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Park S, Goggin K, Morton JM, Hall DA. The effects of tibial tuberosity avulsion and repair on tibial plateau angle in dogs. N Z Vet J 2024; 72:90-95. [PMID: 38228160 DOI: 10.1080/00480169.2023.2291036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/15/2023] [Indexed: 01/18/2024]
Abstract
AIMS To assess whether tibial tuberosity avulsion injury and subsequent surgical repair in skeletally immature dogs are associated with changes in tibial plateau angle (TPA) at skeletal maturity. METHODS Skeletally mature (> 18 months of age) dogs that had previously undergone unilateral surgery when 4-8 months of age to repair tibial tuberosity avulsion were enrolled. Bilateral, mediolateral stifle radiographs were taken. TPA was measured digitally from the radiographs independently by two readers and compared between sides within dogs. As the number of dogs that would be enrolled for the main part of the study was unknown, to understand how the variation between left and right stifles within dogs would affect the power of the main study, 29 client-owned, skeletally mature dogs without stifle pathology were recruited prior to the main study for bilateral, mediolateral projection stifle radiographs. Variation in the differences in TPA between left and right stifles was used to estimate the likely power of the major part of the study for different numbers of enrolled dogs. RESULTS From 29 dogs enrolled in the power assessment, the SD of the differences between left and right stifles was 2.1°. With 10 dogs (20 stifles) enrolled within the main part of the study, and if the SD of the differences between operated and non-operated stifles within a dog was the same as the SD of the differences between non-operated stifles within a dog (2.1°), the study would have power ≥ 0.8 if the mean difference in TPA between operated and non-operated stifles was ≥ 2.1°.Ten dogs were enrolled in phase II of the study. In 8/10 of these dogs, the TPA in the operated stifle was less than in the non-operated stifle. The mean TPA on the operated stifle was 6.4° less than on the non-operated stifle (95% CI = 2.4-10.3° less; p = 0.002). For surgery between 4 and 8 months of age, TPA at maturity increased by 2.7° (95% CI = 1.1-4.3°; p = 0.001) for each additional month of age at surgery. CONCLUSIONS AND CLINICAL RELEVANCE Based on this study, surgical repair of tibial tuberosity avulsion in skeletally immature dogs is associated with a smaller TPA at skeletal maturity. However, causality cannot be established from this cross-sectional study, and this association may be because stifles with a smaller TPA are predisposed to tibial tuberosity avulsion.
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Affiliation(s)
- S Park
- Advanced Vetcare, Melbourne, Australia
| | - K Goggin
- Advanced Vetcare, Melbourne, Australia
| | - J M Morton
- Jemora Pty. Ltd., East Geelong, Australia
| | - D A Hall
- Advanced Vetcare, Melbourne, Australia
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Grieco A, Huffman KM, Cohen ME, Hall BL, Morton JM, Ko CY. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program: Bariatric Surgical Risk/Benefit Calculator: 1-year comorbidity remission. Surg Obes Relat Dis 2024; 20:275-282. [PMID: 37867047 DOI: 10.1016/j.soard.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/14/2023] [Accepted: 09/10/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Clinical calculators can provide patient-personalized estimates of treatment risks and health outcomes. The American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) set out to create a publicly available tool to assess both short-term postoperative risk and long-term benefits for prospective adult patients eligible for 1 of 4 primary bariatric procedures. The calculator is comprised of multiple prediction elements: (1) 30-day postoperative risk, (2) 1-year body mass index projections, and (3) 1-year comorbidity remission. OBJECTIVES To assess the performance of the 1-year comorbidity remission prediction feature of the calculator. SETTING Not-for-profit organization clinical data registry. METHODS MBSAQIP data across 4.5 years from 240,227 total patients indicating at least 1 comorbidity of interest present preoperatively and who had a 1-year follow-up record documenting their comorbidity status were included. Six models were constructed, stratified by the presence of the respective preoperative comorbidity: hypertension, hyperlipidemia, gastroesophageal reflux disease, sleep apnea, non-insulin-dependent diabetes, and insulin-dependent diabetes. A multinomial logistic regression model was used to predict 1-year remission (total, partial, or no remission) of insulin-dependent diabetes. All other outcomes were binary (yes or no at 1 yr), and ordinary logistic regression models were used. RESULTS All models showed adequate discrimination (C statistics ranging from .58 to .68). Plots of observed versus predicted remission (%) showed excellent calibration across all models. CONCLUSION All remission models were well calibrated with sufficient discrimination. The MBSAQIP Bariatric Surgical Risk/Benefit Calculator is a publicly available tool intended for integration into clinical practice to enhance patient-clinician discussions and informed consent.
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Affiliation(s)
| | | | | | - Bruce L Hall
- American College of Surgeons, Chicago, Illinois; Department of Surgery, Center for Health Policy and Olin Business School, Washington University in St. Louis, Saint Louis Veterans Affairs Medical Center, and BJC Healthcare, St. Louis, Missouri
| | - John M Morton
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Clifford Y Ko
- American College of Surgeons, Chicago, Illinois; Department of Surgery, University of California Los Angeles David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
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Morton JM, English W, Jones D, Provost DA. Lessons learned from the metabolic and bariatric surgery accreditation and quality improvement program site surveys: common deficiencies and corrective actions. Surg Obes Relat Dis 2024; 20:154-159. [PMID: 37816651 DOI: 10.1016/j.soard.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/21/2023] [Accepted: 08/28/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) is a joint program between the American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS). On-site surveys of the applicant programs to determine adherence to the MBSAQIP standards are a hallmark of the accreditation process. OBJECTIVES A retrospective review of 619 site surveys completed over 2 years was performed to include analysis of reviewer decisions, tabulation and cross-reference of identified deficiencies to the MBSAQIP standards and determine final disposition of corrective actions and overall accreditation rates. SETTING Accredited Hospitals (Community and Academic) within MBSAQIP. METHODS This is a retrospective review of site surveys by expert panel. RESULTS ≥1 MBSAQIP Standards deficiencies were present at 149 of the 619 program site surveys (24.07%). The 3 leading Standards in Deficiency were in order: Commitment to Quality Care, Continuous Quality Improvement Process, and Data Collection. Within a year following initial site survey of the149 programs with Standards deficiencies, 59 programs demonstrated compliance, 83 programs were placed on probation (with a specific time-frame to demonstrate compliance) and 7 programs were denied accreditation. Ultimately, 98.9% of programs were able to gain or maintain MBSAQIP accreditation. CONCLUSIONS The MBSAQIP accreditation through on-site surveys can identify and improve program adherence to MBSAQIP standards.
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Affiliation(s)
- John M Morton
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Wayne English
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Dan Jones
- Department of Surgery, Rutgers New Jersey School of Medicine, Newark, New Jersey
| | - David A Provost
- Department of Surgery, Scott and White Clinic, Temple, Texas
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Luke TDW, Morton JM, Wales WJ, Ho CKM. Associations between serum health biomarker concentrations and reproductive performance, accounting for milk yield, in pasture-based Holstein cows in southeastern Australia. J Dairy Sci 2024; 107:438-458. [PMID: 37690712 DOI: 10.3168/jds.2022-23006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/23/2023] [Indexed: 09/12/2023]
Abstract
In this single cohort study, we investigated associations between the concentrations of a suite of serum biomarkers measured in the first 30 d of lactation and subsequent reproductive performance measured as mating start date to conception intervals, in pasture-based Holstein cows. A secondary objective was to examine associations between biomarker concentrations and 305-d milk yield to assess whether any positive associations between biomarker concentration and reproductive performance were explained by reduced milk production. The data used had been collected as part of an ongoing project from 2017 to 2020 to compile a data set from a large population of lactating dairy cows. Biomarkers measured were those associated with energy balance (β-hydroxybutyrate [BHB] and nonesterified fatty acids [NEFA]), protein nutritional status (urea and albumin), immune status (globulin, albumin to globulin ratio and haptoglobin), and macromineral status (calcium and magnesium). Associations between biomarker concentrations and mating start date to conception interval were investigated using Cox proportional hazard models, using between 634 and 1,121 lactations (varying by biomarker) from 632 to 1,103 cows and 11 to 17 mating periods from 10 to 13 herds. Based on hazard ratio (HR) estimates and associated 95% confidence intervals (CI), hazard of conception on any particular day of the herds' mating periods was positively associated with the concentrations of albumin (HR = 1.09; 95% CI: 1.05-1.12), albumin to globulin ratio (HR = 2.82; 95% CI: 1.66-4.79), calcium (HR = 2.01; 95% CI: 1.18-3.43), and magnesium (HR = 2.17; 95% CI: 1.01-4.66), and negatively associated with globulin concentration (HR = 0.98; 95% CI: 0.97 to 1.00). There was also some evidence that NEFA concentration was negatively associated (HR = 0.76; 95% CI: 0.57 to 1.01), and urea concentration positively associated (HR = 1.05; 95% CI: 0.99 to 1.11), with reproductive performance, but no evidence that BHB and haptoglobin concentrations were associated with reproductive performance. Except for NEFA, presence and direction of the associations between the biomarker and milk yield were not discordant with that for reproductive performance. Also, except for NEFA, we found no substantial evidence of nonlinear relationships between biomarker concentration and either reproductive performance or milk yield. Correlations between biomarker concentrations were generally weak, indicating that multibiomarker panels may collectively predict reproductive performance better than any single biomarker. We noted substantial variation in the concentrations of all biomarkers within, and for some biomarkers, between herd-year groups. Collectively, these results indicate that there may be scope to improve biomarker concentrations through nutritional, management, and genetic interventions, and by association, reproductive performance and milk yield may also improve.
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Affiliation(s)
- T D W Luke
- Agriculture Victoria Research, AgriBio, Centre for AgriBioscience, Bundoora, Victoria 3083, Australia
| | - J M Morton
- Jemora Pty Ltd., East Geelong, Victoria 3219, Australia
| | - W J Wales
- Agriculture Victoria Research, Ellinbank Centre, Ellinbank, Victoria 3820, Australia; Centre for Agricultural Innovation, School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - C K M Ho
- Agriculture Victoria Research, AgriBio, Centre for AgriBioscience, Bundoora, Victoria 3083, Australia.
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Brown KC, Esnaola G, Morton JM. Complete Intra-Gastric Erosion of a Laparoscopic Vertical Gastric Clip. Obes Surg 2024; 34:290. [PMID: 38015331 DOI: 10.1007/s11695-023-06836-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Kevin C Brown
- Department of Surgery, Yale School of Medicine, 330 Cedar Street, PO Box 208062, New Haven, CT, 06510, USA
| | - Gabriela Esnaola
- Department of Surgery, Yale School of Medicine, 330 Cedar Street, PO Box 208062, New Haven, CT, 06510, USA
| | - John M Morton
- Department of Surgery, Yale School of Medicine, 330 Cedar Street, PO Box 208062, New Haven, CT, 06510, USA.
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Miller SM, Abou-Azar S, Owusu KA, Judson BL, Rhodes D, Morton JM. Improving Post-procedure Outcomes With Clinical Care Pathway for Enteral Access. Am Surg 2023; 89:6362-6365. [PMID: 37203186 DOI: 10.1177/00031348231177914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Our health system introduced an enteral access clinical pathway (EACP) hoping to increase nutritionist consults and decrease presentation to the Emergency Department, readmission to the hospital, and overall hospital length of stay. We followed patients with short-term access (STA), longterm access (LTA), and short-long-term conversions (SLT) seen in the six months prior to the EACP launch (baseline group) and the six months after (performance group). The baseline cohort consisted of 2,553 patients and the performance cohort of 2,419 patients. Those in the performance group were more likely to receive a nutrition consult (52.4% vs 48.0%, P < .01), less likely to re-present to the ED (31.9% vs 42.6%, P < .001), and less likely to be readmitted to the hospital (31.0% vs 41.6%, P < .001. These findings suggest that the EACP may increase the likelihood of both expert-driven nutritional support and effective discharge planning for hospitalized patients.
