The Fontan epidemic: population projections from the Australia and New Zealand Fontan registry

Background: The number and age demographic of the future Fontan population is unknown

Hospital inpatient costs for single ventricle patients surviving the Fontan procedure

We estimated the inpatient resource use for a Fontan patient from birth to adulthood and explored factors that might induce cost differences (2014 US dollar). Inpatient costing records from 4 hospitals with greatest numbers of Fontan patients in Australia and New Zealand were linked with the Fontan registry database. Inpatient records between July 1995 and September 2014 for 420 Fontan patients were linked, and the most frequent primary diagnoses were hypoplastic left heart syndrome (20.7%), tricuspid atresia (19.7%), and double inlet left ventricle (17.1%). The mean hospital cost for a Fontan patient from birth to 18 years of age was estimated to be $390,601 (95$264,703 to $516,499), corresponding to 164 (95$219,482 (95% CI $202,410 to$236,553) and the cost thereafter over 15 years was $146,820 (95$44,409 to $249,231), corresponding to 82 (95% CI 72 to 92) and 65 (95% CI 18 to 112) inpatient days, respectively. Costs were higher in male and hypoplastic left heart syndrome patients in the staged procedures period (

Quality of Health Care for Children in Australia, 2012-2013.

Importance: The quality of routine care for children is rarely assessed, and then usually in single settings or for single clinical conditions. Objective: To estimate the quality of health care for children in Australia in inpatient and ambulatory health care settings. Design, Setting, and Participants: Multistage stratified sample with medical record review to assess adherence with quality indicators extracted from clinical practice guidelines for 17 common, high-burden clinical conditions (noncommunicable [n = 5], mental health [n = 4], acute infection [n = 7], and injury [n = 1]), such as asthma, attention-deficit/hyperactivity disorder, tonsillitis, and head injury. For these 17 conditions, 479 quality indicators were identified, with the number varying by condition, ranging from 9 for eczema to 54 for head injury. Four hundred medical records were targeted for sampling for each of 15 conditions while 267 records were targeted for anxiety and 133 for depression. Within each selected medical record, all visits for the 17 targeted conditions were identified, and separate quality assessments made for each. Care was evaluated for 6689 children 15 years of age and younger who had 15 240 visits to emergency departments, for inpatient admissions, or to pediatricians and general practitioners in selected urban and rural locations in 3 Australian states. These visits generated 160 202 quality indicator assessments. Exposures: Quality indicators were identified through a systematic search of local and international guidelines. Individual indicators were extracted from guidelines and assessed using a 2-stage Delphi process. Main Outcomes and Measures: Quality of care for each clinical condition and overall. Results: Of 6689 children with surveyed medical records, 53.6% were aged 0 to 4 years and 55.5% were male. Adherence to quality of care indicators was estimated at 59.8% (95% CI, 57.5%-62.0%; n = 160 202) across the 17 conditions, ranging from a high of 88.8% (95% CI, 83.0%-93.1%; n = 2638) for autism to a low of 43.5% (95% CI, 36.8%-50.4%; n = 2354) for tonsillitis. The mean adherence by condition category was estimated as 60.5% (95% CI, 57.2%-63.8%; n = 41 265) for noncommunicable conditions (range, 52.8%-75.8%); 82.4% (95% CI, 79.0%-85.5%; n = 14 622) for mental health conditions (range, 71.5%-88.8%); 56.3% (95% CI, 53.2%-59.4%; n = 94 037) for acute infections (range, 43.5%-69.8%); and 78.3% (95% CI, 75.1%-81.2%; n = 10 278) for injury. Conclusions and Relevance: Among a sample of children receiving care in Australia in 2012-2013, the overall prevalence of adherence to quality of care indicators for important conditions was not high. For many of these conditions, the quality of care may be inadequate

Mundos mesclados, espaços segregados: cultura material, mestiçagem e segmentação no sítio Aldeia em Santarém (PA)

This article discusses the processes of cultural exchange between Portuguese, Portuguese-Brazilian, Amerindians, and mestizos based on the analysis of the material culture from households of Santarém (PA), occupied during the eighteenth and nineteenth centuries,. Although these social groups manipulated material culture aiming to express different values, related to hierarchy, social segmentation, and affirmation of identities, ambiguity also characterizes these assemblages. This material ambiguity informs about the mixtures of both practices and cultural references that brought about the building of a mestizo society.Com base na análise da cultura material proveniente de unidades domésticas do núcleo urbano de Santarém (PA), ocupadas nos séculos XVIII e XIX, o presente artigo discute os processos de trocas culturais entre portugueses, luso-brasileiros, indígenas e mestiços. Embora esses grupos sociais tenham manipulado a cultura material visando expressar diferentes valores, relacionados à hierarquia, segmentação social e afirmação de identidades, a ambigüidade é uma característica das amostras analisadas, informando sobre as misturas de práticas e de referenciais culturais que levaram à construção de uma sociedade mestiça

