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The effective management of anadromous Salmo trutta resources is challenging because long-term data on life history, phenology and survival are sparse and most stocks across the range are highly diverse and data-limited. The current study employed acoustic telemetry to tag 448 sea trout across three life stages, to describe the phenology, spawning behaviour and return rates of smolts, finnock (0+ sea age) and adult (≥1+ sea age) sea trout in two Irish river systems during 2018-2021. Tagged smolts (n = 206) exhibited river to sea transition rates of 78%-92% and a number of surviving smolts returned to their natal river as 0+ sea age finnock, exhibiting overall smolt to finnock return rates of between 6% and 17%. Short-term vagrancy occurred among smolts, and 14 individuals were detected in adjacent non-natal rivers. Finnock tagged during the late summer (n = 205) exhibited a range of behaviours with a minority (30%) ascending upstream to spawning areas. Tagged adult sea trout (n = 37) ascended upstream to the spawning grounds and between 50% and 80% successfully returned to sea as kelts after spawning. Subsequent return rates of kelts back to the river in the following year ranged from 9% to 40%. The current study indicated that body size was an influential predictor of behaviour and survival across all three life stages. Increased body size was positively associated with marine transition success in smolts, long-term marine survival in kelts and spawning behaviour in finnock. This work further demonstrates the complexity of sea trout life-history dynamics and provides a comparative perspective across different age classes. An understanding of life-history variation, behaviour and survival is fundamental for the successful management and conservation of sea trout stocks.

In 2018, a regional health authority in British Columbia (BC) initiated a multi-year project to support planning and response to extreme heat. Climate projections indicate that temperatures in the southern interior of BC will continue to increase, with concomitant negative impacts on human health. Successful climate change adaptation must include cross-sectoral action, inclusive of the health sector, to plan for and respond to climate-related events, including extreme heat.The objective of this project was to support the development and implementation of a Heat Alert and Response System (HARS) in a small, rural community. The health authority facilitated collaboration among provincial and local governments, community organizations, and First Nations partners to assess community assets, draft a plan for extreme heat, and prepare for a community-supported response during heat events.Stakeholders expressed the importance of utilizing existing partnerships and community resources, such as physical and procedural infrastructure, in which to embed the HARS. It was imperative that the plan be simple, concise, and considerate of the community's unique context. Educational materials and a tailored method of dissemination were important for collective and individual risk mitigation.A community-driven approach that utilized existing assets allowed for integration of HARS within municipal response plans and established infrastructure. The result is a sustainable public health intervention that has the potential to mitigate the negative health effects of extreme heat. Knowledge acquired through this initiative is informing similar HARS planning processes in other rural BC communities.RéSUMé: Lieu En 2018, une régie régionale de la santé de la Colombie-Britannique a lancé un projet pluriannuel de soutien de la planification et des interventions face à la chaleur extrême. Selon les projections climatiques, les températures dans l’intérieur méridional de la province continueront d’augmenter, ce qui aura des effets nuisibles sur la santé humaine. Pour se préparer aux phénomènes climatiques comme la chaleur extrême et pour intervenir efficacement, les mesures d’adaptation doivent être intersectorielles et englober le secteur de la santé.Intervention Le projet visait à soutenir la création et la mise en œuvre d’un système d’alerte et d’intervention à la chaleur (SAIC) dans une petite communauté rurale. La régie de la santé a facilité la collaboration entre le gouvernement provincial, l’administration locale, les organismes associatifs et les partenaires des Premières Nations pour évaluer les actifs communautaires, dresser un plan en cas de chaleur extrême et se préparer à intervenir avec l’aide de la communauté durant les épisodes de chaleur.Résultats Les acteurs ont souligné l’importance d’utiliser les partenariats et les ressources communautaires existants, comme les infrastructures matérielles et administratives, et d’y intégrer le SAIC. Il fallait absolument que le plan soit simple et concis et qu’il tienne compte du contexte particulier de la communauté. Il a été jugé important d’avoir du matériel pédagogique et une méthode de diffusion créés sur mesure pour atténuer les risques individuels et collectifs.Conséquences Une approche communautaire utilisant les actifs existants a permis d’intégrer le SAIC dans les plans d’intervention municipaux et les infrastructures établies. Il en est résulté une intervention sanitaire durable qui peut potentiellement atténuer les effets néfastes de la chaleur extrême sur la santé. Les connaissances acquises grâce à cette initiative éclairent aujourd’hui des processus de planification de SAIC similaires dans d’autres communautés rurales de la Colombie-Britannique.

