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Purpose Previous work has focused on the role of diabetes in peripheral neuropathy (PN), but PN often occurs before, and independently from, diabetes. This study measures the association of cardiometabolic and inflammatory factor with PN, independent of diabetes. Methods Study of Women's Health Across the Nation participants (n = 1910), ages 60 to 73 (mean 65.6) were assessed for PN by symptom questionnaire and monofilament testing at the 15th follow-up visit (V15). Anthropometric measures and biomarkers were measured at study baseline approximately 20 years prior, and C-reactive protein (CRP) and fibrinogen were measured longitudinally. Log-binomial regression was used to model the association between metabolic syndrome (MetS), obesity (≥35 body mass index), CRP, and fibrinogen with PN, adjusting for sociodemographic and health behavior measures. Results Baseline MetS [prevalence ratio (PR) 1.79, 95% CI (1.45, 2.20)], obesity [PR 2.08 (1.65, 2.61)], median CRP [PR 1.32 per log(mg/dL), (1.20, 1.45)], and mean fibrinogen (PR 1.28 per 100 mg/dL, (1.09, 1.50)] were associated with PN symptoms at V15. After excluding participants with baseline diabetes or obesity, MetS [PR 1.59 (1.17, 2.14)] and CRP [PR 1.19 per log(mg/dL), (1.06, 1.35)] remained statistically significantly associated with PN. There was a negative interaction between MetS and obesity, and the association between these conditions and PN was mediated by CRP. Conclusions Cardiometabolic factors and inflammation are significantly associated with PN, independent of diabetes and obesity. CRP mediates the relationship of both obesity and MetS with PN, suggesting an etiological role of inflammation in PN in this sample.

Background The relationship between intraoperative physiology and postoperative stroke is incompletely understood. Preliminary data suggest that either hypo- or hypercapnia coupled with reduced cerebrovascular inflow (e.g., due to hypotension) can lead to ischemia. This study tested the hypothesis that the combination of intraoperative hypotension and either hypo- or hypercarbia is associated with postoperative ischemic stroke. Methods We conducted a retrospective, case–control study via the Multicenter Perioperative Outcomes Group. Noncardiac, nonintracranial, and nonmajor vascular surgical cases (18 yr or older) were extracted from five major academic centers between January 2004 and December 2015. Ischemic stroke cases were identified via manual chart review and matched to controls (1:4). Time and reduction below key mean arterial blood pressure thresholds (less than 55 mmHg, less than 60 mmHg, less than 65 mmHg) and outside of specific end-tidal carbon dioxide thresholds (30 mmHg or less, 35 mmHg or less, 45 mmHg or greater) were calculated based on total area under the curve. The association between stroke and total area under the curve values was then tested while adjusting for relevant confounders. Results In total, 1,244,881 cases were analyzed. Among the cases that screened positive for stroke (n = 1,702), 126 were confirmed and successfully matched with 500 corresponding controls. Total area under the curve was significantly associated with stroke for all thresholds tested, with the strongest combination observed with mean arterial pressure less than 55 mmHg (adjusted odds ratio per 10 mmHg-min, 1.17 [95% CI, 1.10 to 1.23], P < 0.0001) and end-tidal carbon dioxide 45 mmHg or greater (adjusted odds ratio per 10 mmHg-min, 1.11 [95% CI, 1.10 to 1.11], P < 0.0001). There was no interaction effect observed between blood pressure and carbon dioxide. Conclusions Intraoperative hypotension and carbon dioxide dysregulation may each independently increase postoperative stroke risk. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Viruses in the family Rhabdoviridae infect a variety of hosts, including vertebrates, invertebrates, plants and fungi, with important consequences for health and agriculture. This study describes two newly discovered viruses of freshwater mussels from the United States.

Background Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection.Methods This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008–2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome.Results Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62–4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63–5.51, p = 0.26).Conclusions In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary.

Over 645 million people worldwide have been infected with SARS-CoV-2, the virus that causes COVID-19. Critical knowledge gaps regarding the characteristics, duration, and impact of symptoms due to “long COVID”. This study evaluated the persistence of symptoms at one year following hospitalization with COVID-19, comparing responses on standardized measurement tools to population norms. Adults hospitalized with COVID-19 March-October 2020 during the initial emergence period in Southeast Michigan were eligible. A detailed survey was conducted via telephone 9-15 months after hospital discharge. Questions assessed fatigue, dyspnea, and physical functioning related to their COVID-19 illness. The median World Health Organization Disability Assessment Schedule (WHODAS) polytomous score placed 50% (n=20/40) of participants in the 90 percentile of disability based on population norms. The mean SF-36 physical functioning score was almost nine points below population norms (mean=70.6, standard deviation=27.4). Additionally, 47.5% of individuals (n=19) were severely emotionally affected by their health condition. Over half of participants surveyed were still impacted a year after initial infection, experiencing limited functional ability, fatigue, and emotional difficulties. Given the impact of these symptoms on day-to-day quality of life, further studies are needed to develop strategies for treatment and management of post-COVID conditions.

