Search

Habitat restoration may depend on the recovery of plant microbial symbionts such as arbuscular mycorrhizal (AM) fungi, but this requires a better understanding of the rules that govern their community assembly. We examined the interactions of soil and host-associated AM fungal communities between remnant and restored patches of subtropical montane forests. While AM fungal richness did not differ between habitat types, community membership did and was influenced by geography, habitat and host. These differences were largely driven by rare host-specific AM fungi that displayed near-complete turnover between forest types, while core AM fungal taxa were highly abundant and ubiquitous. The bipartite networks in the remnant forest were more specialized and hosts more specific than in the restored forest. Host-associated AM fungal communities nested within soil communities in both habitats, but only significantly so in the restored forest. Our results provide evidence that restored and remnant forests harbour the same core fungal symbionts, while rare host-specific taxa differ, and that geography, host identity and taxonomic resolution strongly affect the observed distribution patterns of these fungi. We suggest that host-specific interactions with AM fungi, as well as spatial processes, should be explicitly considered to effectively re-establish target host and symbiont communities.

Total knee arthroplasty (TKA) is associated with significant postoperative pain. The population receiving TKA is generally elderly and often have multiple comorbidities that can present a challenge to postoperative management. Safe and effective multimodal pain management has led to improved outcomes while minimizing complications and side effects. The objective of this study was to investigate the efficacy of adductor canal blocks (ACB) in patients receiving TKA within a regional Queensland population. We performed a retrospective comparative cohort analysis of 458 patients who received TKA at a regional private hospital between January 2016 and December 2018. Inclusion criteria included body mass index (BMI)

Compound-specific isotope analyses (CSIA) and multivariate "isotope fingerprinting" track biosynthetic sources and reveal trophic interactions in food webs. However, CSIA have not been widely applied in the study of marine symbioses. Here, we exposed a reef coral (Montipora capitata) in symbiosis with Symbiodiniaceae algae to experimental treatments (autotrophy, mixotrophy, heterotrophy) to test for trophic shifts and amino acid (AA) sources using paired bulk (δ13C, δ15N) and AA-CSIA (δ13CAA, δ15NAA). Treatments did not influence carbon or nitrogen trophic proxies, thereby not supporting nutritional plasticity. Instead, hosts and symbionts consistently overlapped in essential- and nonessential-δ13CAA (11 of 13 amino acids) and trophic- and source-δ15NAA values (9 of 13 amino acids). Host and symbiont trophic-δ15NAA values positively correlated with a plankton end-member, indicative of trophic connections and dietary sources for trophic-AA nitrogen. However, mass balance of AA-trophic positions (TPGlx-Phe) revealed heterotrophic influences to be highly variable (1-41% heterotrophy). Linear discriminant analysis using M. capitata mean-normalized essential-δ13CAA with previously published values (Pocillopora meandrina) showed similar nutrition isotope fingerprints (Symbiodiniaceae vs. plankton) but revealed species-specific trophic strategies. Montipora capitata and Symbiodiniaceae shared identical AA-fingerprints, whereas P. meandrina was assigned to either symbiont or plankton nutrition. Thus, M. capitata was 100% reliant on symbionts for essential-δ13CAA and demonstrated autotrophic fidelity and contrasts with trophic plasticity reported in P. meandrina. While M. capitata AA may originate from host and/or symbiont biosynthesis, AA carbon is Symbiodiniaceae-derived. Together, AA-CSIA/isotope fingerprinting advances the study of coral trophic plasticity and are powerful tools in the study of marine symbioses.

Background Paget's disease of bone (PDB) is a common destructive condition of bone that affects 1-2% of the population, most typically those over the age of 55 years. It is usually asymptomatic. Objective The aim of this article is to describe the clinical presentation, diagnosis and management of patients with PDB. Discussion Most cases of PDB are diagnosed incidentally on radiographs or as an isolated elevation of serum alkaline phosphatase. Symptomatic patients present with bone pain, fractures, arthritis and features of compression neuropathy. Diagnosis is made on the basis of typical radiological features on plain films, while a radionuclide bone scan may be used to assess the extent of disease. The mainstay of treatment for PDB is bisphosphonate therapy, with zoledronic acid being the most effective agent. A single infusion of zoledronic acid leads to a sustained reduction in bone pain and markers of bone turnover. However, bisphosphonates should be reserved for symptomatic patients, as treatment with these agents has been associated with an increase in rates of fracture in patients with asymptomatic PDB.

Plant microbiomes are shaped by forces working at different spatial scales. Environmental factors determine a pool of potential symbionts while host physiochemical factors influence how those microbes associate with distinct plant tissues. These scales are seldom considered simultaneously, despite their potential to interact. Here, we analyze epiphytic microbes from nine Hibiscus tiliaceus trees across a steep, but short, environmental gradient within a single Hawaiian watershed. At each location, we sampled eight microhabitats: leaves, petioles, axils, stems, roots, and litter from the plant, as well as surrounding air and soil. The composition of bacterial communities is better explained by microhabitat, while location better predicted compositional variance for fungi. Fungal community compositional dissimilarity increased more rapidly along the gradient than did bacterial composition. Additionally, the rates of fungal community compositional dissimilarity along the gradient differed among plant parts, and these differences influenced the distribution patterns and range size of individual taxa. Within plants, microbes were compositionally nested such that aboveground communities contained a subset of the diversity found belowground. Our findings indicate that both environmental context and microhabitat contribute to microbial compositional variance in our study, but that these contributions are influenced by the domain of microbe and the specific microhabitat in question, suggesting a complicated and potentially interacting dynamic.

