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Spatial heterogeneity affects plant community composition and diversity. It is particularly noticeable in annual plant communities, which vary in space and time over short distances and periods, forming meta-communities at the regional scale. This study was conducted at the coastal dune ecosystem in Nizzanim nature reserve, Israel. This study aimed to analyze the effect of the spatial heterogeneity, which is expressed in differences in the fixation levels of the dunes and patches outside and beneath the dominant Artemisia monosperma shrubs, on the characteristics of the annual plant meta-community and its temporal stability, considering the mechanisms that may affect it. Thirteen dunes were studied: three mobile, seven semi-fixed, and three fixed dunes. Data on the annual plants were collected during the spring seasons of 2006, 2007, 2009, 2014, 2015, and 2016. For each dune, 72 quadrats of 40×40 cm were sampled yearly, with 24 quadrats per slope aspect (windward, leeward, and crest), 12 under the shrub, and 12 in the open. The results indicate that the transition from mobile dunes through semi-fixed to fixed dunes is characterized by an increase in annual plant cover, species richness, species diversity, changes in plant communities, and stability driven by the asynchrony of species population fluctuations. Asynchrony affected the stability of the meta-community of this ecosystem in patches beneath the shrubs but not in the open patches.

Substantial evidence now suggests that a positive diversity–stability relationship exists. Yet few studies examine the facets of biodiversity that contribute to this relationship, and empirical research is predominantly conducted on grassland communities under controlled conditions. We investigate the roles of species richness, environmental condition (vegetation cover), asynchrony, and weighted population stability in driving community stability across multiple taxa. We used data from a Long-term Ecological Research project to investigate temporal stability of annual plants, beetles, reptiles, and rodents in Nizzanim Coastal Sand Dune Nature Reserve in Israel. All four taxa had a strong positive relationship between asynchrony and community stability. Only rodents showed a positive richness–stability relationship. Perennial plant cover had a significant relationship with community stability for three taxa, but the direction of the correlation varied. Asynchrony had a stronger relationship with perennial plant cover than it did with richness for both plants and beetles. We suggest that community stability is driven by asynchrony for flora as well as fauna. Stability appears to be determined by species’ interactions and their responses to the environment, and not always by diversity. This has important consequences for understanding the effects of environmental degradation on ecosystem stability and productivity, which have destabilizing consequences beyond biodiversity loss.

Since ecological phenomena and patterns vary with scale, scalar analysis is a developing practice in ecology. Scalar analysis is most valuable in heterogeneous environments, since habitat heterogeneity is a key factor in determining biodiversity. One such case can be seen in the changes in annual vegetation in coastal sand dune systems. Most studies in these environments are carried out at the dune scale, comparing dunes at different stabilization states. However, a broader understanding of dune stabilization processes requires analyses at the finer scales of dune slope aspects (directions of exposure to wind) and patches (under and between woody perennial species). Here, we present the results of a study that combines the three scales (dune, slope, and patch) in the Mediterranean coastal dune systems in Israel. Through this multi-scalar analysis, we are able to describe processes at the finer patch and aspect scale and explain how they shape patterns at the dune scale. The results indicate that the dune scale exposes the differences in annual plant characteristics between mobile and fixed dunes, their slopes and patches and the reorganization and spatial distribution of annual plants within mobile and fixed dunes during the stabilization process.

Coastal dune habitats have been declining globally over the last several decades due to rapid urbanization. Within remaining dune systems, dune fixation has resulted in further losses of mobile dunes with negative impacts on their associated species. Some studies suggest vegetation removal can initially promote habitat heterogeneity, and increase availability of suitable habitats for psammophile, xeric and endemic mobile dune species, but longer-term responses are generally unknown. We investigated the temporal trends of four taxonomic groups to determine the effect of vegetation removal on dune assemblages over a 12-year period at an LTER site. Three different forms of removal are investigated here—removal in a grid form on fixed dunes, removal of the wind-facing slope vegetation on semi-fixed dunes and opportunistic off-road driving on disturbed dunes. Results were varied across taxa, highlighting the need for multi-taxa monitoring in conservation and restoration management. Overall, fixed dune treatment had very little effect, while a stronger response was found in semi-fixed treatments in particular for mobile dune indicator species, which showed evidence of recolonization within a few years following treatment. Disturbed dunes were most similar to mobile dunes for animal taxa indicating that pulse removal may not be as effective as continuous press disturbance. Nevertheless, a less destructive form of disturbance such as re-introduction of grazing might be preferable and requires further investigation.

