Publications by authors named "Jason Fisher"

61 Publications

Hyperlipasemia in absence of acute pancreatitis is associated with elevated D-dimer and adverse outcomes in COVID 19 disease.

Pancreatology 2021 Mar 4. Epub 2021 Mar 4.

Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Background: Coronavirus SARS-CoV-2 affects multiple organs. Studies have reported mild elevations of lipase levels of unclear significance. Our study aims to determine the outcomes in patients with COVID-19 and hyperlipasemia, and whether correlation with D-dimer levels explains the effect on outcomes.

Methods: Case-control study from two large tertiary care health systems, of patients with COVID-19 disease admitted between March 1 and May 1, 2020 who had lipase levels recorded. Data analyzed to study primary outcomes of mortality, length of stay (LOS) and intensive care utilization in hyperlipasemia patients, and correlation with D-dimer and outcomes.

Results: 992 out of 5597 COVID-19 patients had lipase levels, of which 429 (43%) had hyperlipasemia. 152 (15%) patients had a lipase > 3x ULN, with clinical pancreatitis in 2 patients. Hyperlipasemia had a higher mortality than normal lipase patients (32% vs. 23%, OR = 1.6,95%CI = 1.2-2.1, P = 0.002). In subgroup analysis, hyperlipasemia patients had significantly worse LOS (11vs.15 days, P = 0.01), ICU admission rates (44% vs. 66%,OR = 2.5,95%CI = 1.3-5.0,P = 0.008), ICU LOS (12vs.19 days,P = 0.01), mechanical ventilation rates (34% vs. 55%,OR = 2.4,95%CI = 1.3-4.8,P = 0.01), and durations of mechanical ventilation (14 vs. 21 days, P = 0.008). Hyperlipasemia patients were more likely to have a D-dimer value in the highest two quartiles, and had increased mortality (59% vs. 15%,OR = 7.2,95%CI = 4.5-11,P < 0.001) and LOS (10vs.7 days,P < 0.001) compared to those with normal lipase and lower D-dimer levels.

Conclusion: There is high prevalence of hyperlipasemia without clinical pancreatitis in COVID-19 disease. Hyperlipasemia was associated with higher mortality and ICU utilization, possibly explained by elevated D-dimer.
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http://dx.doi.org/10.1016/j.pan.2021.02.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929790PMC
March 2021

Morbidity of conversion from venovenous to venoarterial ECMO in neonates with meconium aspiration or persistent pulmonary hypertension.

J Pediatr Surg 2021 Mar 6;56(3):459-464. Epub 2020 Oct 6.

Division of Pediatric Surgery and Department of Surgery, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone. Electronic address:

Background: Outcomes in neonates receiving extracorporeal membrane oxygenation (ECMO) for meconium aspiration syndrome (MAS) and/or persistent pulmonary hypertension (PPHN) are favorable. Infants with preserved perfusion are often offered venovenous (VV) support to spare morbidities of venoarterial (VA) ECMO. Worsening perfusion or circuit complications can prompt conversion from VV-to-VA support. We examined whether outcomes in infants requiring VA ECMO for MAS/PPHN differed if they underwent VA support initially versus converting to VA after a VV trial, and what factors predicted conversion.

Methods: We reviewed the Extracorporeal Life Support Organization registry from 2007 to 2017 for neonates with primary diagnoses of MAS/PPHN. Propensity score analysis matched VA single-runs (controls) 4:1 against VV-to-VA conversions based on age, pre-ECMO pH, and precannulation arrests. Primary outcomes were complications and survival. Data were analyzed using Mann-Whitney U and Fisher's exact testing. Multivariate regression identified independent predictors of conversion for VV patients.

Results: 3831 neonates underwent ECMO for MAS/PPHN, including 2129 (55%) initially requiring VA support. Of 1702 patients placed on VV ECMO, 98 (5.8%) required VV-to-VA conversion. Compared with 364 propensity-matched isolated VA controls, conversion runs were longer (190 vs. 127 h, P < 0.001), were associated with more complications, and decreased survival to discharge (70% vs. 83%, P = 0.01). On multivariate regression, conversion was more likely if neonates on VV ECMO did not receive surfactant (OR = 1.7;95%CI = 1.1-2.7;P = 0.03) or required high-frequency ventilation (OR = 1.9;95%CI = 1.2-3.3;P = 0.01) before ECMO.

Conclusion: Conversion from VV-to-VA ECMO in infants with MAS/PPHN conveys increased morbidity and mortality compared to similar patients placed initially onto VA ECMO. VV patients not receiving surfactant or requiring high-frequency ventilation before cannulation may have increased risk of conversion. While conversions remain rare, decisions to offer VV ECMO for MAS/PPHN must be informed by inferior outcomes observed should conversion be required.

Level Of Evidence: Level of evidence 3 Retrospective comparative study.
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http://dx.doi.org/10.1016/j.jpedsurg.2020.09.053DOI Listing
March 2021

Spatial structure of reproductive success infers mechanisms of ungulate invasion in Nearctic boreal landscapes.

Ecol Evol 2021 Jan 17;11(2):900-911. Epub 2020 Dec 17.

InnoTech Alberta Vegreville AB Canada.

Landscape change is a key driver of biodiversity declines due to habitat loss and fragmentation, but spatially shifting resources can also facilitate range expansion and invasion. Invasive populations are reproductively successful, and landscape change may buoy this success.We show how modeling the spatial structure of reproductive success can elucidate the mechanisms of range shifts and sustained invasions for mammalian species with attendant young. We use an example of white-tailed deer (deer; ) expansion in the Nearctic boreal forest, a North American phenomenon implicated in severe declines of threatened woodland caribou ().We hypothesized that deer reproductive success is linked to forage subsidies provided by extensive landscape change resource extraction. We measured deer occurrence using data from 62 camera traps in northern Alberta, Canada, over three years. We weighed support for multiple competing hypotheses about deer reproductive success using multistate occupancy models and generalized linear models in an AIC-based model selection framework.Spatial patterns of reproductive success were best explained by features associated with petroleum exploration and extraction, which offer early-seral vegetation resource subsidies. Effect sizes of anthropogenic features eclipsed natural heterogeneity by two orders of magnitude. We conclude that anthropogenic early-seral forage subsidies support high springtime reproductive success, mitigating or exceeding winter losses, maintaining populations. . Modeling spatial structuring in reproductive success can become a key goal of remote camera-based global networks, yielding ecological insights into mechanisms of invasion and range shifts to inform effective decision-making for global biodiversity conservation.
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http://dx.doi.org/10.1002/ece3.7103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820139PMC
January 2021

Community-level modelling of boreal forest mammal distribution in an oil sands landscape.

