Dinoflagellate vertical migration fuels an intense red tide.

Harmful algal blooms (HABs) are increasing globally, causing economic, human health, and ecosystem harm. In spite of the frequent occurrence of HABs, the mechanisms responsible for their exceptionally high biomass remain imperfectly understood. A 50-y-old hypothesis posits that some dense blooms derive from dinoflagellate motility: organisms swim upward during the day to photosynthesize and downward at night to access deep nutrients. This allows dinoflagellates to outgrow their nonmotile competitors. We tested this hypothesis with in situ data from an autonomous, ocean-wave-powered vertical profiling system. We showed that the dinoflagellate Lingulodinium polyedra's vertical migration led to depletion of deep nitrate during a 2020 red tide HAB event. Downward migration began at dusk, with the maximum migration depth determined by local nitrate concentrations. Losses of nitrate at depth were balanced by proportional increases in phytoplankton chlorophyll concentrations and suspended particle load, conclusively linking vertical migration to the access and assimilation of deep nitrate in the ocean environment. Vertical migration during the red tide created anomalous biogeochemical conditions compared to 70 y of climatological data, demonstrating the capacity of these events to temporarily reshape the coastal ocean's ecosystem and biogeochemistry. Advances in the understanding of the physiological, behavioral, and metabolic dynamics of HAB-forming organisms from cutting-edge observational techniques will improve our ability to forecast HABs and mitigate their consequences in the future.

Phytoplankton thermal trait parameterization alters community structure and biogeochemical processes in a modeled ocean.

Phytoplankton exhibit diverse physiological responses to temperature which influence their fitness in the environment and consequently alter their community structure. Here, we explored the sensitivity of phytoplankton community structure to thermal response parameterization in a modelled marine phytoplankton community. Using published empirical data, we evaluated the maximum thermal growth rates (µmax ) and temperature coefficients (Q10 ; the rate at which growth scales with temperature) of six key Phytoplankton Functional Types (PFTs): coccolithophores, cyanobacteria, diatoms, diazotrophs, dinoflagellates, and green algae. Following three well-documented methods, PFTs were either assumed to have (1) the same µmax and the same Q10 (as in to Eppley, 1972), (2) a unique µmax but the same Q10 (similar to Kremer et al., 2017), or (3) a unique µmax and a unique Q10 (following Anderson et al., 2021). These trait values were then implemented within the Massachusetts Institute of Technology biogeochemistry and ecosystem model (called Darwin) for each PFT under a control and climate change scenario. Our results suggest that applying a µmax and Q10 universally across PFTs (as in Eppley, 1972) leads to unrealistic phytoplankton communities, which lack diatoms globally. Additionally, we find that accounting for differences in the Q10 between PFTs can significantly impact each PFT's competitive ability, especially at high latitudes, leading to altered modeled phytoplankton community structures in our control and climate change simulations. This then impacts estimates of biogeochemical processes, with, for example, estimates of export production varying by ~10% in the Southern Ocean depending on the parameterization. Our results indicate that the diversity of thermal response traits in phytoplankton not only shape community composition in the historical and future, warmer ocean, but that these traits have significant feedbacks on global biogeochemical cycles.

Predicting Colonic Neoplasia Surgical Complications: A Machine Learning Approach.

