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Single-center studies support benefits of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a method of intraoperative support. Propensity-matched data from a large cohort, however, are currently lacking. Therefore, our goal was to compare outcomes of intraoperative VA-ECMO and cardiopulmonary bypass (CPB) during bilateral lung transplantation (LTx) with a propensity analysis.We performed a retrospective analysis of 795 consecutive primary adult LTx patients (June 1, 2011-December 26, 2020) using no intraoperative support (n = 210), VA-ECMO (n = 150), or CPB (n = 197). Exclusion criteria included LTx on venovenous-ECMO, single/redo LTx, ex vivo lung perfusion, and concomitant solid-organ transplantation or cardiac procedure. Propensity analysis was performed comparing patients who underwent intraoperative CPB or VA-ECMO.The propensity CPB group required more blood products at 72 hours (P = .02) and longer intensive care unit length of stay (P.001) and ventilator dependence days (P.001). There were no differences in cerebrovascular accident (P = 1), reintubation (P = .4), dialysis (P = .068), in-hospital mortality (P = .33), and 1-year (P = .67) and 3-year (P = .32) survival. The CPB group had a higher incidence of grade 3 primary graft dysfunction at 72 hours (P.001). Neither support strategy was a predictor of 1- and 3-year mortality in our multivariable model (VA-ECMO, P = .72 and P = .57; CPB, P = .45 and P = .91, respectively).Intraoperative VA-ECMO during lung transplantation was associated with fewer postoperative blood transfusions, shorter length of mechanical ventilation, and lower incidence of a grade 3 primary graft dysfunction at 72 hours. Although there were some differences in the postoperative course between the VA-ECMO and CPB groups, support type was not associated with differences in survival.

We examined cystic fibrosis (CF) patients and compared their clinical status at the time of primary versus double lung re-transplantation (re-DLTx) in order to better understand lung retransplant practice patterns.We performed a retrospective analysis of the UNOS Database identifying CF patients ≥18 years old undergoing re-DLTx (5/4/2005 and 12/4/2020). Baseline and clinical variables at the primary and re-DLTx were compared utilizing the paired student t-test. Graft survival was defined as time from surgery to retransplant and analyzed using Kaplan-Meier estimates.277 CF patients who underwent re-DLTx experienced a significantly worse 5-year survival when compared to the primary DLTx cohort (47.9% vs 58.8%, p = 0.00012). The following differences were observed comparing CF re-DLTx group to their primary DLTx: higher LAS score at the time of listing (50.66 vs 42.15, p 0.001) and transplant (62.19 vs 48.20, p 0.001), and increase LAS from the time of listing to transplant (+12.22 vs +7.23, p = 0.002). While serum albumin and total bilirubin were similar, CF patients had a higher creatinine (1.05 vs 0.74, p 0.001), dialysis (4.4% vs 0.6%, p 0.001), ECMO bridge to transplant rates (7.6% vs 4.0%, p 0.001), and higher oxygen requirements (5.95 vs 3.93, p 0.001) at the time of listing for a re-DLTx.Compared to their initial transplant, CF patients experience significant clinical decline in renal, cardiac, and pulmonary function at the time of lung retransplantation. This may indicate that an earlier evaluation and rehabilitation process may be necessary to identify patients earlier for lung retransplantation prior significant clinical decline.

The safety of lung transplantation using ex vivo lung perfusion (EVLP) has been confirmed in multiple clinical studies; however, limited evidence is currently available regarding the potential effects of EVLP on posttransplant graft complications and survival with mid-term to long-term follow-up. In this study, we reviewed our institutional data to better understand the impact of EVLP.Lungs placed on EVLP from 2014 through 2020 and transplant outcomes were retrospectively analyzed. Data were compared between lungs transplanted and declined after EVLP, between patients with severe primary graft dysfunction (PGD3) and no PGD3 after EVLP, and between matched patients with lungs transplanted with and without EVLP.In total, 98 EVLP cases were performed. Changes in metabolic indicators during EVLP were correlated with graft quality and transplantability, but not changes in physiological parameters. Among 58 transplanted lungs after EVLP, PGD3 at 72 hours occurred in 36.9% and was associated with preservation time, mechanical support prior to transplant, and intraoperative transfusion volume. Compared with patients without EVLP, patients who received lungs screened with EVLP had a higher incidence of PGD3 and longer ICU and hospital stays. Lung grafts placed on EVLP exhibited a significantly higher chance of developing airway anastomotic ischemic injury by 30 days posttransplant. Acute and chronic graft rejection, pulmonary function, and posttransplant survival were not different between patients with lungs screened on EVLP vs. lungs with no EVLP.EVLP use is associated with an increase of early posttransplant adverse events, but graft functional outcomes and patient survival are preserved. This article is protected by copyright. All rights reserved.