Background Value-based healthcare provider reimbursement models have been proposed as an alternative to traditional fee-for-service arrangements that can align financial reimbursement more closely to the outcomes of value to patients and society. This study aimed to investigate stakeholder perceptions and experiences of different reimbursement systems for healthcare providers in high performance sport, with a focus on fee-for-service versus salaried provider models. Results Three in-depth semi-structured focus group discussions and one individual interview were conducted with key stakeholders across the Australian high performance sport system. Participants included healthcare providers, health managers, sports managers and executive personnel. An interview guide was developed using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, with key themes deductively mapped to the innovation, inner context and outer context domains. A total of 16 stakeholders participated in a focus group discussion or interview. Participants identified several key advantages of salaried provider models over fee-for-service arrangements, including: the potential for more proactive and preventive models of care; enhanced inter-disciplinary collaboration; and the ability for providers to have a deeper understanding of context and how their role aligns with a broader set of priorities for an athlete and the organisation. Noted challenges of salaried provider models included the potential for providers to revert to reactive care delivery when not afforded adequate capacity to provide services, and difficulties for providers in demonstrating and quantifying the value of their work. Conclusions Our findings suggest that high performance sporting organisations seeking to improve primary prevention and multidisciplinary care should consider salaried provider arrangements. Further research to confirm these findings using prospective, experimental study designs remains a priority.

There is growing interest in the phenology of juvenile Salmo trutta and evidence of significant downstream migration during the autumn in some anadromous populations. The present study used acoustic telemetry to examine the phenology of potamodromous trout parr across a region encompassing two large lake catchments. One hundred sixty-seven trout parr were tagged in late summer across four lake tributaries between 2018 and 2020. In total, 75 tagged parr migrated into the lakes with 67 (89%) migrating between September and December and 8 (11%) migrating between March and June. Autumn migration was highly prevalent across all the tributaries, with 16%-66% of each tagged sample exhibiting autumn migration, and 0%-15% of each tagged sample exhibiting spring migration. Autumn migrants were significantly longer and heavier than spring migrants, but condition factor was similar. Autumn migrants were associated with higher river discharge levels and lower water temperatures than spring migrants. The management challenges posed by extensive autumn migration behaviour in migratory trout stocks are examined and discussed.

Introduction Robin sequence (RS) is a leading cause of obstructive sleep apnea (OSA) in newborns. Most studies have focused on understanding anatomic factors leading to OSA and changes in apnea–hypopnea index (AHI) on polysomnography (PSG) beyond the neonatal period. This study aims to define age-related OSA features between patients with RS, without RS and healthy controls using PSG-based analyses of respiratory arousal responses and gas-exchange parameters. Design Retrospective comparison of PSG features in a total of 48 children encompassing three groups: (a) infants with RS (n = 24, Results OSA sleep-stage specific indexes (rapid eye movement [REM] vs non-REM[NREM]) as well as position-specific indexes (supine vs nonsupine) were similar in individuals with and without RS. Relative to the non-RS groups, infants with RS have more sustained hypoxemia (time with SpO2 < 90%) and reduced arousal responses to OSA demonstrated by higher OAHI/respiratory arousal indexes. OAHI/respiratory arousal indexes significantly correlated with the severity of hypoxemia in infants with RS. Conclusion Infants with RS and OSA show reduced arousal responses to apneic events, which correlates with higher hypoxemia severity. OAHI/respiratory arousal indexes in RS may identify high-risk individuals with upper airway obstruction and reduced arousal protective responses.

Background In Australia, the overall prevalence of liver disease is increasing. Maximising uptake of community screening programmes by understanding patient preferences is integral to developing consumer-centred care models for liver disease. Discrete choice experiments (DCEs) are widely used to elicit preferences for various healthcare services. Attribute development is a vital component of a well-designed DCE and should be described in sufficient detail for others to assess the validity of outcomes. Hence, this study aimed to create a list of potential attributes and levels which can be used in a DCE study to elicit preferences for chronic liver disease screening programmes. Methods Key attributes were developed through a multi-stage, mixed methods design. Focus groups were held with consumers and health care providers on attributes of community screening programmes for liver disease. Stakeholders then prioritised attributes generated from the focus group in order of importance via an online prioritisation survey. The outcomes of the prioritisation exercise were then reviewed and refined by an expert panel to ensure clinically meaningful levels and relevance for a DCE survey. Results Fifteen attributes were generated during the focus group sessions deemed necessary to design liver disease screening services. Outcomes of the prioritisation exercise and expert panel stages recognised five attributes, with three levels each, for inclusion in a DCE survey to elicit consumer preferences for community screening for liver disease. This study also highlights broader social issues such as the stigma around liver disease that require careful consideration by policy makers when designing or implementing a liver screening programme. Conclusions The attributes and levels identified will inform future DCE surveys to understand consumer preferences for community screening programmes for liver disease. In addition, the outcomes will help inform the implementation of the LOCATE-NAFLD programme in real-world practice, and could be relevant for other liver and non-liver related chronic disease screening programmes.

STUDY OBJECTIVES: The implementation of positive airway pressure (PAP) therapy to treat obstructive sleep apnea in children is a complex process. PAP therapy data are highly heterogeneous in pediatrics, and the clinical management cannot be generalized. We hypothesize that pediatric PAP users can be subgrouped via clustering analysis to guide tailored interventions. METHODS: PAP therapy data for 250 children with obstructive sleep apnea were retrospectively examined using unsupervised hierarchical cluster analysis based on (1) PAP tolerance (average hours on days used) and (2) consistency of PAP use (percentage of days used). Clinical features in each cluster were defined, and a tree decision analysis was generated for clinical implementation. RESULTS: We were able to subclassify all 250 children (median age = 11.5 years) into five clusters: A (13.6%), B (29.6%), C (17.6%), D (16.4%), and E (22.8%). The clusters showed significant differences in PAP use patterns (Kruskal-Wallis P value < 1e–16). The most consistent PAP use patterns were seen in clusters A, B, and C. Major differences across clusters included the prevalence of obesity, PAP setting, developmental delay, and adenotonsillectomy. We also identified important differences in mask acceptance, OSA severity, and individual responses to PAP therapy based on objective apnea-hypopnea reductions in PAP downloads. CONCLUSIONS: A simple method to subset PAP use patterns in children can be implemented by analyzing cloud-based PAP therapy data. This novel approach may contribute to optimization of PAP therapy in children of all ages based on real-world evidence at the individual level. CITATION: Weiss MR, Allen ML, Landeo-Gutierrez JS, et al. Defining the patterns of PAP adherence in pediatric obstructive sleep apnea: a clustering analysis using real world data. J Clin Sleep Med. 2021;17(5):1005–1013.

Background and Purpose:Early brain injury may be a more significant contributor to poor outcome after aneurysmal subarachnoid hemorrhage (aSAH) than vasospasm and delayed cerebral ischemia. However, studying this process has been hampered by lack of a means of quantifying the spectrum of injury. Global cerebral edema (GCE) is the most widely accepted manifestation of early brain injury but is currently assessed only through subjective, qualitative or semi-quantitative means. Selective sulcal volume (SSV), the CSF volume above the lateral ventricles, has been proposed as a quantitative biomarker of GCE, but is time-consuming to measure manually. Here we implement an automated algorithm to extract SSV and evaluate the age-dependent relationship of reduced SSV on early outcomes after aSAH.Methods:We selected all adults with aSAH admitted to a single institution with imaging within 72 hours of ictus. Scans were assessed for qualitative presence of GCE. SSV was automatically segmented from serial CTs using a deep learning-based approach. Early SSV was the lowest SSV from all early scans. Modified Rankin Scale score of 4 to 6 at hospital discharge was classified as a poor outcome.Results:Two hundred forty-four patients with aSAH were included. Sixty-five (27%) had GCE on admission while 24 developed it subsequently within 72 hours. Median SSV on admission was 10.7 mL but frequently decreased, with minimum early SSV being 3.0 mL (interquartile range, 0.3–11.9). Early SSV below 5 mL was highly predictive of qualitative GCE (area under receiver-operating-characteristic curve, 0.90). Reduced early SSV was an independent predictor of poor outcome, with a stronger effect in younger patients.Conclusions:Automated assessment of SSV provides an objective biomarker of GCE that can be leveraged to quantify early brain injury and dissect its impact on outcomes after aSAH. Such quantitative analysis suggests that GCE may be more impactful to younger patients with SAH.

BACKGROUND: Trisomy 21 (TS21) is a condition with high risk for sleep apnea. In the pediatric population, the risk also includes central breathing disorders. The aim of this study was to define the clinical and polysomnographic characteristics of central apnea in infants, children and adolescents with TS21. METHODS: Retrospective review of baseline polysomnograms (PSG) in children with TS21 in the sleep center at Children's National Medical Center in Washington D.C. RESULTS: We included a total of 158 infants, children and adolescents (0-18 years) with TS21 in this study. The median age was 4.82 years and 62% were male. The primary findings of the study are that: 1) 12% of all pediatric subjects with TS21 included had an central apnea index (CAI) > 2/h; 2) the proportion of TS21 individuals with central breathing abnormalities progressively decreased with age being common in young individuals (≤ 2 years of age) but rare after 10 years of age; 3) additional sleep breathing disturbances (e.g. OSA and/or hypoxemia) are often present in children with TS21 and central apnea; and 4) the prevalence of central breathing abnormalities in TS21 is influenced by sex, being more likely to persist beyond early childhood (>2 years of age) in females than in males. CONCLUSION: Central breathing abnormalities are common in TS21 among young children (≤ 2 years of age) and in females older than 2 years of age. Central apnea is often associated with concomitant obstructive sleep apnea and/or hypoxemia in children with TS21. This article is protected by copyright. All rights reserved.

Objectives:The Tailored Activity Program (TAP) is an evidence-based occupational therapist-led intervention for people living with dementia and their care partners at home, developed in the USA. This study sought to understand its acceptability to people living with dementia, their care partners, and health professionals, and factors that might influence willingness to participate prior to its implementation in Australia.Methods:This study used qualitative descriptive methods. Semi-structured interviews were conducted with people living with dementia in the community (n = 4), their care partners (n = 13), and health professionals (n = 12). People living with dementia were asked about health professionals coming to their home to help them engage in activities they enjoy, whereas care partners’ and health professionals’ perspectives of TAP were sought, after it was described to them. Interviews were conducted face-to-face or via telephone. All interviews were recorded and transcribed. Framework analysis was used to identify key themes.Results:Analysis identified four key themes labelled: (i) TAP sounds like a good idea; (ii) the importance of enjoyable activities; (iii) benefits for care partners; and (iv) weighing things up. Findings suggest the broad, conditional acceptability of TAP from care partners and health professionals, who also recognised challenges to its use. People living with dementia expressed willingness to receive help to continue engaging in enjoyable activities, if offered.Discussion:While TAP appeared generally acceptable, a number of barriers were identified that must be considered prior to, and during its implementation. This study may inform implementation of non-pharmacological interventions more broadly.