BACKGROUND: A range of statistical approaches have been used to help predict outcomes associated with colectomy. The multifactorial nature of complications suggests that machine learning algorithms may be more accurate in determining postoperative outcomes by detecting nonlinear associations, which are not readily measured by traditional statistics. OBJECTIVE: The aim of this study was to investigate the utility of machine learning algorithms to predict complications in patients undergoing colectomy for colonic neoplasia. DESIGN: Retrospective analysis using decision tree, random forest, and artificial neural network classifiers to predict postoperative outcomes. SETTINGS: National Inpatient Sample database (2003-2017). PATIENTS: Adult patients who underwent elective colectomy with anastomosis for neoplasia. MAIN OUTCOME MEASURES: Performance was quantified using sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve to predict the incidence of anastomotic leak, prolonged length of stay, and inpatient mortality. RESULTS: A total of 14,935 patients (4731 laparoscopic, 10,204 open) were included. They had an average age of 67 ± 12.2 years, and 53% of patients were women. The 3 machine learning models successfully identified patients who developed the measured complications. Although differences between model performances were largely insignificant, the neural network scored highest for most outcomes: predicting anastomotic leak, area under the receiver operating characteristic curve 0.88/0.93 (open/laparoscopic, 95% CI, 0.73-0.92/0.80-0.96); prolonged length of stay, area under the receiver operating characteristic curve 0.84/0.88 (open/laparoscopic, 95% CI, 0.82-0.85/0.85-0.91); and inpatient mortality, area under the receiver operating characteristic curve 0.90/0.92 (open/laparoscopic, 95% CI, 0.85-0.96/0.86-0.98). LIMITATIONS: The patients from the National Inpatient Sample database may not be an accurate sample of the population of all patients undergoing colectomy for colonic neoplasia and does not account for specific institutional and patient factors. CONCLUSIONS: Machine learning predicted postoperative complications in patients with colonic neoplasia undergoing colectomy with good performance. Although validation using external data and optimization of data quality will be required, these machine learning tools show great promise in assisting surgeons with risk-stratification of perioperative care to improve postoperative outcomes. See Video Abstract . PREDICCIN DE LAS COMPLICACIONES QUIRRGICAS DE LA NEOPLASIA DE COLON UN ENFOQUE DE MODELO DE APRENDIZAJE AUTOMTICO: ANTECEDENTES:Se han utilizado una variedad de enfoques estadísticos para ayudar a predecir los resultados asociados con la colectomía. La naturaleza multifactorial de las complicaciones sugiere que los algoritmos de aprendizaje automático pueden ser más precisos en determinar los resultados posoperatorios al detectar asociaciones no lineales, que generalmente no se miden en las estadísticas tradicionales.OBJETIVO:El objetivo de este estudio fue investigar la utilidad de los algoritmos de aprendizaje automático para predecir complicaciones en pacientes sometidos a colectomía por neoplasia de colon.DISEÑO:Análisis retrospectivo utilizando clasificadores de árboles de decisión, bosques aleatorios y redes neuronales artificiales para predecir los resultados posoperatorios.AJUSTE:Base de datos de la Muestra Nacional de Pacientes Hospitalizados (2003-2017).PACIENTES:Pacientes adultos sometidos a colectomía electiva con anastomosis por neoplasia.INTERVENCIONES:N/A.PRINCIPALES MEDIDAS DE RESULTADO:El rendimiento se cuantificó utilizando la sensibilidad, especificidad, precisión y la característica operativa del receptor del área bajo la curva para predecir la incidencia de fuga anastomótica, duración prolongada de la estancia hospitalaria y mortalidad de los pacientes hospitalizados.RESULTADOS:Se incluyeron un total de 14.935 pacientes (4.731 laparoscópicos, 10.204 abiertos). Presentaron una edad promedio de 67 ± 12,2 años y el 53% eran mujeres. Los tres modelos de aprendizaje automático identificaron con éxito a los pacientes que desarrollaron las complicaciones medidas. Aunque las diferencias entre el rendimiento del modelo fueron en gran medida insignificantes, la red neuronal obtuvo la puntuación más alta para la mayoría de los resultados: predicción de fuga anastomótica, característica operativa del receptor del área bajo la curva 0,88/0,93 (abierta/laparoscópica, IC del 95%: 0,73-0,92/0,80-0,96); duración prolongada de la estancia hospitalaria, característica operativa del receptor del área bajo la curva 0,84/0,88 (abierta/laparoscópica, IC del 95%: 0,82-0,85/0,85-0,91); y mortalidad de pacientes hospitalizados, característica operativa del receptor del área bajo la curva 0,90/0,92 (abierto/laparoscópico, IC del 95%: 0,85-0,96/0,86-0,98).LIMITACIONES:Los pacientes de la base de datos de la Muestra Nacional de Pacientes Hospitalizados pueden no ser una muestra precisa de la población de todos los pacientes sometidos a colectomía por neoplasia de colon y no tienen en cuenta factores institucionales y específicos del paciente.CONCLUSIONES:El aprendizaje automático predijo con buen rendimiento las complicaciones postoperatorias en pacientes con neoplasia de colon sometidos a colectomía. Aunque será necesaria la validación mediante datos externos y la optimización de la calidad de los datos, estas herramientas de aprendizaje automático son muy prometedoras para ayudar a los cirujanos con la estratificación de riesgos de la atención perioperatoria para mejorar los resultados posoperatorios. (Traducción-Dr. Fidel Ruiz Healy ).

KiteLock 4%: the next generation of CVAD locking solutions.

Central venous access devices (CVADs), including peripherally inserted central catheters (PICCs) and cuffed tunnelled catheters, play a crucial role in modern medicine by providing reliable access for medication and treatments directly into the bloodstream. However, these vital medical devices also pose a significant risk of catheter-related bloodstream infections (CRBSIs) alongside associated complications such as thrombosis or catheter occlusion. To mitigate these risks, healthcare providers employ various strategies, including the use of locking solutions in combination with meticulous care and maintenance protocols. KiteLock 4% catheter lock is a solution designed to combat the triple threat of infection, occlusion and biofilm. This locking solution is described as the only locking solution to provide cover for all three complications.

Extravasation and infiltration: under-recognised complications of intravenous therapy.

