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ObjectivesTo evaluate measurement discrepancies by race between pulse oximetry and arterial oxygen saturation (as measured in arterial blood gas) among inpatients not in intensive care.DesignMulticenter, retrospective cohort study using electronic medical records from general care medical and surgical inpatients.SettingVeteran Health Administration, a national and racially diverse integrated health system in the United States, from 2013 to 2019.ParticipantsAdult inpatients in general care (medical and surgical), in Veteran Health Administration medical centers.Main outcomes measuresOccult hypoxemia (defined as arterial blood oxygen saturation (SaO2) of 2) reading of ≥92%), and whether rates of occult hypoxemia varied by race and ethnic origin.ResultsA total of 30 039 pairs of SpO2-SaO2readings made within 10 minutes of each other were identified during the study. These pairs were predominantly among non-Hispanic white (21 918 (73.0%)) patients; non-Hispanic black patients and Hispanic or Latino patients accounted for 6498 (21.6%) and 1623 (5.4%) pairs in the sample, respectively. Among SpO2values greater or equal to 92%, unadjusted probabilities of occult hypoxemia were 15.6% (95% confidence interval 15.0% to 16.1%) in white patients, 19.6% (18.6% to 20.6%) in black patients (Pvwhite patients, with similar P values in adjusted models), and 16.2% (14.4% to 18.1%) in Hispanic or Latino patients (P=0.53vwhite patients, P2-SaO2pairs restricted to occur within 5 minutes and 2 minutes. In white patients, an initial SpO2-SaO2pair with little difference in saturation was associated with a 2.7% (95% confidence interval −0.1% to 5.5%) probability of SaO22-SaO2reading showing an SpO2of 92%, but black patients had a higher probability (12.9% (−3.3% to 29.0%)).ConclusionsIn general care inpatient settings across the Veterans Health Administration where paired readings of arterial blood gas (SaO2) and pulse oximetry (SpO2) were obtained, black patients had higher odds than white patients of having occult hypoxemia noted on arterial blood gas but not detected by pulse oximetry. This difference could limit access to supplemental oxygen and other more intensive support and treatments for black patients.

Background Although inhaled therapy reduces exacerbations among patients with COPD, the effectiveness of providing inhaled treatment per risk stratification models remains unclear. Research Question Are inhaled regimens that align with the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy associated with clinically important outcomes? Study Design and Methods We conducted secondary analyses of Long-term Oxygen Treatment Trial (LOTT) data. The trial enrolled patients with COPD with moderate resting or exertional hypoxemia between 2009 and 2015. Our exposure was the patient-reported inhaled regimen at enrollment, categorized as either aligning with, undertreating, or potentially overtreating per the 2017 GOLD strategy. Our primary composite outcome was time to death or first hospitalization for COPD. Additional outcomes included individual components of the composite outcome and time to first exacerbation. We generated multivariable Cox proportional hazard models across strata of GOLD-predicted exacerbation risk (high vs low) to estimate between-group hazard ratios for time to event outcomes. We adjusted models a priori for potential confounders, clustered by site. Results The trial enrolled 738 patients (73.4% men; mean age, 68.8 years). Of the patients, 571 (77.4%) were low risk for future exacerbations. Of the patients, 233 (31.6%) reported regimens aligning with GOLD recommendations; most regimens (54.1%) potentially overtreated. During a 2.3-year median follow-up, 332 patients (44.9%) experienced the composite outcome. We found no difference in time to composite outcome or death among patients reporting regimens aligning with recommendations compared with undertreated patients. Among patients at low risk, potential overtreatment was associated with higher exacerbation risk (hazard ratio, 1.42; 95% CI, 1.09-1.87), whereas inhaled corticosteroid treatment was associated with 64% higher risk of pneumonia (incidence rate ratio, 1.64; 95% CI, 1.01-2.66). Interpretation Among patients with COPD with moderate hypoxemia, we found no difference in clinical outcomes between inhaled regimens aligning with the 2017 GOLD strategy compared with those that were undertreated. These findings suggest the need to reevaluate the effectiveness of risk stratification model-based inhaled treatment strategies.

Background: Early experience during the coronavirus disease (COVID-19) pandemic and predictive modeling indicate that the need for respiratory therapists (RTs) will exceed the current supply. Objective: We present an implemented model to train and deploy medical students in the novel role of “respiratory therapist extender” (RTE) to address respiratory therapist shortage during the COVID-19 pandemic. Methods: The RTE role was formulated through discussions with respiratory therapists. A three-part training, with both online and in-person components, was developed and delivered to 25 University of Michigan Medical Students. RTEs were trained in basic respiratory care, documentation, equipment preparation, and equipment processing for clinically stable patients. They operate in a tiered staffing model in which RTEs report to a single RT, thereby extending his/her initial capacity. Results: The first cohort of safely trained RTEs was deployed to provide patient care within 1 week of volunteer recruitment. Conclusion: Our experience has demonstrated that healthcare professionals, including medical students, can be quickly trained and deployed in the novel RTE role as a surge strategy during the COVID-19 pandemic. Because we urgently developed and implemented the RTE role, we recognize the need for ongoing monitoring and adaptation to ensure patient and volunteer safety. We are sharing the RTE concept and training openly to help address RT shortages as the pandemic evolves.

Concept-based curricula have been widely implemented to combat content oversaturation in undergraduate nursing education. While nursing programs have focused on changing the classroom environment, only a few have integrated conceptual learning into clinical education. This qualitative descriptive study measured student perceptions of the effectiveness of concept cards, a concept-based clinical learning activity, in maternity and medical-surgical clinical sites. Two phases of the study indicated that the use of concept cards in clinical practicum deepened and reinforced understanding of concepts and enhanced student learning in the clinical setting.

Background Outcomes of petroclival meningiomas (PCM) (morbidity, permanent cranial nerves deficit, tumor removal and recurrence) are inconsistent in the literature, making it a challenge to predict surgical morbidity. Methods A multicenter study of patients with PCMs larger than 2.5 cm between 1984 and 2017 was conducted. The authors retrospectively reviewed the patients’ medical records, imaging studies and pathology reports to analyze presentation, surgical approach, neurological outcomes, complications, recurrence rates and predictive factors. Results There were 154 patients. The follow-up was 76.8 months on average (range 8–380 months). Gross total resection (GTR) was achieved in 40 (26.0%) patients, subtotal resection (STR) in 101 (65.6%), and partial resection in 13 (8.3%). Six (2.6%) perioperative deaths occurred. The 5-year, 10-year and 15-year progression-free survival (PFS) of GTR and STR with radiation therapy (RT) was similar (100%, 90% and 75%). PFS of STR without adjuvant radiation was associated with progression in 71%, 51% and 31%, respectively. Anterior petrosectomy and combined petrosectomy were associated with higher postoperative CN V and CN VI deficits compared to the retrosigmoid approach. The latter had a significantly higher risk of CN VII, CN VIII and LCN deficit. Temporal lobe dysfunction (seizure and aphasia) were significantly associated with the anterior petrosectomy approach. Conclusions Our study shows that optimal subtotal resection of PCMs associated with postoperative RT or stereotactic radiosurgery results in long-term tumor control to equivalent radical surgery. Case selection and appropriate intraoperative judgement are required to reduce the morbidity.

Objective Intracranial aneurysm (IA) is a frequent vascular malformation that can be managed by endovascular treatment (EVT) or microsurgery. A previously treated IA can recanalize, which may require further treatment. The aim of our study was to evaluate procedural complications related to IA retreatment and their risk factors. Methods All patients retreated for IA between 2007 and 2017 in 4 hospitals were included. We retrospectively reviewed the frequency of procedural complications of IA retreatment, defined as death or ≥ 1-point increase in modified Rankin score 24 h after the procedure. We then screened for risk factors of procedural complications by comparing the characteristics of patients with and without complications. Results During the inclusion period, 4,997 IAs were treated in our 4 institutions. Of these, 237 (4.7%) were retreated. 29 (12.2%) had ≥ 1 procedural complication. However, severe complications, defined as death or dependency at 1 month, occurred only in 3 patients (1.3%). The only risk factor for complications was microsurgical clipping as retreatment. Conclusions Procedural complications during IA retreatment were frequent but, in most cases, retreatment did not lead to death or severe disability. The only risk factor for complications of IA retreatment was clipping as retreatment. However, the design of the study did not allow any conclusion to be drawn as to the optimal means of aneurysm retreatment, and further studies are needed.

