Mainstreaming nature in US federal policy.

Integrated policy changes must be cross-sectoral, appropriate, strategic, and evidence-based.

The Effect of Delay Following the Clinical Decision to Perform Tracheostomy in the Critical Care Setting.

Background: Tracheostomy in patients who are critically ill is generally performed due to prolonged mechanical ventilation and expected extubation failure. However, tracheostomy criteria and ideal timing are poorly defined, including equivocal data from randomized controlled trials and median intubation to tracheostomy times that range from 7-21 d. However, a consistent finding is that only ∼50% of late tracheostomy groups actually undergo tracheostomy, with non-performance due to recovery or clinical deterioration.

Hippocampal, Whole Midbrain, Red Nucleus, and Ventral Tegmental Area Volumes Are Increased by Selective Breeding for High Voluntary Wheel-Running Behavior.

Uncovering relationships between neuroanatomy, behavior, and evolution are important for understanding the factors that control brain function. Voluntary exercise is one key behavior that both affects, and may be affected by, neuroanatomical variation. Moreover, recent studies suggest an important role for physical activity in brain evolution.

The use of a diversion tube to reduce blood culture contamination: A "real-life" quality improvement intervention study.

Background: Blood culture contamination is associated with health care costs and potential patient harm. Diversion of the initial blood specimen reduces blood culture contamination. We report results of the "real-life" clinical implementation of this technique.

Social-ecological vulnerability of fishing communities to climate change: A U.S. West Coast case study.

Climate change is already impacting coastal communities, and ongoing and future shifts in fisheries species productivity from climate change have implications for the livelihoods and cultures of coastal communities. Harvested marine species in the California Current Large Marine Ecosystem support U.S.

Avoiding critical thresholds through effective monitoring.

A major challenge in sustainability science is identifying targets that maximize ecosystem benefits to humanity while minimizing the risk of crossing critical system thresholds. One critical threshold is the biomass at which populations become so depleted that their population growth rates become negative-depensation. Here, we evaluate how the value of monitoring information increases as a natural resource spends more time near the critical threshold.

Perspectives on managing fisheries for community wellbeing in the face of climate change.

Coastal communities are being impacted by climate change, affecting the livelihoods, food security, and wellbeing of residents. Human wellbeing is influenced by the heath of the environment through numerous pathways and is increasingly being included as a desired outcome in environmental management. However, the contributors to wellbeing can be subjective and the values and perspectives of decision-makers can affect the aspects of wellbeing that are included in planning.

The management of acute supraglottitis patients at the intensive care unit.

Introduction: Acute supraglottitis is a potentially life-threatening condition that often necessitates intensive care unit (ICU) admission for airway monitoring. The objective of this study was to identify clinical criteria that predict a benign course for patients with acute supraglottitis.

Methods: A prospective observational study was performed.

Development and validation of in-situ and laboratory X-ray fluorescence (XRF) spectroscopy methods for moss biomonitoring of metal pollution.

Metals are among the pollutants of highest concern in urban areas due to their persistence, bioavailability and toxicity. High concentrations of metals threaten aquatic ecosystem functioning and biodiversity, as well as human health. High-resolution estimates of pollutant sources are required to mitigate exposure to toxic compounds by identifying the specific locations and associated site characteristics where the deposition of metals is greatest.

Low-cost biomonitoring and high-resolution, scalable models of urban metal pollution.

As the global toll on human lives and ecosystems exacted by urban pollution grows, planning tools still lack the resolution to identify priority sites where toxic pollution can be most efficiently averted at a spatial scale that matches funding and management. Here we tackle this gap by demonstrating novel scalable methods to monitor and predict urban metal pollution at high resolution (<5 m) across large areas (10,000-100,000 km) to guide pollution reduction and stormwater management. We showcase and calibrate predictive models of Zn, Cu, and a synthetic index of pollution for the Puget Sound region of Washington State, U.

The role of the computerized tomography scanner in the cross-transmission of carbapenem-resistant Acinetobacter baumannii between hospitalized patients.

Objective: To assess the role of the computerized tomography (CT) scanner in cross-transmission of carbapenem-resistant Acinetobacter baumannii between hospitalized patients undergoing CT scan.

