bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inferring shifts in tree species distribution using asymmetric distribution curves: a case study in the Iberian mountains
Authors: Urli Morgane , Delzon Sylvain , Eyermann Audrey , Couallier Vincent , García‐Valdés Raúl , Zavala Miguel Angel , Porté Annabel J. 
Published: April 2013

AbstractQuestionsThe objectives of this study were to examine altitudinal shifts in tree species distributions over one decade to quantify the potential for tree migration.LocationSpain.MethodsWe analysed presence–absence data using two successive surveys of the Spanish Forest Inventory in five Fagaceae tree species (two temperate: Fagus sylvatica and Quercus petraea, one sub‐Mediterranean: Q. faginea and two Mediterranean: Q. suber and Q. ilex) in two mountain ranges (the Pyrenees and the Iberian system). Half of the fitted altitudinal distributions were skewed and required use of an asymmetric model for unbiased estimates of optimum altitude and changes in the probability of presence along the altitudinal gradient. For each species and mountain range, shifts were considered to have occurred when the difference in optimum altitude was significant or when differences in probability of occurrence between the two surveys demonstrated the occurrence of colonization or extirpation events.ResultsOverall, depending on species and mountain range, shifts in optimum altitude ranged between −34 m and +181 m. The altitudinal distribution of the Mediterranean species at the core of their latitudinal distribution range presented no sign of change. For the temperate and sub‐Mediterranean Fagaceae species, the patterns demonstrated the existence of distribution changes over a 10‐yr period. The largest, although not statistically significant, upward shift in optimum altitude was observed for Q. petraea in the Iberian system. More interestingly, its distribution indicated colonization events at higher altitudes. For Q. faginea in the Pyrenees, the shift in optimum altitude was the second largest and statistically significant, and was associated with large extirpation events at the lower altitudes. No evidence of shifts was observed for F. sylvatica.ConclusionThis work demonstrates that changes in altitudinal distribution could occur over a 10‐yr time period for tree species located at the southern limit of their distribution, such as some temperate and sub‐Mediterranean oaks, whereas no movement was detected for Mediterranean oaks in the core of their distribution area.
The mycorrhizal‐associated nutrient economy: a new framework for predicting carbon–nutrient couplings in temperate forests
Authors: Phillips Richard P. , Brzostek Edward , Midgley Meghan G. 
Published: April 2013

SummaryUnderstanding the context dependence of ecosystem responses to global changes requires the development of new conceptual frameworks. Here we propose a framework for considering how tree species and their mycorrhizal associates differentially couple carbon (C) and nutrient cycles in temperate forests. Given that tree species predominantly associate with a single type of mycorrhizal fungi (arbuscular mycorrhizal (AM) fungi or ectomycorrhizal (ECM) fungi), and that the two types of fungi differ in their modes of nutrient acquisition, we hypothesize that the abundance of AM and ECM trees in a plot, stand, or region may provide an integrated index of biogeochemical transformations relevant to C cycling and nutrient retention. First, we describe how forest plots dominated by AM tree species have nutrient economies that differ in their C–nutrient couplings from those in plots dominated by ECM trees. Secondly, we demonstrate how the relative abundance of AM and ECM trees can be used to estimate nutrient dynamics across the landscape. Finally, we describe how our framework can be used to generate testable hypotheses about forest responses to global change factors, and how these dynamics can be used to develop better representations of plant–soil feedbacks and nutrient constraints on productivity in ecosystem and earth system models.
Utility of Intrathoracic Impedance Monitoring in Pediatric and Congenital Heart Disease
Authors: LaPAGE MARTIN J. , von ALVENSLEBEN JOHANNES , DICK MACDONALD , SERWER GERALD , BRADLEY DAVID J. 
Published: April 2013