Racial Bias in Pulse Oximetry The question of whether pulse oximetry measurements vary according to race has not been adequately studied, despite the wide use of this measure in clinical care. In t...

International audience; Veal calves are often identified as reservoirs for antimicrobial resistant Escherichia coli (E. coli). This production is closely linked with dairy production, as young calves - mostly males - are collected from dairy farms to enter the fattening process. The aim of this prospective study was to explore the factors on dairy farms that favour the selection of antimicrobial resistance (AMR) in the digestive E. coli strains of young calves and to assess whether the resistance levels and selection pressure were the same for males and females. The exposure of calves to antimicrobials was investigated through three factors: antimicrobial treatment of calves; feeding of calves with milk from cows treated with antimicrobials; and the consumption of colostrum from cows treated with antimicrobials at dry-off. The study design involved 100 dairy farms. A calf of each sex was selected from birth on each farm. Information on the calves' exposure to antimicrobials was collected daily and calves were sampled (rectal swab) two weeks after birth, then seven weeks after birth for females only. Laboratory analyses included culture on two distinct media: a non-selective medium (identifying dominant flora) and a medium containing ceftiofur to select the extended-spectrum beta-lactamase (ESBL) phenotype. Susceptibility testing was performed on an E. coli strain from each medium. Generalised linear models were used to assess associations between the resistance of E. coli strains and antimicrobial exposure. A set of 280 swabs from healthy calves were analysed. In dominant flora, high levels of resistance (>60 %) were identified for streptomycin, tetracycline and amoxicillin but AMR levels were low (3 %) for critically important antimicrobials (3rd- and 4th-generation cephalosporins and fluoroquinolones). For females staying in dairy farms, a marked decrease in resistance was observed for almost all antimicrobials between the age of 15 days and 7 weeks. A selective medium revealed an ESBL phenotype for 20.7 % of the calves. Whether for AMR or antimicrobial exposure, no significant difference was found between male and female calves. The antimicrobial treatment of calves was associated with an increased resistance of E. coli from dominant flora for amoxicillin (OR = 2.9), gentamicin (OR = 4.6), florfenicol (OR = 5.0) and trimethoprim-sulfonamide (OR = 5.6). The consumption by calves of milk from cows treated with antimicrobials was also associated with an increased resistance to amoxicillin (OR = 2.6), gentamicin (OR = 4.0), tetracycline (2.6) and trimethoprim-sulfonamide (OR = 2.2). In contrast, the models did not reveal any association between AMR and consumption of colostrum from cows treated with antimicrobials at dry-off.

BackgroundAlthough inhaled therapy reduces exacerbations among patients with COPD, the effectiveness of providing inhaled treatment per risk stratification models remains unclear.Research questionAre inhaled regimens that align with the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy associated with clinically important outcomes?Study design and methodsWe conducted secondary analyses of Long-term Oxygen Treatment Trial (LOTT) data. The trial enrolled patients with COPD with moderate resting or exertional hypoxemia between 2009 and 2015. Our exposure was the patient-reported inhaled regimen at enrollment, categorized as either aligning with, undertreating, or potentially overtreating per the 2017 GOLD strategy. Our primary composite outcome was time to death or first hospitalization for COPD. Additional outcomes included individual components of the composite outcome and time to first exacerbation. We generated multivariable Cox proportional hazard models across strata of GOLD-predicted exacerbation risk (high vslow) to estimate between-group hazard ratios for time to event outcomes. We adjusted models a priori for potential confounders, clustered by site.ResultsThe trial enrolled 738 patients (73.4%men; mean age, 68.8 years). Of the patients, 571 (77.4%) were low risk for future exacerbations. Of the patients, 233 (31.6%) reported regimens aligning with GOLD recommendations; most regimens (54.1%) potentially overtreated. During a 2.3-year median follow-up, 332 patients (44.9%) experienced the composite outcome. We found no difference in time to composite outcome or death among patients reporting regimens aligning with recommendations compared with undertreated patients. Among patients at low risk, potential overtreatment was associated with higher exacerbation risk (hazard ratio, 1.42; 95%CI, 1.09-1.87), whereas inhaled corticosteroid treatment was associated with 64%higher risk of pneumonia (incidence rate ratio, 1.64; 95%CI, 1.01-2.66).InterpretationAmong patients with COPD with moderate hypoxemia, we found no difference in clinical outcomes between inhaled regimens aligning with the 2017 GOLD strategy compared with those that were undertreated. These findings suggest the need to reevaluate the effectiveness of risk stratification model-based inhaled treatment strategies.