BackgroundRSV is a frequent cause of respiratory illness less often diagnosed outside hospital settings; thus, overall prevalence of RSV-associated illness is under-recognized. Information about presence of RSV among those with chronic conditions is especially needed with recent advances in vaccine development.MethodsParticipants prospectively enrolled in an ambulatory surveillance study of respiratory illness (MFIVE) were tested by RT-PCR for RSV and influenza. Participant and illness characteristics were collected by in-person survey and EMR review. Chronic conditions were characterized by the Multimorbidity-weighted index (MWI). Viral factors, including subtype and viral load, were compared between RSV-A and RSV-B. Multivariate logistic regression models were used to compare participant and illness characteristics between those with RSV and those with influenza. Comparisons were also made across RSV subtypes.ResultsAmong 4,442 individuals enrolled in MFIVE from fall 2017 to spring 2020, 9.9% (n=441) had RSV detected. RSV+ participants with increased viral load had increased odds of illness lasting ≥ 7 days [ORadj=2.39 (95% CI: 1.03-5.51) p-value=0.04]. Adults with RSV had higher median MWI scores compared to influenza and RSV/influenza-negative (1.62, 0.40, 0.64, respectively).ConclusionsOur findings support the need for ongoing RSV surveillance, particularly in older adults and those with multimorbidity. Our findings support a recognition of multimorbidity as a significant contributor to RSV-associated MAARI among outpatient adults, with particularly notable impacts among adults under 65.

During October and November 2021, 33 creek chubs, Semotilus atromaculatus, were collected from 3 sites in Polk County, Arkansas (Ouachita River drainage), and their gills, gallbladder, fins, integument, musculature, and other major organs were examined for myxozoans. The gills of 9 (27%) were infected with a new myxozoan, Myxobolus fountainae n. sp. Qualitative and quantitative morphological data were from fresh and formalin-fixed preserved spores, while molecular data consisted of a 1918 base pair sequence of the partial small subunit ribosomal RNA gene. Phylogenetic analysis grouped M. fountainae n. sp. with the other leuciscid-infecting myxobolids from North America and within a larger clade of European myxozoans. In addition, histological information is provided on the infection. A previous record of Myxobolus muelleriBütschli, 1882, from the gills and ureters of S. atromaculatus is considered invalid and represents an unknown species. Myxobolus fountainae n. sp. is the only named myxozoan known to infect the gill filaments of S. atromaculatus, whereas Myxobolus pendula (Guilford, 1967) infects the gill arches.

Latitude and body size are generally considered key drivers of swimming performance for larval marine fishes, but evidence suggests that evolutionary relationships and habitat may also be important. We used a comparative phylogenetic framework, data synthesis and case study approach to investigate how swimming performance differs among larvae of fish species across latitude. First, we investigated how swimming performance changed with body length, and we found that temperate reef fishes have the greatest increases in swimming performance with length. Secondly, we compared differences in three swimming performance metrics (critical swimming speed, in situ swimming, and endurance) among post-flexion larvae, whilst considering phylogenetic relationships and morphology, and we found that reef fishes have higher swimming capacity than non-reef (pelagic and non-reef demersal) fishes, which is likely due to larger, more robust body sizes. Thirdly, we compared swimming performance of late-stage larvae of tropical fishes with oceanographic data to better understand the ecological relevance of their high-capacity swimming. We found that reef fishes have high swimming performance and grow larger than non-reef fish larvae, which we suggest is due to the pressures to find a specific, patchily distributed habitat upon which to settle. Given the current bias towards studies on percomorph fishes at low latitudes, we highlight that there is a need for more research on temperate reef fish larvae and other percomorph lineages from high latitudes. Overall, our findings provide valuable context to understand how swimming and morphological traits that are important for dispersal and recruitment processes are selected for among teleost fish larvae.

