A Management Strategy Evaluation of the Impacts of Interspecific Competition and Recreational Fishery Dynamics on Vermilion Snapper (Rhomboplites aurorubens) in the Gulf of Mexico

In the Gulf of Mexico (GOM), Vermilion Snapper (Rhomboplites auroruben), are believed to compete with Red Snapper directly for prey and habitat. The two species share similar diets and have significant spatial overlap in the Gulf. Red Snapper are thought to be the dominate competitor, forcing Vermilion Snapper to feed on less nutritious prey when local resources are depleted. In addition to ecological pressures, GOM Vermilion Snapper support substantial commercial and recreational fisheries. Over the past decade, recreational landings have steadily increased, reaching a historical high in 2018. One cause may be stricter regulations for similar target species such as Red Snapper and Gray Triggerfish. A better understanding of the impact of ecosystem and fishery dynamics is essential for successful, long-term management of the stock. In this study, I used management strategy evaluation to assess the effectiveness of current and alternative harvest control rules (HCR) for the stock when accounting for interspecific competition and increased recreational landings. I developed an operating model that simulates the underlying population and fishery dynamics of the Vermilion Snapper stock and includes an index of Red Snapper competition. The annual competition index values were the estimated annual abundance of Red Snapper relative to the total virgin or near-virgin abundances of Vermilion and Red Snapper combined. In the second chapter, I used a random utility model to estimate the probability of a recreational angler targeting Vermilion Snapper given past management for Red Snapper and Gray Triggerfish. I incorporated the predicted targeting probabilities into the operating model from chapter one and evaluated the outcomes of the simulation. In both simulations, catch limits were set using empirical or model-based approaches. I ran 100 trials for each scenario, projected over 50 years. I found that the GOM Vermilion Snapper stock is resilient to competition and increased recreational landings, and all HCR effectively managed the stock. This study provides a methodology to incorporate interspecific dynamics into a single-species assessment model

Glycemic Control and Effects of Canagliflozin in Reducing Albuminuria and eGFR:A Post Hoc Analysis of the CREDENCE Trial

BACKGROUND: In the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial, the sodium-glucose cotransporter-2 (SGLT2) inhibitor canagliflozin improved kidney and cardiovascular outcomes and reduced the rate of estimated glomerular filtration decline (eGFR slope) in patients with type 2 diabetes and CKD. In other clinical trials of patients with CKD or heart failure, the protective effects of SGLT2 inhibitors on eGFR slope were greater in participants with versus participants without type 2 diabetes. This post hoc analysis of the CREDENCE trial assessed whether the effects of canagliflozin on eGFR slope varied according to patient subgroups by baseline glycated hemoglobin A1c (HbA1c).METHODS: CREDENCE ( ClinicalTrials.gov [ NCT02065791 ]) was a randomized controlled trial in adults with type 2 diabetes with an HbA1c of 6.5%-12.0%, an eGFR of 30-90 ml/min per 1.73 m 2 , and a urinary albumin-to-creatinine ratio of 300-5000 mg/g. Participants were randomly assigned to canagliflozin 100 mg once daily or placebo. We studied the effect of canagliflozin on eGFR slope using linear mixed-effects models.RESULTS: The annual difference in total eGFR slope was 1.52 ml/min per 1.73 m 2 (95% confidence interval [CI], 1.11 to 1.93) slower in participants randomized to canagliflozin compared with placebo. The rate of eGFR decline was faster in those with poorer baseline glycemic control. The mean difference in total eGFR slope between canagliflozin and placebo was greater in participants with poorer baseline glycemic control (difference in eGFR slope of 0.39, 1.36, 2.60, 1.63 ml/min per 1.73 m 2 for HbA1c subgroups 6.5%-7.0%, 7.0%-8.0%, 8.0%-10.0%, 10.0%-12.0%, respectively; Pinteraction = 0.010). The mean difference in change from baseline in urinary albumin-to-creatinine ratio between participants randomized to canagliflozin and placebo was smaller in patients with baseline HbA1c 6.5%-7.0% (-17% [95% CI, -28 to -5]) compared with those with an HbA1c of 7.0%-12% (-32% [95% CI, -40 to -28]; Pinteraction = 0.03).CONCLUSIONS: The effect of canagliflozin on eGFR slope in patients with type 2 diabetes and CKD was more pronounced in patients with higher baseline HbA1c, partly because of the more rapid decline in kidney function in these individuals.CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: Evaluation of the Effects of Canagliflozin on Renal and Cardiovascular Outcomes in Participants With Diabetic Nephropathy (CREDENCE), NCT02065791.</p

Canagliflozin Reduces Kidney-Related Adverse Events in Type 2 Diabetes and CKD:Findings From the Randomized CREDENCE Trial