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Affiliation(s)
- Samuel M Miller
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Sara Abou-Azar
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Kent A Owusu
- Care Signature, Office of the Chief Medical Officer, Yale New Haven Health System, New Haven, CT, USA
| | - Benjamin L Judson
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Deborah Rhodes
- Care Signature, Office of the Chief Medical Officer, Yale New Haven Health System, New Haven, CT, USA
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - John M Morton
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Brown KC, Esnaola G, Boffa D, Morton JM. Gastroesophageal junction adenocarcinoma 1-year after sleeve gastrectomy. J Surg Case Rep 2023; 2023:rjad518. [PMID: 37771883 PMCID: PMC10532088 DOI: 10.1093/jscr/rjad518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/30/2023] [Indexed: 09/30/2023] Open
Abstract
Gastroesophageal malignancy after sleeve gastrectomy is rare. A 70-year-old male with a BMI of 46 underwent laparoscopic sleeve gastrectomy with normal endoscopy. By 10 months postop, the patient had reduced BMI to 30.5. Eleven months postop, he presented with emesis and endoscopy showed severe stenosis at the gastroesophageal junction with EUS showing a circumferential mass. Patient had adenocarcinoma of the distal esophagus HER 3+ and MMR proficient, clinical T2N1. He underwent esophageal stent placement followed by FOLFOX switched to carboplatin-Taxol with radiation therapy complicated by a localized perforation requiring antibiotics. After PET scan of esophageal mass indicated response, he underwent an open distal esophagectomy, total gastrectomy with Roux-en-Y esophagojejunostomy, and placement of feeding tube. Pathology revealed poorly differentiated invasive adenocarcinoma with negative margins. In the USA, this represents only the second adenocarcinoma following a sleeve gastrectomy and the first in a non-immune compromised patient.
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Affiliation(s)
- Kevin C Brown
- Department of Surgery, Yale School of Medicine, 330 Cedar Street, PO Box 208062, New Haven, CT 06510, United States
| | - Gabriela Esnaola
- Department of Surgery, Yale School of Medicine, 330 Cedar Street, PO Box 208062, New Haven, CT 06510, United States
| | - Dan Boffa
- Department of Surgery, Yale School of Medicine, 330 Cedar Street, PO Box 208062, New Haven, CT 06510, United States
| | - John M Morton
- Department of Surgery, Yale School of Medicine, 330 Cedar Street, PO Box 208062, New Haven, CT 06510, United States
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Morton JM. Comment on: Extended postoperative venous thromboembolism prophylaxis after bariatric surgery: a comparison of existing risk stratification tools and 5-year MBSAQIP analysis. Surg Obes Relat Dis 2023; 19:818. [PMID: 37316437 DOI: 10.1016/j.soard.2023.04.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/23/2023] [Indexed: 06/16/2023]
Affiliation(s)
- John M Morton
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Grieco A, Huffman KM, Cohen ME, Hall BL, Morton JM, Ko CY. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Bariatric Surgical Risk/Benefit Calculator: 1-year weight. Surg Obes Relat Dis 2023; 19:690-696. [PMID: 36639320 DOI: 10.1016/j.soard.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/02/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Data-driven tools can be designed to provide patient-personalized estimates of health outcomes. Clinical calculators are commonly built to assess risk, but potential benefits of treatment should be equally considered. The American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) sought to create a risk and benefit calculator for adult patients considering primary metabolic and bariatric surgery with multiple prediction features: (1) 30-day risk, (2) 1-year body mass index (BMI) projections, and (3) 1-year co-morbidity remission. OBJECTIVE To assess the performance of the 1-year BMI projections feature of this tool. SETTING Not-for-profit organization, clinical data registry. METHODS MBSAQIP data from 596,024 cases across 4.5 years from 882 centers with ∼2.5 million records through 18 months postoperatively were included. A generalized estimating equation model was used to estimate BMI over time for 4 primary procedures: laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. RESULTS The mean absolute error (MAE) in BMI predictions through postoperative month 12 was 1.68 units; overall correlation of actual and predicted BMI was .94. MAE of postoperative BMI estimates (1-12 mo) was lowest for laparoscopic sleeve gastrectomy (1.64) and highest for biliopancreatic diversion with duodenal switch (1.99). BMI predictions at 12 months showed MAE = 2.99 units. CONCLUSIONS Predicted BMI closely aligned with actual BMI values across the 12-month postoperative period. The MBSAQIP Bariatric Surgical Risk/Benefit Calculator is publicly available with the intent to facilitate patient-clinician communication and guide surgical decision making. This tool can aid in evaluating postoperative risk as well as benefits and long-term expectations.
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Affiliation(s)
| | | | | | - Bruce L Hall
- American College of Surgeons, Chicago, Illinois; Department of Surgery, Center for Health Policy and Olin Business School, Washington University in St. Louis, Saint Louis Veterans Affairs Medical Center, and BJC Healthcare, St. Louis, Missouri
| | - John M Morton
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Clifford Y Ko
- American College of Surgeons, Chicago, Illinois; Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California
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Miller SM, Azar SA, Farrelly JS, Salzman GA, Broderick ME, Sanders KM, Anto VP, Patel N, Cordova AC, Schuster KM, Jones TJ, Kodadek LM, Gross CP, Morton JM, Rosenthal RA, Becher RD. Current use of the National Surgical Quality Improvement Program surgical risk calculator in academic surgery: a mixed-methods study. Surg Pract Sci 2023; 13:100173. [PMID: 37502700 PMCID: PMC10373440 DOI: 10.1016/j.sipas.2023.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Background This study aims to quantitatively assess use of the NSQIP surgical risk calculator (NSRC) in contemporary surgical practice and to identify barriers to use and potential interventions that might increase use. Materials and methods We performed a cross-sectional study of surgeons at seven institutions. The primary outcomes were self-reported application of the calculator in general clinical practice and specific clinical scenarios as well as reported barriers to use. Results In our sample of 99 surgeons (49.7% response rate), 73.7% reported use of the NSRC in the past month. Approximately half (51.9%) of respondents reported infrequent NSRC use (<20% of preoperative discussions), while 14.3% used it in ≥40% of preoperative assessments. Reported use was higher in nonelective cases (30.2% vs 11.1%) and in patients who were ≥65 years old (37.1% vs 13.0%), functionally dependent (41.2% vs 6.6%), or with surrogate consent (39.9% vs 20.4%). NSRC use was not associated with training status or years in practice. Respondents identified a lack of influence on the decision to pursue surgery as well as concerns regarding the calculator's accuracy as barriers to use. Surgeons suggested improving integration to workflow and better education as strategies to increase NSRC use. Conclusions Many surgeons reported use of the NSRC, but few used it frequently. Surgeons reported more frequent use in nonelective cases and frail patients, suggesting the calculator is of greater utility for high-risk patients. Surgeons raised concerns about perceived accuracy and suggested additional education as well as integration of the calculator into the electronic health record.
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Affiliation(s)
- Samuel M. Miller
- Department of Surgery, Yale School of Medicine, United States
- National Clinician Scholars Program, Yale School of Medicine, United States
| | - Sara Abou Azar
- Department of Surgery, Yale School of Medicine, United States
| | - James S. Farrelly
- Department of Surgery, Quinnipiac University School of Medicine, United States
| | - Garrett A. Salzman
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, United States
- Department of Surgery, Greater Los Angeles Veterans Affairs Healthcare System, United States
| | | | | | - Vincent P. Anto
- Department of Surgery, University of Pittsburgh School of Medicine, United States
| | - Nathan Patel
- Department of Surgery, Wake Forest School of Medicine, United States
| | - Alfredo C. Cordova
- Department of Surgery, The Ohio State University College of Medicine, United States
| | | | - Tyler J. Jones
- Department of Surgery, Yale School of Medicine, United States
| | - Lisa M. Kodadek
- Department of Surgery, Yale School of Medicine, United States
| | - Cary P. Gross
- Department of Medicine, Yale School of Medicine, United States
| | - John M. Morton
- Department of Surgery, Yale School of Medicine, United States
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Morton JM. Commentary on: Fat-free mass accounts for most of the variance in alcohol elimination rate in women. Alcohol Clin Exp Res 2023. [PMID: 37164945 DOI: 10.1111/acer.15099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023]
Affiliation(s)
- John M Morton
- Department of Surgery Yale School of Medicine New Haven, CT, USA
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Mayes BT, Taylor PS, Cowley FC, Gaughan JB, Morton JM, Doyle BP, Tait LA. The effects of stocking density on behavior and biological functioning of penned sheep under continuous heat load conditions. J Anim Sci 2023; 101:skad223. [PMID: 37392177 PMCID: PMC10362936 DOI: 10.1093/jas/skad223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023] Open
Abstract
Stocking density may impact sheep welfare during live export voyages that occur under hot and humid conditions. The aim of this study was to assess the welfare implications for sheep housed at three allometric stocking densities (k = 0.030, 0.033, 0.042), while exposed to hot and humid climatic conditions. For 21 d, Merino wethers (n = 216) were housed in 12 pens of 18 wethers, in two climate-controlled rooms where wet-bulb temperature (TWB) mimicked the conditions of a live export voyage with high heat and humidity, and limited diurnal variation. Scan sampling of standing and lying behaviors was conducted on days 2, 5, 8, 11, 15, 18, and 20, at hourly intervals. Agonistic interactions were scored continuously on the same days between 1750 and 1800 h. Liveweights were recorded at the start and end of the study. For a subset of focal wethers (3 per pen), whole blood variables were assessed at the start and end of the experiment, along with fecal glucocorticoid metabolites (FGCM), which were also assessed on days 7 and 14. Rumen temperatures (TRUM) of focal wethers were recorded at 10-min intervals, and their respiration rates (RR) were measured every 2 h on days 1, 3, and from days 7 to 21. Focal wethers were slaughtered for necropsy after the study, and both adrenal glands were excised and weighed. The expression of some lying positions was impaired at high stocking densities, and lying with outstretched legs increased at high TWB. For respiration rates, there was an interaction between stocking density and TWB, such that RR was reduced by the provision of additional space at high TWB. TRUM was relatively unaffected by stocking density but increased at higher TWB, and any effects of stocking density on FGCM concentrations, liveweights (LW), adrenal gland weights or blood variables were minimal. Necropsy examination showed no indication that the wethers had experienced ongoing respiratory distress. These results suggest that the wethers were able to cope with these increases in stocking density under the conditions imposed. However, based on this evidence, the provision of additional space under hot conditions may be beneficial to facilitating the expression of some lying positions. Whilst the experiment was designed to emulate certain conditions relevant during live export voyages, other factors that may induce stress during this mode of transport were not present, and so the conclusions must be interpreted in the context of the experimental conditions.
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Affiliation(s)
- Bonnie T Mayes
- School of Environmental and Rural Science, University of New England, Armidale, NSW 2351, Australia
| | - Peta S Taylor
- School of Environmental and Rural Science, University of New England, Armidale, NSW 2351, Australia
| | - Frances C Cowley
- School of Environmental and Rural Science, University of New England, Armidale, NSW 2351, Australia
| | - John B Gaughan
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, QLD, 4343, Australia
| | | | - Brendan P Doyle
- School of Environmental and Rural Science, University of New England, Armidale, NSW 2351, Australia
| | - L Amy Tait
- School of Environmental and Rural Science, University of New England, Armidale, NSW 2351, Australia
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Morton JM. Comment on: Medicaid expansion: the impact of health policy on bariatric surgery. Surg Obes Relat Dis 2023; 19:26-27. [PMID: 36481354 DOI: 10.1016/j.soard.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022]
Affiliation(s)
- John M Morton
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Jacobson E, Morton JM, Woerde DJ, Thompson MF, Spillane AM, Tebb A, Della Valle Z, Birnie G, Malik R. Clinical features, outcomes, and long-term survival times of cats and dogs with central nervous system cryptococcosis in Australia: 50 cases (2000-2020). J Am Vet Med Assoc 2022; 261:246-257. [PMID: 36434766 DOI: 10.2460/javma.22.08.0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the clinical findings and outcomes of Australian cats and dogs with CNS cryptococcosis. ANIMALS 19 cats and 31 dogs with CNS cryptococcosis diagnosed between 2000 and 2020. PROCEDURES A case series and cohort study were performed using the same 50 animals. Both studies were multi-institutional and both retrospective and prospective. Disease features were compared between cats and dogs, and associations between putative risk factors and survival time (ST) were assessed. RESULTS Dogs were younger at initial presentation than cats and had lower latex cryptococcal antigen agglutination titers. Extraneurologic signs were common and frequently involved sinonasal and contiguous tissues. Neuroanatomic localization was predominantly forebrain, central vestibular (including cerebellum), multifocal, or diffuse. CSF analysis predominantly showed pleocytosis, with eosinophilic inflammation common in dogs. Seventy-eight percent (39/50) of patients received antifungal treatment. Median STs (from presentation) in treated patients were 1,678 days for cats and 679 days for dogs. Abnormal mentation at presentation (in dogs) and CSF collection (in cats) were associated with shorter STs. In treated dogs, those that received glucocorticoids prior to diagnosis, or single rather than multiple antifungal agents, had shorter STs. CLINICAL RELEVANCE The prognosis for feline and canine CNS cryptococcosis is guarded, yet long STs are possible with appropriate treatment. Presence of subtle upper respiratory tract signs may suggest cryptococcosis in patients with neurologic signs, while the absence of neurologic signs does not preclude CNS involvement.