Large groups of animals aggregate around resource hotspots, with group size often influenced by the heterogeneity of the environment. In most cases, the foraging success of individuals within groups is interdependent, scaling either constructively or destructively with group size. Here we used biologging tags, acoustic prey mapping, passive acoustic recording of social cues and remote sensing of surface currents to investigate an alternative scenario in which large, dense aggregations of southeast Atlantic humpback whales, Megaptera novaeangliae, and northeast Pacific blue whales, Balaenoptera musculus, were each associated with ephemeral krill aggregations large enough such that their availability to predators appeared to be influenced more by environmental features than by consumption, implying independence of group size and consumption rates. We found that the temporal scale and spatial extent of oceanographic drivers were consistent with the temporal scale and locations of predator aggregations, and additionally found that groups formed above bathymetric features known to promote zooplankton concentration. Additionally, we found calling behaviour counter-indicative of competition: blue whale foraging calls were anomalously high during observed aggregation time periods, suggesting signalling behaviour that could alert conspecifics to the location of high-quality resources. Modelled results suggest that the use of social information reduces the time required for individuals to discover and exploit high-quality resources, allowing for more efficient foraging without apparent costs to the caller. Thus, rorqual whales foraging in these environments appear to exhibit a social foraging strategy whereby a behaviour with negligible individual costs (signalling) provides information that enhances group foraging efficiency. The population density dependence of this social foraging strategy may help explain why some rorqual species were at first slow to recover from human exploitation, but have since increased more rapidly.

The number of lung transplants from donors after circulatory death has increased over the last decade. This study aimed to describe the evolution and outcomes following lung transplantation donation after circulatory death and report the practices and outcomes of ex vivo lung perfusion in this donor population.This was a retrospective study using a prospectively collected national registry. The United Network for Organ Sharing database was queried to identify adult patients who underwent lung transplantation between May 1, 2005, and December 31, 2021. Kaplan-Meier analysis and Weibull regression were used to compare survival in four cohorts (donation after brain death with or without ex vivo lung perfusion, and donation after circulatory death with or without ex vivo lung perfusion). The primary outcome of interest was patient survival.Of the 21,356 recipients who underwent lung transplantation, 20,380 (95.4%) were from brain death donors and 976 (4.6%) from donors after circulatory death. Kaplan-Meier analysis showed no difference in the survival time between the two groups. In a multivariable analysis that controlled for baseline differences in donor and recipient characteristics, recipients who received lungs from cardiac death donors after ex vivo lung perfusion had 28% shorter survival time relative to donor lungs after brain death without ex vivo lung perfusion (HR: 1.53, 95% CI 1.10 - 2.15, p = 0.01).The early survival differences observed after lung transplants from donors after circulatory death in lungs evaluated with ex vivo lung perfusion deserves further investigation. This article is protected by copyright. All rights reserved.

Trophic transfer of energy through marine food webs is strongly influenced by prey aggregation and its exploitation by predators. Rapid aggregation of some marine fish and crustacean forage species during wind-driven coastal upwelling has recently been discovered, motivating the hypothesis that predators of these forage species track the upwelling circulation in which prey aggregation occurs. We examine this hypothesis in the central California Current Ecosystem using integrative observations of upwelling dynamics, forage species' aggregation, and blue whale movement. Directional origins of blue whale calls repeatedly tracked upwelling plume circulation when wind-driven upwelling intensified and aggregation of forage species was heightened. Our findings illustrate a resource tracking strategy by which blue whales may maximize energy gain amid ephemeral foraging opportunities. These findings have implications for the ecology and conservation of diverse predators that are sustained by forage populations whose behaviour is responsive to episodic environmental dynamics.