Occasionally, the administration of intravenous (IV) therapies can go wrong. Infiltration or extravasation is a complication when a drug or IV therapy leaks into the tissues surrounding the vascular access device. Extravasation can cause serious and often life-changing injuries. Extravasation is often associated with systemic anti-cancer therapy but non-chemotherapy drugs have been reported as having a greater risk of serious complications. This study outlines the first UK Infusion unit evaluation of the ivWatch infusion monitoring device which was undertaken from August 2023 to January 2024. Out of 2254 infusions monitored with ivWatch, the device prevented 122 cases of infiltration and extravasation from causing any harm to the patient, corresponding to a 5.4% 'check IV' notification rate.

Rapid haemostasis to achieve dressing longevity: evaluation trial results using StatSeal catheter exit site protection.

Peripherally inserted central catheters (PICCs) are vital in delivering intravenous therapy. Despite their advantages, PICCs can lead to complications such as catheter exit site bleeding, which can cause patient distress and increase infection risk. This study evaluated the efficacy of StatSeal, a topical haemostatic device, in managing PICC exit site bleeding. StatSeal uses a hydrophilic polymer and potassium ferrate to form a seal, reducing access site bleeding and minimising dressing changes. For this study, Patients were recruited at Frimley Health NHS Foundation Trust; the trial involved 177 patients with StatSeal, and shows that 99% did not require additional dressing changes within the standard 7-day period. The findings demonstrate StatSeal's effectiveness in improving patient outcomes by reducing exit site bleeding and associated complications, enhancing the efficiency of vascular access maintenance and potentially lowering associated healthcare costs. The trial emphasises the importance of innovative solutions such as StatSeal to advance PICC care and improve patient experience.

Elastomeric, fillable infusion pumps: an overview for clinical practice.

Due to advances in elastomeric pump technology, there are now devices available that can be filled with intravenous (IV) therapy at the bed or chair side. These devices are safe, reliable and enable the patient to be mobile when having their infusion. The Surefuser™+ elastomeric infusion pump is available in multiple configurations and allows patients to remain independent and receive IV therapy infusions in their own homes. The pump can also be used in the acute healthcare setting where traditional electronic infusion pumps may not be available. This article provides an overview of the Surefuser+ elastomeric infusion pump, its features and mode of action and how it can be used in clinical practice.

How to improve aseptic technique to reduce bloodstream infection during vascular access procedures.

Bloodstream infections associated with vascular access procedures pose a serious risk to patients that can be reduced by better standards of aseptic technique. The objectives of this roundtable of experts were to achieve a consensus on how to improve skin antisepsis in hospital, improve training, competency, compliance and consistency in skin antisepsis, review the role of devices in improving skin antisepsis, identify methods to improve skin antisepsis integrated with the Aseptic Non Touch Technique (ANTT®) approach, and identify challenges to the implementation of the panel's recommendations. Recommendations include using MHRA-licensed 2% chlorhexidine gluconate in 70% isopropyl alcohol solution with bidirectional strokes for up to 30 seconds, then leaving the skin to air dry for 30 seconds; using the ANTT Clinical Practice Framework and terminology as the standard for skin antisepsis training and practice; standardised ANTT and skin antisepsis education with 3-yearly competency assessments for all UK health professionals; and more research to address the evidence gap on transmission of infection after skin antisepsis.

Anthropogenic climate change impacts on copepod trait biogeography.

Copepods are among the most abundant marine metazoans and form a key link between marine primary producers, higher trophic levels, and carbon sequestration pathways. Climate change is projected to change surface ocean temperature by up to 4°C in the North Atlantic with many associated changes including slowing of the overturning circulation, areas of regional freshening, and increased salinity and reductions in nutrients available in the euphotic zone over the next century. These changes will lead to a restructuring of phytoplankton and zooplankton communities with cascading effects throughout the food web. Here we employ observations of copepods, projected changes in ocean climate, and species distribution models to show how climate change may affect the distribution of copepod species in the North Atlantic. On average species move northeast at a rate of 14.1 km decade-1 . Species turnover in copepod communities will range from 5% to 75% with the highest turnover rates concentrated in regions of pronounced temperature increase and decrease. The changes in species range vary according to copepod traits with the largest effects found to occur in the cooling, freshening area in the subpolar North Atlantic south of Greenland and in an area of significant warming along the Scotian shelf. Large diapausing copepods (>2.5 mm) which are higher in lipids and a crucial food source for whales, may have an advantage in the cooling waters due to their life-history strategy that facilitates their survival in the arctic environment. Carnivorous copepods show a basin wide increase in species richness and show significant habitat area increases when their distribution moves poleward while herbivores see significant habitat area losses. The trait-specific effects highlight the complex consequences of climate change for the marine food web.

Medical adhesive-related skin injuries associated with vascular access: minimising risk with Appeel Sterile.

