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The objective of this scoping review was to answer the question, "What has been published describing drug dosing in sustained low-efficiency dialysis (SLED)?" PubMed, Embase, and Scopus were searched on November 18, 2022. Methodology followed the Arksey and O'Malley framework for scoping reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines. Two investigators independently screened abstracts and full-texts of citations identified related to drug dosing and SLED. Exclusion criteria included case reports, conference abstracts, pediatrics, treatment dialysis, and non-human subjects. A standardized data extraction sheet was used to collate and summarize data. The quality of evidence was evaluated by two investigators using the Mixed Methods Appraisal Tool. A total of 230 citations were identified for screening. Of these, 29 studies met criteria for inclusion after full-text review. Four drug groups including beta-lactam antibiotics, non-beta-lactam antibiotics, antifungals, and levetiracetam were identified. Dialysate rates, dialysis durations, and medication doses used varied widely across studies. Outcomes and pharmacokinetic parameters that were assessed were also heterogenous. Drug dosing in SLED is challenging and there is minimal evidence available to guide appropriate dosing. Larger studies are needed to more accurately determine how to appropriately dose medications in SLED. Therapeutic drug monitoring should be used in all patients on SLED when available., (© 2024 Pharmacotherapy Publications, Inc.)

Rationale: Propofol is a first-line sedative agent in the intensive care unit (ICU) but may be associated with hypertriglyceridemia and pancreatitis. To date, the relationship between propofol-induced hypertriglyceridemia and pancreatitis, as well as clinician responses to propofol-induced hypertriglyceridemia, have not been comprehensively studied. Objectives: To assess the incidence of hypertriglyceridemia and pancreatitis in patients receiving continuous propofol infusions in the ICU and to describe the association between hypertriglyceridemia and the use of nonpropofol continuous sedative infusions. Methods: This was a retrospective observational cohort study conducted at three urban academic hospitals within a single health system. Findings were additionally validated using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database containing data from a separate tertiary care hospital. Mechanically ventilated adult patients who received a continuous propofol infusion between 2016 and 2021 were included. The primary exposure was serum triglyceride concentration, and hypertriglyceridemia was defined as a triglyceride concentration greater than 400 mg/dl. Outcomes included new-onset pancreatitis as well as receipt of midazolam, dexmedetomidine, or ketamine after the triglyceride measurement. The incidence of pancreatitis was compared between groups using a Fisher's Exact test. Multivariable logistic regression was used to assess the association between dichotomized triglyceride concentration and alternative sedative use. Results: In the primary cohort of 7,037 patients, 1,724 (24.5%) had one or more triglyceride concentration measured. Of these, 1,365 (79.2%) had a maximum concentration of less than 400 mg/dl, and 359 (20.8%) had a maximum concentration of greater than 400 mg/dl. Compared with patients with low triglyceride concentrations, patients with high triglyceride concentrations were more likely to receive a continuous infusion of midazolam (37.0% vs. 16.4%; adjusted odds ratio [aOR], 3.1; 95% confidence interval [CI], 2.2-4.4; P  < 0.01), ketamine (22.8% vs. 6.9%; aOR, 3.5; 95% CI, 2.3-5.3; P  < 0.01), and dexmedetomidine (57.7% vs. 46.6%; aOR, 1.5; 95% CI, 1.1-2.0; P  < 0.01). Rates of midazolam infusion increased as triglyceride concentrations exceeded 500 mg/dl. Forty-four (0.6%) patients developed pancreatitis after propofol initiation, of which 4 (9.1%) were considered related to propofol-associated hypertriglyceridemia. Findings were similar in the MIMIC-IV cohort. Conclusions: Propofol-associated hypertriglyceridemia is relatively common in mechanically ventilated ICU patients who have triglycerides measured. Pancreatitis related to propofol-associated hypertriglyceridemia is rare. Patients who develop hypertriglyceridemia while receiving propofol are more likely to receive continuous infusions of other sedatives.