Animals' ability to track variable resources in space and time is critical to their survival in dynamic and changing ecosystems. Understanding populations' behavioral flexibility in response to natural and anthropogenic ecosystem variation requires long-term and detailed measurements of both animal behavior and ecosystem properties. In a series of recent studies, we leverage blue whales' widely-propagating songs to understand their capacity to track ecosystem variability across episodic foraging and seasonal-to-interannual migration scales. By integrating individual and population-level study of singing blue whales, we first identify an acoustic signature of their population-level transition from foraging to migration. Applying this acoustic signature to a six-year study period, we find that blue whales flexibly time their transition to migration to track interannual variability in the phenology of their foraging habitat. Within the foraging season, we further track blue whale behavior via a directional acoustic vector sensor. Using this approach, we find that blue whales maximize access to aggregated prey patches by dynamically tracking fine-scale wind-driven upwelling plumes in space and time. Combined, these findings display blue whales' ability to track oceanographic variability across spatial and temporal scales and suggest mechanisms by which these predators individually and collectively sense their dynamic foraging habitat.

To understand the implications of a tiered extracorporeal membrane oxygenation (ECMO) criteria framework and the outcomes of patients with COVID-19 acute respiratory distress syndrome who we were consulted on for ECMO but ultimately declined.All patients declined for ECMO support by a large regional health care system between March 2020 and July 2021 were included. Restrictive selection criteria were enacted midway through the study stratifying the cohort into 2 groups. Primary outcomes included 30-day mortality. Secondary outcomes included reasons for declining ECMO and survival stratified by phase.One hundred ninety-three patients with COVID-19 acute respiratory distress syndrome were declined for ECMO within the study period out of 260 ECMO consults. At the time of consult, 71.0% (n = 137) were mechanically ventilated and 38% (n = 74) were proned and chemically paralyzed. Thirty-day mortality was 66% (n = 117), which increased from 53% to 73% (P = .010) when restrictive criteria were enacted. Patients with multisystem organ failure, prolonged ventilator time, and advanced age had respectively an 11-fold (odds ratio, 10.6; 95% CI, 1.7-65.2), 4-fold (odds ratio, 3.5; 95% CI, 1.1-12.0), and 4-fold (odds ratio, 4.4; 95% CI, 1.9-10.2) increase in the odds of mortality.Patients with COVID-19 acute respiratory distress syndrome declined for ECMO represent a critically ill cohort. We observed an increase in the severity of disease and 30-day mortality in consults in the latter phase of our study period. These findings may reflect our use of tiered selection criteria coupled with ongoing education and communication with referring centers, sparing both patients likely to respond to medical therapy and those who were unsalvageable by ECMO.

Passive acoustic monitoring generates large data sets for which decimation is beneficial to analysis and portability for data sharing. Among the goals for effective decimation are avoidance of aliasing in the passband, accurate and complete control of the attenuation profile, phase preservation, and high efficiency in processing. We present an approach to decimator design that addresses each of these goals, and we demonstrate its application to ocean audio recordings. Anti-aliasing is achieved by windowed-sinc filters that also preserve phase. Control of the passband attenuation profile is based on the specification of the maximum allowed attenuation at a certain percentage of the final output Nyquist frequency. The window type is selected to meet the stopband attenuation requirement. Efficiency is achieved through optimization of the anti-aliasing filters applied in each decimation stage, and through parallelization of processing. The best combination of the sinc function's cutoff frequency and the mainlobe bandwidth of the window function generates the shortest qualifying filter, optimizing the trade-off between filter performance and computational load. Parallelization is enabled by applying the overlap-add method to contiguous segments of audio data, consistent with the commonly used storage of contiguous audio data in files of limited duration. Beyond addressing common goals for effective decimation of audio data, the approach presented is deployable in open-source environments.

Phytoplankton communities residing in the open ocean, the largest habitat on Earth, play a key role in global primary production. Through their influence on nutrient supply to the euphotic zone, open-ocean eddies impact the magnitude of primary production and its spatial and temporal distributions. It is important to gain a deeper understanding of the microbial ecology of marine ecosystems under the influence of eddy physics with the aid of advanced technologies. In March and April 2018, we deployed autonomous underwater and surface vehicles in a cyclonic eddy in the North Pacific Subtropical Gyre to investigate the variability of the microbial community in the deep chlorophyll maximum (DCM) layer. One long-range autonomous underwater vehicle (LRAUV) carrying a third-generation Environmental Sample Processor (3G-ESP) autonomously tracked and sampled the DCM layer for four days without surfacing. The sampling LRAUV's vertical position in the DCM layer was maintained by locking onto the isotherm corresponding to the chlorophyll peak. The vehicle ran on tight circles while drifting with the eddy current. This mode of operation enabled a quasi-Lagrangian time series focused on sampling the temporal variation of the DCM population. A companion LRAUV surveyed a cylindrical volume around the sampling LRAUV to monitor spatial and temporal variation in contextual water column properties. The simultaneous sampling and mapping enabled observation of DCM microbial community in its natural frame of reference.

Passive acoustic monitoring of ocean soundscapes can provide information on ecosystem status for those tasked with protecting marine resources. In 2015, the National Oceanic and Atmospheric Administration (NOAA) established a long-term, continuous, low-frequency (10 Hz-2 kHz) passive acoustic monitoring site in the Cordell Bank National Marine Sanctuary (CBNMS), located offshore of the central United States of America (U.S.) west coast, near San Francisco, CA. The California Current flows southward along the coast in this area, supporting a diverse community of marine animals, including several baleen whale species. Acoustic data analysis revealed that both large vessels and vocalizing baleen whales contribute to the ambient soundscape of the CBNMS. Sound levels fluctuated by month with the highest levels in the fall and lowest levels in the summer. Throughout the year, very low-frequency (10-100 Hz) sound levels were most variable. Vessels and whales overlap in their contributions to ambient sound levels within this range, although vessel contributions were more omnipresent, while seasonal peaks were associated with vocalizing whales. This characterization of low-frequency ambient sound levels in the CBNMS establishes initial baselines for an important component of this site's underwater soundscape. Standardized monitoring of soundscapes directly supports NOAA's ability to evaluate and report on conditions within national marine sanctuaries.

Lung cancer is one of the most prevalent malignancies world-wide with non-small cell lung cancer (NSCLC) comprising nearly 80% of all cases. Unfortunately, many lung cancer patients are diagnosed at advanced stages of the disease with an associated poor prognosis. Recently, the Chinese herb root extract Triptolide/Minnelide (TL) has shown significant promise as a therapeutic agent for NSCLC treatment both in vitro and in vivo. The aim of this study was to investigate the underlying mechanism(s) of action regarding TL-induced cytotoxicity in NSCLC. We demonstrate that triptolide treatment of A549 and H460 NSCLC cells decreases Caveolin-1 (CAV-1) mRNA/protein expression, resulting in activation of the Akt/Bcl-2-mediated mitochondrial apoptosis pathway. CAV-1 down-regulation was triggered by Micro-RNA 204-5p (miR204-5p) up-regulation and could be significantly blocked by pre-treatment with both Sirt-1/Sirt-3 specific siRNA and SIRT-1/SIRT-3 enzyme inhibitors, EX-527 and nicotinamide. Overall, our results provide evidence for a novel mechanism by which TL exerts its cytotoxic effects on NSCLC via CAV-1 down-regulation. Furthermore, these findings demonstrate a pivotal role for TL induction of the Akt/Bax pathway in apoptosis of human lung cancer.