Sci Total Environ 2021 Feb 26;755(Pt 2):142500. Epub 2020 Sep 26.

School of Environmental Studies, University of Victoria, Victoria, BC V8W 2Y2, Canada.

Anthropogenic landscape disturbances are known to alter, destroy, and fragment habitat, which typically leads to biodiversity loss. The effects of landscape disturbance generally vary among species and depend on the nature of the disturbances, which may interact and result in synergistic effects. Western Canada's oil sands region experiences disturbances from forestry and energy sector activities as well as municipal and transportation infrastructure. The effects of those disturbances on single species have been studied and have been implicated in declines of the boreal woodland caribou (Rangifer tarandus caribou). Yet, the specific responses of the mammal community, and of functional groups such as prey and predators, to those interacting disturbances are still poorly known. We investigated the responses of black bear, grey wolf, coyote, fisher, lynx, red fox, American red squirrel, white-tailed deer, moose, caribou, and snowshoe hare to both natural habitat and disturbance associated with anthropogenic features within Alberta's northeast boreal forest. We used a novel community-level modelling framework on three years of camera-trap data collected in an oil sands landscape. This framework allowed us to identify the natural and anthropogenic features which explained the most variation in occurrence frequency among functional groups, as well as compare responses to linear and non-linear anthropogenic disturbance. Occurrence frequency by predators was better explained by anthropogenic features than by natural habitat. Both linear and non-linear anthropogenic features helped explain occurrence frequency by prey and predators, although the effects differed in magnitude and spatial scale. To better conserve boreal biodiversity, management actions should extend beyond a focus on caribou and wolves and aim to restore habitat across a diversity of anthropogenic disturbances and monitor the dynamics of the entire mammal community.
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http://dx.doi.org/10.1016/j.scitotenv.2020.142500DOI Listing
February 2021

Increase in Pediatric Perforated Appendicitis in the New York City Metropolitan Region at the Epicenter of the COVID-19 Outbreak.

Ann Surg 2021 Mar;273(3):410-415

Division of Pediatric Surgery, Department of Surgery, NYU Grossman School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY.

Objective: The aim of the study was to determine whether perforated appendicitis rates in children were influenced by the Coronavirus disease 2019 (COVID-19) surge.

Background: Disruption of care pathways during a public health crisis may prevent children from obtaining prompt assessment for surgical conditions. Progression of appendicitis to perforation is influenced by timeliness of presentation. In the context of state-mandated controls and public wariness of hospitals, we investigated the impact of the COVID-19 outbreak on perforated appendicitis in children.

Study Design: We conducted an analysis of all children presenting to 3 hospital sites with acute appendicitis between March 1 and May 7, 2020, corresponding with the peak COVID-19 outbreak in the New York City region. Control variables were collected from the same institutions for the preceding 5 years. The primary outcome measure was appendiceal perforation.

Results: Fifty-five children presented with acute appendicitis over 10 weeks. Compared to a 5-year control cohort of 1291 patients, we observed a higher perforation rate (45% vs 27%, odds ratio 2.23, 95% confidence interval 1.29-3.85, P = 0.005) and longer mean duration of symptoms in children with perforations (71 ± 39 vs 47 ± 27 h, P = 0.001) during the COVID-19 period. There were no differences in perforation rates (55% vs 59%, P = 0.99) or median length of stay (1.0 vs 3.0 days, P = 0.58) among children screening positive or negative for SARS-CoV-2.

Conclusions: Children in the epicenter of the COVID-19 outbreak demonstrated higher rates of perforated appendicitis compared to historical controls. Preoperative detection of SARS-CoV-2 was not associated with inferior outcomes. Although children likely avoid much of the morbidity directly linked to COVID-19, disruption to local healthcare delivery systems may negatively impact other aspects of pediatric surgical disease.
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http://dx.doi.org/10.1097/SLA.0000000000004426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869969PMC
March 2021

Incidence of acute postoperative robotic port-site hernias: results from a high-volume multispecialty center.

J Robot Surg 2020 Jul 24. Epub 2020 Jul 24.

Division of General Surgery, Department of Surgery, NYU Robert I. Grossman School of Medicine, 530 First Ave, HCC Building, Suite 6 C, New York, NY, 10016, USA.

Fascial closure at 8-mm robotic port sites continues to be controversial. As the use of the robotic platform increases across multiple abdominal specialties, there are more case reports describing reoperation and small bowel resection for acute port-site hernias. A retrospective review of all robotic abdominal surgeries performed from 2012 to 2019 at NYU Langone Medical Center was conducted. Patients who had a reoperation in our facility within 30 days were identified, and medical records reviewed for indications for reoperation and findings. The study included 11,566 patients, of which 82 patients (0.71%) underwent a reoperation related to the index robotic surgery within 30 days. Fifteen of 11,566 patients (0.13%) had acute port-site hernias, and 3 of these 15 patients required small bowel resection. Eleven of 15 acute port-site hernias (73%) were at 8-mm robotic port site, 2 of which required a small bowel resection. More than a third of the patients had a hernia at an 8-mm port site where a surgical drain had been placed. Considering that each robotic case, regardless of specialty, has three ports at a minimum, the true incidence of acute postoperative robotic port-site hernia is 0.032% (11/34,698), with the incidence of concomitant small bowel resection being 0.006% (2/34,698). The incidence of acute port-site hernias from 8-mm robotic ports is exceedingly low across specialties. Our results do not support routine fascial closure at 8-mm robotic port sites due to an extremely low incidence. However, drain sites require special consideration.
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http://dx.doi.org/10.1007/s11701-020-01128-wDOI Listing
July 2020

Oral Antibiotics and Abscess Formation After Appendectomy for Perforated Appendicitis in Children.

J Surg Res 2020 12 16;256:56-60. Epub 2020 Jul 16.