Purpose: Heparin-based regimens are recommended for anticoagulation in hospitalized patients with COVID-19 though a study reported similar mortality with apixaban in critically ill hospitalized COVID-19 patients. Our pilot study sought to determine the differences in all-cause mortality, venous thromboembolism (VTE), and bleeding events between apixaban and therapeutic heparin-based regimens in hospitalized non-critically ill COVID-19 patients. Methods: We conducted a retrospective analysis of non-critically ill COVID-19 patients aged ≥ 18 years admitted to 3 campuses of Montefiore Medical Center during the first (March 2020 to May 2020) and second (January 2021 to February 2021) COVID-19 surges, who received within 48 hours of admission and continued for ≥72 hours a therapeutic dose of low-molecular-weight heparin (LMWH), unfractionated heparin (UFH), or any apixaban dose for VTE prophylaxis. Outcomes data analyzed included mortality, suspected or imaging-confirmed VTE, and bleeding using a defined criteria. Results: Overall, 162 patients met eligibility for analysis. Baseline characteristics were similar between the 2 groups except liver and renal functions. Mortality occurred in 10 (13.3%) patients on apixaban and 23 (26.4%) patients on a heparin-based regimen ( P  = .059). Confirmed VTE events were not different between the groups (8% vs 13.8%, P  = .359), but higher incidence of bleeding occurred in heparin-based group (4% vs 52.9%, P  < .001). Conclusion: There were no differences in mortality or confirmed VTE between apixaban and heparin-based regimens except for more bleeding events with the heparins. This study highlights the utility of apixaban in COVID-19., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background: Vancomycin pharmacokinetics are altered in the critically ill and are further distorted by renal replacement therapy. Limited literature is available evaluating vancomycin dosing in continuous veno-venous hemodialysis (CVVHD)., Objective: The goal of this analysis was to identify factors that affect vancomycin trough concentration in patients on CVVHD and to determine an appropriate dosing strategy., Methods: This was a single-center, retrospective cohort study of adult inpatients admitted to the Cleveland Clinic from May 2016-December 2017. Patients in the intensive care unit who received ≥ 2 doses of vancomycin during CVVHD were included. Patients with interruptions of CVVHD inappropriately timed troughs, a change in dialysate rate, and those who received different vancomycin dosages were excluded. Multivariable linear regression including age, sex, weight, Sequential Organ Failure Assessment score, albumin, 24-hour urine output (UOP), dialysate rate, filter type, and vancomycin dose was run to determine predictors of vancomycin concentration., Results: A total of 160 patients were included. The median vancomycin dose was 12.6 mg/kg with a trough of 24.6 mcg/mL. Weight, 24-hour UOP, vancomycin dose (mg/kg), and dialysate rate (mL/kg/h) were all determined to be independent predictors of vancomycin trough level. Patients who received <10 mg/kg doses of vancomycin (N=18) achieved a median trough of 21.5 mcg/mL, with 83% being therapuetic. In patients who received >10 mg/kg (N=142), the median trough was 25.5 mcg/mL, with 47% being therapeutic., Conclusion and Relevance: Vancomycin dose, dialysate rate, UOP, and weight are independently associated with vancomycin trough concentration. In CVVHD patients, vancomycin dosed at 10 mg/kg every 24 hours may be an appropriate recommendation.

Abstract: The COVID-19 pandemic has created unique challenges for health care workers, who have demonstrated dedication, collaboration, and innovation in response. In this article, the authors describe an important nursing innovation they employed at Montefiore Medical Center in the Bronx, New York, during the spring 2020 COVID-19 surge: the relocation of smart IV infusion pumps outside of patient rooms. The goals of this innovation were to improve delivery of care, conserve personal protective equipment, limit the spread of the virus, and protect staff from exposure. The authors discuss the initial concerns that arose regarding the safety and efficacy of this practice; the research they conducted with other colleagues in nursing, pharmacy, infection control, and patient safety in the face of scant clinical literature relevant to the difficult circumstances the pandemic created; and the strategies they ultimately employed to ensure that this practice maintained safety and efficacy., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Analgesics, sedatives, and antipsychotics are commonly prescribed for agitation and delirium in the intensive care unit (ICU), but their use is limited by adverse effects and lack of efficacy. Valproic acid is an alternative treatment option., Objective: The primary objective of this study was to describe valproic acid prescribing in our institution's ICUs when used for agitation or delirium. Measures of effectiveness and safety were also assessed., Methods: This was a single-center, retrospective, institutional review board-approved cohort study of adult inpatients admitted to the ICU between January 2018 and August 2018. Patients who received valproic acid for the treatment of agitation or delirium for ≥24 hours were included. Prescribing practices were evaluated for dose, frequency, and route of administration. Effectiveness was assessed via agitation and delirium assessment tools and quantity of adjunctive agents used., Results: A total of 80 patients were included, with 35 receiving valproic acid alone and 45 in conjunction with antipsychotics. The most common valproic acid regimen was 250 mg orally 3 times daily. Delirium resolution occurred in 55% of patients: 24 in the valproic acid monotherapy group and 20 in the valproic acid plus antipsychotic group (69% vs 44%; P = 0.03). The incidence of delirium decreased from valproic acid day 0 to day 3 (93% vs 68%; P < 0.01), with no change in agitation (64% vs 63%; P = 0.28)., Conclusion and Relevance: Valproic acid is frequently prescribed in agitated, delirious patients at our institution and may have a role in the management of ICU delirium.