BACKGROUND: Osteoarthritis of the hip and knee is a common cause of pain and reduced mobility. Arthroplasty reliably improves quality of life for most patients when non-operative measures have failed. However, hip and knee arthroplasties are major operations that carry significant risks, including the need for revision surgery. OBJECTIVE: The purpose of this article is to discuss pre-operative patient optimisation prior to arthroplasty to minimise risks and maximise recovery. DISCUSSION: Recent literature has identified a number of modifiable factors that increase the risk of post-operative complications following arthroplasty. These include obesity, diabetes, tobacco use, opioid use, anaemia, malnutrition, poor dentition and vitamin D deficiency. Addressing these factors prior to arthroplasty may reduce the risk of adverse outcomes. Pre-operative education and exercise, termed prehabilitation, has an important role in optimising patient outcomes following hip and knee arthroplasty. Participation in a prehabilitation program prior to arthroplasty is recommended.

To assess the intra- and inter-observer reliability of three commonly referenced radiographic classification systems for knee osteoarthritis in a cohort of arthroplasty candidates. Pre-operative radiographs of 112 patients who subsequently underwent primary total knee arthroplasty were evaluated by four independent observers of varying experience. Each x-ray was de-identified, randomised, and classified according to the International Knee Documentation Committee, Kellgren-Lawrence, and Ahlback classifications. After a 2-week interval period, each x-ray was again randomised and re-classified. Regarding inter-observer reliability, the Ahlback and Kellgren-Lawrence classifications were shown to have ‘substantial agreement’ (AC 0.79 and 0.85 respectively), and the IKDC was shown to have ‘almost perfect agreement’ (AC 0.97). Regarding intra-observer reliability, the two more experienced observers demonstrated ‘good’ or ‘excellent’ reliability for all classification systems, and the two less experienced observers demonstrated ‘moderate’ intra-observer reliability for all classification systems. The International Knee Documentation Committee, Kellgren-Lawrence, and Ahlback radiographic classifications demonstrated adequate intra- and inter-observer reliability, supporting their potential implementation in surgical practice, or in epidemiological and clinical studies of knee osteoarthritis in a comparable cohort of patients. Clinical experience was positively correlated with intra-observer reliability. Whilst the International Knee Documentation Committee classification demonstrated the greatest reliability, this is likely due to its conservative definitions, and the Ahlback and Kellgren-Lawrence classifications are likely more reflective of the spectrum of disease severity encountered in an older patient cohort.

Elevated temperatures and nutrients are degrading coral reef ecosystems, but the understanding of how early life stages of reef corals respond to these stressors remains limited. Here, we test the impact of temperature (mean ~ 27 °C vs. ~ 29 °C) and nitrate and phosphate enrichment (ambient, + 5 µM nitrate, + 1 µM phosphate and combined + 5 µM nitrate with 1 µM phosphate) on coral larvae using three Hawaiian coral species with different modes of symbiont transmission and reproduction: Lobactis scutaria (horizontal, gonochoric broadcast spawner), Pocillopora acuta (vertical, hermaphroditic brooder) and Montipora capitata (vertical, hermaphroditic broadcast spawner). Temperature and nutrient effects were species specific and appear antagonistic for L. scutaria and M. capitata, but not for P. acuta. Larvae survivorship in all species was lowest under nitrate enrichment at 27 °C. M. capitata and L. scutaria survivorship increased at 29 °C. However, positive effects of warming on survivorship were lost under high nitrate, but phosphate attenuated nitrate effects when N/P ratios were balanced. P. acuta larvae exhibited high survivorship (> 91%) in all treatments and showed little change in larval size, but lower respiration rates at 29 °C. Elevated nutrients (+N+P) led to the greatest loss in larvae size for aposymbiotic L. scutaria, while positive growth in symbiotic M. capitata larvae was reduced under warming and highest in +N+P treatments. Overall, we report a greater sensitivity of broadcast spawners to warming and nutrient changes compared to a brooding coral species. These results suggest variability in biological responses to warming and nutrient enrichment is influenced by life-history traits, including the presence of symbionts (vertical transmission), in addition to nutrient type and nutrient stoichiometry.

Reef corals are mixotrophic organisms relying on symbiont-derived photoautotrophy and water column heterotrophy. Coral endosymbionts (Family: Symbiodiniaceae), while typically considered mutualists, display a range of species-specific and environmentally mediated opportunism in their interactions with coral hosts, potentially requiring corals to rely more on heterotrophy to avoid declines in performance. To test the influence of symbiont communities on coral physiology (tissue biomass, symbiont density, photopigmentation) and nutrition (δ13C, δ15N), we sampled Montipora capitata colonies dominated by a specialist symbiont Cladocopium spp. or a putative opportunist Durusdinium glynnii (hereafter, C- or D-colonies) from Kāne‘ohe Bay, Hawai‘i, across gradients in photosynthetically active radiation (PAR) during summer and winter. We report for the first time that isotope values of reef corals are influenced by Symbiodiniaceae communities, indicative of different autotrophic capacities among symbiont species. D-colonies had on average 56% higher symbiont densities, but lower photopigments per symbiont cell and consistently lower δ13C values in host and symbiont tissues; this pattern in isotope values is consistent with lower symbiont carbon assimilation and translocation to the host. Neither C- nor D-colonies showed signs of greater heterotrophy or nutritional plasticity; instead changes in δ13C values were driven by PAR availability and photoacclimation attributes that differed between symbiont communities. Together, these results reveal Symbiodiniaceae functional diversity produces distinct holobionts with different capacities for autotrophic nutrition, and energy tradeoffs from associating with opportunist symbionts are not met with increased heterotrophy.

Case A 57-year-old man presented with tricompartmental left knee osteoarthritis, as well as proximal tibiofibular joint arthritis and a ganglion cyst. He underwent simultaneous total knee arthroplasty and proximal tibiofibular joint arthrodesis, with an excellent outcome. Conclusion Proximal tibiofibular joint arthritis is uncommon and may be associated with tibiofemoral arthritis, proximal tibiofibular joint instability, and ankylosing spondylitis. We present a case of simultaneous total knee arthroplasty and proximal tibiofibular arthrodesis. This is an effective option for treating patients with dual pathology. The proximal tibiofibular joint should be considered as an uncommon cause of lateral knee pain.

