Rates of summertime biological productivity in the Beaufort Gyre : a comparison between the low and record-low ice conditions of August 2011 and 2012

© The Author(s), 2014. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Journal of Marine Systems 147 (2015): 29-44, doi:10.1016/j.jmarsys.2014.04.006.The Arctic Ocean is changing rapidly as the global climate warms but it is not well known how these changes are affecting biological productivity and the carbon cycle. Here we study the Beaufort Gyre region of the Canada Basin in August and use the large reduction in summertime sea ice extent from 2011 to 2012 to investigate potential impacts of climate warming on biological productivity. We use the gas tracers O2/Ar and triple oxygen isotopes to quantify rates of net community production (NCP) and gross oxygen production (GOP) in the gyre. Comparison of the summer of 2011 with the summer of 2012, the latter of which had record low sea ice coverage, is relevant to how biological productivity might change in a seasonally ice-free Arctic Ocean. We find that, in the surface waters measured here, GOP in 2012 is significantly greater than in 2011, with the mean basin-wide 2012 GOP = 38 ± 3 mmol O2 m− 2 d− 1 whereas in 2011, mean basin GOP = 16 ± 5 mmol O2 m− 2 d− 1. We hypothesize that this is because the lack of sea ice and consequent increase in light penetration allows photosynthesis to increase in 2012. However, despite the increase in GOP, NCP is the same in the two years; mean NCP in 2012 is 3.0 ± 0.2 mmol O2 m− 2 y− 1 and in 2011 is 3.1 ± 0.2 mmol O2 m− 2 y− 1. This suggests that the heterotrophic community (zooplankton and/or bacteria) increased its activity as well and thus respired the additional carbon produced by the increased photosynthetic production. In both years, stations on the shelf had GOP 3 to 5 times and NCP 2 to 10 times larger than the basin stations. Additionally, we show that in 2011, the NCP/GOP ratio is smallest in regions with highest ice cover, suggesting that the microbial loop was more efficient at recycling carbon in regions where the ice was just starting to melt. These results highlight that although satellite chlorophyll records show, and many models predict, an increase in summertime primary production in the Arctic Basin as it warms, the net amount of carbon processed by the biological pump during summer may not change as a function of ice cover. Thus, a rapid reduction in summertime ice extent may not change the net community productivity or carbon balance in the Beaufort Gyre.We thank our funding sources: the National Science Foundation (PLR 1304406, PLR-0856531) and the support of Fisheries and Oceans Canada

An integrative approach to improving patient care pathways

Purpose: Globally, healthcare managers continue to struggle with managing increasing demands for their services with limited or shrinking resources. It is therefore, clear that systems, processes and practices need to change to meet these challenges. We assess how integrating two improvement technologies, Lean and Integrated Care Pathways (ICPs) might help. Design/methodology/approach: Lean in healthcare and ICP provide a platform to develop conceptual frameworks for integrating two approaches. Findings: A conceptual integrated framework is provided to assist care pathway designers and implementers to consider the synergistic benefits of combining approaches to improvement. Research limitations/implications: We provide a conceptual framework that requires empirically testing. Practical implications: This research provides a conceptual framework to aid practitioners to improve healthcare design and delivery. Originality/value: For the first time, we bring together two approaches to improving patient care pathway design and considers how these are linked in relation to improving the delivery of health care

Recent climate-driven ecological change across a continent as perceived through local ecological knowledge

