SummaryWe studied the impact of demographic diversity on individual attachment and firm unit performance in a relatively diverse organization. We implemented cross-level regression to study gender and race/ethnic categorical, relational, and organizational demography in a sample of 26 units part of a regional restaurant chain. At the individual level, we found that diversity climate (DC) moderates the impact of relational and categorical demography on affective organizational commitment, organizational identification, and intention to quit. At the organizational level, we found that DC moderates the impact of organizational diversity on firm productivity and return on profit. We discuss the importance of organizational DC as organizational context on individual attachment, and implications for firm effectiveness in diverse organizations.

In order to evaluate the present distribution patterns of salmonids and their potential effects on native fish, we sampled 11 large lakes and 105 streams, encompassing a total of 13 main hydrographic watersheds of southern Chile (39 o to 52 o S). Overall, trout (Salmo trutta and Oncorhynchus mykiss) accounted for more than 60 % of total fish abundance and more than 80 % of total biomass, while 40 % of the streams sampled did not have native fish. Salmon, introduced for aquaculture, such as O. kisutch, Salmo salar, and O. tshawytscha, were only present in lakes with salmon farming and did not seem to be reproducing naturally in affluent streams. We tested the effect of river geographic origin (Andes mountains, central valley, or Coastal range) on fish abundance and found that rainbow trout was more restricted to the Andean streams with higher water discharge, while brown trout was widely distributed and did not relate to any of several catchment attributes measured. The abundance of native fish was greater in lakes than in streams and the highest native fish biodiversity occurred in streams of the central valley. The most common native species were Galaxias maculatus, G. platei, Brachygalaxias bullocki, Aplochiton zebra and Basilichthys australis. Streams with higher conductivity, larger pool areas, more fine sediments, and low brown trout densities were more suitable for native fish. Thus, catchments with higher anthropogenic disturbance appeared as refuges for native species. Given the descriptive nature of our study we can only presume the negative impacts of trout and salmon on native fish; an effect which should be superimposed on biogeographical conditioning of present distribution. Yet based on the present abundance and distribution patterns of salmonids and native fish, negative effects are very likely. Conservation of native fish biodiversity in central valley streams, far from protected areas or national parks and fully exposed to human perturbations represents a great challenge. We propose to enhance conservation by exerting a stronger sport fishing pressure on trout in those streams.

BACKGROUND Stress cardiac magnetic resonance imaging (CMR) has demonstrated excellent diagnostic and prognostic value in single-center studies. OBJECTIVES This study sought to investigate the prognostic value of stress CMR and downstream costs from subsequent cardiac testing in a retrospective multicenter study in the United States. METHODS In this retrospective study, consecutive patients from 13 centers across 11 states who presented with a chest pain syndrome and were referred for stress CMR were followed for a target period of 4 years. The authors associated CMR findings with a primary outcome of cardiovascular death or nonfatal myocardial infarction using competing risk-adjusted regression models and downstream costs of ischemia testing using published Medicare national payment rates. RESULTS In this study, 2,349 patients (63 ± 11 years of age, 47% female) were followed for a median of 5.4 years. Patients with no ischemia or late gadolinium enhancement (LGE) by CMR, observed in 1,583 patients (67%), experienced low annualized rates of primary outcome (<1%) and coronary revascularization (1% to 3%), across all years of study follow-up. In contrast, patients with ischemia+/LGE+ experienced a >4-fold higher annual primary outcome rate and a >10-fold higher rate of coronary revascularization during the first year after CMR. Patients with ischemia and LGE both negative had low average annual cost spent on ischemia testing across all years of follow-up, and this pattern was similar across the 4 practice environments of the participating centers. CONCLUSIONS In a multicenter U.S. cohort with stable chest pain syndromes, stress CMR performed at experienced centers offers effective cardiac prognostication. Patients without CMR ischemia or LGE experienced a low incidence of cardiac events, little need for coronary revascularization, and low spending on subsequent ischemia testing. (Stress CMR Perfusion Imaging in the United States [SPINS]: A Society for Cardiovascular Resonance Registry Study; NCT03192891 )

In order to explore the importance of indigenous agroforestry systems for biodiversity conservation, we compared the abundance, species richness and diversity of dung beetles and terrestrial mammals across a gradient of different land use types from agricultural monocultures (plantains) to agroforestry systems (cocoa and banana) and forests in the BriBri and Cabe´car indigenous reserves in Talamanca, Costa Rica. A total of 132,460 dung beetles of 52 species and 913 tracks of 27 terrestrial mammal species were registered. Dung beetle species richness and diversity were greatest in the forests, intermediate in the agroforestry systems and lowest in the plantain monocultures, while dung beetle abundance was greatest in the plantain monocultures. The number of mammal tracks per plot was significantly higher in forests than in plantain monocultures, whereas mammal species richness was higher in forests than in either cocoa agroforestry systems or plantain monocultures. Species composition of both terrestrial mammals and dung beetles also varied across the different land use types. Our study indicates that indigenous cocoa and banana agroforestry systems maintain an intermediate level of biodiversity (which is less than that of the original forest but significantly greater than that of plantain monocultures) and provide suitable habitat for a number of forest-dependent species. Although the agroforestry systems appear to serve as favorable habitats for many terrestrial mammal species, their potential positive contribution to mammal conservation is being offset by heavy hunting pressure in the reserves. As in other agricultural landscapes, the conservation of biodiversity in Talamanca will depend not only on maintaining the existing forest patches and reducing the conversion of traditional agroforestry systems to monocultures, but also on reducing hunting pressure.

