The Added Complications of Climate Change: Understanding and Managing Biodiversity, Ecosystems, and Ecosystem Services Under Multiple Stressors.

Ecosystems around the world are already threatened by land-use and land-cover change, extraction of natural resources, biological disturbances, and pollution. These environmental stressors have been the primary source of ecosystem degradation to date, and climate change is now exacerbating some of their effects. Ecosystems already under stress are likely to have more rapid and acute reactions to climate change; it is therefore useful to understand how multiple stresses will interact, especially as the magnitude of climate change increases. Understanding these interactions could be critically important in the design of climate adaptation strategies, especially because actions taken by other sectors (eg energy, agriculture, transportation) to address climate change may create new ecosystem stresses

Common Carp Disrupt Ecosystem Structure and Function Through Middle-out Effects

Middle-out effects or a combination of top-down and bottom-up processes create many theoretical and empirical challenges in the realm of trophic ecology. We propose using specific autecology or species trait (i.e. behavioural) information to help explain and understand trophic dynamics that may involve complicated and nonunidirectional trophic interactions. The common carp (Cyprinus carpio) served as our model species for whole-lake observational and experimental studies; four trophic levels were measured to assess common carp-mediated middle-out effects across multiple lakes. We hypothesised that common carp could influence aquatic ecosystems through multiple pathways (i.e. abiotic and biotic foraging, early life feeding, nutrient). Both studies revealed most trophic levels were affected by common carp, highlighting strong middle-out effects likely caused by common carp foraging activities and abiotic influence (i.e. sediment resuspension). The loss of water transparency, submersed vegetation and a shift in zooplankton dynamics were the strongest effects. Trophic levels furthest from direct pathway effects were also affected (fish life history traits). The present study demonstrates that common carp can exert substantial effects on ecosystem structure and function. Species capable of middle-out effects can greatly modify communities through a variety of available pathways and are not confined to traditional top-down or bottom-up processes

Assessment of Potential Augmentation and Management Strategies for Razorback Sucker \u3cem\u3eXyrauchen texanus\u3c/em\u3e in Lake Mead and Grand Canyon: A 2021 Science Panel Summary

Razorback Sucker Xyrauchen texanus is a large-bodied, long-lived species endemic to the Colorado River Basin. This species historically ranged throughout the basin from the Colorado River delta in Mexico to Wyoming and Colorado. Currently, the species persists ,in a small portion of its historical range with the help of intensive management efforts including augmentation. Recruitment to adult life stages is extremely limited in the wild, but is documented consistently in Lake Mead. Research and monitoring efforts in Lake Mead are ongoing since 1996 and have recently expanded to include the Colorado River inflow area and portions of lower Grand Canyon. Despite evidence of recruitment, the current population size in Lake Mead and Grand Canyon is believed to be small (data) and susceptible to stochastic effects. This raised interest in the potential to augment the population to prevent loss of genetic diversity and increase abundance and distribution in general, as well as explore recruitment bottlenecks. To address critical uncertainties surrounding this management option and to brainstorm other potential options, a Planning Committee and Steering Committee made up of representatives of state (Arizona, Nevada), tribal (Hualapai Tribe, Navajo Nation), and federal (Bureau of Reclamation, National Park Service, and U.S. Fish and Wildlife Service) management agencies convened an Expert Science Panel (ESP; 2021), to consider augmentation and management strategies for Razorback Sucker in Lake Mead and Grand Canyon. The purpose of this report is to summarize those findings

Medical student and academic staff perceptions of role models: an analytical cross-sectional study

BACKGROUND: This study explored the associations between the perceptions of students and the perceptions of academic staff about the characteristics of clinical lecturers at the Department of Internal Medicine at Kerman University of Medical Sciences (KUMS). It also assessed what characteristics constitute a 'role model' from the point of view of students and staff. METHODS: Staff and students were questioned about the characteristics of their colleagues and lecturers, respectively. They were asked about 15 characteristics under four headings: personality, teaching skill, group working and overall performance as a role model. Associations between lecturers' characteristics were explored using Pearson correlation and characteristics were allocated into groups by partition cluster method. In addition, predictors of being a valuable lecturer were assessed using logistic regression analysis. RESULTS: Based on staff responses, the strongest association observed was between honesty and being respectful (r = 0.93, p < 0.0001). Based on student responses, the strongest association observed was between being professional and honesty (r = 0.98, p < 0.0001). None of the correlations between student and staff perceptions were significant for any characteristic. Two groups were recognized among the characteristics. group one contained those characteristics which were related to the lecturer's activity; while the second group contained characteristics that were related to the personality or teaching performance of the lecturer. The predictors of lecturer as 'role model' (i.e., perceptions of students) consisted mostly of characteristics from the first group, while the predictors of a 'role model' by fellow academic staff consisted of characteristics that were in both groups. CONCLUSION: These findings showed considerable differences between the perceptions of students about their lecturers when compared with perceptions of staff about their colleagues. Students were more concerned with the personality of their lecturers, while staff also considered their ideas and behaviors. This suggests that a more comprehensive assessment of a lecturer's performance could be obtained by taking into account feedback from both students and colleagues

Teaching clinical informatics to third-year medical students: negative results from two controlled trials