Division of Pediatric Surgery, Department of Surgery, NYU Langone Health, New York, New York. Electronic address:

Background: There is little consensus regarding the use of postoperative antibiotics in the management of perforated appendicitis in children. Patients are commonly discharged with oral antibiotics after a course of intravenous antibiotics; however, recent literature suggests that patients can be safely discharged without any oral antibiotics. To further evaluate this protocol, we conducted a multicenter retrospective preimplementation/postimplementation study comparing rates of abscess formation and rehospitalization between patients discharged with and without oral antibiotics.

Materials And Methods: We reviewed the records of all pediatric patients who underwent appendectomies for perforated appendicitis at NYU Tisch Hospital, Bellevue Hospital, and Hackensack University Medical Center from January 2014 to June 2019. Data pertaining to patient demographics, hospital course, intraoperative appearance of the appendix, antibiotic treatment, abscess formation, and rehospitalization were collected.

Results: A total of 253 patients were included: 162 received oral antibiotics and 91 did not. The median length of antibiotic treatment (oral and intravenous) was 11 (10-14) d for patients on oral antibiotics and 5 (3-6) d for patients without oral antibiotics (P < 0.01). The median leukocyte count at discharge was 9.5 (7.4-10.9) and 8.1 (6.8-10.4) for these groups, respectively (P = 0.02). Postoperative abscesses occurred in 22% of patients receiving oral antibiotics and 15% of patients on no antibiotics (P = 0.25). Rates of rehospitalization for these groups were 10% and 11%, respectively (P = 0.99).

Conclusions: Children who have undergone appendectomy for perforated appendicitis can be safely discharged without oral antibiotics on meeting clinical discharge criteria and white blood cell count normalization.
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http://dx.doi.org/10.1016/j.jss.2020.05.082DOI Listing
December 2020

The use of faculty policy teams for advancing policy advocacy and colleagueship.

Nurs Forum 2020 Nov 1;55(4):582-588. Epub 2020 Jun 1.

School of Nursing, University of North Carolina Wilmington, Wilmington, North Carolina.

Policy changes that impact nursing occur at multiple levels. The scope and pace of policy changes make it impossible for one faculty member to fill the role of policy advocate. Faculty are frequently reticent to participate, yet, policy work can be very rewarding for faculty. When engaged in policy advocacy, nursing faculty can be a valuable resource to the university, to legislators, and to other stakeholders. This article discusses the team approach to policy advocacy activity and outlines key steps in the policy process. Strategies for overcoming barriers when merging academic and advocacy responsibilities are identified. An example of a college of nursing faculty policy team that utilized nursing presence and their combined intellectual, social, and political capital is provided. In this example, the policy team influences policy discussions on issues impacting both the university community and citizens throughout the state. The strategies provided and the policy process steps discussed are applicable to policy changes at the local, state, and federal levels. Nursing faculty are positioned to engage students, alumni, practice leaders, and community stakeholders in interdisciplinary and transdisciplinary efforts that influence policy initiatives.
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http://dx.doi.org/10.1111/nuf.12473DOI Listing
November 2020

Influences of landscape change and winter severity on invasive ungulate persistence in the Nearctic boreal forest.

Sci Rep 2020 05 26;10(1):8742. Epub 2020 May 26.

Former address: InnoTech Alberta, Bag 4000, Vegreville, Alberta, T9C1T4, Canada.

Climate and landscape change are drivers of species range shifts and biodiversity loss; understanding how they facilitate and sustain invasions has been empirically challenging. Winter severity is decreasing with climate change and is a predicted mechanism of contemporary and future range shifts. For example, white-tailed deer (Odocoileus virginianus) expansion is a continental phenomenon across the Nearctic with ecological consequences for entire biotic communities. We capitalized on recent temporal variation in winter severity to examine spatial and temporal dynamics of invasive deer distribution in the Nearctic boreal forest. We hypothesized deer distribution would decrease in severe winters reflecting historical climate constraints, and remain more static in moderate winters reflecting recent climate. Further, we predicted that regardless of winter severity, deer distribution would persist and be best explained by early seral forage subsidies from extensive landscape change via resource extraction. We applied dynamic occupancy models in time, and species distribution models in space, to data from 62 camera traps sampled over 3 years in northeastern Alberta, Canada. Deer distribution shrank more markedly in severe winters but rebounded each spring regardless of winter severity. Deer distribution was best explained by anthropogenic landscape features assumed to provide early seral vegetation subsidy, accounting for natural landcover. We conclude that deer dynamics in the northern boreal forest are influenced both by landscape change across space and winter severity through time, the latter expected to further decrease with climate change. We contend that the combined influence of these two drivers is likely pervasive for many species, with changing resources offsetting or augmenting physiological limitations.
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http://dx.doi.org/10.1038/s41598-020-65385-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7250834PMC
May 2020

Rapid Ketamine Infusion at an Analgesic Dose Resulting in Transient Hypotension and Bradycardia in the Emergency Department.

J Spec Oper Med 2020 ;20(1):31-33

Ketamine's favorable hemodynamic and safety profile is motivating increasing use in the prehospital environment. Despite these advantages, certain side effects require advanced planning and training. We present a case of rapid intravenous administration of ketamine causing bradycardia and hypotension. A 46-year-old man presented to the emergency department for an exacerbation of chronic shoulder pain. Given the chronicity of the pain and multiple failed treatment attempts, ketamine at an analgesic dose was used. Despite the local protocol directing administration over several minutes, it was pushed rapidly, resulting in malaise, nausea, pallor, bradycardia, and hypotension. The patient returned to his baseline without intervention. This and other known side effects of ketamine, such as behavioral disturbances, altered sense of reality, and elevated heart rate and blood pressure, are well documented in the literature. With this report, the authors aim to raise awareness of transient bradycardia and hypotension associated with the rapid administration of ketamine at an analgesic dose.
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May 2020

Boreal predator co-occurrences reveal shared use of seismic lines in a working landscape.

Ecol Evol 2020 Feb 30;10(3):1678-1691. Epub 2020 Jan 30.

Department of Forest Resources Management University of British Columbia Vancouver Canada.