Vascular access device insertion is a common procedure in healthcare, and complications associated with vascular access can be serious and cause considerable patient harm. The use of care bundles to reduce the risks of these complications is well documented. However, the removal of devices, especially those associated with medical adhesive, can cause significant skin injuries, which often could be avoided if this aspect is included in the care bundle and the risk factors are better understood in healthcare. Appeel Sterile is an effective sterile silicone-based medical adhesive remover that is available in a variety of formats. It is the only sterile medical adhesive remover available, which makes it the safest choice for use with vascular access devices.

Universal adhesive vascular access securement with Grip-Lok devices.

The use of sutureless, adhesive securement devices in vascular access has become recommended as best practice, because they are a cost-effective, reliable solution. After a vascular access device has been inserted, catheter securement is one of the most important aspects of care and maintenance. The Grip-Lok® range offers secure, comfortable adhesive securement for all types of vascular access devices. The products use hypoallergenic medical adhesive, which reduces the risk of skin irritation and provides a reliable, adaptable alternative to suturing.

Anthropogenic climate change drives shift and shuffle in North Atlantic phytoplankton communities.

Anthropogenic climate change has shifted the biogeography and phenology of many terrestrial and marine species. Marine phytoplankton communities appear sensitive to climate change, yet understanding of how individual species may respond to anthropogenic climate change remains limited. Here, using historical environmental and phytoplankton observations, we characterize the realized ecological niches for 87 North Atlantic diatom and dinoflagellate taxa and project changes in species biogeography between mean historical (1951-2000) and future (2051-2100) ocean conditions. We find that the central positions of the core range of 74% of taxa shift poleward at a median rate of 12.9 km per decade (km⋅dec(-1)), and 90% of taxa shift eastward at a median rate of 42.7 km⋅dec(-1) The poleward shift is faster than previously reported for marine taxa, and the predominance of longitudinal shifts is driven by dynamic changes in multiple environmental drivers, rather than a strictly poleward, temperature-driven redistribution of ocean habitats. A century of climate change significantly shuffles community composition by a basin-wide median value of 16%, compared with seasonal variations of 46%. The North Atlantic phytoplankton community appears poised for marked shift and shuffle, which may have broad effects on food webs and biogeochemical cycles.

The case for using a disinfecting cap for needlefree connectors.

Catheter-related bloodstream infections (CRBSIs) are a signification cause of infection. When CRBSI rates are high, the cost to the patient and the organisation can be significant. More than ever before, there is a high demand for vascular access. Advances in treatment often entail extended indwell times for central vascular access devices. The care and maintenance of these devices is crucial in avoiding complications such as infection. Using care bundles in conjunction with other simple interventions, such as passive disinfecting caps, can help reduce CRBSI rates. The published evidence demonstrates that passive disinfecting caps can help reduce infection rates associated with different types of central venous catheters by protecting needlefree connectors from colonisation by pathogens and serving as a clear indicator that the line has been disinfected.

Intravenous infusion drug administration: flushing guidance.

Andrew Barton and NIVAS board colleagues have produced evidence-based guidelines for health profesionals on how to avoid under-dosing in IV therapy. These guidelines, in association with NIVAS, are presented here.

Clinical use of closed-system safety peripheral intravenous cannulas.

Peripheral intravenous (IV) cannulas are the quickest and most effective way of gaining venous vascular access and administering IV therapy. Closed-system peripheral IV cannulas have been shown to be safe and more reliable than open, non-valved peripheral cannulas in clinical practice. This article introduces the Smiths Medical DeltaVen closed-system peripheral IV cannula and includes three case studies describing its use in clinical practice and associated patient outcomes.

Evaluation of a device to improve non-coring needle insertion into implanted intravenous ports.

Implanted intravenous ports (IPs) are increasingly used in health care. The experience of having IPs accessed can vary a great deal for patients. Successful IP access depends on the experience and skill of the health professional and wrongly positioned attempts are not only painful for the patient but can also cause damage to the outer casing of the IP. The more skin punctures made over the port, the higher the risk of infection in the subcutaneous tissue. The Portacator is a sterile, single-use product that sits on the skin over the IP insertion site. Its purpose is to enable the successful insertion of a non-coring needle into the centre of the IP. The device's efficacy was investigated using a port test rig and by conducting a clinical evaluation in two hospital units that support patients with IPs who require regular IV therapy infusions for long-term illness. The device provides an easy reference for central non-coring needle insertion, and users were able to insert the needle closer to the port chamber centre when using the device as only two fingers are used to hold it in place, which gave them a less obstructed view of the site. The device improved the rates of first-time IP puncture success with a non-coring needle. Patient satisfaction increased as they were more confident insertion would be successful first time so they would experience less pain. Nurses felt better supported and more confident they could achieve success at their first attempt at IP access using the device.