Background Minocycline black bone disease is a rare finding that can cause concern when unexpectedly encountered during routine arthroplasty. Prolonged minocycline use can cause selective staining of subchondral bone, whilst peri-articular soft tissue and cartilage appear uninvolved. Methods A systematic review according to PRISMA guidelines was performed to identify all reported cases in the literature. Results Including the patient we present, eleven cases of minocycline black bone disease encountered during arthroplasty have been reported in the literature. All cases have had an excellent outcome, with no complications reported to date. Conclusions Minocycline black bone disease can be a concerning intra-operative finding when unexpectedly encountered during routine arthroplasty, but should not affect the operative plan. Surgeons should exclude alternative causes of bone discolouration when the history is unclear.

CASE A 9-year-old boy sustained a right distal clavicle physeal separation with superior and posterior displacement through the periosteum. He was treated surgically with open reduction, Kirschner wire fixation, and periosteal repair and had an excellent outcome. CONCLUSION Distal clavicle fractures are rare in children, and acromioclavicular joint (ACJ) separations are exceedingly rare. Differentiating between the 2 is often difficult radiographically and clinically. Our case represents a Type IV distal clavicle fracture but could be confused with an ACJ separation. Surgical treatment was successful.

The absorbtion of human-emitted CO2 by the oceans (elevated PCO2) is projected to alter the physiological performance of coral reef organisms by perturbing seawater chemistry (i.e. ocean acidification). Simultaneously, greenhouse gas emissions are driving ocean warming and changes in irradiance (through turbidity and cloud cover), which have the potential to influence the effects of ocean acidification on coral reefs. Here, we explored whether physiological impacts of elevated PCO2 on a coral–algal symbiosis (Pocillopora acuta–Symbiodiniaceae) are mediated by light and/or temperature levels. In a 39 day experiment, elevated PCO2 (962 versus 431 µatm PCO2) had an interactive effect with midday light availability (400 versus 800 µmol photons m−2 s−1) and temperature (25 versus 29°C) on areal gross and net photosynthesis, for which a decline at 29°C was ameliorated under simultaneous high-PCO2 and high-light conditions. Light-enhanced dark respiration increased under elevated PCO2 and/or elevated temperature. Symbiont to host cell ratio and chlorophyll a per symbiont increased at elevated temperature, whilst symbiont areal density decreased. The ability of moderately strong light in the presence of elevated PCO2 to alleviate the temperature-induced decrease in photosynthesis suggests that higher substrate availability facilitates a greater ability for photochemical quenching, partially offsetting the impacts of high temperature on the photosynthetic apparatus. Future environmental changes that result in moderate increases in light levels could therefore assist the P. acuta holobiont to cope with the ‘one–two punch’ of rising temperatures in the presence of an acidifying ocean.

Compound‐specific isotope analyses (CSIA) and multivariate “isotope fingerprinting” track biosynthetic sources and reveal trophic interactions in food webs. However, CSIA have not been widely applied in the study of marine symbioses. Here, we exposed a reef coral (Montipora capitata) in symbiosis with Symbiodiniaceae algae to experimental treatments (autotrophy, mixotrophy, heterotrophy) to test for trophic shifts and amino acid (AA) sources using paired bulk (δ13C, δ15N) and AA‐CSIA (δ13CAA, δ15NAA). Treatments did not influence carbon or nitrogen trophic proxies, thereby not supporting nutritional plasticity. Instead, hosts and symbionts consistently overlapped in essential‐ and nonessential‐δ13CAA (11 of 13 amino acids) and trophic‐ and source‐δ15NAA values (9 of 13 amino acids). Host and symbiont trophic‐δ15NAA values positively correlated with a plankton end‐member, indicative of trophic connections and dietary sources for trophic‐AA nitrogen. However, mass balance of AA‐trophic positions (TPGlx–Phe) revealed heterotrophic influences to be highly variable (1–41% heterotrophy). Linear discriminant analysis using M. capitata mean‐normalized essential‐δ13CAA with previously published values (Pocillopora meandrina) showed similar nutrition isotope fingerprints (Symbiodiniaceae vs. plankton) but revealed species‐specific trophic strategies. Montipora capitata and Symbiodiniaceae shared identical AA‐fingerprints, whereas P. meandrina was assigned to either symbiont or plankton nutrition. Thus, M. capitata was 100% reliant on symbionts for essential‐δ13CAA and demonstrated autotrophic fidelity and contrasts with trophic plasticity reported in P. meandrina. While M. capitata AA may originate from host and/or symbiont biosynthesis, AA carbon is Symbiodiniaceae‐derived. Together, AA‐CSIA/isotope fingerprinting advances the study of coral trophic plasticity and are powerful tools in the study of marine symbioses.

Plant microbiomes are shaped by forces working at different spatial scales. Environmental factors determine a pool of potential symbionts while host physiochemical factors influence how those microbes associate with distinct plant tissues. Interactions between these scales, however, are seldom considered. Here we analyze epiphytic microbes from nine Hibiscus tiliaceus trees across a steep environmental gradient within a single Hawaiian watershed. At each location we sampled eight microhabitats: leaves, petioles, axils, stems, roots, and litter from the plant, as well as surrounding air and soil. While the composition of microbial communities is driven primarily by microhabitat, this variable predicted more than twice the compositional variance for bacteria compared to fungi. Fungal community compositional dissimilarity increased more rapidly along the gradient than did bacteria. Additionally, the spatial dynamics of fungal communities differed among plant parts, and these differences influenced the distribution patterns and range size of individual taxa. Within plants, microbes were compositionally nested such that aboveground communities contained a subset of the diversity found belowground. Our findings identify potential differences underlying the mechanisms shaping communities of fungi and bacteria associated with plants, and indicate an interaction between assembly mechanisms working simultaneously on different spatial scales.

BACKGROUND: Joint replacement surgery is a highly effective treatment option for patients with severe osteoarthritis (OA) of the hip and knee when other treatments have failed. Unfortunately, as a result of the COVID-19 pandemic, a temporary suspension of non-urgent elective surgery was implemented. Thousands of patients currently awaiting hip and knee replacements have been affected. Many of these patients will present to their general practitioners for symptom management during this interim period. OBJECTIVE: The purpose of this article is to summarise current recommendations for the non-operative management of patients with symptomatic OA. DISCUSSION: Non-operative treatment modalities for OA include education, lifestyle modification and exercise, mass reduction, physiotherapy, orthoses, psychology, pharmaceuticals and injections. Multimodal therapy is required for patients with severe symptoms. A number of useful online resources are presented, as access to public allied health services may be limited because of the COVID-19 pandemic.

Global climate change is altering coral reef ecosystems. Notably, marine heat waves are producing widespread coral bleaching events that are increasing in frequency, with projections for annual bleaching events on reefs worldwide by mid-century.The response of corals to elevated seawater temperatures can be modulated by abiotic factors at site of origin and dominant endosymbiont type, which can result in a shift in multiple coral traits and drive physiological legacy effects that influence the trajectory of reef corals under subsequent thermal stress events. It is critical, therefore, to evaluate the potential for shifting physiological and cellular baselines driven by these factors in in situ bleaching (and recovery) events. Here, we use the back-to-back regional bleaching events of 2014 and 2015 in the Hawaiian Islands and subsequent recovery periods to test the hypothesis that coral multivariate trait space (here termed physiotype, sensu (Van Straalen, 2003) shift in multiple bleaching events, modulated by both environmental histories and symbiotic partnerships (Symbiodiniaceae).Despite fewer degree heating weeks in the first-bleaching event relative to the second (7 vs. 10), bleaching severity in a dominant reef building coral on Hawaiian reefs, Montipora capitata, was greater (~70% vs. 50% bleached cover) and differences due to environmental history (reef site) were more pronounced. Melanin, an immune cytotoxic response, provided an initial defense during the first event, potentially priming antioxidant activity, which peaked in the second-bleaching event (i.e., a legacy effect). While magnitude of bleaching differed, immune response patterns were shared among corals harboring heat-sensitive and heat-tolerant Symbiodiniaceae. This supports a pattern of increased constitutive immunity in corals resulting from repeat bleaching events, with greater specialized enzymes (catalase, peroxidase, superoxide dismutase) and attenuated melanin synthesis.This study demonstrates bleaching events have implications for reef corals beyond shaping their ecological assemblages. These events can change the magnitude and/or identity of response variables contributing to physiotype, thus generating physiological legacies carried over into the future. Quantifying baseline coral physiotypes and tracking their shifts will be critical to understanding and forecasting the effects of increased bleaching frequency on coral biology and ecology in the Anthropocene.

The temporary suspension of elective surgery will affect thousands of patients currently awaiting orthopaedic surgery.

Background Anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. We developed a novel, low dose computed tomography (LDCT) protocol to assess tunnel position post-operatively. The effective radiation dose of this protocol is Methods Twenty-six patients who underwent primary ACL reconstruction were included in the study. A LDCT scan was performed 6 weeks post-operatively. Femoral and tibial tunnel positions were measured on three dimensional (3D) reconstructions using previously validated techniques. Measurements were performed independently by three observers at two time points, 4 weeks apart. Results There was excellent intra- and inter-rater reliability for all measurements using the images obtained from the LDCT protocol. Intra-class correlation coefficient (ICC) values were > 0.9 for all measurements. Conclusions The LDCT protocol described in this study accurately demonstrates femoral and tibial tunnels post ACL reconstruction, while exposing the patient to a quarter of the radiation dose of a conventional CT. This protocol could be used by orthopaedic surgeons for routine post-operative imaging, in place of plain film radiographs.

Scleractinian corals form symbioses with diverse photosynthetic dinoflagellates (genus Symbiodinium) that confer varying levels of performance and stress tolerance to their hosts. Variation in thermal stress susceptibility (i.e., bleaching) among conspecific corals is linked to variability in symbiont community composition, yet factors driving heterogeneous symbiont associations within a population are poorly understood. To investigate potential drivers, we characterized Symbiodinium communities in Montipora capitata (N = 707 colonies) across the biophysical regions, reef types, and depth range of Kāne‘ohe Bay (Hawai‘i, USA), where this dominant reef-builder associates with Symbiodinium spp. in clade C (C31) and/or D (S. glynnii), and occurs as brown and orange color morphs. The distribution of these traits was primarily influenced by depth: orange, D-dominated colonies were more prevalent in shallow, high light environments (

The negative effects of deforestation can potentially be ameliorated through ecological restoration. However, reforestation alone may not reassemble the same ecological communities or functions as primary forests. In part, this failure may be owed to forest ecosystems inherently involving complex interactions among guilds of organisms. Plants, which structure forest food webs, rely on intimate associations with symbiotic microbes such as root-inhabiting mycorrhizal fungi. Here, we leverage a large-scale reforestation project on Hawai'i Island underway for over three decades to assess whether arbuscular mycorrhizal (AM) fungal communities have concurrently been restored. The reference ecosystem for this restoration project is a remnant montane native Hawaiian forest that provides critical habitat for endangered birds. We sampled soils from 12 plots within remnant and restored forest patches and characterized AM fungal communities using high-throughput amplicon sequencing. While some AM fungal community metrics were comparable between remnant and restored forest (e.g. species richness), other key characteristics were not. Specifically, community membership and the identity of AM fungal keystone species differed between the two habitat types, as well as the primary environmental factors influencing community composition. Remnant forest AM fungal communities were strongly associated with soil chemical properties, especially pH, while restored forest communities were influenced by the spatial proximity to remnant forests. We posit that combined, these differences in soil AM fungal communities could be negatively affecting the recruitment of native plant hosts and that future restoration efforts should consider plant-microbe interactions as an important facet of forest health.

