Accurately measuring the abundance of benthic microalgae in spatially variable habitats

Although many studies measure the abundance of benthic microalgae (BMA), at the meters squared scale, comparing these studies is difficult due to the variety of sampling, extraction, and analysis techniques. This difficulty is exacerbated by the fact that BMA abundance has high spatial and temporal variability, at all spatial scales. A suitable standard sampling regimen would reduce variation in estimates due to different sample collection and processing greatly facilitating comparisons between studies. This study examined the effect of varying the volume of extraction solvent, sampling core diameter, and sample replication on BMA biomass estimates. Key findings, applicable to all spatial scales, to accurately determine biomass were the use of a minimum sediment to extraction solvent ratio of 1:2 and use of a sampling core diameter of 19 mm. Across a wide range of sediment types, at the meters squared scale and using spectrophotometric techniques, a minimum replication number of 8 was found to be appropriate. We report the significant effect coring depth and units of expression have on BMA biomass estimates across a range of sediment types, highlighting the potential pitfalls when comparing studies

Measures of nutrient processes as indicators of stream ecosystem health

To better understand how freshwater ecosystems respond to changes in catchment land-use, it is important to develop measures of ecological health that include aspects of both ecosystem structure and function. This study investigated measures of nutrient processes as potential indicators of stream ecosystem health across a land-use gradient from relatively undisturbed to highly modified. A total of seven indicators (potential denitrification; an index of denitrification potential relative to sediment organic matter; benthic algal growth on artificial substrates amended with (a) N only, (b) P only, and (c) N and P; and delta N-15 of aquatic plants and benthic sediment) were measured at 53 streams in southeast Queensland, Australia. The indicators were evaluated by their response to a defined gradient of agricultural land-use disturbance as well as practical aspects of using the indicators as part of a monitoring program. Regression models based on descriptors of the disturbance gradient explained a large proportion of the variation in six of the seven indicators. Denitrification index, algal growth in N amended substrate, and delta N-15 of aquatic plants demonstrated the best regression. However, the delta N-15 value of benthic sediment was found to be the best indicator overall for incorporation into a monitoring program, as samples were relatively easy to collect and process, and were successfully collected at more than 90% of the study sites

Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study.

BACKGROUND/OBJECTIVE: Dysnatremia is common in severe traumatic brain injury (TBI) patients and may contribute to mortality. However, serum sodium variability has not been studied in TBI patients. We hypothesized that such variability would be independently associated with mortality. METHODS: We collected 6-hourly serum sodium levels for the first 7 days of ICU admission from 240 severe TBI patients in 14 neurotrauma ICUs in Europe and Australia. We evaluated the association between daily serum sodium standard deviation (dNaSD), an index of variability, and 28-day mortality. RESULTS: Patients were 46 ± 19 years of age with a median initial GCS of 6 [4-8]. Overall hospital mortality was 28%. Hypernatremia and hyponatremia occurred in 64% and 24% of patients, respectively. Over the first 7 days in ICU, serum sodium standard deviation was 2.8 [2.0-3.9] mmol/L. Maximum daily serum sodium standard deviation (dNaSD) occurred at a median of 2 [1-4] days after admission. There was a significant progressive decrease in dNaSD over the first 7 days (coefficient - 0.15 95% CI [- 0.18 to - 0.12], p < 0.001). After adjusting for baseline TBI severity, diabetes insipidus, the use of osmotherapy, the occurrence of hypernatremia, and hyponatremia and center, dNaSD was significantly independently associated with 28-day mortality (HR 1.27 95% CI (1.01-1.61), p = 0.048). CONCLUSIONS: Our study demonstrates that daily serum sodium variability is an independent predictor of 28-day mortality in severe TBI patients. Further prospective investigations are necessary to confirm the significance of sodium variability in larger cohorts of TBI patients and test whether attenuating such variability confers outcome benefits to such patients

Early Osmotherapy in Severe Traumatic Brain Injury : An International Multicenter Study

