Accounting for Critical Attributes and Uncertainty in Flow-Ecology Relationships

Environmental flows are used to maintain streamflow for aquatic species in rivers while also sustaining human water requirements. While there are many approaches to develop environmental flows, they all rely on a strong conceptual understanding of flow-ecology relationships, which are often uncertain. Uncertainty in flow-ecology relationships can stem from using limited data to develop or test relationships or an incomplete understanding of the attributes inherent to each relationship, such as climate and land conditions. Accounting for these attributes and uncertainty in flow-ecology relationships is critical given mounting interest to develop and implement environmental flows at large scales, often with limited information. Using the South Fork Eel River watershed in northern California USA as a case study, I explored attributes and uncertainty in flow-ecology relationships through a targeted review of academic journal articles and Bayesian Network modeling. I found that few relationships describe explicit links between the flow regime and species or cover the full range of climate and land conditions present in the watershed. These gaps informed several scenarios within a Bayesian Network model—represented as different sets of probabilities—which show that model results can differ by up to 50% depending on the uncertainty scenario. This study informs future field monitoring efforts to develop flow-ecology relationships and promotes effective translation and modeling of existing flow-ecology relationships and their uncertainties

The Vehicle, Spring 2007

Table of Contents She Might Just Take You for GrantedRebecca M. Griffithpage 1 ShwagDarius Juttipage 2 In LoveAmanda Vealepage 9 SubmissiveSarah Ellerpage 10 Wedding SongRebecca M. Griffithpage 11 Why No Ladies and Gentlemen, My Shit Never StinksJacob Fosterpage 13 Death of an English MajorLindsey Durbinpage 14 Summer\u27s PerfumeRebecca M. Griffithpage 15 Gigavolt and ChrisEric Schumacherpage 16 UntitledKris Jonespage 22 Ode to the MuseGreg Harrellpage 23 TenderAmanda Vealepage 24 When the Muses HeaveElizabeth Hoodpage 25 Depression LiftingAmanda Vealepage 26 Red SwordAndrew Deckerpage 27 Warring IdeologyMargaret B. Hamperpage 29 ConfessionGreg Harrellpage 34 A Glass PuzzleBrittany Morganpage 35 Hey MaJacob Fosterpage 36 As July Faded AwayRebecca M. Griffithpage 37 About the LeftoversGina LoBiancopage 38 Me, Myself & ILindsey Durbinpage 39 Iced Parking LotRebecca M. Griffithpage 41 About the Authors Art Submissions Mike\u27s Revelation and MikeSean Walkercovers UntitledChad Navelpage 9 Morning in Tintern AbbeyCarrie Muellerpage 12 WestminsterCarrie Muellerpage 21 A Fighting ChanceOsha Rudduckpage 22 Rooftop SunsetJennifer O\u27Neilpage 25 EIU IVCarrie Muellerpage 28 MandolinOsha Rudduckpage 38 EIU IIICarrie Muellerpage 42https://thekeep.eiu.edu/vehicle/1087/thumbnail.jp

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Gendered health, economic, social and safety impact of COVID-19 on adolescents and young adults in Nairobi, Kenya

Background Infectious disease outbreaks like COVID-19 and their mitigation measures can exacerbate underlying gender disparities, particularly among adolescents and young adults in densely populated urban settings. Methods An existing cohort of youth ages 16–26 in Nairobi, Kenya completed a phone-based survey in August-October 2020 (n = 1217), supplemented by virtual focus group discussions and interviews with youth and stakeholders, to examine economic, health, social, and safety experiences during COVID-19, and gender disparities therein. Results COVID-19 risk perception was high with a gender differential favoring young women (95.5% vs. 84.2%; p<0.001); youth described mixed concern and challenges to prevention. During COVID-19, gender symmetry was observed in constrained access to contraception among contraceptive users (40.4% men; 34.6% women) and depressive symptoms (21.8% men; 24.3% women). Gender disparities rendered young women disproportionately unable to meet basic economic needs (adjusted odds ratio [aOR] = 1.21; p<0.05) and in need of healthcare during the pandemic (aOR = 1.59; p<0.001). At a bivariate level, women had lower full decisional control to leave the house (40.0% vs. 53.2%) and less consistent access to safe, private internet (26.1% vs. 40.2%), while men disproportionately experienced police interactions (60.1%, 55.2% of which included extortion). Gender-specific concerns for women included menstrual hygiene access challenges (52.0%), increased reliance on transactional partnerships, and gender-based violence, with 17.3% reporting past-year partner violence and 3.0% non-partner sexual violence. Qualitative results contextualize the mental health impact of economic disruption and isolation, and, among young women, privacy constraints. Implications Youth and young adults face gendered impacts of COVID-19, reflecting both underlying disparities and the pandemic’s economic and social shock. Economic, health and technology-based supports must ensure equitable access for young women. Gender-responsive recovery efforts are necessary and must address the unique needs of youth

The Vehicle, Spring 2007

Table of Contents She Might Just Take You for GrantedRebecca M. Griffithpage 1 ShwagDarius Juttipage 2 In LoveAmanda Vealepage 9 SubmissiveSarah Ellerpage 10 Wedding SongRebecca M. Griffithpage 11 Why No Ladies and Gentlemen, My Shit Never StinksJacob Fosterpage 13 Death of an English MajorLindsey Durbinpage 14 Summer\u27s PerfumeRebecca M. Griffithpage 15 Gigavolt and ChrisEric Schumacherpage 16 UntitledKris Jonespage 22 Ode to the MuseGreg Harrellpage 23 TenderAmanda Vealepage 24 When the Muses HeaveElizabeth Hoodpage 25 Depression LiftingAmanda Vealepage 26 Red SwordAndrew Deckerpage 27 Warring IdeologyMargaret B. Hamperpage 29 ConfessionGreg Harrellpage 34 A Glass PuzzleBrittany Morganpage 35 Hey MaJacob Fosterpage 36 As July Faded AwayRebecca M. Griffithpage 37 About the LeftoversGina LoBiancopage 38 Me, Myself & ILindsey Durbinpage 39 Iced Parking LotRebecca M. Griffithpage 41 About the Authors Art Submissions Mike\u27s Revelation and MikeSean Walkercovers UntitledChad Navelpage 9 Morning in Tintern AbbeyCarrie Muellerpage 12 WestminsterCarrie Muellerpage 21 A Fighting ChanceOsha Rudduckpage 22 Rooftop SunsetJennifer O\u27Neilpage 25 EIU IVCarrie Muellerpage 28 MandolinOsha Rudduckpage 38 EIU IIICarrie Muellerpage 42https://thekeep.eiu.edu/vehicle/1087/thumbnail.jp

Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry

Objectives: To determine factors associated with COVID-19-related death in people with rheumatic diseases. Methods: Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category. Results: Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death. Conclusion: Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants