The impact of musculoskeletal ill health on quality of life and function after critical care : a multicentre prospective cohort study

Physical disability is a common component of post-intensive care syndrome, but the importance of musculoskeletal health in this population is currently unknown. We aimed to determine the musculoskeletal health state of intensive care unit survivors and assess its relationship with health-related quality of life; employment; and psychological and physical function. We conducted a multicentre prospective cohort study of adults admitted to intensive care for > 48 h without musculoskeletal trauma or neurological insult. Patients were followed up 6 months after admission where musculoskeletal health state was measured using the validated Musculoskeletal Health Questionnaire score. Of the 254 participants, 150 (59%) had a musculoskeletal problem and only 60 (24%) had received physiotherapy after discharge. Functional Comorbidity Index, Clinical Frailty Scale, duration of intensive care unit stay and prone positioning were all independently associated with worse musculoskeletal health. Musculoskeletal health state moderately correlated with quality of life, rs = 0.499 (95%CI 0.392–0.589); anxiety, rs = -0.433 (95%CI -0.538 to -0.315); and depression, rs = -0.537 (95%CI -0.631 to -0.434) (all p < 0.001). Patients with a musculoskeletal problem were less physically active than those without a problem (median (IQR [range]) number of 30 min physical activity sessions per week 1 (0–3.25 [0–7]) vs. 4 (1–7 [0–7]), p < 0.001, respectively). This study found that musculoskeletal health problems were common after intensive care unit stay. However, we observed that < 25% of patients received physical rehabilitation after discharge home. Our work has identified potential high-risk groups to target in future interventional studies

Pinyon and juniper encroachment into sagebrush ecosystems impacts distribution and survival of greater sage-grouse

In sagebrush (Artemisia spp.) ecosystems, encroachment of pinyon (Pinus spp.) and juniper (Juniperus spp.; hereafter, "pinyon-junipeR&Rdquo;) trees has increased dramatically since European settlement. Understanding the impacts of this encroachment on behavioral decisions, distributions, and population dynamics of greater sage-grouse (Centrocercus urophasianus) and other sagebrush obligate species could help benefit sagebrush ecosystem management actions. We employed a novel two-stage Bayesian model that linked avoidance across different levels of pinyon-juniper cover to sage-grouse survival. Our analysis relied on extensive telemetry data collected across 6 yr and seven subpopulations within the Bi-State Distinct Population Segment (DPS), on the border of Nevada and California. The first model stage indicated avoidance behavior for all canopy cover classes on average, but individual grouse exhibited a high degree of heterogeneity in avoidance behavior of the lowest cover class (e.g., scattered isolated trees). The second stage modeled survival as a function of estimated avoidance parameters and indicated increased survival rates for individuals that exhibited avoidance of the lowest cover class. A post hoc frailty analysis revealed the greatest increase in hazard (i.e., mortality risk) occurred in areas with scattered isolated trees consisting of relatively high primary plant productivity. Collectively, these results provide clear evidence that local sage-grouse distributions and demographic rates are influenced by pinyon-juniper, especially in habitats with higher primary productivity but relatively low and seemingly benign tree cover. Such areas may function as ecological traps that convey attractive resources but adversely affect population vital rates. To increase sage-grouse survival, our model predictions support reducing actual pinyon-juniper cover as low as 1.5%, which is lower than the published target of 4.0%. These results may represent effects of pinyon-juniper cover in areas with similar ecological conditions to those of the Bi-State DPS, where populations occur at relatively high elevations and pinyon-juniper is abundant and widespread.The Rangeland Ecology & Management archives are made available by the Society for Range Management and the University of Arizona Libraries. Contact [email protected] for further information

Encounters with pinyon-juniper influence riskier movements in greater sage-grouse across the great basin