Background: Concept-based curricula, coupled with conceptual approach to teaching, fosters conceptual learning. There is a need for clarity in the definition of conceptual learning. Method: Walker and Avant's method of concept analysis was used. Results: Conceptual learning is a process in which learners organize concept-relevant knowledge, skills, and attitudes to form logical cognitive connections resulting in assimilation, storage, retrieval, and transfer of concepts to applicable situations, familiar and unfamiliar. Attributes identified were (a) recognizing patterns in information, (b) forming linkages with concepts, (c) acquiring deeper understanding of concepts, (d) developing personal relevance, and (e) applying concepts to other situations. Antecedents were (a) learner cognitive potential, (b) organized conceptual framework, and (c) conceptual approach to teaching. Consequences were (a) enhanced synthesis and analysis, (b) improved problem solving, (c) ability to translate theory to practice, (d) appreciation of linear/nonlinear ways of thinking, and (e) enhanced concept construction. Conclusion: This analysis provides a referent for recognizing the occurrence of conceptual learning and developing instruments to measure its outcomes. [ J Nurs Educ . 2019;58(1):7–15.]

Concept-based curricula have been widely implemented to combat content oversaturation in undergraduate nursing education. While nursing programs have focused on changing the classroom environment, only a few have integrated conceptual learning into clinical education. This qualitative descriptive study measured student perceptions of the effectiveness of concept cards, a concept-based clinical learning activity, in maternity and medical-surgical clinical sites. Two phases of the study indicated that the use of concept cards in clinical practicum deepened and reinforced understanding of concepts and enhanced student learning in the clinical setting.

PURPOSE Medical school admissions committees are tasked with fulfilling the values of their institutions through careful recruitment. Making accurate predictions regarding enrollment behavior of admitted students is critical to intentionally formulating class composition and impacts long-term physician representation. The predictive accuracy and potential advantages of employing an enrollment predictive model in medical school admissions compared with expert human judgment have not been tested. METHOD The enrollment management-based predictive model previously generated using historical data was employed to provide a predicted enrollment percentage for each admitted student in the 2016-2017 application pool (N = 352). Concurrently, the human expert created a predicted enrollment percentage for each applicant while blinded to the values generated by the model. An absolute error for each applicant for both approaches was calculated. Statistical significance between approaches (expert vs. enrollment model) was assessed using t tests. RESULTS The enrollment management approach was noninferior to expert prediction in all cases (P < .05) with a superior correct classification rate (77.7% vs. 71.2%). When considering subgroup analyses for specific populations of potential importance in recruiting (underrepresented in medicine, female, and in-state applicants), the enrollment management predictions were statistically more accurate (P < .05). CONCLUSIONS Examining a single admitted class, the enrollment predictions using the enrollment management model were at least as accurate as the expert human estimates, and in specific populations of interest more accurate. This information can be readily exported for a real-time dashboard system to drive recruitment behaviors.