BackgroundThe utility of cardiac device‐based intrathoracic monitoring (OptiVol, Medtronic Inc., Minneapolis, MN, USA) for congestive heart failure (CHF) exacerbation has not been evaluated in pediatric or congenital heart disease patients.MethodsThis was a retrospective study of all patients at a single center with an endocardial OptiVol capable device. OptiVol index values were collected in 2‐week bins from January 2007 to December 2010. The clinical outcomes were CHF exacerbation defined as hospitalization or medication change for CHF and device‐treated ventricular arrhythmia based on remote or in‐office device interrogation. Clinical and OptiVol data were collected by separate investigators blinded to the other parameter. OptiVol data were correlated to the clinical outcomes to determine sensitivity and predictability for multiple threshold values in the entire cohort and pediatric and congenital subgroups.ResultsForty‐seven patients were included. A total of 1,106 months of OptiVol data were collected. Median age of the cohort was 18 years (range 6–58 years). There were 23 pediatric, median age 13 years (range 6–16), at device implant, and 18 patients, median age 31 years (range 13–58), considered at risk for heart failure at implant. There were three heart failure exacerbations and 17 treated ventricular arrhythmias. The study population‐specific positive predictive value (PPV) of OptiVol was low (sensitivity 33% and PPV ≤4.4%) for both CHF exacerbation and arrhythmias in all analyzed groups.ConclusionsThe sensitivity and positive predictive value of intrathoracic impedance monitoring was low in this population of adult congenital and pediatric patients. Recent improvements to the OptiVol algorithm may decrease these deficiencies.
ADVANCE CARE PLANNING IN PAEDIATRICS: THE CARE PROVIDERS' PERSPECTIVE
Authors: Lotz J D , Jox R J , Borasio G D , Führer M 
Published: April 2013

BackgroundResearch on advance care planning (ACP) has focused on adults, but ACP is also being practiced in pediatrics (pACP). Health care providers may have to deal with unknown diagnoses and prognoses, patients without decision making capacity and a complex social network. However, research on pACP has widely neglected the professionals' perspective.AimInvestigating the experiences and needs of both the facilitators and the recipients of ACP.MethodsWe conducted 17 semi-structured interviews with experts in the care of severely ill children and adolescents. Interviewees were from different professions, settings and institutions. The interviews were evaluated using inductive categorisation and thematic comparative analysis.ResultsPediatric ACP concerns all care providers. Particularly important issues are: An interdisciplinary care conference, repeated discussions with the parents, a continuous point of contact as well as emergency planning. Advance directives (AD) should be individualised, validated by the treating physician (shared decision making) and be available. Perceived challenges are: Parents' reluctance to think ahead, uncertain prognoses and uncertainty about involving the child. Conflicting interests exist between emergency physicians who are uncomfortable with accepting a child's AD when they are called in, and non-medical providers who are uncomfortable with accepting an AD without the verification by a physician.DiscussionThis is the first European study that investigates the perspective of professionals on pACP. There is a need for pACP, but the perspectives differ between care providers.ConclusionThis study helps in understanding the needs of the different care providers as well as barriers to pACP.
IMPLEMENTATION OF THE LIVERPOOL CARE PATHWAY IN THE ACUTE SETTING IMPROVED END OF LIFE CARE
Authors: Fullerton S , Bhagat Sandeep 
Published: April 2013

BackgroundThe care of dying patients and families represents an important aspect of health service provision. 1500 patients a year die in Eastern Health beds, only 40% of whom are seen by the hospital based palliative care consultation team (HBPCCT). There is room to improve the quality of care offered to dying patients and families outside a specialist palliative care setting. The Liverpool Care Pathway (LCP) is an integrated, evidence-based, multidisciplinary document representing the ‘Gold Standard’ in quality end-of-life-care provision.AimTo implement and evaluate the LCP in acute wards in EH.MethodsWards with the highest numbers of deaths were identified. After consultation, the LCP was implemented. Surveys of staff were carried out before and after implementation.ResultsMore than 200 patients and families have been cared for on the LCP. Some patients were discharged back to residential care and some to palliative care beds. Only 9% of the 88 surveyed staff who had used the LCP felt that it had not helped improve the care of dying patients and families in EH, and 6% of staff felt that the LCP had not helped staff in caring for dying patients.ConclusionsStaff feel that the introduction of the LCP improved end of life care at EH. Use of LCP did not prevent transfer from acute beds to specialist palliative care beds.
VICTORIAN END-OF-LIFE CARE PATHWAYS COORDINATING PROGRAM
Authors: Duck C , Boughey M , Quinn K , Hall J 
Published: April 2013