Many sponges host abundant and active microbial communities that may play a role in the uptake of dissolved organic matter (DOM) by the sponge holobiont, although the mechanism of DOM uptake and metabolism is uncertain. Bulk and compound-specific isotopic analysis of whole sponge, isolated sponge cells, and isolated symbiotic microbial cells of the shallow water tropical Pacific sponge Mycale grandis were used to elucidate the trophic relationships between the host sponge and its associated microbial community. δ15N and δ13C values of amino acids in M. grandis isolated sponge cells are not different from those of its bacterial symbionts. Consequently, there is no difference in trophic position of the sponge and its symbiotic microbes indicating that M. grandis sponge cell isolates do not display amino acid isotopic characteristics typical of metazoan feeding. Furthermore, both the isolated microbial and sponge cell fractions were characterized by a similarly high ΣV value-a measure of bacterial-re-synthesis of organic matter calculated from the sum of variance among individual δ15N values of trophic amino acids. These high ΣV values observed in the sponge suggest that M. grandis is not reliant on translocated photosynthate from photosymbionts or feeding on water column picoplankton, but obtains nutrition through the uptake of amino acids of bacterial origin. Our results suggest that direct assimilation of bacterially synthesized amino acids from its symbionts, either in a manner similar to translocation observed in the coral holobiont or through phagotrophic feeding, is an important if not primary pathway of amino acid acquisition for M. grandis.

Background: Major lower limb amputation is occasionally required in the management of end-stage pathology where other treatment options have failed. The primary aim of this study was to determine the 30-day and 1-year mortality rates of patients undergoing nontraumatic major lower limb amputation. Secondary aims were to investigate risk factors for poor outcomes, incidence of previous minor amputation, and the rate of subsequent major amputation. Methods: All nontraumatic, major lower limb amputations performed at Toowoomba Hospital during an 18-year period were retrospectively reviewed. Mortality data were obtained from the Queensland Registry of Births, Deaths and Marriages. Kaplan–Meier analysis was performed to determine survival after amputation. Results: A total of 147 patients were included in the study, with 104 undergoing below knee and 43 undergoing above knee amputations. Ten patients identified as having an Aboriginal and Torres Strait Islander background. For all patients, the 30-day mortality was 4.1% and 1-year mortality was 21.1%. For Indigenous patients, 30-day mortality was 10%. Previous minor amputation had occurred in 40 patients. Twenty-nine patients underwent further minor surgery after their initial major amputation, with thirteen requiring subsequent major amputation. Factors that increased mortality risk were the presence of peripheral vascular disease, an American Society of Anesthesiologists score of four and age greater than 65 years. Conclusion: The morbidity and mortality following major lower limb amputation is significant. The findings of this study highlight the importance of preventative measures to minimize the incidence of lower limb amputations in the future.

Ocean warming and the increased prevalence of coral bleaching events threaten coral reefs. However, the biology of corals during and following bleaching events under field conditions is poorly understood. We examined bleaching and post-bleaching recovery inMontipora capitataandPorites compressacorals that either bleached or did not bleach during a 2014 bleaching event at three reef locations in Kāne‘ohe Bay, O‘ahu. We measured changes in chlorophylls, biomass, and nutritional plasticity using stable isotopes (δ13C, δ15N). Coral traits showed significant variation among bleaching conditions, reef sites, time periods, and their interactions. Bleached colonies of both species had lower chlorophyll and total biomass. WhileM. capitatachlorophyll and biomass recovered three months later,P. compressachlorophyll recovery was location-dependent and total biomass of previously bleached colonies remained low. Biomass energy reserves were not affected by bleaching, insteadM. capitataproteins andP. compressabiomass energy declined over time, andP. compressalipid biomass was site-specific. Stable isotope analyses of host and symbiont tissues did not indicate increased heterotrophic nutrition in bleached colonies of either species, during or after thermal stress. Instead, mass balance calculations revealed variance in δ13C values was best explained by augmented biomass composition, whereas δ15N values reflected spatial and temporal variability in nitrogen sources in addition to bleaching effects on symbiont nitrogen demand. These results emphasize total biomass quantity may change substantially during bleaching and recovery. Consequently, there is a need to consider the influence of biomass composition in the interpretation of isotopic values in corals.

Invasive macroalgae pose a serious threat to coral reef biodiversity by monopolizing reef habitats, competing with native species, and directly overgrowing, and smothering reef corals. Several invasive macroalgae (Eucheuma clade E, Kappaphycus clade A and B, Gracilaria salicornia, and Acanthophora spicifera) are established within Kāne‘ohe Bay (O‘ahu, Hawai‘i, USA), and reducing invasive macroalgae cover is a coral reef conservation and management priority. However, invasive macroalgae control techniques are limited and few successful large-scale applications exist. Therefore, a two-tiered invasive macroalgae control approach was designed, where first, divers manually remove invasive macroalgae (Eucheuma and Kappaphycus) aided by an underwater vacuum system (“The Super Sucker”). Second, hatchery-raised juvenile sea urchins (Tripneustes gratilla), were outplanted to graze and control invasive macroalgae regrowth. To test the effectiveness of this approach in a natural reef ecosystem, four discrete patch reefs with high invasive macroalgae cover (15 – 26 %) were selected, and macroalgae removal plus urchin biocontrol (treatment reefs, n = 2), or no treatment (control reefs, n = 2), was applied at the patch reef-scale. In applying the invasive macroalgae treatment, the control effort manually removed ~ 19,000 kg of invasive macroalgae and ~ 99,000 juvenile sea urchins were outplanted across to two patch-reefs, totaling ~ 24,000 m2 of reef area. Changes in benthic cover were monitored over two years (five sampling periods) before-and-after the treatment was applied. Over the study period, removal and biocontrol reduced invasive macroalgae cover by 85 % at treatment reefs. Our results show that manual removal in combination with hatchery raised urchin biocontrol is an effective management approach for controlling invasive macroalgae at reef-wide spatial scales and temporal scales of months to years.

