Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

What is the effectiveness of methods for eradicating or controlling abundance and biomass of invasive aquatic plants in Canada? A systematic review protocol

1.Invasive freshwater aquatic plants can have adverse ecological effects on the systems to which they are introduced, changing ecosystem function, threatening native plant species and causing billions of dollars in damage to infrastructure. Additionally, once established, invasive aquatic plants are often difficult to eradicate or control. 2.Given the importance of managing invasive aquatic plants, and the high associated economic costs of doing so, it is essential to determine the relative effectiveness of different control methods. Here, we present a protocol for a systematic review that will estimate the effectiveness of various biological, chemical, habitat manipulations and/or manual/mechanical methods for eradicating or controlling invasive plant abundance and biomass. 3.This systematic review will use published and grey literature, without date restriction, that determines the effectiveness of invasive plant control methods. English-language searches will be performed using five bibliographic databases, Google Scholar, and networking tools to find relevant literature. Eligibility screening will be conducted at two stages: (1) title and abstract and (2) full text. Studies that evaluate the effectiveness of methods for controlling the abundance or biomass or eradicating invasive plants will be included. A list of plant species currently, or potentially, in Canadian freshwater systems and of management concern will be considered. 4.Included studies will undergo critical appraisal of internal study validity. We will extract information on study characteristics, intervention and comparator details, measured outcomes (abundance and biomass, broadly defined) and effect modifiers (e.g., plant growth pattern or timing of treatments). A narrative synthesis will be used to describe the quantity and characteristics of the evidence base, while quantitative synthesis (i.e., meta-analysis) will be conducted to estimate an overall mean and variance of effect when sufficient numbers of similar studies are available

Assessing diverse evidence to improve conservation decision-making

Meeting the urgent need to protect and restore ecosystems requires effective decision‐making through wisely considering a range of evidence. However, weighing and assessing evidence to make complex decisions is challenging, particularly when evidence is of diverse types, subjects, and sources, and varies greatly in its quality and relevance. To tackle these challenges, we present the Balance Evidence Assessment Method (BEAM), an intuitive way to weigh and assess the evidence relating to the core assumptions underpinning the planning and implementation of conservation projects, strategies, and actions. Our method directly tackles the question of how to bring together diverse evidence whilst assessing its relevance, reliability, and strength of support for a given assumption, which can be mapped, for example to a Theory of Change. We consider how simple principles and safeguards in applying this method could help to respectfully, and equitably, include more local forms of knowledge when assessing assumptions, such as by ensuring diverse groups of individuals contribute and assess evidence. The method can be flexibly applied within existing decision‐making tools, platforms, and frameworks whenever assumptions (i.e., claims and hypotheses) are made. This method could greatly facilitate and improve the weighing of diverse evidence to make decisions in a range of situations, from local projects to global policy platforms

Identifying stakeholders and collaborating with communities

Working with communities, including local and Indigenous communities, is fundamental to most successful conservation practice. Key elements include determining the appropriate level of engagement, identifying the key stakeholders, identifying appropriate means of collaborating with different stakeholders, creating and maintaining trust, and collaborating to deliver the objectives

Early intervention and prevention of traumatic stress among first responders and health care workers

First responders (paramedics, fire and emergency workers, police, and medical emergency workers) are at high risk of being exposed to traumatic events in their occupational roles. Responding to critical incidents often involves exposure to life-threatening circumstances, dealing with fatalities, as well as encountering highly stressful situations that may trigger traumatic responses. There is a need for evidence-based support for first responders and healthcare workers who have been exposed to trauma in their working roles

Connecting island communities on a global scale: case studies in island biosecurity