Documenting effects of climate change is an important step towards designing mitigation and adaptation responses. Impacts of climate change on terrestrial biodiversity and ecosystems have been well-documented in the Northern Hemisphere, but long-term data to detect change in the Southern Hemisphere are limited, and some types of change are generally difficult to measure. Here we present a novel approach using local ecological knowledge to facilitate a continent-scale view of climate change impacts on terrestrial biodiversity and ecosystems that people have perceived in Australia. We sought local knowledge using a national web-based survey, targeting respondents with close links to the environment (e.g. farmers, ecologists), and using a custom-built mapping tool to ask respondents to describe and attribute recent changes they had observed within an area they knew well. Results drawn from 326 respondents showed that people are already perceiving simple and complex climate change impacts on hundreds of species and ecosystems across Australia, significantly extending the detail previously reported for the continent. While most perceived trends and attributions remain unsubstantiated, \u3e35 reported anecdotes concurred with examples in the literature, and \u3e20 were reported more than once. More generally, anecdotes were compatible with expectations from global climate change impact frameworks, including examples across the spectrum from organisms (e.g. increased mortality in \u3e75 species), populations (e.g. changes in recruitment or abundance in \u3e100 species, phenological change in \u3e50 species), and species (e.g. \u3e80 species newly arriving or disappearing), to communities and landscapes (e.g. \u3e50 examples of altered ecological interactions). The overarching pattern indicated by the anecdotes suggests that people are more often noticing climate change losers (typically native species) than winners in their local areas, but with observations of potential ‘adaptation in action’ via compositional and phenological change and through arrivals and range shifts (particularly for native birds and exotic plants). A high proportion of climate change-related anecdotes also involved cumulative or interactive effects of land use. We conclude that targeted elicitation of local ecological knowledge about climate change impacts can provide a valuable complement to data-derived knowledge, substantially extending the volume of explicit examples and offering a foundation for further investigation

Personalizing neoadjuvant chemotherapy for locally advanced colon cancer:protocols for the international phase III FOxTROT2 and FOxTROT3 randomized controlled trials

AIM: FOxTROT1 established a new standard of care for managing locally advanced colon cancer (CC) with neoadjuvant chemotherapy (NAC). Six weeks of neoadjuvant oxaliplatin and fluoropyrimidine (OxFp) chemotherapy was associated with greater 2-year disease-free survival (DFS) when compared with proceeding straight to surgery (STS). There is now a need to refine the use of NAC and identify those most likely to benefit. FOxTROT2 will aim to investigate NAC in older adults and those with frailty. FOxTROT3 will aim to assess whether intensified triplet NAC provides additional benefits over OxFp.METHOD: FOxTROT2 and FOxTROT3 are international, open-label, phase III randomized controlled trials. Eligible patients will be identified by the multidisciplinary team. Patient age, frailty and comorbidities will be considered to guide trial entry. Participants will be randomized 2:1 to the intervention or control arm: 6 weeks of dose-adapted neoadjuvant OxFp versus STS in FOxTROT2 and 6 weeks of neoadjuvant modified oxaliplatin, 5-fluorouracil and irinotecan versus OxFp in FOxTROT3. The primary endpoint in FOxTROT2 is 3-year DFS. In FOxTROT3, tumour regression grade and 3-year DFS are co-primary endpoints.DISCUSSION: FOxTROT2 and FOxTROT3 will establish the FOxTROT platform, a key part of our long-term strategy to develop neoadjuvant treatments for CC. FOxTROT2 will investigate NAC in a population under-represented in FOxTROT1 and wider research. FOxTROT3 will assess whether it is possible to induce greater early tumour responses and whether this translates to superior long-term outcomes. Looking ahead, the FOxTROT platform will facilitate further trial comparisons and extensive translational research to optimize the use of NAC in CC.</p

Genetic and Dietary Factors Influencing the Progression of Nuclear Cataract.

PURPOSE: To determine the heritability of nuclear cataract progression and to explore prospectively the effect of dietary micronutrients on the progression of nuclear cataract. DESIGN: Prospective cohort study. PARTICIPANTS: Cross-sectional nuclear cataract and dietary measurements were available for 2054 white female twins from the TwinsUK cohort. Follow-up cataract measurements were available for 324 of the twins (151 monozygotic and 173 dizygotic twins). METHODS: Nuclear cataract was measured using a quantitative measure of nuclear density obtained from digital Scheimpflug images. Dietary data were available from EPIC food frequency questionnaires. Heritability was modeled using maximum likelihood structural equation twin modeling. Association between nuclear cataract change and micronutrients was investigated using linear and multinomial regression analysis. The mean interval between baseline and follow-up examination was 9.4 years. MAIN OUTCOME MEASURES: Nuclear cataract progression. RESULTS: The best-fitting model estimated that the heritability of nuclear cataract progression was 35% (95% confidence interval [CI], 13-54), and individual environmental factors explained the remaining 65% (95% CI, 46-87) of variance. Dietary vitamin C was protective against both nuclear cataract at baseline and nuclear cataract progression (β = -0.0002, P = 0.01 and β = -0.001, P = 0.03, respectively), whereas manganese and intake of micronutrient supplements were protective against nuclear cataract at baseline only (β = -0.009, P = 0.03 and β = -0.03, P = 0.01, respectively). CONCLUSIONS: Genetic factors explained 35% of the variation in progression of nuclear cataract over a 10-year period. Environmental factors accounted for the remaining variance, and in particular, dietary vitamin C protected against cataract progression assessed approximately 10 years after baseline

Coding sequences of sarcoplasmic reticulum calcium ATPase regulatory peptides and expression of calcium regulatory genes in recurrent exertional rhabdomyolysis

Background: Sarcolipin (SLN), myoregulin (MRLN), and dwarf open reading frame (DWORF) are transmembrane regulators of the sarcoplasmic reticulum calcium transporting ATPase (SERCA) that we hypothesized played a role in recurrent exertional rhabdomyolysis (RER). Objectives: Compare coding sequences of SLN, MRLN, DWORF across species and between RER and control horses. Compare expression of muscle Ca2+ regulatory genes between RER and control horses. Animals: Twenty Thoroughbreds (TB), 5 Standardbreds (STD), 6 Quarter Horses (QH) with RER and 39 breed-matched controls. Methods: Sanger sequencing of SERCA regulatory genes with comparison of amino acid (AA) sequences among control, RER horses, human, mouse, and rabbit reference genomes. In RER and control gluteal muscle, quantitative real-time polymerase chain reaction of SERCA regulatory peptides, the calcium release channel (RYR1), and its accessory proteins calsequestrin (CASQ1), and calstabin (FKBP1A). Results: The SLN gene was the highest expressed horse SERCA regulatory gene with a uniquely truncated AA sequence (29 versus 31) versus other species. Coding sequences of SLN, MRLN, and DWORF were identical in RER and control horses. A sex-by-phenotype effect occurred with lower CASQ1 expression in RER males versus control males (P \u3c .001) and RER females (P = .05) and higher FKBP1A (P = .01) expression in RER males versus control males. Conclusions and Clinical Importance: The SLN gene encodes a uniquely truncated peptide in the horse versus other species. Variants in the coding sequence of SLN, MLRN, or DWORF were not associated with RER. Males with RER have differential gene expression that could reflect adaptations to stabilize RYR1

An Electronic Clinical Decision Support System for the Management of Low Back Pain in Community Pharmacy: Development and Mixed Methods Feasibility Study