Rising ocean temperatures can induce the breakdown of the symbiosis between reef building corals and Symbiodinium in the phenomenon known as coral bleaching. Environmental history may, however, influence the response of corals to stress and affect bleaching outcomes. A suite of physiological and immunological traits was evaluated to test the effect of environmental history (low vs. high variable pCO2) on the response of the reef coral Montipora capitata to elevated temperature (24.5 °C vs. thermal ramping to 30.5 °C). Heating reduced maximum photochemical efficiency (Fv/Fm) and chlorophyll a but increased tissue melanin in corals relative to the ambient treatment, indicating a role of the melanin synthesis pathway in the early stages of thermal stress. However, interactions of environmental history and temperature treatment were not observed. Rather, parallel reaction norms were the primary response pattern documented across the two temperature treatments with respect to reef environmental history. Corals with a history of greater pCO2 variability had higher constitutive antioxidative and immune activity (i.e., catalase, superoxide dismutase, prophenoloxidase) and Fv/Fm, but lower melanin and chlorophyll a, relative to corals with a history of lower pCO2 variability. This suggests that reef environments with high magnitude pCO2 variability promote greater antioxidant and immune activity in resident corals. These results demonstrate coral physiology and immunity reflect environmental attributes that vary over short distances, and that these differences may buffer the magnitude of thermal stress effects on coral phenotypes.

Many tropical corals have declined in abundance in the last few decades, and evaluating the causal basis of these losses is critical to understanding how coral reefs will change in response to ongoing environmental challenges. Motivated by the likelihood that marine environments will become increasingly unfavorable for coral growth as they warm and become more acidic (i.e., ocean acidification), it is reasonable to evaluate whether specific phenotypic traits of the coral holobiont are associated with ecological success (or failure) under varying environmental conditions including those that are adverse to survival. Initially, we asked whether it was possible to identify corals that are resistant or sensitive to such conditions by compiling quantitative measures of their phenotypic traits determined through empirical studies, but we found only weak phenotypic discrimination between ecological winners and losers, or among taxa. To reconcile this outcome with ecological evidence demonstrating that coral taxa are functionally unequal, we looked beyond the notion that phenotypic homogeneity arose through limitations of empirical data. Instead, we examined the validity of contemporary means of categorizing corals based on ecological success. As an alternative means to distinguish among functional groups of corals, we present a demographic approach using integral projection models (IPMs) that link organismal performance to demographic outcomes, such as the rates of population growth and responses to environmental stress. We describe how IPMs can be applied to corals so that future research can evaluate within a quantitative framework the extent to which changes in physiological performance influence the demographic underpinnings of ecological performance.

Early life stages of the coral Seriatopora caliendrum were used to test the hypothesis that the depression of dark respiration in coral recruits by high pCO2 is caused by perturbed protein metabolism. First, the contribution of protein anabolism to respiratory costs under high pCO2 was evaluated by measuring the aerobic respiration of S. caliendrum recruits with and without the protein synthesis inhibitor emetine following 1 to 4 days at 45 Pa versus 77 Pa pCO2. Second, protein catabolism under high pCO2 was evaluated by measuring the flux of ammonium (NH4 (+)) from juvenile colonies of S. caliendrum incubated in darkness at 47 Pa and 90 Pa pCO2. Two days after settlement, respiration of recruits was affected by an interaction between emetine and pCO2, with emetine reducing respiration 63% at 45 Pa pCO2 and 27% at 77 Pa pCO2. The interaction disappeared 5 days after settlement, when respiration was reduced 27% by emetine under both pCO2 conditions. These findings suggest that protein anabolism accounted for a large proportion of metabolic costs in coral recruits and was affected by high pCO2, with consequences detected in aerobic respiration. Juvenile S. caliendrum showed net uptake of NH4 (+) at 45 Pa pCO2 but net release of NH4 (+) at 90 Pa pCO2, indicating that protein catabolism, NH4 (+) recycling, or both were affected by high pCO2. Together, these results are consistent with the hypothesis that high pCO2 affects protein metabolism in corals.

It is often presumed plant recruitment from the soil seed bank and nearby wetlands will be sufficient to establish a wetland plant community following the restoration or creation of wetland hydrology. This approach to wetland restoration was examined in four compensatory wetlands and a natural oxbow wetland (Oxbow) in a floodplain of the West Fork Trinity River in north-central Texas. We assessed: (1) similarities in vegetation and seed bank composition among natural and compensatory wetlands, (2) within site similarity of vegetation relative to its seed bank community, and (3) the effects of hydrology (Wet vs. Drained soil) on the germination of seeds from the seed bank. Species richness of the standing vegetation was variable across sites and years, however when pooled across years (2008–2009) vegetation and seed banks showed similar species richness (66 vs. 70 species). Fewer wetland species (i.e., species occurring in wetlands >50 % of the time) were observed in the vegetation relative to the seed bank (25 vs. 41 species), and seed banks of compensatory wetlands were more similar to the natural wetland than was the standing vegetation. In the seed bank study, location (i.e., site) significantly affected total species richness, wetland species richness, diversity, and germinated seeds m−2, however no significant effect of hydrology was detected. These results suggest hydrology alone is not sufficient to establish a desired wetland plant community in a created wetland and the inclusion of seed bank surveys with field vegetation surveys provides a more complete assessment of wetland creation and restoration.

The objective of this study was to test whether elevated pCO2 predicted for the year 2100 (85.1 Pa) affects bleaching in the coral Seriatopora caliendrum (Ehrenberg 1834) either independently or interactively with high temperature (30.5 °C). Response variables detected the sequence of events associated with the onset of bleaching: reduction in the photosynthetic performance of symbionts as measured by maximum photochemical efficiency (Fv/Fm) and effective photochemical efficiency (ΔF/Fm′) of PSII, declines in net photosynthesis (Pnet) and photosynthetic efficiency (alpha, α), and finally, reduced chlorophyll a and symbiont concentrations. S. caliendrum was collected from Nanwan Bay, Taiwan, and subjected to combinations of temperature (27.7 vs. 30.5 °C) and pCO2 (45.1 vs. 85.1 Pa) for 14 days. High temperature reduced values of all dependent variables (i.e., bleaching occurred), but high pCO2 did not affect Symbiodinium photophysiology or productivity, and did not cause bleaching. These results suggest that short-term exposure to 81.5 Pa pCO2, alone and in combination with elevated temperature, does not cause or affect coral bleaching.