Epidemiologic evidence documenting the incidence of fracture and subsequent fractures among adults with cerebral palsy (CP) is lacking, which could inform fracture prevention efforts. The objective was to characterize the 5-year rate of initial and subsequent fragility fractures among adults with CP.This retrospective cohort study used Medicare claims from 01/01/2008-12/31/2019 from adults ≥18 years old with CP (The IR of fragility fracture at any site over the 5-year follow-up was similar for 18-30-year-old men with CP (IR = 5.2; 95%CI = 4.4-5.9) and 30-34-year-old women with CP (IR = 6.3; 95%CI = 5.3-7.2) compared to the same sex youngest-old (65-74 years old) without CP (IRR = 1.09 and 0.94, respectively, bothYoung and middle-aged adults with CP had similar-to-worse initial and subsequent fragility fracture profiles compared to the general elderly population- a well characterized group for bone fragility. Findings emphasize the need for fracture prevention efforts at younger ages for CP, possibly by ~5 decades younger.

Biophysical dispersal models for marine fish larvae are widely used by marine ecologists and managers of fisheries and marine protected areas to predict movement of larval fishes during their pelagic larval duration (PLD). Over the past 25 years, it has become obvious that behaviour—primarily vertical positioning, horizontal swimming and orientation—of larvae during their PLD can strongly influence dispersal outcomes. Yet, most published models do not include even one of these behaviours, and only a tiny fraction include all three. Furthermore, there is no clarity on how behaviours should be incorporated into models, nor on how to obtain the quantitative, empirical data needed to parameterize models. The PLD is a period of morphological, physiological and behavioural change, which presents challenges for modelling. The present paper aims to encourage the inclusion of larval behaviour in biophysical dispersal models for larvae of marine demersal fishes by providing practical suggestions, advice and insights about obtaining and incorporating behaviour of larval fishes into such models based on experience. Key issues are features of different behavioural metrics, incorporation of ontogenetic, temporal, spatial and among-individual variation, and model validation. Research on behaviour of larvae of study species should be part of any modelling effort.

For much of their pelagic larval dispersal (PLD) stage, larval perciform fishes are able to directly influence their dispersal by horizontal swimming, but it is unclear which means of measuring swimming ability is most appropriate for modelling dispersal and studying demographic and genetic connectivity. Most studies use critical speed (Ucrit), a laboratory flume measure derived by increasing flow until larvae can no longer maintain their position. Most swimming ability data on fish larvae are Ucrit, usually for larvae nearing the end of PLD. Recognizing that a forced laboratory measure is inappropriate for dispersal, researchers have used decreased Ucrit values, usually by 50%, and have argued that Ucrit is strongly correlated with more relevant swimming measures. Here I examined the suitability of Ucrit versus in situ speed (ISS), wherein speed of larvae is measured by divers following them in the ocean with a flow meter. Considerations of dispersal require inclusion of swimming ontogeny. Swimming speed regressions of speed on size of 10 species in 8 families showed that Ucrit and ISS are not well correlated. The Ucrit:standard length (SL) slope was greater than the ISS:SL slope in 6 species, and did not differ in the other 4 species. No overall metric, e.g. X% of Ucrit = ISS, was appropriate for conversion of Ucrit to ISS. Conversion of Ucrit to ISS is not straightforward. Ucrit measures swimming potential, not what larvae do in the ocean, whereas ISS directly measures larvae swimming in the ocean. Ucrit ontogeny is less variable, but ISS ontogeny is more relevant to dispersal. Ucrit may be useful for other purposes.

During April 2016 and again in November 2021, four Chain Pickerels, Esox niger were collected from Union (n = 3) and Nevada (n = 1) counties, Arkansas, USA, and 65 Grass Pickerels, Esox americanus vermiculatus were collected between January 2015 and December 2021 from four counties of Arkansas (n = 31) and McCurtain County, Oklahoma, USA (n = 34), and examined for myxozoans. Gallbladders of an individual E. niger from Nevada County, Arkansas, as well as a single individual of E. a. vermiculatus from Sevier County, Arkansas, were infected with a new myxozoan, Myxidium whippsi n. sp. Qualitative and quantitative morphological data were from formalin-fixed preserved myxospores while molecular data (SSU rRNA gene) consisted of 2031bp (host: E. niger) and 1723 bp (host: E. a. vermiculatus) partial sequences of the small subunit ribosomal RNA gene. Phylogenetic analysis placed M. whippsi n. sp. in a clade with two other myxozoans, Zschokkella nova and Myxidium truttae, previously reported from cyprinids and salmonids, respectively. We document the first report of a myxozoan from E. a. vermiculatus. This article was registered in the Official Register of Zoological Nomenclature (ZooBank) as urn:lsid:zoobank.org:pub:A50FCEB3-68C3-428E-A04E-37A16790F1EB.

