Climate-driven impacts of prey abundance on the population structure of a tropical aquatic predator

In the present study we explore how annual variation in climate (late wet-season rainfall) affects population demography in a gape-limited obligate piscivorous predator, the Arafura filesnake Acrochordus arafurae in the Australian tropics. These aquatic snakes display extreme sexual dimorphism, with body sizes and relative head sizes of females much larger than those of males. Two consecutive years with low rainfall during the late wet season reduced the abundance of small but not large sized fish. Although snake residual body mass (RBM, calculated from a general linear regression of ln-transformed mass to ln-SVL) decreased after the first year with low prey availability, it was not until the second year that reduced prey abundance caused a dramatic decline in filesnake survival, and hence in population numbers. Thus, our results suggest that most snakes survived the first year of reduced prey abundance, but a successive year with low prey availability proved fatal for many animals. However, the effects of prey scarcity on RBM and survival fell disproportionately on some size classes of snakes. Medium-sized animals (large males and intermediate-sized females) were affected more dramatically than were small or large snakes. We attribute the higher survival of small snakes to their lower energy needs compared to medium-sized individuals, and the higher survival of large snakes to the continued abundance of large prey (mainly large catfish). Two successive years with low abundance of smaller sized prey thus massively modified the size-structure of the filesnake population, virtually eliminating large males and intermediate-sized females. Our field data provide a clear demonstration of the ways in which stochastic variation in climatic conditions can have dramatic effects on predator population demography, mediated via effects on prey availability.

Mortality and use of the auxiliary score in extensive toxic epidermal necrolysis patients admitted to an adult burns referral centre

 Background: Toxic epidermal necrolysis (TEN) is a rare but fatal condition characterised by cutaneous exfoliation of the dermoepidermal layer and mucosal surfaces. Extensive TEN with epidermal detachment >30% of the total body surface area has been associated with a high mortality. Objective: This study aims to evaluate factors associated with mortality in extensive TEN. In the absence of data to qualify scoring systems such as SCORTEN, this study also aims to evaluate the use of the auxiliary score as a tool for calculating expected mortality. Methods: A retrospective chart review of all patients presenting to our burns service with extensive TEN was undertaken. Application and evaluation of the auxiliary score was also undertaken for this patient population. Results: In extensive TEN, age and delay in admission to a burns centre were factors associated with mortality. Applying the auxiliary score to our patient population, there were no significant differences between expected mortality and observed mortality. Conclusion: Mortality was associated with age and delay in definitive treatment in extensive TEN. Whilst SCORTEN is the gold standard prognostic tool for patients with TEN, in the absence of SCORTEN values, the auxiliary score provides an alternative scoring system to evaluate expected mortality.

Consent as a Common Law Defence to Non-Sexual Assaults: The Effect of Neal v The Queen

The following discussion is an exposition of the recognised exceptions to the general rule that the law will not sanction the giving of a lawful consent to the application or threat of actual or grievous bodily harm. The discussion will also focus on a series of decisions in the UK and Australia, particularly Neal v The Queen, that have altered the law's approach to these exceptions and, more importantly, now permit a personto give an informed consent to the risk of contracting HIV or any other sexually transmitted diseases, provided there was no intention on the part of the accused to actually infect the other person. The underlying rationale for sanctioning an informed consent to such a risk is that consenting adults should be accorded the utmost autonomy in conductingtheir private affairs, and particularly so in the context of the choices they make regarding their private sexual activities. Whether one agrees or disagrees with the notion of allowing one to lawfully consent to such a risk, it raises an important question as to the current status of the general rule that one cannot generally give an informed consent to the applicationor threat of actual or grievous bodily harm. More succinctly stated, if the law is prepared to allow an informed consent to the risk of contracting a potentially fatal disease, then what remains of what had previously been a well-settled rule that, save for a few well-recognised exceptions, persons were generally prohibited from consenting to the application or threat of actual or grievous bodily harm?