To evaluate the effects of temperature and pCO2 on coral larvae, brooded larvae of Pocillopora damicornis from Nanwan Bay, Taiwan (21°56.179′N, 120°44.85′E), were exposed to ambient (419–470 μatm) and high (604–742 μatm) pCO2 at ~25 and ~29 °C in two experiments conducted in March 2010 and March 2012. Larvae were sampled from four consecutive lunar days (LD) synchronized with spawning following the new moon, incubated in treatments for 24 h, and measured for respiration, maximum photochemical efficiency of PSII (F v/F m), and mortality. The most striking outcome was a strong effect of time (i.e., LD) on larvae performance: respiration was affected by an LD × temperature interaction in 2010 and 2012, as well as an LD × pCO2 × temperature interaction in 2012; F v/F m was affected by LD in 2010 (but not 2012); and mortality was affected by an LD × pCO2 interaction in 2010, and an LD × temperature interaction in 2012. There were no main effects of pCO2 in 2010, but in 2012, high pCO2 depressed metabolic rate and reduced mortality. Therefore, differences in larval performance depended on day of release and resulted in varying susceptibility to future predicted environmental conditions. These results underscore the importance of considering larval brood variation across days when designing experiments. Subtle differences in experimental outcomes between years suggest that transgenerational plasticity in combination with unique histories of exposure to physical conditions can modulate the response of brooded coral larvae to climate change and ocean acidification.

Ocean acidification (OA) is predicted to reduce reef coral calcification rates and threaten the long-term growth of coral reefs under climate change. Reduced coral growth at elevated p CO 2 may be buffered by sufficiently high irradiances; however, the interactive effects of OA and irradiance on other fundamental aspects of coral physiology, such as the composition and energetics of coral biomass, remain largely unexplored. This study tested the effects of two light treatments (7.5 versus 15.7 mol photons m −2 d −1 ) at ambient or elevated p CO 2 (435 versus 957 µatm) on calcification, photopigment and symbiont densities, biomass reserves (lipids, carbohydrates, proteins), and biomass energy content (kJ) of the reef coral Pocillopora acuta from Kāne‘ohe Bay, Hawai‘i. While p CO 2 and light had no effect on either area- or biomass-normalized calcification, tissue lipids gdw −1 and kJ gdw −1 were reduced 15% and 14% at high p CO 2 , and carbohydrate content increased 15% under high light. The combination of high light and high p CO 2 reduced protein biomass (per unit area) by approximately 20%. Thus, under ecologically relevant irradiances, P. acuta in Kāne‘ohe Bay does not exhibit OA-driven reductions in calcification reported for other corals; however, reductions in tissue lipids, energy content and protein biomass suggest OA induced an energetic deficit and compensatory catabolism of tissue biomass. The null effects of OA on calcification at two irradiances support a growing body of work concluding some reef corals may be able to employ compensatory physiological mechanisms that maintain present-day levels of calcification under OA. However, negative effects of OA on P. acuta biomass composition and energy content may impact the long-term performance and scope for growth of this species in a high p CO 2 world.

In 2007, due to growing concerns of declines in nearshore fisheries in Hawai‘i, a ban on gillnets was implemented in designated areas around the island of O‘ahu in the main Hawaiian Islands. Utilizing a 17 year time-series of juvenile fish abundance beginning prior to the implementation of the gillnet ban, we examined the effects of the ban on the abundance of juveniles of soft-bottom associated fish species. Using a Before-After-Control-Impact (BACI) sampling design, we compared the abundance of targeted fishery species in a bay where gillnet fishing was banned (Kailua, O‘ahu), and an adjacent bay where fishing is still permitted (Waimānalo, O‘ahu). Our results show that when multiple juvenile fish species were combined, abundance declined over time in both locations, but the pattern varied for each of the four species groups examined. Bonefishes were the only species group with a significant BACI effect, with higher abundance in Kailua in the period after the gillnet ban. This study addressed a need for scientific assessment of a fisheries regulation that is rarely possible due to lack of quality data before enactment of such restrictions. Thus, we developed a baseline status of juveniles of an important fishery species, and found effects of a fishery management regulation in Hawai‘i.

To identify the importance of arbuscular mycorrhizal fungi (AMF) colonizing wetland seedlings following flooding, we assessed the effects of AMF on seedling establishment of two pioneer species, Bidens frondosa and Eclipta prostrata grown under three levels of water availability and ask: (1) Do inoculated seedlings differ in growth and development from non-inoculated plants? (2) Are the effects of inoculation and degree of colonization dependent on water availability? (3) Do plant responses to inoculation differ between two closely related species? Inoculation had no detectable effects on shoot height, or plant biomass but did affect biomass partitioning and root morphology in a species-specific manner. Shoot/root ratios were significantly lower in non-inoculated E. prostrata plants compared with inoculated plants (0.381 ± 0.066 vs. 0.683 ± 0.132). Root length and surface area were greater in non-inoculated E. prostrata (259.55 ± 33.78 cm vs. 194.64 ± 27.45 cm and 54.91 ± 7.628 cm(2) vs. 46.26 ± 6.8 cm(2), respectively). Inoculation had no detectable effect on B. frondosa root length, volume, or surface area. AMF associations formed at all levels of water availability. Hyphal, arbuscular, and vesicular colonization levels were greater in dry compared with intermediate and flooded treatments. Measures of mycorrhizal responsiveness were significantly depressed in E. prostrata compared with B. frondosa for total fresh weight (-0.3 ± 0.18 g vs. 0.06 ± 0.06 g), root length (-0.78 ± 0.28 cm vs.-0.11 ± 0.07 cm), root volume (-0.49 ± 0.22 cm(3) vs. 0.06 ± 0.07 cm(3)), and surface area (-0.59 ± 0.23 cm(2) vs.-0.03 ± 0.08 cm(2)). Given the disparity in species response to AMF inoculation, events that alter AMF prevalence in wetlands could significantly alter plant community structure by directly affecting seedling growth and development.