Fine-scale spatiotemporal studies can better identify relationships between individual survival and habitat fragmentation so thatmechanistic interpretations can be made at the population level. Recent advances in Global Positioning System(GPS) technology and statistical models capable of deconstructing high-frequency location data have facilitated interpretation of animal movement within a behaviorally mechanistic framework. Habitat fragmentation due to singleleaf pinyon (Pinus monophylla; hereafter pinyon) and Utah juniper (Juniperus osteosperma; hereafter juniper) encroachment into sagebrush (Artemisia spp.) communities is a commonly implicated perturbation that can adversely influence greater sage-grouse (Centrocercus urophasianus; hereafter sage-grouse) demographic rates. Using an extensive GPS data set (233 birds and 282,954 locations) across 12 study sites within the Great Basin, we conducted a behavioral change point analysis and constructed Brownian bridgemovementmodels fromeach behaviorally homogenous section.Wefound the probability of encountering pinyon-juniper among adults was two and three times greater than that of yearlings and juveniles, respectively. However, the movement rate in response to the probability of encountering pinyon-juniper trees was 1.5 times greater for juveniles. Parameter estimates indicated a 6.1% increase in the probability of encountering pinyonjuniper coupled with a 6.2 km/hour increase in movement speed resulted in a 56%, 42% and 16% increase in risk of daily mortality, for juveniles, yearlings, and adults, respectively. The effect of pinyon-juniper encounters on survival was dependent on movement rate and differed among age class. Under fast speed movements (i.e., flight), mortality risk increased as encountering pinyon-juniper increased across all age classes. In contrast, slower speeds (i.e., average) yielded similar adverse effects for juveniles and yearlings but not for adults. This analytical framework supports a behavioral mechanism that explains reduced survival related to pinyon-juniper within sagebrush environments,whereby encountering pinyon-juniper stimulates riskier movements that likely increase vulnerability to visually acute predators.The Rangeland Ecology & Management archives are made available by the Society for Range Management and the University of Arizona Libraries. Contact [email protected] for further information

Encounters with pinyon-juniper influence riskier movements in greater sage-grouse across the great basin

Fine-scale spatiotemporal studies can better identify relationships between individual survival and habitat fragmentation so thatmechanistic interpretations can be made at the population level. Recent advances in Global Positioning System(GPS) technology and statistical models capable of deconstructing high-frequency location data have facilitated interpretation of animal movement within a behaviorally mechanistic framework. Habitat fragmentation due to singleleaf pinyon (Pinus monophylla; hereafter pinyon) and Utah juniper (Juniperus osteosperma; hereafter juniper) encroachment into sagebrush (Artemisia spp.) communities is a commonly implicated perturbation that can adversely influence greater sage-grouse (Centrocercus urophasianus; hereafter sage-grouse) demographic rates. Using an extensive GPS data set (233 birds and 282,954 locations) across 12 study sites within the Great Basin, we conducted a behavioral change point analysis and constructed Brownian bridgemovementmodels fromeach behaviorally homogenous section.Wefound the probability of encountering pinyon-juniper among adults was two and three times greater than that of yearlings and juveniles, respectively. However, the movement rate in response to the probability of encountering pinyon-juniper trees was 1.5 times greater for juveniles. Parameter estimates indicated a 6.1% increase in the probability of encountering pinyonjuniper coupled with a 6.2 km/hour increase in movement speed resulted in a 56%, 42% and 16% increase in risk of daily mortality, for juveniles, yearlings, and adults, respectively. The effect of pinyon-juniper encounters on survival was dependent on movement rate and differed among age class. Under fast speed movements (i.e., flight), mortality risk increased as encountering pinyon-juniper increased across all age classes. In contrast, slower speeds (i.e., average) yielded similar adverse effects for juveniles and yearlings but not for adults. This analytical framework supports a behavioral mechanism that explains reduced survival related to pinyon-juniper within sagebrush environments,whereby encountering pinyon-juniper stimulates riskier movements that likely increase vulnerability to visually acute predators.The Rangeland Ecology & Management archives are made available by the Society for Range Management and the University of Arizona Libraries. Contact [email protected] for further information

Improved regression calibration

The likelihood for generalized linear models with covariate measurement error cannot in general be expressed in closed form which makes maximum likelihood estimation taxing. A popular alternative is regression calibration which is computationally efficient at the cost of inconsistent estimation. We propose an improved regression calibration approach, a general pseudo maximum likelihood estimation method based on a conveniently decomposed form of the likelihood. It is both consistent and computationally efficient, and produces point estimates and estimated standard errors which are practically identical to those obtained by maximum likelihood. Simulations suggest that improved regression calibration which is easy to implement in standard software, works well in a range of situations