Risky driving in young adults : A review of the literature

Young drivers aged between 16 and 25 are consistently over-represented in fatal crash statistics and are more likely than older drivers to be involved in a range of intentional risky driving behaviours, such as drink driving, speeding, drag racing, and tailgating. This paper reports the fndings of a systematic search of published peer-reviewed literature, identifying the association between age and the characteristics of risky drivers, as well as interventions that have been developed to improve their safety. The results suggest that it is young males who are predominantly involved in unsafe driving and that these drivers are generally high in reward sensitivity, have antisocial peers, and believe that they are not dangerous drivers. Further to this, deterrence-based interventions have shown limited efectiveness for the specifc category of 'hoon' drivers, suggesting the need for targeted interventions across a multitude of domains. Efective intervention requires an understanding of the antecedents of dangerous driving behaviour, and it is concluded that interventions might be most efective when targeted towards these identifed criminogenic needs.

Higher dietary calcium intakes are associated with reduced risks of fractures, cardiovascular events, and mortality: a prospective cohort study of older men and women

The aim of this population-based, prospective cohort study was to investigate long-term associations between dietary calcium intake and fractures, non-fatal cardiovascular disease (CVD), and death from all causes. Participants were from the Melbourne Collaborative Cohort Study, which was established in 1990 to 1994. A total of 41,514 men and women (∼99% aged 40 to 69 years at baseline) were followed up for a mean (SD) of 12 (1.5) years. Primary outcome measures were time to death from all causes (n = 2855), CVD-related deaths (n = 557), cerebrovascular disease-related deaths (n = 139), incident non-fatal CVD (n = 1827), incident stroke events (n = 537), and incident fractures (n = 788). A total of 12,097 participants (aged ≥50 years) were eligible for fracture analysis and 34,468 for non-fatal CVD and mortality analyses. Mortality was ascertained by record linkage to registries. Fractures and CVD were ascertained from interview ∼13 years after baseline. Quartiles of baseline energy-adjusted calcium intake from food were estimated using a food-frequency questionnaire. Hazard ratios (HR) and odds ratios (OR) were calculated for quartiles of dietary calcium intake. Highest and lowest quartiles of energy-adjusted dietary calcium intakes represented unadjusted means (SD) of 1348 (316) mg/d and 473 (91) mg/d, respectively. Overall, there were 788 (10.3%) incident fractures, 1827 (9.0%) incident CVD, and 2855 people (8.6%) died. Comparing the highest with the lowest quartile of calcium intake, for all-cause mortality, the HR was 0.86 (95% confidence interval [CI] 0.76-0.98, ptrend  = 0.01); for non-fatal CVD and stroke, the OR was 0.84 (95% CI 0.70-0.99, ptrend  = 0.04) and 0.69 (95% CI 0.51-0.93, ptrend  = 0.02), respectively; and the OR for fracture was 0.70 (95% CI 0.54-0.92, ptrend  = 0.004). In summary, for older men and women, calcium intakes of up to 1348 (316) mg/d from food were associated with decreased risks for fracture, non-fatal CVD, stroke, and all-cause mortality.

HealthMap: a visual platform for patient suicide risk review

Misjudging suicide risk can be fatal. Risk assessment is complicated by multiplicity of risk factors, none of which individually can reliably predict risk. This paper addresses the need for better clinical support, visualising risk factors scattered in raw electronic medical records. HealthMap is a visual tool that helps clinicians effectively examine patient histories during a suicide risk assessment. We characterise the information visualisation problems accompanying suicide risk assessments. A design driven by visualisation principles was implemented. The prototype was evaluated by clinicians and accepted into daily clinical work-flow.

Cardiovascular alterations and management

This chapter reviews the support of cardiovascular function in the face of
many compromises to the system. It focuses on two of the most prevalent and fatal diseases affecting the heart: coronary heart disease and heart failure. These diseases are also a common comorbidity in elderly patients admitted to critical care units. The first section on coronary heart disease reviews the pathophysiological concepts of myocardial ischaemia and associated complications, with detailed consideration of the clinical implications, assessment and associated management. Heart failure is discussed in terms of the body’s compensatory mechanisms and the clinical sequelae and associated clinical features of heart failure. Nursing and medical management is outlined including the management of acute exacerbations of heart failure. Finally, other cardiovascular disorders commonly managed in critical care units are reviewed, ranging from other forms of heart failure to hypertensive emergencies and aortic aneurysms. The case study presented at the end of the chapter highlights the key aspects of the management of coronary heart disease and heart failure in patients admitted to critical care units.