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Affiliation(s)
- Else Jacobson
- 1Department of Internal Medicine, Veterinary Specialist Services, Underwood, QLD, Australia
| | | | - Dennis J Woerde
- 3Department of Internal Medicine, Animal Referral Hospital, Homebush West, NSW, Australia
| | - Mary F Thompson
- 4Department of Internal Medicine, The Animal Hospital, School of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
| | - Amanda M Spillane
- 5Department of Internal Medicine, Queensland Veterinary Specialists, Stafford, QLD, Australia
| | - Anna Tebb
- 6Department of Internal Medicine, Western Australian Veterinary Emergency and Specialty, Success, WA, Australia
| | - Zoe Della Valle
- 7Department of Internal Medicine, Melbourne Veterinary Specialist Centre, Glen Waverley, VIC, Australia
| | - Gemma Birnie
- 8Department of Internal Medicine, Brisbane Veterinary Specialist Centre, Albany Creek, QLD, Australia
| | - Richard Malik
- 9Centre for Veterinary Education, Veterinary Science Conference Centre, The University of Sydney, NSW, Australia
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15
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Mayes BT, Tait LA, Cowley FC, Morton JM, Doyle BP, Arslan MA, Taylor PS. Corrigendum: Stocking density, restricted trough space, and implications for sheep behaviour and biological functioning. Front Vet Sci 2022; 9:1077412. [DOI: 10.3389/fvets.2022.1077412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022] Open
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16
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Mayes BT, Tait LA, Cowley FC, Morton JM, Doyle BP, Arslan MA, Taylor PS. Stocking density, restricted trough space, and implications for sheep behaviour and biological functioning. Front Vet Sci 2022; 9:965635. [PMID: 36246333 PMCID: PMC9556270 DOI: 10.3389/fvets.2022.965635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Stocking density and trough space allowance can potentially impact sheep welfare during live export voyages. The aim of this study was to assess the welfare implications for sheep housed at five allometric stocking densities, with either unrestricted or restricted trough space allowance. Merino wethers (n = 720) were housed in 40 pens of 18 heads for 18 days. Two 5-min continuous focal animal observations (n = 3/pen) were conducted on days 3, 5, 11, and 17. Scan sampling of standing and lying behaviours were conducted on the same days at hourly intervals. Live weights and immune cell counts were quantified at the start and end of the experiment, as well as faecal glucocorticoid metabolites (FGCMs), which were also assessed on days 6 and 12. Focal animals housed at higher stocking densities spent less time lying during one of the continuous observation periods, but no important effects on the overall number of animals lying or on the synchronicity of lying were evident. The scan sampling results indicated that the expression of some preferred lying positions was impaired at high stocking densities, and that high stocking densities also resulted in increased agonistic social interactions and displacement events at the start of the trial. There was a slight reduction in day 18 live weights for animals housed at higher stocking densities, but FGCM concentrations and immune cell counts were essentially unaffected. Trough space had no important effects on day 18 live weight, FGCM concentrations, or immune cell counts, and had limited effects on sheep behaviour. The lack of important impacts on biological fitness traits suggests that the behavioural responses observed were sufficient in allowing sheep to cope with their environment. However, we provide evidence that the provision of additional space is beneficial in reducing the time it takes for animals to adapt to their environment and to facilitate the expression of some preferred lying positions. While designed to emulate certain conditions relevant during live export voyages, some factors that may induce stress during this mode of transport were not present such as heat and ocean swell, so the conclusions must be interpreted in the context of the experimental conditions.
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Affiliation(s)
- Bonnie T. Mayes
- School of Environmental and Rural Science, University of New England, Armidale, NSW, Australia,*Correspondence: Bonnie T. Mayes
| | - L. Amy Tait
- School of Environmental and Rural Science, University of New England, Armidale, NSW, Australia
| | - Frances C. Cowley
- School of Environmental and Rural Science, University of New England, Armidale, NSW, Australia
| | | | - Brendan P. Doyle
- School of Environmental and Rural Science, University of New England, Armidale, NSW, Australia
| | - Muhammad A. Arslan
- School of Environmental and Rural Science, University of New England, Armidale, NSW, Australia
| | - Peta S. Taylor
- School of Environmental and Rural Science, University of New England, Armidale, NSW, Australia
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Thumpkin E, Paterson MBA, Morton JM, Pachana NA. Adoption Can Be a Risky Business: Risk Factors Predictive of Dogs Adopted from RSPCA Queensland Being Returned. Animals (Basel) 2022; 12:ani12192568. [PMID: 36230311 PMCID: PMC9559252 DOI: 10.3390/ani12192568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Not all dog adoptions are successful. This two-year retrospective study used survival (i.e., time-to-event) analyses to investigate readmissions for dogs adopted from RSPCA Queensland shelters between 1 January 2019 and 31 December 2020. A better understanding of temporal patterns and risk factors associated with readmission may help RSPCA Queensland shelters better target and tailor resources to improve retention by adopters. The failure function (the cumulative percentage of adoptions that were readmitted by day of the adoption period) increased rapidly during the first 14 days of the adoption period. Approximately two-thirds of all returns occurred in this period. This readmission rate may have been influenced by the RSPCA Queensland adoption-fee refund policy. The cumulative percentage of adoptions that were readmitted plateaued at just under 15%. Dog size, age, coat colour, breed, and spending time in foster before adoption were factors associated with the risk of readmission. Failure functions for a low and a high-risk adoption example demonstrated the large degree of difference in hazard of readmission between covariate patterns, with estimated percentages of adoptions being returned by 90 days for those examples being 2% and 17%, respectively. Spending time in foster care before adoption appears to be protective against readmission, presumably because it supports a successful transition to the new home environment. Behaviour support and training provided for dogs during foster care may contribute to improve their outcomes. These findings highlight the profile of the higher-risk dogs potentially providing shelters with an opportunity to examine where and how resources could be allocated to maximize outcomes for the overall cohort. Population attributable 90-day failure estimates were calculated for each of bodyweight and age at adoption, coat colour, spending time in foster care before adoption, and breed. This calculation shows the expected reduction in the cumulative percentage of dogs readmitted by day 90 if the hazards of readmission for higher risk categories were reduced to those of a lower risk category. Expected reductions for individual factors ranged from 1.8% to 3.6% with one additional estimate of 6.8%. Risk of readmission could be reduced through increased development of foster capacity and capability, targeted interventions, improved adopter-dog matching processes, and more effective targeting of support for higher risk dogs, such as older or larger dogs. Population impact analyses provide a macro view that could assist shelters in strategically assessing the return on investment for various strategies aiming to improve adoption outcomes and potentially reduce readmissions.
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Affiliation(s)
- Eileen Thumpkin
- School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia
- Correspondence: ; Tel.: +61-419-645-530
| | - Mandy B. A. Paterson
- Royal Society for the Prevention of Cruelty to Animals Queensland, Brisbane, QLD 4076, Australia
- School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia
| | | | - Nancy A. Pachana
- School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia
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18
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Morton JM, Khoury H, Baker JW, Brethauer SA, Sweet WA, Mattar S, Ponce J, Nguyen NT, Rosenthal RJ, DeMaria EJ. The American Society of Metabolic and Bariatric Surgery Closed-Claims Registry: Prevalence, Causes, and Lessons. Surg Obes Relat Dis 2022; 18:943-947. [DOI: 10.1016/j.soard.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 12/22/2022]
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Magness DR, Hoang L, Belote RT, Brennan J, Carr W, Stuart Chapin F, Clifford K, Morrison W, Morton JM, Sofaer HR. Management Foundations for Navigating Ecological Transformation by Resisting, Accepting, or Directing Social–Ecological Change. Bioscience 2021. [DOI: 10.1093/biosci/biab083] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Despite striking global change, management to ensure healthy landscapes and sustained natural resources has tended to set objectives on the basis of the historical range of variability in stationary ecosystems. Many social–ecological systems are moving into novel conditions that can result in ecological transformation. We present four foundations to enable a transition to future-oriented conservation and management that increases capacity to manage change. The foundations are to identify plausible social–ecological trajectories, to apply upstream and deliberate engagement and decision-making with stakeholders, to formulate management pathways to desired futures, and to consider a portfolio approach to manage risk and account for multiple preferences across space and time. We use the Kenai National Wildlife Refuge in Alaska as a case study to illustrate how the four foundations address common land management challenges for navigating transformation and deciding when, where, and how to resist, accept, or direct social–ecological change.
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Affiliation(s)
- Dawn R Magness
- US Fish and Wildlife Service (USFWS), Kenai National Wildlife Refuge, Soldotna, Alaska, United States
| | - Linh Hoang
- US Forest Service's Northern Region, Missoula, Montana, United States
| | | | - Jean Brennan
- USFWS and is now the climate adaptation coordinator for the Giant Sequoia Lands Coalition, Three Rivers, California, United States
| | - Wylie Carr
- National Park Service, Fort Collins, Colorado, United States
| | - F Stuart Chapin
- University of Alaska's Institute of Arctic Biology, Fairbanks, Alaska, United States
| | | | - Wendy Morrison
- National Oceanic and Atmospheric Administration Fisheries, Silver Springs, Maryland, United States
| | - John M Morton
- USFWS and is now vice president of the Alaska Wildlife Alliance, Anchorage, Alaska, United States
| | - Helen R Sofaer
- USGS Pacific Island Ecosystems Research Center, Hawaii National Park, Honolulu, Hawaii, United States
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20
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Lynch AJ, Thompson LM, Morton JM, Beever EA, Clifford M, Limpinsel D, Magill RT, Magness DR, Melvin TA, Newman RA, Porath MT, Rahel FJ, Reynolds JH, Schuurman GW, Sethi SA, Wilkening JL. RAD Adaptive Management for Transforming Ecosystems. Bioscience 2021. [DOI: 10.1093/biosci/biab091] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Intensifying global change is propelling many ecosystems toward irreversible transformations. Natural resource managers face the complex task of conserving these important resources under unprecedented conditions and expanding uncertainty. As once familiar ecological conditions disappear, traditional management approaches that assume the future will reflect the past are becoming increasingly untenable. In the present article, we place adaptive management within the resist–accept–direct (RAD) framework to assist informed risk taking for transforming ecosystems. This approach empowers managers to use familiar techniques associated with adaptive management in the unfamiliar territory of ecosystem transformation. By providing a common lexicon, it gives decision makers agency to revisit objectives, consider new system trajectories, and discuss RAD strategies in relation to current system state and direction of change. Operationalizing RAD adaptive management requires periodic review and update of management actions and objectives; monitoring, experimentation, and pilot studies; and bet hedging to better identify and tolerate associated risks.
