The use of remote sensing imagery for monitoring recovery in the aftermath of a natural disaster: the Hurricane Katrina Case

Although Recovery is often defined as the less studied and documented phase of the Emergency Management Cycle, a wide literature is available for describing characteristics and sub-phases of this process. Previous works do not allow to gain an overall perspective because of a lack of systematic consistent monitoring of recovery utilizing advanced technologies such as remote sensing and GIS technologies. Taking into consideration the key role of Remote Sensing in Response and Damage Assessment, this thesis is aimed to verify the appropriateness of such advanced monitoring techniques to detect recovery advancements over time, with close attention to the main characteristics of the study event: Hurricane Katrina storm surge. Based on multi-source, multi-sensor and multi-temporal data, the post-Katrina recovery was analysed using both a qualitative and a quantitative approach. The first phase was dedicated to the investigation of the relation between urban types, damage and recovery state, referring to geographical and technological parameters. Damage and recovery scales were proposed to review critical observations on remarkable surge- induced effects on various typologies of structures, analyzed at a per-building level. This wide-ranging investigation allowed a new understanding of the distinctive features of the recovery process. A quantitative analysis was employed to develop methodological procedures suited to recognize and monitor distribution, timing and characteristics of recovery activities in the study area. Promising results, gained by applying supervised classification algorithms to detect localization and distribution of blue tarp, have proved that this methodology may help the analyst in the detection and monitoring of recovery activities in areas that have been affected by medium damage. The study found that Mahalanobis Distance was the classifier which provided the most accurate results, in localising blue roofs with 93.7% of blue roof classified correctly and a producer accuracy of 70%. It was seen to be the classifier least sensitive to spectral signature alteration. The application of the dissimilarity textural classification to satellite imagery has demonstrated the suitability of this technique for the detection of debris distribution and for the monitoring of demolition and reconstruction activities in the study area. Linking these geographically extensive techniques with expert per-building interpretation of advanced-technology ground surveys provides a multi-faceted view of the physical recovery process. Remote sensing and GIS technologies combined to advanced ground survey approach provides extremely valuable capability in Recovery activities monitoring and may constitute a technical basis to lead aid organization and local government in the Recovery management.

Innovative treatments for shelf-life extension of whole and fresh-cut fruit

Maintaining the postharvest quality of whole and fresh-cut fruit during storage and distribution is the major challenge facing fruit industry. For this purpose, industry adopt a wide range of technologies to enable extended shelf-life. Many factors can lead to loss of quality in fresh product, hence the common description of these products as ‘perishable’. As a consequence normal factors such as transpiration and respiration lead ultimately to water loss and senescence of the product. Fruits and vegetables are living commodities and their rate of respiration is of key importance to maintenance of quality. It has been commonly observed that the greater the respiration rate of a product, the shorter the shelf-life. The principal problem for fresh-cut fruit industries is the relative shorter shelf-life of minimally processed fruit (MPF) compared to intact product. This fact is strictly connected with the higher ethylene production of fruit tissue stimulated during fresh-cut processing (peeling, cutting, dipping). 1-Methylcyclopropene (1-MCP) is an inhibitor of ethylene action and several researches have shown its effectiveness on the inhibition of ripening and senescence incidence for intact fruit and consequently on their shelf-life extension. More recently 1-MCP treatment has been tested also for shelf-life extension of MPF but discordant results have been obtained. Considering that in some countries 1-MCP is already a commercial product registered for the use on a number of horticultural products, the main aim of this actual study was to enhance our understanding on the effects of 1-MCP treatment on the quality maintenance of whole and fresh-cut climacteric and non-climacteric fruit (apple, kiwifruit and pineapple). Concerning the effects of 1-MCP on whole fruit, was investigated the effects of a semi-commercial postharvest treatment with 1-MCP on the quality of Pink Lady apples as functions of fruit ripening stage, 1-MCP dose, storage time and also in combination with controlled atmospheres storage in order to better understand what is the relationship among these parameters and if is possible to maximize the 1-MCP treatment to meet the market/consumer needs and then in order to put in the market excellent fruit. To achieve this purpose an incomplete three-level three-factor design was adopted. During the storage were monitored several quality parameters: firmness, ripening index, ethylene and carbon dioxide production and were also performed a sensory evaluations after 6 month of storage. In this study the higher retention of firmness (at the end of storage) was achieved by applying the greatest 1-MCP concentration to fruits with the lowest maturity stage. This finding means that in these semi-commercial conditions we may considerate completely blocked the fruit softening. 1-MCP was able to delay also the ethylene and CO2 production and the maturity parameters (soluble solids content and total acidity). Only in some cases 1-MCP generate a synergistic effect with the CA storage. The results of sensory analyses indicated that, the 1-MCP treatment did not affect the sweetness and whole fruit flavour while had a little effect on the decreasing cut fruit flavour. On the contrary the treated apple was more sour, crisp, firm and juicy. The effects of some treatment (dipping and MAP) on the nutrient stability were also investigated showing that in this case study the adopted treatments did not have drastic effects on the antioxidant compounds on the contrary the dipping may enhance the total antioxidant activity by the accumulation of ascorbic acid on the apple cut surface. Results concerning the effects of 1-MCP in combination with MAP on the quality parameters behaviour of the kiwifruit were not always consistent and clear: in terms of colour maintenance, it seemed to have a synergistic effect with N2O MAP; as far as ripening index is concerned, 1-MCP had a preservative effect, but just for sample packed in air.

