Wildlife Protection, Mitigation, and Enhancment Plan: Minidoka Dam: Final Report.

A wildlife protection, mitigation, and enhancement plan has been developed for the US Bureau of Reclamation's Minidoka Dam and Reservoir in south-central Idaho. Specific objectives of this study included the following: Develop protection, mitigation, and enhancement goals and objectives for target wildlife species; identify potential protection, mitigation, and enhancement opportunities to achieve the mitigation objectives; and coordinate project activities with agencies, tribes, and the public. The interagency work group previously assessed the impacts of Minidoka Dam on wildlife. There were estimated losses of 10,503 habitat units (HU's) for some target wildlife species and gains of 5,129 HU's for other target species. The work group agreed that mitigation efforts should be directed toward target species that were negatively impacted by Minidoka Dam. They developed the following prioritized mitigation goals: 1,531 river otter HU's in riparian/river habitat, 1,922 sage grouse HU's in shrub-steppe (sagebrush-grassland) habitat, 1,746 mule deer HU's in shrub-steppe habitat, and 175 yellow warbler HU's in deciduous scrub-shrub wetland habitat. The work group proposed the following preferred mitigation options, in priority order: Provide benefits of 1,706 river otter and yellow warbler HU's by protecting and enhancing riparian/river habitat in south central Idaho; and provide benefits of 3,668 sage grouse and mule deer HU's by protecting and enhancing shrub-steppe (sagebrush-grassland) habitat. 38 refs., 2 figs., 5 tabs

Determinants and prognosis of high-sensitivity cardiac troponin T peak plasma concentration in patients hospitalized for non-cardiogenic shock

Purpose: The aim of this study was to assess the determinants and prognostic value of high-sensitivity cardiac troponin T peak plasma concentration in intensive care unit patients with non-cardiogenic shock. Material and methods: A prospective observational cohort study was conducted in a single intensive care unit between November 2014 and December 2015. Results: During the study period, 206 patients were hospitalized in the intensive care unit for non-cardiogenic shock and the median peak high-sensitivity cardiac troponin T was 55.1 [24.5–136] pg/mL. A multivariate analysis combining all variables showed that higher body mass index ( t  = 2.52, P  = 0.01), lower left ventricular systolic function ( t  = −2.73, P  = 0.007), higher white blood cell count ( t  = 3.72, P  = 0.0001), lower creatinine clearance ( t  = −2.84, P  = 0.0005), higher lactate level ( t  = 2.62, P  = 0.01) and ST-segment depression ( t  = 3.98, P  = 0.0001) best correlated with log 10 -transformed high-sensitivity cardiac troponin T peak plasma concentration. After multivariate analysis, the high-sensitivity cardiac troponin T peak was not associated with a significant reduction of in-hospital mortality (adjusted odds ratio = 0.99 (95% confidence interval: 0.93–1.02)). Conclusion: High-sensitivity cardiac troponin T elevation was very common in patients hospitalized for non-cardiogenic shock. The factors significantly associated with high-sensitivity cardiac troponin T peak plasma concentration were higher body mass index, decreased left ventricular systolic ejection fraction, higher leucocyte count, decreased renal function, increased lactate level, and ST-segment depression. The high-sensitivity cardiac troponin T peak was not significantly associated with in-hospital mortality in this setting

Effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia

Background: Ventilator-associated pneumonia (VAP) caused by Stenotrophomonas maltophilia is poorly described in the literature. However, it has been shown to be associated with increased morbidity and mortality. Probabilistic antibiotic therapy against S. maltophilia is often ineffective as this pathogen is resistant to many antibiotics. There is no consensus at present on the best therapeutic strategy to adopt (class of antibiotics, antibiotic combination, dosage, treatment duration). The aim of this study was to evaluate the effect of antibiotic therapy strategy on the prognosis of patients with VAP caused by S. maltophilia. Results: This retrospective study evaluated all consecutive patients who developed VAP caused by S. maltophilia between 2010 and 2018 while hospitalized in the intensive care unit (ICU) of a French university hospital in Reunion Island, in the Indian Ocean region. A total of 130 patients with a median Simplified Acute Physiology Score II of 58 [43-73] had VAP caused by S. maltophilia after a median duration of mechanical ventilation of 12 [5-18] days. Ventilator-associated pneumonia was polymicrobial in 44.6% of cases, and ICU mortality was 50.0%. After multivariate Cox regression analysis, the factors associated with increased ICU mortality were older age (hazard ratio (HR): 1.03; 95% CI 1.01-1.04, p = 0.001) and high Sequential Organ Failure Assessment score on the day of VAP onset (HR: 1.08; 95% CI 1.03-1.14, p = 0.002). Appropriate antibiotic therapy, and in particular trimethoprim-sulfamethoxazole, was associated with decreased ICU mortality (HR: 0.42; 95% CI 0.24-0.74, p = 0.003) and decreased hospital mortality (HR: 0.47; 95% CI 0.28-0.79, p = 0.04). Time to start of appropriate antibiotic therapy, combination therapy, and duration of appropriate antibiotic therapy had no effect on ICU mortality (p > 0.5). Conclusion: In our study, appropriate antibiotic therapy, and in particular trimethoprim-sulfamethoxazole, was associated with decreased ICU and hospital mortality in patients with VAP caused by S. maltophilia

Os Contornos e o Entorno da Nova Sociologia da Moral

Neste ensaio vou expor brevemente como vejo o desenvolvimento do campo da Sociologia da Moral, com foco em seu potencial fundamentalmente interdisciplinar, destacando os estudos e tradições que merecem ser incorporados à sociologia. A moral, como tema de investigação da ciência social, perpassa os campos da psicologia (social e do desenvolvimento), sociologia, antropologia, neurociências e economia. Aqueles entre nós implicados no seu desenvolvimento afirmam que ela serve de fundamento para toda a organização e interação social. Assumo, implicitamente, a posição do filósofo Charles Taylor e do sociólogo Christian Smith de que os seres humanos vivem envolvidos em teias de significados, pelas quais são moldados, conforme versões de "certo" e de "bem". Os seres humanos são fundamentalmente morais, não no sentido de serem convencionalmente altruístas ou de se preocuparem com os outros, mas de que as pessoas humanas, por serem seres sociais habitando um espaço social, devem assumir posições sobre temas relevantes nessas sociedades e grupos. As pessoas, de um modo geral, nesse meu paradigma, ancoram seus sentidos de si em posicionamentos morais, padrões que oferecem um solo a partir do qual dão sentido ao mundo através de lentes morais. Uma sociologia da moral compreende a formação dessas crenças, sua relativa imutabilidade ou as circunstâncias pelas quais elas mudam, sua influência sobre a ação e sua reconstrução retrospectiva diante de efeitos desajustados ou de pressões sociais

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk