Widespread habitat loss and redistribution of marine top predators in a changing ocean.

The Northwest Atlantic Ocean and Gulf of Mexico are among the fastest warming ocean regions, a trend that is expected to continue through this century with far-reaching implications for marine ecosystems. We examine the distribution of 12 highly migratory top predator species using predictive models and project expected habitat changes using downscaled climate models. Our models predict widespread losses of suitable habitat for most species, concurrent with substantial northward displacement of core habitats >500 km. These changes include up to >70% loss of suitable habitat area for some commercially and ecologically important species. We also identify predicted hot spots of multi-species habitat loss focused offshore of the U.S. Southeast and Mid-Atlantic coasts. For several species, the predicted changes are already underway, which are likely to have substantial impacts on the efficacy of static regulatory frameworks used to manage highly migratory species. The ongoing and projected effects of climate change highlight the urgent need to adaptively and proactively manage dynamic marine ecosystems.

Building use-inspired species distribution models: Using multiple data types to examine and improve model performance.

Species distribution models (SDMs) are becoming an important tool for marine conservation and management. Yet while there is an increasing diversity and volume of marine biodiversity data for training SDMs, little practical guidance is available on how to leverage distinct data types to build robust models. We explored the effect of different data types on the fit, performance and predictive ability of SDMs by comparing models trained with four data types for a heavily exploited pelagic fish, the blue shark (Prionace glauca), in the Northwest Atlantic: two fishery dependent (conventional mark-recapture tags, fisheries observer records) and two fishery independent (satellite-linked electronic tags, pop-up archival tags). We found that all four data types can result in robust models, but differences among spatial predictions highlighted the need to consider ecological realism in model selection and interpretation regardless of data type. Differences among models were primarily attributed to biases in how each data type, and the associated representation of absences, sampled the environment and summarized the resulting species distributions. Outputs from model ensembles and a model trained on all pooled data both proved effective for combining inferences across data types and provided more ecologically realistic predictions than individual models. Our results provide valuable guidance for practitioners developing SDMs. With increasing access to diverse data sources, future work should further develop truly integrative modeling approaches that can explicitly leverage the strengths of individual data types while statistically accounting for limitations, such as sampling biases.

Bottom marine heatwaves along the continental shelves of North America.

Recently, there has been substantial effort to understand the fundamental characteristics of warm ocean temperature extremes-known as marine heatwaves (MHWs). However, MHW research has primarily focused on the surface signature of these events. While surface MHWs (SMHW) can have dramatic impacts on marine ecosystems, extreme warming along the seafloor can also have significant biological outcomes. In this study, we use a high-resolution (~8 km) ocean reanalysis to broadly assess bottom marine heatwaves (BMHW) along the continental shelves of North America. We find that BMHW intensity and duration varies strongly with bottom depth, with typical intensities ranging from ~0.5 °C-3 °C. Further, BMHWs can be more intense and persist longer than SMHWs. While BMHWs and SMHWs often co-occur, BMHWs can also exist without a SMHW. Deeper regions in which the mixed layer does not typically reach the seafloor exhibit less synchronicity between BMHWs and SMHWs.

Thermal displacement by marine heatwaves.

Marine heatwaves (MHWs)-discrete but prolonged periods of anomalously warm ocean temperatures-can drastically alter ocean ecosystems, with profound ecological and socioeconomic impacts1-8. Considerable effort has been directed at understanding the patterns, drivers and trends of MHWs globally9-11. Typically, MHWs are characterized on the basis of their intensity and persistence at a given location-an approach that is particularly relevant for corals and other sessile organisms that must endure increased temperatures. However, many ecologically and commercially important marine species respond to environmental disruptions by relocating to favourable habitats, and dramatic range shifts of mobile marine species are among the conspicuous impacts of MHWs1,4,12,13. Whereas spatial temperature shifts have been studied extensively in the context of long-term warming trends14-18, they are unaccounted for in existing global MHW analyses. Here we introduce thermal displacement as a metric that characterizes MHWs by the spatial shifts of surface temperature contours, instead of by local temperature anomalies, and use an observation-based global sea surface temperature dataset to calculate thermal displacements for all MHWs from 1982 to 2019. We show that thermal displacements during MHWs vary from tens to thousands of kilometres across the world's oceans and do not correlate spatially with MHW intensity. Furthermore, short-term thermal displacements during MHWs are of comparable magnitude to century-scale shifts inferred from warming trends18, although their global spatial patterns are very different. These results expand our understanding of MHWs and their potential impacts on marine species, revealing which regions are most susceptible to thermal displacement, and how such shifts may change under projected ocean warming. The findings also highlight the need for marine resource management to account for MHW-driven spatial shifts, which are of comparable scale to those associated with long-term climate change and are already happening.

Comparing and synthesizing quantitative distribution models and qualitative vulnerability assessments to project marine species distributions under climate change.

Species distribution shifts are a widely reported biological consequence of climate-driven warming across marine ecosystems, creating ecological and social challenges. To meet these challenges and inform management decisions, we need accurate projections of species distributions. Quantitative species distribution models (SDMs) are routinely used to make these projections, while qualitative climate change vulnerability assessments are becoming more common. We constructed SDMs, compared SDM projections to expectations from a qualitative expert climate change vulnerability assessment, and developed a novel approach for combining the two methods to project the distribution and relative biomass of 49 marine species in the Northeast Shelf Large Marine Ecosystem under a "business as usual" climate change scenario. A forecasting experiment using SDMs highlighted their ability to capture relative biomass patterns fairly well (mean Pearson's correlation coefficient between predicted and observed biomass = 0.24, range = 0-0.6) and pointed to areas needing improvement, including reducing prediction error and better capturing fine-scale spatial variability. SDM projections suggest the region will undergo considerable biological changes, especially in the Gulf of Maine, where commercially-important groundfish and traditional forage species are expected to decline as coastal fish species and warmer-water forage species historically found in the southern New England/Mid-Atlantic Bight area increase. The SDM projections only occasionally aligned with vulnerability assessment expectations, with agreement more common for species with adult mobility and population growth rates that showed low sensitivity to climate change. Although our blended approach tried to build from the strengths of each method, it had no noticeable improvement in predictive ability over SDMs. This work rigorously evaluates the predictive ability of SDMs, quantifies expected species distribution shifts under future climate conditions, and tests a new approach for integrating SDMs and vulnerability assessments to help address the complex challenges arising from climate-driven species distribution shifts.

Challenges to natural and human communities from surprising ocean temperatures.

The community of species, human institutions, and human activities at a given location have been shaped by historical conditions (both mean and variability) at that location. Anthropogenic climate change is now adding strong trends on top of existing natural variability. These trends elevate the frequency of "surprises"-conditions that are unexpected based on recent history. Here, we show that the frequency of surprising ocean temperatures has increased even faster than expected based on recent temperature trends. Using a simple model of human adaptation, we show that these surprises will increasingly challenge natural modes of adaptation that rely on historical experience. We also show that warming rates are likely to shift natural communities toward generalist species, reducing their productivity and diversity. Our work demonstrates increasing benefits for individuals and institutions from betting that trends will continue, but this strategy represents a radical shift that will be difficult for many to make.

Climate vulnerability and resilience in the most valuable North American fishery.

Managing natural resources in an era of increasing climate impacts requires accounting for the synergistic effects of climate, ecosystem changes, and harvesting on resource productivity. Coincident with recent exceptional warming of the northwest Atlantic Ocean and removal of large predatory fish, the American lobster has become the most valuable fishery resource in North America. Using a model that links ocean temperature, predator density, and fishing to population productivity, we show that harvester-driven conservation efforts to protect large lobsters prepared the Gulf of Maine lobster fishery to capitalize on favorable ecosystem conditions, resulting in the record-breaking landings recently observed in the region. In contrast, in the warmer southern New England region, the absence of similar conservation efforts precipitated warming-induced recruitment failure that led to the collapse of the fishery. Population projections under expected warming suggest that the American lobster fishery is vulnerable to future temperature increases, but continued efforts to preserve the stock's reproductive potential can dampen the negative impacts of warming. This study demonstrates that, even though global climate change is severely impacting marine ecosystems, widely adopted, proactive conservation measures can increase the resilience of commercial fisheries to climate change.