A group of 36 1+ age class Salmo trutta were surgically implanted with dummy acoustic tags and monitored for 370 days. In total 13 tags were expelled throughout the experiment with an overall tag loss rate of c. 0.035 tags per day. Fish length was the only explanatory variable which had a significant association with subsequent tag expulsion. The estimated probability of retaining a tag for a year for a fish of length 32 cm was 0.76, 34 cm was 0.60 and 36 cm was 0.38. The long-term tag loss patterns were examined and discussed.

OBJECTIVEDelayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) may result in focal neurological deficits and cerebral infarction, believed to result from critical regional rather than global impairments in cerebral blood flow (CBF). However, the burden of such regional hypoperfusion has not been evaluated by gold-standard voxel-by-voxel CBF measurements. Specifically, the authors sought to determine whether the proportion of brain affected by hypoperfusion was greater in patients with DCI than in SAH controls without DCI and whether the symptomatic hemisphere (in those with lateralizing deficits) exhibited a greater cerebral hypoperfusion burden.METHODSSixty-one patients with aneurysmal SAH underwent 15O PET to measure regional CBF during the period of risk for DCI (median 8 days after SAH, IQR 7–10 days). Regions of visibly abnormal brain on head CT studies, including areas of hemorrhage and infarction, were excluded. Burden of hypoperfusion was defined as the proportion of PET voxels in normal-appearing brain with CBF < 25 ml/100 g/min. Global CBF and hypoperfusion burden were compared between patients with and those without DCI at the time of PET. For patients with focal impairments from DCI, the authors also compared average CBF and hypoperfusion burden in symptomatic versus asymptomatic hemispheres.RESULTSTwenty-three patients (38%) had clinical DCI at the time of PET. Those with DCI had higher mean arterial pressure (MAP; 126 ± 14 vs 106 ± 12 mm Hg, p < 0.001) and 18 (78%) were on vasopressor therapy at the time of PET study. While global CBF was not significantly lower in patients with DCI (mean 39.4 ± 11.2 vs 43.0 ± 8.3 ml/100 g/min, p = 0.16), the burden of hypoperfusion was greater (20%, IQR 12%–23%, vs 12%, 9%–16%, p = 0.006). Burden of hypoperfusion performed better than global CBF as a predictor of DCI (area under the curve 0.71 vs 0.65, p = 0.044). Neither global CBF nor hypoperfusion burden differed in patients who responded to therapy compared to those who had not improved by the time of PET. Although hemispheric CBF was not lower in the symptomatic versus contralateral hemisphere in the 13 patients with focal deficits, there was a trend toward greater burden of hypoperfusion in the symptomatic hemisphere (21% vs 18%, p = 0.049).CONCLUSIONSThe burden of hypoperfusion was greater in patients with DCI, despite hemodynamic therapies, higher MAP, and equivalent global CBF. Similarly, hypoperfusion burden was greater in the symptomatic hemisphere of DCI patients with focal deficits even though the average CBF was similar to that in the contralateral hemisphere. Evaluating the proportion of the brain with critical hypoperfusion after SAH may better capture the extent of DCI than averaging CBF across heterogenous brain regions.

An experiment was undertaken, using acoustic telemetry, to compare the survival and migratory timing of Salmo salar L. smolts sampled, under optimal conditions, in a traditional fixed Wolf trap against a sample of rod-caught fish captured using a sensitive angling technique. No significant difference was evident in survival with 83% of both samples detected in the river outflow, 67% of the trap and 76% of the rod samples were detected in coastal waters and finally 43% of the trap and 35% of the rod samples were detected on an offshore array c. 50 km from the river outlet. No significant difference was evident in the time taken for trap- and rod-sampled fish to reach either the river outflow, coastal or offshore waters. Angling, if undertaken sensitively, can provide an effective, resource-efficient and ethically justifiable sampling tool for juvenile salmonid age classes.