Background: Mentorship is the foundation for training and career development. However, only about half of interventional radiology (IR) residency programs in the United States have a formal mentorship program at their institution. A new tiered mentorship program was introduced at our institution., Methods: A structured mentorship program was created at our institution in 2020 for IR residents to pair 1-2 faculty advisors with a group of residents, one from each PGY class, based on personal interests and career paths. A quality improvement survey with Likert scale format (1-5) was sent to IR residents and faculty members., Results: Responses were recorded from 11 IR residents in addition to all 6 IR faculty mentors. IR respondents reported satisfaction with feeling more assimilated in the department and all would recommend the current mentorship model to other institutions. Most respondents agreed the program made them comfortable conducting effective mentorship relationships as an attending and that the tiered structured of being mentee and mentor simultaneously was beneficial. Both IR residents and faculty agreed that the program helped prevent burnout., Conclusions: The tiered mentorship model has had a positive impact on the IR program by providing structured mentoring and longitudinal relationships. The most notable benefits for IR residents is the early integration into the program, sustained mentorships relationships, and the prevention of burnout. Similar models can help other programs establish structured faculty and peer mentorship for residents early in training., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To avoid the need for extensive adhesiolysis in patients with small bowel obstruction (SBO). We evaluated the feasibility of using advanced imaging, percutaneous access, and endoscopy as alternative therapies for SBO., Design: Retrospective case series (IDEAL [Idea, Development, Exploration, Assessment, and Long-term Study Collaborative] stages 1 and 2a)., Setting: Single tertiary referral center., Participants: Twelve adults with chronic SBO resulting from inflammatory bowel disease, disseminated cancer, radiation, and/or adhesive disease. Participants were included if they underwent one of three novel access procedures. There were no exclusion criteria. The median age of participants was 67.5 years (range 42-81); two-thirds were women; and median American Society of Anesthesiology class was 3., Interventions: All participants underwent one of three novel access methods, followed by wire-guided balloon dilation of a narrowed area of small bowel. These methods combined endoscopic, fluoroscopic, and surgical techniques. The techniques were (1) a purely endoscopic approach aided by an over-the-scope double-balloon device, (2) a combined endoscopic and percutaneous approach, and (3) a cut-down approach., Main Outcome Measures: Procedural success (defined as successful access to the small bowel and successful balloon dilation of the stenotic area). Secondary outcomes included major complications, recurrence, length of stay, and procedure time., Results: Procedural success was achieved in 10 of 12 patients (83%). At the time of median follow-up of 10 months, recurrence of SBO was observed in two patients. In only one patient, the novel method did not change the treatment plan. No major complications occurred. Conventional operative intervention was avoided in all patients who achieved technical success with one of the novel approaches. The median postprocedure length of hospital stay was 4 days. Median procedure time was 135 min., Conclusions: Novel minimally invasive approaches to SBO represent feasible alternatives to surgical procedures in select patients. Further study should compare these approaches to standard ones as new methods are refined., Competing Interests: Competing interests: Art Sedrakyan is an Editor-in-Chief of this journal., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To examine the effect of a clinic workflow intervention on follow-up for routine ercutaneous nephrostomy tube (PCN) exchanges., Methods: An intervention consisting of automated electronic tracking for all PCN placements and exchanges followed by phone call reminders to schedule a follow-up exchange 60 days post-procedure was introduced on March 19, 2019. All PCN exchanges performed from March 19, 2018 to September 18, 2019 were identified through a local electronic database search to assess the impact of intervention as a quality improvement project. Basic demographic information and procedure details were collected. Routine follow-up at our institution is recommended every 90 days. The exchange rates within 90 days were compared between groups using a Chi-squared test., Results: A total of 160 PCN placements or exchanges were performed pre-intervention and 69 PCN exchanges were performed post-intervention. Pre-intervention, 75/160 (46.3%) were exchanged within 90 days compared to 47/69 (68.1%) exchanged within 90 days post-intervention. The remainder had delayed follow-up due to loss to follow-up or scheduling delays. Post-intervention, there was a significantly improved rate of compliance for PCN exchanges within the recommended 90 days at our institution (p-value = 0.002)., Conclusion: Automated tracking and phone call follow-up at 60 days post-procedure is a simple and effective intervention that can improve compliance for routine PCN exchanges and reduce the number of patients that are lost to follow-up., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Hospitals rapidly developed new procedure and protocols and engaged in emergency construction projects to adapt their facilities and procedures to provide safe and effective patient care during the COVID- 19 pandemic surge in the New York metropolitan area. Physical and procedural revisions were necessary in the operating room to continue to care for emergent patients both with and without COVID. Similar adaptions in non operating room procedure suites, recognized commonly as Non-operating Room Anesthesiology (NORA), necessitated the engagement of multiple departments in order to develop protocols and to redesign procedural areas. This article describes in detail the collaborative planning, construction and preparation implemented in two academic medical centers with regard to their various NORA programs. In developing patient care, personal protective equipment training and repurposing of procedure suites, the multidisciplinary collaborative teams have taken into consideration the professional national societies governing Gastroenterology, Cardiology, and Interventional Radiology., Competing Interests: None., (© 2020 Elsevier Inc. All rights reserved.)