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Affiliation(s)
- Abigail J Lynch
- US Geological Survey (USGS), National Climate Adaptation Science Center, Reston, Virginia, United States
| | - Laura M Thompson
- USGS National Climate Adaptation Science Center and an adjunct faculty member, University of Tennessee, Knoxville, Tennessee, United States
| | - John M Morton
- US Fish and Wildlife Service (USFWS) and is now vice president of the Alaska Wildlife Alliance, Anchorage, Alaska, United States
| | - Erik A Beever
- USGS Northern Rocky Mountain Science Center and a research professor for the Department of Ecology, Montana State University, Bozeman, Montana, United States
| | | | - Douglas Limpinsel
- National Oceanic and Atmospheric Administration, Anchorage, Alaska, United States
| | | | - Dawn R Magness
- USFWS Kenai National Wildlife Refuge, Soldotna, Alaska, United States
| | - Tracy A Melvin
- Michigan State University, East Lansing, Michigan, United States
| | - Robert A Newman
- University of North Dakota, Grand Forks, North Dakota, United States
| | - Mark T Porath
- USFWS Ecological Services Nebraska Field Office, Wood River, Nebraska, United States
| | - Frank J Rahel
- University of Wyoming, Laramie, Wyoming, United States
| | - Joel H Reynolds
- US National Park Service (NPS) Climate Change Response Program, Fort Collins, Colorado, United States
| | - Gregor W Schuurman
- NPS Climate Change Response Program, Fort Collins, Colorado, United States
| | - Suresh A Sethi
- USGS New York Cooperative Fish and Wildlife Research Unit at Cornell University, Ithaca, New York, United States
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21
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Schuurman GW, Cole DN, Cravens AE, Covington S, Crausbay SD, Hoffman CH, Lawrence DJ, Magness DR, Morton JM, Nelson EA, O'Malley R. Navigating Ecological Transformation: Resist–Accept–Direct as a Path to a New Resource Management Paradigm. Bioscience 2021. [DOI: 10.1093/biosci/biab067] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Natural resource managers worldwide face a growing challenge: Intensifying global change increasingly propels ecosystems toward irreversible ecological transformations. This nonstationarity challenges traditional conservation goals and human well-being. It also confounds a longstanding management paradigm that assumes a future that reflects the past. As once-familiar ecological conditions disappear, managers need a new approach to guide decision-making. The resist–accept–direct (RAD) framework, designed for and by managers, identifies the options managers have for responding and helps them make informed, purposeful, and strategic choices in this context. Moving beyond the diversity and complexity of myriad emerging frameworks, RAD is a simple, flexible, decision-making tool that encompasses the entire decision space for stewarding transforming ecosystems. Through shared application of a common approach, the RAD framework can help the wider natural resource management and research community build the robust, shared habits of mind necessary for a new, twenty-first-century natural resource management paradigm.
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Affiliation(s)
- Gregor W Schuurman
- US National Park Service Climate Change Response Program, Fort Collins, Colorado, United States
| | - David N Cole
- US Forest Service, Aldo Leopold Wilderness Research Institute, Missoula, Montana, United States
| | - Amanda E Cravens
- US Geological Survey's Social and Economic Analysis Branch, Fort Collins, Colorado, United States
| | - Scott Covington
- US Fish and Wildlife Service's National Wildlife Refuge System, Falls Church, Virginia, United States
| | - Shelley D Crausbay
- Conservation Science Partners, Inc, Fort Collins, Colorado, United States
- US Geological Survey North Central Climate Adaptation Science Center, Boulder, Colorado, United States
| | - Cat Hawkins Hoffman
- Supervisory natural resource specialist and program manager, Fort Collins, Colorado, United States
| | - David J Lawrence
- US National Park Service Climate Change Response Program, Fort Collins, Colorado, United States
| | - Dawn R Magness
- US Fish and Wildlife Service, Kenai National Wildlife Refuge, Soldotna, Alaska, United States
| | - John M Morton
- Alaska Wildlife Alliance, Anchorage, Alaska, United States
| | - Elizabeth A Nelson
- Science advisor on conservation and climate change at Parks Canada, Vancouver, British Columbia, Canada
| | - Robin O'Malley
- USGS North Central Climate Adaptation Science Center, and is based in Fort Collins, Colorado, United States
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Coombe JE, Morton JM, Beggs DS, Dodds MJ, Pyman MF. Breed structures in Australian dairy herds. Aust Vet J 2021; 100:29-39. [PMID: 34651306 DOI: 10.1111/avj.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 11/28/2022]
Abstract
Breed structures of Australian dairy herds over time were described for a large subset of milk-recording herds. The focus for this study was to describe the use of crossbreeding by dairy farmers, specifically proportions of herds using crossbreeding, whether they were using two-breed or three-breed crossbreeding systems, and how herd-breed structures changed over time. The most common breed structure in Australian milk-recording herds between 2000 and 2013 was two-breed crossbreeding (39% of herd-years). The next most common breed structure was purebred (35%). Over the period studied, the proportion of herds that were purebred decreased, while the proportion of herds that were crossbreeding increased (particularly three-breed crossbreeding herds). Herd-breed structures and changes over time varied with region and with the herd's calving system. There were also considerable changes in breed structure within herds, including herds changing breed structure before reverting back to their original breed structure. These results indicate that breed structures in milk-recording dairy herds in Australia are dynamic, and that farmers have commonly employed crossbreeding strategies.
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Affiliation(s)
- J E Coombe
- Melbourne Veterinary School, University of Melbourne, 250 Princes Highway, Werribee, Victoria, 3030, Australia
| | - J M Morton
- Jemora Pty Ltd, PO Box 5010, East Geelong, Victoria, 3219, Australia
| | - D S Beggs
- Melbourne Veterinary School, University of Melbourne, 250 Princes Highway, Werribee, Victoria, 3030, Australia
| | - M J Dodds
- Melbourne Veterinary School, University of Melbourne, 250 Princes Highway, Werribee, Victoria, 3030, Australia
| | - M F Pyman
- Melbourne Veterinary School, University of Melbourne, 250 Princes Highway, Werribee, Victoria, 3030, Australia
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Harvey AM, Morton JM, Mellor DJ, Russell V, Chapple RS, Ramp D. Use of Remote Camera Traps to Evaluate Animal-Based Welfare Indicators in Individual Free-Roaming Wild Horses. Animals (Basel) 2021; 11:2101. [PMID: 34359229 PMCID: PMC8300222 DOI: 10.3390/ani11072101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022] Open
Abstract
We previously developed a Ten-Stage Protocol for scientifically assessing the welfare of individual free-roaming wild animals using the Five Domains Model. The protocol includes developing methods for measuring or observing welfare indices. In this study, we assessed the use of remote camera traps to evaluate an extensive range of welfare indicators in individual free-roaming wild horses. Still images and videos were collected and analysed to assess whether horses could be detected and identified individually, which welfare indicators could be reliably evaluated, and whether behaviour could be quantitatively assessed. Remote camera trapping was successful in detecting and identifying horses (75% on still images and 72% on video observation events), across a range of habitats including woodlands where horses could not be directly observed. Twelve indicators of welfare across the Five Domains were assessed with equal frequency on both still images and video, with those most frequently assessable being body condition score (73% and 79% of observation events, respectively), body posture (76% for both), coat condition (42% and 52%, respectively), and whether or not the horse was sweating excessively (42% and 45%, respectively). An additional five indicators could only be assessed on video; those most frequently observable being presence or absence of weakness (66%), qualitative behavioural assessment (60%), presence or absence of shivering (51%), and gait at walk (50%). Specific behaviours were identified in 93% of still images and 84% of video events, and proportions of time different behaviours were captured could be calculated. Most social behaviours were rarely observed, but close spatial proximity to other horses, as an indicator of social bonds, was recorded in 36% of still images, and 29% of video observation events. This is the first study that describes detailed methodology for these purposes. The results of this study can also form the basis of application to other species, which could contribute significantly to advancing the field of wild animal welfare.
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Affiliation(s)
- Andrea M. Harvey
- Centre for Compassionate Conservation, School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - John M. Morton
- Jemora Pty Ltd., P.O. Box 2277, Geelong, VIC 3220, Australia;
| | - David J. Mellor
- Animal Welfare Science and Bioethics Centre, School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand;
| | - Vibeke Russell
- Veterinary Contractor, c/o Animal Emergency Australia, P.O. Box 1854, Springwood, QLD 4217, Australia;
| | - Rosalie S. Chapple
- Blue Mountains World Heritage Institute, 16 Dunmore Lane, Katoomba, NSW 2780, Australia;
| | - Daniel Ramp
- Centre for Compassionate Conservation, School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007, Australia;
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Schmidt JH, Reynolds JH, White KS, Schertz DT, Morton JM, Kim HS. Integrating Distance Sampling and Minimum Count Data: A Reply to Becker and Herreman. J Wildl Manage 2021. [DOI: 10.1002/jwmg.22021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Joshua H. Schmidt
- U.S. National Park Service, Central Alaska Network 4175 Geist Road Fairbanks AK 99709 USA
| | - Joel H. Reynolds
- U.S. National Park Service, Climate Change Response Program 1201 Oakridge Drive, Suite 200 Fort Collins CO 80525 USA
| | - Kevin S. White
- Alaska Department of Fish and Game, Division of Wildlife Conservation P.O. Box 110024 Juneau AK 99811 USA
| | - Dylan T. Schertz
- U.S. National Park Service, Arctic Network 4175 Geist Road Fairbanks AK 99709 USA
| | - John M. Morton
- Alaska Wildlife Alliance P.O. Box 202022 Anchorage AK 99520 USA
| | - H. Sharon Kim
- U.S. National Park Service, Kenai Fjords National Park P.O. Box 1727 Seward AK 99664 USA
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Grieco A, Huffman KM, Cohen ME, Hall BL, Morton JM, Ko CY. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program bariatric surgical risk/benefit calculator: 30-day risk. Surg Obes Relat Dis 2021; 17:1117-1124. [PMID: 33773930 DOI: 10.1016/j.soard.2021.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/19/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is increasing demand for data-driven tools that provide accurate and clearly communicated patient-specific information. These can aid discussions between practitioners and patients, promote shared decision-making, and enhance informed consent. The American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) sought to create a risk calculator for adult patients considering primary metabolic and bariatric surgery, with multiple prediction features: (1) 30-day risk; (2) 1-year body mass index projections; and (3) 1-year co-morbidity remission. OBJECTIVES To evaluate the 30-day risk estimation feature of this tool. SETTING Not-for-profit organization, international bariatric surgery clinical data registry. METHODS MBSAQIP data across 5.5 years, 925 hospitals, and 775,291 cases were used to develop the 30-day risk feature. Logistic regression models were employed to estimate postoperative risks for 9 outcomes across 4 procedures: laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, laparoscopic adjustable gastric band, and biliopancreatic diversion with duodenal switch. RESULTS The tool showed good discrimination for mortality and surgical site infection models (c-statistics, .80 and .70, respectively), and was slightly less accurate for the 7 other complications (.62-.69). Graphical representations showed excellent calibration for all 9 outcomes. CONCLUSIONS Overall, the 30-day risk models were accurate and well calibrated, with acceptable discrimination. The MBSAQIP bariatric surgical risk/benefit calculator is publicly available, with the intent to be integrated into healthcare practice to guide bariatric surgical decision-making and care planning, and to enhance communication between patients and their surgical care team.