Association between perception of fault for the crash and function, return to work and health status 1 year after road traffic injury: a registry-based cohort study

Objectives To establish the association between the patient's perception of fault for the crash and 12-month outcomes after non-fatal road traffic injury.Setting Two adult major trauma centres, one regional trauma centre and one metropolitan trauma centre in Victoria, Australia.Participants 2605 adult, orthopaedic trauma patients covered by the state's no-fault third party insurer for road traffic injury, injured between September 2010 and February 2014.Outcome measures EQ-5D-3L, return to work and functional recovery (Glasgow Outcome Scale—Extended score of upper good recovery) at 12 months postinjury.Results After adjusting for key confounders, the adjusted relative risk (ARR) of a functional recovery (0.57, 95% CI 0.46 to 0.69) and return to work (0.92, 95% CI 0.86 to 0.99) were lower for the not at fault compared to the at fault group. The ARR of reporting problems on EQ-5D items was 1.20–1.35 times higher in the not at fault group. Conclusions Patients who were not at fault, or denied being at fault despite a police report of fault, experienced poorer outcomes than the at fault group. Attributing fault to others was associated with poorer outcomes. Interventions to improve coping, or to resolve negative feelings from the crash, could facilitate better outcomes in the future.

The addition of depression to the Framingham Risk Equation model for predicting coronary heart disease risk in women

BACKGROUND: Depression is widely considered to be an independent and robust predictor of Coronary Heart Disease (CHD), however is seldom considered in the context of formal risk assessment. We assessed whether the addition of depression to the Framingham Risk Equation (FRE) improved accuracy for predicting 10-year CHD in a sample of women.

DESIGN: A prospective, longitudinal design comprising an age-stratified, population-based sample of Australian women collected between 1993 and 2011 (n=862).

METHODS: Clinical depressive disorder was assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-I/NP), using retrospective age-of-onset data. A composite measure of CHD included non-fatal myocardial infarction, unstable angina coronary intervention or cardiac death. Cox proportional-hazards regression models were conducted and overall accuracy assessed using area under receiver operating characteristic (ROC) curve analysis.

RESULTS: ROC curve analyses revealed that the addition of baseline depression status to the FRE model improved its overall accuracy (AUC:0.77, Specificity:0.70, Sensitivity:0.75) when compared to the original FRE model (AUC:0.75, Specificity:0.73, Sensitivity:0.67). However, when calibrated against the original model, the predicted number of events generated by the augmented version marginally over-estimated the true number observed.

CONCLUSIONS: The addition of a depression variable to the FRE equation improves the overall accuracy of the model for predicting 10-year CHD events in women, however may over-estimate the number of events that actually occur. This model now requires validation in larger samples as it could form a new CHD risk equation for women.

Depression is a risk factor for incident coronary heart disease in women: an 18-year longitudinal study