Although coronavirus disease 2019 was first identified in December 2019, it rapidly spread and became a global pandemic. The number of patients infected with the novel coronavirus (severe acute respiratory syndrome coronavirus 2) rose rapidly in New York State, placing great stress on healthcare systems. The traditional roles and practices of healthcare providers were dramatically redefined to meet the demand to care for the large number of ill patients. While literature reports on the experiences of many frontline staff, there is a scarcity of reports on the role of clinical pharmacists during this crisis. We report the role of critical care clinical pharmacists at a large academic medical center in New York City during this pandemic. Effective crisis management required clinical pharmacists to employ a wide array of skills and knowledge. Areas included clinical expertise, education, data analysis, health informatics infrastructure, and inventory management in times of surging medication use and manufacturer shortages. Clinical pharmacists fulfilled an essential service during the coronavirus pandemic by working to ensure the best possible outcomes for the patients they served on the frontline., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Background: Accurate recording of problems and diagnoses in health records is key to safe and effective patient care, yet it is often done poorly. Electronic health record systems vary in their functionality and ease of use, and are not optimally designed for easy recording and sharing of clinical information. There is a lack of professional consensus and guidance on how problems and diagnoses should be recorded., Methods: The Professional Record Standards Body commissioned work led by the Royal College of Physicians Health Informatics Unit to carry out a literature review, draft guidance, carry out an online consultation and round table discussion, and produce a report including recommendations for systems. A patient workshop was held to explore patient preferences for mechanisms for sharing diagnosis information between primary and secondary care., Results: Consensus was reached among medical specialties on key elements of diagnosis recording, and draft guidance was produced ready for piloting in a variety of care settings. Patients were keen for better ways for diagnosis information to be shared., Discussion: Improving the recording of diagnoses and problems will require a major effort of which the new guidance is only a part. The guidance needs to be embedded in training, and clinical systems need to have improved, standardised functionality. Front-line clinicians, specialist societies, clinical informaticians and patients need to be engaged in developing information models for diagnoses to support care and research, accessible via user-friendly interfaces., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Data on the effectiveness of definitive oral (PO) antibiotics for BSIs in preparation for discharge from hospital are lacking, particularly for Gram-positive bacterial BSIs (GP-BSI). The objective of this study was to determine rates of treatment failure based on bioavailability of PO antimicrobial agents used for GP-BSI., Methods: This was a single-center, retrospective cohort study of adult inpatients admitted to an academic medical center over a three-year period. Patients with a non-staphylococcal GP-BSI who received intravenous antibiotics and were then switched to PO antibiotics for at least a third of their treatment course were included. The cohort was stratified into high (⩾90%) and low (<90%) bioavailability groups. The primary endpoint was the proportion of patients experiencing clinical failure in each group. Secondary endpoints included clinical failure stratified by antibiotic group, bactericidal versus bacteriostatic PO agents, and organism., Results: A total of 103 patients met criteria for inclusion, which failed to reach the a priori power calculation. Of the patients included, 26 received high bioavailability agents and 77 received low bioavailability agents. Infections originated largely from a pulmonary source (30%) and were caused primarily by streptococcal species (75%). Treatment failure rates were 19.2% in the high bioavailability group and 23.4% in the low bioavailability group ( p = 0.66). Clinical failure stratified by subgroups also did not yield statistically significant differences., Conclusions: Clinical failure rates were similar among patients definitively treated with high or low bioavailability agents for GP-BSI, though the study was underpowered to detect such a difference., Competing Interests: Conflict of interest statement: The authors declare that there is no conflict of interest.

