Use of Novel Strategies to Develop Guidelines for Management of Pyogenic Osteomyelitis in Adults: A WikiGuidelines Group Consensus Statement.

Importance Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence. Objective To construct a clinical guideline for pyogenic osteomyelitis management, with a new standard of evidence to resolve the gap between strength of recommendation and quality of evidence, through the use of a novel open access approach utilizing social media tools. Evidence Review This consensus statement and systematic review study used a novel approach from the WikiGuidelines Group, an open access collaborative research project, to construct clinical guidelines for pyogenic osteomyelitis. In June 2021 and February 2022, authors recruited via social media conducted multiple PubMed literature searches, including all years and languages, regarding osteomyelitis management; criteria for article quality and inclusion were specified in the group's charter. The GRADE system for evaluating evidence was not used based on previously published concerns regarding the potential dissociation between strength of recommendation and quality of evidence. Instead, the charter required that clear recommendations be made only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were drafted to discuss pros and cons of care choices. Both clear recommendations and clinical reviews were planned with the intention to be regularly updated as new data become available. Findings Sixty-three participants with diverse expertise from 8 countries developed the group's charter and its first guideline on pyogenic osteomyelitis. These participants included both nonacademic and academic physicians and pharmacists specializing in general internal medicine or hospital medicine, infectious diseases, orthopedic surgery, pharmacology, and medical microbiology. Of the 7 questions addressed in the guideline, 2 clear recommendations were offered for the use of oral antibiotic therapy and the duration of therapy. In addition, 5 clinical reviews were authored addressing diagnosis, approaches to osteomyelitis underlying a pressure ulcer, timing for the administration of empirical therapy, specific antimicrobial options (including empirical regimens, use of antimicrobials targeting resistant pathogens, the role of bone penetration, and the use of rifampin as adjunctive therapy), and the role of biomarkers and imaging to assess responses to therapy. Conclusions and Relevance The WikiGuidelines approach offers a novel methodology for clinical guideline development that precludes recommendations based on low-quality data or opinion. The primary limitation is the need for more rigorous clinical investigations, enabling additional clear recommendations for clinical questions currently unresolved by high-quality data

Building a multi-scaled geospatial temporal ecology database from disparate data sources: fostering open science and data reuse

Although there are considerable site-based data for individual or groups of ecosystems, these datasets are widely scattered, have different data formats and conventions, and often have limited accessibility. At the broader scale, national datasets exist for a large number of geospatial features of land, water, and air that are needed to fully understand variation among these ecosystems. However, such datasets originate from different sources and have different spatial and temporal resolutions. By taking an open-science perspective and by combining site-based ecosystem datasets and national geospatial datasets, science gains the ability to ask important research questions related to grand environmental challenges that operate at broad scales. Documentation of such complicated database integration efforts, through peer-reviewed papers, is recommended to foster reproducibility and future use of the integrated database. Here, we describe the major steps, challenges, and considerations in building an integrated database of lake ecosystems, called LAGOS (LAke multi-scaled GeOSpatial and temporal database), that was developed at the sub-continental study extent of 17 US states (1,800,000 km² ). LAGOS includes two modules: LAGOS[subscript]GEO , with geospatial data on every lake with surface area larger than 4 ha in the study extent (~50,000 lakes), including climate, atmospheric deposition, land use/cover, hydrology, geology, and topography measured across a range of spatial and temporal extents; and LAGOS[subscript]LIMNO , with lake water quality data compiled from ~100 individual datasets for a subset of lakes in the study extent (~10,000 lakes). Procedures for the integration of datasets included: creating a flexible database design; authoring and integrating metadata; documenting data provenance; quantifying spatial measures of geographic data; quality-controlling integrated and derived data; and extensively documenting the database. Our procedures make a large, complex, and integrated database reproducible and extensible, allowing users to ask new research questions with the existing database or through the addition of new data. The largest challenge of this task was the heterogeneity of the data, formats, and metadata. Many steps of data integration need manual input from experts in diverse fields, requiring close collaboration.Keywords: LAGOS, Integrated database, Data harmonization, Database Ecoinformatics, Macrosystems ecology, Landscape limnology, Water qualityKeywords: LAGOS, Integrated database, Ecoinformatics, Data harmonization, Water quality, Data sharing, Landscape limnology, Macrosystems ecology, Database documentation, Data reus

State of the ART: Using artificial refuge traps to control invasive crayfish in southern California streams.