Influence of habitat and climate change on European bird communities

Die Fragmentierung von Waldgebieten, der Verlust geeigneter Habitate, die Invasion exotischer Arten und globale Klimaveränderung haben auf Artengemeinschaften erhebliche Auswirkungen. Vögel dienen in vielen Fällen als Indikatorarten für Umweltveränderungen und, besonders, für Veränderungen im Zusammenhang mit globaler Erwärmung. In meiner Arbeit habe ich zuerst einen Literaturüberblick über die Auswirkungen globaler Klimaveränderung auf die Verbreitungsgebiete, den Artenreichtum und die Zusammensetzung von Vogelgemeinschaften dargestellt. Zahlreiche Untersuchungen zeigen, daß die Grenzen der Verbreitungsgebiete der meisten Vogelarten mit klimatischen Faktoren korrelieren. Verschiebungen der Verbreitungsgebiete in nördliche Richtung oder in höhere Regionen im Gebirge konnten bereits für viele temperate Vogelarten beobachtet werden. Weiterhin wurde ein zunehmender Artenreichtum besonders in nördlichen Breiten und in höheren Lagen für viele temperate Vogelgemeinschaften vorhergesagt. In trockenen Gebieten ist dagegen mit einer Abnahme des Artenreichtums zu rechnen. Im zweiten Teil meiner Arbeit habe ich untersucht, ob beobachtete Veränderungen in der Zusammensetzung europäischer Vogelgemeinschaften tatsächlich durch aktuelle Klimaveränderungen beeinflußt werden. Das Zugverhalten der Arten war dabei ein Schwerpunkt der Untersuchung, weil zu erwarten war, daß Vogelarten mit verschiedenem Zugverhalten unterschiedlich auf Klimaveränderungen reagieren. Ich habe ein Regressionsmodell genutzt, welches die räumliche Beziehung zwischen dem Anteil von Langstreckenziehern, Kurzstreckenziehern und Standvögeln in europäischen Vogelgemeinschaften und verschiedenen Klimavariablen beschreibt. Für 21 Gebiete in Europa habe ich Daten über beobachtete Veränderungen in der Struktur der Vogelgemeinschaften und isochrone Klimaveränderungen zusammengetragen. Mit Hilfe dieser Klimaveränderungen und dem räumlichen Regressionsmodell konnte ich berechnen, welche Veränderungen in den Vogelgemeinschaften aufgrund der veränderten Klimabedingungen zu erwarten wären und sie mit beobachteten Veränderungen vergleichen. Beobachtete und berechnete Veränderungen korrelierten signifikant miteinander. Die beobachteten Veränderungen konnten nicht durch räumliche Autokorrelationseffekte oder durch alternative Faktoren, wie z.B. Veränderungen in der Landnutzung, erklärt werden. Im dritten Teil der Arbeit untersuchte ich für eine mitteleuropäische Vogelgemeinschaft welchen Einfluß Habitatveränderungen, die Invasion exotischer Arten und die Klimaveränderung auf Veränderungen der Häufigkeit und Verbreitungsgröße der 159 Vogelarten am Bodensee zwischen 1980-1981 und 2000-2002 hatten. Dabei konnte gezeigt werden, daß Veränderungen in der regionalen Abundanz sowohl durch Habitatveränderungen als auch durch Klimavänderungen hervorgerufen wurden. Exotische Arten schienen in dieser Zeit keinen bedeutenden Einfluß zu haben. Besonders bei Agrarlandarten, Arten mit nördlicheren Verbreitungsgebieten und bei Langstreckenziehern konnten signifikante Abnahmen in der Abundanz beobachtet werden. Vor allem die anhaltenden negativen Bestandsveränderungen bei Langstreckenziehern und die in den letzten zehn Jahren aufgetretenen Abnahmen nördlicher verbreiteter Vogelarten deuten darauf hin, daß die Klimaveränderung aktuell als der größte Einfluß für Vögel in Europa angesehen werden muß. Insgesamt zeigen die Ergebnisse dieser Arbeit, daß sich der anhaltende Druck auf die Umwelt in erster Linie durch Habitat- und Klimaveränderungen manifestiert.