Overview of a co-curricular professional development program in a college of pharmacy.

The goal of a professional program at a school or college of pharmacy is to produce competent and professional pharmacy practitioners. In 2009, The American College of Clinical Pharmacy published a white paper to assist in the teaching of professionalism in schools/colleges of pharmacy to include traits such as responsibility, commitment to excellence, respect for others, honesty and integrity, and care with compassion. In February 2015, the Accreditation Council for Pharmacy Education released their updated accreditation standards (Standards 2016) which introduced the concept of co-curricular activities (Standard 12.3): experiences that complement, augment, and/or advance what is learned in the formal didactic and experiential curriculum. This article details the Professional Development Curriculum at Western University of Health Sciences (WesternU) College of Pharmacy as a potential educational model that promotes professionalism through mandating co-curricular activities for student pharmacists.

Response to Comments on "Slow adaptation in the face of rapid warming leads to collapse of the Gulf of Maine cod fishery".

Palmer et al and Swain et al suggest that our "extra mortality" time series is spurious. In response, we show that including temperature-dependent mortality improves abundance estimates and that warming waters reduce growth rates in Gulf of Maine cod. Far from being spurious, temperature effects on this stock are clear, and continuing to ignore them puts the stock in jeopardy.

A Vulnerability Assessment of Fish and Invertebrates to Climate Change on the Northeast U.S. Continental Shelf.

Climate change and decadal variability are impacting marine fish and invertebrate species worldwide and these impacts will continue for the foreseeable future. Quantitative approaches have been developed to examine climate impacts on productivity, abundance, and distribution of various marine fish and invertebrate species. However, it is difficult to apply these approaches to large numbers of species owing to the lack of mechanistic understanding sufficient for quantitative analyses, as well as the lack of scientific infrastructure to support these more detailed studies. Vulnerability assessments provide a framework for evaluating climate impacts over a broad range of species with existing information. These methods combine the exposure of a species to a stressor (climate change and decadal variability) and the sensitivity of species to the stressor. These two components are then combined to estimate an overall vulnerability. Quantitative data are used when available, but qualitative information and expert opinion are used when quantitative data is lacking. Here we conduct a climate vulnerability assessment on 82 fish and invertebrate species in the Northeast U.S. Shelf including exploited, forage, and protected species. We define climate vulnerability as the extent to which abundance or productivity of a species in the region could be impacted by climate change and decadal variability. We find that the overall climate vulnerability is high to very high for approximately half the species assessed; diadromous and benthic invertebrate species exhibit the greatest vulnerability. In addition, the majority of species included in the assessment have a high potential for a change in distribution in response to projected changes in climate. Negative effects of climate change are expected for approximately half of the species assessed, but some species are expected to be positively affected (e.g., increase in productivity or move into the region). These results will inform research and management activities related to understanding and adapting marine fisheries management and conservation to climate change and decadal variability.

Slow adaptation in the face of rapid warming leads to collapse of the Gulf of Maine cod fishery.

Several studies have documented fish populations changing in response to long-term warming. Over the past decade, sea surface temperatures in the Gulf of Maine increased faster than 99% of the global ocean. The warming, which was related to a northward shift in the Gulf Stream and to changes in the Atlantic Multidecadal Oscillation and Pacific Decadal Oscillation, led to reduced recruitment and increased mortality in the region's Atlantic cod (Gadus morhua) stock. Failure to recognize the impact of warming on cod contributed to overfishing. Recovery of this fishery depends on sound management, but the size of the stock depends on future temperature conditions. The experience in the Gulf of Maine highlights the need to incorporate environmental factors into resource management.

Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care panel.

DESCRIPTION: After HIV diagnosis, timely entry into HIV medical care and retention in that care are essential to the provision of effective antiretroviral therapy (ART). Adherence to ART is among the key determinants of successful HIV treatment outcome and is essential to minimize the emergence of drug resistance. The International Association of Physicians in AIDS Care convened a panel to develop evidence-based recommendations to optimize entry into and retention in care and ART adherence for people with HIV. METHODS: A systematic literature search was conducted to produce an evidence base restricted to randomized, controlled trials and observational studies with comparators that had at least 1 measured biological or behavioral end point. A total of 325 studies met the criteria. Two reviewers independently extracted and coded data from each study using a standardized data extraction form. Panel members drafted recommendations based on the body of evidence for each method or intervention and then graded the overall quality of the body of evidence and the strength for each recommendation. RECOMMENDATIONS: Recommendations are provided for monitoring entry into and retention in care, interventions to improve entry and retention, and monitoring of and interventions to improve ART adherence. Recommendations cover ART strategies, adherence tools, education and counseling, and health system and service delivery interventions. In addition, they cover specific issues pertaining to pregnant women, incarcerated individuals, homeless and marginally housed individuals, and children and adolescents, as well as substance use and mental health disorders. Recommendations for future research in all areas are also provided.

The Role of the Home Environment and Routinization in ART Adherence.

Previous research suggests that routinization of medication-taking behavior promotes antiretroviral therapy (ART) adherence. The current study explored the nature of medication-taking routines in the home environment, where medication is most often taken, to identify home-based cues for taking ART. Qualitative interviews were conducted in the homes of 31 HIV-positive adult males in the United States with varying levels of adherence problems. Interviews were audiotaped and transcribed. Content analysis was performed to elicit themes from the text and further categorize responses. Patients with more routinized medication-taking behavior reported fewer adherence problems. Home-based medication-taking triggers that were especially common among patients who reported fewer adherence problems included meals, pillboxes, time of day, and visual cues. Findings characterize the nature of home-based medication-taking routines and suggest the potential utility of the home environment as a setting for adherence interventions.

The association between family history of mental disorder and delusional-like experiences: a general population study.

Recent studies have indicated that isolated delusional-like experiences (DLE) are common in the general population. Furthermore, there is preliminary evidence to suggest that these experiences are more common in those with a family history of mental disorders. We had the opportunity to explore the association between family history of a wide range of mental disorders and DLE in an Australian general population survey. The Australian National Survey of Mental Health and Wellbeing 2007 examined 8,841 adult community residents. The Composite International Diagnostic Interview was used to generate various DSM-IV lifetime diagnoses and to assess DLE. The participants were asked to report mental disorders in their first-degree relatives. The influence of family history of mental disorders on DLE endorsement was assessed with logistic regression, with adjustments for age, sex, and the presence of comorbid psychiatric diagnoses in the respondents. A family history of anxiety, depression, schizophrenia, bipolar disorder, or alcohol or illicit drug abuse/dependence was each significantly associated with endorsement of DLE, and these associations remained significant when we adjusted for the presence of mental illness in the respondents. When we examined a more restrictive definition of DLE, only a family history of depression and schizophrenia remained significantly associated with DLE. DLE are associated with a family history of a wide range of mental disorders. These findings suggest that familial factors associated with DLE may be shared with a wide range of common mental disorders.

Forecasting the dynamics of a coastal fishery species using a coupled climate--population model.