Pseudomurraytrema fergusoni n. sp. is described from the Pealip Redhorse, Moxostoma pisolabrum from the Black River (White River drainage), Lawrence County, Arkansas, USA. This represents the second monogenean described from M. pisolabrum as well as the second species of Pseudomurraytrema reported from an Arkansas catostomid. The description includes partial 18S rRNA and 28S rRNA gene sequences (732 bp and 851 bp, respectively), helping fill a void in sequence data from North American monogeneans, particularly those in the genus Pseudomurraytrema. In addition, histopathologic changes associated with the infection resulted in severe localized pathologic lesions in gills of the host, suggesting compromise of respiratory surfaces within affected areas adjacent to the worms.

Freshwater mussels (Unionida) are among the world’s most imperiled taxa, but the relationship between freshwater mussel mortality events and infectious disease is largely unstudied. We surveyed viromes of a widespread and abundant species (mucket, Actinonaias ligamentina; syn: Ortmanniana ligamentina) experiencing a mortality event of unknown etiology in the Huron River, Michigan, in 2019–2020 and compared them to viromes from mucket in a healthy population in the St. Croix River, Wisconsin and a population from the Clinch River, Virginia and Tennessee, where a mortality event was affecting the congeneric pheasantshell (Actinonaias pectorosa; syn: Ortmanniana pectorosa) population. We identified 38 viruses, most of which were associated with mussels collected during the Huron River mortality event. Viral richness and cumulative viral read depths were significantly higher in moribund mussels from the Huron River than in healthy controls from each of the three populations. Our results demonstrate significant increases in the number and intensity of viral infections for freshwater mussels experiencing mortality events, whereas individuals from healthy populations have a substantially reduced virome comprising a limited number of species at low viral read depths.

The larval stage is the main dispersive mechanism of most marine teleost fish species. The degree to which larval behavior controls dispersal outcome has been a subject of debate in the past decades. Multiple studies demonstrated orientation mechanisms in several species separately, however a cross-species analysis examining fundamental orientation traits has not been carried out. Here, we apply a cross-species meta-analysis, focusing on the fundamental question of whether larval fish use external cues for directional movement. We compare the observed directional patterns to those expected under a strict use of internal cues. We find that the bulk of fish larvae use external cues for directional swimming, highlighting the contribution of larval orientation behavior to larval dispersal outcome. This finding is an essential step towards a proper implementation of larval behavior in biophysical dispersal models, improving our understanding of population connectivity, and facilitating sustainable management and conservation of marine resources.

To test for differences in DISE findings in children sedated with propofol versus dexmedetomidine. We hypothesized that the frequency of ≥ 50% obstruction would be higher for the propofol than dexmedetomidine group at the dynamic levels of the airway (velum, lateral walls, tongue base, and supraglottis) but not at the more static adenoid level.A single-center retrospective review was performed on children age 1-18 years with a diagnosis of sleep disordered breathing or obstructive sleep apnea (OSA) who underwent DISE from July 2014 to Feb 2019 scored by the Chan-Parikh scale sedated with either propofol or dexmedetomidine (with or without ketamine). Logistic regression was used to test for a difference in the odds of ≥ 50% obstruction (Chan-Parikh score ≥ 2) at each airway level with the use of dexmedetomidine vs. propofol, adjusted for age, sex, previous tonsillectomy, surgeon, positional OSA, and ketamine co-administration.Of 117 subjects, 57% were sedated with propofol and 43% with dexmedetomidine. Subjects were 60% male, 66% Caucasian, 31% obese, 38% syndromic, and on average 6.5 years old. Thirty-three percent had severe OSA and 41% had previous tonsillectomy. There was no statistically significant difference in the odds of ≥ 50% obstruction between the two anesthetic groups at any level of the airway with or without adjustment for potential confounders.We did not find a significant difference in the degree of upper airway obstruction on DISE in children sedated with propofol versus dexmedetomidine. Prospective, randomized studies would be an important next step to confirm these findings.

Coral reef fishes are famous for their fantastic colors and forms. Easily overlooked are the cryptic and diminutive (cryptobenthic) bottom-dwelling fishes that also call coral reefs home. By linking empirical data and ecosystem modeling, Brandl et al. (1), on page 1189 of this issue, propose that pelagic (open-water) larvae of cryptobenthic fishes and their small juveniles that recently settled on reefs constitute a key food source for other reef residents. Such a scenario could help explain why coral reefs in nutrientpoor waters teem with life.