Introduction: Surgical data from the National Lung Screening Trial (NLST) has yet to be closely examined. We sought to analyze surgical procedures and complications from the NLST to determine their relevance to modern surgical practice., Methods: The NLST database was queried for patients who underwent surgical resection for confirmed lung cancer, specifically evaluating postoperative complications. Numerical variables were compared using the Mann-Whitney U test. Categorical variables were compared using the χ 2 test. Logistic regression uni- and multivariable analysis of independent risk factors of postoperative complications was performed., Results: At operation, 80% of patients (n = 821) had lobectomy, 4.1% (n = 42) had pneumonectomy, and 16.1% (n = 166) had sublobar resection, among whom 69% (n = 114) had wedge resection. Only 29.6% (n = 305) of the cohort had a thoracoscopic resection. Although the overall rate of surgical patients with any complication was 31% (n = 318), only 15.5% of patients (n = 160) had major complications, most commonly prolonged air leaks (n = 67, 6.5%). Respiratory failure (n = 28, 2.7%), prolonged ventilation (n = 9, 0.9%), myocardial infarction or cardiac arrest (n = 7, 0.7%), and stroke (n = 2, 0.2%) were rare events. Overall 30-day mortality in patients undergoing resection was 1.7% (n = 18). On multivariable analysis, greater smoking pack history (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.001-1.01) and pulmonary comorbidities (OR, 1.34; 95% CI, 0.98-1.82) were significant or approached significance for an association with complications/death, whereas sublobar resection (OR, 0.59; 95% CI, 0.38-0.94) and video-assisted thoracoscopic surgery approach (OR, 0.76; 95% CI, 0.56-1.04) were significant or approached significance for an association with decreased rates of complications/death., Conclusions: Operative mortality and postoperative morbidity were very low in patients undergoing resection for screen-detected lung cancer. Increased use of sublobar resection and minimally invasive surgical approaches may be associated with fewer complications., (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Interventional radiologists provide an essential role in the therapy and management of cancer patients. Computed-tomography (CT) guided percutaneous procedures have enabled interventionalists to treat multiple solid organ malignancies with minimal risk, however, certain lesions may present challenges to physicians due to a difficult approach, or their close proximity to other vital structures. The following presents a brief summary of tips and tricks the interventionalist may use to provide their patients with safe and effective therapy., (Copyright © 2018. Published by Elsevier Inc.)