Invasive alien species represent one of the greatest threats to island ecosystems and the unique species that inhabit them. In many instances, eradication or control programs for invasive alien species have effectively curtailed the ongoing loss of biodiversity on islands. Prevention is a more proactive and cost-effective approach, however, and is an emerging global priority in the conservation of island ecosystems. Island biosecurity programs attempt to prevent the introduction and establishment of invasive alien species on islands and dictate actions when an invasive species is detected. Targeted and robust collaboration efforts among the global island community on biosecurity advances and challenges can strengthen and improve local biosecurity programs. In this paper we review the principal tenets of island biosecurity—prevention, detection, and response—using case studies of current island biosecurity programs from New Zealand, Chile, Mexico, the United States, and Canada. Systematic evaluations of biosecurity activities are necessary to ensure that programs are effective and relevant. Key priority actions for the future include strengthening global collaboration on biosecurity through holding annual meetings, sharing resources online, leveraging funding opportunities, and forming working groups that will be engaged in improving critically important but under-resourced biosecurity programs.Las especies exóticas invasoras representan una de las mayores amenazas para los ecosistemas insulares y para las especies endémicas de las islas. En muchos casos, los programas de erradicación o de control de dichas especies, redujeron efectivamente la constante pérdida de biodiversidad en las islas. Sin embargo, la prevención es un enfoque más proactivo y rentable, y una prioridad mundial emergente en relación a la conservación de los ecosistemas insulares. Los programas de bioseguridad insular intentan prevenir la introducción y el establecimiento de las especies exóticas invasoras, y llevar a cabo acciones cuando se detecta la introducción de una especie invasora. Las labores sólidas y precisas de colaboración de la comunidad insular global relacionadas a los avances y a los desafíos de bioseguridad pueden fortalecer y mejorar los programas locales. En este documento, revisamos los postulados principales de la bioseguridad en islas: prevención, detección y respuesta, utilizando estudios de caso de programas de bioseguridad en islas, que incluyen a Nueva Zelanda, Chile, México, Estados Unidos y Canadá. Es necesario llevar a cabo evaluaciones sistemáticas de las actividades de bioseguridad, para garantizar la efectividad y la relevancia de los programas. Las medidas prioritarias para el futuro, incluyen el fortalecimiento de la colaboración global en materia de bioseguridad, mediante reuniones anuales, intercambio de recursos en línea, aprovechamiento de oportunidades de financiamiento y grupos de trabajo dedicados a mejorar los programas de bioseguridad, que no cuentan con recursos suficientes, pero que son de gran importancia

Ten people-centered rules for socially sustainable ecosystem restoration

As the UN Decade on Ecosystem Restoration begins, there remains insufficient emphasis on the human and social dimensions of restoration. The potential that restoration holds for achieving both ecological and social goals can only be met through a shift toward people-centered restoration strategies. Toward this end, this paper synthesizes critical insights from a special issue on “Restoration for whom, by whom” to propose actionable ways to center humans and social dimensions in ecosystem restoration, with the aim of generating fair and sustainable initiatives. These rules respond to a relative silence on socio-political issues in di Sacco et al.'s “Ten golden rules for reforestation to optimize carbon sequestration, biodiversity recovery and livelihood benefits” on socio-political issues and offer complementary guidance to their piece. Arranged roughly in order from pre-intervention, design/initiation, implementation, through the monitoring, evaluation and learning phases, the 10 people-centered rules are: (1) Recognize diversity and interrelations among stakeholders and rightsholders'; (2) Actively engage communities as agents of change; (3) Address socio-historical contexts; (4) Unpack and strengthen resource tenure for marginalized groups; (5) Advance equity across its multiple dimensions and scales; (6) Generate multiple benefits; (7) Promote an equitable distribution of costs, risks, and benefits; (8) Draw on different types of evidence and knowledge; (9) Question dominant discourses; and (10) Practice inclusive and holistic monitoring, evaluation, and learning. We contend that restoration initiatives are only tenable when the issues raised in these rules are respectfully addressed

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: insights from the LUNG SAFE study

Contains fulltext : 218568.pdf (publisher's version ) (Open Access)BACKGROUND: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. METHODS: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 >/= 0.60 during hyperoxemia). RESULTS: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). CONCLUSIONS: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. TRIAL REGISTRATION: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016

© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. Findings: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30–30·30 million) new cases of TBI and 0·93 million (0·78–1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331–412) per 100 000 population for TBI and 13 (11–16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40–57·62 million) and of SCI was 27·04 million (24·98–30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (−0·2% [–2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (−3·6% [–7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0–10·4 million) YLDs and SCI caused 9·5 million (6·7–12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82–141) per 100 000 for TBI and 130 (90–170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. Interpretation: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments. Funding: Bill & Melinda Gates Foundation