Strict Guidelines (strict + guideline)

Distribution by Scientific Domains

Selected Abstracts

Large-scale spatio-temporal shifts in the diet of a predator mediated by an emerging infectious disease of its main prey

Marcos Moleón
Abstract Aim, To explore the influence of an emerging infectious disease (EID) affecting a prey species on the spatial patterns and temporal shifts in the diet of a predator over a large geographical scale. We reviewed studies on the diet of Bonelli's eagles (Hieraaetus fasciatus) in order to determine the repercussions of the reduction in the density of its main prey, the rabbit (Oryctolagus cuniculus), caused by outbreaks of rabbit haemorrhagic disease (RHD) since 1988. Location, Western continental Europe. Methods, We compiled published and unpublished information on the diet of breeding Bonelli's eagles from Portugal, Spain and France for a 39-year study period (1968,2006). Nonparametric tests were used in order to analyse temporal shifts in diet composition and trophic diversity (H,) between the periods of ,high' (before outbreak of RHD) and ,low' rabbit density (after outbreak of RHD). A combination of hierarchical agglomerative clustering and non-metric multidimensional scaling (NMDS) analyses were used to test for the existence of geographical patterns in the diet of Bonelli's eagles in each period. Results, The diet of the Bonelli's eagle consisted of rabbit (28.5%), pigeons (24.0%), partridges (15.3%), ,other birds' (11.6%), ,other mammals' (7.1%), corvids (7.0%), and herptiles (6.4%). However, RHD had large consequences for its feeding ecology: the consumption of rabbits decreased by one-third after the outbreak of RHD. Conversely, trophic diversity (H,) increased after outbreak of RHD. At the same time, the analyses showed clear geographical patterns in the diet of the Bonelli's eagle before, but not after, RHD outbreak. Main conclusions, Geographical patterns in the diet of the Bonelli's eagle in western Europe seem to be driven mainly by spatio-temporal variation in the abundance of rabbits and, to a lesser extent, by the local (territorial) environmental features conditioning the presence and density of alternative prey species. We show that an EID can disrupt predator,prey relationships at large spatial and temporal scales through a severe decline in the population of the main prey species. Hence we argue that strict guidelines should be drawn up to prevent human-aided dissemination of ,pathogen pollution', which can threaten wildlife not only at the population and species level but also at the community and ecosystem scale. [source]

Effect of Donor Age on Long-Term Survival Following Cardiac Transplantation

Veli K. Topkara M.D.
Our objective was to analyze the effect of donor age on outcomes after cardiac transplantation. Methods: We retrospectively studied 864 patients who underwent cardiac transplantation at New York Presbyterian Hospital , Columbia University between 1992 and 2002. Patients were divided into two groups; donor age <40 years (Group A, n = 600) and donor age ,40 years (Group B, n = 264). Results: Characteristics including gender, body mass index, and cytomegalovirus (CMV) status were significantly different between the two donor age groups. Race, CMV status, toxoplasmosis status, left ventricular assist device prior to transplant, diabetes mellitus, and retransplantation were similar in both the recipient groups, while age, gender, and BMI were different. Early mortality was lower in Group A, 5%, versus 9.5% in Group B. Multivariate analysis revealed recipient female gender (odd ratio (OR) = 1.71), retransplantation (OR = 1.63), and increased donor age (OR = 1.02) as significant predictors of poor survival in the recipient population. Actuarial survival at 1 year (86.7% vs 81%), 5 years (75% vs 65%), and 10 years (56% vs 42%) was significantly different as well with a log rank p = 0.002. Conclusions: These findings suggest that increased donor age is an independent predictor of long-term survival. However, the shortage of organs makes it difficult to follow strict guidelines when placing hearts; therefore, decisions need to be made on a relative basis. [source]

Reducing patient financial liability for hospitalizations: The physician role,

Edward A. Ross MD
Abstract With increasingly strict guidelines for insurance coverage, hospitals have adopted meticulous resource utilization review and management processes. It is important for physicians to appreciate that careful documentation of certain patient parameters may not only optimize the facility's reimbursement but have profound impact on the patient's out-of-pocket expenses. Hospital utilization teams have access to the frequently changing national payor guidelines for policy benefits, usually revolving around whether the patient meets medical necessity criteria for being classified as an "inpatient" vs. an "observation" outpatient. Those statuses are not merely time-based, and lead to marked differences in patient deductibles and coverage for medication, room, procedure, laboratory, and ancillary charges. There are nationally-recognized guidelines for classification, based on severity of illness and intensity of services provided. By participating in case management activities, physicians can have an important patient advocate role, and thereby minimize the financial burden to these individuals and their families. Journal of Hospital Medicine 2010;5:160,162. © 2010 Society of Hospital Medicine. [source]