Objectives This study sought to perform a systematic review and meta-analysis to understand the prognostic value of myocardial scarring as evidenced by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) in patients with known or suspected cardiac sarcoidosis. Background Although CMR is increasingly used for the diagnosis of cardiac sarcoidosis, the prognostic value of CMR has been less well described in this population. Methods PubMed, Cochrane CENTRAL, and meta-Register of Controlled Trials were searched for CMR studies with ≥ 1 year of prognostic data. Primary end-points were all-cause mortality and a composite outcome of arrhythmogenic events (ventricular arrhythmia, ICD shock, sudden cardiac death) plus all-cause mortality during follow-up. Summary effect estimates were generated with random-effects modeling. Results Ten studies were included, involving a total of 760 patients with a mean follow up of 3.0 ± 1.1 years. Patients had a mean age of 53 years, 41% were male, 95.3% had known extra-cardiac sarcoidosis, and 21.6% had known cardiac sarcoidosis. The average ejection fraction was 57.8 ± 9.1%. Patients with late gadolinium enhancement had higher odds for all-cause mortality (odds ratio [OR]: 3.06, p < 0.03) and higher odds of the composite outcome (OR: 10.74, p< .00001) compared to those without LGE. Patients with LGE had an increased annualized event rate of the composite outcome (11.9% v. 1.1%; p<0.0001) Conclusions In patients with known or suspected cardiac sarcoidosis, the presence of late gadolinium enhancement on cardiac MRI is associated with increased odds of both all-cause mortality and arrhythmogenic events.

Employer offerings of on-site child care benefits have grown tremendously in the past few decades; both beneficial and detrimental effects on worker attitudes and behaviors have been noted. Some research suggests that offering on-site child care benefits can cause resentment among childless workers and/or workers with children who do not use the center. In a field sample of 271 employees, current and past use of the on-site child care center, as well as anticipated future use of the on-site child care center, were related to more positive proximal reactions such as attitudes closely related to the on-site child care center, but not to more general attitudes or behaviors. Results indicate that any "family-friendly backlash" may be limited to proximal reactions. These findings are discussed in light of organizational justice theories.

We used telemedicine to improve genetics services to patients in the rural northwestern region of Florida. Patients were first seen via videoconference by a genetic counsellor, who obtained family and medical history. A local paediatrician then performed the physical examination, and a plan for evaluation was established. The videoconferencing equipment was connected at a bandwidth of 384 kbit/s, using three ISDN lines. During the first three telemedicine clinics, seven patients were evaluated and then returned to the centre for a face-to-face consultation with the clinical geneticist. No new diagnoses were made face-to-face that had not been identified by telemedicine. No diagnoses made by telemedicine were judged to be wrong when the child was evaluated face-to-face. During a two-year study of patient satisfaction with 12 telegenetics clinics, the 50 families evaluated via videoconferencing were asked to complete surveys; 40 surveys were returned (a response rate of 80%). All individuals either strongly agreed or agreed that the evaluation of their child was appropriate, sufficient and sufficiently protective of their child's privacy. The waiting time for a new patient consultation with the clinical genetics team was 16.9 months (SD 1.9) at the start and 3.0 months (SD 1.0) at the end of the trial period. The difference was significant (t-test, P < 0.0001). Telegenetics allows more rapid assurance that a genetic syndrome has not been identified, or a quicker initial evaluation and diagnosis for children who do have an identifiable genetic syndrome.

We sought to compare the diagnostic performance of computed coronary tomography angiography (CCTA), computed tomography perfusion (CTP) and computed tomography fractional flow reserve (CT-FFR) for assessing the functional significance of coronary stenosis as defined by invasive fractional flow reserve (FFR), in patients with known or suspected coronary artery disease. CCTA has proven clinically useful for excluding obstructive CAD due to its high sensitivity and negative predictive value (NPV), however the ability of CTA to identify functionally significant CAD has remained challenging. We searched PubMed/Medline for studies evaluating CCTA, CTP or CT-FFR for the non-invasive detection of obstructive CAD as compared to catheter-derived FFR as the reference standard. Pooled sensitivity, specificity, PPV, NPV, likelihood ratios (LR), odds ratio (OR) of all diagnostic tests were assessed. Eighteen studies involving a total of 1535 patients were included. CTA demonstrated a pooled sensitivity of 0.92, specificity 0.43, PPV of 0.56 and NPV of 0.87 on a per-patient level. CT-FFR and CTP increased the specificity to 0.72 and 0.77 respectively (P=0.004 and P=0.0009)) resulting in higher point estimates for PPV 0.70 and 0.83 respectively. There was no improvement in the sensitivity. The CTP protocol involved more radiation (3.5 mSv CCTA VS 9.6 mSv CTP) and a higher volume of iodinated contrast (145 mL). In conclusion, CTP and CT-FFR improve the specificity of CCTA for detecting functionally significant stenosis as defined by invasive FFR on a per-patient level; both techniques could advance the ability to non-invasively detect the functional significance of coronary lesions.