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Affiliation(s)
| | | | | | - Bruce L Hall
- American College of Surgeons, Chicago, Illinois; Department of Surgery, Center for Health Policy, St. Louis, Missouri; Olin Business School, Washington University in St. Louis, St. Louis, Missouri; Saint Louis Veterans Affairs Medical Center, St. Louis, Missouri; BJC Healthcare, St. Louis, Missouri
| | - John M Morton
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Clifford Y Ko
- American College of Surgeons, Chicago, Illinois; Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California; The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
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Reddell P, De Ridder TR, Morton JM, Jones PD, Campbell JE, Brown G, Johannes CM, Schmidt PF, Gordon V. Wound formation, wound size, and progression of wound healing after intratumoral treatment of mast cell tumors in dogs with tigilanol tiglate. J Vet Intern Med 2021; 35:430-441. [PMID: 33438258 PMCID: PMC7848365 DOI: 10.1111/jvim.16009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022] Open
Abstract
Background Tigilanol tiglate (TT) is a novel small molecule for intratumoral treatment of nonmetastatic mast cell tumors (MCTs) in dogs. In a randomized controlled clinical study, 75% of dogs that received a single TT treatment achieved complete resolution of the MCT by 28 days, with no recurrence in 93% of dogs at 84 days. Critical to TT's efficacy was the area of the wound (tissue deficit) after slough of the necrotic tumor relative to pretreatment tumor volume. Objectives To analyze data collected during the previous study to (a) describe wounds after slough of treated MCTs and (b) identify determinants of wound area and speed of wound healing. Methods Wound presence, condition, and area were determined from clinical records of 117 dogs over 84 days after a single intratumoral TT treatment. Results Tumor slough occurred 3 to 14 days after treatment, exposing granulation tissue in the wound bed. Wound area after tumor slough in general was related to pretreatment tumor volume, with maximal recorded wound area fully evident in 89% of dogs by day 7. In dogs achieving complete tumor resolution, all wounds were left to heal by secondary intention. Bandaging and other wound management interventions only were required in 5 dogs. Time to healing (ie, full re‐epithelialization of treatment site) depended on wound area and location on the body, with most wounds being fully healed between 28 and 42 days after treatment. Conclusions Wound area and healing after slough of TT‐treated tumors follow a consistent clinical pattern for most dogs.
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Affiliation(s)
- Paul Reddell
- QBiotics Group Limited, Yungaburra, Queensland, Australia
| | | | | | - Pamela D Jones
- QBiotics Group Limited, Yungaburra, Queensland, Australia
| | | | - Graham Brown
- QBiotics Group Limited, Yungaburra, Queensland, Australia
| | - Chad M Johannes
- Iowa State University, College of Veterinary Medicine, Ames, Iowa, USA
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Hazelton MS, Morton JM, Bosward KL, Sheehy PA, Parker AM, Dwyer CJ, Niven PG, House JK. Mycoplasma species in vaginas of dairy cows before and after exposure to bulls and their association with conception. J Dairy Sci 2020; 103:11795-11805. [PMID: 33041030 DOI: 10.3168/jds.2020-18758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/29/2020] [Indexed: 11/19/2022]
Abstract
Mycoplasma species can colonize the urogenital tract of dairy cattle. However, interrelationships between Mycoplasma spp. and reproductive performance in dairy herds are unclear. In this study, we measured apparent prevalences of Mycoplasma spp. in the vaginas of dairy cows (n = 629) pre- and post-bull exposure in dairy herds with and without Mycoplasma bovis clinical disease (n = 5 herds), and assessed associations between variables describing reproductive performance and consequent Mycoplasma spp. isolation. Mycoplasma spp. were infrequently isolated from the vagina pre- (1.9%; 12/629) and post-bull (3.2%; 20/629) exposure. Of the mycoplasmas isolated, Mycoplasma bovigenitalium was isolated most frequently (87.5%; 28/32), followed by Mycoplasma californicum (9.3%; 3/32). Mycoplasma bovis was only isolated from one cow. We were unable to provide any evidence of venereal transmission of M. bovis in cows in M. bovis-infected herds that use natural service bulls. There was an insufficient number of cows with Mycoplasma spp. in the vagina pre-bull exposure to assess effects on subsequent reproductive performance. Cows that had not conceived before post-bull exposure sampling had much greater odds (odds ratio 14.8; 95% confidence interval 4.2 to 52.3) of having a Mycoplasma sp. isolated from the vagina at this time compared with those that had conceived. Also, within those that had conceived, delayed conception increased the odds of having a Mycoplasma spp. isolated from the vagina at the post-bull exposure sampling by a factor of 1.62 for every additional week not pregnant. The likely cause of these findings is that cows that remain not pregnant for longer are more likely to be served by a bull (likely repeatedly) and subsequently become colonized with a Mycoplasma sp. (mostly M. bovigenitalium) through venereal transmission. In dairy herds that use bulls, there is a greater chance of isolating a Mycoplasma sp. (mostly M. bovigenitalium) after a period of bull breedings from the vaginas of cows that have remained nonpregnant for longer during the bull breeding period.
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Affiliation(s)
- M S Hazelton
- Faculty of Science, Sydney School of Veterinary Science, The University of Sydney, Camden, New South Wales 2570 Australia.
| | - J M Morton
- Jemora Pty Ltd., Geelong, Victoria 3220, Australia
| | - K L Bosward
- Faculty of Science, Sydney School of Veterinary Science, The University of Sydney, Camden, New South Wales 2570 Australia
| | - P A Sheehy
- Faculty of Science, Sydney School of Veterinary Science, The University of Sydney, Camden, New South Wales 2570 Australia
| | - A M Parker
- Faculty of Science, Sydney School of Veterinary Science, The University of Sydney, Camden, New South Wales 2570 Australia
| | - C J Dwyer
- Smithton Veterinary Service, Tasmania 7330, Australia
| | - P G Niven
- Pure Source Dairy Farm Company Ltd., Qihe County, Dezhou City, Shandong Province 251100, China
| | - J K House
- Faculty of Science, Sydney School of Veterinary Science, The University of Sydney, Camden, New South Wales 2570 Australia
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Cusack P, Bergman EL, Hay KE, Morton JM. Serological status of cattle to bovine viral diarrhoea virus and bovine herpesvirus 1 at entry to and exit from Australian feedlot backgrounding facilities. Aust Vet J 2020; 99:20-23. [PMID: 33006140 DOI: 10.1111/avj.13021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
A total of 6195 cattle were enrolled in this observational study. Serum antibody concentrations to bovine herpesvirus 1 (BHV1) and bovine viral diarrhoea virus (BVDV) were measured at entry to and exit from backgrounding facilities to assess their statuses on arrival and the extent of seroconversion to these viruses during backgrounding. The backgrounding facilities were contiguous with five feedlots in: Queensland (two sites), New South Wales, South Australia and Western Australia. Cattle were held in the backgrounding facilities for a minimum of 29 days and a median of 34 days. On backgrounding facility entry, 32.7% of the study population was seronegative to BVDV, but 85.7% was seronegative to BHV1. After commingling in the backgrounding facilities, of the cattle that were seronegative on backgrounding facility entry, 33.9% and 30.3% showed a serological increase to BVDV and BHV1, respectively. At backgrounding facility exit, when cattle were placed in their feedlots, 19.6% and 59.1% were seronegative to BVDV and BHV1, respectively, and 0.26% were persistently infected with BVDV. There was a strong association between seroincrease to BVDV and seroincrease to BHV1 (P = 0.005) at animal level in cohorts known to contain an animal persistently infected with BVDV.
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Affiliation(s)
- Pmv Cusack
- Australian Livestock Production Services, Cowra, New South Wales, 2794, Australia
| | - E L Bergman
- Swans Veterinary Services, Esperance, Western Australia, Australia
| | - K E Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - J M Morton
- Jemora Pty Ltd, Geelong, Victoria, Australia
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Hazelton MS, Morton JM, Parker AM, Bosward KL, Sheehy PA, Dwyer CJ, Niven PG, House JK. Mycoplasma bovis and other Mollicutes in replacement dairy heifers from Mycoplasma bovis-infected and uninfected herds: A 2-year longitudinal study. J Dairy Sci 2020; 103:11844-11856. [PMID: 32981720 DOI: 10.3168/jds.2020-18921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/16/2020] [Indexed: 11/19/2022]
Abstract
Replacement dairy heifers exposed to Mycoplasma bovis as calves may be at risk of future clinical disease and pathogen transmission, both within and between herds; however, little information is available about these risks. We conducted a 2-yr longitudinal (panel) study starting with 450 heifer calves reared to weaning in 8 herds (7 M. bovis infected with clinical disease, 1 uninfected) under the same ownership. After weaning, heifers were commingled and managed with non-study heifers at a single heifer rearing facility. Nose, conjunctival, and vaginal swabs were collected along with a blood sample at weaning, prebreeding, precalving, and approximately 1 mo postcalving. Additionally, a colostrum sample was collected upon calving and a composite milk sample was collected 1 mo postcalving. The swabs, colostrum, and milk samples were cultured for Mycoplasma spp., and serum from the blood was evaluated for serological evidence of exposure to M. bovis using an ELISA. Despite a high M. bovis ELISA seroprevalence at weaning in the heifers from the 7 M. bovis-infected herds with clinical disease [72% (289/400); range by herd: 28-98%], M. bovis was isolated from only 4% (16/400) of the same heifers at the same time. In heifers from the uninfected herd at weaning, M. bovis seroprevalence was 2% (1/50) and M. bovis was not detected by culture. Mycoplasma bovis was isolated from 0.5% (2/414) of heifers at prebreeding, 0% (0/374) of heifers at precalving, and 0.3% (1/356) of heifers 1 mo postcalving. The nose was the predominant anatomical site of M. bovis colonization (74%; 14/19 culture positives). A single heifer (from an M. bovis-infected herd with clinical disease) was repeatedly detected with M. bovis in its nose at weaning, prebreeding, and postcalving samplings. This demonstrates the possibility, albeit rare, of a long-term M. bovis carrier state in replacement heifers exposed to M. bovis as calves, up to at least 1 mo after entry into the milking herd. No M. bovis clinical disease was detected in any heifer from weaning through to the end of the study (approximately 1 mo after calving). Acholeplasma spp. were commonly isolated throughout the study. Mycoplasma bovigenitalium, Mycoplasma bovoculi, and Mycoplasma bovirhinis were isolated infrequently. Mycoplasma bovis seroprevalences at prebreeding, precalving, and postcalving samplings were 27% (112/414), 12% (46/374), and 18% (65/356), respectively. Overall, the results show that replacement heifers from groups exposed to M. bovis preweaning can become colonized with M. bovis and that colonization can, uncommonly, be present after their first calving. For groups of 50 or more heifers exposed to M. bovis preweaning, there is at least a nontrivial probability that the group will contain at least 1 shedding heifer postcalving.
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Affiliation(s)
- M S Hazelton
- Faculty of Science, Sydney School of Veterinary Science, The University of Sydney, Camden, New South Wales 2570, Australia.
| | - J M Morton
- Jemora Pty Ltd., Geelong, Victoria 3220, Australia
| | - A M Parker
- Faculty of Science, Sydney School of Veterinary Science, The University of Sydney, Camden, New South Wales 2570, Australia
| | - K L Bosward
- Faculty of Science, Sydney School of Veterinary Science, The University of Sydney, Camden, New South Wales 2570, Australia
| | - P A Sheehy
- Faculty of Science, Sydney School of Veterinary Science, The University of Sydney, Camden, New South Wales 2570, Australia
| | - C J Dwyer
- Smithton Veterinary Service, Tasmania 7330, Australia
| | - P G Niven
- Pure Source Dairy Farm Company Ltd., Qihe County, Dezhou City, Shandong Province 251100, China
| | - J K House
- Faculty of Science, Sydney School of Veterinary Science, The University of Sydney, Camden, New South Wales 2570, Australia
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Sanders MT, Morton JM, Kaese HJ, Ford M, Stanley RG. Association between preoperative gonioscopic status and postoperative glaucoma after phacoemulsification in dogs: A retrospective cohort study of 505 eyes. Vet Ophthalmol 2020; 24 Suppl 1:39-49. [PMID: 32946201 DOI: 10.1111/vop.12818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether preoperative gonioscopy status is associated with the development of postoperative glaucoma after phacoemulsification. PROCEDURE Eligible dogs and eyes were selected from medical records (2007-2017), and each eye was classified as having normal or abnormal gonioscopy status. Records were examined for postoperative glaucoma, and data were collected for baseline variables including patient signalment, surgical factors, and pre, intra, and postoperative medications. RESULTS Of 305 dogs (505 eyes) selected for review in this study, 111 dogs (163 eyes) had abnormal gonioscopy findings, and 194 dogs (342 eyes) had normal gonioscopy findings. Postoperative glaucoma occurred in 24% (39/163) of eyes with abnormal gonioscopy and in 14% (49/342) eyes with normal gonioscopy. Eyes with abnormal gonioscopy status were at higher risk of postoperative glaucoma compared to normal eyes (P = .025). There was no important confounding due to the numerous baseline variables summarised above. Regardless of gonioscopy status, the risk of glaucoma was highest during the first 2 months after surgery. CONCLUSIONS Eyes with abnormal gonioscopy findings are at increased risk of postoperative glaucoma compared with eyes with normal gonioscopy findings. Gonioscopy is recommended as a part of presurgical assessment in all dogs prior to phacoemulsification. Further study is needed to assess whether the incidence of postoperative glaucoma can be reduced by increased monitoring or altered treatment protocols in cases that are known to have abnormal gonioscopy findings prior to cataract surgery.