Late hepatic allograft dysfunction

Professor of Medicine Russell H. Wiesner MD
Key Points 1Lifelong monitoring of graft function, immunosuppressive levels, and screening for drug toxicity is required in all liver recipients. 2Late hepatic allograft dysfunction is common and is caused by a variety of etiologies including rejection, infection, biliary/vascular abnormalities, recurrence of disease, and drug hepatotoxicity. 3In all patients with late hepatic allograft dysfunction, liver biopsy should be performed to assess for the presence of rejection, and to thus avoid excessive use of bolus corticosteroid therapy and guide appropriate immunosuppressive management. 4Recurrence of disease is the most common cause of late hepatic allograft dysfunction. 5Hepatitis C universally reinfects the hepatic allograft, and is associated with decreased patient and graft survival and leads to the recurrence of cirrhosis in 28% of patients within 5 years of transplantation. 6Major advances have been made in preventing recurrence of hepatitis B by the use of hepatitis B immune globulin in combination with lamivudine therapy. 7Autoimmune liver diseases such as primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis have a recurrence rate of approximately 20% to 30%. 8In patients developing recurrence of autoimmune hepatitis, steroid withdrawal is the most common cause. 9Recurrent hepatocellular cancer can be markedly reduced if strict guidelines are adhered to in selecting patients. 10Drug hepatotoxicity must always be considered in the differential diagnosis of late hepatic allograft dysfunction. [source]

Recommendations for Integrating Restoration Ecology and Conservation Biology in Ponderosa Pine Forests of the Southwestern United States

Reed F. Noss
Abstract Over the past century, ponderosa pine,dominated landscapes of the southwestern United States have been altered by human activities such as grazing, timber harvest, road building, and fire exclusion. Most forested areas within these landscapes now show increased susceptibility to stand-replacing fires, insect outbreaks, and drought-related mortality. Recent large wildfires in the region have spurred public interest in large-scale fuel reduction and restoration programs, which create perceived and real conflicts with the conservation of biodiversity. Conservation concerns include the potential for larger road networks, soil and understory disturbance, exotic plant invasion, and the removal of large trees in treated areas. Pursuing prescribed burning, thinning, or other treatments on the broad scale that many scientists and managers envision requires the reconciliation of ecological restoration with biodiversity conservation. This study presents recommendations from a workshop for integrating the principles and practices of restoration ecology and conservation biology, toward the objective of restoring the composition, structure, and function of dry ponderosa pine forests. Planning on the scale of hundreds of thousands of hectares offers opportunities to achieve multiple objectives (e.g., rare species protection and restoration of ecological structures and processes) that cannot easily be addressed on a site-by-site basis. However, restoration must be coordinated with conservation planning to achieve mutual objectives and should include strict guidelines for protection of rare, declining, and sensitive habitats and species. [source]

Worker flows, job flows and firm wage policies

An analysis of Slovenia
Abstract Like many transition economies, Slovenia is undergoing profound changes in the workings of the labour market with potentially greater flexibility in terms of both wage and employment adjustment. To investigate the impact of these changes, we use unique longitudinal matched employer-employee data that permits measurement of employment transitions and wages for workers and enables links of the workers to the firms in which they are employed. We can thus measure worker flows and job flows in a comprehensive and integrated manner. We find a high pace of job flows in Slovenia especially for young, small, private and foreign-owned firms and for young, less educated workers. While job flows have approached the rates observed in developed market economies, the excess of worker flows above job flows is lower than that observed in market economies. A key factor in the patterns of the worker and job flows is the determination of wages in Slovenia. A base wage schedule provides strict guidelines for minimum wages for different skill categories. However, firms are permitted to offer higher wages to an individual based upon the success of the worker and/or the firm. Our analysis shows that firms deviate from the base wage schedule significantly and that the idiosyncratic wage policies of firms are closely related to the observed pattern of worker and job flows at the firm. Firms with more flexible wages (measured as less compression of wages within the firm) have less employment instability and are also able to improve the match quality of their workers. JEL Classifications: J23, J31, J41, J61, P23, P31. [source]