Background: Delirium or an acute confusional state (ACS) is characterised as being a frequent and complex hospital complication in older adult patients, which can affect their level of independence and increase patient morbidity and mortality. Critically ill patients in the intensive care unit (ICU) frequently develop ICU delirium, leading to longer hospital and ICU stays, increased mortality and long-term impairment. Objectives: This review aims to assess existing evidence of interventions that can be considered effective for the management and prevention of delirium in ICUs, reducing short-term morbidity and mortality, ICU and hospital admission times and the occurrence of other long-term complications. Methodology: For this systematic review, we searched Medline, PubMed, Cochrane Library, CINHAL, LILACS, SciELO and Dialnet from January 2018 to August 2024, in English, Spanish and French. MeSH descriptors were adjusted to search the different databases. We also checked Prospero for ongoing systematic reviews. Main results: The electronic search yielded a total of 2656 studies, of which 14 trials met the eligibility criteria, with a total of 14,711 participants. We included eight randomised clinical trial (RCTs), four cohort analyses, one systematic review and one observational trial, including participants over 65 years admitted to the ICU. Ten of these studies were based on pharmacological interventions, three of them examined non-pharmacological interventions and the remaining study examined mixed (pharmacological and non-pharmacological) interventions. Six placebo RCTs were included, plus four reported comparisons between different drugs. Regarding non-pharmacological interventions, nursing programmes focused on optimising modifiable risk factors or the use of therapies such as bright light are emerging. Regarding mixed interventions, we found the combination of invasive techniques and with sedoanalgesia. Conclusions: Due to its satisfactory level of sedation, dexmedetomidine is presented as a viable option because, although olanzapine offers safer results, postoperative administration angiotensin inhibitor systems significantly reduced the incidence of delirium. As for propofol, no significant differences were found. Among the non-pharmacological and mixed therapies, bright light therapy was able to reduce the incidence of delirium, and the combination of epidural/general anaesthesia was effective in all subtypes of delirium. Concerning the remaining interventions, the scientific evidence is still insufficient to provide a definitive recommendation. [ABSTRACT FROM AUTHOR]

Context: Microplastics are a concern for maritime nations such as Fiji, which rely heavily on seafood, such as bivalves, which can transfer pollutants through the food chain. The lack of biomonitoring studies in the Pacific region highlights the necessity of researching microplastic pollution in seafood. Aims: This study quantifies microplastics in Anadara antiquata , a commonly consumed shellfish in Fiji, and evaluates its general biochemical responses. As a baseline, this study is not to draw an association between the two endpoints (microplastics and biochemical responses), rather present these as baselines for future studies. Methods: A total of 58 specimens from Ba River Delta, Rakiraki Bay and Vueti Navakavu were examined, where differences in potential sources or pathways for microplastics, including anthropogenic pollutants with the potential to induce stress on marine animals, were considered (rivers, industrial zones, stormwater outlets, sewerage outfalls and mining area). Specific hepatopancreatic enzyme activities associated with detoxification (glutathione-S transferase, GST) and oxidative stress (glutathione peroxidase, GPX, and glutathione reductase, GR) were measured. Key results: Microplastics were extracted, classified by morphology and quantified. The study found that 64% of specimens had microplastics, <1.0 mm being more prevalent. Ba River Delta showed significant biochemical stress (Kruskal–Wallis test; P < 0.05) with GST (χ 2 = 40.28, d.f. = 2, P -value < 0.001), GPX (χ 2 = 38.38, d.f. = 2, P -value < 0.001) and GR χ 2 = 45.14, d.f. = 2, P -value < 0.001) being considered as likely to be responding to pollution. Conclusion: As a baseline, the study underlines the need for biomonitoring as a result of varying and concerning levels of pollution and biochemical stress responses found across the study areas. Integrating biomonitoring methods into risk-assessment protocols in Fiji may support establishment of opportunities or considerations for health guidelines and policy interventions to minimise human exposure to microplastics, and regulate environmental pollution. Implications: These measures are crucial for protecting public health and monitoring pollution impacts. Researchers in Fiji found microplastics in 64% of local edible cockles, with higher levels of microplastics and associated biological stress signs in the edible cockles from more polluted areas. The findings highlighted the need for continuous environmental and biomonitoring of pollution effects in seafood. This scientific contribution will inform and shape future policy on regulating pollution and promoting human-health needs in seafood quality. [ABSTRACT FROM AUTHOR]