RATIONALE AND OBJECTIVE: Canagliflozin reduced the risk of kidney failure and related outcomes in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) in the CREDENCE trial. This analysis of CREDENCE trial data examines the effect of canagliflozin on the incidence of kidney-related adverse events (AEs). STUDY DESIGN: A randomized, double-blind, placebo-controlled, multicenter, international trial. SETTING AND PARTICIPANTS: 4,401 trial participants with T2DM, CKD, and urinary albumin:creatinine ratio >300-5000mg/g. INTERVENTIONS: Participants were randomly assigned to receive canagliflozin 100mg/day or placebo. OUTCOMES: Rates of kidney-related AEs were analyzed using an on-treatment approach, overall and by screening estimated glomerular filtration rate (eGFR) strata (30-<45, 45-<60, and 60-<90 mL/min/1.73m2). RESULTS: Canagliflozin was associated with a reduction in the overall incidence rate of kidney-related AEs (60.2 vs 84.0 per 1,000 patient-years; hazard ratio [HR]: 0.71 [95% confidence interval (CI): 0.61, 0.82]; P<0.001), with consistent results for serious kidney-related AEs (HR: 0.72 [95% CI: 0.51, 1.00]; P=0.05) and acute kidney injury (AKI; HR: 0.85 [95% CI: 0.64, 1.13]; P=0.3). The rates of kidney-related AEs were lower with canagliflozin relative to placebo across the 3 eGFR strata (HRs of 0.73, 0.60, and 0.81 for eGFR 30-<45, 45-<60, and 60-<90 mL/min/1.73m2, respectively; P-interaction=0.3), with similar results for AKI (P-interaction=0.9). Full recovery of kidney function within 30 days after an AKI event occurred more frequently with canagliflozin versus placebo (53.1% vs 35.4%; odds ratio: 2.2 [95% CI: 1.0, 4.7]; P=0.04). LIMITATIONS: Kidney-related AEs including AKI were investigator-reported and collected without central adjudication. Biomarkers of AKI and structural tubular damage were not measured and creatinine data after an AKI event were not available for all participants. CONCLUSION: Canagliflozin compared to placebo was associated with a reduced incidence of serious and non-serious kidney-related AEs in patients with T2DM and CKD. These results highlight the safety of canagliflozin with regard to adverse kidney disease events

Early Change in Albuminuria with Canagliflozin Predicts Kidney and Cardiovascular Outcomes:A Post Hoc Analysis from the CREDENCE Trial

Background The association between early changes in albuminuria and kidney and cardiovascular events is primarily based on trials of renin-angiotensin system blockade. It is unclear whether this association occurs with sodium-glucose cotransporter 2 inhibition. Methods TheCanagliflozin and Renal Events inDiabeteswith EstablishedNephropathy Clinical Evaluation (CREDENCE) trial enrolled 4401 patients with type 2 diabetes and CKD (urinary albumin-creatinine ratio [UACR].300 mg/g). This post hoc analysis assessed canagliflozin's effect on albuminuria and how early change in albuminuria (baseline to week 26) is associated with the primary kidney outcome (ESKD, doubling of serum creatinine, or kidney death), major adverse cardiovascular events, and hospitalization for heart failure or cardiovascular death. Results Complete data for early change in albuminuria and other covariates were available for 3836 (87.2%) participants in the CREDENCE trial. Compared with placebo, canagliflozin lowered UACR by 31% (95% confidence interval [95% CI], 27% to 36%) at week 26, and significantly increased the likelihood of achieving a 30% reduction in UACR ( odds ratio, 2.69; 95% CI, 2.35 to 3.07). Each 30% decrease in UACR over the first 26 weeks was independently associated with a lower hazard for the primary kidney outcome (hazard ratio [HR], 0.71; 95% CI, 0.67 to 0.76; P,0.001), major adverse cardiovascular events (HR, 0.92; 95% CI, 0.88 to 0.96; P,0.001), and hospitalization for heart failure or cardiovascular death (HR, 0.86; 95% CI, 0.81 to 0.90; P,0.001). Residual albuminuria levels at week 26 remained a strong independent risk factor for kidney and cardiovascular events, overall and in each treatment arm. Conclusions In people with type 2 diabetes and CKD, use of canagliflozin results in early, sustained reductions in albuminuria, which were independently associated with long-term kidney and cardiovascular outcomes

Sodium-Glucose Cotransporter 2 Inhibitors and Risk of Hyperkalemia in People With Type 2 Diabetes: A Meta-Analysis of Individual Participant Data From Randomized, Controlled Trials