IntroductionCOVID-19, caused by SARS-CoV-2, remains a global pandemic that has affected more than 100 million people worldwide with over 4.8 million deaths as of October 2021. Patients with diabetes have both an increased susceptibility to SARS-CoV-2 infection, enhanced disease severity and increased risk of mortality. The challenge presented in these patients is both to improve glycaemic control—which itself may confer a survival advantage—and to help maintain or restore immunological homeostasis. The specific glucokinase activator AZD1656 may address both of these challenges via its glucose-lowering effect and its immunological mechanism of action. The aim of the Alleviation of cardioRespiratory complications in patients with COVID-19 And DIAbetes (ARCADIA) trial is to investigate this hypothesis and determine whether AZD1656 can improve clinical outcomes for these patients.Methods and analysisARCADIA is a double-blind, placebo-controlled, interventional study of AZD1656 in 150 patients with either type 1 or type 2 diabetes who have been admitted to hospital with COVID-19. Eligible, consented patients will be randomised in a 1:1 manner to receive either active drug or matched placebo tablets while they are in hospital. All patients will receive the usual and current standard of care for patients with COVID-19 in that hospital. Clinical and laboratory data will be collected and assessed at baseline and throughout their participation in the study. Data will be captured in the case report form, which will be electronically archived at the end of the trial in the trial master file. The WHO 8-point Ordinal Scale for Clinical Improvement will be used to measure clinical outcome for the primary endpoint of the trial.Ethics and disseminationEthical approval has been obtained from the East Midlands-Leicester South Ethics Committee (REC 20/EM/0198) in the UK, from the National Bioethics Committee of Medicines and Medical Devices in Bucharest, Romania, and from the Ethics Committee IKEM a TN in Prague, Czech Republic. All study-related data will be used by the sponsor in accordance with local data protection law. In the UK, all patient identifiable data will be stored on a password-protected National Health Service N3 network with full audit trail. Anonymised data will be stored in an ISO27001 certificated data warehouse.Trial registration numberEudraCT 2020-002211-21, NCT04516759.

This study quantifies the processes involved in regulating the European eel population of Lough Neagh, a lake in Northern Ireland. The relationship between glass eel input and silver eel output for the 1923-1997 cohorts was best described by a Beverton-Holt stock recruitment model. Glass eel input time series was not complete and was thus derived from the relationship between catches elsewhere in Europe and Lough Neagh, together with the addition of stocked glass eel. Silver eel output was the sum of silver eel escapement, catch and yellow eel catch converted to silver eel equivalents. Natural mortality increased with glass eel density, ranging from 0.017 to 0.142 year-1 . The mean carrying capacity increased from ≈3.25 M silver eels (≈26 kg ha-1 ) for the 1923-1943 cohorts to ≈5.0 M (≈40 kg ha-1 ) for the 1948-1971 cohorts before regressing back to ≈3.25 M. The total silver eel output was highest during the late 1970s/early 1980s at 35-45 kg ha-1 year-1 and lowest during the early years of the 20th century and is currently at 10-15 kg ha-1 year-1 . The findings are discussed in relation to (a) the ecological changes that have occurred within the lough, associated with eutrophication and the introduction of roach (Rutilus rutilus L.), and (b) the decline of the wider European eel stock across its distribution range. The findings from this study have relevance for the wider management of the European eel stock.

The framework, model and methods of Nürnberg were applied and evaluated in Lough Neagh and 19 other lakes in order to establish inflow phosphorus concentrations that support target lake values. Supporting concentrations, in the absence of an internal load, were derived and the effect of uncertainty in the model retention coefficient was relatively small, ±11-20 % in Lough Neagh and an average (n = 17) of ±9.7 % in the other lakes. There was further support for the model and methods from an independent estimate of the net internal load in Lough Neagh (13 % difference) and from another model in the other lakes (Supporting concentrations, which should be lower, were by an average of 11 mg P m

The long-term response of chlorophyll-a (chl-a) to changing lake water nutrient concentrations and increasing water temperature was investigated in Lough Neagh, a large, hypereutrophic lake in Northern Ireland. Trends in external and internal nutrient loading and their relation to lake nutrient concentrations were also established. Lake water concentrations of total P (TP) have increased since the 1990s but were not correlated with catchment inputs, which showed no trend. The characteristics of internal loading of P have changed since the mid-1990s, with an earlier and larger mass of P released from the sediments each summer. Catchment inputs of total oxidised N (NOx) decreased from the peak value of 10,186T/yr in 1995 to 5,396T/yr in 2011, coinciding with a reduction in lake water concentrations. External inputs and lake concentrations of NOx were highly correlated (R=0.88). Water temperature increased approximately 1C and was a predictor of variation in chl-a from 1974 to 2012. After the peak chl-a concentration in 1993, dissolved inorganic N (DIN) also became an important predictor, accounting for almost half of the 44% variance explained by a hierarchical partition model. Decreasing log (DIN:TP) ratios suggest that N limitation of chl-a has become more important in the lake recently.

International audience; Abstract BACKGROUND Randomized controlled trials evaluating mechanical thrombectomy (MT) for acute ischemic stroke predominantly studied anterior circulation patients. Both procedural and clinical predictors of outcome in posterior circulation patients have not been evaluated in large cohort studies. OBJECTIVE To investigate technical and clinical predictors of functional independence after posterior circulation MT while comparing different frontline thrombectomy techniques. METHODS In a retrospective multicenter international study of 3045 patients undergoing MT for stroke between 06/2014 and 12/2018, 345 patients had posterior circulation strokes. MT was performed using aspiration, stent retriever, or combined approach. Functional outcomes were assessed using the 90-d modified Rankin score dichotomized into good (0-2) and poor outcomes (3-6). RESULTS We included 2700 patients with anterior circulation and 345 patients with posterior circulation strokes. Posterior patients (age: 60 ± 14, 46% females) presented with mainly basilar occlusion (80%) and were treated using contact aspiration or ADAPT (39%), stent retriever (31%) or combined approach (19%). Compared to anterior strokes, posterior strokes had delayed treatment (500 vs 340 min, P