Coral recruitment was examined on terracotta tiles deployed for four six-month periods between March 2001 and April 2003 on the West Fore Reef at Discovery Bay, Jamaica. During each sampling period, four tiles were deployed on each of two arrays at six depths ranging from 3 m to 33 m. Only three Acropora spat recruited to the tiles over the sampling period. The Acropora spat recruited during only one of the four six-month sampling periods and at only one depth, 3m. That represents a density of 8 spat m(-2) at 3 m depth for one six-month sampling period. Acropora recruitment represented <1 % of the total spat recruiting to the tiles deployed at 3 m during the four sampling periods. Density of acroporids on the West Fore Reef is low. Only one Acropora colony (an A. palmata) was recorded during Point-Quarter surveys of coral cover and density at depths of 3 m, 9 m, 14 m and 19 m. Considering the paucity of acroporid colonies and the infrequent settlement of acroporid spat on the West Fore Reef, it is unlikely that the historic abundance of A. palmata and A. cervicornis will return soon.

Long-term, high accuracy seawater temperature data sets are essential in studies assessing environmental changes that may alter coral reef communities. Located at the approximately the same latitude, the subsurface seawater temperature (S3T) off Discovery Bay, Jamaica (DBJ) and the U.S. Virgin Islands (USVI) had the same overall mean temperature. The USVI S3T during the winter months is approximately 0.5 degrees C warmer than DBJ, while May - July at DBJ is approximately 1 degrees C warmer than USVI S3T. With the passing of tropical storms in 1995 and 1997 in the USVI S3T dropped as much as 1.5 degrees C within a 20 hr period and did not revert to the previous temperature during that calendar year. Mean monthly S3T during 2000 and 2001 in the USVI was > 0.5 degrees C warmer than during similar periods in the early 1990s. Mean monthly S3T during 1999-2002 at DBJ was 0.27 degrees C cooler than during 1994-1995.

Puerulus settlement of the western Atlantic spiny lobster, Panulirus argus, was monitored using modified Witham collectors from December 1996 to March 1998 at seven sites around St. Thomas, U.S. Virgin Islands. A total of 605 pueruli were collected from 553 samples for a catch per unit effort (CPUE) for all sites of 1.09 pueruli. The greatest settlement occurred on sites within a recently declared marine reserve, which had an overall CPUE of 1.77 pueruli. Settlement in non-reserve sites was much lower with an overall CPUE of 0.31 pueruli. Pueruli recruitment declined 67% at inshore sites and 53% at offshore sites between July 1992 - April 1994 and February 1997 - March 1998. Also, only 10% of months sampled in 1997-98 had a CPUE > 0.5 compared to 55% in a previous study in 1992 - 1993. Despite the decline in pueruli CPUE in 1997-98 compared to 1992-94, the commercial lobster catch in the 2000-01 fishing season, and by inference the adult lobster population (legal lobster size in the US Virgin Islands is > or = 3.5 cm carapace length), remained stable.

Coral reef ecosystems are facing severe degradation due to anthropogenic activities at both local and global scales. In response, extensive restoration efforts are underway, aiming to bolster coral cover and enhance reef fish communities to foster facilitation between fish and corals. This reciprocal relationship is anticipated to improve overall restoration efficacy and enhance coral reef resilience in the face of global warming. Here, we investigate the impact of coral restoration using out-planted Acropora cervicornis colonies attached to raised domes on the associated fish community on the isolated, well-protected reef of Little Cayman Island in the Central Caribbean. Surveys were conducted immediately preceding out-planting, five days later, and 85 days later to capture temporal changes in the fish community. After 85 days of out-planting, there were no changes in fish biomass, abundance, or species richness for the entire fish community. This pattern was consistent for selected fish functional groups. Additionally, no significant differences were observed in the fish community before outplanting, five days after out-planting, or 85 days after out-planting of restoration domes. Our results underscore the limited impact of coral restoration for influencing fish communities in the isolated and highly protected reef of Little Cayman over an 85-day period. Consequently, our findings have implications for using coral restoration as a mechanism to enhance fish populations, particularly in marginally disturbed regions where structural complexity has not been lost. Future restoration programs should therefore incorporate local knowledge of environmental history and restoration needs along with an increased data-driven understanding of the intricate interaction between fish and coral populations to be successful. [ABSTRACT FROM AUTHOR]