The distribution and connectivity of marine populations are largely dependent on biophysical factors affecting pelagic larval dispersal between spawning at adult spawning sites and settlement to juvenile nursery habitats. Behaviour and swimming ability of pelagic larvae are increasingly understood to influence patterns of dispersal, but it is unclear which sensory cues are involved and when during ontogeny these abilities first develop. Here we studied the early ontogenetic development of responses to olfactory cues from coastal and estuarine waters in larvae of two temperate estuarine-associated fish species, Australian bass, Macquaria novemaculeata, and mulloway, Argyrosomus japonicus, to determine when olfaction begins to influence dispersal. Olfactory responses to habitat-associated cues were not present when larvae first transitioned from nonswimming to swimming (indicated by flexion of the notochord), but emerged after ca. 7 days in a species-specific manner that was consistent across different cohorts. Based on general additive models (GAMs), age (in days posthatch) best explained the ontogenetic pattern in both species. The emergence of chemotactic responses coincides with an exponential increase in swimming endurance reported for these species. This suggests the existence of ontogenetic milestones during larval development that, once reached, trigger active influence on dispersal. Salinity and pH did not influence choice behaviour after these ontogenetic milestones; however, the presence of cues generated by seagrass harvested from the estuary habitat elicited strong responses in fish larvae consistent with species-specific habitat preferences, indicating an important role for aquatic vegetation in driving these behaviours.

The pirate perch

Lobotes, Datnioides and Hapalogenys are assigned to a newly defined Acanthuriformes on the basis of their pattern of tooth replacement (termed posterolateral tooth replacement), where new teeth form at the posterolateral ends of series. Posterolateral tooth replacement is shown to be a synamorphy of the order. The order is expanded to include Chaetodontidae, Pomacanthidae, Drepaneidae, Ephippidae, Leiognathidae, Antigonia, Scatophagidae and Capros, along with the more traditional members, Siganidae, Luvaridae, Zanclidae and Acanthuridae. Three-item analysis of 63 adult and larval morphological characters yields two optimal trees that differ only in the relative positions of Capros and Siganidae. The intersection tree of the two optimal trees is: (((Hapalogenys (Datnioides, Lobotidae)) (Pomacanthidae (Drepaneidae (Chaetodontidae (Ephippidae (Leiognathidae (Scatophagidae (Antigonia (Siganidae, Capros (Luvaridae (Zanclidae, Acanthuridae)))))))))))). This cladogram is compared with recent phylogenies based on analyses of sequence data, and few differences are found once the weakly-supported interior nodes of the latter are collapsed. Aside from expansion of the Acanthuriformes, the following classification changes are proposed in order to reflect the phylogenetic relationships: redefinition of the Lobotidae to include Lobotes, Datnioides and Hapalogenys; separate families for Antigonia and Capros (Antigoniidae and Caproidae, respectively); continued recognition of Drepaneidae (often considered a synonym of Ephippidae). The larvae of Capros aper are illustrated to show features overlooked in earlier descriptions.

Frontal fibrosing alopecia is an increasingly common form of scarring alopecia. The aim of this study was to describe the demographic and clinical characteristics of patients with FFA seen at the trichology unit of a medium-sized regional hospital and to report on treatments used.We reviewed the medical records of all patients with FFA seen at the trichology unit of Hospital Universitario Infanta Sofía in Madrid, Spain between May 2016 and May 2018. We analyzed associations between disease severity, clinical patterns, need for oral medications, and other characteristics.Seventy-five patients (73 women and 2 men) were studied. Diagnosis was clinical in most cases and 13 cases (17.3%) were confirmed histologically. Median (interquartile range) age at reported onset of symptoms was 61 (12) years. Involvement of the eyebrows was recorded in 70 patients (93.3%) and signs of oral and genital lichen planus in 7 (9.6%). Eleven patients (14.7%) had hypothyroidism and 15 (20.0%) had signs of rosacea. Only 5 of the patients who presented a linear pattern (21.7%) had severe hairline recession. Patients with unstable and/or symptomatic disease (n=24) were treated with oral medications (5-alpha reductase inhibitors, hydroxychloroquine, corticosteroids, and isotretinoin) or intralesional corticosteroids. Eighteen patients (75.0%) achieved disease stability. Ten of the 15 patients with signs of rosacea and 10 of those with facial papules required systemic treatment.Most of the patients in this series of FFA were postmenopausal women. The prevalence of oral and genital lichen planus was higher than that observed in the general population. Patients with a linear pattern had less severe disease. Facial papules were more common in younger patients and both facial papules and rosacea were associated with a greater need for oral treatment.