BACKGROUND: According to a recent position paper by the American Heart Association, it remains unclear whether depression is a risk factor for incident Coronary Heart Disease (CHD). We assessed whether a depressive disorder independently predicts 18-year incident CHD in women. METHOD: A prospective longitudinal study of 860 women enrolled in the Geelong Osteoporosis Study (1993-2011) was conducted. Participants were derived from an age-stratified, representative sample of women (20-94 years) randomly selected from electoral rolls in South-Eastern Australia. The exposure was a diagnosis of a depressive disorder using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. Outcomes data were collected from hospital medical records: (1) Primary outcome: a composite measure of cardiac death, non-fatal Myocardial Infarction or coronary intervention. (2) Secondary outcome: any cardiac event (un/stable angina, cardiac event not otherwise defined) occurring over the study period. RESULTS: Seven participants were excluded based on CHD history. Eighty-three participants (9.6%) recorded ≥1 cardiac event over the study period; 47 had a diagnosis that met criteria for inclusion in the primary analysis. Baseline depression predicted 18-year incidence, adjusting for (1) anxiety (adj. OR:2.39; 95% CIs:1.19-4.82), plus (2) typical risk factors (adj. OR:3.22; 95% CIs:1.45-6.93), plus (3) atypical risk factors (adj. OR:3.28; 95% CIs:1.36-7.90). This relationship held when including all cardiac events. No relationship was observed between depression and recurrent cardiac events. CONCLUSION: The results of this study support the contention that depression is an independent risk factor for CHD incidence in women. Moreover, the strength of association between depression and CHD incidence was of a greater magnitude than any typical and atypical risk factor.

Acidentes de trânsito fatais e sua associação com indicadores sociais e adolescência

Introdução - Os acidentes de trânsito são um grave problema de saúde pública universal, em países desenvolvidos e subdesenvolvidos, estando entre as primeiras causas de morte em quase todos os países do mundo (DEL CIAMPO & RICCO, 1996). No Brasil, assu-mem grande relevância, especialmente pela alta morbidade e mortalidade, predominância em populações jovens e/ou economicamente ativas, maior perda de anos de vida produtiva e ele-vado custo direto e indireto para a sociedade. Objetivo - Os objetivos deste trabalho foram descrever a magnitude da mortali-dade por acidentes de trânsito, avaliar sua correlação com indicadores sociais e proporção de jovens na população e testar a sua associação com adolescência, sexo masculino e consumo de álcool. Material e Métodos - Foi realizado, inicialmente, um estudo ecológico envolven-do todas as capitais das unidades da federação e Distrito Federal (exceto o município do Rio de Janeiro), com coleta de dados sobre acidentes de trânsito com vítimas no Departamento Nacional de Trânsito. Foram descritos os índices de acidentes de trânsito com vítimas p/ 1.000 veículos (IAT-V) e de feridos p/ 1.000 veículos (IF-V) referentes aos anos de 1995, 1997 e 1998 e o índice de mortos p/ 10.000 veículos (IM-V) referente ao período de 1995 a 1998. Em seguida, avaliou-se a existência de correlação entre o IM-V e taxa de mortalidade infantil (TMI), índice municipal de desenvolvimento humano (IDH-M), índice de condições de vida (ICV), proporção de condutores adolescentes envolvidos em acidentes de trânsito com vítimas (PCJ-ATV) e proporção de residentes jovens (PRJ) nas diferentes capitais. Em um segundo momento, realizou-se um estudo de caso controle, onde foram estudados 863 condu-tores envolvidos em acidentes de trânsito com vítimas atendidos no Departamento Médico Legal de Porto Alegre, no período de 1998 a 1999. Os condutores foram divididos em dois grupos: condutores envolvidos em acidentes de trânsito com vítima fatal (casos) e com vítima não fatal (controles). Os grupos foram comparados com relação a adolescência, sexo mascu-lino e consumo de álcool, através da razão de chances e seu intervalo de confiança, com signi-ficância determinada pelo teste de qui-quadrado. Resultados - No estudo ecológico, observou-se, no Brasil, uma tendência decres-cente quanto aos indicadores de eventos relacionados ao trânsito no período de 1995 a 1998. Nas capitais das unidades da federação e Distrito Federal, apesar da ampla variação apresenta-da, a maioria manteve a mesma tendência decrescente observada para o país como um todo. Na análise das correlações entre o IM-V e os indicadores sociais, observou-se forte correlação positiva com a TMI (r = 0,57; P = 0,002), ou seja, quanto maior a TMI, maior a mortalidade no trânsito, além de correlação negativa com o IDH-M (r = - 0,41; P = 0,038) e com o ICV (r = - 0,58; P = 0,02). Quando se avaliaram o IDH-M e o ICV separados em suas dimensões, a dimensão renda de ambos indicadores foi a única que não demonstrou correlação com o IM- -V. As demais dimensões do IDH-M e ICV demonstraram correlação negativa, sendo que a dimensão infância (r = - 0,62; P = 0,001) apresentou a maior correlação. A análise da asso-ciação entre o IM-V e a PCJ-ATV não demonstrou correlação, mas, quando avaliada a asso-ciação com a PRJ nas capitais, houve forte correlação positiva (r = 0,59; P = 0,002). No estudo de caso controle, quando avaliada a relação entre condutores envolvidos em acidentes com vítima fatal e adolescência, sexo masculino e consumo de álcool, não foi observada asso-ciação importante em nenhum dos fatores em estudo. Conclusões - Apesar de os indicadores de eventos relacionados ao trânsito (IAT- -V, IF-V e IM-V) terem apresentado uma tendência decrescente durante o período de estudo, acidentes de trânsito continuam sendo um grave problema de saúde pública. O estudo ecológico evidenciou a existência de relação entre o IM-V e os indicadores sociais (TMI, IDH-M e ICV), sendo que a dimensão renda não demonstrou correlação e a dimensão infância apresen-tou a correlação negativa de maior valor. Quanto à PCJ-ATV, não foi encontrada associação relevante entre este indicador e o IM-V. Entretanto, observou-se forte associação entre a PRJ e o IM-V. O estudo de caso controle não evidenciou associação entre adolescência e os de-mais fatores estudados e maior risco para acidente de trânsito fatal.

