Line days as a determinant of central line-associated bloodstream infections in pediatric patients with tunneled femoral peripherally inserted central catheters.

Background: Ultrasound (US)-guided tunneled femoral peripherally inserted central catheters (PICCs) are a safe central venous access option in infants and neonates. Studies have shown, however, that femoral central venous access has the potential for high central line-associated bloodstream infection (CLABSI) rates with a significant increase in risk around line day 30, though no studies have evaluated these risks exclusively for tunneled femoral PICCs.

Objective: The primary purpose of this study was to evaluate the relationship between line duration and the risk of CLABSI in tunneled femoral PICCs in children.

The case for information fiduciaries: The implementation of a data ethics checklist at Seattle Children's Hospital.

There is little debate about the importance of ethics in health care, and clearly defined rules, regulations, and oaths help ensure patients' trust in the care they receive. However, standards are not as well established for the data professions within health care, even though the responsibility to treat patients in an ethical way extends to the data collected about them. Increasingly, data scientists, analysts, and engineers are becoming fiduciarily responsible for patient safety, treatment, and outcomes, and will require training and tools to meet this responsibility.

Forehead location and large segmental pattern of facial port-wine stains predict risk of Sturge-Weber syndrome.

Background: Children with forehead port-wine stains (PWSs) are at risk of Sturge-Weber syndrome (SWS). However, most will not develop neurologic manifestations.

Objective: To identify children at greatest risk of SWS.

Eutrophication forcings on a peri-urban lake ecosystem: Context for integrated watershed to airshed management.

Peri-urban lakes increasingly experience intensified anthropogenic impacts as watershed uses and developments increase. Cultus Lake is an oligo-mesotrophic, peri-urban lake near Vancouver, British Columbia, Canada that experiences significant seasonal tourism, anthropogenic nutrient loadings, and associated cultural eutrophication. Left unabated, these cumulative stresses threaten the critical habitat and persistence of two endemic species at risk (Coastrange Sculpin, Cultus population; Cultus Lake sockeye salmon) and diverse lake-derived ecosystem services.

Black-swan events in animal populations.

Black swans are improbable events that nonetheless occur-often with profound consequences. Such events drive important transitions in social systems (e.g.

Rethinking Trade-Driven Extinction Risk in Marine and Terrestrial Megafauna.

Large animals hunted for the high value of their parts (e.g., elephant ivory and shark fins) are at risk of extinction due to both intensive international trade pressure and intrinsic biological sensitivity.

Ecology of conflict: marine food supply affects human-wildlife interactions on land.

Human-wildlife conflicts impose considerable costs to people and wildlife worldwide. Most research focuses on proximate causes, offering limited generalizable understanding of ultimate drivers. We tested three competing hypotheses (problem individuals, regional population saturation, limited food supply) that relate to underlying processes of human-grizzly bear (Ursus arctos horribilis) conflict, using data from British Columbia, Canada, between 1960-2014.

An Evaluation of Rebuilding Policies for U.S. Fisheries.

Rebuilding depleted fish populations is a priority of modern fisheries management. In the U.S.

Checklist to meet Ethical and Legal Obligations in the consent pathway for critically ill patients (ChELO): A quality improvement project and case studies.

Ethical or legal errors related to the consent pathway for incapable patients are an everyday reality. Quality improvements in communication or palliative care have been attempted, but little attention has been given to meeting basic legal and ethical obligations. In this paper, the authors share lessons learned during two years of implementing the Checklist for meeting Ethical and Legal Obligations (ChELO) in the intensive care unit of a large community hospital in Ontario.

The Impacts of Wind Speed Trends and 30-Year Variability in Relation to Hydroelectric Reservoir Inflows on Wind Power in the Pacific Northwest.

In hydroelectric dominated systems, the value and benefits of energy are higher during extended dry periods and lower during extended or extreme wet periods. By accounting for regional and temporal differences in the relationship between wind speed and reservoir inflow behavior during wind farm site selection, the benefits of energy diversification can be maximized. The goal of this work was to help maximize the value of wind power by quantifying the long-term (30-year) relationships between wind speed and streamflow behavior, using British Columbia (BC) and the Pacific Northwest (PNW) as a case study.

