Migrating raptor counts: the need for sharing objectives and field protocols, and the benefits of using radar

Capsule: Raptor migration attracts the interest for different reasons, but not all raptor counts achieve the goal of repeatability through the use of standardized field protocols, and this does not allow comparisons of data to be made across years and sites. Aims: We analysed migrating raptor count activities in Italy to verify the interest on this phenomenon by identifying organizers of such counts, and we ascertained the use of a minimum repeatable field protocol (MRFP), and the implications of using it or not. Moreover, we tested the use of radar to support field monitoring. Methods: We analysed 298 migrating raptor counts carried out between 1984 and 2016 by considering characteristics of raptor counts at migratory bottlenecks (number of years covered, use of MRFP, numbers of raptors counted, etc.). In addition, we analysed two case studies using radar to evaluate the effectiveness of raptor counts. Results: There is a growing interest in raptor migration, as well as an increasing use of a MRFP, although differences between counts emerged, probably due to the different aims of the promoting organizations. At sites not using MRFP, more raptors were counted than at other sites, probably because of a greater bias in the data collected. Radar is able to clarify the water-crossing behaviour of raptors at coastal sites, and allows the proportion of birds passing undetected by observers to be evaluated. It also provides data on the spatial density of migrants across a sample area. Conclusions: The use of MRFP is important to harmonize data collection and is necessary to allow comparisons across years and sites. Moreover, the use of radar can be recommended for optimizing raptor monitoring schemes

Comparison of indirect radiation dose estimates with directly measured radiation dose for patients and operators during complex endovascular procedures

BackgroundA great deal of attention has been directed at the necessity and potential for deleterious outcomes as a result of radiation exposure during diagnostic evaluations and interventional procedures. We embarked on this study in an attempt to accurately determine the amount of radiation exposure given to patients undergoing complex endovascular aortic repair. These measured doses were then correlated with radiation dose estimates provided by the imaging equipment manufacturers that are typically used for documentation and analysis of radiation-induced risk.MethodsConsecutive patients undergoing endovascular thoracoabdominal aneurysm (eTAAA) repair were prospectively studied with respect to radiation dose. Indirect parameters as cumulative air kerma (CAK), kerma area product (KAP), and fluoroscopy time (FT) were recorded concurrently with direct measurements of dose (peak skin dose [PSD]) and radiation exposure patterns using radiochromatic film placed in the back of the patient during the procedure. Simultaneously, operator exposure was determined using high-sensitivity electronic dosimeters. Correlation between the indirect and direct parameters was calculated. The observed radiation exposure pattern was reproduced in phantoms with over 200 dosimeters located in mock organs, and effective dose has been calculated in an in vitro study. Scatter plots were used to evaluate the relationship between continuous variables and Pearson coefficients.ResultseTAAA repair was performed in 54 patients over 5 months, of which 47 had the repair limited to the thoracoabdominal segment. Clinical follow-up was complete in 98% of the patients. No patients had evidence of radiation-induced skin injury. CAK exceeded 15 Gy in 3 patients (the Joint Commission on Accreditation of Healthcare Organizations [JCAHO] threshold for sentinel events); however, the direct measurements were well below 15 Gy in all patients. PSD was measured by quantifying the exposure of the radiochromatic film. PSD correlated weakly with FT but better with CAK and KAP (r = 0.55, 0.80, and 0.76, respectively). The following formula provides the best estimate of actual PSD = 0.677 + 0.257 CAK. The average effective dose was 119.68 mSv (for type II or III eTAAA) and 76.46 mSv (type IV eTAAA). The operator effective dose averaged 0.17 mSv/case and correlated best with the KAP (r = 0.82, P < .0001).ConclusionFT cannot be used to estimate PSD, and CAK and KAP represent poor surrogate markers for JCAHO-defined sentinel events. Even when directly measured PSDs were used, there was a poor correlation with clinical event (no skin injuries with an average PSD >2 Gy). The effective radiation dose of an eTAAA is equivalent to two preoperative computed tomography scans. The maximal operator exposure is 50 mSv/year, thus, a single operator could perform up to 294 eTAAA procedures annually before reaching the recommended maximum operator dose

Endovascular treatment as first line approach for infrarenal aortic occlusive disease

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Perioperative cardiac events in endovascular repair of complex aortic aneurysms and association with preoperative studies