Small-sized eels of the Tropical Conger, Ariosoma scheelei, appear to be common in shallow Indo-Pacific tropical sheltered-bay and lagoon-type habitats when they are sampled appropriately and their larvae are abundant offshore of these areas, but little is known about their biology. Collections of about 7800 likely A. scheelei larvae in May 1997 using a 2-mm mesh 70 m2 mouth-opening trawl with a multiple opening-and-closing codend system at 13 Northwest Coral Sea (NWCS) areas (5 upper-200 m sampling depth-layers, 2 nighttime trawl-deployments/area) and a surface net were used to examine the vertical and geographic distributions of abundance and size of the leptocephali and metamorphosing larvae. 76.5% of trawl-caught A. scheelei leptocephali (33–169 mm, 95.3 ± 22.9 mm) were collected in the 0–12 m depth-layer and 927 (43–151 mm, 83.6 ± 19.5 mm) were examined from surface catches. Some larvae were caught at 12–25 m (12.3%) and 25–50 m (10.1%), but few were caught at 50–100 m (0.77%) and 100–200 m (0.12%). Leptocephali were most abundant offshore in the southeast and metamorphosing larvae (N=532, 82–146 mm) were most abundant in the northwest near the large shelf areas of Torres Strait and the Gulf of Papua. Regional size variations, proportions of metamorphosing larvae, and currents entering/exiting the NWCS suggested that larvae experience transport among areas, and have potential for retention by the Coral Sea Gyre or other recirculations. The high larval abundance of this small-size eel that reaches reproductive maturity at sizes

Larval dispersal is a critically important yet enigmatic process in marine ecology, evolution, and conservation. Determining the distance and direction that tiny larvae travel in the open ocean continues to be a challenge. Our current understanding of larval dispersal patterns at management-relevant scales is principally and separately informed by genetic parentage data and biological-oceanographic (biophysical) models. Parentage datasets provide clear evidence of individual larval dispersal events, but their findings are spatially and temporally limited. Biophysical models offer a more complete picture of dispersal patterns at regional scales but are of uncertain accuracy. Here, we develop statistical techniques that integrate these two important sources of information on larval dispersal. We then apply these methods to an extensive genetic parentage dataset to successfully validate a high-resolution biophysical model for the economically important reef fish species Plectropomus maculatus in the southern Great Barrier Reef. Our results demonstrate that biophysical models can provide accurate descriptions of larval dispersal at spatial and temporal scales that are relevant to management. They also show that genetic parentage datasets provide enough statistical power to exclude poor biophysical models. Biophysical models that included species-specific larval behaviour provided markedly better fits to the parentage data than assuming passive behaviour, but incorrect behavioural assumptions led to worse predictions than ignoring behaviour altogether. Our approach capitalises on the complementary strengths of genetic parentage datasets and high-resolution biophysical models to produce an accurate picture of larval dispersal patterns at regional scales. The results provide essential empirical support for the use of accurately parameterised biophysical larval dispersal models in marine spatial planning and management., Our understanding of marine fish larva dispersal is currently limited by sparse data and unvalidated models; combining DNA parentage matches with an oceanographic model of fish larvae on Australia’s Great Barrier Reef allows the authors to ground-truth a vital tool for sustainably managing coral reef fisheries.

Larval fishes are a useful metric of marine ecosystem state and change, as well as species-specific patterns in phenology. The high level of taxonomic expertise required to identify larval fishes to species level, and the considerable effort required to collect samples, make these data very valuable. Here we collate 3178 samples of larval fish assemblages, from 12 research projects from 1983-present, from temperate and subtropical Australian pelagic waters. This forms a benchmark for the larval fish assemblage for the region, and includes recent monitoring of larval fishes at coastal oceanographic reference stations. Comparing larval fishes among projects can be problematic due to differences in taxonomic resolution, and identifying all taxa to species is challenging, so this study reports a standard taxonomic resolution (of 218 taxa) for this region to help guide future research. This larval fish database serves as a data repository for surveys of larval fish assemblages in the region, and can contribute to analysis of climate-driven changes in the location and timing of the spawning of marine fishes.