BackgroundThe Victorian End-of-Life Care Pathways Coordinating Program was established in response to the recommendations of the Department of Health funded projectEnd of Life Care Pathways in Victoria: Report and Recommendations(2011).Aims▸ To provide a centralised and coordinated approach to end-of-life care pathway activity in Victoria, focusing on the gold standard Liverpool Care Pathway (LCP).▸ To support services in planning, implementing and evaluating all end-of-life care pathways (EoLCPs).MethodsWe investigated end-of-life care (EoLC) activity across Victoria and ways in which emerging activity could be encouraged, supported and sustained.ResultsEoLC activity varies considerably across services and regions, ranging from preliminary exploration to pathways that are firmly embedded in organisational policy, culture and practice. Many of the pathways are registered LCPs or adaptations of the LCP. Others include the Residential Aged Care End of Life Care Pathway.Resources (current and in development) include:Victorian LCP and Victorian Model Pathway (endorsement from Marie Curie Palliative Care Institute Liverpool is in progress)Suites of generic materials applicable to all EoLCPsNational benchmarking through the National Palliative Care Reference GroupOpportunities for clinicians implementing EoLCPs to share experiences, including:–Databank of EoL activity in Victoria (publically available)–E-News–Workshops.DiscussionEnd-of-life care is core business and an integral part of accreditation in most health settings.ConclusionThis programme supports Victorian health services to develop expertise, confidence and consistency in caring for patients and families in the last hours and days of life.
CPR POLICY AND PRACTICE IN AUSTRALIAN RESIDENTIAL AGED CARE FACILITIES (RACFS)
Authors: Sellars M , Silvester W , Fullam R , Sjanta R , Jackson L , Mawren D , Mountjoy R 
Published: April 2013

BackgroundInternational literature suggests current Cardiopulmonary Resuscitation (CPR) policy and practice is highly variable and often ad-hoc in aged care settings. At present, there is no comparable published research on CPR policy and practice in Australian RACFs.AimTo conduct a national survey on staff knowledge and attitudes, and policies and practices regarding CPR in Australian RACFs.MethodsAn online survey was distributed to Australian RACF managers to examine the above.ResultsOf 541 RACF managers, only 19% agreed that CPR should be initiated in a witnessed cardiac arrest yet 83% reported that their facility would provide CPR. However, no CPR was administered in 75% of the facilities in the last 12 months and only once in 15%. Only 63% of facilities had a CPR policy and, of these 44% believe that the policy is inadequate. 98% agreed that it is important to discuss resuscitation status with the resident or family, 96% agreed that a resident CPR plan would help to reduce staff uncertainty and 82% supported the introduction of government CPR guidelines. 75% of respondents believed that survival rate of CPR in RACFs is <10% and 35% (correctly) that survival is <2%.DiscussionCPR policy and practice is highly variable between RACFs in Australia, is inconsistent with the recognised outcomes and does not always reflect managerial attitudes and beliefs regarding CPR.ConclusionThe development of a national CPR guideline in Australian RACFs, and provision of education, will assist services in providing consistent and appropriate CPR practices to residents.
THE STATE OF PLAY: CURRENT ADVANCE CARE PLANNING (ACP) PRACTICE IN RESIDENTIAL AGED CARE IN ONE REGULAR AUSTRALIAN AREA HEALTH SERVICE
Authors: Dellit J , Shepherd K , Urban A 
Published: April 2013