Interspecific interactions are an integral aspect of ecosystem functioning that may be disrupted in an increasingly anthropocentric world. Industrial landscape change creates a novel playing field on which these interactions take place, and a key question for wildlife managers is whether and how species are able to coexist in such working landscapes. Using camera traps deployed in northern Alberta, we surveyed boreal predators to determine whether interspecific interactions affected occurrences of black bears (), coyotes (), and lynx () within a landscape disturbed by networks of seismic lines (corridors cut for seismic exploration of oil and gas reserves). We tested hypotheses of species interactions across one spatial-only and two spatiotemporal (daily and weekly) scales. Specifically, we hypothesized that (1) predators avoid competition with the apex predator, gray wolf (), (2) they avoid competition with each other as intraguild competitors, and (3) they overlap with their prey. All three predators overlapped with wolves on at least one scale, although models at the daily and weekly scale had substantial unexplained variance. None of the predators showed avoidance of intraguild competitors or overlap with prey. These results show patterns in predator space use that are consistent with both facilitative interactions or shared responses to unmeasured ecological cues. Our study provides insight into how predator species use the working boreal landscape in relation to each other, and highlights that predator management may indirectly influence multiple species through their interactions.
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http://dx.doi.org/10.1002/ece3.6028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029072PMC
February 2020

Comparative outcomes of right versus left congenital diaphragmatic hernia: A multicenter analysis.

J Pediatr Surg 2020 Jan 26;55(1):33-38. Epub 2019 Oct 26.

Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.

Background: Congenital diaphragmatic hernia (CDH) occurs in 1 out of 2500-3000 live births. Right-sided CDHs (R-CDHs) comprise 25% of all CDH cases, and data are conflicting on outcomes of these patients. The aim of our study was to compare outcomes in patients with right versus left CDH (L-CDH).

Methods: We analyzed a multicenter prospectively enrolled database to compare baseline characteristics and outcomes of neonates enrolled from January 2005 to January 2019 with R-CDH vs. L-CDH.

Results: A total of 588, 495 L-CDH, and 93 R-CDH patients with CDH were analyzed. L-CDHs were more frequently diagnosed prenatally (p=0.011). Lung-to-head ratio was similar in both cohorts. R-CDHs had a lower frequency of primary repair (p=0.022) and a higher frequency of need for oxygen at discharge (p=0.013). However, in a multivariate analysis, need for oxygen at discharge was no longer significantly different. There were no differences in long-term neurodevelopmental outcomes assessed at two year follow up. There was no difference in mortality, need for ECMO, pulmonary hypertension, or hernia recurrence.

Conclusion: In this large series comparing R to L-CDH patients, we found no significant difference in mortality, use of ECMO, or pulmonary complications. Our study supports prior studies that R-CDHs are relatively larger and more often require a patch or muscle flap for repair.

Type Of Study: Prognosis study LEVEL OF EVIDENCE: Level II.
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http://dx.doi.org/10.1016/j.jpedsurg.2019.09.046DOI Listing
January 2020

Laparoscopic Transabdominal Colopexy for Prolapse of a Newborn End Colostomy: A Novel Technique.

J Laparoendosc Adv Surg Tech A 2019 Oct 4;29(10):1368-1371. Epub 2019 Sep 4.

Division of Pediatric Surgery, Hackensack Meridian School of Medicine at Seton Hall, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey.

Prolapse can occur in up to 20% of newborn end colostomies and may be associated with significant morbidities that require operative intervention. Prolapse repair is traditionally performed through an open parastomal or laparotomy incision. We report on 2 cases that utilized a novel laparoscopic transabdominal colopexy technique, which offered a minimally invasive solution uniquely suited to neonates and infants while obviating the morbidity of open reoperative surgery. Retrospective review of 2 patients at a single center undergoing a laparoscopic transabdominal colopexy for end colostomy prolapse. The primary outcome measure was prolapse recurrence. Secondary outcomes included intraoperative or immediate postoperative complications. Both patients who underwent the laparoscopic transabdominal colopexy procedure had prolapsed end colostomies. There were no intraoperative or immediate postoperative complications. Both patients had no additional episodes of recurrence during the follow-up period. One patient has since had their colostomy reversed without complications. We present our initial results in the utilization of a novel technique for repair of a newborn end colostomy prolapse-laparoscopic transabdominal colopexy. Our technique thus far has demonstrated success in preventing recurrent prolapse through a minimally invasive technique with no significant morbidity.
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http://dx.doi.org/10.1089/lap.2019.0208DOI Listing
October 2019

Corridors best facilitate functional connectivity across a protected area network.

Sci Rep 2019 07 26;9(1):10852. Epub 2019 Jul 26.

School of Environmental Studies, University of Victoria, Victoria, BC, V8Z 2Y2, Canada.

Biologging data allow animal ecologists to directly measure species' fine-scale spatiotemporal responses to environments, such as movement - critical for our understanding of biodiversity declines in the Anthropocene. Animal movement between resource patches is a behavioral expression of multiple ecological processes that affect individual fitness. Protected area (PA) networks are a tool used to conserve biodiversity by sustaining habitat patches across vast heterogeneous landscapes. However, our ability to design PA networks that conserve biodiversity relies on our accurate understanding of animal movement and functional connectivity; this understanding is rarely tested in real-world situations due to the large geographic expanse of most PA networks. Using a tractable PA network mesocosm, we employ cutting-edge biologging technology to analyze animal movement decisions in response to a highly heterogeneous landscape. We analyze these data to test, in a novel way, three common hypotheses about functional connectivity - structural corridors, least cost paths, and stepping stones. Consistently, animals moved along structurally self-similar corridors. In reference to the Aichi 2020 Biodiversity Targets, relying on species to "stepping stone" across habitat remnants may not achieve protected area network conservation objectives.
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http://dx.doi.org/10.1038/s41598-019-47067-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659697PMC
July 2019

Electrically elicited quadriceps muscle torque: Comparison at three knee angles.

Physiother Theory Pract 2019 Jul 11:1-7. Epub 2019 Jul 11.

a School of Physical Therapy , Husson University , Bangor , ME , USA.

