Sequential Compression Device Compliance for Venous Thromboembolism in High-Risk Trauma: A Quality Improvement Study.

BACKGROUND: Hospital-acquired, perioperative venous thromboembolism is a recognized patient safety indicator in the adult trauma patient population. Mechanical prophylaxis has been identified as a standard intervention to reduce the incidence of venous thromboembolism when prescribed along with anticoagulation or if anticoagulation is contraindicated in the surgical population. Adherence to consistent mechanical prophylaxis remains a nursing issue impacted by numerous factors in patient care. OBJECTIVE: The purpose of this quality improvement project was to improve the compliance of sequential compression device utilization to decrease the hospital-acquired, perioperative venous thromboembolism rate in the adult hospitalized trauma patient population. METHODS: A pre- and postintervention quality improvement approach utilized a nurse-led strategy to engage multidisciplinary team members to increase the consistency of sequential compression device utilization on patients within trauma units. The patient safety indicator rate per 1,000 for hospital-acquired, perioperative venous thromboembolism was monitored for improvement. RESULTS: The patient safety indicator rate per 1,000 for hospital-acquired, perioperative venous thromboembolism demonstrated a decline from 10.60 to 4.95 rate per 1,000 over 12 months. In the trauma units, sequential compression device compliance increased from an initial direct observation audit of only 12% to an average of 65% compliance rate during the last 16-week audits. CONCLUSION: We found that a multidisciplinary, nurse-driven approach in the trauma units was effective in improving the compliance of sequential compression device utilization and impacted the hospital acquired, perioperative venous thromboembolism rate in the adult trauma patient population.

Salinity and temperature affect the symbiont profile and host condition of Florida USA blue crabs Callinectes sapidus.

Subtropical Florida blue crabs, Callinectes sapidus, exhibit differing life history traits compared to their temperate counterparts, likely influencing symbiont infection dynamics. Little information exists for Florida C. sapidus symbiont profiles, their distribution among various habitats, and influence on crab condition. Using histopathology, genomics, and transmission electron microscopy, we describe the first symbiont profiles for Florida C. sapidus occupying freshwater to marine habitats. Twelve symbiont groups were identified from 409 crabs including ciliophorans, digenean, microsporidian, Haplosporidia, Hematodinium sp., Nematoda, filamentous bacteria, gregarine, Callinectes sapidus nudivirus, Octolasmis sp., Cambarincola sp., and putative microcell. Overall, 78% of C. sapidus were documented with one or more symbiont groups demonstrating high infection rates in wild populations. Environmental variables water temperature and salinity explained 48% of the variation in symbiont groups among Florida habitats, and salinity was positively correlated with C. sapidus symbiont diversity. This suggests freshwater C. sapidus possess fewer symbionts and represent healthier individuals compared to saltwater populations. Crab condition was examined using the reflex action mortality predictor (RAMP) to determine if reflex impairment could be linked to symbiont prevalence. Symbionts were found positively correlated with crab condition, and impaired crabs were more likely to host symbionts, demonstrating symbiont inclusion may boost predictive ability of the RAMP application. The microsporidian symbiont group had a particularly strong effect on C. sapidus reflex response, and impairment was on average 1.57 times higher compared to all other symbiont groups. Our findings demonstrate the importance of considering full symbiont profiles and their associations with a spatially and temporally variable environment to fully assess C. sapidus population health.

The importance of context in the acoustic behaviors of marine, subtropical fish speciesa).

Despite the importance of acoustic signaling in fishes, the prevalence of the behavioral contexts associated with their active (i.e., intentional) sound production remains unclear. A systematized review was conducted to explore documented acoustic behaviors in marine, subtropical fishes and potential influences affecting their relative pervasiveness. Data were collected on 186 actively soniferous fish species studied across 194 publications, identified based on existing FishSounds and FishBase datasets. Disturbance was the most common behavioral context associated with active sound production-reported for 140 species or 75% of the species studied-and then aggression (n = 46 species, 25%) and reproduction (n = 34 species, 18%). This trend, however, somewhat differed when examined by research effort, study environment, and fish family, such as reproductive sounds being more commonly reported by studies conducted in the wild. The synthesis of fish sound production behaviors was in some ways stymied by the fact that many species' sound production did not have discernible associated behavioral contexts and that some investigations did not clearly identify the study environments in which active sound production was observed. These findings emphasize the importance of context-behavioral or otherwise-when studying acoustic behaviors in fishes.

