BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Urbanisation and Fishing Alter the Body Size and Functional Traits of a Key Fisheries Species

Human pressures on ecosystems from landscape transformation and harvesting can result in changes to body size and functional traits of affected species. However, these effects remain very poorly understood in many settings. Here we examine whether and how fishing and the attributes of coastal seascapes can operate in concert to change the body size and functional traits of the giant mud crab, Scylla serrata; a prized fisheries species. We captured 65 legal sized (> 15 cm carapace width) male giant mud crabs from 13 estuaries in southeast Queensland, Australia. These estuaries span a wide range of fishing and catchment landscape transformation intensity. We made a total of 9000 external morphometric measurements in the study. There was a distinct effect of estuarine landscape context on body size, with the largest individuals captured from systems with bigger inlets and lower extent of intertidal flats. Variation in functional traits was most often associated with variation in fishing pressure and human population size in the catchment. Crabs from areas with less commercial fishing pressure and lower human populations in the catchment had the largest chelipeds. We also found effects of urbanisation (negative correlations), intertidal flats (inconsistent effects) and mangrove extent (positive correlations) on the size of some functional traits. Our results show that human pressures can have sublethal effects on animals in estuaries that alter body size and functional traits. These phenotypic responses might have consequences for the fitness and ecological roles of targeted species, and the yields of fisheries catches

Effective protection of fish on inshore coral reefs depends on the scale of mangrove -reef connectivity

Connectivity is an important consideration in conservation, but is rarely quantified when assessing marine reserve performance. Mangrove-reef connectivity is known to enhance reserve effectiveness when habitats are close together (< 250 m apart). Coral reefs are, however, often farther from mangroves, making it difficult to integrate mangrove-reef connectivity into conservation more widely. To determine if connectivity affects reserve performance beyond 250 m, we examined effects on reef fish in Hervey Bay, Queensland, Australia. Reserves affected fish assemblages and enhanced the abundances of harvested species and key functional groups on reefs within 500 m of mangroves (about 10 times greater inside reserves), but not on isolated reefs. Connectivity can affect reserve performance over broader distances than previously shown. We suggest that connectivity effects on inshore reef fish may simply be amplified on reefs located closest to adjacent mangroves, provided those reefs are within the migratory capabilities of fish. Mangrove-reef connectivity should be viewed as an important conservation target and may be broadly incorporated into reserve design by prioritizing the protection of seascapes where mangroves and reefs are closest

Resource type influences the effects of reserves and connectivity on ecological functions

Connectivity is a pivotal feature of landscapes that affects the structure of populations and the functioning of ecosystems. It is also a key consideration in conservation planning. But the potential functional effects of landscape connectivity are rarely evaluated in a conservation context. The removal of algae by herbivorous fish is a key ecological function on coral reefs that promotes coral growth and recruitment. Many reef herbivores are harvested and some use other habitats (like mangroves) as nurseries or feeding areas. Thus, the effects of habitat connectivity and marine reserves can jointly promote herbivore populations on coral reefs, thereby influencing reef health. We used a coral reef seascape in eastern Australia to test whether seascape connectivity and reserves influence herbivory. We measured herbivore abundance and rates of herbivory (on turf algae and macroalgae) on reefs that differed in both their level of connectivity to adjacent mangrove habitats and their level of protection from fishing. Reserves enhanced the biomass of herbivorous fish on coral reefs in all seascape settings and promoted consumption of turf algae. Consumption of turf algae was correlated with the biomass of surgeonfish that are exploited outside reserves. By contrast, both reserve status and connectivity influenced herbivory on macroalgae. Consumption of macroalgae was greatest on fished reefs that were far from mangroves and was not strongly correlated with any fish species. Our findings demonstrate that landscape connectivity and reserve status can jointly affect the functioning of ecosystems. Moreover, we show that reserve and connectivity effects can differ markedly depending on resource type (in this case turf algae vs. macroalgae). The effectiveness of conservation initiatives will therefore depend on our ability to understand how these multiple interactive effects structure the distribution of ecological functions. These findings have wider implications for the spatial conservation of heterogeneous environments and strengthen the case that the impact of conservation on ecosystem functioning is contingent on how reserves are positioned in landscapes

Low redundancy and complementarity shape ecosystem functioning in a low-diversity ecosystem

Flint, N ORCiD: 0000-0003-4331-4109Ecosystem functioning is positively linked to biodiversity on land and in the sea. In high-diversity systems (e.g. coral reefs), species coexist by sharing resources and providing similar functions at different temporal or spatial scales. How species combine to deliver the ecological function they provide is pivotal for maintaining the structure, functioning and resilience of some ecosystems, but the significance of this is rarely examined in low-diversity systems such as estuaries. We tested whether an ecological function is shaped by biodiversity in a low-diversity ecosystem by measuring the consumption of carrion by estuarine scavengers. Carrion (e.g. decaying animal flesh) is opportunistically fed on by a large number of species across numerous ecosystems. Estuaries were chosen as the model system because carrion consumption is a pivotal ecological function in coastal seascapes, and estuaries are thought to support diverse scavenger assemblages, which are modified by changes in water quality and the urbanization of estuarine shorelines. We used baited underwater video arrays to record scavengers and measure the rate at which carrion was consumed by fish in 39 estuaries across 1,000 km of coastline in eastern Australia. Carrion consumption was positively correlated with the abundance of only one species, yellowfin bream Acanthopagrus australis, which consumed 58% of all deployed carrion. The consumption of carrion by yellowfin bream was greatest in urban estuaries with moderately hardened shorelines (20%–60%) and relatively large subtidal rock bars (>0.1 km2). Our findings demonstrate that an ecological function can be maintained across estuarine seascapes despite both limited redundancy (i.e. dominated by one species) and complementarity (i.e. there is no spatial context where the function is delivered significantly when yellowfin bream are not present) in the functional traits of animal assemblages. The continued functioning of estuaries, and other low-diversity ecosystems, might therefore not be tightly linked to biodiversity, and we suggest that the preservation of functionally dominant species that maintain functions in these systems could help to improve conservation outcomes for coastal seascapes.© 2019 British Ecological Societ