: The effect of knee angle on electrically elicited quadriceps muscle torque has not been established. The goal of this study was to determine which knee angle allowed for the production of the greatest knee extensor maximal voluntary isometric torque (KEMVIT), the greatest electrically elicited torque, and the highest percent of KEMVIT from the knee extensor muscles. : Eighteen participants were secured in a force dynamometer with the knee positioned at 30°, 60°, and 90° flexion. Participants performed KEMVITs followed by electrically elicited contractions to their maximum tolerance. : The mean ± SD of the peak KEMVITs was 123.7 ± 35.7 Nm, 222.6 ± 67.1 Nm, and 248.2 ± 81.1 Nm at 30°, 60°, and 90°, respectively. Significantly greater KEMVITs were produced at 60° and 90° than at 30° ( < 0.001). The mean ± SD of the maximally tolerated electrically elicited torques was 71.8 ± 18.8 Nm, 170.9 ± 70.4 Nm, and 134.6 ± 72.6 Nm at 30°, 60°, and 90°, respectively. Significantly higher torques were tolerated at 60° than at 30° ( < 0.001) and 90° ( = 0.018). The mean ± SD of the percent KEMVITs was 59.7 ± 11.7%, 78.2 ± 23.8%, and 52.6 ± 18.7% at 30°, 60°, and 90°, respectively. Significantly greater percent KEMVITs were produced at 60° than at 30° ( = 0.001) and 90° ( < 0.001). : Electrically elicited quadriceps torque production is greater at 60° as compared to 30° and 90° knee flexion.
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http://dx.doi.org/10.1080/09593985.2019.1639867DOI Listing
July 2019

Retrieval of Inferior Vena Cava Filters Temporarily Placed in a Suprarenal Position: A Review of 13 Patients.

Vasc Endovascular Surg 2019 Aug 2;53(6):446-451. Epub 2019 May 2.

1 Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Purpose: To evaluate the safety and efficacy of retrieval of inferior vena cava filters (IVCF) temporarily placed in a suprarenal position.

Methods: Retrieval of IVCF placed in a suprarenal position was performed in 13 patients (5 men and 8 women; mean age: 45.1 ± 13.8 years) between July 2006 and May 2018 using either a loop snare technique or endobronchial forceps. Electronic medical records were reviewed for patient demographics and procedural information.

Results: Inferior vena cava filters retrieved included Option Elite (n = 9, 69%) and Günther Tulip (n = 4, 31%). Caval thrombosis was not detected in any patients on pre- or postretrieval cavogram. Eleven suprarenal IVCF (84%) were retrieved during the first retrieval attempt after a median indwelling time of 1.8 months (range, 0.03-12.10 months). Retrieval was initially unsuccessful in 2 (16%) patients with Option Elite filters, but both were successfully removed on second attempt using endobronchial forceps. Thirteen suprarenal IVCF (100%) were ultimately retrieved.

Conclusion: Endovascular retrieval of IVCF temporarily placed in a suprarenal position is safe and efficacious.
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http://dx.doi.org/10.1177/1538574419843697DOI Listing
August 2019

Regarding "Treatment of postoperative high-volume lymphatic complications using isosulfan blue".

J Vasc Surg Venous Lymphat Disord 2019 03;7(2):309-310

Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, Alexandria, Va.

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http://dx.doi.org/10.1016/j.jvsv.2018.10.013DOI Listing
March 2019

Sequential evolution of virulence and resistance during clonal spread of community-acquired methicillin-resistant .

Proc Natl Acad Sci U S A 2019 01 11;116(5):1745-1754. Epub 2019 Jan 11.

Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016;

The past two decades have witnessed an alarming expansion of staphylococcal disease caused by community-acquired methicillin-resistant (CA-MRSA). The factors underlying the epidemic expansion of CA-MRSA lineages such as USA300, the predominant CA-MRSA clone in the United States, are largely unknown. Previously described virulence and antimicrobial resistance genes that promote the dissemination of CA-MRSA are carried by mobile genetic elements, including phages and plasmids. Here, we used high-resolution genomics and experimental infections to characterize the evolution of a USA300 variant plaguing a patient population at increased risk of infection to understand the mechanisms underlying the emergence of genetic elements that facilitate clonal spread of the pathogen. Genetic analyses provided conclusive evidence that fitness (manifest as emergence of a dominant clone) changed coincidently with the stepwise emergence of () a unique prophage and mutation of the regulator of the pyrimidine nucleotide biosynthetic operon that promoted abscess formation and colonization, respectively, thereby priming the clone for success; and () a unique plasmid that conferred resistance to two topical microbiocides, mupirocin and chlorhexidine, frequently used for decolonization and infection prevention. The resistance plasmid evolved through successive incorporation of DNA elements from non- spp. into an indigenous cryptic plasmid, suggesting a mechanism for interspecies genetic exchange that promotes antimicrobial resistance. Collectively, the data suggest that clonal spread in a vulnerable population resulted from extensive clinical intervention and intense selection pressure toward a pathogen lifestyle that involved the evolution of consequential mutations and mobile genetic elements.
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http://dx.doi.org/10.1073/pnas.1814265116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6358666PMC
January 2019

Reply to Letter to the Editor.

J Pediatr Surg 2019 04 21;54(4):867. Epub 2018 Dec 21.

Department of Surgery, Hassenfeld Children's Hospital at NYU Langone Health; Department of Radiology, Hassenfeld Children's Hospital at NYU Langone Health.

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http://dx.doi.org/10.1016/j.jpedsurg.2018.12.007DOI Listing
April 2019

Simple preoperative radiation safety interventions significantly lower radiation doses during central venous line placement in children.

J Pediatr Surg 2019 Jan 5;54(1):170-173. Epub 2018 Oct 5.

Division of Pediatric Surgery, Department of Surgery, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY.

Purpose: The purpose of this study was to reduce radiation exposure during pediatric central venous line (CVL) placement by implementing a radiation safety process including a radiation safety briefing and a job-instruction model with a preradiation time-out.

Methods: We reviewed records of all patients under 21 who underwent CVL placement in the operating room covering 22 months before the intervention through 10 months after 2013-2016. The intervention consisted of a radiation safety briefing by the surgeon to the intraoperative staff before each case and a radiation safety time-out. We measured and analyzed the dose area product (DAP), total radiation time pre- and postintervention, and the use of postprocedural chest radiograph.

Results: 100 patients with valid DAP measurements were identified for analysis (59 preintervention, 41 postintervention). Following implementation of the radiation safety process, there was a 79% decrease in median DAP (61.4 vs 13.1 rad*cm, P < 0.001) and a 73% decrease in the median radiation time (28 vs 7.6 s, P < 0.001). Additionally, there was a significant reduction in use of confirmatory CXR (95% vs 15%, P < 0.01).