Lung cancer is a global health burden and is among the most common and deadliest of all malignancies worldwide. The goal of screening programs is to detect tumors in earlier, curable stages, consequently reducing disease-specific mortality. The issue of screening has great relevance to thoracic surgeons, who should play a leading role in the debate over screening and its consequences. The burden is on thoracic surgeons to work in a multidisciplinary setting to guide and treat these patients safely and responsibly, ensuring low morbidity and mortality of potential diagnostic or therapeutic interventions., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: Bedside sonography for diagnosis of pneumothorax has been well described in emergency and trauma medicine literature. Its role in detection of iatrogenic pneumothorax has not been well studied. We describe the performance of bedside sonography for detection of procedure-related pneumothorax and highlight some limitations., Methods: A total of 185 patients underwent thoracentesis (n = 60), transbronchial biopsy (n = 48), and computed tomography-guided needle lung biopsy (n = 77). Bedside preprocedure and postprocedure transthoracic sonography and postprocedure chest radiograph were performed in all patients. Patients in whom the pleural surface was not well imaged with sonography were said to have a limited examination. Chest radiography was the standard for diagnosing pneumothorax., Results: Chest radiography showed pneumothorax in 8 of 185 patients (4.0%). These patients had undergone computed tomography-guided needle lung biopsy (n = 7) and transbronchial needle lung biopsy (n = 1). Sonography showed pneumothorax in 7 of these patients. The sensitivity, specificity, and diagnostic accuracy were 88%, 97%, and 97%, respectively. Limited-quality sonographic examinations due to preexisting lung disease were seen in 43 of 185 patients. The positive and negative likelihood ratios for patients with adequate scans were 55 and 0.17, respectively. The likelihood ratio for patients with limited-quality scans was 1.08., Conclusions: When a good-quality scan is achieved, bedside chest sonography is a valuable tool for evaluation of postprocedure pneumothorax. Patients with preexisting lung disease, in whom the quality of the sonographic examination is limited, should be studied with chest radiography.

Ischemic complications after endovascular abdominal aortic aneurysm repair (EVAR) are well-recognized and have been reported to be as high as 9%. The goal of our study was to examine the incidence, management, and outcome of ischemic complications at our institution after EVAR and to compare complications according to graft type and time period. This is a retrospective review of all EVARs performed at our institution from 1993 through 2005 (n = 430). EVAR was performed in asymptomatic patients in most cases. Follow-up consisted of a computed tomography scan and office visit at 1, 6, and 12 months and yearly thereafter. Ischemic complications after EVAR have decreased significantly with the advent of lower-profile devices with easier delivery systems and supported limbs. Simultaneous coil embolization of internal iliac artery at the time of EVAR implant does not appear to increase the risk of pelvic or lower-extremity ischemia, can be done safely, and does not need to be staged.

Objectives: The proliferation of minimally invasive cardiac surgery has increased dependence on augmented venous return techniques for cardiopulmonary bypass. Such augmented techniques have the potential to introduce venous air emboli, which can pass to the patient. We examined the potential for the transmission of air emboli with different augmented venous return techniques., Methods: In vitro bypass systems with augmented venous drainage were created with either kinetically augmented or vacuum-augmented venous return. Roller or centrifugal pumps were used for arterial perfusion in combination with a hollow fiber oxygenator and a 40-micrometer arterial filter. Air was introduced into the venous line via an open 25-gauge needle. Test conditions involved varying the amount of negative venous pressure, the augmented venous return technique, and the arterial pump type. Measurements were recorded at the following sites: pre-arterial pump, post-arterial pump, post-oxygenator, and patient side., Results: Kinetically augmented venous return quickly filled the centrifugal venous pump with macrobubbles requiring continuous manual clearing; a steady state to test for air embolism could not be achieved. Vacuum-augmented venous return handled the air leakage satisfactorily and microbubbles per minute were measured. Higher vacuum pressures resulted in delivery of significantly more microbubbles to the "patient" (P <.001). The use of an arterial centrifugal pump was associated with fewer microbubbles (P =.02)., Conclusions: Some augmented venous return configurations permit a significant quantity of microbubbles to reach the patient despite filtration. A centrifugal pump has air-handling disadvantages when used for kinetic venous drainage, but when used as an arterial pump in combination with vacuum-assisted venous drainage it aids in clearing air emboli.