Habitat proximity exerts opposing effects on key ecological functions

Connectivity is an important property of landscapes that shapes populations and ecosystem functioning. We do not know, however, whether and how different types of spatial linkages combine to influence ecological functions, and this hampers their integration into conservation planning.We used coral reef seascapes in eastern Australia as a model system to test whether the proximity of other reefs (habitat proximity) or the proximity of other habitats (seascape proximity) exert stronger effects on two key ecological functions (herbivory and piscivory).We measured rates of herbivory (on fleshy macroalgae) and piscivory (on prey fish) on reefs that differed in their proximity to both other reefs and nearby mangroves and seagrass.The extent of habitat proximity between reefs significantly influenced both ecological functions, but in different ways: isolated reefs supported high herbivory but low piscivory, whilst, conversely, reefs that were closer to other reefs supported high piscivory but low herbivory. This was not caused by herbivores avoiding their predators, as the dominant piscivores (small predatory snappers) were too small to consume the dominant herbivores (large rabbitfishes). Seascape proximity (e.g., distance to mangroves or seagrass) was less important in shaping ecological functions on reefs in this system.We suggest that the effects of seascape configuration on ecological functions depends on the type of spatial linkage, and the ecological functions in question. To better integrate connectivity into conservation, we must develop a deeper understanding of how different spatial linkages combine to shape ecosystem functioning across landscapes

Landscape transformation alters functional diversity in coastal seascapes

Flint, N ORCiD: 0000-0003-4331-4109Ecography published by John Wiley & Sons on behalf of Nordic Society Oikos The ecological impacts of landscape modification and urbanisation have transformed the composition of plant and animal assemblages, and altered the condition of ecosystems globally. Landscape transformation influences the spatial distribution of species and ecological functions by selecting for generalist species with wide ecological niches, which can adapt to opportunities in highly-modified environments. These effects of landscape modification can shape functional diversity on land, but it is not clear whether they have similar functional consequences in the sea. We used estuaries as a model system to test how landscape transformation alters functional diversity in coastal seascapes, and measured how variation in level of urbanisation, catchment modification and habitat loss influenced fish diversity across thirty-nine estuaries in eastern Australia. Fish were surveyed with baited remote underwater video stations and functional diversity was indexed with three metrics that describe variation in the functional traits and niche space of assemblages. The extent of landscape transformation in the catchment of each estuary was associated with variation in the functional diversity of estuarine fish assemblages. These effects were, however, not what we expected as functional diversity was highest in modified estuaries that supported a large area of both urban and grazing land in their catchments, were bordered by a small area of natural terrestrial vegetation and that contained a moderate area of mangroves. Zoobenthivores and omnivores dominated assemblages in highly-modified estuaries, and piscivorous fishes were common in natural waterways. Our results demonstrate, that the modification and urbanisation of ecosystems on land can alter functional diversity in the sea. Intense landscape transformation appears to select for abundant generalists with wide trophic niches, and against species with specialised diets, and we suggest that these changes might have fundamental consequences for ecosystem functioning in estuaries, and other highly modified seascapes. © 2019 The Authors

Cryptogenic stroke and underlying atrial fibrillation

BACKGROUND: Current guidelines recommend at least 24 hours of electrocardiographic (ECG) monitoring after an ischemic stroke to rule out atrial fibrillation. However, the most effective duration and type of monitoring have not been established, and the cause of ischemic stroke remains uncertain despite a complete diagnostic evaluation in 20 to 40% of cases (cryptogenic stroke). Detection of atrial fibrillation after cryptogenic stroke has therapeutic implications. METHODS: We conducted a randomized, controlled study of 441 patients to assess whether long-term monitoring with an insertable cardiac monitor (ICM) is more effective than conventional follow-up (control) for detecting atrial fibrillation in patients with cryptogenic stroke. Patients 40 years of age or older with no evidence of atrial fibrillation during at least 24 hours of ECG monitoring underwent randomization within 90 days after the index event. The primary end point was the time to first detection of atrial fibrillation (lasting >30 seconds) within 6 months. Among the secondary end points was the time to first detection of atrial fibrillation within 12 months. Data were analyzed according to the intention-to-treat principle. RESULTS: By 6 months, atrial fibrillation had been detected in 8.9% of patients in the ICM group (19 patients) versus 1.4% of patients in the control group (3 patients) (hazard ratio, 6.4; 95% confidence interval [CI], 1.9 to 21.7; P<0.001). By 12 months, atrial fibrillation had been detected in 12.4% of patients in the ICM group (29 patients) versus 2.0% of patients in the control group (4 patients) (hazard ratio, 7.3; 95% CI, 2.6 to 20.8; P<0.001). CONCLUSIONS: ECG monitoring with an ICM was superior to conventional follow-up for detecting atrial fibrillation after cryptogenic stroke. (Funded by Medtronic; CRYSTAL AF ClinicalTrials.gov number, NCT00924638.)