Conclusion: A preoperative radiation safety briefing and a radiation safety time-out supported by a job-instruction model were effective in significantly lowering the absorbed doses of radiation in children undergoing CVL insertion.

Type Of Study: Case-control study.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1016/j.jpedsurg.2018.10.013DOI Listing
January 2019

The importance of considering multiple interacting species for conservation of species at risk.

Conserv Biol 2019 06 19;33(3):709-715. Epub 2018 Dec 19.

School of Environmental Studies, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8W 2Y2, Canada.

Conservation of species at risk of extinction is complex and multifaceted. However, mitigation strategies are typically narrow in scope, an artifact of conservation research that is often limited to a single species or stressor. Knowledge of an entire community of strongly interacting species would greatly enhance the comprehensiveness and effectiveness of conservation decisions. We investigated how camera trapping and spatial count models, an extension of spatial-recapture models for unmarked populations, can accomplish this through a case study of threatened boreal woodland caribou (Rangifer tarandus caribou). Population declines in caribou are precipitous and well documented, but recovery strategies focus heavily on control of wolves (Canis lupus) and pay less attention to other known predators and apparent competitors. Obtaining necessary data on multispecies densities has been difficult. We used spatial count models to concurrently estimate densities of caribou, their predators (wolf, black bear [Ursus americanus], and coyote [Canis latrans]), and alternative prey (moose [Alces alces] and white-tailed deer [Odocoileus virginianus]) from a camera-trap array in a highly disturbed landscape within northern Alberta's Oil Sands Region. Median densities were 0.22 caribous (95% Bayesian credible interval [BCI] = 0.08-0.65), 0.77 wolves (95% BCI = 0.26-2.67), 2.39 moose (95% BCI = 0.56-7.00), 2.64 coyotes (95% BCI = 0.45-6.68), and 3.63 black bears (95% BCI = 1.25-8.52) per 100 km . (The white-tailed deer model did not converge.) Although wolf densities were higher than densities recommended for caribou conservation, we suggest the markedly higher black bear and coyote densities may be of greater concern, especially if government wolf control further releases these species. Caribou conservation with a singular focus on wolf control may leave caribou vulnerable to other predators. We recommend a broader focus on the interacting species within a community when conserving species.
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http://dx.doi.org/10.1111/cobi.13233DOI Listing
June 2019

Cumulative effects of climate and landscape change drive spatial distribution of Rocky Mountain wolverine ( L.).

Ecol Evol 2017 11 21;7(21):8903-8914. Epub 2017 Sep 21.

University of Victoria Victoria BC Canada.

Contemporary landscapes are subject to a multitude of human-derived stressors. Effects of such stressors are increasingly realized by population declines and large-scale extirpation of taxa worldwide. Most notably, cumulative effects of climate and landscape change can limit species' local adaptation and dispersal capabilities, thereby reducing realized niche space and range extent. Resolving the cumulative effects of multiple stressors on species persistence is a pressing challenge in ecology, especially for declining species. For example, wolverines ( L.) persist on only 40% of their historic North American range. While climate change has been shown to be a mechanism of range retractions, anthropogenic landscape disturbance has been recently implicated. We hypothesized these two interact to effect declines. We surveyed wolverine occurrence using camera trapping and genetic tagging at 104 sites at the wolverine range edge, spanning a 15,000 km gradient of climate, topographic, anthropogenic, and biotic variables. We used occupancy and generalized linear models to disentangle the factors explaining wolverine distribution. Persistent spring snow pack-expected to decrease with climate change-was a significant predictor, but so was anthropogenic landscape change. Canid mesocarnivores, which we hypothesize are competitors supported by anthropogenic landscape change, had comparatively weaker effect. Wolverine population declines and range shifts likely result from climate change and landscape change operating in tandem. We contend that similar results are likely for many species and that research that simultaneously examines climate change, landscape change, and the biotic landscape is warranted. Ecology research and species conservation plans that address these interactions are more likely to meet their objectives.
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http://dx.doi.org/10.1002/ece3.3337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677488PMC
November 2017

Increased capture of pediatric surgical complications utilizing a novel case-log web application to enhance quality improvement.

J Pediatr Surg 2017 Jan 28;52(1):166-171. Epub 2016 Oct 28.

Division of Pediatric Surgery, Department of Surgery, NYU Langone Medical Center, NYU School of Medicine, New York, NY.

Purpose: Documenting surgical complications is limited by multiple barriers and is not fostered in the electronic health record. Tracking complications is essential for quality improvement (QI) and required for board certification. Current registry platforms do not facilitate meaningful complication reporting. We developed a novel web application that improves accuracy and reduces barriers to documenting complications.

Methods: We deployed a custom web application that allows pediatric surgeons to maintain case logs. The program includes a module for entering complication data in real time. Reminders to enter outcome data occur at key postoperative intervals to optimize recall of events. Between October 1, 2014, and March 31, 2015, frequencies of surgical complications captured by the existing hospital reporting system were compared with data aggregated by our application.

Results: 780 cases were captured by the web application, compared with 276 cases registered by the hospital system. We observed an increase in the capture of major complications when compared to the hospital dataset (14 events vs. 4 events).

Conclusions: This web application improved real-time reporting of surgical complications, exceeding the accuracy of administrative datasets. Custom informatics solutions may help reduce barriers to self-reporting of adverse events and improve the data that presently inform pediatric surgical QI.

Type Of Study: Diagnostic study/Retrospective study.

Level Of Evidence: Level III - case control study.
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http://dx.doi.org/10.1016/j.jpedsurg.2016.10.036DOI Listing
January 2017

Grizzly Bear Noninvasive Genetic Tagging Surveys: Estimating the Magnitude of Missed Detections.

PLoS One 2016 7;11(9):e0161055. Epub 2016 Sep 7.

Alberta Environment and Parks, Parks Division, Suite 201, 800 Railway Avenue, Canmore, Alberta, T1W 1P1, Canada.

