Multiple sclerosis relapse risk in the postoperative period: Effects of invasive surgery and anesthesia.

BACKGROUND: Postoperative multiple sclerosis (MS) relapses are a concern among patients and providers. OBJECTIVE: To determine whether MS relapse risk is higher postoperatively. METHODS: Data were extracted from medical records of MS patients undergoing surgery at a tertiary center (2000–2016). Conditional logistic regression estimated within-patient unadjusted and age-adjusted odds of postoperative versus preoperative relapse. RESULTS: Among 281 patients and 609 surgeries, 12 postoperative relapses were identified. The odds of postoperative versus preoperative relapse in unadjusted (OR=0.56, 95%CI:0.18–1.79; P=0.33) or age-adjusted models (OR=0.66, 95%CI:0.20–2.16; P=0.49) were not increased. CONCLUSIONS: Surgery/anesthesia exposure did not increase postoperative relapse risk. These findings require confirmation in larger studies

The use of (Delta)15N signatures of translocated macroalgae to map coastal nutrient plumes: Improving species selection and spatial analysis of metropolitan datasets

The definition of the spatial footprint of land-derived nutrient plumes is a key element to the design of initiatives to combat eutrophication in urbanised coastal regions. These plumes, however, are difficult to monitor because of their inherent high-frequency temporal and spatial variability. Biomonitoring with macroalgae provides time-integration of bioavailable nitrogen inputs through the measurement of δ¹⁵N signatures in tissues, and adequate spatial coverage through translocation to desirable monitoring locations. In this study, we used laboratory incubations to compare three different species of macroalgae as bioindicators, and a field experiment to investigate the applicability of the technique for the large-scale mapping of nutrient plumes. Cladophora valonioides was selected for the field experiment as it showed rapid changes in δ¹⁵N values in the laboratory incubations, was abundant in shallow depths making collection cost-efficient, and had tough thalli capable of withstanding deployment in open water. Ecklonia radiata also performed well in the laboratory incubations, but field harvest from subtidal depths was comparatively more expensive. Ulva lactuca had fragile thalli, and large nitrogen reserves that acted to mask the isotopic signal of newly acquired nitrogen. Cladophora valonioides was translocated to 246 sites covering an area of ~445 km² along the highly urbanized temperate coast of Adelaide, South Australia. The resulting isotopic signatures of nitrogen in tissues were spatially interpolated to produce maps of land-derived nutrient plumes, to model probability and standard error in the predictive surface, and to optimize sampling design.M. Fernandes, S. Benger, S. K. Sharma, S. Gaylard, T. Kildea, S. Hoare, M. Braley and A. D. Irvin

Assessing morphological and DNA-based diet analysis techniques in a generalist predator, the arrow squid Nototodarus gouldi

Establishing the diets of marine generalist consumers is difficult, with most studies limited to the use of morphological methods for prey identification. Such analyses rely on the preservation of diagnostic hard parts, which can limit taxonomic resolution and introduce biases. DNA-based analyses provide a method to assess the diets of marine species, potentially overcoming many of the limitations introduced by other techniques. This study compared the effectiveness of morphological and DNA-based analysis for determining the diet of a free-ranging generalist predator, the arrow squid (Nototodarus gouldi). A combined approach was more effective than using either of the methods in isolation. Nineteen unique prey taxa were identified, of which six were found by both methods, 10 were only detected using DNA and three were only identified using morphological methods. Morphological techniques only found 50% of the total number of identifiable prey taxa, whereas DNA-based techniques found 84%. This study highlights the benefits of using a combination of techniques to detect and identify prey of generalist marine consumers.Michelle Braley, Simon D. Goldsworthy, Brad Page, Mike Steer and Jeremy J. Austi

Trophodynamics of the eastern Great Australian Bight ecosystem : ecological change associated with the growth of Australia\u27s largest fishery

We used the Ecopath with Ecosim software to develop a trophic mass-balance model of the eastern Great Australian Bight ecosystem, off southern Australia. Results provide an ecosystem perspective of Australia's largest fishery, the South Australian sardine fishery, by placing its establishment and growth in the context of other dynamic changes in the ecosystem, including: the development of other fisheries; changing abundances of apex predator populations and oceanographic change. We investigated the potential impacts of the sardine fishery on high tropic level predators, particularly land-breeding seals and seabirds which may be suitable ecological performance indicators of ecosystem health. Results indicate that despite the rapid growth of the sardine fishery since 1991, there has likely been a negligible fishery impact on other modelled groups, suggesting that current levels of fishing effort are not impacting negatively on the broader ecosystem structure and function in the eastern Great Australian Bight. Results highlight the importance of small pelagic fish to higher trophic levels, the trophic changes that have resulted from loss and recovery of apex predator populations, and the potential pivotal role of cephalopod biomass in regulating ‘bottom-up’ trophic processes. The ability to resolve and attribute potential impacts from multiple fisheries, other human impacts and ecological change in this poorly understood region is highlighted by the study, and will be critical to ensure future ecologically sustainable development within the region.Simon D. Goldsworthy, Brad Page, Paul J. Rogers, Cathy Bulman, Annelise Wiebkin, Lachlan J. McLeay, Luke Einoder, Alastair M.M. Baylis, Michelle Braley, Robin Caines, Keryn Daly, Charlie Huveneers, Kristian Peters, Andrew D. Lowther, Tim M. War