Background People with low back pain (LBP) in the community often do not receive evidence-based advice and management. Community pharmacists can play an important role in supporting people with LBP as pharmacists are easily accessible to provide first-line care. However, previous research suggests that pharmacists may not consistently deliver advice that is concordant with guideline recommendations and may demonstrate difficulty determining which patients require prompt medical review. A clinical decision support system (CDSS) may enhance first-line care of LBP, but none exists to support the community pharmacist–client consultation. Objective This study aimed to develop a CDSS to guide first-line care of LBP in the community pharmacy setting and to evaluate the pharmacist-reported usability and acceptance of the prototype system. Methods A cross-platform Web app for the Apple iPad was developed in conjunction with academic and clinical experts using an iterative user-centered design process during interface design, clinical reasoning, program development, and evaluation. The CDSS was evaluated via one-to-one user-testing with 5 community pharmacists (5 case vignettes each). Data were collected via video recording, screen capture, survey instrument (system usability scale), and direct observation. Results Pharmacists’ agreement with CDSS-generated self-care recommendations was 90% (18/20), with medicines recommendations was 100% (25/25), and with referral advice was 88% (22/25; total 70 recommendations). Pharmacists expressed uncertainty when screening for serious pathology in 40% (10/25) of cases. Pharmacists requested more direction from the CDSS in relation to automated prompts for user input and page navigation. Overall system usability was rated as excellent (mean score 92/100, SD 6.5; 90th percentile compared with similar systems), with acceptance rated as good to excellent. Conclusions A novel CDSS (high-fidelity prototype) to enhance pharmacist care of LBP was developed, underpinned by clinical practice guidelines and informed by a multidisciplinary team of experts. User-testing revealed a high level of usability and acceptance of the prototype system, with suggestions to improve interface prompts and information delivery. The small study sample limits the generalizability of the findings but offers important insights to inform the next stage of system development. </jats:sec

Variations in rates of biological production in the Beaufort Gyre as the arctic changes: Rates from 2011 to 2016

Author Posting. © American Geophysical Union, 2019. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research-Oceans 124(6), (2019): 3628-3644, doi:10.1029/2018JC014805.The Arctic Ocean is experiencing profound environmental changes as the climate warms. Understanding how these changes will affect Arctic biological productivity is key for predicting future Arctic ecosystems and the global CO2 balance. Here we use in situ gas measurements to quantify rates of gross oxygen production (GOP, total photosynthesis) and net community production (NCP, net CO2 drawdown by the biological pump) in the mixed layer in summer or fall from 2011 to 2016 in the Beaufort Gyre. NCP and GOP show spatial and temporal variations with higher values linked with lower concentrations of sea ice and increased upper ocean stratification. Mean rates of GOP range from 8 ± 1 to 54 ± 9 mmol O2·m−2·d−1 with the highest mean rates occurring in summer of 2012. Mean rates of NCP ranged from 1.3 ± 0.2 to 2.9 ± 0.5 mmol O2·m−2·d−1. The mean ratio of NCP/GOP, a measure of how efficiently the ecosystem is recycling its nutrients, ranged from 0.04 to 0.17, similar to ratios observed at lower latitudes. Additionally, a large increase in total photosynthesis that occurred in 2012, a year of historically low sea ice coverage, persisted for many years. Taken together, these data provide one of the most complete characterizations of interannual variations of biological productivity in this climatically important region, can serve as a baseline for future changes in rates of production, and give an intriguing glimpse of how this region of the Arctic may respond to future lack of sea ice.We sincerely thank the scientific teams of Fisheries and Oceans Canada's Joint Ocean Ice Studies expedition and Woods Hole Oceanographic Institution's Beaufort Gyre Observing System. The hydrographic, nutrient, and chlorophyll data were collected and made available by the Beaufort Gyre Exploration Program based at the Woods Hole Oceanographic Institution (http://www.whoi.edu/beaufortgyre) in collaboration with researchers from Fisheries and Oceans Canada at the Institute of Ocean Sciences. We thank the captains and crews of the Canadian icebreaker CCGS Louis S. St‐Laurent and Mike Dempsey for sample collection. This paper was improved by the suggestions of Michael DeGrandpre and one anonymous reviewer. We are grateful to Qing Wang at Wellesley College for her assistance with statistics. We thank our funding sources: the National Science Foundation (NSF 1547011, NSF 1302884, NSF 1719280, NSF 1643735) and the support of Fisheries and Oceans Canada. Data presented and discussed in this paper can be found in the Arctic Data Center (http://10.18739/A2W389).2019-10-3