Sound wildlife conservation decisions require sound information, and scientists increasingly rely on remotely collected data over large spatial scales, such as noninvasive genetic tagging (NGT). Grizzly bears (Ursus arctos), for example, are difficult to study at population scales except with noninvasive data, and NGT via hair trapping informs management over much of grizzly bears' range. Considerable statistical effort has gone into estimating sources of heterogeneity, but detection error-arising when a visiting bear fails to leave a hair sample-has not been independently estimated. We used camera traps to survey grizzly bear occurrence at fixed hair traps and multi-method hierarchical occupancy models to estimate the probability that a visiting bear actually leaves a hair sample with viable DNA. We surveyed grizzly bears via hair trapping and camera trapping for 8 monthly surveys at 50 (2012) and 76 (2013) sites in the Rocky Mountains of Alberta, Canada. We used multi-method occupancy models to estimate site occupancy, probability of detection, and conditional occupancy at a hair trap. We tested the prediction that detection error in NGT studies could be induced by temporal variability within season, leading to underestimation of occupancy. NGT via hair trapping consistently underestimated grizzly bear occupancy at a site when compared to camera trapping. At best occupancy was underestimated by 50%; at worst, by 95%. Probability of false absence was reduced through successive surveys, but this mainly accounts for error imparted by movement among repeated surveys, not necessarily missed detections by extant bears. The implications of missed detections and biased occupancy estimates for density estimation-which form the crux of management plans-require consideration. We suggest hair-trap NGT studies should estimate and correct detection error using independent survey methods such as cameras, to ensure the reliability of the data upon which species management and conservation actions are based.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161055PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014381PMC
August 2017

A novel approach to leveraging electronic health record data to enhance pediatric surgical quality improvement bundle process compliance.

J Pediatr Surg 2016 Jun 2;51(6):1030-3. Epub 2016 Mar 2.

Division of Pediatric Surgery, NYU Langone Medical Center, NYU School of Medicine, New York, NY.

Purpose: Quality improvement (QI) bundles have been widely adopted to reduce surgical site infections (SSI). Improvement science suggests when organizations achieve high-reliability to QI processes, outcomes dramatically improve. However, measuring QI process compliance is poorly supported by electronic health record (EHR) systems. We developed a custom EHR tool to facilitate capture of process data for SSI prevention with the aim of increasing bundle compliance and reducing adverse events.

Methods: Ten SSI prevention bundle processes were linked to EHR data elements that were then aggregated into a snapshot display superimposed on weekly case-log reports. The data aggregation and user interface facilitated efficient review of all SSI bundle elements, providing an exact bundle compliance rate without random sampling or chart review.

Results: Nine months after implementation of our custom EHR tool, we observed centerline shifts in median SSI bundle compliance (46% to 72%). Additionally, as predicted by high reliability principles, we began to see a trend toward improvement in SSI rates (1.68 to 0.87 per 100 operations), but a discrete centerline shift was not detected.

Conclusion: Simple informatics solutions can facilitate extraction of QI process data from the EHR without relying on adjunctive systems. Analyses of these data may drive reductions in adverse events. Pediatric surgical departments should consider leveraging the EHR to enhance bundle compliance as they implement QI strategies.
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http://dx.doi.org/10.1016/j.jpedsurg.2016.02.080DOI Listing
June 2016

Wolverine behavior varies spatially with anthropogenic footprint: implications for conservation and inferences about declines.

Ecol Evol 2016 03 9;6(5):1493-503. Epub 2016 Feb 9.

School of Environmental Studies University of Victoria 3800 Finnerty Rd. Victoria BC Canada V8W 2Y2; Ecosystem Management Unit Alberta Innovates-Technology Futures 3-4476 Markham St. Victoria BC Canada V8Z 7X8.

Understanding a species' behavioral response to rapid environmental change is an ongoing challenge in modern conservation. Anthropogenic landscape modification, or "human footprint," is well documented as a central cause of large mammal decline and range contractions where the proximal mechanisms of decline are often contentious. Direct mortality is an obvious cause; alternatively, human-modified landscapes perceived as unsuitable by some species may contribute to shifts in space use through preferential habitat selection. A useful approach to tease these effects apart is to determine whether behaviors potentially associated with risk vary with human footprint. We hypothesized wolverine (Gulo gulo) behaviors vary with different degrees of human footprint. We quantified metrics of behavior, which we assumed to indicate risk perception, from photographic images from a large existing camera-trapping dataset collected to understand wolverine distribution in the Rocky Mountains of Alberta, Canada. We systematically deployed 164 camera sites across three study areas covering approximately 24,000 km(2), sampled monthly between December and April (2007-2013). Wolverine behavior varied markedly across the study areas. Variation in behavior decreased with increasing human footprint. Increasing human footprint may constrain potential variation in behavior, through either restricting behavioral plasticity or individual variation in areas of high human impact. We hypothesize that behavioral constraints may indicate an increase in perceived risk in human-modified landscapes. Although survival is obviously a key contributor to species population decline and range loss, behavior may also make a significant contribution.
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http://dx.doi.org/10.1002/ece3.1921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747315PMC
March 2016

Factors associated with failure of nonoperative treatment of complicated appendicitis in children.

J Pediatr Surg 2016 Jul 2;51(7):1174-6. Epub 2016 Feb 2.

Department of Surgery, Division of Pediatric Surgery, New York University Langone Medical Center. Electronic address:

Unlabelled: Appendicitis remains the most common cause for emergency abdominal surgery in children. Immediate appendectomy in complicated, perforated appendicitis can be hazardous and nonoperative therapy has been gaining use as an initial therapy in children. Previous studies have reported failure rates in nonoperative therapy in such cases ranging from 10% to 41%. Factors leading to treatment failures have been studied with various and disparate results. We reviewed our institutional experience in treated complicated appendicitis, with focus on those initially managed nonoperatively.

Methods: Records of all children admitted with the diagnosis of perforated appendicitis to NYU Langone Medical Center and Bellevue Hospital Center from January 1, 2003 to December 31, 2013 were reviewed. The diagnosis was made with ultrasound and/or computed tomography scan. Those with abscesses amenable to drainage underwent aspiration and drain placement by an interventional radiologist. Broad spectrum intravenous (IV) antibiotics were given until the patient became afebrile, pain free and tolerating a regular diet. Oral antibiotics were continued for an additional week and interval appendectomy was done eight weeks later. The primary outcome measure was treatment response with failure defined as those who did not improve or required readmission for additional IV antibiotics and/or early appendectomy. Multiple patient and treatment related variables, including those previously reported as predicting failure in nonoperative therapy, were studied. Continuous variables were reported as means ± standard error and compared using 2-tailed unpaired t tests; nonparametric variables were analyzed by Mann-Whitney U tests. Categorical variables were reported as medians ± interquartile ranges and compared using Chi-square testing. Statistical significance was accepted for p<.05.