The optimal osmotic agent to treat intracranial hypertension in patients with severe traumatic brain injury (TBI) remains uncertain. We aimed to test whether the choice of mannitol or hypertonic saline (HTS) as early (first 96 h) osmotherapy in these patients might be associated with a difference in mortality. We retrospectively analyzed data from 2015 from 14 tertiary intensive care units (ICUs) in Australia, UK, and Europe treating severe TBI patients with intracranial pressure (ICP) monitoring and compared mortality in those who received mannitol only versus HTS only. We performed multi-variable analysis adjusting for site and illness severity (Injury Severity Score, extended IMPACT score, and mean ICP over the first 96 h) using Cox proportional hazards regression. We collected data on 262 patients and compared patients who received early osmotherapy with mannitol alone (n = 46) with those who received HTS alone (n = 46). Mannitol patients were older (median age, 49.2 (19.2) vs. 40.5 (16.8) years; p = 0.02), with higher Injury Severity Scores (42 (15.9) vs. 32.1 [11.3]; p = 0.001), and IMPACT-TBI predicted 6-month mortality (34.5% [23-46] vs. 25% [13-38]; p = 0.02), but had similar APACHE-II scores, and mean and maximum ICPs over the first 96 h. The unadjusted hazard ratio for in-hospital mortality in patients receiving only mannitol was 3.35 (95% confidence interval [CI], 1.60-7.03; p = 0.001). After adjustment for key mortality predictors, the hazard ratio for in-hospital mortality in patients receiving only mannitol was 2.64 (95% CI, 0.96-7.30; p = 0.06). The choice of early osmotherapy in severe TBI patients may affect survival, or simply reflect clinician beliefs about their different roles, and warrants controlled investigation.Peer reviewe

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Investigating the potential for groundwater from different vegetation, soil and landuses to stimulate blooms of the cyanobacterium Lyngbya majuscula in coastal waters

Over the past decade, toxic blooms of the cyanobacterium Lyngbya majuscula have increased in frequency and severity in south-east Queensland, Australia, with blooms in Deception Bay linked to increased inputs of dissolved nutrients and organic carbon from land-based sources. The current study investigates the potential for groundwater from ten combinations of vegetation, soil and landuses to stimulate L. majuscula growth in Deception Bay. The photosynthetic response (14C-bicarbonate uptake rate) of L. majuscula to diluted samples of groundwater (1 part groundwater to 19 parts seawater) was measured under laboratory conditions. The results from the present study show that groundwaters from vegetation/soil/landuse systems characterised by acid sulfate soils, exotic pine plantations and Melaleuca vegetation significantly stimulated L. majuscula photosynthesis. These areas typically have low pH and/or high dissolved organic carbon concentrations with strong iron complexation properties, favouring the bioavailability of nutrients. Data from the current study have been incorporated into models and hazard maps to identify areas most vulnerable to the export of nutrients of concern for L. majuscula growth. The hazard maps are part of the Harmful Algal Bloom Policy within the draft South-east Queensland Coastal Management Plan and are aimed at reducing the severity of L. majuscula blooms

In situ field experiment shows Lyngbya majuscula (cyanobacterium) growth stimulated by added iron, phosphorus and nitrogen

Coastal waters worldwide have experienced an increase in the occurrence of harmful algal blooms. Over the past decade, nuisance blooms of the toxic cyanobacterium Lyngbya majuscula have increased in frequency and severity in south-east Queensland, Australia, with blooms in Moreton Bay hypothesised to be linked to increased inputs of dissolved nutrients and organic carbon from land-based sources. An in situ field experiment was conducted in northern Moreton Bay (Deception Bay), Australia, to determine the growth response of L. majuscula to phosphorus, nitrogen and organically chelated iron additions to the water column. A three-way analysis of variance showed each of these nutrients stimulated L. majuscula biomass under field conditions, with organically chelated iron (FeEDTA) > phosphorus > nitrogen. Concurrent addition of all three nutrients [FeEDTA + P + N] caused the greatest response being 18 times the control after 49 days; this resulted in an additional 928 g m of L. majuscula biomass over the control (54 g m). These results show that water borne nutrients, particularly organically chelated iron, phosphorus and nitrogen can promote prolific growth of the bloom-forming cyanobacterium L. majuscula. It is also likely that the addition of iron and/or phosphorus stimulated nitrogen fixation in L. majuscula, based on the large L. majuscula biomass and higher tissue nitrogen content in the iron and phosphorus treatments. Enrichment with poultry litter (sourced from the adjacent catchment) also substantially enhanced L. majuscula biomass. The experiment shows that a precautionary approach to limit or reduce nutrient additions to streams, estuaries and coastal waters is justified; otherwise the magnitude of L. majuscula blooms is likely to increase in Moreton Bay in the future