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Affiliation(s)
| | | | | | - Marnie Ford
- Animal Eye Care, East Malvern, Vic, Australia
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Jung JJ, Jüni P, Gee DW, Zak Y, Cheverie J, Yoo JS, Morton JM, Grantcharov T. Development and Evaluation of a Novel Instrument to Measure Severity of Intraoperative Events Using Video Data. Ann Surg 2020; 272:220-226. [PMID: 32675485 DOI: 10.1097/sla.0000000000003897] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To develop and evaluate a novel instrument to measure SEVERE processes using video data. BACKGROUND Surgical video data can serve an important role in understanding the relationship between intraoperative events and postoperative outcomes. However, a standard tool to measure severity of intraoperative events is not yet available. METHODS Items to be included in the instrument were identified through literature and video reviews. A committee of experts guided item reduction, including pilot tests and revisions, and determined weighted scores. Content validity was evaluated using a validated sensibility questionnaire. Inter-rater reliability was assessed by calculating intraclass correlation coefficient. Construct validity was evaluated on a sample of 120 patients who underwent laparoscopic Roux-en-Y gastric bypass procedure, in which comprehensive video data was obtained. RESULTS SEVERE index measures severity of 5 event types using ordinal scales. Each intraoperative event is given a weighted score out of 10. Inter-rater reliability was excellent [0.87 (95%-confidence interval, 0.77-0.92)]. In a sample of consecutive 120 patients undergoing gastric bypass procedures, a median of 12 events [interquartile range (IQR) 9-18] occurred per patient and bleeding was the most frequent type (median 10, IQR 7-14). The median SEVERE score per case was 11.3 (IQR 8.3-16.9). In risk-adjusted multivariable regression models, history of previous abdominal surgery (P = 0.02) and body mass index (P = 0.005) were associated with SEVERE scores, demonstrating construct validity evidence. CONCLUSION The SEVERE index may prove to be a useful instrument in identifying patients with high risk of developing postoperative complications.
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Affiliation(s)
- James J Jung
- International Centre for Surgical Safety, Keenan Centre for Biomedical Research, St., Michael's Hospital, Toronto, ON
- Department of Surgery, University of Toronto, Toronto, ON
| | - Peter Jüni
- Applied Health Research Centre, St. Michael's Hospital, Toronto, ON
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Yulia Zak
- Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Joslin Cheverie
- Department of Surgery, University of California San Diego, San Diego, CA
| | - Jin S Yoo
- Department of Surgery, Duke University Health System, Durham, NC
| | - John M Morton
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Teodor Grantcharov
- International Centre for Surgical Safety, Keenan Centre for Biomedical Research, St., Michael's Hospital, Toronto, ON
- Department of Surgery, University of Toronto, Toronto, ON
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Boffa DJ, Judson BL, Billingsley KG, Galetta D, Fontanez P, Odermatt C, Lindner K, Mitchell MR, Henderson CM, Carafeno T, Pinto J, Wagner JA, Ancuta MM, Beley P, Turner AL, Banack T, Laurans MS, Johnson DC, Yoo PS, Morton JM, Zurich H, Davis K, Ahuja N. Pandemic Recovery Using a COVID-Minimal Cancer Surgery Pathway. Ann Thorac Surg 2020; 110:718-724. [PMID: 32417195 PMCID: PMC7227551 DOI: 10.1016/j.athoracsur.2020.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 12/30/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented disruption in health care delivery around the world. In an effort to prevent hospital-acquired COVID-19 infections, most hospitals have severely curtailed elective surgery, performing only surgeries if the patient's survival or permanent function would be compromised by a delay in surgery. As hospitals emerge from the pandemic, it will be necessary to progressively increase surgical activity at a time when hospitals continue to care for COVID-19 patients. In an attempt to mitigate the risk of nosocomial infection, we have created a patient care pathway designed to minimize risk of exposure of patients coming into the hospital for scheduled procedures. The COVID-minimal surgery pathway is a predetermined patient flow, which dictates the locations, personnel, and materials that come in contact with our cancer surgery population, designed to minimize risk for virus transmission. We outline the approach that allowed a large academic medical center to create a COVID-minimal cancer surgery pathway within 7 days of initiating discussions. Although the pathway represents a combination of recommended practices, there are no data to support its efficacy. We share the pathway concept and our experience so that others wishing to similarly align staff and resources toward the protection of patients may have an easier time navigating the process.
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Affiliation(s)
- Daniel J Boffa
- Smilow Cancer Hospital, Yale New Haven Hospital, New Haven, Connecticut; Department of Surgery, Yale School of Medicine, New Haven, Connecticut; Department of Neurosurgery, Yale New Haven Hospital, New Haven, Connecticut.
| | - Benjamin L Judson
- Smilow Cancer Hospital, Yale New Haven Hospital, New Haven, Connecticut; Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Kevin G Billingsley
- Smilow Cancer Hospital, Yale New Haven Hospital, New Haven, Connecticut; Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | | | - Marci R Mitchell
- Smilow Cancer Hospital, Yale New Haven Hospital, New Haven, Connecticut
| | - Cara M Henderson
- Smilow Cancer Hospital, Yale New Haven Hospital, New Haven, Connecticut; Yale New Haven Hospital, New Haven, Connecticut
| | | | | | | | - Michael M Ancuta
- Department of Anesthesia, Yale New Haven Hospital, New Haven, Connecticut
| | - Peggy Beley
- Yale New Haven Hospital, New Haven, Connecticut
| | | | - Trevor Banack
- Department of Anesthesia, Yale New Haven Hospital, New Haven, Connecticut
| | - Maxwell S Laurans
- Department of Neurosurgery, Yale New Haven Hospital, New Haven, Connecticut
| | - Dirk C Johnson
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Peter S Yoo
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - John M Morton
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | - Kimberly Davis
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Nita Ahuja
- Smilow Cancer Hospital, Yale New Haven Hospital, New Haven, Connecticut; Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Cusack P, Bergman EL, Hay KE, Morton JM. Health and production effects of killed vaccines against Mannheimia haemolytica, bovine viral diarrhoea virus and bovine herpesvirus 1, in locally backgrounded feedlot cattle. Aust Vet J 2020; 99:24-31. [PMID: 32671826 DOI: 10.1111/avj.12995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study evaluates the effects of respiratory vaccines on health and growth rates in cattle placed in local backgrounding facilities then feedlots. METHODS A total of 7011 cattle entering backgrounding facilities contiguous with six feedlots in Australia were allocated to eight respiratory vaccine categories, including an untreated control category. The vaccines, against Mannheimia haemolytica, bovine viral diarrhoea virus and bovine herpesvirus 1, were administered in various combinations at backgrounding facility entry and subsequent feedlot entry. Cattle were held in the backgrounding facilities for a minimum of 28 days. RESULTS During their feedlot phase, 3.7% of study animals were detected with bovine respiratory disease (BRD). BRD sub hazard was lowest in cattle vaccinated with Bovilis MH + infectious bovine rhinotracheitis® (sub hazards ratio: 0.47; 95% confidence interval: 0.27-0.83; P = 0.010), and point estimates for other vaccine combinations did not differ (P > 0.10) from controls. Six of the respiratory vaccine combinations decreased growth rate during backgrounding relative to untreated controls (P ≤ 0.003). Overall, the feedlot growth rate was not significantly affected by the vaccine category (overall Wald P = 0.191). CONCLUSIONS Use of these respiratory vaccines in cattle held for at least 28 days in backgrounding facilities contiguous with their feedlots before feedlot entry reduces growth rate during the backgrounding period and does not result in large beneficial effects on either BRD risk or average daily live weight gain during the feedlot phase.
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Affiliation(s)
- Pmv Cusack
- Australian Livestock Production Services, Cowra, New South Wales, 2794, Australia
| | - E L Bergman
- Swans Veterinary Services, Esperance, Western Australia, Australia
| | - K E Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - J M Morton
- Jemora Pty Ltd, Geelong, Victoria, Australia
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Abstract
PURPOSE OF REVIEW Bariatric surgery is the most effective and durable method for treating obesity. This review highlights the results and safety of bariatric surgery. RECENT FINDINGS The global prevalence of obesity and its related comorbidities including cancer are on the rise. Bariatric surgery has demonstrated more robust and durable weight loss than current medical treatment. Bariatric surgery also reduces significantly the risk of complications associated with obesity comorbidities, such as diabetes and cardiovascular disease, and the risk of mortality in comparison with medical management. Due to accreditation efforts, the safety profile of bariatric surgery is equivalent or superior to many common operations. Obesity is associated with increased all cause morbidity and mortality. The current bariatric procedures produce significant and durable weight loss and reduce the morbidity and mortality associated with obesity-related diseases substantially. The risk/benefit ratio for bariatric surgery is decidedly in favor for the benefit for bariatric surgery.
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Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Division of Bariatric and Gastrointestinal Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520, USA.
| | - John M Morton
- Department of Surgery, Division of Bariatric and Gastrointestinal Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520, USA
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Hazelton MS, Morton JM, Parker AM, Sheehy PA, Bosward KL, Malmo J, House JK. Whole dairy herd sampling to detect subclinical intramammary Mycoplasma bovis infection after clinical mastitis outbreaks. Vet Microbiol 2020; 244:108662. [PMID: 32402350 DOI: 10.1016/j.vetmic.2020.108662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/19/2020] [Accepted: 03/25/2020] [Indexed: 11/20/2022]
Abstract
After clinical Mycoplasma bovis mastitis outbreaks in dairy herds, M. bovis can persist as subclinical intramammary infections. Identification and culling of sub-clinically infected cows may be warranted to reduce future pathogen transmission and disease. In this study, apparent cow-level prevalences of M. bovis intramammary infection within 4 milking herds immediately following outbreaks of clinical disease due to M. bovis were determined utilising PCR and culture. All clinically affected M. bovis cows had been culled from the herds prior to herd sampling. Composite milk samples were collected once from each cow (n = 2,258) using a routine milk recording sampling technique. These samples were pooled for PCR screening; positive pools were analysed in different sized pools as needed from large to small, until individual PCR-positive animals could be identified. Despite M. bovis seroprevalences of 76% (herd 1), 40% (herd 2), 20% (herd 3) and 16% (herd 4), apparent prevalences of intramammary infection in the main milking group based on PCR in herds 1 to 4 were 0.2% (1/497), 0.0% (0/475), 0.1% (1/816) and 0.0% (0/444), respectively. Due to the low apparent prevalences of subclinical intramammary mycoplasma infections in these herds and the high expense associated with milk sample collection and testing, the return on diagnostic investment was very limited, particularly considering that additional cows are likely to have been colonised with mycoplasma in other anatomical sites. The results of this study suggest that pursuing identification of cows with subclinical intramammary mycoplasma infections following resolution of clinical M. bovis disease outbreaks in dairy herds may be of minimal benefit in programs designed to control or eradicate M. bovis.