Deep vein thrombosis (DVT) remains a common complication following lung transplantation despite universal routine DVT screening. Moreover, many of the previously reported risk factors are incompletely defined. We sought to explore the influence of DVT screening and to more definitively assess predisposing risk factors.A single-institution, retrospective, cohort study of 1141 patients undergoing lung transplantation from January 1, 2005, to December 31, 2014, was performed evaluating for the rate of DVT. Patients were given prophylactic subcutaneous heparin postoperatively. DVT events were noted if they occurred before 90 days after transplant. We compared DVT rates before and after 2008 when universal screening was implemented. We also evaluated the timing of DVT event and location (above the knee vs below the knee). DVTs were treated with standard anticoagulation therapy or an inferior cava filter when patients were unable to tolerate anticoagulation treatment. Univariable and multivariable models were used to identify risk factors for occurrence. A propensity match was performed to match groups across the eras, and a Cox regression was performed to identify differences in 1-year survival trajectory between cohorts.The rates of DVT before and after routine screening were 8.8% (36 DVT out of 412 transplants) and 17.3% (126 out of 729 transplants), respectively. These 2 rates were significantly different (P .01); moreover, the observed DVT incidence per year was not significantly different across the 6 years after universal DVT screening was implemented (P .90 for all comparisons). Observed DVT incidence at day 0 and day 14 were 3.8% and 3.8%, respectively, for the cohort before DVT protocols were established. Observed DVT incidence for the cohort after protocols were established at the same time points was 8.7% and 3.7%, respectively. Univariable analysis revealed that significant factors associated with a DVT include hypercholesterolemia (odds ratio [OR], 6.90; 95% confidence interval [CI], 1.82-26.13; P .01), the number of days in the intensive care unit (OR, 1.03; 95% CI, 1.00-1.01; P .01), and the length of stay in the hospital (OR, 1.01; 95% CI, 1.01-1.02; P .01), whereas having quit smoking (vs never smoked) was associated with a decrease in DVT development (OR, 0.50; 95% CI, 0.33-0.75; P .01). Multivariable analysis revealed 2 significant variables: hypercholesterolemia (OR, 8.13; 95% CI, 1.22-54.37; P = .03) and length of stay (OR, 1.03; 95% CI, 1.01-1.05; P .01). There was a trend for better 1-year survival in the post-2008 era (Exp[β], 1.49; P = .09).The rate of DVT diagnosis significantly increased after universal DVT screening was implemented. Furthermore, those patients undergoing lung transplantation with extended length of stay and hypercholesterolemia were prone to increased rates of DVT. There was a trend toward better 1-year survival in DVT-screened patients, suggesting DVT screening may result in beneficial outcomes.

Although the incidence of bronchial dehiscence following lung transplantation has decreased significantly due to improvements in perioperative managements and surgical techniques, it remains a devastating postoperative complication associated with high morbidity and mortality.We retrospectively reviewed 811 lung transplantation performed at our institution between January 2011 and December 2020. Bronchial dehiscence was confirmed with flexible bronchoscopy, computed tomography (CT) scan, or clinical findings grade using International Society for Heart and Lung Transplantation recommendations.Bronchial dehiscence was diagnosed in 38 patients (4.7%). The overall survival rates of the patients with bronchial dehiscence were significantly worse than those of the patients without bronchial dehiscence (p = .003). Multivariate analysis identified use of our basiliximab induction protocol (odds ratio = 3.03, p = .008) as an independent predictive factor of postoperative airway dehiscence in our multivariable model, along with total ventilator duration (odds ratio = 1.02, p = .002).Based on our analysis, patients that underwent our basiliximab induction protocol for lung transplantation experienced a higher rate of postoperative bronchial dehiscence when compared with patients who receive alemtuzumab induction. We believe this may be associated with a higher steroid exposure in this population. Additional studies are necessary to further characterize the relationship between different induction protocols and bronchial dehiscence following transplantation.

Background: Pleural metastasis in lung cancer found at diagnosis has a poor prognosis, with 5–11 months’ survival. We hypothesized that prognosis might be different for patients who have had curative-intent surgery and subsequent pleural recurrence and that survival might differ based on the location of the first metastasis (distant versus pleural). This may clarify if pleural recurrence is a local event or due to systemic disease. Methods: A database of 5089 patients who underwent curative-intent surgery for lung cancer was queried, and 85 patients were found who had biopsy-proven pleural metastasis during surveillance. We examined survival based on pattern of metastasis (pleural first versus distant first/simultaneously). Results: Median survival was 34 months (range: 1–171) from the time of surgery and 13 months (range: 0–153) from the time of recurrence. The shortest median survival after recurrence was in patients with adenocarcinoma and pleural metastasis as the first site (6 months). For patients with pleural metastasis as the first site, those with adenocarcinoma had a significantly shorter post-recurrence survival when compared with squamous cell carcinoma (6 vs. 12 months; HR = 0.34) and a significantly shorter survival from the time of surgery when compared with distant metastases first/simultaneously (25 vs. 52 months; HR = 0.49). Conclusions: Patients who undergo curative-intent surgery for lung adenocarcinoma that have pleural recurrence as the first site have poor survival. This may indicate that pleural recurrence after lung surgery is not likely due to a localized event but rather indicates systemic disease; however, this would require further study.

