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Climate and land-use change are modifying the availability of food and water resources, which is driving more wildlife to the wildland-urban interface. For many wildlife populations, use of these areas still requires habitat connectivity both within the interface and/or to wildland habitats. However, navigating these areas can be difficult due to human development and sensory pollutants, such as artificial night light. Determining how these components of urbanization influence the behaviors and functional connectivity of species is important for managing wildlife within these mixed-use landscapes. Here we used a movescape approach based on graph theory to characterize functional uses of the landscape using metrics for behavior, connectivity, and space use intensity. We found that mule deer (Odocoileus hemionus ; n = 43) functional uses of anthropogenic landscapes in the Intermountain West, USA, were dependent not only on physical barriers, terrain, and sensory factors, but also the local levels of light exposure and vegetative greenness. Remotely sensed artificial light levels had a strong influence on how mule deer used the landscape by reducing the intensity of use in the most illuminated areas given forage availability. In contrast, relatively high local light levels were associated with increased use intensity within less developed areas—highlighting the foraging tradeoffs for species using the wildland-urban interface. Corridor use was reduced in areas where road and housing density were higher, and within-corridor movement was faster when artificial light was high and vegetative greenness was low. Developing a more mechanistic understanding of how species functionally use the landscape in relation to features of urbanization can enhance conservation by delineating areas important for connectivity and foraging, while providing insights into how future development and climate change may alter movement and behavior. Spatially-explicit estimates of functional uses can directly guide management decisions to maintain species resiliency and improve land-use planning. [ABSTRACT FROM AUTHOR]

Background: Operative time is related to complications in primary total hip arthroplasty (THA). This study compared operative time in direct anterior (DA) and posterior approach THA and whether differences were related to increased hospital readmissions within 90 days of discharge.Methods: Prospectively documented data on 3,152 consecutively performed THAs by 16 surgeons at a large Midwestern United States academic healthcare system were retrospectively reviewed. All surgeons were beyond their learning curve. Cases characterized by factors extending operative time were excluded. A total of 1,235 analysis cases were performed with the DA approach and 1,608 with the posterior approach. DA patients had lower mean body mass index (P < .001), were more likely to be classified as American Society of Anesthesiologists Physical Status 1 or 2 (P < .001), and more likely to have surgery in an ambulatory setting (P < .001).Results: Time under anesthesia was significantly longer for DA procedures by 19 to 27 minutes in hospital and ambulatory settings, respectively (P < .001). Increasing body mass index had a greater impact on anesthesia time for DA patients (P = .020). There were no differences in nontraumatic readmissions within 90 days of surgery based on surgical approach (P ≥ .480); however, significantly more DA patients classified as ASA-PS 3 or 4 were readmitted compared to those classified as ASA-PS 1 or 2 (P < .001), a difference not observed for posterior approach patients.Conclusion: Anesthesia time is a modifiable risk factor for patient safety and an important factor in healthcare resource utilization. Consideration of ways to reduce DA operative times is encouraged. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2006.11.012 Byline: Sebastien Bergeron (a), Graham S. Hillis (a), Eric N. Haugen (b), Jae K. Oh (a), Kent R. Bailey (c), Patricia A. Pellikka (a) Abstract: Although dobutamine stress echocardiography (DSE) is cited in clinical guidelines for the evaluation of patients with chronic kidney disease (CKD), there are limited data regarding its prognostic utility in this setting. The current study assesses the prognostic value of DSE in patients with CKD. Author Affiliation: (a) Division of Cardiovascular Diseases, Mayo Clinic Rochester, MN (b) Division of Nephrology, Mayo Clinic Rochester, MN (c) Department of Biostatistics, Mayo Clinic Rochester, MN Article History: Received 16 August 2006; Accepted 21 November 2006 Article Note: (footnote) Dr Bergeron was supported by a grant from Laval University, Quebec, Canada, and Dr Hillis by a grant from the British Heart Foundation. The study was supported by a grant from the Mayo Foundation.

The willingness-to-pay (WTP) model is utilized to evaluate the advantages of poison control centers when direct access is obstructed. A greater WTP is found on those callers whose access are blocked as compared to those callers who came through easily. An explanation for the higher WTP implies that maybe it was due to being barred to achieve direct access for a needed service. WTP, which is capable of evaluating factors that are difficult to quantify, is found to increase with income.

Doppler echocardiography, the use of sound waves to visualize internal heart structures, was used to assess the progression of aortic stenosis, the narrowing of the aortic valve which directs blood flow from the left ventricle to the aorta (the major vessel carrying oxygenated blood from the left ventricle to blood vessels throughout the body). One hundred twelve patients with aortic stenosis underwent three examinations by Doppler echocardiography during an average period of 25 months. At the beginning of the study, the peak aortic velocity, or maximum flow rate in the aorta, was about 2.9 meters per second; the ejection fraction, or fraction of blood emptied from the left ventricle during contraction, was 63 percent; and the percentage of patients who had symptoms was 52 percent. By the third echocardiogram, aortic peak velocity had increased to 3.3 meters per second and 65 percent of patients had symptoms. Age, sex, and ejection fraction were not predictors of disease progression. Coronary artery disease, present in 57 patients, and initial aortic peak velocity did not affect disease progression. The rate of progression of aortic stenosis was faster in 38 patients who complained of an increase in symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Practice consolidation in healthcare has widespread consequences for providers and patients. Although many studies describe this phenomenon in various medical specialties, no such analysis has been performed in neurosurgery specifically. The goal of this study was to assess the trends in the size of U.S. neurosurgery practices over a 5-year period. Neurosurgery practice characteristics were obtained from the Medicare Physician Compare database from March 2014 through October 2019 on the Centers for Medicare & Medicaid Services Website. Neurosurgeons were separated on the basis of their practice size. Group practice sizes ranged from solo practitioner practice to large multispecialty groups and health organizations. Eight groups were identified (1 or 2, 3–9, 10–24, 25–49, 50–99, 100–499, 500–999, and ≥1000 members). Additionally, neurosurgery practices were analyzed across the 4 U.S. geographical regions to understand changes in practice size and distribution. The percentage of neurosurgeons in smaller practices of 1 or 2 members decreased, from 20.09% to 13.05%; 3–9 members, from 17.79% to 9.41%; and 10–24 members, from 10.53% to 8.0%. The largest increase was seen in health organizations of 1000 members or more, with an increase from 9.85% to 22.84%. This study shows that over the past 5 years, a substantial trend toward increasing practice sizes has evolved. The effect of the differences in practice size should be examined to determine the large-scale impacts on patient care, payment models, and healthcare access, in addition to neurosurgeon compensation, and satisfaction. [ABSTRACT FROM AUTHOR]