BACKGROUND: Prior educational interventions to increase seeking evidence by medical students have been unsuccessful. METHODS: We report two quasirandomized controlled trials to increase seeking of medical evidence by third-year medical students. In the first trial (1997–1998), we placed computers in clinical locations and taught their use in a 6-hour course. Based on negative results, we created SUMSearch(TM), an Internet site that automates searching for medical evidence by simultaneous meta-searching of MEDLINE and other sites. In the second trial (1999–2000), we taught SUMSearch's use in a 5½-hour course. Both courses were taught during the medicine clerkship. For each trial, we surveyed the entire third-year class at 6 months, after half of the students had taken the course (intervention group). The students who had not received the intervention were the control group. We measured self-report of search frequency and satisfaction with search quality and speed. RESULTS: The proportion of all students who reported searching at least weekly for medical evidence significantly increased from 19% (1997–1998) to 42% (1999–2000). The proportion of all students who were satisfied with their search results increased significantly between study years. However, in neither study year did the interventions increase searching or satisfaction with results. Satisfaction with the speed of searching was 27% in 1999–2000. This did not increase between studies years and was not changed by the interventions. CONCLUSION: None of our interventions affected searching habits. Even with automated searching, students report low satisfaction with search speed. We are concerned that students using current strategies for seeking medical evidence will be less likely to seek and appraise original studies when they enter medical practice and have less time

The U.S. Inland Creel and Angler Survey Catalog (CreelCat): Development, Applications, and Opportunities

Inland recreational fishing, defined as primarily leisure-driven fishing in freshwaters, is a popular pastime in the USA. State natural resource agencies endeavor to provide high-quality and sustainable fishing opportunities for anglers. Managers often use creel and other angler survey data to inform state- and waterbody-level management efforts. Despite the broad implementation of angler surveys and their importance to fisheries management at state scales, regional and national coordination among these activities is minimal, limiting data applicability for larger-scale management practices and research. Here, we introduce the U.S. Inland Creel and Angler Survey Catalog (CreelCat), a first-of-its-kind, publicly available national database of angler survey data that establishes a baseline of national inland recreational fishing metrics. We highlight research and management applications to help support sustainable inland recreational fishing practices, consider cautions, and make recommendations for implementation

'Correction:'Peer chart audits: A tool to meet Accreditation Council on Graduate Medical Education (ACGME) competency in practice-based learning and improvement

<p>Abstract</p> <p>Background</p> <p>The Accreditation Council on Graduate Medical Education (ACGME) supports chart audit as a method to track competency in Practice-Based Learning and Improvement. We examined whether peer chart audits performed by internal medicine residents were associated with improved documentation of foot care in patients with diabetes mellitus.</p> <p>Methods</p> <p>A retrospective electronic chart review was performed on 347 patients with diabetes mellitus cared for by internal medicine residents in a university-based continuity clinic from May 2003 to September 2004. Residents abstracted information pertaining to documentation of foot examinations (neurological, vascular, and skin) from the charts of patients followed by their physician peers. No formal feedback or education was provided.</p> <p>Results</p> <p>Significant improvement in the documentation of foot exams was observed over the course of the study. The percentage of patients receiving neurological, vascular, and skin exams increased by 20% (from 13% to 33%) (p = 0.001), 26% (from 45% to 71%) (p < 0.001), and 18% (51%–72%) (p = 0.005), respectively. Similarly, the proportion of patients receiving a well-documented exam which includes all three components – neurological, vascular and skin foot exam – increased over time (6% to 24%, p < 0.001).</p> <p>Conclusion</p> <p>Peer chart audits performed by residents in the absence of formal feedback were associated with improved documentation of the foot exam in patients with diabetes mellitus. Although this study suggests that peer chart audits may be an effective tool to improve practice-based learning and documentation of foot care in diabetic patients, evaluating the actual performance of clinical care was beyond the scope of this study and would be better addressed by a randomized controlled trial.</p

Cognitive behavioural therapy (CBT) for anxiety in people with dementia: study protocol for a randomised controlled trial

Background Many people with dementia experience anxiety, which can lead to decreased independence, relationship difficulties and increased admittance to care homes. Anxiety is often treated with antipsychotic medication, which has limited efficacy and serious side effects. Cognitive behavioural therapy (CBT) is widely used to treat anxiety in a range of populations, yet no RCTs on CBT for anxiety in dementia exist. This study aims to develop a CBT for anxiety in dementia manual and to determine its feasibility in a pilot RCT. Methods/design Phase I involves the development of a CBT for anxiety in dementia manual, through a process of (1) focus groups, (2) comprehensive literature reviews, (3) expert consultation, (4) a consensus conference and (5) field testing. Phase II involves the evaluation of the manual with 50 participants with mild to moderate dementia and anxiety (and their carers) in a pilot, two-armed RCT. Participants will receive either ten sessions of CBT or treatment as usual. Primary outcome measures are anxiety and costs. Secondary outcome measures are participant quality of life, behavioural disturbance, cognition, depression, mood and perceived relationship with the carer, and carer mood and perceived relationship with the person with dementia. Measures will be administered at baseline, 15 weeks and 6 months. Approximately 12 qualitative interviews will be used to gather service-users' perspectives on the intervention. Discussion This study aims to determine the feasibility of CBT for people with anxiety and dementia and provide data on the effect size of the intervention in order to conduct a power analysis for a definitive RCT. The manual will be revised according to qualitative and quantitative findings. Its publication will enable its availability throughout the NHS and beyond. Trial registration ISRCTN6480685