Purpose of project The purpose of this article is to demonstrate the effectiveness of the Cumulative Complexity Model as a framework to build an Excel tool and a Pareto tool that will enable inpatient case managers to predict the increased risk for and prevent repeat falls. The Excel tool is based on work explained in a previous article by and uses a macro to analyze the factors causing the repeat falls and then calculate the probability of it happening again. This enables the case manager to identify trends in how the patient is transitioning toward goals of care and identify problems before they become barriers to the smooth transition to other levels of care. Thus, the case manager will save the facility money by avoiding unneeded days of care and avoiding the costs that result from rendering medical care for the patient who has fallen. Primary practice settings In July 2015, a group of nurses at a small Veterans Health Administration Hospital in the Northwest collaborated to find ways to reverse a trend of increasing falls and repeat falls. Methodology and sample A retrospective chart review of all falls and repeat falls (N = 73) that happened between January 2013 and July 2015 was used to generate a list of top 11 contributing variables that enabled evaluation of the data. A bundle of 3 interventions was instituted in October 2015: (1) development of a dedicated charge nurse/resource nurse, (2) use of a standardized method of rounding, and (3) use of a noncontact patient monitoring system ("virtual nurses"). Falls pre- and postimplementation (N = 109) were analyzed using linear and logistic regression analyses. Data were entered into an Excel sheet and analyzed to identify the major contributing factors to falls and repeat falls and to identify trends. These data were also evaluated to find out whether length of stay and nurse workload contributed to falls. Results Fifteen months after implementation of the aforementioned interventions, falls on the unit went down from 30 aggregate falls in 2015 to 17 aggregate falls in 2016. Repeat falls in 2015 went from 9 repeat falls after admission to the unit down to 2 repeat falls in 2016. Each additional extrinsic variable that was present added an additional 1.43 to the odds ratio (OR) for a fall. Similarly, each additional intrinsic variable present added 2.08 to the OR for a fall. The linear regression of length of stay and falls demonstrated that 17.5% of falls correlated with length of stay, F(1,36) = 7.63, p = .009, R = .175, adjusted R = .152. Workload correlated with work 17% of the time, as measured by using ward days of care, F(1,100) = 20.84, p = .00001, R = .17, adjusted R = .16. Implications for case managers Two examples of the how to use these tools are located in the "Discussion" section of the article.

Larval coral-reef fishes have good orientation abilities. Through-water orientation of larvae in some species is location-dependent at meso-scales In situ observation of the damselfish Chromis atripectoralis showed that settlement-stage larvae swam in a southerly direction (mean = 175 ± 11°) at 100 to 1000 m from shore, both east and west of Lizard Island, northern Great Barrier Reef (NGBR), in 10 datasets from 1998 to 2008. Wind direction did not directly influence through-water swimming direction at NGBR. During 2014, in situ diver observation tested if orientation of C. atripectoralis differed regionally in the central Great Barrier Reef (CGBR), 620 km south of NGBR, and in the New Caledonia reef lagoon (NCRL), 1950 km east of CGBR. In all 3 regions, >90% of larvae swam directionally with similar precision and speeds, and with significant among-individual orientation. Yet through-water orientation was easterly at CGBR (72 ± 30°) and NCRL (87 ± 20°), and significantly different from NGBR. Over-bottom orientation (i.e. the result of current and larval swimming), measured by GPS at start and end of observing each larva, was weak east-southeasterly at NGBR (116 ± 40°, p = 0.045), not significantly directional at CGBR, and strongly westerly at NCRL (246 ± 28°, p = 0.0006), indicating that dispersal of C. atripectoralis is both current- and behaviour-dependent. This is the first report of location-dependent larval fish orientation at a regional scale. This might be an evolutionary response to regional hydrodynamic conditions to limit downstream dispersal.

Gouty panniculitis is caused by the deposition of urate crystals in the subcutaneous tissue, accompanied by a lobular panniculitis. It presents as subcutaneous nodules, most commonly located on the lower extremities. Being an unusual clinical presentation of gout, the sonographic findings of gouty panniculitis have been scarcely described in the literature. Our report describes the ultrasound features we found in a case of gouty panniculitis and the usefulness of this technique for diagnosis and monitoring of this disease.

International audience; Understanding larval dispersal requires knowledge of whether larvae in situ have orientated swimming, and how this varies temporally and spatially. Orientation of >300 settlement-stage larvae of Chromis atripectoralis (Pomacentridae) measured over 1998-2008 by divers near Lizard Island, Great Barrier Reef was consistent. All 10 data sets had southerly orientation at all locations; 94% of larvae swam directionally. Median bearings east and west of Lizard Island were 166 degrees and 170 degrees, respectively. Orientation precision was significantly higher under sunny than cloudy skies. Similar mean bearings were obtained in 2008 with more than 125 larvae observed in a drifting in situ chamber (DISC). Orientation varied with time of day. In sunny conditions, precision was weakly, significantly correlated with time of day, but not solar elevation; however, a greater proportion of larvae was significantly directional at low (50 degrees) solar elevation. Mean bearing and time of day were weakly, but significantly correlated. Bearings changed from SE during most of the day to SSW in the late afternoon, with distribution of bearings significantly different. Location-independent but diurnally-dependent orientation implies that larvae used celestial cues for orientation. Of 91 Pomacentrus lepidogenys larvae that were followed by divers, 89% swam directionally, but orientation differed among locations and years. DISC results with 20 larvae were similar. The similarity of orientation returned by different methods used on 2 fish species corroborates previous results using diver following. Both methods are useful for the study of larval-fish orientation in situ: each has advantages and limitations, and their use is complementary.