Isquemia silenciosa e arritmias ventriculares são preditores independentes de evenos no pós-infarto do miocárdio de baixo risco

pós-infarto agudo do miocárdio (IAM) têm mostrado baixo valor preditivo positivo quando estudados isoladamente. A possibilidade da Eletrocardiografia Dinâmica de 24 horas (ECGD) fornecer dados referentes a isquemia silenciosa (IS), arritmias ventriculares e modulação autonômica do coração pelo estudo da variabilidade da freqüência cardíaca (VFC), levou o autor a empregar este método em pacientes acometidos de IAM com o objetivo de avaliar se estas três variáveis estariam relacionadas a presença de eventos desfavoráveis em evolução a médio prazo. Material e Métodos – Foram selecionados 91 pacientes acometidos de um primeiro IAM não-complicado e realizados exames de ECGD de 24 h por dois dias consecutivos, antes da alta hospitalar. Os parâmetros pesquisados nos exames foram: isquemia silenciosa, identificação e quantificação de arritmias ventriculares e determinação dos índices de VFC pelos métodos do domínio do tempo e do mapa de retorno tridimensional. Foram considerados como desfechos: re-infarto, angina instável, taquicardia ventricular sustentada e morte. Resultados – No seguimento médio de 27,7 meses (DP=15,45), 23 (25%) dos pacientes apresentaram eventos, sendo nove fatais. Os eventos foram mais freqüentes entre os pacientes que apresentaram extra-sístoles ventriculares ≥10/hora (p=0,01) e também naqueles com IS (p=0,02). Em modelo de análise multifatorial, a presença de dislipidemia elevou o valor preditivo positivo dessas variáveis. Nenhum dos índices de VFC esteve significativamente relacionado ao surgimento de eventos. Conclusões – Em pacientes pós-IAM de baixo risco, a presença de arritmias ventriculares freqüentes ou de isquemia silenciosa está relacionada a um prognóstico desfavorável. O estudo da VFC não mostrou utilidade na estratificação de risco destes pacientes.

The state of the youth: prisons, drugs and car crashes

By virtue of the volume and nature of their attributions, including secondary school as well as problem-areas such as security and traffic, the Brazilian states are the ultimate responsible entities for young people. This study argues in favour of granting greater freedom for the states to define their own public policy parameters to deal with local features and to increase the degree of learning about such actions at the national level. In empirical terms, the study assesses the impacts of new laws, such as the new traffic code (from the joint work with Leandro Kume, EPGE/FGV doctor’s degree student) and traces the statistics for specific questions like drugs, violence and car accidents. The findings show that these questions produce different results for young men and women.The main characters in these dramas are young single males, suggesting the need for more distinguished public policies according not only to age, but also by gender. The study also reveals that the magnitude of these problems changes according to the youth’s social class. Prisons concern poorer men (except for the functional illiterate) while fatal car accidents and the confessed use of drugs concern upper-class boys.