Introduction Chez les patients atteints de maladie de Cushing, la localisation de l’adenome hypophysaire corticotrope reste difficile : 27.5 % des microadenomes ne sont pas localisables meme avec les IRM actuelles, ce qui complique le traitement chirurgical. Notre objectif est la mise au point d’un diagnostic peroperatoire des microadenomes corticotropes par l’analyse proteomique de tissus hypophysaires en imagerie par spectrometrie de masse (ISM). Methode Nous avons etudie des hypophyses saines et des prelevements adenomateux corticotropes. Les prelevements etaient apposes sur lame de silicium puis analyses en ISM par desorption-ionisation laser assistee par matrice. Les images obtenues etaient comparees a une analyse anatomopathologique, puis les donnees spectrometriques etaient analysees en composantes principales. Resultats Nous avons analyse 2 hypophyses saines, incluant ante et post-hypophyse, prelevees en autopsie en laboratoire d’anatomie, et 23 prelevements du centre de ressource biologique du CHU Grenoble Alpes : 19 fragments adenomateux corticotropes et 4 prelevements peri-adenomateux. Sur 142 proteines identifiees en ISM les plus discriminantes etaient : vasopressine pour distinguer ante et post hypophyse (Se 0,95, Sp 0,99) ; ACTH pour distinguer le tissu adenomateux corticotrope de l’antehypophyse saine (Se 0,90, Sp 0,95). D’autres marqueurs d’interet tels que la neurophysine 2 et la β-endorphine etaient egalement detectes. Discussion La mesure par ISM de l’expression de vasopressine et ACTH d’un tissu hypophysaire permet de distinguer l’ante de la post-hypophyse et l’adenome corticotrope du tissu sain. Nous travaillons a rendre cette methode exploitable pour la detection extemporanee d’adenomes corticotropes, l’objectif etant d’assister le neurochirurgien dans la recherche d’adenomes n’ayant pas pu etre detectes radiologiquement.

Hypogammaglobulinemia (serum IgG levels 7.0 g/L) has been associated with increased risk of COPD exacerbations but has not yet been shown to predict hospitalizations.To determine the relationship between hypogammaglobulinemia and the risk of hospitalization in patients with COPD.Serum IgG levels were measured on baseline samples from four COPD cohorts (n = 2,259): Azithromycin for Prevention of AECOPD (MACRO, n = 976); Simvastatin in the Prevention of AECOPD (STATCOPE, n = 653), Long-Term Oxygen Treatment Trial (LOTT, n = 354), and COPD Activity: Serotonin Transporter, Cytokines and Depression (CASCADE, n = 276). IgG levels were determined by immunonephelometry (MACRO; STATCOPE) or mass spectrometry (LOTT; CASCADE). The effect of hypogammaglobulinemia on COPD hospitalization risk was evaluated using cumulative incidence functions for this outcome and deaths (competing risk). Fine-Gray models were performed to obtain adjusted subdistribution hazard ratios (SHR) related to IgG levels for each study and then combined using a meta-analysis. Rates of COPD hospitalizations per person-year were compared according to IgG status.The overall frequency of hypogammaglobulinemia was 28.4%. Higher incidence estimates of COPD hospitalizations were observed among participants with low IgG levels compared with those with normal levels (Gray's test, P .001); pooled SHR (meta-analysis) was 1.29 (95% CI, 1.06-1.56, P = .01). Among patients with prior COPD admissions (n = 757), the pooled SHR increased to 1.58 (95% CI, 1.20-2.07, P .01). The risk of COPD admissions, however, was similar between IgG groups in patients with no prior hospitalizations: pooled SHR = 1.15 (95% CI, 0.86-1.52, P =.34). The hypogammaglobulinemia group also showed significantly higher rates of COPD hospitalizations per person-year: 0.48 ± 2.01 vs 0.29 ± 0.83, P .001.Hypogammaglobulinemia is associated with a higher risk of COPD hospital admissions.

Deployment and maturation of computerized medical records has improved insight into the unintended variability of glucose management in hyperglycemic inpatients. We used expert panels and extensive field testing to design a Glycemic Management Program to simultaneously reduce mean glucose levels and the frequency of hypoglycemic events. Factors observed as contributing to glucose control variation included over-use of sliding scale insulin; inconsistencies in timing, type and dose of insulin; and the alignment of blood glucose testing with meal tray delivery. We designed our Glycemic Management Program to address these factors with four distinct components: 1) Change management via targeted education; 2) Standardization of the ordering process for nutrition, blood glucose monitoring frequency, and a single subcutaneous insulin order set with decision support; 3) Standardization of workflow, including the timing and coordination of glucose testing and meal tray delivery; and 4) Patient specific, customized ongoing insulin dosing recommendations through FDA-approved decision support software. We implemented our Glycemic Management Program pilot in a 325 bed community hospital in the southeastern United States. Since its launch, 2277 patients have been managed on the program. By six months post-implementation, the rate of severe hypoglycemia ( A comprehensive program that incorporates decision support with attention to workflow, provider engagement, and education can result in improved glucose management in an inpatient setting. Feedback has led to programmatic changes to maximize positive outcomes and ensure sustainability. Disclosure R. Freeman: None. W.E. Gay: None. T.L. Garthwaite: Advisory Panel; Self; Ondine Biomedical. L. Hollis: None. J. McCannon (Bush): None. C. Spencer-Smith: None. E.E. Samuelson: None. P. Mehta: None.