Background: Hyperkalemia increases risk of cardiac arrhythmias and death and limits the use of renin-angiotensin-aldosterone system (RAAS) inhibitors and mineralocorticoid receptor antagonists (MRAs), which improve clinical outcomes in people with chronic kidney disease (CKD) and/or systolic heart failure. Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of cardiorenal events in people with type 2 diabetes at high cardiovascular risk or with CKD. However, their effect on hyperkalemia has not been systematically evaluated. / Methods: A meta-analysis was conducted using individual participant data from randomized, double-blind, placebo-controlled clinical outcome trials with SGLT2 inhibitors in people with type 2 diabetes at high cardiovascular risk and/or with CKD, in which serum potassium levels were routinely measured. The primary outcome was time to serious hyperkalemia, defined as central laboratory determine serum potassium ≥6.0 mmol/L, with other outcomes including investigator-reported hyperkalemia events and hypokalemia (serum potassium ≤3.5 mmol/L). Cox regression analyses were performed to estimate treatment effects from each trial with hazards ratios (HR) and corresponding 95% CI pooled using random effects models to obtain summary treatment effects, overall and across key subgroups. / Results: Results from six trials were included comprising 49,875 participants assessing four SGLT2 inhibitors. 1,754 participants developed serious hyperkalemia and an additional 1,119 investigator-reported hyperkalemia events were recorded. SGLT2 inhibitors reduced the risk of serious hyperkalemia (HR 0.84, 95% CI 0.76-0.93), an effect consistent across studies (P-heterogeneity=0.71). The incidence of investigator-reported hyperkalemia was also lower with SGLT2 inhibitors (HR 0.80, 95% CI 0.68-0.93; P-heterogeneity=0.21). Reductions in serious hyperkalemia were observed across a range of subgroups including baseline kidney function, history of heart failure, RAAS inhibitor, diuretic and MRA use. SGLT2 inhibitors did not increase the risk of hypokalemia (HR 1.04, 95% CI 0.94-1.15; P-heterogeneity=0.42). / Conclusions: SGLT2 inhibitors reduce the risk of serious hyperkalemia in people with type 2 diabetes at high cardiovascular risk and/or with CKD, without increasing the risk of hypokalemia

Effects of Canagliflozin in Patients with Baseline eGFR:Subgroup Analysis of the Randomized CREDENCE Trial

BACKGROUND AND OBJECTIVES: The Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial demonstrated that the sodium glucose cotransporter 2 (SGLT2) inhibitor canagliflozin reduced the risk of kidney failure and cardiovascular events in participants with type 2 diabetes mellitus and CKD. Little is known about the use of SGLT2 inhibitors in patients with eGFR 300-5000 mg/g, and an eGFR of 30 to 0.20). The estimate for kidney failure in participants with eGFR 0.12). CONCLUSIONS: This post hoc analysis suggests canagliflozin slowed progression of kidney disease, without increasing AKI, even in participants with eGFR <30 ml/min per 1.73 m2

Kidney, Cardiovascular, and Safety Outcomes of Canagliflozin according to Baseline Albuminuria:A CREDENCE Secondary Analysis

BACKGROUND AND OBJECTIVES: The kidney protective effects of renin-angiotensin system inhibitors are greater in people with higher levels of albuminuria at treatment initiation. Whether this applies to sodium-glucose cotransporter 2 (SGLT2) inhibitors is uncertain, particularly in patients with a very high urine albumin-to-creatinine ratio (UACR; ≥3000 mg/g). We examined the association between baseline UACR and the effects of the SGLT2 inhibitor, canagliflozin, on efficacy and safety outcomes in the Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) randomized controlled trial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The study enrolled 4401 participants with type 2 diabetes, an eGFR of 30 to 300 to 5000 mg/g. Using Cox proportional hazards regression, we examined the relative and absolute effects of canagliflozin on kidney, cardiovascular, and safety outcomes according to a baseline UACR of ≤1000 mg/g (n=2348), >1000 to 1000 to <3000 mg/g, and 37% (HR, 0.63; 95% CI, 0.47 to 0.84) in the highest subgroup (Pheterogeneity=0.55). Absolute risk reductions for kidney outcomes were greater in participants with higher baseline albuminuria; the number of primary composite events prevented across ascending UACR categories were 17 (95% CI, 3 to 38), 45 (95% CI, 9 to 81), and 119 (95% CI, 35 to 202) per 1000 treated participants over 2.6 years (Pheterogeneity=0.02). Rates of kidney-related adverse events were lower with canagliflozin, with a greater relative reduction in higher UACR categories. CONCLUSIONS: Canagliflozin safely reduces kidney and cardiovascular events in people with type 2 diabetes and severely increased albuminuria. In this population, the relative kidney benefits were consistent over a range of albuminuria levels, with greatest absolute kidney benefit in those with an UACR ≥3000 mg/g. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: ClinicalTrials.gov: CREDENCE, NCT02065791. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_02_22_CJN15260920_final.mp3