On-orbit performance of the MIPS instrument

The Multiband Imaging Photometer for Spitzer (MIPS) provides long wavelength capability for the mission, in imaging bands at 24, 70, and 160 microns and measurements of spectral energy distributions between 52 and 100 microns at a spectral resolution of about 7%. By using true detector arrays in each band, it provides both critical sampling of the Spitzer point spread function and relatively large imaging fields of view, allowing for substantial advances in sensitivity, angular resolution, and efficiency of areal coverage compared with previous space far-infrared capabilities. The Si:As BIB 24 micron array has excellent photometric properties, and measurements with rms relative errors of 1% or better can be obtained. The two longer wavelength arrays use Ge:Ga detectors with poor photometric stability. However, the use of 1.) a scan mirror to modulate the signals rapidly on these arrays, 2.) a system of on-board stimulators used for a relative calibration approximately every two minutes, and 3.) specialized reduction software result in good photometry with these arrays also, with rms relative errors of less than 10%

Watershed restoration experiments: maximizing learning while trying to recover endangered species

Ecosystem experiments are arguably the most direct method available for predicting a population or environmental response to management and have contributed greatly to our understanding of ecological processes within watersheds. Often the experiments involve a large disturbance to be applied to a watershed (e.g. timber harvest, acid rain), and then evaluate how the system responds to the loss of an ecological service. Stream restoration has been used extensively throughout the world to improve fish population performance; however, the reach level scale at which they are often applied provides too small of an effect size to the target population, or more commonly are never monitored. Stream restoration could be implemented at a large enough scale to potentially produce an increase in population production, while maximizing learning if conducted in an ecosystem experimental fashion. These concepts have led to the development of Intensively Monitored Watershed (IMW) studies to evaluate anadromous salmonid population level responses to large-scale restoration efforts the Pacific Northwest United States. The goal is to develop a network of IMWs to assess limiting factors, develop actions aimed at restoring ecosystem processes, and evaluate the effectiveness of different actions or a suite of actions on fish populations across a range of watershed types. These large-scale experiments include detailed monitoring to not only detect changes but to identify the mechanisms of response to help generalize results. We summarize the monitoring, implementation plan, and experimental designs of two of these studies we are currently conducting. In these examples, pre-restoration information of salmonid abundance, growth, and survival across multiple life-stages has been collected using seining, electroshocking, weirs and PIT tag technologies. In addition, physical habitat has been assessed using aerial photography, aerial and ground-based LiDAR, and GPS and total station survey techniques. Restoration actions will be implemented in a staircase fashion in treatment reaches and watersheds, while control analogs remain unmanipulated. The monitoring techniques and experimental design provide a powerful means to compare the baseline condition to expected changes in physical habitat quality and quantity and ultimately in salmonid population processes

A geomorphic assessment to inform strategic stream restoration planning in the Middle Fork John Day Watershed, Oregon, USA

A geomorphic assessment of the Middle Fork John Day Watershed, Oregon, USA, was used to generate a hierarchical, map-based understanding of watershed impairments and potential opportunities for improvements. Specifically, we (1) assessed river diversity (character and behavior) and patterns of reach types (and their controls); (2) evaluated the geomorphic condition of the streams; (3) interpreted their geomorphic recovery potential; and (4) synthesized the above into a hypothetical, strategic management plan. Collectively, these maps can set bounds and provide realistic guidance for river rehabilitation, design and implementation efforts. Fifteen distinct reach types were identified, two-thirds of which are found along perennial streams. On the basis of a variety of geo-indicators, approximately two-thirds of all perennial stream reaches were found to be in ‘good’ geomorphic condition, whereas one-third had departed to ‘moderate’ and ‘poor’ condition. Departures from ‘good’ condition were primarily related to riparian vegetation removal, conversion of floodplain to agricultural land uses (farming and grazing), logging, and channel bed dredge mining for gold. Encouragingly, the majority of reaches classified as being in moderate geomorphic condition were found to have high recovery potential. While our geomorphic assessment has practical utility for informing physically realistic expectation management for efforts like salmonid habitat restoration, the maps themselves are the key vehicle for communicating and visualizing among stakeholders