In higher education, enrollment management has been developed to accurately predict the likelihood of enrollment of admitted students. This allows evidence to dictate numbers of interviews scheduled, offers of admission, and financial aid package distribution. The applicability of enrollment management techniques for use in medical education was tested through creation of a predictive enrollment model at the University of Michigan Medical School (U-M).U-M and American Medical College Application Service data (2006-2014) were combined to create a database including applicant demographics, academic application scores, institutional financial aid offer, and choice of school attended. Binomial logistic regression and multinomial logistic regression models were estimated in order to study factors related to enrollment at the local institution versus elsewhere and to groupings of competing peer institutions. A predictive analytic "dashboard" was created for practical use.Both models were significant at P.001 and had similar predictive performance. In the binomial model female, underrepresented minority students, grade point average, Medical College Admission Test score, admissions committee desirability score, and most individual financial aid offers were significant (P.05). The significant covariates were similar in the multinomial model (excluding female) and provided separate likelihoods of students enrolling at different institutional types.An enrollment-management-based approach would allow medical schools to better manage the number of students they admit and target recruitment efforts to improve their likelihood of success. It also performs a key institutional research function for understanding failed recruitment of highly desirable candidates.

BACKGROUND Long-term treatment with supplemental oxygen has unknown efficacy in patients with stable chronic obstructive pulmonary disease (COPD) and resting or exercise-induced moderate desaturation. METHODS We originally designed the trial to test whether long-term treatment with supplemental oxygen would result in a longer time to death than no use of supplemental oxygen among patients who had stable COPD with moderate resting desaturation (oxyhemoglobin saturation as measured by pulse oximetry [Spo2], 89 to 93%). After 7 months and the randomization of 34 patients, the trial was redesigned to also include patients who had stable COPD with moderate exercise-induced desaturation (during the 6-minute walk test, Spo2 ≥80% for ≥5 minutes and

Forest canopy structure controls the timing, amount, and chemical character of precipitation supply to soils through interception and drainage along crown surfaces (primarily as throughfall). Yet, few studies have examined forest canopy structural connections to soil microbial communities, and none have measured how throughfall affects microbial nitrogen (N) functions. Maritime Quercus virginiana Mill. (southern live oak) forests on St Catherine’s Island (GA, USA) provide an ideal venue to study this interaction as its throughfall patterns are spatially heterogeneous due to the arboreal epiphyte, Tillandsia usneoides L. (Spanish moss), and its edaphic conditions are relatively homogeneous. To test the hypothesis that throughfall patterns alter soil microbial community N-function, we examined soil microbial community N-functional (ammonia oxidizing and chitinolytic) genes, soil chemistry/texture, and throughfall amounts/chemistry for points along a canopy coverage continuum: large canopy gaps (0%), bare Q. virginiana canopy (50–60%), and Q. virginiana canopy hosting heavy T. usneoides (>=85%) over a typical growing season (Mar–Sep 2014). Denaturing Gradient Gel Electrophoresis (DGGE) and quantitative Polymerase Chain Reaction (qPCR) analyses were used to assess changes in the diversity and abundance, respectively, of soil chitinolytic bacterial and ammonia oxidizing archaeal genes. Significant differences in throughfall water and solute delivery (Na+, Cl−, PO43−, SO42−, K+, Ca2+, NO3−, NH4+) were found to alter soil sodicity and salinity. Diversity of chitinolytic bacterial and ammonia oxidizing archaeal communities significantly differed across cover classes and negatively correlated to soil salinity, soil Na+ concentration, and throughfall Cl−, SO42−, and PO43- concentrations. Results suggest throughfall can alter patterns in the soil microbial community’s N-functional gene diversity.