Mediterranean-type climate in the South Aegean (Eastern Mediterranean) during the Late Miocene: Evidence from isotope and element proxies

The present-day climate in the Mediterranean region is characterized by mild, wet winters and hot, dry summers. There is contradictory evidence as to whether the present-day conditions (“Mediterranean climate”) already existed in the Late Miocene. This thesis presents seasonally-resolved isotope and element proxy data obtained from Late Miocene reef corals from Crete (Southern Aegean, Eastern Mediterranean) in order to illustrate climate conditions in the Mediterranean region during this time. There was a transition from greenhouse to icehouse conditions without a Greenland ice sheet during the Late Miocene. Since the Greenland ice sheet is predicted to melt fully within the next millennia, Late Miocene climate mechanisms can be considered as useful analogues in evaluating models of Northern Hemispheric climate conditions in the future. So far, high resolution chemical proxy data on Late Miocene environments are limited. In order to enlarge the proxy database for this time span, coral genus Tarbellastraea was evaluated as a new proxy archive, and proved reliable based on consistent oxygen isotope records of Tarbellastraea and the established paleoenvironmental archive of coral genus Porites. In combination with lithostratigraphic data, global 87Sr/86Sr seawater chronostratigraphy was used to constrain the numerical age of the coral sites, assuming the Mediterranean Sea to be equilibrated with global open ocean water. 87Sr/86Sr ratios of Tarbellastraea and Porites from eight stratigraphically different sampling sites were measured by thermal ionization mass spectrometry. The ratios range from 0.708900 to 0.708958 corresponding to ages of 10 to 7 Ma (Tortonian to Early Messinian). Spectral analyses of multi-decadal time-series yield interannual δ18O variability with periods of ~2 and ~5 years, similar to that of modern records, indicating that pressure field systems comparable to those controlling the seasonality of present-day Mediterranean climate existed, at least intermittently, already during the Late Miocene. In addition to sea surface temperature (SST), δ18O composition of coral aragonite is controlled by other parameters such as local seawater composition which as a result of precipitation and evaporation, influences sea surface salinity (SSS). The Sr/Ca ratio is considered to be independent of salinity, and was used, therefore, as an additional proxy to estimate seasonality in SST. Major and trace element concentrations in coral aragonite determined by laser ablation inductively coupled plasma mass spectrometry yield significant variations along a transect perpendicular to coral growth increments, and record varying environmental conditions. The comparison between the average SST seasonality of 7°C and 9°C, derived from average annual δ18O (1.1‰) and Sr/Ca (0.579 mmol/mol) amplitudes, respectively, indicates that the δ18O-derived SST seasonality is biased by seawater composition, reducing the δ18O amplitude by 0.3‰. This value is equivalent to a seasonal SSS variation of 1‰, as observed under present-day Aegean Sea conditions. Concentration patterns of non-lattice bound major and trace elements, related to trapped particles within the coral skeleton, reflect seasonal input of suspended load into the reef environment. δ18O, Sr/Ca and non-lattice bound element proxy records, as well as geochemical compositions of the trapped particles, provide evidence for intense precipitation in the Eastern Mediterranean during winters. Winter rain caused freshwater discharge and transport of weathering products from the hinterland into the reef environment. There is a trend in coral δ18O data to more positive mean δ18O values (–2.7‰ to –1.7‰) coupled with decreased seasonal δ18O amplitudes (1.1‰ to 0.7‰) from 10 to 7 Ma. This relationship is most easily explained in terms of more positive summer δ18O. Since coral diversity and annual growth rates indicate more or less constant average SST for the Mediterranean from the Tortonian to the Early Messinian, more positive mean and summer δ18O indicate increasing aridity during the Late Miocene, and more pronounced during summers. The analytical results implicate that winter rainfall and summer drought, the main characteristics of the present-day Mediterranean climate, were already present in the Mediterranean region during the Late Miocene. Some models have argued that the Mediterranean climate did not exist in this region prior to the Pliocene. However, the data presented here show that conditions comparable to those of the present-day existed either intermittently or permanently since at least about 10 Ma.