BackgroundElevated systolic blood pressure (SBP) after mechanical thrombectomy (MT) correlates with worse outcome. However, the association between SBP reduction (SBPr) and outcome after successful reperfusion with MT is not well established.ObjectiveTo investigate the association between SBPr in the first 24 hours after successful reperfusion and the functional and safety outcomes of MT.MethodsA multicenter retrospective study, which included 10 comprehensive stroke centers, was carried out. Patients with acute ischemic stroke and anterior circulation large vessel occlusions who achieved successful reperfusion via MT were included. SBPr was calculated using the formula 100×([admission SBP−mean SBP]/admission SBP). Poor outcome was defined as a modified Rankin Scale (mRS) score of 3–6 at 90 days. Safety endpoints included symptomatic intracerebral hemorrhage, mortality, and requirement for hemicraniectomy during admission. A generalized mixed linear model was used to study the association between SBPr and outcomes.ResultsA total of 1361 patients were included in the final analysis. SBPr as a continuous variable was inversely associated with poor outcome (OR=0.97; 95% CI 0.95 to 0.98; p20%), the rate of poor outcome was highest in the first group.ConclusionSBPr in the first 24 hours after successful reperfusion was inversely associated with poor outcome. No association between SBPr and safety outcome was found.

OBJECTIVE Elevated systolic blood pressure (SBP) after successful revascularization (SR) via endovascular therapy (EVT) is a known predictor of poor outcome. However, the optimal SBP goal following EVT is still unknown. Our objective was to compare functional and safety outcomes between different SBP goals after EVT with SR. METHODS This international multicenter study included 8 comprehensive stroke centers and patients with anterior circulation large vessel occlusion who were treated with EVT and achieved SR. SR was defined as modified thrombolysis in cerebral ischemia 2b to 3. Patients were divided into 3 groups based on SBP goal in the first 24 hours after EVT. Inverse probability of treatment weighting (IPTW) propensity analysis was used to assess the effect of different SBP goals on clinical outcomes. RESULTS A total of 1,019 patients were included. On IPTW analysis, the SBP goal of

An investigation with acoustic telemetry of the passage of Salmo salar smolts through a large natural lake found heavy mortality occurred at the river-to-lake confluences (mean 31.2% km-1 ), but was lower in the main body of the lake (mean 2.4% km-1 ). Predation was a significant pressure on emigrating smolts as tagged pike Esox lucius aggregated at river-to-lake confluences during the peak of the smolt run. Tagged smolts mainly emmigrated into the lake in the late evening after dusk, possibly as a predator-avoidance behaviour.

Background Improving hospital environmental hygiene can reduce environmental contamination and cross-transmission risk, a precursor to healthcare associated infections (HAI). With poor cleaning practice a demonstrated problem, the process of converting evidence into practice requires investigation. The aim of this study was to assess the effectiveness of an environmental hygiene bundle in terms of changes to HAI rates, cleaning performance and environmental services workers (ESW) knowledge and attitudes. Methods A multi-modal bundle was designed and implemented with ESW in eight wards, in a 400-bed metropolitan teaching hospital, using a prospective, before-and-after study design. This consisted of a three-month pre-intervention phase and six-month intervention phase. This research used an implementation science framework to guide the transition from evidence into practice, with data collected in the pre-intervention phase synthesised to design the implementation strategy. Results There was no statistically significant change in infection rates in the six-month period. Significant improvements in cleaning performance were observed, with the average proportion of ultraviolet markers removed during cleaning across the wards increasing from 61.1% to 95.4%. Results also demonstrate improvements to both the knowledge and attitudes of ESW. Conclusion By combining infection prevention and implementation science, this bundle was an effective way to engage environmental services staff and improve hospital cleaning.

Background The purpose of this paper is to highlight the range of cleaning practices and processes in 11 Australian hospitals and to discuss the challenges this variation poses to the implementation of clinical trials or changes to hospital cleaning practices. Methods A cross-sectional study design was used to determine cleaning practices and processes in hospitals participating in the ‘Researching Effective Approaches to Cleaning in Hospitals' (REACH) study. A standardised template and approach was used to collect information. Data collection activities included structured on-site discussions, a review of hospital practices and a document review of policy and procedural documents related to cleaning. Results Variations in the auditing process used to evaluate environmental cleanliness, cleaning practices, product use, training and communication pathways available to cleaning staff were identified. There was also variation in workforce structure and responsibilities for cleaning. Conclusion This paper is the first to describe the differences in cleaning practices between Australian hospitals. The variations identified present a number of challenges for the conduct of research and have important implications for both monitoring of and standards for cleanliness. These challenges include implementing a practice change or cleaning study where hospitals have different processes, practices and structures.