As the uncertainty surrounding the future of U.S. health care policy intensifies, political advocacy and campaign contributions have become increasingly relevant. This study describes the trends of political contributions of U.S. neurosurgeons from the years 2003–2019. Individual contribution data from 2003–2019 were obtained from the Federal Election Commission website. Contributions were filtered for occupation lines matching either "neurosurg," "neurologic surgeon," or "neurological surgeon." Each contribution is designated to a recipient committee associated with a political candidate or group. The party designations of these committees were used to catalogue donations as "Republican," "Democratic," or "Independent." From 2003–2019 a total of 9242 political donations were made by self-identified neurosurgeons amounting to $8,469,121. Most of these contribution dollars were directed to Independent committees (47.9%). Of all Independent contribution dollars from 2005–2019, 95.9% were directed to the American Association of Neurological Surgeons Political Action Committee. The total number of unique contributions increased from 442 contributions in 2003 to 650 in 2019. Democrats experienced the most substantial increase in support, from 4.8% of all contribution dollars in 2003 to 26.3% in 2019. Republican support was noted to be more widespread across the United States compared with Democratic support. Political contributions from U.S. neurosurgeons have increased steadily over time. Donations were largely Independent but became increasingly partisan in recent years. Overall, this displays an increase in political involvement among the neurosurgeon community. Future studies are warranted into how this involvement translates to representative health policy. [ABSTRACT FROM AUTHOR]

We sought to determine the proportion and number of female neurosurgeons in the workforce at different stages of practice. The Physician Compare National Downloadable File data set was obtained from the Centers for Medicare & Medicaid Services for physicians who indicated "neurosurgery" as their primary specialty. Physician duplicates, physicians with no listed medical school graduation year, and physicians expected to be in residency (graduation years 2013–2019) were removed, yielding 4956 neurosurgeons. Five-year intervals were used to measure the number of male and female neurosurgeons by different stages of their careers. For example, graduates from years 2008–2012 were expected to be in their first 1–5 years of practice. There were 405 female (8.2%) and 4551 male (91.8%) neurosurgeons. At 1–5 years of practice, 13.8% (105/760) were women; 6–10 years, 11.5% (94/820) women; 11–15 years, 8.9% (64/720) women; 16–20 years, 8.7% (59/682) women; 21–25 years, 7.4% (46/619) women; 26–30 years, 3.8% (20/520) women; 31–35 years, 3.6% (15/413) women; and 36 years or more, 0.5% women (2/422). The number of female neurosurgeons varied among states, ranging from 0 in Hawaii to 53 in California. The states with the lowest percentage of female neurosurgeons were Hawaii (0%), Oklahoma (3.1%), and Nevada (3.6%). The states with the highest percentage of female neurosurgeons were New Hampshire (20.0%), Vermont (16.7%), and Rhode Island (15.8%). The number of practicing female neurosurgeons within the United States is increasing, as shown by the growing percentage of women who are earlier in their surgical careers. [ABSTRACT FROM AUTHOR]

Background: Total joint arthoplasty (TJA) cost containment has been a key focus for the Centers for Medicare and Medicaid Services spawning significant research and programmatic change, including a move toward early discharge and outpatient TJA. TJA outpatients receive few, if any, medical interventions before discharge, but the type and quantity of interventions provided for TJA patients who stay overnight in the hospital is unknown. This study quantified the nature, frequency, and outcome of interventions occurring overnight after primary TJA.Methods: 1725 consecutive primary unilateral TJAs performed between 2012 and 2017 by a single surgeon in a rapid-discharge program, managed by a perioperative internal medicine specialist, were reviewed. Medical records were examined for diagnostic tests, treatments, and procedures, results of interventions, and readmissions.Results: 759 patients were discharged on postoperative day 1. Eighty-four percent (641 of 759) received no medical interventions during their overnight hospital stay. Twelve (1.6%) received diagnostic tests, 90 (11.9%) received treatments, and 29 (3.8%) received procedures. Ninety-two percent (11 of 12) of diagnostic tests were negative, 66% of 100 treatments in 90 patients were intravenous fluids for oliguria or hypotension, and all procedures were in and out catheterizations for urinary retention. 90-day all-cause readmission rates were similar in patients who received (2.5%) and did not receive (3.3%) a clinical intervention.Conclusion: Most patients received no overnight interventions, suggesting unnecessary costly hospitalization. The most common issues addressed were oliguria, urinary retention, and hypotension. Protocols to prevent these conditions would facilitate outpatient TJA, improve patient safety, and reduce costs. [ABSTRACT FROM AUTHOR]