Validation of a new method to assess the long-term Hypothalamic-Pituitary-Adrenal Activity using hair glucocorticoids as biomarkers. - Studies on pigs and laboratory Sprague-Dawley Rats

The evaluation of chronic activity of the hypothalamic-pituitary-adrenal (HPA) axis is critical for determining the impact of chronic stressful situations. The potential use of hair glucocorticoids as a non-invasive, retrospective, biomarker of long term HPA activity is of great interest, and it is gaining acceptance in humans and animals. However, there are still no studies in literature examining hair cortisol concentration in pigs and corticosterone concentration in laboratory rodents. Therefore, we developed and validated, for the first time, a method for measuring hair glucocorticoids concentration in commercial sows and in Sprague-Dawley rats. Our preliminary data demonstrated: 1) a validated and specific washing protocol and extraction assay method with a good sensitivity in both species; 2) the effect of the reproductive phase, housing conditions and seasonality on hair cortisol concentration in sows; 3) similar hair corticosterone concentration in male and female rats; 4) elevated hair corticosterone concentration in response to chronic stress manipulations and chronic ACTH administration, demonstrating that hair provides a good direct index of HPA activity over long periods than other indirect parameters, such adrenal or thymus weight. From these results we believe that this new non-invasive tool needs to be applied to better characterize the overall impact in livestock animals and in laboratory rodents of chronic stressful situations that negatively affect animals welfare. Nevertheless, further studies are needed to improve this methodology and maybe to develop animal models for chronic stress of high interest and translational value in human medicine.

Tailoring molecular weight of the conjugated model polymer MEH-PPV and its structure-property relations

In der vorliegenden Arbeit wurden Struktur-Eigenschaftsbeziehungen des konjugierten Modell-Polymers MEH-PPV untersucht. Dazu wurde Fällungs-fraktionierung eingesetzt, um MEH-PPV mit unterschiedlichem Molekulargewicht (Mw) zu erhalten, insbesondere MEH-PPV mit niedrigem Mw, da dieses für optische Wellenleiterbauelemente optimal geeignet ist Wir konnten feststellen, dass die Präparation einer ausreichenden Menge von MEH-PPV mit niedrigem Mw und geringer Mw-Verteilung wesentlich von der geeigneten Wahl des Lösungsmittels und der Temperatur während der Zugabe des Fällungsmittels abhängt. Alternativ dazu wurden UV-induzierte Kettenspaltungseffekte untersucht. Wir folgern aus dem Vergleich beider Vorgehensweisen, dass die Fällungsfraktionierung verglichen mit der UV-Behandlung besser geeignet ist zur Herstellung von MEH-PPV mit spezifischem Mw, da das UV-Licht Kettendefekte längs des Polymerrückgrats erzeugt. 1H NMR and FTIR Spektroskopie wurden zur Untersuchung dieser Kettendefekte herangezogen. Wir konnten außerdem beobachten, dass die Wellenlängen der Absorptionsmaxima der MEH-PPV Fraktionen mit der Kettenlänge zunehmen bis die Zahl der Wiederholeinheiten n  110 erreicht ist. Dieser Wert ist signifikant größer als früher berichtet. rnOptische Eigenschaften von MEH-PPV Wellenleitern wurden untersucht und es konnte gezeigt werden, dass sich die optischen Konstanten ausgezeichnet reproduzieren lassen. Wir haben die Einflüsse der Lösungsmittel und Temperatur beim Spincoaten auf Schichtdicke, Oberflächenrauigkeit, Brechungsindex, Doppelbrechung und Wellenleiter-Dämpfungsverlust untersucht. Wir fanden, dass mit der Erhöhung der Siedetemperatur der Lösungsmittel die Schichtdicke und die Rauigkeit kleiner werden, während Brechungsindex, Doppelbrechung sowie Wellenleiter-Dämpfungsverluste zunahmen. Wir schließen daraus, dass hohe Siedetemperaturen der Lösungsmittel niedrige Verdampfungsraten erzeugen, was die Aggregatbildung während des Spincoatings begünstigt. Hingegen bewirkt eine erhöhte Temperatur während der Schichtpräparation eine Erhöhung von Schichtdicke und Rauhigkeit. Jedoch nehmen Brechungsindex und der Doppelbrechung dabei ab.rn Für die Schichtpräparation auf Glassubstraten und Quarzglas-Fasern kam das Dip-Coating Verfahren zum Einsatz. Die Schichtdicke der Filme hängt ab von Konzentration der Lösung, Transfergeschwindigkeit und Immersionszeit. Mit Tauchbeschichtung haben wir Schichten von MEH-PPV auf Flaschen-Mikroresonatoren aufgebracht zur Untersuchung von rein-optischen Schaltprozessen. Dieses Verfahren erweist sich insbesondere für MEH-PPV mit niedrigem Mw als vielversprechend für die rein-optische Signalverarbeitung mit großer Bandbreite.rn Zusätzlich wurde auch die Morphologie dünner Schichten aus anderen PPV-Derivaten mit Hilfe von FTIR Spektroskopie untersucht. Wir konnten herausfinden, dass der Alkyl-Substitutionsgrad einen starken Einfluss auf die mittlere Orientierung der Polymerrückgrate in dünnen Filmen hat.rn

