes to improve quality in research reporting. Recognition of the potential benefit of this research in the broader research community, and those who sit on ethics committees, is perhaps needed. In addition, changes to the ethical review process which involve separation between those who review proposals to undertake methodological research using ethics applications, and those with responsibility for reviewing ethics applications for trials, should be considered. Finally, we contend that the research community could benefit from quality improvement approaches used in allied sectors.</p

“Being Guided”: What Oncofertility Patients’ Decisions Can Teach Us About the Efficacy of Autonomy, Agency, and Decision-Making Theory in the Contemporary Critical Encounter

Recent research on patient decision-making reveals a disconnect between theories of autonomy, agency, and decision-making and their practice in contemporary clinical encounters. This study examines these concepts in the context of female patients making oncofertility decisions in the United Kingdom in light of the phenomenon of “being guided.” Patients experience being guided as a way to cope with, understand, and defer difficult treatment decisions. Previous discussions condemn guided decision-making, but this research suggests that patients make an informed, autonomous decision to be guided by doctors. Thus, bioethicists must consider the multifaceted ways that patients enact their autonomy in medical encounters

A Disease-Mediated Trophic Cascade in the Serengeti and its Implications for Ecosystem C

The removal of rinderpest had cascading effects on herbivore populations, fire, tree density, and even ecosystem carbon in the Serengeti ecosystem of East Africa