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Introduction: In patients with severe pelvic ring injuries, exsanguination still is the leading cause of death in the early post-injury phase. While mechanical pelvic ring stabilization and pre-peritoneal pelvic packing are mainly addressing venous bleeding, angio-embolization aims to control arterial bleeding. The goal of the present study was to evaluate the rate of postoperative angio-embolization after mechanical pelvic ring injury stabilization and pre-peritoneal pelvic packing. Bleeding sources detected in the angiography and the patient's outcome were investigated. Patients and Methods: Retrospective observational cohort study at a single academic level I trauma center, reviewing all patients with pelvic ring injuries admitted from 01/2010 to 12/2019. Patients with emergent mechanical pelvic ring stabilization (supraacetabular external fixator and/or pelvic C-clamp) and direct pre-peritoneal pelvic packing were further analyzed. Patients that underwent postoperative angio-embolization were compared with those that did not. All postoperative angio-embolizations were evaluated with regards to bleeding sources and type of embolization. Results: During the study period, a total of 39 patients required immediate mechanical pelvic stabilization and direct pre-peritoneal pelvic packing. Of these, 12 patients (30.8%) underwent a postoperative angio-embolization. The following vessels were identified as bleeding sources: superior gluteal artery (n = 6), obturator artery (n = 2), internal pudendal artery (n = 2), unnamed branches of the internal iliac artery (n = 3). A selective embolization was successful in 11 patients; in 1 patient, an unilateral complete occlusion of the internal iliac artery was performed to control the bleeding. Mean time from hospital admission to the surgical procedure was 52.8 ± 14.7 min and the mean time from admission to angio-embolization was 189.1 ± 55.5 min. The in-hospital mortality rate of patients with angio-embolization was 25.0% (n = 3). Of these, 2 patients died due to multiple organ failure and 1 patient due to severe head injury. Conclusion: Secondary angio-embolization after external pelvic fixation and pre-peritoneal pelvic packing was effective in controlling ongoing bleeding. The most frequently detected bleeding vessel was the superior gluteal artery, which is difficult to surgically address, further highlighting the importance of angio-embolization in the management algorithm.
In the face of increasing invasions and limited resources, appropriate management of invasive species requires prioritisation of species for management action. This process often relies on knowledge of species specific impacts. However, as studies explicitly measuring impact of marine alien species are rare, prioritisation of management actions is often based on studies from outside the geographic area of interest. Further, few impact studies account for context dependency (e.g. seasonal variability or distinct environmental regimes), raising the question of how transferrable knowledge about the impact of a species is between invaded ranges. This study addressed this question by using the widespread invasive solitary ascidian Ciona robusta as a case study for assessing impacts across two invaded regions: South Africa and California, USA. We replicated a previously conducted experiment from California that showed that C. robusta depresses local species richness in San Francisco Bay. Our South African experiment showed no effect of C. robusta on species richness, the Shannon-Weiner diversity index or community composition, despite experiments being carried out over two years and at two depths. While these results may reflect strong density dependency in the impact of C. robusta, they serve to highlight context dependency in invasive species impacts. This suggests that until studies of impact in marine systems become common place, context dependency should be explicitly addressed as a source of uncertainty during the prioritisation of species for management action.
Ambrosia artemisiifolia is an invasive annual herb infamous for the high allergenicity of its pollen, which is related to increasing medical costs. Additionally, it can cause serious yield losses as agricultural weed. Common ragweed seeds accumulate in the soil and can remain therein viable for decades, which poses a problem for the sustainable management of these populations. A long term management should thus target a reduction of the soil seed bank. We observed the influence of four different mowing regimes on the ragweed soil seed bank at six roadside populations in eastern Austria. The mowing regimes were based on methods from common roadside management practice and specifically adapted to reduce seed production. After three years of application, the soil seed bank was indeed reduced by 45 to 80 percent through three of the four mowing regimes tested. Therefore, we suggest that the best mowing regime for the most effective reduction of the size of the soil seed bank is the one consisting of one cut just after the beginning of female flowering (around the 3rd week of August in Eastern Central Europe), followed by a second cut 2–3 weeks later.