Low-frequency sound from large vessels is a major, global source of ocean noise that can interfere with acoustic communication for a variety of marine animals. Changes in vessel activity provide opportunities to quantify relationships between vessel traffic levels and soundscape conditions in biologically important habitats. Using continuous deep-sea (890 m) recordings acquired ∼20 km (closest point of approach) from offshore shipping lanes, we observed reduction of low-frequency noise within Monterey Bay National Marine Sanctuary (California, United States) associated with changes in vessel traffic during the onset of the COVID-19 pandemic. Acoustic modeling shows that the recording site receives low-frequency vessel noise primarily from the regional shipping lanes rather than via the Sound Fixing and Ranging (SOFAR) channel. Monthly geometric means and percentiles of spectrum levels in the one-third octave band centered at 63 Hz during 2020 were compared with those from the same months of 2018–2019. Spectrum levels were persistently and significantly lower during February through July 2020, although a partial rebound in ambient noise levels was indicated by July. Mean spectrum levels during 2020 were more than 1 dB re 1 μPa2 Hz–1 below those of a previous year during 4 months. The lowest spectrum levels, in June 2020, were as much as 1.9 (mean) and 2.4 (25% exceedance level) dB re 1 μPa2 Hz–1 below levels of previous years. Spectrum levels during 2020 were significantly correlated with large-vessel total gross tonnage derived from economic data, summed across all California ports (r = 0.81, p < 0.05; adjusted r2 = 0.58). They were more highly correlated with regional presence of large vessels, quantified from Automatic Identification System (AIS) vessel tracking data weighted according to vessel speed and modeled acoustic transmission loss (r = 0.92, p < 0.01; adjusted r2 = 0.81). Within the 3-year study period, February–June 2020 exhibited persistently quiet low-frequency noise and anomalously low statewide port activity and regional large-vessel presence. The results illustrate the ephemeral nature of noise pollution by documenting how it responds rapidly to changes in offshore large-vessel traffic, and how this anthropogenic imprint reaches habitat remote from major ports and shipping lanes.

Species and habitats are the subjects of legislation that mandates reporting of information on ecosystem conditions. Improvements in sensors, sampling platforms, information systems, and collaborations among experts and information users now enables more effective and up-to-date information to meet regional and national needs. Specifically, advances in environmental DNA (eDNA)-based assessments of biodiversity, community science data, various underwater imaging devices, and environmental, behavioral, and physiology observations from animal telemetry provide new opportunities to address multiple requirements for reporting status and trends, including insights into life in the deep ocean. Passive and active acoustic sensors help monitor marine life, boat traffic, and noise pollution. Satellites provide repeated, frequent, and long-term records of many relevant variables from global to local scales and, when combined with numerical computer simulations, allow planning for future scenarios. Metadata standards facilitate the transfer of data from machine to machine, thus streamlining assessments and forecasting and providing knowledge directly to the public. The Marine Biodiversity Observation Network (MBON) facilitates this exchange of information on life in the sea. The collaborative efforts of the Central and Northern California Ocean Observing System (CeNCOOS) of the US Integrated Ocean Observing System and its partners provide an example of a regional MBON process for information delivery. This includes linking policy and management needs, prioritizing observing data from various platforms and methods, streamlining data handling practices, and delivery of information for management such as for the Monterey Bay National Marine Sanctuary and the California Current Large Marine Ecosystem, with iterative process adaptation.