BackgroundEndovascular repair of complex aortic aneurysms (CAAs) can be performed in high-risk individuals, yet is still associated with significant morbidity, including spinal cord ischemia, cardiac complications, and death. This analysis was undertaken to better define the cardiac risk for CAA.MethodsA prospective database of patients undergoing thoracoabdominal or juxtarenal aortic aneurysm repair with branched and fenestrated endografts was used to retrospectively determine the number of cardiac events, defined as myocardial infarction (MI), atrial fibrillation (AF), and ventricular arrhythmia (VA), that occurred ≤30 days of surgery. Postoperative serial troponin measurements were performed in 266 patients. Any additional available cardiac information, including preoperative echocardiography, physiologic stress tests, and history of cardiac disease, was obtained from medical records. The efficacy of preoperative stress testing and the association of various echo parameters were evaluated in the context of cardiac outcomes using univariable and multivariable logistic regression models.ResultsBetween August 2001 and December 2007, 395 patients underwent endovascular repair of a thoracoabdominal or juxtarenal aortic aneurysm. The incidence of AF, VA, and 30-day cardiac-related death was 9%, 3%, and 2%, respectively. Overall 30-day mortality was 6%. Univariable analysis showed the presence of mitral annulus calcification was associated with MI (odds ratio [OR], 3.5; 95% confidence interval [CI], 0.9-13.8; P = .07). Left atrium cavity area, ejection fraction, left ventricle mass, and left ventricular mass index were univariably associated with the presence of VA. Multivariable analysis showed only the left atrium cavity area was independently associated with VA (OR, 1.2; 95% CI, 1.0-1.5; P = .07). Stress test was done in 179 patients. Negative stress test results occurred in 152 (85%), of whom 9 (6%) sustained an MI during the 30-day perioperative course. MI occurred in 2 of the 27 patients (7%) who had a positive stress test result.ConclusionsEndovascular repair of CAA can be performed in high-risk individuals but is associated with significant cardiac risk. It remains difficult to risk stratify patients using preoperative stress testing. Echo evaluation may help to identify patients who may be more likely to develop ventricular arrhythmias in the postoperative period and thus warrant closer monitoring. Postoperative troponin monitoring of all patients undergoing repair of CAA is warranted given the overall risk of MI

Urgent and emergent repair of complex aortic aneurysms using an off-the-shelf branched device

IntroductionEndovascular repair using off-the-shelf endografts is a viable solution in patients with ruptured or symptomatic complex aortic aneurysms. This analysis aimed to present the peri-operative and follow-up outcomes in urgent and emergent cases managed with the t-Branch multibranched thoracoabdominal endograft.MethodsProspectively collected data from all consecutive urgent and emergent cases managed in two aortic centers between January 1st, 2014, to November 30th, 2022, using the t-Branch device (Cook Medical Inc., Bjaeverskov, Denmark) were analyzed. Patients presenting with ruptured aortic complex aneurysms were characterized as emergent and patients with aneurysms &gt;90 mm of diameter, or symptomatic aneurysms were characterized as urgent. Technical success, 30-day mortality, major adverse events (MAE) and spinal cord ischemia (SCI) rates were assessed.Results225 patients (36.5% females, 72.5 ± 2.8 years) were included; 73.0% were urgent. The mean aneurysm diameter was 109 ± 3.9 mm and 44.4% were type I–III TAAAs. Females (p = .03), para-renal aneurysms (p = .02) and ASA score IV (p &lt; .001) were more common in emergent cases. Technical success was 97.8%. Thirty-day mortality and MAE rates were 17.8% and 30.6%, respectively. SCI rate was 14.7%, (4.8% paraplegia rate) with 22.2% of patients receiving prophylactic cerebrospinal drainage. Thirty-day mortality (13.3% vs. 26.7%, p = .04) and MAE (26.0% vs. 43.0%, p = .02) were more common among emergent cases while technical success (97.6% vs. 98.3%, p = .9), and SCI (13.3% vs. 18.3%, p = .4) were similar. Survival at 12-months was 83.5% (SE 5.9%) for the urgent and 77.1% (SE 8.2%) for the emergent group (log rank, p = 0.96).ConclusionT-Branch represents an effective and safe solution for the management of urgent and emergent cases with complex aortic aneurysms, with high technical success, promising early mortality and SCI rates

Monitoring Risk Factors and Improving Adherence to Therapy in Patients With Chronic Kidney Disease (Smit-CKD Project): Pilot Observational Study