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Affiliation(s)
- M S Hazelton
- The University of Sydney, Faculty of Science, Sydney School of Veterinary Science, Camden, New South Wales 2570, Australia.
| | - J M Morton
- Jemora Pty Ltd, Geelong, Victoria 3220, Australia
| | - A M Parker
- The University of Sydney, Faculty of Science, Sydney School of Veterinary Science, Camden, New South Wales 2570, Australia
| | - P A Sheehy
- The University of Sydney, Faculty of Science, Sydney School of Veterinary Science, Camden, New South Wales 2570, Australia
| | - K L Bosward
- The University of Sydney, Faculty of Science, Sydney School of Veterinary Science, Camden, New South Wales 2570, Australia
| | - J Malmo
- Maffra Veterinary Centre, Victoria 3860, Australia
| | - J K House
- The University of Sydney, Faculty of Science, Sydney School of Veterinary Science, Camden, New South Wales 2570, Australia
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Bowser ML, Brassfield R, Dziergowski A, Eskelin T, Hester J, Magness DR, McInnis M, Melvin T, Morton JM, Stone J. Towards conserving natural diversity: A biotic inventory by observations, specimens, DNA barcoding and high-throughput sequencing methods. Biodivers Data J 2020; 8:e50124. [PMID: 32165853 PMCID: PMC7058680 DOI: 10.3897/bdj.8.e50124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/15/2020] [Indexed: 11/12/2022] Open
Abstract
The Kenai National Wildlife Refuge has been given a broad conservation mandate to conserve natural diversity. A prerequisite for fulfilling this purpose is to be able to identify the species and communities that make up that biodiversity. We tested a set of varied methods for inventory and monitoring of plants, birds and terrestrial invertebrates on a grid of 40 sites in a 938 ha study area in the Slikok Creek watershed, Kenai Peninsula, Alaska. We sampled plants and lichens through observation and specimen-based methods. We surveyed birds using bird call surveys on variable circular plots. We sampled terrestrial arthropods by sweep net sampling, processing samples with High Throughput Sequencing methods. We surveyed for earthworms, using the hot mustard extraction method and identified worm specimens by morphology and DNA barcoding. We examined community membership using clustering methods and Nonmetric Multidimensional Scaling. We documented a total of 4,764 occurrences of 984 species and molecular operational taxonomic units: 87 vascular plants, 51 mosses, 12 liverworts, 111 lichens, 43 vertebrates, 663 arthropods, 9 molluscs and 8 annelid worms. Amongst these records, 102 of the arthropod species appeared to be new records for Alaska. We found three non-native species: Deroceras agreste (Linnaeus, 1758) (Stylommatophora: Agriolimacidae), Dendrobaena octaedra (Savigny, 1826) (Crassiclitellata: Lumbricidae) and Heterarthrus nemoratus (Fallén, 1808) (Hymenoptera: Tenthredinidae). Both D. octaedra and H. nemoratus were found at sites distant from obvious human disturbance. The 40 sites were grouped into five community groups: upland mixed forest, black spruce forest, open deciduous forest, shrub-sedge bog and willow. We demonstrated that, at least for a subset of species that could be detected using these methods, we were able to document current species distributions and assemblages in a way that could be efficiently repeated for the purposes of biomonitoring. While our methods could be improved and additional methods and groups could be added, our combination of techniques yielded a substantial portion of the data necessary for fulfilling Kenai National Wildlife Refuge's broad conservation purposes.
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Affiliation(s)
- Matthew Lewis Bowser
- U.S. Fish & Wildlife Service, Kenai National Wildlife Refuge, Soldotna, Alaska, United States of AmericaU.S. Fish & Wildlife Service, Kenai National Wildlife RefugeSoldotna, AlaskaUnited States of America
| | - Rebekah Brassfield
- Salish Kootenai College, Pablo, Montana, United States of AmericaSalish Kootenai CollegePablo, MontanaUnited States of America
| | - Annie Dziergowski
- U.S. Fish & Wildlife Service, North Florida Ecological Services Office, Jacksonville, Florida, United States of AmericaU.S. Fish & Wildlife Service, North Florida Ecological Services OfficeJacksonville, FloridaUnited States of America
| | - Todd Eskelin
- U.S. Fish & Wildlife Service, Kenai National Wildlife Refuge, Soldotna, Alaska, United States of AmericaU.S. Fish & Wildlife Service, Kenai National Wildlife RefugeSoldotna, AlaskaUnited States of America
| | - Jennifer Hester
- City of Soldotna, Planning and Zoning Commision, Soldotna, Alaska, United States of AmericaCity of Soldotna, Planning and Zoning CommisionSoldotna, AlaskaUnited States of America
| | - Dawn Robin Magness
- U.S. Fish & Wildlife Service, Kenai National Wildlife Refuge, Soldotna, Alaska, United States of AmericaU.S. Fish & Wildlife Service, Kenai National Wildlife RefugeSoldotna, AlaskaUnited States of America
| | - Mariah McInnis
- Auburn University, School of Forestry & Wildlife Sciences, Auburn, Alabama, United States of AmericaAuburn University, School of Forestry & Wildlife SciencesAuburn, AlabamaUnited States of America
| | - Tracy Melvin
- Michigan State University, College of Agriculture & Natural Resources, Department of Fisheries and Wildlife, East Lansing, Michigan, United States of AmericaMichigan State University, College of Agriculture & Natural Resources, Department of Fisheries and WildlifeEast Lansing, MichiganUnited States of America
| | - John M. Morton
- U.S. Fish & Wildlife Service (retired), Soldotna, Alaska, United States of AmericaU.S. Fish & Wildlife Service (retired)Soldotna, AlaskaUnited States of America
| | - Joel Stone
- University of Alaska Fairbanks, Fairbanks, Alaska, United States of AmericaUniversity of Alaska FairbanksFairbanks, AlaskaUnited States of America
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Abstract
The intragastric dual balloon was FDA approved in 2015 for the treatment of obesity. The objective of this study was to report the weight loss, comorbidity remission, and biochemical improvements experienced by 28 patients following intragastric dual balloon placement at a single institution between September 2015 and June 2017. Demographic data were collected preoperatively. Anthropometric, clinical, and biochemical data were collected preoperatively and 3 and 6 months postoperatively. Two patients were lost to data follow-up. Participants experienced significant improvements in blood pressure and lipid profiles, in addition to substantial weight loss 6 months after balloon insertion. The results of this study underscore the promise of the intragastric dual balloon as an efficacious intervention for weight loss and comorbidity remission in patients with early-stage obesity.
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Affiliation(s)
- Luis Garcia
- Stanford University School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA, 94305, USA
| | - Sean Vajanaphanich
- Stanford University School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA, 94305, USA
| | - John M Morton
- Stanford University School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA, 94305, USA.
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Affiliation(s)
- John M Morton
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Trit Garg
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Natalia Leva
- Department of Urology, University of California, San Francisco
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Brethauer SA, Grieco A, Fraker T, Evans-Labok K, Smith A, McEvoy MD, Saber AA, Morton JM, Petrick A. Employing Enhanced Recovery Goals in Bariatric Surgery (ENERGY): a national quality improvement project using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Surg Obes Relat Dis 2019; 15:1977-1989. [DOI: 10.1016/j.soard.2019.08.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/14/2019] [Accepted: 08/23/2019] [Indexed: 12/11/2022]
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Schmidt JH, Reynolds JH, Rattenbury KL, Phillips LM, White KS, Schertz D, Morton JM, Kim HS. Integrating distance sampling with minimum counts to improve monitoring. J Wildl Manage 2019. [DOI: 10.1002/jwmg.21691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joshua H. Schmidt
- U.S. National Park ServiceCentral Alaska Network 4175 Geist Road Fairbanks AK 99709 USA
| | - Joel H. Reynolds
- U.S. National Park ServiceAlaska Region 240 W. 5th Avenue Anchorage AK 99501 USA
| | - Kumi L. Rattenbury
- U.S. National Park ServiceArctic Network 4175 Geist Road Fairbanks AK 99709 USA
| | - Laura M. Phillips
- U.S. National Park ServiceDenali National Park and Preserve P.O. Box 9, Denali Park AK 99755 USA
| | - Kevin S. White
- Alaska Department of Fish and GameDivision of Wildlife Conservation P.O. Box 110024 Juneau AK 99811 USA
| | - Dylan Schertz
- Wildlife Conservation SocietyArctic Beringia Office 3550 Airport Way, Suite 5 Fairbanks AK 99709 USA
| | - John M. Morton
- U.S. Fish and Wildlife ServiceKenai National Wildlife Refuge P.O. Box 2139 Soldotna AK 99669 USA
| | - H. Sharon Kim
- U.S. National Park ServiceKenai Fjords National Park P.O. Box 1727 Seward AK 99664 USA
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Abstract
Obesity provides an opportunity for bariatric and orthopedic surgeons to collaborate through emphasis on safety, effectiveness and patient experience. A value equation can be offered for combining weight loss for the patient with obesity and joint disease.
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Affiliation(s)
- John M Morton
- Vice-Chair, Quality and Division Chief, Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University, New Haven, CT
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Ammann EM, Kalsekar I, Yoo A, Scamuffa R, Hsiao CW, Stokes AC, Morton JM, Johnston SS. Assessment of obesity prevalence and validity of obesity diagnoses coded in claims data for selected surgical populations: A retrospective, observational study. Medicine (Baltimore) 2019; 98:e16438. [PMID: 31335698 PMCID: PMC6709187 DOI: 10.1097/md.0000000000016438] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
In many types of surgery, obesity may influence patient selection, prognosis, and/or management. Quantifying the accuracy of the coding of obesity and other prognostic factors is important for the design and interpretation of studies of surgical outcomes based on administrative healthcare data. This study assessed the validity of obesity diagnoses recorded in insurance claims data in selected surgical populations.This was a retrospective, observational study. Deidentified electronic health record (EHR) and linked administrative claims data were obtained for US patients age ≥20 years who underwent a qualifying surgical procedure (bariatric surgery, total knee arthroplasty [TKA], cardiac ablation, or hernia repair) in 2014Q1-2017Q1 (first = index). Patients' body mass index (BMI) as coded in the claims data (error-prone measure) during the index procedure or 180d pre-index was compared with their measured BMI as recorded in the EHR (criterion standard) to estimate the sensitivity and positive predictive value (PPV) of obesity diagnosis codes.Among patients who underwent bariatric surgery (N = 1422), TKA (N = 8670), cardiac ablation (N = 167), or hernia repair (N = 5450), obesity was present in 98%, 63%, 52%, and 54%, respectively, based on measured BMI. PPVs of obesity diagnosis codes were high: 99.3%, 96.0%, 92.8%, and 94.1% in bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively. The sensitivity of obesity diagnoses was: 99.8%, 46.2%, 41.3%, and 42.3% in bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively. Among false-positive patients diagnosed as obese but with measured BMI <30, the proportion with a BMI ≥28 was 40.0%, 67.6%, 60.7%, and 65.8% for bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively.Our data indicate that obesity is highly prevalent in many surgical populations, obesity diagnosis codes have high PPVs, but also obesity is generally undercoded in claims data. Quantifying the validity of diagnosis codes for obesity and other important prognostic factors is important for the design and interpretation of studies of surgical outcomes based on administrative data. Further research is needed to determine the extent to which undercoding of BMI and obesity can be addressed through the use of proxies that may be better documented in claims data.