Background: Agitation is a common clinical problem encountered in the intensive care unit (ICU). Treatment options are based on clinical experience and sparse quality literature. Aim: The aim of this study was to describe the effect of valproic acid (VPA) as adjuvant treatment for agitation in the ICU, identify predictors of response to VPA and evaluate the independent effect of VPA on agitation compared to standard of care (SOC). Method: This retrospective single center observational study evaluated adult patients admitted to the ICU for whom a psychiatric consultation was requested for agitation management, with agitation defined as a Richmond Agitation Sedation Score of 2 or greater. A descriptive analysis of the proportion of agitation-free patients per day of follow-up, the incidence of agitation-related-events, as well as the evolution of co-medications use over time are presented. A logistic regression model was used to assess predictors of VPA response, defined as being agitation-free on Day 7 and generalized estimating equations were used to evaluate the independent effect of VPA as adjuvant therapy for agitation in the critically ill. Results: One hundred seventy-five patients were included in the study with 78 receiving VPA. The percentage of agitation-free patients on VPA was 6.5% (5/77) on Day 1, 14.1% (11/78) on Day 3 and 39.5% (30/76) on Day 7. Multivariate regression model for clinical and demographic variables identified female gender as predictor of response on Day 7 (OR 6.10 [1.18–31.64], p = 0.03). The independent effect of VPA was non-significant when compared to SOC. Conclusion: Although VPA used as adjuvant treatment was associated with a decrease in agitation, its effect when compared to SOC did not yield significant results. [ABSTRACT FROM AUTHOR]

Purpose: Assess the efficacy and safety of valproic acid (VPA) for delirium and agitation in the intensive care unit (ICU) as compared to the use of other antipsychotics. Materials and Methods: This was a retrospective cohort study of patients treated for delirium and agitation in the ICU. Patients were included if they had a Richmond Agitation-Sedation Scale ≥2 and Confusion Assessment Method for the ICU positive. Patients were split into two groups based on their VPA exposure. The primary outcome was delirium free days. Secondary outcomes included agitation free days, ICU length of stay (LOS), mechanical ventilation duration, and mortality. Results: One hundred eight patients were included, 49 patients in the VPA group and 59 patients in the control group. Baseline characteristics were similar between groups. There was no significant difference in the primary outcome (difference −.15, 95% CI: 0.63-.93, P =.70). There were no significant differences in agitation-free days, mortality, mechanical ventilation duration, or ICU LOS. Conclusions: Our findings suggest that VPA is associated with similar delirium and agitation-free days compared to other non-VPA medications, with some adverse effects. Larger prospective studies are needed to validate the routine use of VPA in this setting. [ABSTRACT FROM AUTHOR]

Purpose: To assess the in vitro activity of ceftaroline and a panel of comparator agents against isolates of Gram-positive bacteria, including Staphylococcus aureus, Streptococcus pneumoniae, β-hemolytic streptococci, and coagulase-negative staphylococci (CoNS) from blood collected in Africa and Middle East (AfME), Asia Pacific (APAC), Europe, Latin America (LATAM), and North America from 2017 to 2020 as a part of the Antimicrobial Testing Leadership and Surveillance (ATLAS) program.Methods: Susceptibility and minimum inhibitory concentration were determined using broth microdilution for all antimicrobial agents by a central reference laboratory according to the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines.Results: Ceftaroline showed good activity (susceptibility ≥ 89.8%, MIC90 0.008– 2 mg/L) against all Gram-positive isolates tested. All isolates of methicillin-susceptible S. aureus, penicillin-susceptible S. pneumoniae, S. agalactiae, S. dysgalactiae, and S. pyogenes were susceptible to ceftaroline (MIC90 0.008– 0.25 mg/L). Ceftaroline susceptibility for MRSA isolates was 89.8% globally (MIC90 2 mg/L). Among the comparator agents, all isolates were susceptible to vancomycin, except S. epidermis (susceptibility, 99.9%). Among other agents, daptomycin, linezolid, and tigecycline showed potent activity (susceptibility ≥ 97.9%, MIC90 0.03– 2 mg/L) against all isolates tested.Conclusion: Ceftaroline showed potent in vitro activity against global bloodstream isolates of Gram-positive bacteria collected between 2017 and 2020. Monitoring and surveillance of global as well as regional longitudinal trends of resistance rates among Gram-positive isolates causing bloodstream infections are important to limit the spread of AMR, establish stewardship measures, and manage and appropriately treat infections. [ABSTRACT FROM AUTHOR]