Submerged Aquatic Vegetation Species and Populations Within Species Respond Differently to Environmental Stressors Common in Restorations.

Submerged aquatic vegetation (SAV) improves environmental conditions by acting as a sediment stabilizer and nutrient retention tool; therefore, reintroduction of SAV is a common freshwater restoration goal. Initial plant establishment is often difficult in suboptimal conditions, and planting material with specific traits may increase establishment rates. Here we evaluate the variability in plant traits based on collection location. We find consistent differences in traits of plants collected from different natural water bodies, and those differences persist in plants grown from seeds under common garden greenhouse conditions-presumably because of genetic differentiation. In three separate mesocosm experiments, we tested the interactive impacts of collection location and environmental condition (control conditions, reduced light, elevated nutrients, or a combination of reduced light and elevated nutrients) on plant reproduction and on traits that might indicate future restoration success (plant height, number of leaves, and rhizome diameter). In most cases, plant traits at the end of the experiments varied by collection location, environmental condition, and an interaction between the two. The best performing plants also depended on response variable (e.g., plant height or number of new shoots produced). Together these results suggest that unpredictable environmental conditions at restoration sites will make selection of a single high-performing plant source difficult, so we suggest incorporating a diverse set of collection locations to increase the probability of incorporating desirable traits.

Microbiomes of Thalassia testudinum throughout the Atlantic Ocean, Caribbean Sea, and Gulf of Mexico are influenced by site and region while maintaining a core microbiome.

Plant microbiomes are known to serve several important functions for their host, and it is therefore important to understand their composition as well as the factors that may influence these microbial communities. The microbiome of Thalassia testudinum has only recently been explored, and studies to-date have primarily focused on characterizing the microbiome of plants in a single region. Here, we present the first characterization of the composition of the microbial communities of T. testudinum across a wide geographical range spanning three distinct regions with varying physicochemical conditions. We collected samples of leaves, roots, sediment, and water from six sites throughout the Atlantic Ocean, Caribbean Sea, and the Gulf of Mexico. We then analyzed these samples using 16S rRNA amplicon sequencing. We found that site and region can influence the microbial communities of T. testudinum, while maintaining a plant-associated core microbiome. A comprehensive comparison of available microbial community data from T. testudinum studies determined a core microbiome composed of 14 ASVs that consisted mostly of the family Rhodobacteraceae. The most abundant genera in the microbial communities included organisms with possible plant-beneficial functions, like plant-growth promoting taxa, disease suppressing taxa, and nitrogen fixers.

Herbivore effects increase with latitude across the extent of a foundational seagrass.

Climate change is altering the functioning of foundational ecosystems. While the direct effects of warming are expected to influence individual species, the indirect effects of warming on species interactions remain poorly understood. In marine systems, as tropical herbivores undergo poleward range expansion, they may change food web structure and alter the functioning of key habitats. While this process ('tropicalization') has been documented within declining kelp forests, we have a limited understanding of how this process might unfold across other systems. Here we use a network of sites spanning 23° of latitude to explore the effects of increased herbivory (simulated via leaf clipping) on the structure of a foundational marine plant (turtlegrass). By working across its geographic range, we also show how gradients in light, temperature and nutrients modified plant responses. We found that turtlegrass near its northern boundary was increasingly affected (reduced productivity) by herbivory and that this response was driven by latitudinal gradients in light (low insolation at high latitudes). By contrast, low-latitude meadows tolerated herbivory due to high insolation which enhanced plant carbohydrates. We show that as herbivores undergo range expansion, turtlegrass meadows at their northern limit display reduced resilience and may be under threat of ecological collapse.

Global inventory of species categorized by known underwater sonifery.

A working group from the Global Library of Underwater Biological Sounds effort collaborated with the World Register of Marine Species (WoRMS) to create an inventory of species confirmed or expected to produce sound underwater. We used several existing inventories and additional literature searches to compile a dataset categorizing scientific knowledge of sonifery for 33,462 species and subspecies across marine mammals, other tetrapods, fishes, and invertebrates. We found 729 species documented as producing active and/or passive sounds under natural conditions, with another 21,911 species deemed likely to produce sounds based on evaluated taxonomic relationships. The dataset is available on both figshare and WoRMS where it can be regularly updated as new information becomes available. The data can also be integrated with other databases (e.g., SeaLifeBase, Global Biodiversity Information Facility) to advance future research on the distribution, evolution, ecology, management, and conservation of underwater soniferous species worldwide.

Prior exposure to weathered oil influences foraging of an ecologically important saltmarsh resident fish.

Estuarine ecosystem balance typically relies on strong food web interconnectedness dependent on a relatively low number of resident taxa, presenting a potential ecological vulnerability to extreme ecosystem disturbances. Following the Deepwater Horizon (DwH) oil spill disaster of the northern Gulf of Mexico (USA), numerous ecotoxicological studies showed severe species-level impacts of oil exposure on estuarine fish and invertebrates, yet post-spill surveys found little evidence for severe impacts to coastal populations, communities, or food webs. The acknowledgement that several confounding factors may have limited researchers' abilities to detect negative ecosystem-level impacts following the DwH spill drives the need for direct testing of weathered oil exposure effects on estuarine residents with high trophic connectivity. Here, we describe an experiment that examined the influence of previous exposure to four weathered oil concentrations (control: 0.0 L oil m-2; low: 0.1 L oil m-2; moderate: 0.5-1 L oil m-2; high: 3.0 L oil m-2) on foraging rates of the ecologically important Gulf killifish (Fundulus grandis). Following exposure in oiled saltmarsh mesocosms, killifish were allowed to forage on grass shrimp (Palaeomonetes pugio) for up to 21 h. We found that previous exposure to the high oil treatment reduced killifish foraging rate by ~37% on average, compared with no oil control treatment. Previous exposure to the moderate oil treatment showed highly variable foraging rate responses, while low exposure treatment was similar to unexposed responses. Declining foraging rate responses to previous high weathered oil exposure suggests potential oil spill influence on energy transfer between saltmarsh and off-marsh systems. Additionally, foraging rate variability at the moderate level highlights the large degree of intraspecific variability for this sublethal response and indicates this concentration represents a potential threshold of oil exposure influence on killifish foraging. We also found that consumption of gravid vs non-gravid shrimp was not independent of prior oil exposure concentration, as high oil exposure treatment killifish consumed ~3× more gravid shrimp than expected. Our study findings highlight the sublethal effects of prior oil exposure on foraging abilities of ecologically valuable Gulf killifish at realistic oil exposure levels, suggesting that important trophic transfers of energy to off-marsh systems may have been impacted, at least in the short-term, by shoreline oiling at highly localized scales. This study provides support for further experimental testing of oil exposure effects on sublethal behavioral impacts of ecologically important estuarine species, due to the likelihood that some ecological ramifications of DwH on saltmarshes likely went undetected.

Drift macroalgal distribution in northern Gulf of Mexico seagrass meadows.

