Migration timing and marine space use of an anadromous Arctic fish (Arctic Char, Salvelinus alpinus) revealed by local spatial statistics and network analysis.

BACKGROUND: The ice-free season (typically late-June to early-October) is crucial for anadromous species of fish in the Arctic, including Arctic Char (Salvelinus alpinus), which must acquire adequate resources for growth, reproduction, and survival during a brief period of feeding in the marine environment. Arctic Char is an important food fish for Inuit communities across the Arctic. Understanding drivers and patterns of migration in the marine environment is thus essential for conservation and management of the species. METHODS: We used passive acoustic telemetry to characterize migration patterns of 51 individual anadromous Arctic Char during the ice-free season in the marine environment of Coronation Gulf (Nunavut, Canada; 2019-2022). Based on recent genetic evidence, some tagged individuals were likely Dolly Varden (Salvelinus malma malma), a closely related species to Arctic Char. Using local Getis G* and network analysis, we described movement patterns and identified high-use locations in the marine environment. We also related freshwater overwintering location to migration timing and movement pattern. RESULTS: Comparing groups of fish that overwintered in distinct locations, we found: (i) limited evidence that marine movements were associated with overwintering location; (ii) minor differences in use of marine space; and, (iii) timing of freshwater return differed significantly between overwintering groups, and was related to length and difficulty of the migratory pathway in freshwater. Results from both network analysis and local Getis G* revealed that, regardless of overwintering location, coastal locations were highly used by fish. CONCLUSIONS: Overwintering locations, and the migratory routes to access overwintering locations, affect the timing of freshwater return. Preference of fish for coastal marine locations is likely due to abundance of forage and patterns in break-up of sea ice. Similarities in marine space use and movement patterns present challenges for managing this and other mixed stock fisheries of anadromous Salvelinus spp. Absences or periods of time when fish were not detected prevented comprehensive assessment of movement patterns. Local Getis G*, a local indicator of spatial association, is a helpful tool in identifying locations associated with absences in acoustic telemetry arrays, and is a complementary method to network analysis.

Overwintering ecology and movement of anadromous Arctic char (Salvelinus alpinus) in a large, ice-covered river in the Canadian Arctic.

Arctic char (Salvelinus alpinus) is a facultatively anadromous fish species that is critically important to many Inuit communities in the Canadian Arctic. Plasticity in life history has allowed the species to persist in a diversity of challenging Holarctic environments. Despite their ecological and cultural importance and their presence in aquatic ecosystems that are ice-covered for much of the year, few under-ice studies of Arctic char have been conducted. Most winter studies of adult Arctic char have focused on lakes, where they typically overwinter. Several populations of Arctic char, however, overwinter in large river systems, and subsistence fishers have reported that Arctic char overwinter in the lower reaches of the Coppermine River. The Coppermine River is a large Arctic river that flows into Coronation Gulf near Kugluktuk, Nunavut, Canada. The authors used acoustic telemetry to investigate the overwintering ecology of Arctic char in the region. Consistent with local knowledge, they detected Arctic char overwintering within the fluvial environment of the Coppermine River from 2018 to 2020. Unlike other fluvial environments known to be used by overwintering Arctic char, the lower reaches of the Coppermine River are completely ice-covered throughout the winter, are of moderate depths (3.8-14.1 m) and have no known groundwater inputs. Acoustic telemetry observations indicated long-distance movement (7-8 km) within the river in early winter (October) in response to dynamic ice formation. Under-ice movement generally declined 2 weeks after river freeze-up but continued throughout winter in the lower 5 km of the river, where there were fewer under-ice disturbances. Migration into the marine environment before river ice break-up (June), as well as winter (November-May) movements into and within the marine environment, was unexpectedly observed for some fish. Under-ice use of the marine environment is unusual for Arctic char at the distances observed (up to 18 km) and has not previously been documented at the temperatures (fish body temperatures from -0.76 to 1.90°C) observed. Results allow further understanding of the diverse life-history tactics employed by Arctic char and lay a foundation for future research into fluvial and other diverse overwintering tactics employed by the species.

Cardiohelp System use in school age children and adolescents at a center with interfacility mobile extracorporeal membrane oxygenation capability.

Cardiohelp System use for pediatric extracorporeal membrane oxygenation (ECMO) beyond the transport setting is sparsely described in literature. We report the use of Getinge's Cardiohelp System in children and integrated utilization of Mobile ECMO Retrieval Team (MERT) at an all-age specialized cardiorespiratory center. Electronic database of all patients under 16 years of age who received ECMO with use of the Cardiohelp System between January 2018 and March 2020 was retrospectively reviewed and analyzed for demographics, set-up, complications, and outcomes. Out of 41 patients, seven patients (four in middle childhood, three in early teenage) with median age of 10 years (range 8.8-15.6) were supported with use of Cardiohelp System. Median weight and height were 34 kg (range 28-53) and 145 cm (range 134-166) respectively. Initial ECMO deployment was veno-arterial (V-A) in five patients and veno-venous (V-V) in two. There were three interhospital transfers by our MERT, and 12 intrahospital transfers for interventions or imaging. The median ECMO therapy was 7 days (range 4-25), with standard 3/8-inch tubing and ECMO flow rate range at 56-100 mL/kg/min (1.89-5.0 LPM). There were two circuit changes and three reconfigurations of support. Two patients received continuous veno-venous hemofiltration via ECMO circuit. The 90-day and 180-day survival rates were 100% (including two heart transplants at day 7 and day 8). There were no transport-related or circuit-related complications during the 1750 h of Cardiohelp use. Cardiohelp System use is safe in pediatric patients for diverse application of ECMO support including inter- and intrahospital transfers.

Early communication is key - Designing a new communication tool to immediately empower people with psychogenic nonepileptic seizures.