Introduction: Endovascular thrombectomy (ET) for treating acute stroke in the real-world has expanded beyond the selection criteria used in major trials, and currently includes posterior circulation strokes. Posterior circulation stroke is believed to have worse outcomes than anterior circulation stroke, and its outcomes following ET are still being studied. We explored the major determinants of functional recovery after ET for posterior circulation stroke in a large cohort of patients from the Stroke Thrombectomy and Aneurysm Registry (STAR). Methods: STAR includes patients undergoing ET for acute ischemic stroke at 12 comprehensive stroke centers in the US and globally. Data on patient demographics, technical and clinical outcomes was reviewed retrospectively from patient charts and procedure notes. Primary outcomes was the modified Ranking Score (mRS) at 90 days dichotomized into favorable (mRS 0-2) and poor outcome (mRS 3-6). Results: A total of 3850 patients were reviewed, of which 345 patients (mean age 60±14) were treated for posterior circulation stroke with predominantly basilar artery occlusion (80%). Patients were treated using aspiration thrombectomy (ADAPT, 39%), stent retriever thrombectomy (31%), combined approach (19%) or intracranial stenting (7%). The overall rate of favorable outcome was 33%. Patients with diabetes, high NIHSS on admission, and proximal occlusions had significantly higher odds of poor functional outcomes on multivariate analysis (p Conclusions: Despite similar rates of functional recovery after ET for anterior circulation stroke between stent retriever and ADAPT, our analysis demonstrates that in posterior circulation stroke, ADAPT may lead to better functional outcomes compared to stent retriever without differences in safety profiles.

International audience; Background and Purpose— Successful reperfusion can be achieved in more than two-thirds of patients treated with mechanical thrombectomy. Therefore, it is important to understand the effect of blood pressure (BP) on clinical outcomes after successful reperfusion. In this study, we investigated the relationship between BP on admission and during the first 24 hours after successful reperfusion with clinical outcomes. Methods— This was a multicenter study from 10 comprehensive stroke centers. To ensure homogeneity of the studied cohort, we included only patients with anterior circulation who achieved successful recanalization at the end of procedure. Clinical outcomes included 90-day modified Rankin Scale, symptomatic intracerebral hemorrhage (sICH), mortality, and hemicraniectomy. Results— A total of 1245 patients were included in the study. Mean age was 69±14 years, and 51% of patients were female. Forty-nine percent of patients had good functional outcome at 90-days, and 4.7% suffered sICH. Admission systolic BP (SBP), mean SBP, maximum SBP, SBP SD, and SBP range were associated with higher risk of sICH. In addition, patients in the higher mean SBP groups had higher rates of sICH. Similar results were found for hemicraniectomy. With respect to functional outcome, mean SBP, maximum SBP, and SBP range were inversely associated with the good outcome (modified Rankin Scale score, 0–2). However, the difference in SBP parameters between the poor and good outcome groups was modest. Conclusions— Higher BP within the first 24 hours after successful mechanical thrombectomy was associated with a higher likelihood of sICH, mortality, and requiring hemicraniectomy.

A hydro power plant constructed around a waterfall on a coastal spate river, used the fall as a natural fish pass and applied a previous telemetry study on local Atlantic salmon Salmo salar to determine the abstraction conditions for the site. The current study used the same telemetry approach to monitor the efficacy of S. salar passage and to compare migratory behaviour at the waterfall pre and post the hydro development. The probability of S. salar successfully crossing the waterfall was higher post-hydro when 80% of tagged fish successfully crossed in comparison to the pristine pre-hydro period when 44% of tagged fish ascended. The flow range used by tagged S. salar to cross the waterfall ranged from 2.49-7.87 m3 s-1 in the pre-hydro period but broadened to 1.32-12.91 m3 s-1 during the post-hydro period. This was principally due to the hydro diverting water away from the waterfall during spate conditions, damping the flow across the barrier and facilitating upstream migration within a more suitable discharge range. During 2017-2018 implementation of the hydro-operation protocol elongated the duration of the migratory window for successful upstream migration by 36-128%. A strong diurnal pattern was observed for movements across the Salmon Leap waterfall during both the pre-hydro and post-hydro monitoring periods with most tagged S. salar crossing the complex obstacle in daylight.

The US Advanced Battery Consortium goals for 2023 call for low cost, fast charge, electric vehicle (EV) batteries with a 15-minute charge time at 80% pack capacity.[1] This milestone would have a huge impact on the universal market adoption of EVs. Unfortunately, fast charging at rates above 1C, defined as the current at which it takes one hour for a battery to charge/discharge to full capacity, imposes extensive deleterious effects on current lithium-ion battery (LiB) chemistries. High charging rates aggressively accelerate degradation mechanisms owed to structural damage due to both increased cycling temperature and inhomogeneous Li ion mass transport properties. The induced electrode damage can cause void formation between the active material and conductive-binder matrix and delamination from the current collecting foil. The now electronically isolated active material results in large costs on the capacity retention of the battery. In this study, we report measurements via operando X-ray microtomography of cylindrical cells used in EVs under simulated fast charge and drive cycles. Three batteries were measured during cycling after antecedent fast charging cycles, the 3rd, 5th, and 81st - 82nd cycles were analyzed to track morphological damage at different battery life points. To track the spatial and morphological degradation of both the anode and cathode structures, we employed a deep learning segmentation method using the U-Net convolutional neural network (CNN). Using a Euclidean Distance Mapping method, void formation is tracked spatially in 3-dimensions within the electrode coating. Insight into how fast charging induces structural damage will better inform research into fast-charge protocols and new battery chemistries for electrolytes, electrolyte additives, and novel electrode architectures. [1]Liu, Y.; Zhu, Y.; Cui, Y. Challenges and Opportunities towards Fast-Charging Battery Materials. Nat. Energy 2019, 4 (7), 540–550. https://doi.org/10.1038/s41560-019-0405-3.