Endocarditis due to Tropheryma whipplei: rapid detection, limited genetic diversity, and long-term clinical outcome in a local experience

The characteristic features of Whipple's disease include abdominal pain, diarrhoea, wasting, and arthralgias, with the causative agent, Tropheryma whipplei, being detected mainly in intestinal biopsies. PCR technology has led to the identification of T. whipplei in specimens from various other locations, including the central nervous system and the heart. T. whipplei is now recognized as one of the causes of culture-negative endocarditis, and endocarditis can be the only manifestation of the infection with T. whipplei. Although it is considered a rare disease, the true incidence of endocarditis due to T. whipplei is not clearly established. With the increasing use of molecular methods, it is likely that T. whipplei will be more frequently identified. Questions also remain about the genetic variability of T. whipplei strains, optimal diagnostic procedures and therapeutic options. In the present study, we provide clinical data on four new patients with documented endocarditis due to T. whipplei in the context of the available published literature. There was no clinical involvement of the gastrointestinal tract. Genetic analysis of the T. whipplei strains with DNA isolated from the excised heart valves revealed little to no genetic variability. In a selected case, we describe acridine orange staining for early detection of the disease, prompting early adaptation of the antibiotic therapy. We provide long-term follow-up data on the patients. In our hands, an initial 2-week course of intravenous antibiotics followed by cotrimoxazole for at least 1 year was a suitable treatment option for T. whipplei endocarditis.

Angiotensinergic and noradrenergic neurons in the rat and human heart

Although the physiological and pharmacological evidences suggest a role for angiotensin II (Ang II) with the mammalian heart, the source and precise location of Ang II are unknown. To visualize and quantitate Ang II in atria, ventricular walls and interventricular septum of the rat and human heart and to explore the feasibility of local Ang II production and function, we investigated by different methods the expression of proteins involved in the generation and function of Ang II. We found mRNA of angiotensinogen (Ang-N), of angiotensin converting enzyme, of the angiotensin type receptors AT(1A) and AT(2) (AT(1B) not detected) as well as of cathepsin D in any part of the hearts. No renin mRNA was traceable. Ang-N mRNA was visualized by in situ hybridization in atrial ganglial neurons. Ang II and dopamine- -hydroxylase (D H) were either colocalized inside the same neuronal cell or the neurons were specialized for Ang II or D H. Within these neurons, the vesicular acetylcholine transporter (VAChT) was neither colocalized with Ang II nor D H, but VAChT-staining was found with synapses en passant encircle these neuronal cells. The fibers containing Ang II exhibited with blood vessels and with cardiomyocytes supposedly angiotensinergic synapses en passant. In rat heart, right atrial median Ang II concentration appeared higher than septal and ventricular Ang II. The distinct colocalization of neuronal Ang II with D H in the heart may indicate that Ang II participates together with norepinephrine in the regulation of cardiac functions: Produced as a cardiac neurotransmitter Ang II may have inotropic, chronotropic or dromotropic effects in atria and ventricles and contributes to blood pressure regulation.