Pre-post changes in psychosocial functioning among relatives of patients with depressive disorders after Brief Multifamily Psychoeducation: A pilot study

<p>Abstract</p> <p>Background</p> <p>Depressive disorder is often chronic and recurrent, and results in a heavy psychosocial burden on the families of patients with this disorder. This study aims to examine the effectiveness of brief multifamily psychoeducation designed to alleviate their psychosocial burden.</p> <p>Methods</p> <p>Thirty-two relatives of patients with major depressive disorder participated in an open study testing the effectiveness of brief multifamily psychoeducation. The intervention consisted of four sessions over the course of 6 weeks. Outcome measures focused on emotional distress, care burden and Expressed Emotion (EE).</p> <p>Results</p> <p>The emotional distress, care burden and EE of the family all showed statistically significant improvements from baseline to after the family intervention. The proportion of relatives scoring 9 or more on K6, which indicates possible depressive or anxiety disorder, decreased from sixteen relatives (50.0%) at baseline, to only 3 relatives (9.3%) after the intervention.</p> <p>Conclusions</p> <p>This study suggests that brief multifamily psychoeducation is a useful intervention to reduce the psychosocial burden of the relatives of patients with depressive disorder. Further evaluation of family psychoeducation for relatives of patients with depressive disorder is warranted.</p

Understanding the Structure and Resilience of Trophic Dynamics in the Northern Gulf of Mexico Using Network Analysis

Network analysis is a framework that allows integration and evaluation of predator-prey interactions. In the present study, we synthesized diet composition information from 94 published studies (n = 12,335 unique predator-prey interactions) that reported food habits of teleost fishes in the northern Gulf of Mexico (nGOM). Using this information, we constructed 12 weighted trophic network models using three diet metrics and four levels of taxonomic resolution of predators and prey. We evaluated network resilience to simulated random and directed taxa loss by assessing changes in topological indices complexity, connectance, efficiency, and robustness with respect to a priori minima. We found all networks were resilient to random removal of nodes. However, the response to directed removal varied depending on the index used to determine node importance. Directed removal simulations that targeted taxa with the greatest number of trophic interactions had the strongest impact on network topological indices. Using an additional simulation, we assessed how removal of taxa of commercial interest impacted the predation pressure on other taxa. We found a greater magnitude of predator diet shifts when Gulf menhaden (Brevoortia patronus Goode, 1878) were removed than when blue crab (Callinectes sapidus Rathbun, 1896) were removed, indicating predators of Gulf menhaden have a more limited portfolio of diet items than do predators of blue crab. Compared to previously described marine trophic networks, the network that describes the trophic dynamics in the nGOM is less connected and complex. This conclusion highlights the need for consistent reporting of stomach contents and improved understanding of the food habits of lesser-known taxa in the region

Construction and Evaluation of a Robust Trophic Network Model for the Northern Gulf of Mexico Ecosystem

A critical issue in understanding trophic connectivity in ecological systems is the lack in quality and quantity of information about feeding habits. In this work, we present a method for integrating a diversity of feeding habits data from published studies to evaluate the impact on indices that describe characteristics of individual taxa and their connectivity. We focus our study on feeding habits of the fishes of the northern Gulf of Mexico and seek to understand the importance of the forage fish Gulf Menhaden (Brevoortia patronus) in predator diets. We created a database of diet studies from the northern Gulf of Mexico that included six diet metrics: frequency of occurrence, wet weight, dry weight, number, volume, index of relative importance, and index of caloric importance. We then used this information to construct a set of traditional networks (all prey and predators were from a single taxonomic level and trophic connections were parameterized with a single diet metric). We also constructed a “robust” network where all taxa were identified to the lowest taxonomic level and trophic connections were parameterized using a resampling approach that included all available information. Linear regression and resampling methods were used to convert data reported in other diet metrics into the frequency of occurrence diet metric. For both traditional and robust networks, we used network indices to describe topological properties. With the robust network, we conducted removal simulations where the forage fish species Gulf Menhaden, and associated Clupeidae representatives, were removed from the network and the feeding effort of the predators was reallocated among their other prey items. We found that network and node-specific indices were sensitive to the choice of taxonomy and diet metric level. In the robust network, predator species with the greatest number of identified prey had the lowest precision in their connections and prey from the Arthropoda phyla had the lowest precision for connections. From the removal and reallocation simulations, we found that Actinopterygii and Arthropoda were the most impacted prey taxa with 1.2% to 4.3% increase in predation and approximately 23 taxa would receive 50% of the reallocated predation. Overall, the resampling methods we present provide a potential means for combining disparate diet data and enables a comprehensive understanding of trophic interactions within an ecosystem