Marine fisheries management strives to maintain sustainable populations while allowing exploitation. However, well-intentioned management plans may not meet this balance as most do not include the effect of climate change. Ocean temperatures are expected to increase through the 21st century, which will have far-reaching and complex impacts on marine fisheries. To begin to quantify these impacts for one coastal fishery along the east coast of the United States, we develop a coupled climate-population model for Atlantic croaker (Micropogonias undulatus). The model is based on a mechanistic hypothesis: recruitment is determined by temperature-driven, overwinter mortality of juveniles in their estuarine habitats. Temperature forecasts were obtained from 14 general circulation models simulating three CO2 emission scenarios. An ensemble-based approach was used in which a multimodel average was calculated for a given CO2 emission scenario to forecast the response of the population. The coupled model indicates that both exploitation and climate change significantly affect abundance and distribution of Atlantic croaker. At current levels of fishing, the average (2010-2100) spawning biomass of the population is forecast to increase by 60-100%. Similarly, the center of the population is forecast to shift 50 100 km northward. A yield analysis, which is used to calculate benchmarks for fishery management, indicates that the maximum sustainable yield will increase by 30 100%. Our results demonstrate that climate effects on fisheries must be identified, understood, and incorporated into the scientific advice provided to managers if sustainable exploitation is to be achieved in a changing climate.

Interprofessional education in six US colleges of pharmacy.

OBJECTIVE: To present and describe interprofessional education (IPE) in 6 US colleges of pharmacy including benefits, barriers, and strategies for implementation. METHODS: A focus group with campus faculty IPE leaders and administrators was conducted at each of the 6 colleges. External facilitators used a structured script with open-ended questions to guide each session. A qualitative approach was used and content analysis of transcripts was conducted. RESULTS: On a 10-point scale, mean participant interest in IPE was 8.8 +/- 1.7. Incentives included enhanced student education, instructional economies of scale, improved communication among disciplines, and promotion of teamwork to improve quality of care. Curricular logistics, limited resources, lack of conceptual support, and cultural issues were the major barriers to IPE. Institutions were at various stages of IPE implementation. Participants emphasized that full institutional support was critical in maintaining IPE programs. CONCLUSION: Interest in IPE was high and opportunities were numerous as described by faculty members at the institutions; however, numerous challenges to implementation were identified.

Prospective study of topical testosterone gel (AndroGel) versus intramuscular testosterone in testosterone-deficient HIV-infected men.

PURPOSE: Testosterone replacement therapy via deep intramuscular injections causes extraphysiologic variations in serum testosterone concentrations. A topical transdermal testosterone gel formulation (AndroGel(R)) provides sustained physiologic concentrations of serum testosterone. The objective of this open-label switch study was to compare pharmacokinetics, safety, tolerability, and efficacy of delivery of daily testosterone gel versus intramuscular testosterone injection every 1 or 2 weeks in hypogonadal human immunodeficiency virus (HIV)-infected men. METHOD: Patients received intramuscular testosterone (100-200 mg/wk) for 8 weeks, then switched to daily topical testosterone gel (5-10 g gel/day) for 8 weeks. Study endpoints included free serum testosterone concentrations and quality-of-life scores. RESULTS: Thirty patients (average age, 45 years) were recruited; 24 completed the study. Mean peak free testosterone concentrations with intramuscular testosterone and testosterone gel were 42 pg/mL and 23 pg/mL, respectively, and mean peaktrough fluctuations in free testosterone were 26.7 +/- 12.8 pg/mL and 2.7 +/- 10.7 pg/mL, respectively (p < .001). Quality-of-life scores indicated more improved physical and emotional well-being with gel versus intramuscular testosterone. No significant changes in laboratory parameters or lean body mass were noted. CONCLUSION: Daily testosterone gel produced stable testosterone concentrations and improved quality of life compared with intermittent intramuscular testosterone injections.

Serious renal impairment occurs rarely with use of tenofovir DF.