The association between body-mass index and patient outcome in septic shock: a retrospective cohort study

It is unknown whether body-mass index (BMI) and commonly defined BMI categories are associated with mortality in patients with septic shock.

The shock index and the simplified PESI for identification of low-risk patients with acute pulmonary embolism

We compared the test characteristics of the shock index (SI) and the simplified pulmonary embolism severity index (sPESI) for predicting 30-day outcomes in a cohort of 1,206 patients with objectively confirmed pulmonary embolism (PE). The primary outcome of the study was all-cause mortality. The secondary outcome was nonfatal symptomatic recurrent venous thromboembolism (VTE) or nonfatal major bleeding. Overall, 119 (9.9%) out of 1,206 patients died (95% CI 8.2-11.5%) during the first month of follow-up. The sPESI classified fewer patients as low-risk (369 (31%) out of 1,206 patients, 95% CI 28-33%) compared to the SI (1,024 (85%) out of 1,206 patients, 95% CI 83-87%) (p<0.001). Low-risk patients based on the sPESI had a lower 30-day mortality than those based on the SI (1.6% (95% CI 0.3-2.9%) versus 8.3% (95% CI 6.6-10.0%)), while the 30-day rate of nonfatal recurrent VTE or major bleeding was similar (2.2% (95%CI 0.7-3.6%) versus 3.3% (95%CI 2.2-4.4%)). The net reclassification improvement with the sPESI was 13.4% (p = 0.07). The integrated discrimination improvement was estimated as 1.8% (p<0.001). The sPESI quantified the prognosis of patients with PE better than the SI.

Local pain and spreading hyperalgesia induced by intramuscular injection of nerve growth factor are not reduced by local anesthesia of the muscle

Injections with local anesthesia for therapeutic and diagnostic purposes are common clinical practice. This double-blind placebo controlled study explores the rational of local anesthetic blocks for the detection of muscle pain as the primary generator in spreading hyperalgesic conditions.

The Spatial Signature of Biotic Interactions of a Clonal and a Non-clonal Palmetto in a Subtropical Plant Community

Spatial analyses of plant-distribution patterns can provide inferences about intra- and interspecific biotic interactions. Yet, such analyses are rare for clonal plants because effective tools (i.e., molecular markers) needed to map naturally occurring clonal individuals have only become available recently. Clonal plants are unique in that a single genotype has a potential to spatially place new individuals (i.e., ramets) in response to intra- and interspecific biotic interactions. Laboratory and greenhouse studies suggest that some clonal plants can avoid intra-genet, inter-genet, and inter-specific competition via rootplacement patterns. An intriguing and yet to be explored question is whether a spatial signature of such multi-level biotic interactions can be detected in natural plant communities. The facultatively clonal Serenoa repens and non-clonal Sabal etonia are ecologically similar and co-dominant palmettos that sympatrically occur in the Florida peninsula. We used amplified fragment length polymorphisms (AFLPs) to identify Serenoa genets and also to assign field-unidentifiable small individuals as Sabal seedlings, Serenoa seedlings, or Serenoa vegetative sprouts. Then, we conducted univariate and bivariate multi-distance spatial analyses to examine the spatial interactions of Serenoa (n=271) and Sabal (n=137) within a 20x20 m grid at three levels, intragenet, intergenet and interspecific. We found that spatial interactions were not random at all three levels of biotic interactions. Serenoa genets appear to spatially avoid self-competition as well as intergenet competition. Furthermore, Serenoa and Sabal were spatially negatively associated with each other. However, this negative association pattern was also evident in a spatial comparison between non-clonal Serenoa and Sabal, suggesting that Serenoa genets’ spatial avoidance of Sabal through placement of new ramets is not the explanation of the interspecific-level negative spatial pattern. Our results emphasize the importance of investigating spatial signatures of biotic as well as abiotic interactions at multiple levels in understanding spatial distribution patterns of clonal plants in natural plant communities.

