Susceptibility of the Endangered Karner Blue Butterfly (Lepidoptera: Lycaenidae) to \u3ci\u3eBacillus Thuringiensis\u3c/i\u3e Var. \u3ci\u3eKurstaki\u3c/i\u3e Used for Gypsy Moth Suppression in Michigan

We investigated the phenological and physiological susceptibility of the endangered Karner blue butterfly (Lycaeides melissa samuelis) to Bacillus thuringiensis var. kurstaki (Bt), a product widely used for gypsy moth (Lymantria dispar) suppression in Michigan and other infested states. We monitored phenology of the bivoltine Karner blue in two regions of Michigan from 1993 to 1995 to determine if larval stages overlapped temporally with the period of Bt application for gypsy moth suppression. Karner blue larvae of the spring generation were found during the period that Bt was applied in nearby areas in 1993 only. However, spring-generation adults or newly laid eggs were observed up to 11 days before applications in 1994 and 1995. Since Karner blue eggs develop within one week, summer-generation larvae were most likely present during or shortly after 1994 and 1995 Bt application periods. These larvae would have been at risk, assuming Bt persistence of 4 to 6 days. Physiological susceptibility of Karner blue larvae to Bt was determined in a laboratory bioassay. Larvae were reared on wild lupine (Lupinus perennis) foliage that was untreated, or sprayed with Bt formulations at rates of 30-37 or 90 BIU/ha. A similar bioassay with second instar gypsy moth larvae on similarly treated white oak (Quercus alba) foliage was conducted concurrently. Karner blue survival was 100%, 27% and 14% on control, low and high Bt treatments, respectively. Early and late Karner blue instars were equally susceptible to Bt. Survival of gypsy moth was 80%, 33% and 5% on control, low and high Bt treatments, respectively, and did not differ significantly from Karner blue survival. We conclude that Karner blue is both phenologically and physiologically susceptible to Bt used for gypsy moth suppression, although the larval generation at risk and extent of phenological overlap may vary from year to year

Ecological impacts of non-native Pacific oysters (Crassostrea gigas) and management measures for protected areas in Europe

Pacific oysters are now one of the most ‘globalised’ marine invertebrates. They dominate bivalve aquaculture production in many regions and wild populations are increasingly becoming established, with potential to displace native species and modify habitats and ecosystems. While some fishing communities may benefit from wild populations, there is now a tension between the continued production of Pacific oysters and risk to biodiversity, which is of particular concern within protected sites. The issue of the Pacific oyster therefore locates at the intersection between two policy areas: one concerning the conservation of protected habitats, the other relating to livelihoods and the socio-economics of coastal aquaculture and fishing communities. To help provide an informed basis for management decisions, we first summarise evidence for ecological impacts of wild Pacific oysters in representative coastal habitats. At local scales, it is clear that establishment of Pacific oysters can significantly alter diversity, community structure and ecosystem processes, with effects varying among habitats and locations and with the density of oysters. Less evidence is available to evaluate regional-scale impacts. A range of management measures have been applied to mitigate negative impacts of wild Pacific oysters and we develop recommendations which are consistent with the scientific evidence and believe compatible with multiple interests. We conclude that all stakeholders must engage in regional decision making to help minimise negative environmental impacts, and promote sustainable industry development

From staff-mix to skill-mix and beyond: towards a systemic approach to health workforce management

Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Our review describes evidence about the benefits and pitfalls of current approaches to human resources optimisation in health care. We conclude that in order to use human resources most effectively, health care organisations must consider a more systemic approach - one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

Susceptibility of the Endangered Karner Blue Butterfly (Lepidoptera: Lycaenidae) to \u3ci\u3eBacillus Thuringiensis\u3c/i\u3e Var. \u3ci\u3eKurstaki\u3c/i\u3e Used for Gypsy Moth Suppression in Michigan

We investigated the phenological and physiological susceptibility of the endangered Karner blue butterfly (Lycaeides melissa samuelis) to Bacillus thuringiensis var. kurstaki (Bt), a product widely used for gypsy moth (Lymantria dispar) suppression in Michigan and other infested states. We monitored phenology of the bivoltine Karner blue in two regions of Michigan from 1993 to 1995 to determine if larval stages overlapped temporally with the period of Bt application for gypsy moth suppression. Karner blue larvae of the spring generation were found during the period that Bt was applied in nearby areas in 1993 only. However, spring-generation adults or newly laid eggs were observed up to 11 days before applications in 1994 and 1995. Since Karner blue eggs develop within one week, summer-generation larvae were most likely present during or shortly after 1994 and 1995 Bt application periods. These larvae would have been at risk, assuming Bt persistence of 4 to 6 days. Physiological susceptibility of Karner blue larvae to Bt was determined in a laboratory bioassay. Larvae were reared on wild lupine (Lupinus perennis) foliage that was untreated, or sprayed with Bt formulations at rates of 30-37 or 90 BIU/ha. A similar bioassay with second instar gypsy moth larvae on similarly treated white oak (Quercus alba) foliage was conducted concurrently. Karner blue survival was 100%, 27% and 14% on control, low and high Bt treatments, respectively. Early and late Karner blue instars were equally susceptible to Bt. Survival of gypsy moth was 80%, 33% and 5% on control, low and high Bt treatments, respectively, and did not differ significantly from Karner blue survival. We conclude that Karner blue is both phenologically and physiologically susceptible to Bt used for gypsy moth suppression, although the larval generation at risk and extent of phenological overlap may vary from year to year