Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study

Introduction: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods: We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen's ?. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria. Results: Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (? ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician's diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions: Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Multiethnic Meta-Analysis Identifies RAI1 as a Possible Obstructive Sleep Apnea-related Quantitative Trait Locus in Men.

Obstructive sleep apnea (OSA) is a common heritable disorder displaying marked sexual dimorphism in disease prevalence and progression. Previous genetic association studies have identified a few genetic loci associated with OSA and related quantitative traits, but they have only focused on single ethnic groups, and a large proportion of the heritability remains unexplained. The apnea-hypopnea index (AHI) is a commonly used quantitative measure characterizing OSA severity. Because OSA differs by sex, and the pathophysiology of obstructive events differ in rapid eye movement (REM) and non-REM (NREM) sleep, we hypothesized that additional genetic association signals would be identified by analyzing the NREM/REM-specific AHI and by conducting sex-specific analyses in multiethnic samples. We performed genome-wide association tests for up to 19,733 participants of African, Asian, European, and Hispanic/Latino American ancestry in 7 studies. We identified rs12936587 on chromosome 17 as a possible quantitative trait locus for NREM AHI in men (N = 6,737; P = 1.7 × 10 <sup>-8</sup> ) but not in women (P = 0.77). The association with NREM AHI was replicated in a physiological research study (N = 67; P = 0.047). This locus overlapping the RAI1 gene and encompassing genes PEMT1, SREBF1, and RASD1 was previously reported to be associated with coronary artery disease, lipid metabolism, and implicated in Potocki-Lupski syndrome and Smith-Magenis syndrome, which are characterized by abnormal sleep phenotypes. We also identified gene-by-sex interactions in suggestive association regions, suggesting that genetic variants for AHI appear to vary by sex, consistent with the clinical observations of strong sexual dimorphism

Long Term Productivity Benefits of Soil Conservation

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Long Term Productivity Benefits of Soil Conservation

Please contact the NWISRL if you have a copy of this publication

Long term productivity benefits of soil conservation

Many studies have documented that erosion reduces crop yields (Langdale and Shrader, 1982; Follet and Stewart, 1985; Am. Soc. Ag. Engr., 1985). Few of those studies have incorporated the effect on yield of changes in technology (Young, 1984) and only one, to our knowledge, has considered the effect of yield-enhancing agricultural technical progress on erosion damage assessment (Walker and Young, 1986). Lost yield potential is the major on-site effect of erosion. Off-site effects in the form of sedimentation and impaired water quality are also important but are not discussed here. A conservation practice that reduces erosion and yield damage produces a benefit from conservation. This potential benefit, in the form of yield damage avoided, is the objective of soil conservation research and conservation adoption. Understanding the cost of erosion damage and the benefits from erosion control are essential for developing long range policies for conserving soil resources. The tri-state STEEP multidisciplinary research program is dedicated to finding solutions to the erosion problems in the Pacific Northwest. STEEP research results concerning the long term productivity impacts of erosion are the focus of this paper. This paper describes the different types of erosion damage and presents concepts for correctly measuring that damage or the potential benefits from erosion control. STEEP research is presented to show the effect of erosion on the soil resource and on crop productivity. The potential for restoring productivity on eroded soils is discussed. The paper also describes how to separate the effects of technology and yield damage and presents empirical estimates of conservation benefits. A first classification of erosion damage distinguishes between current damage and long-term damage. Current erosion damage is due primarily to seedbed erosion, reduced tillering, and plant suffocation by sediment, all of which reduce stand density. Current damage is yield loss this year due to erosion this year. These erosional effects do not carry over into subsequent years. Long-term erosion damage occurs when erosion this year reduces yield in future years. This yield loss is due to the loss of nutrient-rich topsoil, to degradation of soil structure and to reduction of plant-available water-holding capacity of eroded soil. Long-term damage is of great concern because its effects are enduring, even irreversible in large part. Estimates of the long-term productivity benefits of soil conservation are formulated in terms of long-term erosion damage avoided by conservation

Encouraging outlook for recovery of a once severely exploited marine megaherbivore

Aim: To critically review the status of the green sea turtle (Chelonia mydas) using the best available scientific studies as there is a prevailing view that this species is globally endangered and its marine ecosystem functions compromised. Location: Ogasawara (Japan), Hawaii (USA), Great Barrier Reef (Australia), Florida (USA), Tortuguero (Costa Rica). Methods: We compiled seasonal nesting activity data from all reliable continuous long-term studies (>.25 years), which comprised data series for six of the world's major green turtle rookeries. We estimated the underlying time-specific trend in these six rookery-specific nester or nest abundance series using a generalized smoothing spline regression approach. Results: Estimated rates of nesting population increase ranged from c. 4-14% per annum over the past two to three decades. These rates varied considerably among the rookeries, reflecting the level of historical exploitation. Similar increases in nesting population were also evident for many other green turtle stocks that have been monitored for shorter durations than the long-term studies presented here. Main conclusions: We show that six of the major green turtle nesting populations in the world have been increasing over the past two to three decades following protection from human hazards such as exploitation of eggs and turtles. This population recovery or rebound capacity is encouraging and suggests that the green turtle is not on the brink of global extinction even though some stocks have been seriously depleted and are still below historical abundance levels. This demonstrates that relatively simple conservation strategies can have a profound effect on the recovery of once-depleted green turtle stocks and presumably the restoration of their ecological function as major marine consumers. © 2007 The Authors Journal compilatio