Results: Sixty-four patients were identified as undergoing initial nonoperative therapy. Fifty-two (81%) were categorized as treatment successes being treated nonoperatively and 12 (19%) were failures. Variables showing no significance in predicting treatment failures included duration of symptoms, presence of appendicolith, presence of phlegmon, presence of abscess, initial white blood cell count, and SIRS (Systemic Inflammatory Response Syndrome) positive. The variables that predicted failure of nonoperative therapy vs. successes were presence of bandemia (75% vs. 40%, p=0.052) and small bowel obstruction on imaging (42% vs. 15%, p=0.052) and presence of bandemia ≥15% which was highly predictive of failure (67% vs. 4%, p<0.01).

Conclusions: Predicting which patients with complicated perforated appendicitis will respond well to nonoperative therapy may allow us to more effectively treat patients with complicated perforated appendicitis. In our study the presence of small bowel obstruction and bandemia, especially ≥15% correlated with treatment failure; this suggests that these select patients may need a modified treatment strategy.
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http://dx.doi.org/10.1016/j.jpedsurg.2016.01.006DOI Listing
July 2016

Spatial patterns of breeding success of grizzly bears derived from hierarchical multistate models.

Conserv Biol 2014 Oct 24;28(5):1249-59. Epub 2014 Apr 24.

Alberta Innovates - Technology Futures, Ecosystem Management Unit, 3-4476 Markham St, Victoria, BC V8Z 7X8, Canada.

Conservation programs often manage populations indirectly through the landscapes in which they live. Empirically, linking reproductive success with landscape structure and anthropogenic change is a first step in understanding and managing the spatial mechanisms that affect reproduction, but this link is not sufficiently informed by data. Hierarchical multistate occupancy models can forge these links by estimating spatial patterns of reproductive success across landscapes. To illustrate, we surveyed the occurrence of grizzly bears (Ursus arctos) in the Canadian Rocky Mountains Alberta, Canada. We deployed camera traps for 6 weeks at 54 surveys sites in different types of land cover. We used hierarchical multistate occupancy models to estimate probability of detection, grizzly bear occupancy, and probability of reproductive success at each site. Grizzly bear occupancy varied among cover types and was greater in herbaceous alpine ecotones than in low-elevation wetlands or mid-elevation conifer forests. The conditional probability of reproductive success given grizzly bear occupancy was 30% (SE = 0.14). Grizzly bears with cubs had a higher probability of detection than grizzly bears without cubs, but sites were correctly classified as being occupied by breeding females 49% of the time based on raw data and thus would have been underestimated by half. Repeated surveys and multistate modeling reduced the probability of misclassifying sites occupied by breeders as unoccupied to <2%. The probability of breeding grizzly bear occupancy varied across the landscape. Those patches with highest probabilities of breeding occupancy-herbaceous alpine ecotones-were small and highly dispersed and are projected to shrink as treelines advance due to climate warming. Understanding spatial correlates in breeding distribution is a key requirement for species conservation in the face of climate change and can help identify priorities for landscape management and protection.
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http://dx.doi.org/10.1111/cobi.12302DOI Listing
October 2014

Monoclonal B lymphocytosis versus chronic lymphocytic leukemia: factors affecting implementation of an absolute threshold.

Cytometry B Clin Cytom 2013 May 8;84(3):149-56. Epub 2013 Mar 8.

Division of Hematopathology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213-2582, USA.

Background: Laboratories utilize diverse methods to determine the absolute count used to distinguish chronic lymphocytic leukemia (CLL) from monoclonal B lymphocytosis, with many using dual platform (DP) methods (flow cytometric percent of CLL-like B cells × hematology analyzer white blood cell count). However, flow cytometric tube-to-tube variation may make interpretation difficult, particularly when the CLL-like B-cell count straddles the recommended threshold. This study investigates the extent, and potential sources, of this variability.

Methods: Flow cytometric enumeration was performed on 20 samples with CLL-like B cells and 10 control specimens using single platform (SP) and two DP tubes A: kappa, lambda, CD5, CD10, CD19, CD38, CD45, CD20 and B: FMC-7, CD23, CD19, CD5, with and without racking to remove doublets. In addition, reproducibility studies were performed.

Results: Three specimens showed discordant CLL-like B-cell counts relative to the threshold of 5 × 10⁹ /L. Bland-Altman analysis demonstrated a systematic bias with DP Tube B > A (5.9%) and SP > DP Tube A (9.5%). The doublet percent varied between specimens, but did not account for the bias between DP tubes. Variation was also seen in enumeration of other cell types, suggesting multiple potential sources of inconsistency.

Conclusions: Significant tube-to-tube variation may be seen in CLL-like B-cell counts. The precise cause of these differences is uncertain, but is likely multifactorial. If the clinical utility of an absolute threshold for the diagnosis of CLL can be confirmed, it will be important to establish recommendations for standardization, similar to those employed for CD4 and CD34 enumeration.
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http://dx.doi.org/10.1002/cyto.b.21077DOI Listing
May 2013

Improvised method to retrieve a proximally displaced ureteral stent in a remote surgical setting.

J Endourol 2013 Jul 26;27(7):922-4. Epub 2013 Mar 26.

Michigan State University College of Osteopathic Medicine, Farmington Hills, Michigan, USA.

Purpose: To present an improvised method for repositioning a proximally displaced stent using only a cystoscope and a guidewire.

Methods: A Glidewire guidewire (Boston Scientific) was passed through a cystoscope and into the distal ureter, and manipulated up the ureteral stent into the renal pelvis, reflected, and passed antegrade down the ureter and into the bladder. The guidewire was then grasped in the bladder, clamped at the penis, and retracted, pulling the stent back into the bladder.

Results: The patient proceeded with lithotripsy, and the stent was removed in 2 weeks without complication.

Conclusion: Methods at retrieving proximally displaced ureteral stents after deployment have been previously reported; however, these methods necessitated access to a ureteroscope and special graspers/baskets that may not be available in an outpatient surgical center setting. Here, an improvised method for stent repositioning using only a cystoscope and a guidewire allowed successful retrieval of a proximally migrated stent.
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http://dx.doi.org/10.1089/end.2012.0755DOI Listing
July 2013