Rapid advance of spring arrival dates in long-distance migratory birds

Several bird species have advanced the timing of their spring migration in response to recent climate change. European short-distance migrants, wintering in temperate areas, have been assumed to be more affected by change in the European climate than long-distance migrants wintering in the tropics. However, we show that tong-distance migrants have advanced their spring arrival in Scandinavia more than short-distance migrants. By analyzing a long-term data set from southern Italy, we show that long-distance migrants also pass through the Mediterranean region earlier. We argue that this may reflect a climate-driven evolutionary change in the timing of spring migration

End-of-life practices in traumatic brain injury patients: Report of a questionnaire from the CENTER-TBI study

Purpose We aimed to study variation regarding specific end-of-life (EoL) practices in the intensive care unit (ICU) in traumatic brain injury (TBI) patients. Materials and methods Respondents from 67 hospitals participating in The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study completed several questionnaires on management of TBI patients. Results In 60% of the centers, ≤50% of all patients with severe neurological damage dying in the ICU, die after withdrawal of life-sustaining measures (LSM). The decision to withhold/withdraw LSM was made following multidisciplinary consensus in every center. Legal representatives/relatives played a role in the decision-making process in 81% of the centers. In 82% of the centers, age played a role in the decision to withhold/withdraw LSM. Furthermore, palliative therapy was initiated in 79% of the centers after the decision to withdraw LSM was made. Last, withholding/withdrawing LSM was, generally, more often considered after more time had passed, in a patient with TBI, who remained in a very poor prognostic condition. Conclusion We found variation regarding EoL practices in TBI patients. These results provide insight into variability regarding important issues pertaining to EoL practices in TBI, which can be useful to stimulate discussions on EoL practices, comparative effectiveness research, and, ultimately, development of recommendations

End-of-life practices in traumatic brain injury patients: Report of a questionnaire from the CENTER-TBI study

Purpose We aimed to study variation regarding specific end-of-life (EoL) practices in the intensive care unit (ICU) in traumatic brain injury (TBI) patients. Materials and methods Respondents from 67 hospitals participating in The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study completed several questionnaires on management of TBI patients. Results In 60% of the centers, ≤50% of all patients with severe neurological damage dying in the ICU, die after withdrawal of life-sustaining measures (LSM). The decision to withhold/withdraw LSM was made following multidisciplinary consensus in every center. Legal representatives/relatives played a role in the decision-making process in 81% of the centers. In 82% of the centers, age played a role in the decision to withhold/withdraw LSM. Furthermore, palliative therapy was initiated in 79% of the centers after the decision to withdraw LSM was made. Last, withholding/withdrawing LSM was, generally, more often considered after more time had passed, in a patient with TBI, who remained in a very poor prognostic condition. Conclusion We found variation regarding EoL practices in TBI patients. These results provide insight into variability regarding important issues pertaining to EoL practices in TBI, which can be useful to stimulate discussions on EoL practices, comparative effectiveness research, and, ultimately, development of recommendations

How do 66 European institutional review boards approve one protocol for an international prospective observational study on traumatic brain injury? Experiences from the CENTER-TBI study

Bakgrunn Den europeiske unionen (EU) har som mål å optimalisere pasientbeskyttelse og effektivitet i helseforskningen ved å harmonisere prosedyrer i alle medlemsstater. Likevel kreves ytterligere forbedringer for å øke forskningseffektiviteten i multisenter. Vi undersøkte IRB-prosedyrer i en stor potensiell europeisk multisenterstudie om traumatisk hjerneskade (TBI), med sikte på å informere og stimulere tiltak for å forbedre effektiviteten. Metoder Vi gjennomgikk relevante dokumenter angående IRB-innlevering og IRB-godkjenning fra europeiske nevrotraumasentre som deltar i Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Dokumentene inkluderte detaljert informasjon om IRB-prosedyrer og varigheten fra IRB-innlevering til godkjenning (er). De ble oversatt og analysert for å bestemme nivået på harmonisering av IRB-prosedyrer i Europa. Resultater Fra 18 land leverte 66 sentre de etterspurte dokumentene. Den primære IRB-gjennomgangen ble utført sentralt ( N  = 11, 61%) eller lokalt ( N  = 7, 39%) og primær IRB-godkjenning ble oppnådd etter en ( N  = 8, 44%), to ( N  = 6, 33% ) eller tre ( N  = 4, 23%) gjennomgangsrunder med en medianvarighet på henholdsvis 50 og 98 dager frem til primær IRB-godkjenning. Ytterligere IRB-godkjenning var nødvendig i 55% av landene og kunne øke varigheten til 535 dager. Total varighet fra innlevering til nødvendig IRB-godkjenning ble oppnådd var 114 dager (IQR 75-224) og så ut til å være kortere etter innlevering til lokale IRBer sammenlignet med sentrale IRBer (50 mot 138 dager, p  = 0,0074). Konklusjon Vi fant variasjon i IRB-prosedyrer mellom og innenfor europeiske land. Det var forskjeller i krav til innlevering og godkjenning, antall gjennomgangsrunder og total varighet. Forskningssamarbeid kan ha nytte av implementeringen av mer enhetlig lovgivning og regulering samtidig som de anerkjenner lokale kulturvaner og moralske verdier mellom land