O movimento E.C.R.: estudo de caso Sendas

Este estudo demonstrou os impactos do E.C.R. ¿ Resposta Eficiente ao Consumidor na cadeia de suprimentos de uma empresa de varejo, precisamente do grupo Sendas, empresa esta que busca na logística um diferencial competitivo para sobreviver neste mercado acompanhando as mudanças e as melhorias operacionais no fluxo de produtos e das operações, causadas pela evolução tecnológica que o varejo vem sofrendo nos últimos anos. Para tanto foram realizadas pesquisas bibliográfica e documental, de forma a embasar conceitualmente e com informações relevantes a caracterização da empresa inserindo a mesma neste contexto de cadeia de suprimentos e foco no cliente, estabelecendo uma relação entre a empresa pesquisada e a aplicação da tecnologia existente. Quanto aos aspectos relacionados aos ganhos de eficiência, houve uma preocupação com a implantação das ferramentas do E.C.R. como um fator determinante para a perpetuação do negócio. Os ganhos de eficiência permitiram a empresa este diferencial competitivo na disputa pelo mercado, certamente outros aspectos como atendimento são relevantes para garantir a eficiência da cadeia, portanto, avaliamos as interfaces entre os participantes da cadeia (fabricantes, fornecedores), grupo Sendas (varejista) e consumidores. Assim, concluímos este estudo mapeando pontos fortes e fracos desta relação, identificando as barreiras a serem vencidas e algumas recomendações.

Avaliação do uso de guias sonoras como medida de redução de acidentes nas rodovias do Rio Grande do Sul

Nos últimos anos, os profissionais que atuam na área da engenharia rodoviária têm se dedicado à busca de tratamentos e soluções de engenharia que conduzam a melhores condições de segurança na malha viária. Entre as soluções de engenharia capazes de contribuir de forma efetiva para a segurança viária, estão as Guias Sonoras. As Guias Sonoras são ranhuras ou saliências que marcam o pavimento das rodovias alertando motoristas desatentos. Este trabalho teve por objetivo sistematizar os conhecimentos existentes sobre o uso de Guias Sonoras no país e no mundo, afim de divulgar um dispositivo de baixo custo e de simples aplicação e manutenção. O estudo aborda questões referentes ao custo do dispositivo, aos seus aspectos construtivos e à sua durabilidade, bem como o seu potencial na redução de acidentes. Foi realizada um ampla pesquisa bibliográfica e um estudo de caso. No estudo de caso realizado, buscou-se (a) verificar a existência de locais com características geométricas que resultam em uma maior propensão à ocorrência de acidentes do tipo saída de pista, principal evento evitável pelo uso das Guias Sonoras,e (b) comparar os custos de implantação do dispositivo com os custos dos acidentes evitáveis pelas Guias Sonoras. O estudo de caso mostrou que acidentes do tipo saída de pista representam aproximadamente 30% do total de acidentes de uma rodovia típica. Esse percentual é compatível com o verificado na revisão bibliográfica. A análise dos segmentos nos quais este tipo de acidente ocorria de forma mais freqüente revelou uma tendência à sua ocorrência em aclives/declives e/ou curvas. De acordo com o comparativo feito entre custos dos acidentes e custos de implantação de Guias Sonoras, o custo de um acidente apenas com feridos equivale à execução de 3,8 quilômetros de Guias Sonoras nos acostamentos da rodovia. Já, o custo de um acidente com vítima fatal equivale à execução de 31 quilômetros de Guias Sonoras. Adicionalmente, constatou-se que o investimento necessário para a implantação do dispositivo nos acostamentos do trecho analisado seria menor do que os custos de acidentes de saída de pista ocorridos no trecho no período de 3 anos.