BackgroundRespecting Patient Choices (RPC) model of ACP has been established in Australia for 10 years. Peninsula Health has 35 residential aged care facilities (RACF) in its catchment area, yet few residents present to acute care with an ACP.AimTo assess the current levels of ACP implementation including the degree of variation from the RPC model of evidence-based practice in the aged care sector.Methods30 participating RACFs underwent a comprehensive survey conducted via interview and a random 10% sample health record audit to collect data. Data was collated and graphed across 30 domains of enquiry into ACP practice.ResultsThe survey revealed a state of broad variance in how ACP is implemented and practiced. Only 21% indicated they routinely invite the resident to participate in ACP discussions. 20% of audited health records showed any evidence of the resident's involvement in ACP and only 41% had evidence of a substitute decision maker. Only 24% files evidenced recording of medical end of life care wishes (figure 1).Figure 1DiscussionSignificant gaps were identified in the nature and content of discussions undertaken and in the recorded level of involvement enabled from residents or their representatives.ConclusionThis study reveals that Aged Care Facilities need significant support to enable a transition to best practice in ACP.
HEART AND SOUL: EFFECTIVE ADVANCE CARE PLANNING PROGRAMME PROVIDES INTERNATIONAL MODEL
Authors: Malley P , Jane Markley M , Rastas L 
Published: April 2013

BackgroundAging with Dignity introduced the ACP toolFive Wishesin the USA in 1998 with a focus on personal care, family relationships, dignity, and spirituality. The concept is now helping to shape international efforts. Programme expansion includesVoicing My Choices:A Planning Guide for Adolescents and Young Adults,developed with the National Institutes of Health.AimDescribe a non-traditional, and replicable, approach to ACP that has proven effective and is positively influencing the development of ACP programmes internationally.MethodsCompilation of data on issues identified as ‘most important’ at the end-of-life, examination of an ACP resource that responds to these issues, review of data from recent NIH study of perceptions of ACP by adolescents and young adults, and an overview of the influence on international ACP efforts.ResultsMore than 19 million Five Wishes documents, available in 27 languages, are in circulation. More than 35 000 partner organisations include hospitals, health systems, and places of worship. Known sites of replication efforts include Australia, China, Taiwan, Norway, and Italy.DiscussionHaving a user-friendly and easy-to-understand tool that encourages people to discuss their personal, emotional, and spiritual needs along with their medical wishes results in increased completion of usable and meaningful advance care plans.ConclusionPeople respond well to ACP when matters of the heart and soul are included in the process, as well as when patients and families are empowered to make their own decisions. Lessons learned in this initiative provide helpful guidance for international efforts to encourage ACP.
THE LEGAL CONSEQUENCES OF PHYSICIANS WHO PRACTICE EUTHANASIA IN ITALY: A REVIEW
Authors: Veshi D 
Published: April 2013

BackgroundThere was an increase in medical discoveries that led to the reconsideration of our lives.AimThe punishment of the physician who practices euthanasia in Italy.MethodIn Italy, where there no law about euthanasia, judges interpret the Criminal Code through the Constitutional right to health and the ‘European Convention on Human Rights and Biomedicine’ (‘Oviedo Convention’) of 7 April 1940.ResultPassive euthanasia to an unconscious patient and active euthanasia to a conscious patient are considered as homicides. Moreover, active euthanasia to a non-consensual patient is considered as intentional homicide. But, passive euthanasia to a consensual patient is treated as assisted suicide. However, it should be emphasised that, except in cases of active euthanasia to non-consensual patient, judges enhance the internal legislation by interpreting it through the constitutional right to health and the ‘Oviedo Convention’ of April 4, 1997. Article 32 of the Italian Constitution recognises the ‘Right to health’ which grants patients the right to consent to or even withhold from medical treatment. Furthermore, article 9 of the ‘Oviedo Convention’ gives full legitimacy to the ‘Advance Directives’ by considering them as ‘statements of intent’ and not as ‘declaration of intent’.DiscussionInterpreting the Italian Criminal Code with fundamental rights recognised in the Italian Constitution and in the ‘European Convention on Human Rights and Biomedicine’ is an effective way to fill the gap in the Italian legal framework.ConclusionThis study supports the introduction of a clear law that disciplines End-of-life Decision Making in Italy.
DOES ADVANCE CARE PLANNING TRANSLATE INTO IMPROVED CARE IN A RURAL WESTERN AUSTRALIAN HOSPITAL SETTING?
Authors: Auret K , Sinclair C , Averill B , Evans S F 
Published: April 2013