Drift macroalgae, often found in clumps or mats adjacent to or within seagrass beds, can increase the value of seagrass beds as habitat for nekton via added food resources and structural complexity. But, as algal biomass increases, it can also decrease light availability, inhibit faunal movements, smother benthic communities, and contribute to hypoxia, all of which can reduce nekton abundance. We quantified the abundance and distribution of drift macroalgae within seagrass meadows dominated by turtle grass Thalassia testudinum across the northern Gulf of Mexico and compared seagrass characteristics to macroalgal biomass and distribution. Drift macroalgae were most abundant in areas with higher seagrass shoot densities and intermediate canopy heights. We did not find significant relationships between algal biomass and point measures of salinity, temperature, or depth. The macroalgal genera Laurencia and Gracilaria were present across the study region, Agardhiella and Digenia were collected in the western Gulf of Mexico, and Acanthophora was collected in the eastern Gulf of Mexico. Our survey revealed drift algae to be abundant and widespread throughout seagrass meadows in the northern Gulf of Mexico, which likely influences the habitat value of seagrass ecosystems.

Differential habitat use and antipredator response of juvenile roach (Rutilus rutilus) to olfactory and visual cues from multiple predators.

The indirect, behavioral effects of predation and predator-predator interactions can significantly alter the trophic ecology of many communities. In numerous instances, the strength of these effects may be determined by the ability of prey to identify predation risk through predator-specific cues and respond accordingly to avoid capture. We exposed juvenile roach (Rutilus rutilus), a common forage fish in many brackish and freshwater environments, to vision and/or olfactory cues from two predators with different hunting methods: northern pike (Esox lucius, an ambush predator) and European perch (Perca fluviatilis, a roving predator). Our results demonstrated that responses of roach to perceived risk (as evidenced by their selection of structured or open-water habitats) were highly dependent on cue type and predator identity. For instance, roach responded to olfactory cues of pike by entering open-water habitat, but entered structured habitat when presented with a vision cue of this predator. Opposite responses were elicited from roach for both olfactory and visual cues of perch. Interestingly, roach defaulted to selection of structured habitat when presented with vision + olfaction cues of either predator. Moreover, when presented individual cues of both predators together, roach responded by choosing open-water habitat. Upon being presented with vision + olfaction cues of both predators, however, roach strongly favored structured habitat. Differences in habitat selection of roach were likely in response to the alternative foraging strategies of the two predators, and suggest that prey species may not always use structured habitats as protection. This appears particularly true when a threat is perceived, but cannot immediately be located. These results provide insight to the complex and variable nature by which prey respond to various cues and predators, and offer a mechanistic guide for how behaviorally mediated and predator-predator interactions act as structuring processes in aquatic systems.

Poleward expansion of common snook Centropomus undecimalis in the northeastern Gulf of Mexico and future research needs.

Globally, rising temperatures have resulted in numerous examples of poleward shifts in species distribution patterns with accompanying changes in community structure and ecosystem processes. In the Gulf of Mexico, higher mean temperatures and less frequent winter freezes have led to the expansion of tropics-associated marine organisms. Our objectives were to quantify changing environmental conditions and the poleward expansion of the common snook Centropomus undecimalis into the Cedar Keys area of Florida, USA (29 deg N). The snook is an economically and recreationally important sport fish found from southern Brazil to south Florida. Cedar Key and the Lower Suwannee River are north of the snook's historically documented range, likely due to lethal water temperatures during winter. Using data from a long-term monitoring program, we report an increase in catches of snook in this area since 2007. The spatial and temporal expansion of the species began with adult fish in 2007. By 2018, snook of all sizes were found in the region, and we found strong evidence of local reproduction during 2016-2018. The locations of nursery habitat and winter thermal refuges (e.g., freshwater springs) need to be identified and have implications for land-use policy and minimum-flow regulations for rivers. The arrival of the snook in the northern Gulf of Mexico could affect food web ecology and habitat interactions among estuarine predators, and future studies should evaluate snook's food habits and competitive interactions with resident fishes in this expanded range. Our study provides an example of how species range expansions due to changing temperatures should result in new research priorities to evaluate impacts of climate change on coastal systems.

Previous oil exposure alters Gulf Killifish Fundulus grandis oil avoidance behavior.