Acute limb compartment syndrome is a surgical emergency associated with significant morbidity if not diagnosed promptly and treated effectively. We describe a case of severe and eventually lethal acute limb compartment syndrome, which complicated veno-arterial extracorporeal membrane oxygenation in a previously well young woman who had suffered an unexplained cardiac arrest. We recommend that intensive care units develop clinical practice guidelines for the use of extracorporeal membrane oxygenation therapy in order to minimise the risk of similar adverse events in the future.

Purpose To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck fractures with measured fracture angulation would recommend surgery as often as surgeons shown unmarked radiographs. Methods Members of the Science of Variation Group, an international collaboration of fully trained orthopedic and trauma surgeons, were asked to review 20 little finger metacarpal neck fracture cases, which included a vignette and 3 high-quality radiographs. Members were then randomized to review radiographs with or without measured fracture angulation on the lateral view and select operative or nonoperative management. Results Surgeons shown radiographs with measured angulation were more likely to recommend surgery, and there was less variability among these surgeons, particularly for fractures with less angular deformity. Conclusions Measured fracture angulation has a small but significant influence on treatment recommendations for little finger metacarpal neck fractures. Copyright (C) 2014 by the American Society for Surgery of the Hand. All rights reserved

Juvenile colonies of massive Porites spp. were exposed to manipulated pH and bicarbonate ([HCO3-]) in situ to test the hypothesis that ocean acidification (OA) does not affect respiration and calcification. Incubations lasted 28 h and exposed corals to ambient temperature and light with ecologically relevant water motion. Three treatments were applied: (1) ambient conditions of pH 8.04 and 1751 μmol HCO3- kg(-1) (Treatment 1), (2) pCO2-induced ocean acidification of pH 7.73 and 2011 μmol HCO3- kg(-1) (Treatment 2), and (3) pCO2 and HCO3--enriched seawater of pH 7.69 and 2730 μmol HCO3- kg(-1) (Treatment 3). The third treatment providing elevated [HCO3-] was used to test for stimulatory effects of dissolved inorganic carbon on calcification under low pH and low saturation of aragonite (Ωarag), but it does not reflect conditions expected to occur under CO2-driven OA. Calcification of juvenile massive Porites spp. was affected by treatments, with an 81% elevation in Treatment 3 versus Treatment 1, but no difference between Treatments 1 and 2; respiration and the metabolic expenditure concurrent with calcification remained unaffected. These findings indicate that juvenile massive Porites spp. are resistant to short exposures to OA in situ, and separately, that they can increase calcification at low pH and low Ωarag if [HCO3-] is elevated. Juvenile Porites spp. may therefore be limited by dissolved inorganic carbon under ambient pCO2 conditions.

Purpose To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. Methods We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when deciding between treatment and following the natural history of the disease and 12 factors when deciding between 2 operative treatments using a 5-point Likert scale between "very important" and "very unimportant." Results According to the percentages of statements rated very important or somewhat important, the most popular factors influencing recommendations when evidence is inconclusive between treatment and following the natural course of the illness were "works in my hands," "familiarity with the treatment," and "what my mentor taught me." The most important factors when evidence shows no difference between 2 surgeries were "fewer complications," "quicker recovery," "burns fewer bridges," "works in my hands" and "familiarity with the procedure." Europeans rated "works in my hands" and "cheapest/most resourceful" of significantly greater importance and "what others are doing," "highest reimbursement," and "shorter procedure" of significantly lower importance than surgeons in the United States. Observers with fewer than 10 years in independent practice rated "what my mentor taught me," "what others are doing" and "highest reimbursement" of significantly lower importance compared to observers with 10 or more years in independent practice. Conclusions Surgeons deciding between 2 treatment options, when the evidence is inconclusive, fall back to factors that relate to their perspective and reflect their culture and circumstances, more so than factors related to the patient's perspective, although this may be different for younger surgeons. Clinical relevance Hand surgeons might benefit from consensus fallback preferences when evidence is inconclusive. It is possible that falling back to personal comfort makes us vulnerable to unhelpful commercial and societal influences.

BACKGROUND: Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia. METHODS: Clinical practice guidelines for the management of acute limb compartment syndrome following trauma were developed in accordance with Australian National Health and Medical Research Council recommendations. The guidelines were based on critically appraised literature evidence and the consensus opinion of a multidisciplinary team involved in trauma management who met in a nominal panel process. RESULTS: Recommendations were developed for key decision nodes in the patient care pathway, including methods of diagnosis in alert and unconscious patients, appropriate assessment of compartment pressure, timing and technique of fasciotomy, fasciotomy wound management, and prevention of compartment syndrome in patients with limb injuries. The recommendations were largely consensus based in the absence of well-designed clinical trial evidence. CONCLUSIONS: Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes.

Background: Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency and is associated with significant morbidity if not diagnosed promptly and treated effectively. Despite the urgency of effective management to minimize the risk of adverse outcomes, there is currently little consensus in the published reports as to what constitutes best practice in the management of acute limb compartment syndrome. Methods: A structured survey was sent to all currently practising orthopaedic surgeons and accredited orthopaedic registrars in Australia to assess their current practice in the management of acute, traumatic compartment syndrome of the leg. Questions were related to key decision nodes in the management process, as identified in a literature review. These included identification of patients at high risk, diagnosis of the condition in alert and unconscious patients, optimal timeframe and technique for carrying out a fasciotomy and management of fasciotomy wounds. Results: A total of 264 valid responses were received, a response rate of 29% of all eligible respondents. The results indicated considerable variation in management of acute compartment syndrome of the leg, in particular in the utilization of compartment pressure measurement and the appropriate pressure threshold for fasciotomy. Of the 78% of respondents who regularly measured compartment pressure, 33% used an absolute pressure threshold, 28% used a differential pressure threshold and 39% took both into consideration. Conclusions: There is variation in the management of acute, traumatic compartment syndrome of the leg in Australia. The development of evidence-based clinical practice guidelines may be beneficial.