INTRODUCTION: Patient empowerment and shared decision-making has been increasingly recognized as key factors for a favorable prognosis. This is particularly true in complex brain disorders such as psychogenic nonepileptic seizures (PNES) which go along with several challenges. People with PNES (PW-PNES) often feel lost in the healthcare system. Early clear communication is one of the few favorable prognostic variables. Our goal was to design a new ultrashort user-friendly communication tool allowing immediate patient empowerment. METHODS: We conceptualized a design thinking process with patient engagement of PW-PNES. Together with a larger group of PW-PNES, we developed a comprehensive user-friendly 1-page document summarizing the key features of PNES. We applied document engineering (DE) as a cognitive science-based new methodology. Document engineering is well established in the aviation, oil, and mining industries and measurably reduces comprehension and performance errors. RESULTS: The design thinking process encompassed 5 phases (empathize, ideate, define, prototype, and test). A prototype of a 1-page document, the 1-Pager-PNES, was created which contained the essential 7 domains organized in a simple structure such as a promise-question-answer (PQA) format. Information was kept poignant, complete, easy-to-read integrating cognitive principles to optimize navigation. The prototype "1-Pager-PNES" was subsequently tested in a 7-member focus group. All patients expressed significant improvement in understanding their disease and felt immediately empowered. Implementing their specific feedbacks, reiterative testing, and involving PNES experts resulted in the final version of the "1-Pager-PNES". CONCLUSION: A promising new communication tool reduced to 1-page only is introduced which improves patient guidance and enables better coping mechanisms with this complex disease. The patient/user is empowered quickly through finding answers to pressing questions. Our study is unique for three reasons: 1) it engaged patients in the developing process, 2) it produced a tool for immediate communication for PW-PNES, which follows principles of human behavior and cognitive science, and 3) it used cross-industry thinking. Despite all limitations, we consider our small pilot study an inspiration for future studies with focus on patient empowerment through user-friendly documents.

Epilepsy: Transition from pediatric to adult care. Recommendations of the Ontario epilepsy implementation task force.

The transition from a pediatric to adult health care system is challenging for many youths with epilepsy and their families. Recently, the Ministry of Health and Long-Term Care of the Province of Ontario, Canada, created a transition working group (TWG) to develop recommendations for the transition process for patients with epilepsy in the Province of Ontario. Herein we present an executive summary of this work. The TWG was composed of a multidisciplinary group of pediatric and adult epileptologists, psychiatrists, and family doctors from academia and from the community; neurologists from the community; nurses and social workers from pediatric and adult epilepsy programs; adolescent medicine physician specialists; a team of physicians, nurses, and social workers dedicated to patients with complex care needs; a lawyer; an occupational therapist; representatives from community epilepsy agencies; patients with epilepsy; parents of patients with epilepsy and severe intellectual disability; and project managers. Three main areas were addressed: (1) Diagnosis and Management of Seizures; 2) Mental Health and Psychosocial Needs; and 3) Financial, Community, and Legal Supports. Although there are no systematic studies on the outcomes of transition programs, the impressions of the TWG are as follows. Teenagers at risk of poor transition should be identified early. The care coordination between pediatric and adult neurologists and other specialists should begin before the actual transfer. The transition period is the ideal time to rethink the diagnosis and repeat diagnostic testing where indicated (particularly genetic testing, which now can uncover more etiologies than when patients were initially evaluated many years ago). Some screening tests should be repeated after the move to the adult system. The seven steps proposed herein may facilitate transition, thereby promoting uninterrupted and adequate care for youth with epilepsy leaving the pediatric system.

Implementing a one-on-one peer support program for cancer survivors using a motivational interviewing approach: results and lessons learned.

Peer Connect matches cancer survivors and caregivers (guides) with those currently experiencing cancer-related issues seeking support (partners). Motivational interviewing (MI)-based communication skills are taught to provide patient-centered support. There is little guidance about MI-based applications with cancer survivors who may have multiple coping needs. This paper addresses the results and lessons learned from implementing Peer Connect. Thirteen cancer survivors and two caregivers received a 2-day MI, DVD-based training along with six supplemental sessions. Nineteen partners were matched with guides and received telephone support. Evaluation included guide skill assessment (Motivational Interviewing Treatment Integrity Code) and 6-month follow-up surveys with guides and partners. Guides demonstrated MI proficiency and perceived their training as effective. Guides provided on average of five calls to each partner. Conversation topics included cancer fears, family support needs, coping and care issues, and cancer-related decisions. Partners reported that guides provided a listening ear, were supportive, and nonjudgmental. Limited time availability of some guides was a challenge. MI can provide support for cancer survivors and caregivers without specific behavioral concerns (e.g., weight and smoking). An MI support model was both feasible and effective and can provide additional support outside of the medical system.

An audit of acupuncture in general practice.

An audit was conducted to determine the effects of acupuncture treatment used in a dedicated clinic in primary care by a GP, starting shortly after first learning acupuncture. The outcome measure was MYMOP2 which was developed into the MYMOP pictorial during the course of the audit to improve patient compliance. Out of 62 patients enrolled in the audit, 55 completed both the initial and follow-up questionnaires: they had a mean age of 56 years, and included 43 women. The overall mean improvement in symptom 1 was 2.0 (standard deviation 1.6) scale points, and the improvement was significant in 30 patients (55%). Twenty-eight patients reported significant improvement in activity (58% of those reporting this section), and 23 patients (48% of those reporting) obtained a significant improvement in wellbeing. Adverse events were minor, though one patient fainted and fell to the floor. Although the conclusions of this audit are limited by its small size, nevertheless the results were generally encouraging, and the authors recommend that acupuncture should be considered for use in primary care for a wide range of complaints.