Oil spills threaten the structure and function of ecological communities. The Deepwater Horizon spill was predicted to have catastrophic consequences for nearshore fishes, but field studies indicate resilience in populations and communities. Previous research indicates many marsh fishes exhibit avoidance of oil contaminated areas, representing one potential mechanism for this resilience. Here, we test whether prior oil exposure of Gulf killifish Fundulus grandis alters this avoidance response. Using choice tests between unoiled and oiled sediments at one of three randomized concentrations (low: 0.1 L oil m-2, medium: 0.5 L oil m-2, or high: 3.0 L oil m-2), we found that, even at low prior exposure levels, killifish lose recognition of oiled sediments compared to control, unexposed fish. Preference for unoiled sediments was absent across all oil concentrations after oil exposure, and some evidence for preference of oiled sediments at high exposure was demonstrated. These results highlight the lack of response to toxic environments in exposed individuals, indicating altered behavior despite organism survival. Future research should document additional sublethal consequences that affect ecosystem and food web functioning.

Disturbance-driven changes to northern Gulf of Mexico nekton communities following the Deepwater Horizon oil spill.

The 2010 Deepwater Horizon (DwH) oil spill in the Gulf of Mexico discharged ~3.19 million barrels of oil into Gulf waters, making it one of the largest marine disasters in history in terms of volume. We report on the results of a study to assess oil impacts to coastal fishes and invertebrates. Using two-decades of fisheries-independent data in coastal Alabama and Mississippi, we document variability following both natural and anthropogenic disturbances from two periods pre-DwH (1997-2001 and 2007-2009), one intra-spill period for acute DwH effects (2010-2012) and one period post-spill for chronic, longer-term impacts (2014-2017). Results indicated significant changes to community structure, relative abundance, and diversity in the intra-spill period. Causation for changes is confounded by variables such as behavioral emigration, altered freshwater inflow, death of consumers, and the mandated fishery closure. Results highlight the need for long-term, comprehensive monitoring/observing systems to provide adequate background for assessing future disturbances.

Rapid HIV testing in transgender communities by community-based organizations in three cities.

OBJECTIVES: This article describes the demographic and behavioral characteristics, human immunodeficiency virus (HIV) testing history, and results of HIV testing of transgender (TG) people recruited for rapid HIV testing by community-based organizations (CBOs) in three cities. METHODS: CBOs in Miami Beach, Florida, New York City, and San Francisco offered TG people rapid HIV testing and prevention services, and conducted a brief survey. Participants were recruited in outreach settings using various strategies. The survey collected information on demographic characteristics, HIV risk behaviors, and HIV testing history. RESULTS: Among 559 male-to-female (MTF) TG participants, 12% were newly diagnosed with HIV infection. None of the 42 female-to-male participants were newly diagnosed with HIV. A large proportion of MTF TG participants reported high-risk behaviors in the past year, including 37% who reported unprotected receptive anal intercourse and 44% who reported commercial sex work. Several factors were independently associated with increased likelihood of being newly diagnosed with HIV infection among MTF TG participants, including having a partner of unknown HIV status in the past year; being 20-29 or > or = 40 years of age; having last been tested for HIV more than 12 months ago; and having been recruited at the New York City site. CONCLUSIONS: Based on the high proportion of undiagnosed HIV infection among those tested, TG people represent an important community for enhanced HIV testing and prevention efforts. MTF TG people should be encouraged to have an HIV test at least annually or more often if indicated, based upon clinical findings or risk behaviors. Efforts should continue for developing novel strategies to overcome barriers and provide HIV testing and prevention services to TG people.

Herbivory of oil-exposed submerged aquatic vegetation Ruppia maritima.