No-take marine reserves are widely advocated as a means to conserve biodiversity and sustain fisheries. Within adequately protected reserves, the abundance, mean size and age of targeted fish and invertebrate species are often increased. However, the magnitude and rate of recovery within reserves varies among locations and species, and increases in abundance in reserves are not universal. One potential contributing factor to variability in reserve performance is spatial variability in the supply of recruits. Many reef fish species exhibit disproportionate levels of recruitment in relatively small areas (so-called "recruitment hotspots"). Here we tested the hypothesis that the presence of recruitment hotspots enhances the effectiveness of reserves for two important fishery species, coral trout (Plectropomus maculatus) and stripey snapper (Lutjanus carponotatus), on coral reefs of the Keppel Island group, Great Barrier Reef. To do this we compared fish densities in areas that did or did not contain previously identified recruitment hotspots, both inside and outside reserves. For both species, the mean densities of adult fish above the minimum legal size were approximately three times as high in reserves with hotspots than in reserves without hotspots. Furthermore, the mean densities in reserves without hotspots were similar to those in nearby areas that were open to fishing. In contrast, the densities of sub-legal size individuals of both species were primarily explained by the presence of recruitment hotspots, irrespective of reserve protection. Our results suggest that identifying and incorporating recruitment hotspots into the selection of sites for reserves could enhance both conservation and fisheries objectives. © 2013 Elsevier Ltd.

Behavioural and ecological observations were made on young, reared Platax orbicularis in Opunohu Bay, Moorea, French Polynesia, during their transition from the pelagic, dispersive stage to the reeforientated demersal stage. Seventy-two young P. orbicularis (17–75mm standard length, LS) were released in the pelagic zone and 20 (40–70mm LS) adjacent to the reefs. Swimming speed was slow (mean 5·2 cms−1) and independent of size. An ontogenetic descent was observed: the smallest P. orbicularis swam at the surface, medium-sized P. orbicularis swam in midwater (mean 5–13 m) and the largest P. orbicularis swam to the bottom, where many lay on their sides. Platax orbicularis swam southerly on average, away from the ocean and into the bay. Smaller P. orbicularis were more likely to swim directionally than larger individuals. Young P. orbicularis released near reef edges swam at similar, but more variable speeds (mean 6·6 cms−1). About half of those released near reefs swam away, but fewer swam away from an inshore fringing reef than from a patch reef near the bay mouth. Many P. orbicularis swam up the slope onto the reef top, but the little settlement observed was near the reef base. Average, near-reef swimming direction was also southerly. Some reef residents, in particular the triggerfish Balistapus undulatus, harassed young P. orbicularis.

We report in situ behavioural observations of presettlement schooling in Priacanthus tayenus off Coral Bay, Western Australia collected using pelagic Baited Remote Underwater stereo-Video systems. Two groups of fish (8 and 9 individuals) were observed that aggregated into a single school. Mean total length was 24.1 mm (12.5–30.2 mm). The fish swam at a mean speed of 8.5 cm s−1 in a group spacing themselves more or less evenly at a distance of around one body length from the nearest neighbour within the school. P. tayenus appeared to be sometimes associated with juveniles of other species. The results presented here add to the limited, but growing body of literature on the schooling behaviour of the early pelagic stages of demersal fishes.

The treatment of inflammatory and autoimmune diseases is challenging because of their frequency and complexity. Treatment of these diseases is based on the suppression of the patient's immune system using corticosteroids, corticosteroid-sparing immunosuppressive agents, and biologic drugs, making an understanding of the management of immunosuppressive therapy essential. Before an immunosuppressive agent is prescribed, a study must be carried out to identify contraindications, detect latent infections, and determine the most appropriate dose. During treatment, regular monitoring is required to detect adverse effects. The clinician must be familiar with the time lag between start of treatment and onset of the immunosuppressive effect as well as the maximum recommended duration of treatment and cumulative dose for each drug. As dermatologists we are accustomed to using these immunosuppressive agents, but we should have a good knowledge of the guidelines for their use and the monitoring required in each case if we are to reduce variability and avoid potentially serious adverse effects.