Background: Chronic kidney disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the increased penetration of mobile phones, a mobile app could educate patients to autonomously monitor cardiorenal risk factors. Objective: With this background in mind, we developed an integrated system of a server and app with the aim of improving self-monitoring of cardiovascular and renal risk factors and adherence to therapy. Methods: The software infrastructure for both the Smit-CKD server and Smit-CKD app was developed using standard web-oriented development methodologies preferring open source tools when available. To make the Smit-CKD app suitable for Android and iOS, platforms that allow the development of a multiplatform app starting from a single source code were used. The integrated system was field tested with the help of 22 participants. User satisfaction and adherence to therapy were measured by questionnaires specifically designed for this study; regular use of the app was measured using the daily reports available on the platform. Results: The Smit-CKD app allows the monitoring of cardiorenal risk factors, such as blood pressure, weight, and blood glucose. Collected data are transmitted in real time to the referring general practitioner. In addition, special reminders improve adherence to the medication regimen. Via the Smit-CKD server, general practitioners can monitor the clinical status of their patients and their adherence to therapy. During the test phase, 73% (16/22) of subjects entered all the required data regularly and sent feedback on drug intake. After 6 months of use, the percentage of regular intake of medications rose from 64% (14/22) to 82% (18/22). Analysis of the evaluation questionnaires showed that both the app and server components were well accepted by the users. Conclusions: Our study demonstrated that a simple mobile app, created to self-monitor modifiable cardiorenal risk factors and adherence to therapy, is well tolerated by patients affected by chronic kidney disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence and if self-monitoring of risk factors will improve clinical outcomes in this population

Neurosteroids and epilepsy

Purpose of reviewNeurosteroids are a family of compounds synthesized directly in the brain bytransforming cholesterol into pregnenolone, which is then converted to compoundssuch as allopregnanolone and allotetrahydrodeoxycorticosterone. In view of their abilityto modulate neurotransmission, neurosteroids may influence the clinical course ofepileptic disorders. In this review, we highlight two emerging properties ofneurosteroids, that is, their anticonvulsant and antiepileptogenic activities.Recent findingsIt has been shown that fluctuations in neurosteroid synthesis, such as those seen inresponse to stress or during the ovarian cycle, determine an increase in seizurethreshold. Moreover, increased neurosteroid synthesis, presumably occurring in glialcells during epileptogenesis, delays the appearance of recurrent spontaneous seizuresin an animal model of temporal lobe epilepsy; such an effect may be due to augmentedtonic g-aminobutyric acid type A receptor-mediated inhibition. Finally, clinical trials withganaxolone, an allopregnanolone analogue, have demonstrated beneficial effects inpharmacoresistant epileptic patients, whereas finasteride – which interferes withneurosteroid synthesis – facilitates seizures in catamenial epilepsy.SummaryThe overall evidence suggests that neurosteroids may represent a novel therapeuticstrategy in epileptic disorders and a future perspective to control epileptogenicity

Flying by the seat of your pants and magic behind doors : an interpretative phenomenological analysis of difficult decision making in clinical practice

Introduction The process of decision making has been widely studied within different academic paradigms. Many theories and models have been developed from this research activity. However, there is a lack of in-depth research on individuals’ experience of decision making. The present research explores this topic with Clinical Psychologists. This group of professionals are trained to be expert in a specific discipline, which emphasises the need for making informed judgements and for justifying decisions. Objectives To provide an in-depth account of how Clinical Psychologists experience decision making in the context of clinical practice. To relate the analysis to theories and models of decision making and to research on factors thought to influence judgement and decision making. Method Semi-structured interviews were conducted with seven Clinical Psychologists. These were transcribed and analysed using Interpretative Phenomenological Analysis (IPA) methodology. Outcomes Elements of the decision making environment such as managing one’s conflicting beliefs and difficult emotions, responding to uncertainty and changeable scenarios and normative versus unique elements of one’s practice were elucidated in the analyses. The contribution of this work to research in decision making and the development of clinical practice are discussed.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Circannual variation in movement patterns of the Black Kite (Milvus migrans migrans): a review

The nominal subspecies of the Black Kite is a summer resident in Europe and Asia that winters mostly in western Africa, although numbers of birds wintering in the Mediterranean area are increasing. During migrations, tens of thousands are observed migrating through the Strait of Gibraltar between Spain and Morocco, along the eastern side of the Black Sea, and in the Middle East, while substantial numbers cross the central Mediterranean and the Bosphorus. This paper provides a review of research concerning migration and its relationship with foraging behaviour in a circannual perspective. In particular, research made both by satellite tracking and by visual observations suggests a more evident time-selected migration during autumn rather than spring. Moreover, differences in timing occurring among different flyways could be explained either by different rates of intra-specific competition in areas with different breeding density and/or by different distances between wintering and breeding grounds