The Care Ecosystem: The Effectiveness and Implementation of Telephone-Based Collaborative Dementia Care.

BACKGROUND: Health systems are increasingly interested in collaborative dementia care. Implementation challenges include the limited dementia specialist workforce, time pressures of high-volume care, increasing use of telemedicine, and inadequate reimbursement. The Care Ecosystem is a telephone-based collaborative dementia care model designed to augment existing healthcare services and be amenable to scale. Here we present the latest evidence for the Care Ecosystem, including the effects among subpopulations at risk for health disparities (rural and Hispanic/Latino), and facilitators from the early phase of Care Ecosystem implementation at 6 diverse health systems. METHOD: Effectiveness was evaluated in a single-blind, randomized clinical trial (N = 804). Persons with dementia (PWD)-caregiver dyads were randomized to receive 12 months of the intervention (N = 527) or usual care (N = 277). Outcomes were measured via telephone surveys at 6 and 12 months after randomization and medical record review. Subgroup analyses were performed for the 124 dyads who identified as Hispanic/Latino, and the 66 who lived in rural Nebraska or Iowa. The intervention was primarily delivered by an unlicensed, trained care team navigator, who provided education, support and care coordination with supervision and help from a dementia specialist team (advanced practice nurse, social worker, and pharmacist). Implementation facilitators were evaluated through observation and qualitative interviews with clinical teams at 6 health systems implementing the model. RESULTS: The PWD-caregiver dyads lived in California (n = 476), Nebraska (n = 286), or Iowa (n = 42). Compared with usual care, the Care Ecosystem improved PWD quality of life, reduced emergency department visits, reduced the use of potentially inappropriate medications, and decreased caregiver depression and caregiver burden. Effect sizes were similar or greater in Hispanic/Latino and rural subgroups on most outcomes. Facilitators of Care Ecosystem implementation included open-access implementation tools (online training, care protocols), the adaptability of the care model, the care team navigator role, and remote care delivery. CONCLUSION: Effective dementia care can be delivered by care team navigators via telephone to mitigate the burdens of dementia, including for underserved PWD living in rural areas or who identify as Hispanic/Latino. Implementation is a challenge although features of the care model appear to facilitate adoption

Overnight auto-adjusting continuous airway pressure + standard care compared with standard care alone in the prevention of morbidity in sickle cell disease phase II (POMS2b): study protocol for a randomised controlled trial

BACKGROUND: In addition to pain, sickle cell anaemia (HbSS) complications include neurocognitive difficulties in attention and processing speed associated with low daytime and night-time oxygen saturation compounded by obstructive sleep apnoea (OSA). In the general population OSA is treated with continuous positive airways pressure (CPAP). The aim of this single-blind, randomised, controlled phase II trial is to compare auto-adjusting CPAP (APAP) with standard care to standard care alone in individuals with HbSS to determine whether the intervention improves attention and processing speed, brain structure, pain and quality of life. METHODS/DESIGN: Eligibility criteria include: ability to provide informed consent; age > 8 years; diagnosis of HbSS; and mean overnight saturation of  23 years); silent infarction on MRI; minimum overnight oxygen saturation > 90% or < 90%; and hydroxyurea use. For APAP individuals, the intervention is administered at home. Adherence and effectiveness are recorded using software documenting hours of use each night and overnight oximetry. Participant support in terms of appropriate facemask and facilitating adherence are provided by an unblinded sleep physiologist. The primary outcome is change in the cancellation subtest from the Wechsler scales. Secondary outcomes include general cognitive functioning, quantitative brain MRI, blood and urine chemistry, quality of life and daily pain via a smartphone App (GoMedSolutions, Inc) and, where possible MRI heart, echocardiography, and 6-min walk. These outcomes will be assessed at baseline and after six months of treatment by assessors blind to treatment assignment. DISCUSSION: Altering oxygen saturation in HbSS may lead to bone marrow suppression. This risk will be reduced by monitoring full blood counts at baseline, two weeks, three months and six months, providing treatment as appropriate and reporting as safety events