BackgroundWestern Australia (WA) passed legislation supporting formal advance care planning (ACP) in 2010, allowing Advance Health Directive (AHD) and Enduring Power of Guardianship (EPG) forms. It is timely to audit the quality of end-of-life care provided in a rural area.AimReport ACP uptake and impact on end-of-life care in a rural hospital setting.MethodsThis retrospective case notes-based audit of 90 admissions resulting in death was conducted in five rural hospitals in the Great Southern region of WA in 2012: the 100-bed regional centre (N=50) and four more remote ∼10-bed facilities (N=10). A palliative care nurse used an in-house designed audit tool to collect data on demographics, process and outcomes measures. A palliative physician double coded five randomly selected sets of notes.ResultsMost patients elderly (M=79.6 years), admitted via ED (58%), on average 13 days before death. Malignancy accounted for 40% of deaths. Some form of ACP was documented in 34%, with 9% having an AHD and 1% having an EPG. 50% died on the Liverpool end-of-life care pathway, those on the pathway scored higher on a composite measure of care quality (χ2(2,90)=31.6, p<0.001). ACP documentation did not predict likelihood of being commenced on the pathway (p>0.05) or scores on the composite measure (p>0.05).DiscussionAs ACP is promoted in our community, our rural hospital network must develop system-wide responses to guarantee ACP influences care.ConclusionThis audit reports baseline data, which can be repeated following ACP-based interventions.
PALLIATIVE CARE: AN ALTERNATIVE TO EUTHANASIA
Authors: Omipidam B A 
Published: April 2013

BackgroundToday, euthanasia has become the option for terminally ill persons, in order to die with dignity. Palliative care on the other hand seeks to re-assure people with terminal or chronic ailments that they are still worthy of living.AimTo show case Palliative care as an efficient alternative to euthanasia for terminally ill persons.MethodsI examined request for euthanasia and or assisted suicide on the basis of personal interviews carried out on terminally ill patients in the six geo-political zones of Nigeria in the last 24 months; current arguments for and against the concept and views expressed by stake-holders on the concept.ResultsOutcome of the study carried out shows that request for euthanasia and or assisted suicide, are largely due to the fear of being a burden and abandoned by families and relatives.DiscussionSince it deals with care rather than cure, a combination of doctors, nurses and social work palliative care specialists, Massage therapists, pharmacists, nutritionists, chaplains, amongst others, will re-assure terminally and chronically ill patients that they are not a burden, and that the remaining part of their lives are worth living.ConclusionPalliative care should be the focus of all government across the globe so that, terminally and chronically ill persons can be adequately catered for as they approach their end of life. If this is wholly embraced, the request for euthanasia and or assisted suicide will be condemned to the dustbin of history.
IMPACT OF AN ADVANCE CARE PLANNING CLINIC ON PATIENTS OF A REGIONAL CARE COORDINATION SERVICE
Authors: Ironside J , Appleton W , Dugdale P 
Published: April 2013

BackgroundCHHS policy calls for staff to complete advance care plans (including a statement of choices) for patients with chronic disease. Numbers of completed plans are low, partly because some patients do not wish to complete one, and partly due to practical barriers to completion.AimTo overcome practical barriers to completion of advance care plans.MethodsFrom April 2011 our Care Coordination Service established a fortnightly home- based Advance Care Planning Clinic, in which two staff visit patients at their home. In August 2012 this was supplemented by a fortnightly hospital-based clinic. Patients can be booked into either clinic. In the clinic, an Advance Care Plan is prepared comprising of a Statement of Choices and may include Enduring Power of Attorney, witnessed by an authorised clinic staff member. Partners are also offered the opportunity to complete their advance care plan at this time.ResultsIn January–March 2011, prior to the commencement of the clinic, there were 54 patients receiving care coordination of whom 19 (35%) had a completed advance care plan, including a Statement of Choices. In October–December 2012 there were 89 patients who had received care coordination of whom 35 (39%) had a completed advance care plan.ConclusionThe establishment of Advance Care Planning Clinics has been a practical way to help overcome multifactorial barriers to preparing a Statement of Choices, providing increased access opportunities and support for timely completion. This approach enabled staff to improve completion rates whilst managing a 65% caseload increase.