Oil spills, such as the Deepwater Horizon spill in the Gulf of Mexico, have the potential to dramatically alter coastal food webs through a variety of mechanisms. While oil can have direct impacts on primary producers through toxicity and shading, it is also possible that more subtle, indirect changes to the interactions among organisms could alter energy flow through the ecosystem. Here, we present the results of a series of manipulative experiments to determine the impacts of oil exposure on herbivory of Ruppia maritima, one of the most common species of submerged vegetation found in the region impacted by the 2010 Deepwater Horizon oil spill. In previous experiments, R. maritima was grown in a range of manipulated sediment oil concentrations. Using plant tissue from this experiment, we analyzed the effects of oil on plant chemical composition and found that plant carbon:nitrogen ratio (C:N) was reduced by as much as 21% in plants exposed to higher concentrations of oil. Given that nitrogen plays a key role in herbivore preference patterns, we performed herbivory assays and found oil-contaminated plants were preferred by herbivores in choice trials, although subsequent no-choice experiments indicated herbivores consumed less oil-contaminated tissue. We hypothesize the reason for this is that more tissue of higher C:N content is needed to meet similar metabolic demands while avoiding the potentially negative impacts of feeding on contaminated tissues. These results indicate that substantial food web alterations may occur via enhanced consumption of oil-exposed plants and provides vital information necessary to assess the large-scale impact of oil on submerged macrophytes.

Effects of Oil-Contaminated Sediments on Submerged Vegetation: An Experimental Assessment of Ruppia maritima.

Oil spills threaten the productivity of ecosystems through the degradation of coastal flora and the ecosystem services these plants provide. While lab and field investigations have quantified the response of numerous species of emergent vegetation to oil, the effects on submerged vegetation remain uncertain. Here, we discuss the implications of oil exposure for Ruppia maritima, one of the most common species of submerged vegetation found in the region affected by the recent Deepwater Horizon oil spill. We grew R. maritima in a range of manipulated sediment oil concentrations: 0, 0.26, 0.53, and 1.05 mL oil /L tank volume, and tracked changes in growth (wet weight and shoot density/length), reproductive activity (inflorescence and seed production), root characteristics (mass, length, diameter, and area), and uprooting force of plants. While no statistical differences were detected in growth, plants exhibited significant changes to reproductive output, root morphology, and uprooting force. We found significant reductions in inflorescences and fruiting bodies at higher oil concentrations. In addition, the roots growing in the high oil were shorter and wider. Plants in medium and high oil required less force to uproot. A second experiment was performed to separate the effects of root morphology and oiled sediment properties and indicated that there were also changes to sediment cohesion that contributed to a reduction in uprooting forces in medium and high oil. Given the importance of sexual reproduction for these plants, oil contamination may have substantial population-level effects. Moreover, areas containing buried oil may be more susceptible to high energy storm events due to the reduction in uprooting force of foundation species such as R. maritima.

Naïve prey exhibit reduced antipredator behavior and survivorship.

Prey naiveté has been hypothesized to be one of the major driving forces behind population declines following the introduction of novel predators or release of inexperienced prey into predator rich environments. In these cases, naïve prey may lack sufficient antipredator behavior and, as a result, suffer increased mortality. Despite this, some evidence suggests that many prey utilize a generalized response to predators. Here, the naiveté hypothesis is tested using a predator-prey pair sharing an evolutionary history: the red swamp crayfish (Procambarus clarkii Girard, 1852) and largemouth bass (Micropterus salmoides Lacépède, 1802). Using farm-reared, naïve crayfish and wild-caught, experienced individuals, laboratory experiments demonstrated that naïve, farmed crayfish lack behavioral responses to chemical cues from bass, both in terms of movement and use of structural refuge. In contrast, experienced crayfish responded strongly to the same cues. In a subsequent field tethering experiment, these naïve individuals suffered a three-fold increase in predation rate. Based on these results, recognition of predators may not be innate in all prey, and previous experience and learning likely play a key role in the development of antipredator behavior.

Dental headache care and assessing and treating dental force-related problems.

An innovative assessment and treatment protocol system now enables dentists to more effectively and comprehensively assess and treat patients with chronic headache and migraine pain, as well as other dental force-related conditions. The system combines objective assessment with scientifically based, systematic, and predictable treatment methods and technologies to offer successful outcomes and maintenance.