Barrier island forests are sensitive to changing precipitation characteristics as they typically rely on a precipitation-fed freshwater lens. Understanding and predicting significant rainfall losses is, therefore, critical to the prediction and management of hydrometeorological processes in the barrier island forest ecosystem. This study measures and models one such loss, canopy rainfall interception, for a barrier island forest common across subtropical and tropical coastlines: epiphyte-laden Quercus virginiana on St. Catherine’s Island (Georgia, United States). Reformulated Gash analytical models (RGAMs) relying on static- and variable-canopy-storage formulations were parameterized using common maximum water storage (minimum, mean, maximum, and laboratory submersion) and evaporation (Penman–Monteith, saturated rain–throughfall regression, and rain–interception regression) estimation methods. Cumulative interception loss was 37% of rainfall, and the epiphyte community contribution to interception loss was 11%. Variable-storage RGAMs using inferred evaporation and maximum water storage estimates performed best: mean absolute error of 1–2 mm, normalized mean percent error of 15%–25%, and model efficiency of 0.88–0.97, resulting in a 2%–5% overestimate of cumulative interception. Static- and variable-storage RGAMs using physically derived evaporation (Penman–Monteith) underestimated observed interception loss (40%–60%), yet the error was significantly lowered for submersion estimates of maximum water storage. Greater apparent error when using Penman–Monteith rates may result from unknown drying times, evaporation sources, and/or in situ epiphyte storage dynamics. As such, it is suggested that future research apply existing technologies to quantify evaporative processes during rainfall (e.g., eddy covariance) and to develop new methods to directly monitor in situ epiphyte water storage.

Antimicrobial-resistant bacteria in dogs can be transmitted to humans and close contact between dogs and people might foster dissemination of resistance determinants. The aim of our study was to describe the antimicrobial resistance (AMR) pattern of the major causative agents of canine otitis – one of the most common diseases in dogs – isolated in France. Data collected between 2012 and 2016 by the French national surveillance network for AMR, referred to as RESAPATH, were analysed. Resistance trends were investigated using non-linear analysis (generalised additive models). A total of 7021 antibiograms were analysed. The four major causative agents of canine otitis in France were coagulase-positive staphylococci, Pseudomonas aeruginosa, Proteus mirabilis and streptococci. Since 2013, resistance to fluoroquinolones has been on the decrease in both P. aeruginosa and Staphylococcus pseudintermedius isolates. For P. aeruginosa, 19.4% of isolates were resistant to both enrofloxacin and gentamicin. The levels of multidrug resistance (acquired resistance to at least one antibiotic in three or more antibiotic classes) ranged between 11.9% for P. mirabilis and 16.0% for S. pseudintermedius. These results are essential to guide prudent use of antibiotics in veterinary medicine. They will also help in designing efficient control strategies and in measuring their effectiveness.

Surveillance and control of Mycoplasma spp. responsible for contagious agalactia (CA) in caprine herds are important challenges in countries with a large small-ruminant dairy industry. In the absence of any clinical signs, being able to determine the potential circulation of mycoplasmas within a herd could help to prevent biosecurity issues during animal exchanges between farms and improve health management practices. The objective of this study was to determine whether regular sampling of bulk tank milk was suitable for such surveillance. Twenty farms were sampled once a month for 2 yr and CA-responsible mycoplasmas were detected by real-time PCR on DNA extracted from milk, using 3 different DNA extraction methods. The pattern of mycoplasma excretion in bulk tank milk was assessed over time and several herd characteristics were recorded together with any event occurring within the herds. In general, the results obtained with the different detection methods were comparable and mainly agreed with the culture results. Several patterns of excretion were observed but were not related to herd characteristics (size, breed, and so on). Recurrence of the same (sub)species and same pulsed-field gel electrophoresis subtype during the 2-yr period is indicative of the considerable persistence of mycoplasmas. This persistence was associated with intermittent excretion. In conclusion, bulk tank milk sampling could be valuable for controlling CA in caprine herds provided it is repeated several times, yet to be defined, per year and analyzed using an appropriate methodology and the right cut-off for interpretation.