A comparison of the original and simplified Pulmonary Embolism Severity Index

The Pulmonary Embolism Severity Index (PESI) is a validated clinical prognostic model for patients with pulmonary embolism (PE). Recently, a simplified version of the PESI was developed. We sought to compare the prognostic performance of the original and simplified PESI. Using data from 15,531 patients with PE, we compared the proportions of patients classified as low versus higher risk between the original and simplified PESI and estimated 30-day mortality within each risk group. To assess the models' accuracy to predict mortality, we calculated sensitivity, specificity, and predictive values and likelihood ratios for low- versus higher-risk patients. We also compared the models' discriminative power by calculating the area under the receiver-operating characteristic curve. The overall 30-day mortality was 9.3%. The original PESI classified a significantly greater proportion of patients as low-risk than the simplified PESI (40.9% vs. 36.8%; p<0.001). Low-risk patients based on the original and simplified PESI had a mortality of 2.3% and 2.7%, respectively. The original and simplified PESI had similar sensitivities (90% vs. 89%), negative predictive values (98% vs. 97%), and negative likelihood ratios (0.23 vs. 0.28) for predicting mortality. The original PESI had a significantly greater discriminatory power than the simplified PESI (area under the ROC curve 0.78 [95% CI: 0.77-0.79] vs. 0.72 [95% CI: 0.71-0.74]; p<0.001). In conclusion, even though the simplified PESI accurately identified patients at low-risk of adverse outcomes, the original PESI classified a higher proportion of patients as low-risk and had a greater discriminatory power than the simplified PESI.

Analysis of patient flows for orthopedic procedures using small area analysis in Switzerland

BACKGROUND: In general cantons regulate and control the Swiss health service system; patient flows within and between cantons are thereby partially disregarded. This paper develops an alternative spatial model, based upon the construction of orthopedic hospital service areas (HSAOs), and introduces indices for the analysis of patient streams in order to identify areas, irrespective of canton, with diverse characteristics, importance, needs, or demands. METHODS: HSAOs were constructed using orthopedic discharge data. Patient streams between the HSAOs were analysed by calculating three indices: the localization index (% local residents discharged locally), the netindex (the ratio of discharges of nonlocal incoming residents to outgoing local residents), and the market share index (% of local resident discharges of all discharges in local hospitals). RESULTS: The 85 orthopedic HSAOs show a median localization index of 60.8%, a market share index of 75.1%, and 30% of HSAOs have a positive netindex. Insurance class of bed, admission type, and patient age are partially but significantly associated with those indicators. A trend to more centrally provided health services can be observed not only in large urban HSAOs such as Geneva, Bern, Basel, and Zurich, but also in HSAOs in mountain sport areas such as Sion, Davos, or St.Moritz. Furthermore, elderly and emergency patients are more frequently treated locally than younger people or those having elective procedures. CONCLUSION: The division of Switzerland into HSAOs provides an alternative spatial model for analysing and describing patient streams for health service utilization. Because this small area model allows more in-depth analysis of patient streams both within and between cantons, it may improve support and planning of resource allocation of in-patient care in the Swiss healthcare system.

Spatial heterogeneity of soil nutrients and plant species in herb-dominated communities of contrasting land use

Recent interest in spatial pattern in terrestrial ecosystems has come from an awareness of theintimate relationship between spatial heterogeneity of soil resources and maintenance of plant species diversity. Soil and vegetation can vary spatially inresponse to several state factors of the system. In this study, we examined fine-scale spatial variability of soil nutrients and vascular plant species in contrasting herb-dominated communities (a pasture and an oldfield) to determine degree of spatial dependenceamong soil variables and plant community characteristics within these communities by sampling at 1-m intervals. Each site was divided into 25 1-m 2 plots. Mineral soil was sampled (2-cm diameter, 5-cm depth) from each of four 0.25-m2 quarters and combined into a single composite sample per plot. Soil organic matter was measured as loss-on-ignition. Extractable NH4 and NO3 were determined before and after laboratory incubation to determine potential net N mineralization and nitrification. Cations were analyzed using inductively coupled plasma emission spectrometry. Vegetation was assessed using estimated percent cover. Most soiland plant variables exhibited sharp contrasts betweenpasture and old-field sites, with the old field having significantly higher net N mineralization/nitrification, pH, Ca, Mg, Al, plant cover, and species diversity, richness, and evenness. Multiple regressions revealedthat all plant variables (species diversity, richness,evenness, and cover) were significantly related to soil characteristics (available nitrogen, organic matter,moisture, pH, Ca, and Mg) in the pasture; in the old field only cover was significantly related to soil characteristics (organic matter and moisture). Both sites contrasted sharply with respect to spatial pattern of soil variables, with the old field exhibiting a higher degree of spatial dependence. These results demonstrate that land-use practices can exert profound influence on spatial heterogeneity of both soil properties and vegetation in herb-dominated communities.