Invasive species are a widespread threat to stream ecosystems across the planet. In Southern California, USA, the invasive red swamp crayfish Procambarus clarkii (Girard, 1852) poses a significant threat to native aquatic fauna. Studies have suggested that artificial refuge traps (ARTs) resembling crayfish burrows can be used to remove invasive crayfish, but, to date, no studies have focused on optimizing ART design and deployment to maximize crayfish catch. This month-long study tested the effect of modifications on ART diameter, color, and soak time on P. clarkii catch effectiveness across 160 traps. We evaluated catch data by creating multiple candidate generalized linear mixed models predicting P. clarkii catches with different modeling parameterizations and a priori hypothesized predictor variables. During the study period, ARTs removed a total of 240 red swamp crayfish with no incidental bycatch. Larger P. clarkii (2-6-cm carapace length) were found more frequently in 5.1-cm-diameter traps, and smaller P. clarkii (1-4 cm) were found more frequently in 2.5-cm-diameter traps. Catch numbers varied between trap types, with black-colored 5.1-cm-diameter traps removing the greatest amount of the total P. clarkii caught in the study (mean = 0.27, SD = 0.29; 35% of the total caught) and black-colored 2.5-cm-diameter traps removing the least amount (mean = 0.09, SD = 0.55; 12% of the total). Further, ART deployment duration was an important predictor variable for candidate models, where ARTs with 4-d and 7-d deployment durations had lower catch/unit effort than traps with 1-d and 2-d deployments. This factorial experiment is the 1st study to suggest specific design modifications to ARTs that optimize invasive red swamp crayfish removal without incurring non-target incidental bycatch. This study demonstrates that ARTs can be a valuable tool for conservation managers interested in restoring streams through invasive crayfish removal, especially where there are sensitive biological resources

Data from: Multi-scale landscape and wetland drivers of lake total phosphorus and water color

We quantified relationships between local wetland cover in the riparian lake buffer and lake total phosphorus (TP) and water color (color) using multilevel mixed-effects models that also incorporate landscape features such as hydrogeomorphology and land use at broad regional scales to determine 1) Within regions, are local wetland relationships with TP and color affected by interactions with local land use or hydrogeomorphic variables? 2) Across regions, are local wetland relationships with TP and color different? And if so, 3) Are differences in local wetland relationships with TP and color a result of cross-scale interactions? We answered these questions by analyzing TP, color, and multi-scaled landscape data for 1790 North temperate lakes. We found that local wetland-TP and wetland-color relationships were not affected by local-scale interactions; we found that local wetland-TP and wetland-color relationships were different across regions; and these differences were related to cross-scale interactions with regional landscape characteristics. For example, regional human land-use affected local wetland-TP relationships such that in regions with high amounts of agriculture, local wetlands were associated with decreased lake TP. However, in regions with low amounts of agriculture, local wetlands were associated with increased lake TP. In contrast, regional hydrogeomorphic characteristics influenced local wetland-color relationships such that in regions with high groundwater contribution, the strength of local wetland relationships were weak. Regional landscape setting influences local wetland relationships with TP and color through cross-scale interactions and lake TP and color are controlled by both local-scale wetland extent and regional-scale landscape variables

Spatial Variation in Nutrient and Water Color Effects on Lake Chlorophyll at Macroscales