Methods: A single-centre retrospective observational analysis of inpatients undergoing CT scans. Patient-unique CT scans were defined as 'index cases' (patients undergoing CT scan with carbapenem-resistant Acinetobacter baumannii (CRAB) colonization documented during the previous 60 days), 'incident cases' (patients found colonized with CRAB within 14 days following CT scan), and 'negative cases' (negative for CRAB before and after CT scan).

Is it financially beneficial for hospitals to prevent nosocomial infections?

Background: Financial incentives represent a potential mechanism to encourage infection prevention by hospitals. In order to characterize the place of financial incentives, we investigated resource utilization and cost associated with hospital-acquired infections (HAI) and assessed the relative financial burden for hospital and insurer according to reimbursement policies.

Methods: We conducted a prospective matched case-control study over 18 months in a tertiary university medical center.

Difficult airway management practice changes after introduction of the GlideScope videolaryngoscope: A retrospective cohort study.

Background: Introduction of the GlideScope videolaryngoscope caused a change in use of other devices for difficult airway management.

Objective: The influence of the GlideScope videolaryngoscope on changes in the indications for and the frequency of use of flexible fibreoptic-assisted intubation and other difficult airway management techniques.

Design: Retrospective cohort study.

A Retrospective Study of Short-term versus Long-term Use of High Flow Nasal Cannula after Extubation in the Intensive Care Unit.

Background: The use of a high flow nasal cannula (HFNC) was examined for different clinical indications in the critically ill.

Objectives: To describe a single center experience with HFNC in post-extubation critical care patients by using clinical indices.

Methods: In this single center study, the authors retrospectively evaluated the outcome of patients who were connected to the HFNC after their extubation in the intensive care unit (ICU).

Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016.

Importance: End-of-life decisions occur daily in intensive care units (ICUs) around the world, and these practices could change over time.

Objective: To determine the changes in end-of-life practices in European ICUs after 16 years.

Design, Setting, And Participants: Ethicus-2 was a prospective observational study of 22 European ICUs previously included in the Ethicus-1 study (1999-2000).

Modification of Blood Test Draw Order to Reduce Blood Culture Contamination: A Randomized Clinical Trial.

Background: Blood culture contamination leads to unnecessary interventions and costs. It may be caused by bacteria in deep skin structures unsusceptible to surface decontamination. This study was designed to test whether diversion of blood obtained at venipuncture into a lithium heparin tube prior to aspiration of blood culture reduces contamination.

The Use of High-Flow Nasal Cannula Oxygen Outside the ICU.

Background: High-flow nasal cannula (HFNC) oxygen therapy is a routine, evidence-based treatment in the ICU. Due to its ease of application, non-evidence-based use of HFNC has spread to non-ICU wards. This study reports on the experience with HFNC outside the ICU.

Obstacles to the successful introduction of an electronic hand hygiene monitoring system, a cohort observational study.

Background: Hand hygiene (HH) compliance remains low in many intensive care units (ICU). Technology has been suggested to improve HH compliance.We describe the introduction of an electronic HH surveillance and intervention system into the general ICU of a tertiary care teaching hospital, the obstacles to success and reasons for the system's ultimate failure and removal.

Intensive Care Admissions and Associated Severity of Influenza B Versus A During Influenza B Vaccine-mismatched Seasons.

Patients admitted to hospital with influenza B and A in Jerusalem, Israel, during the 2015-2016 and 2017-2018 influenza seasons demonstrated similar rates of intensive care unit (ICU) admission and associated disease severity. Most (63%) influenza B ICU patients received influenza B-mismatched trivalent vaccine. These findings call into question the equivalence of trivalent and quadrivalent vaccines in preventing severe influenza B.

An intervention to control an ICU outbreak of carbapenem-resistant Acinetobacter baumannii: long-term impact for the ICU and hospital.

Background: Following a fatal intensive care unit (ICU) outbreak of carbapenem-resistant Acinetobacter baumanii (CRAB) in 2015, an aggressive infection control intervention was instituted. We outline the intervention and long-term changes in the incidence and prevalence of CRAB.

Methods: The infection control intervention included unit closure (3 days), environmental cleaning, hand hygiene interventions, and environmental culturing.