PURPOSE: The purpose of this study was to evaluate the short-term effects (up to 6 months) of tenofovir disoproxil fumarate (DF) use on renal function in patients being treated for HIV-1 infection. METHOD: The charts of 447 HIV-1-infected patients who received at least three months of tenofovir DF treatment were reviewed. Data collected included demographics, concurrent antiretrovirals, other concurrent medications, CD4 counts and HIV-1 viral loads, and serum creatinine values while on tenofovir DF. Data collection was truncated at 6 months. RESULTS: Baseline serum creatinine (SCr) was 1.0 mg/dL, with a calculated creatinine clearance (CLCr) of 95.2 mL/min (using the Cockroft-Gault equation). There was no significant change in SCr or CLCr at 12 weeks (1.1 mg/dL and 92.7 mL/min, respectively) or 24 weeks (1.1 mg/dL and 92.9 mL/min, respectively). All three patients with grade 2 increases in SCr had other medical reasons for an increased SCr (one patient each had indinavir-associated nephrolithiasis, lactic acidosis, and pancreatitis). No patients experienced any complications from these increases in SCr. CONCLUSION: Increases in SCr and CLCr within the first 6 months of tenofovir DF therapy were rare. Although no clinical nephrotoxicity was observed, continued observation of renal function is warranted in patients predisposed to renal impairment.

Understanding and avoiding antiretroviral adverse events.

UNLABELLED: To discuss prevention and management of adverse drug reactions which result from antiretroviral use in patients infected with HIV. There are four classes of antiretroviral agents used in the treatment of HIV/AIDS. Side effects to medications are common place and often difficult to avoid. In many cases, research is not able to identify the exact cause of an event. The severity of adverse reactions varies greatly, and some may be difficult to manage; typically, prevention is more desirable than treatment. However, this is not always true. This paper will review class-wide and individual side effects from antiretrovirals and, in some cases, the mechanism of action that results in the event. Class-wide side effects for nucleoside/tide reverse transcriptase inhibitors (NRTIs) include lactic acidosis, peripheral neuropathy and lipoatrophy. Adverse reactions from individual NRTIs, such as abacavir-induced hypersensitivity reactions, will also be discussed. Class-wide side effects to non-nucleoside reverse transcriptase inhibitors include rash and hepatotoxicity, while efavirenz has its own unique CNS reactions. Protease inhibitor side effects include hyperglycemia, lipoaccumulation, dyslipidemia, and gastrointestinal (GI) intolerance. We will also review specific side effects caused by indinavir, ritonavir, and atazanavir. Finally, adverse reactions from the fusion inhibitor, enfuvirtide, will be mentioned. CONCLUSION: Antiretrovirals are an important break-through in the treatment of HIV/AIDS. However, adverse reactions from these drugs can range from mild to life-threatening, and determining which agent is the cause is frequently difficult to discern. Fortunately, side effects can be monitored, treated and in many cases, prevented.

Simplifying the treatment of HIV infection with ritonavir-boosted protease inhibitors in antiretroviral-experienced patients.

PURPOSE: The rationale, advantages, and disadvantages of attempting to enhance the efficacy of a primary protease inhibitor (PI) with ritonavir in the management of HIV infection, especially in patients who have previously undergone highly active antiretroviral therapy (HAART), are discussed. SUMMARY: PIs are pivotal components of the HAART regimens used to fight HIV infection. Long-term viral suppression remains a major clinical challenge. Certain pharmacologic features of many PIs, such as their limited oral bioavailability, necessitate burdensome dosage schedules, creating a barrier to patient adherence. Compliance may be further compromised by adverse events. Any factors that undermine adherence may increase the risk that plasma drug concentrations will be suboptimal and that viral resistance and subsequent treatment failure will develop. The pharmacokinetic enhancement, or "boosting," of PI levels with low-dose ritonavir may increase PI potency and efficacy, as well as decrease the emergence of viral resistance, reduce the pill burden, and simplify administration. A number of clinical studies suggest that PI-boosted regimens are safe and effective in HIV-infected patients who have been previously treated with antiretroviral agents, but more research is needed. CONCLUSION: PI boosting with ritonavir can improve PI pharmacokinetics so that potency and efficacy are increased and regimens are simplified, thereby potentially reducing antiretroviral resistance and promoting patient adherence.