<div><p>The nutrient-water color paradigm is a framework to characterize lake trophic status by relating lake primary productivity to both nutrients and water color, the colored component of dissolved organic carbon. Total phosphorus (TP), a limiting nutrient, and water color, a strong light attenuator, influence lake chlorophyll <i>a</i> concentrations (CHL). But, these relationships have been shown in previous studies to be highly variable, which may be related to differences in lake and catchment geomorphology, the forms of nutrients and carbon entering the system, and lake community composition. Because many of these factors vary across space it is likely that lake nutrient and water color relationships with CHL exhibit spatial autocorrelation, such that lakes near one another have similar relationships compared to lakes further away. Including this spatial dependency in models may improve CHL predictions and clarify how well the nutrient-water color paradigm applies to lakes distributed across diverse landscape settings. However, few studies have explicitly examined spatial heterogeneity in the effects of TP and water color together on lake CHL. In this study, we examined spatial variation in TP and water color relationships with CHL in over 800 north temperate lakes using spatially-varying coefficient models (SVC), a robust statistical method that applies a Bayesian framework to explore space-varying and scale-dependent relationships. We found that TP and water color relationships were spatially autocorrelated and that allowing for these relationships to vary by individual lakes over space improved the model fit and predictive performance as compared to models that did not vary over space. The magnitudes of TP effects on CHL differed across lakes such that a 1 μg/L increase in TP resulted in increased CHL ranging from 2–24 μg/L across lake locations. Water color was not related to CHL for the majority of lakes, but there were some locations where water color had a positive effect such that a unit increase in water color resulted in a 2 μg/L increase in CHL and other locations where it had a negative effect such that a unit increase in water color resulted in a 2 μg/L decrease in CHL. In addition, the spatial scales that captured variation in TP and water color effects were different for our study lakes. Variation in TP–CHL relationships was observed at intermediate distances (~20 km) compared to variation in water color–CHL relationships that was observed at regional distances (~200 km). These results demonstrate that there are lake-to-lake differences in the effects of TP and water color on lake CHL and that this variation is spatially structured. Quantifying spatial structure in these relationships furthers our understanding of the variability in these relationships at macroscales and would improve model prediction of chlorophyll <i>a</i> to better meet lake management goals.</p></div

Summary statistics of the full lake dataset.

<p>Summary statistics of the full lake dataset.</p

inland_lake_p_color_WI_MI_NH_ME

Lake data were compiled for four lake-rich U.S. states: Maine, New Hampshire, Michigan, and Wisconsin. Only natural inland lakes were included in the database (i.e., no reservoirs). Lake water chemistry were collected from databases maintained by state agencies responsible for monitoring lakes under the Federal Clean Water Act, which requires standard procedures and quality assurance and quality control protocols. Lakes with surface area ≥ 1 ha and maximum depth ≥ 2 m were included in the dataset. Each lake was assigned a unique identifier. We quantified land cover, land use, and groundwater hydrology within a 500 m landscape buffer surrounding the lakes and within the Ecological Drainage Unit (EDU) region. Lake data came from the following state agencies: Maine Department of Environmental Protection, Maine Department of Inland Fisheries and Wildlife’s Lake Survey table (1/21/03); New Hampshire Department of Environmental Services; Michigan Department of Environmental Quality; Wisconsin Department of Natural Resources. The purpose of the dataset was to investigate lake and landscape controls on lake water chemistry across broad geographic regions

Spatially-varying TP–CHL coefficients maps derived from the SVC_FULL model.

<p>Surface map of spatially-varying TP–CHL relationships created by interpolation of the posterior mean values that were estimated by lake location in the model building dataset (N = 779). Blue to red color gradient represents low to high TP–CHL coefficient values.</p

Spatially-varying water color–CHL coefficients maps derived from the SVC_FULL model.

<p>a) Surface map of spatially-varying water color–CHL relationships created by interpolation of the posterior mean values that were estimated by lake location in the model building dataset (N = 779). Blue to red color gradient represents low to high water color–CHL coefficient values. b) Map of lake point locations symbolized by water color–CHL relationships: positive (blue), negative (red), not significant (black outlined dot). Significant relationships were determined based on 95% credible intervals not overlapping zero.</p

Summary of TP and water color ~ CHL candidate models including posterior estimated coefficients, model fit criteria, and model predictive performance measures.

<p>Summary of TP and water color ~ CHL candidate models including posterior estimated coefficients, model fit criteria, and model predictive performance measures.</p