As legislation, research and management of invasive alien species (IAS) are not fully coordinated across countries or different stakeholder groups, one approach leading to more or less standardized activities is based on producing lists of prominent IAS that attain high level of concern and are a subject of priority monitoring and management. These so-called Black, Grey and Watch (alert) Lists represent a convenient starting point for setting priorities in prevention, early warning and management systems. It is important that these lists be based on transparent and robust criteria so as to accommodate interests and perception of impacts by groups of concerned authorities and stakeholders representing sectors as diverse as, e.g. forestry, horticulture, aquaculture, hunting, and nature conservation, and to justify possible trade restrictions. The principles for blacklisting need to be general enough to accommodate differences among taxonomic groups (plants, invertebrates, vertebrates) and invaded environments (e.g. aquatic, terrestrial, urban, suburban, seminatural), and must take into account invasion dynamics, the impact the IAS pose, and management strategies suitable for each particular invader. With these assumptions in mind, we synthesize available information to present Black, Grey and Watch Lists of alien species for the Czech Republic, with recommended categorized management measures for land managers, policy makers and other stakeholders. We took into account differences in the listed species’ distribution, invasion status, known or estimated environmental impact, as well as possible management options, and apply these criteria to both plants and animals. Species with lower impact, but for which some level of management and regulation is desirable, are included on the Grey List. Some potentially dangerous species occurring in European countries with comparable climatic conditions, as well as those introduced in the past but without presently known wild populations in the Czech Republic, are listed on the Watch list. In total, there are 78 plant and 39 animal species on the Black List, 47 and 16 on the Grey List, and 25 and 27, respectively, on the Watch List. The multilayered approach to the classification of alien species, combining their impacts, population status and relevant management, can serve as a model for other countries that are in process of developing their Black Lists.
This study investigated laypersons’ perception of invasive alien plant species (IAPS) and attitudes towards their management with the help of a written questionnaire in the cities of Zurich, Geneva, and Lugano, Switzerland. Survey participants (n = 720) judged attractiveness from certain species on visual contact (eight IAPS were shown as photographs). Trachycarpus fortunei and Ludwigia grandiflora were liked most, while Ambrosia artemisiifolia was clearly disliked most. With the exception of Trachycarpus fortunei, all plant species were perceived as rather ordinary, familiar and native to Switzerland, and feelings of ordinariness, familiarity and nativeness were positively correlated. Few participants could correctly identify the species depicted. Knowledge of an IAPS (ability to identify it) and desire to have it around were negatively correlated. Participants agreed most with the eradication of IAPS that cause serious costs and problems. However, people were rather unwilling to remove Buddleja davidii, Solidago canadensis, and Trachycarpus fortunei which are already widely established ornamentals in settlement areas or gardens. Overall, willingness to remove an IAPS and to report it to the authorities decreased with increasing desirability (and thus beauty) of a species.
Antithrombotic management of patients with atrial fibrillation (AF) undergoing coronary stenting is complicated by the need for anticoagulant therapy for stroke prevention and dual antiplatelet therapy for prevention of stent thrombosis and coronary events. Triple antithrombotic therapy, typically comprising warfarin, aspirin, and clopidogrel, is associated with a high risk of bleeding. A modest-sized trial of oral anticoagulation with warfarin and clopidogrel without aspirin showed improvements in both bleeding and thrombotic events compared with triple therapy, but large trials are lacking. The RE-DUAL PCI trial (NCT 02164864) is a phase 3b, a strategy of prospective, randomized, open-label, blinded-endpoint trial. The main objective is to evaluate dual antithrombotic therapy with dabigatran etexilate (110 or 150 mg twice daily) and a P2Y12 inhibtor (either clopidogrel or ticagrelor) compared with triple antithrombotic therapy with warfarin, a P2Y12 inhibtor (either clopidogrel or ticagrelor, and low-dose aspirin (for 1 or 3 months, depending on stent type) in nonvalvular AF patients who have undergone percutaneous coronary intervention with stenting. The primary endpoint is time to first International Society of Thrombosis and Hemostasis major bleeding event or clinically relevant nonmajor bleeding event. Secondary endpoints are the composite of all cause death or thrombotic events (myocardial infarction, or stroke/systemic embolism) and unplanned revascularization; death or thrombotic events; individual outcome events; death, myocardial infarction, or stroke; and unplanned revascularization. A hierarchical procedure for multiple testing will be used. The plan is to randomize ∼ 2500 patients at approximately 550 centers worldwide to try to identify new treatment strategies for this patient population.
Recent critics of invasion biology advocate reduced efforts against nonnative species, arguing that attempts to manage invasions are often costly and futile and that managers are indiscriminately managing species regardless of their impact. Whether this criticism has affected ground-level operations is unknown. A survey of land stewards of a major conservation NGO reveals that this plea has not been heeded; in fact, managers report that they would increase nonnative species management if more resources were available. While respondents overwhelmingly listed nonnative, invasive species as their highest priority for management, we found little evidence supporting the criticism that practitioners focus on nonnative species with minimal ecological impact. Additionally, we found that more conservation practitioners reported managing problematic "weedy" native species over nonnative species that are not invasive. Our results indicate that these managers are selective rather than profligate, targeting species that are having a demonstrable impact or are likely to do so. They feel hamstrung by resource shortages despite their rigorous target selection. Why the increasing literature calling for changed treatment of nonnatives has not led to changed operations is uncertain. Possible reasons are that the critics are not prescriptive or unified about management prioritization, or that these managers simply reject the proposed new paradigm.