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Affiliation(s)
- Eric M. Ammann
- Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ
| | | | - Andrew Yoo
- Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ
| | | | - Chia-Wen Hsiao
- Health Economics & Market Access, Ethicon, Cincinnati, OH
| | - Andrew C. Stokes
- Department of Global Health, School of Public Health, Boston University, Boston, MA
| | - John M. Morton
- Department of Surgery, Stanford University Medical Center, Stanford, CA
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Ulman SEG, Williams CK, Morton JM, DeLiberty TL, Ness BN. Vegetation Change on an Alaska Estuary after the 1964 Great Alaska Earthquake. Northwest Science 2019. [DOI: 10.3955/046.093.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sadie E. G. Ulman
- Department of Entomology and Wildlife Ecology, University of Delaware, 531 South College Ave, Newark, Delaware 19716
| | - Christopher K. Williams
- Department of Entomology and Wildlife Ecology, University of Delaware, 531 South College Ave, Newark, Delaware 19716
| | - John M. Morton
- Kenai National Wildlife Refuge, US Fish and Wildlife Service, PO Box 2139, Soldotna, Alaska 99669
| | - Tracy L. DeLiberty
- Department of Geography, University of Delaware, 125 Academy Street, Newark, Delaware 19716
| | - Brenna N. Ness
- Delaware Wild Lands, PO Box 505, 315 Main Street, Odessa, Delaware 19730
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Johnston SS, Morton JM, Kalsekar I, Ammann EM, Hsiao CW, Reps J. Using Machine Learning Applied to Real-World Healthcare Data for Predictive Analytics: An Applied Example in Bariatric Surgery. Value Health 2019; 22:580-586. [PMID: 31104738 DOI: 10.1016/j.jval.2019.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/05/2018] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Laparoscopic metabolic surgery (MxS) can lead to remission of type 2 diabetes (T2D); however, treatment response to MxS can be heterogeneous. Here, we demonstrate an open-source predictive analytics platform that applies machine-learning techniques to a common data model; we develop and validate a predictive model of antihyperglycemic medication cessation (validated proxy for A1c control) in patients with treated T2D who underwent MxS. METHODS We selected patients meeting the following criteria in 2 large US healthcare claims databases (Truven Health MarketScan Commercial [CCAE]; Optum Clinformatics [Optum]): underwent MxS between January 1, 2007, to October 1, 2013 (first = index); aged ≥18 years; continuous enrollment 180 days pre-index (baseline) to 730 days postindex; baseline T2D diagnosis and treatment. The outcome was no antihyperglycemic medication treatment from 365 to 730 days after MxS. A regularized logistic regression model was trained using the following candidate predictor categories measured at baseline: demographics, conditions, medications, measurements, and procedures. A 75% to 25% split of the CCAE group was used for model training and testing; the Optum group was used for external validation. RESULTS 13 050 (CCAE) and 3477 (Optum) patients met the study inclusion criteria. Antihyperglycemic medication cessation rates were 72.9% (CCAE) and 70.8% (Optum). The model possessed good internal discriminative accuracy (area under the curve [AUC] = 0.778 [95% CI = 0.761-0.795] in CCAE test set N = 3527) and transportability (external AUC = 0.759 [95% CI = 0.741-0.777] in Optum N = 3477). CONCLUSION The application of machine learning techniques to real-world healthcare data can yield useful predictive models to assist patient selection. In future practice, establishment of prerequisite technological infrastructure will be needed to implement such models for real-world decision support.
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Affiliation(s)
- Stephen S Johnston
- Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA.
| | - John M Morton
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Iftekhar Kalsekar
- Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | - Eric M Ammann
- Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | | | - Jenna Reps
- Epidemiology, Johnson & Johnson, Titusville, NJ, USA
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Hosie J, Rowe SM, Morton JM, Tranter WP, Cavalieri J. Use of a sanitary sheath at artificial insemination by nonprofessional technicians does not markedly improve pregnancy rates to artificial insemination in pasture-based dairy cows. J Dairy Sci 2019; 102:5588-5598. [PMID: 31005323 DOI: 10.3168/jds.2018-16082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/27/2019] [Indexed: 11/19/2022]
Abstract
Plastic sanitary sheaths over artificial insemination (AI) guns have been used at the time of AI to improve hygiene at AI and fertility in cattle, but fertility responses have been variable in studies when AI was performed by professional inseminators. The aims of this study were to investigate whether the use of a sanitary sheath at the time of AI carried out by nonprofessional (do-it-yourself, or DIY) inseminators improves pregnancy rates to AI in pasture-based dairy cows and whether effects of sheaths are greater in cows with contaminated vulvas and in cows at increased risk of extended calving to conception intervals. Lactating dairy cows located in 10 pasture-based herds in a subtropical region of northern Australia were inseminated by herd-based DIY inseminators and assigned to be inseminated with (n = 3,655) or without (n = 3,969) a sanitary sheath, with potential effects assessed using multivariable logistic regression. Overall, use of a sheath at the time of AI did not significantly affect pregnancy rates to AI (36.3% for those inseminated without a sheath vs. 36.8% for those inseminated with a sheath; odds ratio: 1.02; 95% confidence interval: 0.92-1.11). Effects of using a sheath on pregnancy rates to AI varied by herd, with lower pregnancy rates with the use of sheaths in 1 herd and some evidence of increases in 3 herds. Unexpectedly, there was evidence that the effect of sheath on pregnancy rates was less positive (or more negative) when the vulva was classified as dirty before any cleaning of the vulva before insemination compared with when the vulva was classified as clean (interaction odds ratio: 0.75; 95% CI: 0.56-1.00). Interactions between sheath and other explanatory variables that could affect fertility were not significant; thus, there was no compelling evidence that the effect of using a sheath was modified by any of these variables. We conclude that the use of sheaths during AI of pasture-based dairy cows by DIY inseminators does not, on average, markedly improve pregnancy rates to AI. However, responses may vary between herds, and the response to sheaths may be inferior (i.e., less positive or more negative) when a cow's vulva is contaminated with feces or discharge at the time of AI compared with when the vulva is clean.
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Affiliation(s)
- J Hosie
- Tableland Veterinary Service, PO Box 43, Malanda QLD 4885, Australia
| | - S M Rowe
- Tableland Veterinary Service, PO Box 43, Malanda QLD 4885, Australia; Department of Veterinary Population Medicine, University of Minnesota, St. Paul 55108
| | - J M Morton
- Jemora Pty Ltd., PO Box 2277, Geelong Vic 3220, Australia
| | - W P Tranter
- Tableland Veterinary Service, PO Box 43, Malanda QLD 4885, Australia; College of Public Health, Medical and Veterinary Sciences, James Cook University, QLD 4811, Australia
| | - J Cavalieri
- College of Public Health, Medical and Veterinary Sciences, James Cook University, QLD 4811, Australia.
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Magness DR, Morton JM. Using climate envelope models to identify potential ecological trajectories on the Kenai Peninsula, Alaska. PLoS One 2018; 13:e0208883. [PMID: 30586421 PMCID: PMC6306222 DOI: 10.1371/journal.pone.0208883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 11/27/2018] [Indexed: 11/18/2022] Open
Abstract
Managers need information about the vulnerability of historical plant communities, and their potential future conditions, to respond appropriately to landscape change driven by global climate change. We model the climate envelopes of plant communities on the Kenai Peninsula in Southcentral Alaska and forecast to 2020, 2050, and 2080. We assess 6 model outputs representing downscaled climate data from 3 global climate model outputs and 2 representative concentration pathways. We use two lines of evidence, model convergence and empirically measured rates of change, to identify the following plausible ecological trajectories for the peninsula: (1.) alpine tundra and sub-alpine shrub decrease, (2.) perennial snow and ice decrease, (3.) forests remain on the Kenai Lowlands, (4.) the contiguous white-Lutz-Sitka spruce complex declines, and (5.) mixed conifer afforestation occurs along the Gulf of Alaska coast. We suggest that converging models in the context of other lines of evidence is a viable approach to increase certainty for adaptation planning. Extremely dynamic areas with multiple outcomes (i.e., disagreement) among models represent ecological risk, but may also represent opportunities for facilitated adaptation and other managerial approaches to help tip the balance one way or another. By reducing uncertainty, this eclectic approach can be used to inform expectations about the future.
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Affiliation(s)
- Dawn Robin Magness
- Kenai National Wildlife Refuge, U. S. Fish and Wildlife Service, Soldotna, Alaska, United States of America
| | - John M. Morton
- Kenai National Wildlife Refuge, U. S. Fish and Wildlife Service, Soldotna, Alaska, United States of America
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Jukes A, Lui M, Morton JM, Marshall R, Yeow N, Gunew M. Associations between increased body condition score, bodyweight, age and breed with urethral obstruction in male castrated cats. Vet J 2018; 244:7-12. [PMID: 30825898 DOI: 10.1016/j.tvjl.2018.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 11/13/2018] [Accepted: 11/27/2018] [Indexed: 12/17/2022]
Abstract
Identifying potential risk factors for urethral obstruction in male cats may help in disease prevention. The aims of this study were to assess whether breed, pedigree status, age, bodyweight and body condition score (BCS) are risk factors for urethral obstruction in castrated male cats using a primary care population. Within this, a specific question was whether any increase in rate of urethral obstruction in male cats due to excess body condition is because of higher bodyweight. A retrospective hospital-based matched case-control study was performed using 195 cases of urethral obstruction in castrated male cats and 195 control consultations for cats presenting to a feline-only first opinion veterinary practice in Brisbane, Australia. The incidence rate of urethral obstruction did not vary significantly with bodyweight but increased with BCS (incidence rate ratio 1.6; 95% CI 1.2-2.1; P<0.001). The effect of BCS was not due to high BCS cats having higher bodyweights. The incidence was lower in Burmese cats compared to Domestic shorthair cats (incidence rate ratio 0.1; 95% CI 0.0-0.4; P=0.001), and higher in non-pedigree cats compared to pedigree cats (incidence rate ratio 2.8; 95% CI 1.7-4.6; P<0.001). Incidence rate ratios increased with age to 2 to 4years (the ages with highest incidences) then progressively declined with each additional year of age. Further research is needed to define why there is a positive association between BCS and rate of urethral obstruction. In the interim, clinicians should encourage owners of castrated male pet cats to ensure their cat's BCS is not high.
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Affiliation(s)
- A Jukes
- The Cat Clinic, 189 Creek Rd, Mt Gravatt 4122, Queensland, Australia.
| | - M Lui
- The Cat Clinic, 189 Creek Rd, Mt Gravatt 4122, Queensland, Australia
| | - J M Morton
- Jemora Pty Ltd, Geelong 3220, Victoria, Australia
| | - R Marshall
- The Cat Clinic, 189 Creek Rd, Mt Gravatt 4122, Queensland, Australia
| | - N Yeow
- The Cat Clinic, 189 Creek Rd, Mt Gravatt 4122, Queensland, Australia
| | - M Gunew
- The Cat Clinic, 189 Creek Rd, Mt Gravatt 4122, Queensland, Australia
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Morton JM, Ponce J, Malangone-Monaco E, Nguyen N. Association of Bariatric Surgery and National Medication Use. J Am Coll Surg 2018; 228:171-179. [PMID: 30453056 DOI: 10.1016/j.jamcollsurg.2018.10.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Bariatric surgical procedures are an effective and enduring treatment for severe obesity. In addition to improvements in health status, bariatric operations have been noted to potentially decrease postoperative healthcare costs, particularly medication use. STUDY DESIGN We performed a longitudinal analysis of 2007-2012 claims data comparing a bariatric surgical cohort with a propensity-matched nonsurgical control group during a 5-year time period. Truven Health Analytics MarketScan Commercial Claims and Encounters Database, with a total enrollment of 56 million covered lives from all insurers and representing all 50 states, was used. An initial sample of 384,343 obese patients was identified, with a total of 5,978 matched 1:1 pairs of obese bariatric surgical patients and nonsurgical control patients designated after matching and propensity score matching procedure. Two thousand seven hundred of those matched pairs had at least 4 years of follow-up after index date. RESULTS The matched cohorts included 2,700 patients (77.2% female, mean age 47.1 years). During the 4-year follow-up period, bariatric surgical patients had 22.6% lower pharmacy costs compared with nonsurgical control patients (p < 0.001). Mean total pharmacy costs showed a sustained decrease in the surgical group compared with the matched control group ($8,411 vs $9,900; p < 0.001). Medication use in the surgical group declined significantly from 1 year preoperative to 4 years postoperative in contrast to the control group. In the 4-year postoperative period, the numbers of antidiabetic, antihypertensive, and cardiac prescriptions in the surgical patients were reduced by 73.7%, 48.3%, and 48.9%, respectively, compared with the control patients. CONCLUSIONS Total pharmacy use and costs showed a significant and sustained reduction during a 4-year follow-up period among patients undergoing gastric bypass or band operations in comparison with a propensity-matched control group.
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Chen MJ, Bhowmick S, Beseler L, Schneider KL, Kahan SI, Morton JM, Goodman SB, Amanatullah DF. Strategies for Weight Reduction Prior to Total Joint Arthroplasty. J Bone Joint Surg Am 2018; 100:1888-1896. [PMID: 30399084 DOI: 10.2106/jbjs.18.00020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael J Chen
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
| | - Subhrojyoti Bhowmick
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
| | - Lucille Beseler
- Family Nutrition Center of South Florida, Coconut Creek, Florida
| | - Kristin L Schneider
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Scott I Kahan
- National Center for Weight and Wellness, Washington, DC
| | - John M Morton
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
| | - Stuart B Goodman
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
| | - Derek F Amanatullah
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
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Morton JM, Garcia L. Adjustable Gastric Band to Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Bariatric Surgery in Evolution. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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