Forest canopy alters the amount of rainfall reaching the surface by redistributing it as throughfall. Throughfall is critical to watershed ecological variables (soil moisture, stream water discharge/chemistry, and stormflow pathways) and controlled by canopy structural interactions with meteorological conditions across temporal scales (from seasonal to within-event). This work uses complete linkage cluster analysis to identify intrastorm rain pulses of distinct meteorological conditions (beginning-of-storm and internal-to-storm pulses that are atmospherically dry, moderate, or wet), relates each cluster to intrastorm throughfall responses, then applies multiple correspondence analyses (MCAs) to a range of meteorological thresholds (median intensity, coefficient of variation (CV) of intensity, mean wind-driven droplet inclination angle, and CV of wind speed) for identification of interacting storm conditions corresponding to hot moments in throughfall generation (≥ 80% of rainfall). Equalling/exceeding rain intensity thresholds (median and CV) corresponded with throughfall hot moments across all rain pulse types. Under these intensity conditions, two wind mechanisms produced significant correspondences: (1) high wind-driven droplet inclination angles under steady wind increased surface wetting; and (2) sporadic winds shook entrained droplets from surfaces. Correspondences with these threshold conditions were greatest for pulses of moderate vapour pressure deficit (VPD), but weakest under high VPD. Weaker correspondences between throughfall hot moments and meteorological thresholds for high VPD pulses may be because canopy structures were not included in the MCA. In that vein, strongest meteorological threshold correspondences to throughfall hot moments at our site may be a function of heavy T. usneoides coverage. Future applications of MCA within other forests are, therefore, recommended to characterize how throughfall hot moments may be affected along drainage paths dependent on different structures (leaves, twigs, branches, etc.).

Summary Forest canopies alter rainfall reaching the surface by redistributing it as throughfall. Throughfall supplies water and nutrients to a variety of ecohydrological components (soil microbial communities, stream water discharge/chemistry, and stormflow pathways) and is controlled by canopy structural interactions with meteorological conditions across temporal scales. This work introduces and applies multiple correspondence analyses (MCAs) to a range of meteorological thresholds (median intensity, median absolute deviation (MAD) of intensity, median wind-driven droplet inclination angle, and MAD of wind speed) for an example throughfall problem: identification of interacting storm conditions corresponding to temporal concentration in relative throughfall beyond the median observation (⩾73% of rain). MCA results from the example show that equalling or exceeding rain intensity thresholds (median and MAD) corresponded with temporal concentration of relative throughfall across all storms. Under these intensity conditions, two wind mechanisms produced significant correspondences: (1) high, steady wind-driven droplet inclination angles increased surface wetting; and (2) sporadic winds shook entrained droplets from surfaces. A discussion is provided showing that these example MCA findings agree well with previous work relying on more historically common methods (e.g., multiple regression and analytical models). Meteorological threshold correspondences to temporal concentration of relative throughfall at our site may be a function of heavy Tillandsia usneoides coverage. Applications of MCA within other forests may provide useful insights to how temporal throughfall dynamics are affected for drainage pathways dependent on different structures (leaves, twigs, branches, etc.).

Alterations to forest canopy structure directly affect the hydrology and biogeochemistry of wooded ecosystems. Epiphytes alter canopy structure, thereby intercepting rainwater, reducing penetration of rain to the surface (as throughfall), modifying throughfall chemistry, and changing throughfall responses to storm conditions. These processes are well established for epiphyte presence versus absence; yet, it is unknown how epiphyte–throughfall interactions change across an epiphyte cover continuum (important information for prediction of ecological changes with epiphyte establishment or decline from disturbance). To fill this gap, we monitored throughfall water and dissolved ions (Na+, NH4+, K+, Mg2+, Ca2+, Cl–, NO3–, PO43–, SO42–) beneath a common epiphyte (Tillandsia usneoides L.) across cover percentages (0%–20%, 21%–40%, 41%–60%, 61%–80%, 81%–100%) for 47 storms. Throughfall amount inversely responded to epiphyte cover while increasing salt wash-off and intracellular leaching. Greater epiphyte cover released NH4+ and decreased NO3– from throughfall. Storm conditions (high vapor pressure deficit, moderate wind speeds, and low intensity) strengthened throughfall responses as T. usneoides cover increased. Factorial MANOVA results revealed significant trends for throughfall ion enrichment or depletion via wash-off, leaching, and uptake. These data suggest that inclusion of epiphyte alterations to rainwater and solute inputs in ecosystem nutrient budgeting studies should consider the full continuum of epiphyte cover represented at that site.