Finding high-value locations for in situ data collection is of substantial importance in ocean science, where diverse bio-physical processes interact to create dynamically evolving phenomena. These cover a variable spatial extent, and are sparse and difficult to predict. Autonomous robotic platforms can sustain themselves in harsh conditions with persistent presence, but require deployment at the correct place and time. To that end, we consider the use of remote sensing data for building compact models that can improve skill in predicting sub-mesoscale features and inform onboard sampling. The model enables prediction of regional patterns based on sparse in situ data, a capability that is essential in regions where use of satellite remote sensing in real time is often limited by cloud cover. Our model is based on classification of sea-surface temperature (SST) images, but the technique is general across any remotely sensed parameter. Images having similar magnitude and spatial patterns are grouped into a compact set of conditional means representing the dominant states. The classification is unsupervised and uses a combination of dictionary learning and hierarchical clustering. The method is demonstrated using SST images from Monterey Bay, California. The consistency of the classification result is verified and compared with oceanographic forcing using historical wind measurements. The established model is then shown to work in a real application using measurements from an autonomous surface vehicle (ASV), together with forecast and sampling strategies. Finally an analysis of the model prediction error is presented and compared across different paths and survey duration. © 2019. This is the authors' accepted and refereed manuscript to the article. The final authenticated version is available online at: https://doi.org/10.1177%2F0278364919884141

Coastal retention zones occur in the lee of headlands and within bays of coastal upwelling environments. Because retention zones can concentrate and retain communities of coastal planktonic organisms that would otherwise be advected offshore by wind-driven transport, they are ecologically significant. While the consequences of these zones for plankton retention and recruitment have been examined, the degree to which they remain retentive under variable upwelling intensity is less well understood. This aspect of coastal plankton ecology was studied during 2012 in the retentive upwelling shadow of northern Monterey Bay, California. Environmental and biological data show that exceptionally strong upwelling can greatly diminish resident plankton populations in the upwelling shadow. Results indicate that wind-driven circulation, essential to primary productivity and the formation of retention zones, can surpass levels that allow accumulation and retention of plankton communities.

OBJECTIVES Extracorporeal membrane oxygenation is a life-sustaining therapy for severe respiratory failure. Extracorporeal membrane oxygenation circuits require systemic anticoagulation that creates a delicate balance between circuit-related thrombosis and bleeding-related complications. Although unfractionated heparin is most widely used anticoagulant, alternative agents such as bivalirudin have been used. We sought to compare extracorporeal membrane oxygenation circuit thrombosis and bleeding-related outcomes in respiratory failure patients receiving either unfractionated heparin or bivalirudin for anticoagulation on venovenous extracorporeal membrane oxygenation support. DESIGN Retrospective cohort study. SETTING Single-center, cardiothoracic ICU. PATIENTS Consecutive patients requiring venovenous extracorporeal membrane oxygenation who were maintained on anticoagulation between 2013 and 2020. INTERNVENTIONS IV bivalirudin or IV unfractionated heparin. MEASUREMENTS AND MAIN RESULTS Primary outcomes were the presence of extracorporeal membrane oxygenation in-circuit-related thrombotic complications and volume of blood products administered during extracorporeal membrane oxygenation duration. One hundred sixty-two patients receiving unfractionated heparin were compared with 133 patients receiving bivalirudin for anticoagulation on venovenous extracorporeal membrane oxygenation. In patients receiving bivalirudin, there was an overall decrease in the number of extracorporeal membrane oxygenation circuit thrombotic complications (p < 0.005) and a significant increase in time to circuit thrombosis (p = 0.007). Multivariable Cox regression found that heparin was associated with a significant increase in risk of clots (Exp[B] = 2.31, p = 0.001). Patients who received bivalirudin received significantly less volume of packed RBCs, fresh frozen plasma, and platelet transfusion (p < 0.001 for each). There was a significant decrease in the number major bleeding events in patients receiving bivalirudin, 40.7% versus 11.7%, p < 0.001. CONCLUSIONS Patients receiving bivalirudin for systemic anticoagulation on venovenous extracorporeal membrane oxygenation experienced a decrease in the number of extracorporeal membrane oxygenation circuit-related thrombotic events as well as a significant decrease in volume of blood products administered.