Portfolio conservation of metapopulations under climate change.

Climate change is likely to lead to increasing population variability and extinction risk. Theoretically, greater population diversity should buffer against rising climate variability, and this theory is often invoked as a reason for greater conservation. However, this has rarely been quantified.

Modeling population responses of Chinook and coho salmon to suspended sediment using a life history approach.

This study develops a quantitative framework for estimating the effects of extreme suspended-sediment events (SSC>25 mg L(-1)) on virtual populations of Chinook (Oncorhynchus tshawytscha) and coho (O. kisutch) salmon in a coastal watershed of British Columbia, Canada. We used a life history model coupled with a dose-response model to evaluate the populations' responses to a set of simulated suspended sediments scenarios.

Linking removal targets to the ecological effects of invaders: a predictive model and field test.

Species invasions have a range of negative effects on recipient ecosystems, and many occur at a scale and magnitude that preclude complete eradication. When complete extirpation is unlikely with available management resources, an effective strategy may be to suppress invasive populations below levels predicted to cause undesirable ecological change. We illustrated this approach by developing and testing targets for the control of invasive Indo-Pacific lionfish (Pterois volitans and P.

Confronting uncertainty in wildlife management: performance of grizzly bear management.

Scientific management of wildlife requires confronting the complexities of natural and social systems. Uncertainty poses a central problem. Whereas the importance of considering uncertainty has been widely discussed, studies of the effects of unaddressed uncertainty on real management systems have been rare.

Changes in the distribution of atlantic bluefin tuna (Thunnus thynnus) in the Gulf of Maine 1979-2005.

The Gulf of Maine, NW Atlantic Ocean, is a productive, seasonal foraging ground for Atlantic bluefin tuna (Thunnus thynnus), but commercial landings of adult size classes were up to 40% below the allocated total allowable catch between 2004 to 2008 for the rod and reel, harpoon, and purse seine categories in the Gulf of Maine. Reduction in Atlantic bluefin tuna catches in the Gulf of Maine could represent a decline in spawning stock biomass, but given wide-ranging, complex migration patterns, and high energetic requirements, an alternative hypothesis is that their dispersal patterns shifted to regions with higher prey abundance or profitability, reducing availability to U.S.

Scarcity: the context of rationing in an Ontario ICU.

Objectives: Clinicians' perceptions of scarcity influence rationing of critical care resources, which may lead to serious adverse outcomes for patients who are denied access. We sought to better understand the phenomenon of scarcity in the critical care setting.

Design: Qualitative research methods.

Reliability of indicators of decline in abundance.

Although there are many indicators of endangerment (i.e., whether populations or species meet criteria that justify conservation action), their reliability has rarely been tested.

Global population trajectories of tunas and their relatives.

Tunas and their relatives dominate the world's largest ecosystems and sustain some of the most valuable fisheries. The impacts of fishing on these species have been debated intensively over the past decade, giving rise to divergent views on the scale and extent of the impacts of fisheries on pelagic ecosystems. We use all available age-structured stock assessments to evaluate the adult biomass trajectories and exploitation status of 26 populations of tunas and their relatives (17 tunas, 5 mackerels, and 4 Spanish mackerels) from 1954 to 2006.

Checklist to meet ethical and legal obligations to critically ill patients at the end of life.

Despite improvements in communication, errors in end-of-life care continue to be made. For example, healthcare professionals may take direction from the wrong substitute decision-maker, or from family members when the patient is capable; permit families to propose treatment plans; conflate values and beliefs with prior expressed wishes or fail to inquire about prior expressed wishes. Sometimes healthcare professionals know what prior expressed wishes are but do not respect them; others do not believe they have enough time to have an end-of-life discussion or lack the confidence, willingness and skills to manage one.

Documentation of best interest by intensivists: a retrospective study in an Ontario critical care unit.

Background: Intensive care physicians often must rely on substitute decision makers to address all dimensions of the construct of "best interest" for incapable, critically ill patients. This task involves identifying prior wishes and to facilitate the substitute decision maker's understanding of the incapable patient's condition and their likely response to treatment. We sought to determine how well such discussions are documented in a typical intensive care unit.