Current industrial methodologies for lithium-ion battery cathode materials are suited to the production of well-defined, dense, spherical secondary particle structures assembled from nanocrystalline primary particles. Specifically, LiNixMnyCozO2 (LNMC) cathode material is synthesized by first growing the hydroxide precursor, NixMnyCoz(OH)2 (NMC), through a coprecipitation method using a stoichiometric ratio of mixed transition metal sulfate solutions, sodium hydroxide, and ammonia hydroxide pumped into a continuous stirred tank reactor (CSTR). Each new composition of cathode material requires an extensive synthesis parameter optimization study to refine the even formation of metal species, density, and uniformity of size and shape of the final cathode material. The characterization and visualization of the three-dimensional secondary cathode structure, internal morphology, and void network is an elusive task using traditional scanning electron microscopy (SEM) because it is 2D technique that requires the use of mechanical cross-sectioning which can cause the deformation of the internal structure. Yet the variation of the internal structure and density changes within LNMC secondary particles can have large effects on both the cycling kinetics, capacity, and lifetime of the final cathode material. In this study, we present a five-parameter optimization study of Ni0.25Mn0.25Co0.50(OH)2 (NMC112) using our lab-built CSTR. The optimization and morphological changes of the primary and secondary particles during high temperature lithiation is investigated further. Using synchrotron-based transmission X-ray microscopy tomography (TXM) in combination with a novel deep learning semantic segmentation process, the three-dimensional cathode structure and internal pore network of LNMC112 particles was mapped across different lithiation temperature and reaction times. The deep learning semantic segmentation allowed for the quantification of void volume, shape, size, and final overall density of the cathode secondary particles. The results of these morphological differences show effects in both the kinetics and cyclability through galvanostatic cycling. The quantification of the three-dimensional cathode microstructure shown in this study is agnostic of the specific cathode composition. Therefore, it is highly suited to better inform optimization targets of the coprecipitation synthesis, as well as illuminating the importance the internal pore network of secondary particles.

Ruminant production is a vital part of food industry but it raises environmental concerns, partly due to the associated methane outputs. Efficient methane mitigation and estimation of emissions from ruminants requires accurate prediction tools. Equations recommended by international organizations or scientific studies have been developed with animals fed conserved forages and concentrates and may be used with caution for grazing cattle. The aim of the current study was to develop prediction equations with animals fed fresh grass in order to be more suitable to pasture-based systems and for animals at lower feeding levels. A study with 25 nonpregnant nonlactating cows fed solely fresh-cut grass at maintenance energy level was performed over two consecutive grazing seasons. Grass of broad feeding quality, due to contrasting harvest dates, maturity, fertilisation and grass varieties, from eight swards was offered. Cows were offered the experimental diets for at least 2 weeks before housed in calorimetric chambers over 3 consecutive days with feed intake measurements and total urine and faeces collections performed daily. Methane emissions were measured over the last 2 days. Prediction models were developed from 100 3-day averaged records. Internal validation of these equations, and those recommended in literature, was performed. The existing in greenhouse gas inventories models under-estimated methane emissions from animals fed fresh-cut grass at maintenance while the new models, using the same predictors, improved prediction accuracy. Error in methane outputs prediction was decreased when grass nutrient, metabolisable energy and digestible organic matter concentrations were added as predictors to equations already containing dry matter or energy intakes, possibly because they explain feed digestibility and the type of energy-supplying nutrients more efficiently. Predictions based on readily available farm-level data, such as liveweight and grass nutrient concentrations were also generated and performed satisfactorily. New models may be recommended for predictions of methane emissions from grazing cattle at maintenance or low feeding levels.

Introduction: Current AHA/ASA guidelines recommend keeping blood pressure (BP) Methods: This was a multicenter international retrospective study that included 7 comprehensive stroke centers. Inclusion criteria were anterior circulation large vessel occlusion (LVO) that was treated with MT, and successful recanalization at the conclusion of the procedure. Patients were divided into three groups based on systolic BP (SBP) goals in the first 24 hours post MT. Group 1) included patients with SBP goal ≤140 mm Hg or ≤120 mm Hg; group 2 included patients with SBP goal ≤160 mm Hg; group 3) included patients with SBP goal ≤220 mm Hg or ≤180 mm Hg. Successful recanalization was defined as TICI 2b-3. Outcome measures included symptomatic intracerebral hemorrhage (sICH), 90-day modified Rankin Scale (mRS), and 90-day mortality. Results: A total of 985 patients were included in the study. More patients in group 3 were white and had Afib than groups 1-2. Likewise, more patients in group 3 received IV tPA. Complete recanalization (TICI 2c-3) was achieved in 88.2%, 53.6%, and 73.2% in groups 1,2,3 respectively (p Conclusion: Blood pressure goals ≤140 and ≤160 were associated with favorable functional outcome.