Impacts of alien species on human health have recently become a major issue in medical research and invasion ecology, but comprehensive assessments of this subject are largely lacking. Here, we provide a literature review of alien species with public health impacts in Europe based on a systematic search in the Thomson Reuters Web of Science. We detected 77 relevant articles, of which 21 were reviews and 56 were original research articles. The taxonomic focus was on vascular plants (n=31 articles) and dipterans (n=25 articles). The original research articles mainly covered the spread of the study species, while early invasion stages (introduction, establishment) as well as impact and management were less investigated. Alien species of health concern in Europe are mostly introduced as contaminants, and mostly originate from climatically similar regions of the Northern Hemisphere. In those cases (36% of all articles) when information on the trend in range and abundance was provided, this trend was mostly increasing. We detected little information on the severity of the impacts (two articles) and the interaction with climate change (three articles). In 15 original articles (28%) specific management measures were suggested, in only one article the socioeconomic costs were assessed. We conclude that European research on human health impacts of alien species is biased towards few species, and that several important aspects such as early invasion stages, severity of impact and its temporal trends, and the scale of the socioeconomic costs caused are poorly understood. Interdisciplinary projects bridging gaps between ecologists medical researchers, socioeconomists and public health authorities are required to link alien species to severity and trends of impacts, which is a crucial requisite for risk assessment and decision making.
We performed a survey of grassland communities in the Ukrainian Carpathians with the aim of: (1) syntaxonomically classifying the meso- and subxerophilous grassland vegetation; (2) analysing the main gradients in their species composition; (3) estimating the effect of selected environmental factors on grassland species composition; (4) assessing the species richness of vascular plants and bryophytes in relation to the measured environmental variables. We collected 46 phytosociological relevés during the growing seasons of 2010 and 2011. Species composition and species richness were studied at two spatial scales (1 m² and 16 m²) in relation to soil parameters (soil depth, pH (KCl), content of P, K, Mg, N and C), management regime (mowing, grazing, ploughing in the past and burning), and other factors (altitude, litter cover, open soil, inclination, solar radiation and animal excrement). Seven grassland types were distinguished belonging to 3 classes and 4 alliances, namely the Nardetea strictae including the Violion caninae (mesic pastures at altitudes of 400–600 m mostly on moderate slopes) and the Nardo strictae-Agrostion tenuis (grasslands on moderate slopes at altitudes of 700–900 m usually managed by mowing and grazing the aftermath); the Molinio-Arrhenatheretea, including the Arrhenatherion elatioris (submontane grasslands originated mostly on former fields after their abandonment in the past) and the Cynosurion cristati (intensive pastures); and the Festuco-Brometea including the Cirsio-Brachypodion pinnati (abandoned grasslands dominated by Brachypodium pinnatum and Inula salicina). Detrended correspondence analysis indicated that the major compositional turnover was related to altitude and soil reaction. A canonical correspondence analysis confirmed that altitude had the strongest effect on species composition in the analysed dataset, followed by management treatments (former ploughing, grazing intensity). For vascular plant species richness, regression tree analysis identified grazing intensity as the most important predictor at the 1 m² scale. At the 16 m² scale, soil humus content was evaluated as the most important predictor of vascular plant species richness, followed by litter cover and grazing intensity. The number of bryophytes was not determined by the studied environmental factors at either of the two spatial scales. Although the number of analysed relevés in this study was limited, our results significantly contribute to the understanding of submontane grasslands in the Ukrainian Carpathians.
Understanding the diverging opinions of academic experts, stakeholders and the public is important for effective conservation management. This is especially so when a consensus is needed for action to minimize future risks but the knowledge upon which to base this action is uncertain or missing. How to manage non-native, invasive species (NIS) is an interesting case in point: the issue has long been controversial among stakeholders, but publicly visible, major disagreement among experts is recent. To characterize the multitude of experts’ understanding and valuation of non-native, NIS we performed structured qualitative interviews with 26 academic experts, 13 of whom were invasion biologists and 13 landscape experts. Within both groups, thinking varied widely, not only about basic concepts (e.g., non-native, invasive) but also about their valuation of effects of NIS. The divergent opinions among experts, regarding both the overall severity of the problem in Europe and its importance for ecosystem services, contrasted strongly with the apparent consensus that emerges from scientific synthesis articles and policy documents. We postulate that the observed heterogeneity of expert judgments is related to three major factors: (1) diverging conceptual understandings, (2) lack of empirical information and high scientific uncertainties due to complexities and contingencies of invasion processes, and (3) missing deliberation of values. Based on theory from science studies, we interpret the notion of an NIS as a boundary object, i.e., concepts that have a similar but not identical meaning to different groups of experts and stakeholders. This interpretative flexibility of a concept can facilitate interaction across diverse groups but bears the risk of introducing misunderstandings. An alternative to seeking consensus on exact definitions and risk assessments would be for invasive species experts to acknowledge uncertainties and engage transparently with stakeholders and the public in deliberations about conflicting opinions, taking the role of honest brokers of policy alternatives rather than of issue advocates.