Context. No prospective studies address disease-specific advance care planning (ACP) for adults living with HIV/AIDS. Objective. To examine the efficacy of FAmily-CEntered (FACE) ACP in increasing ACP and advance directive documentation in the medical record. Methods. Longitudinal, two-arm, randomized controlled trial with intent-to-treat design recruited from five hospital-based outpatient HIV clinics in Washington, DC. Adults living with HIV and their surrogate decision-makers (N ¼ 233 dyads) were randomized to either an intensive facilitated two-session FACE ACP (Next Steps: Respecting Choices goals of care conversation and Five Wishes advance directive) or healthy living control (conversations about developmental/relationship history and nutrition). Results. Patients (n ¼ 223) mean age: 51 years, 56% male, 86% African-American. One hundred ninety-nine dyads participated in the intervention. At baseline, only 13% of patients had an advance directive. Three months after intervention, this increased to 59% for the FACE ACP group versus 17% in the control group (P < 0.0001). Controlling for race, the odds of having an advance directive in the medical record in the FACE ACP group was approximately seven times greater than controls (adjusted odds ratio ¼ 6.58, 95% CI: 3.21e13.51, P < 0.0001). Among African-Americans randomized to FACE, 58% had completed/documented advance directives versus 20% of controls (P < 0.0001). Conclusions. The FACE ACP intervention significantly improved ACP completion and advance directive documentation in the medical record among both African-American and non-African-American adults living with HIV in Washington, DC, providing health equity in ACP, which can inform best practices.
Mating systems, which can reveal temporal and spatial plasticity within a given species, may influence inbreeding, effective population size, genetic diversity, reproductive fitness, and survival. Although observational research on white-tailed deer has indicated dominant males monopolize breeding opportunities, recent molecular studies suggest a more complex system. It is possible that population characteristics fostered under management strategies designed to balance the sex ratio and extend the male age structure, such as Quality Deer Management (QDM), influence the pre-breeding interactions that affect the distribution of mating success across age classes. Therefore, our objective was to evaluate the white-tailed deer mating system under QDM through paternity analysis. Using 8 microsatellite loci and tissue samples harvested from hunter-killed deer at Chesapeake Farms in Chestertown, Maryland, we evaluated 731 deer. The 3.5 age class dominated mating at Chesapeake Farms, with 41% of paternity. However, together, the 1.5-and 2.5-year-old age classes accounted for more than half of paternity (59%). No evidence of polyandry was detected. Our results indicate the interaction between the sex ratio and age structure, fostered by strategies that balance the sex ratio and extend the male age structure, facilitate breeding by younger males. These results indicate management strategies that employ QDM practices with a goal of propagating the genes of dominant males may fall short, and the interplay among sex ratio, age structure, and dominance relationships may be the main influences of mating success. Managers should account for these findings when setting expectations for reproduction under restricted harvest. Ó 2016 The Wildlife Society.
BackgroundUnderstanding the distribution of disease in wildlife is key to predicting the impact of emerging zoonotic one health concerns, especially for wildlife species with extensive human and livestock interfaces. The widespread distribution and complex interactions of white-tailed deer (Odocoileus virginianus) with humans suggest deer population health and management may have implications beyond stewardship of the animals. The intracranial abscessation suppurative meningitis (IASM) disease complex in deer has been linked to Arcanobacterium pyogenes, an under-diagnosed and often misdiagnosed organism considered commensal in domestic livestock but associated with serious disease in numerous species, including humans.MethodsOur study used standard bacterial culture techniques to assess A. pyogenes prevalence among male deer sampled across six physiogeographic regions in Maryland and male and female deer in the Upper Eastern Shore under Traditional Deer Management (TDM) and Quality Deer Management (QDM), a management protocol that alters population demographics in favor of older male deer. Samples were collected from antler pedicles for males, the top of the head where pedicles would be if present for females, or the whole dorsal frontal area of the head for neonates. We collected nasal samples from all animals by swabbing the nasopharyngeal membranes. A gram stain and catalase test were conducted, and aerobic bacteria were identified to genus and species when possible. We evaluated the effect of region on whether deer carried A. pyogenes using Pearson's chi-square test with Yates’ continuity correction. For the white-tailed deer management study, we tested whether site, age class and sex predisposed animals to carrying A. pyogenes using binary logistic regression.ResultsA. pyogenes was detected on deer in three of the six regions studied, and was common in only one region, the Upper Eastern Shore. In the Upper Eastern Shore, 45% and 66% of antler and nasal swabs from deer were positive for A. pyogenes, respectively. On the Upper Eastern Shore, prevalence of A. pyogenes cultured from deer did not differ between management areas, and was abundant among both sexes and across all age classes. No A. pyogenes was cultured from a small sample of neonates.ConclusionOur study indicates A. pyogenes may be carried widely among white-tailed deer regardless of sex or age class, but we found no evidence the pathogen is acquired in utero. The distribution of A. pyogenes across regions and concentration in a region with low livestock levels suggests the potential for localized endemicity of the organism and the possibility that deer may serve as a maintenance reservoir for an emerging one health concern.
Coyotes (Canis latrans) may affect adult and neonate white‐tailed deer (Odocoileus virginianus) survival and have been implicated as a contributor to the decline of deer populations. Additionally, coyote diet composition is influenced by prey availability, season, and region. Because coyote movement and diet vary by region, local data are important to understand coyote population dynamics and their impact on prey species. In southeast Minnesota, we investigated the effect of coyotes on white‐tailed deer populations by documenting movement rates, distances moved, and habitats searched by coyotes during fawning and nonfawning periods. Additionally, we determined survival, cause‐specific mortality, and seasonal diet composition of coyotes. From 2001 to 2003, we captured and radiocollared 30 coyotes. Per‐hour rate of movement averaged 0.87 km and was greater (P = 0.046) during the fawning (1.07 km) than the nonfawning period (0.80 km); areas searched were similar (P = 0.175) between seasons. Coyote habitat use differed during both seasons; habitats were not used in proportion to their availability (P < 0.001). Croplands were used more (P < 0.001) than their proportional availability during both seasons. Use of grasslands was greater during the fawning period (P = 0.030), whereas use of cropland was greater in the nonfawning period (P < 0.001). We collected 66 fecal samples during the nonfawning period; coyote diets were primarily composed of Microtus spp. (65.2%), and consumption of deer was 9.1%. During the study, 19 coyotes died; annual survival rate range was 0.33–0.41, which was low compared with other studies. Consumption of deer was low and coyotes searched open areas (i.e., cropland) more than fawning areas with dense cover. These factors in addition to high coyote mortality suggested that coyote predation was not likely limiting white‐tailed deer populations in southeast Minnesota. © 2011 The Wildlife Society.
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