Coastal river systems provide essential habitats for a diversity of fish species that transition marine, estuarine, and freshwater environments to complete their lifecycles. Movement among and within these environments is important to access resources that optimise growth, survival, and reproduction. Knowledge on the movements, including the drivers, underpins management strategies, although this information is often lacking for many species. We used acoustic telemetry to quantify the relative importance of a range of abiotic stimuli in relation to seasonal movement patterns in blue salmon catfish Neoarius graeffei throughout an unregulated coastal river catchment, the Clarence River in northern New South Wales, Australia. Neoarius graeffei continuously occupied the Clarence River system for the duration of the 1-year study and were mostly confined to estuarine reaches, with occasional movement into freshwater habitats. Seasonal differences in habitat occupation were observed, with N. graeffei using habitats close to the river mouth in winter and upstream estuary habitats in spring. Broad-scale movement patterns were influenced by both water temperature and river flow, and high-flow events (> 1.5 m) resulted in short-term changes (~ 10 days) in habitat use. Sex-specific differences in seasonal habitat use were also observed which we hypothesise is linked to contrasting energetic investment in reproduction. The response of N. graeffei to changes in river flow highlights the need for assessment on these impacts for estuarine-dependent species more broadly, in the face of climate change and increased river regulation. [ABSTRACT FROM AUTHOR]

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Coral-eating crown-of-thorns seastars (CoTS, Acanthaster spp.) are major contributors to the coral reef crises across the Indo-Pacific region. Until recently, CoTS throughout the Indo-Pacific were regarded to be a single species, Acanthaster planci. However, genetic and morphological analyses demonstrated that there are at least four distinct species: Acanthaster benziei in the Red Sea, Acanthaster mauritiensis and A. planci in the Indian Ocean, and Acanthaster cf. solaris in the western Pacific. Acanthaster cf. ellisii in the eastern Pacific needs more taxonomic attention. Here, we review the biological knowledge for each species adapting a pragmatic geographical species definition and using a systematic literature review complemented with more focused searches for individual species. The vast majority of CoTS research (88%) was conducted on A. cf. solaris, with much of this research undertaken on the Great Barrier Reef or in Japan. Many studies of A. cf. solaris are focused on monitoring or documenting incidences of outbreaks, though there is a solid base of knowledge on larval, juvenile and adult ecology derived from field and laboratory experiments. By contrast, most of the published studies on the four remaining species simply document cases of population outbreaks. The major taxonomic bias in CoTS research constitutes a significant limitation for understanding and managing these species for two reasons. First, even for A. cf. solaris, which is the most studied species, limited fundamental knowledge of their biology and ecology constrains understanding of the drivers of outbreaks and hinders corresponding management actions for prevention and control of these events. Second, understanding and management of other species are predicated on the assumption that all CoTS species have similar biology and behaviour, an unsatisfying assumption for ecosystem management. [ABSTRACT FROM AUTHOR]

Octopuses present a difficult resource to manage because of their relatively short life spans, rapid growth rates, high natural mortality and seasonal fluctuations in abundance. With exploitation efforts increasing worldwide, particularly in the Pacific Island region, substantial knowledge gaps in their biology, exploitation and management remain. We conducted a literature review to summarise their species distribution, abundance, ecological attributes, utilization, importance and management within the Pacific Island Countries and Territories (PICTs) of Fiji, Vanuatu, the Solomon Islands, New Caledonia, Tonga, Samoa and American Samoa. We found that 23 species of octopuses within 11 genera were recorded from these PICTs, belonging to the families Amphitretidae and Octopodidae. Overall, Tonga was the most speciose country with 11 occurrence records and Samoa recorded the least with just a single species. All other countries recorded between 2 and 8 taxa. The day octopus (Octopus cyanea) was recorded from all PICTs except Samoa. There are no specific national regulations on octopus fisheries within the PICTs and management is largely dependent on overarching national fisheries legislation. However, community-based management efforts can be an effective platform in sustaining octopus stocks. Octopuses also play an important role in the folklore and customs of many Pacific Islanders, and we provide a summary of these for the specific PICTs assessed. This review highlights areas for further research and development for the Pacific Island region and the urgent need to address specific knowledge gaps on octopus taxonomy, stock assessment and fishery management. [ABSTRACT FROM AUTHOR]

Indo-Pacific corals predominantly reproduce using synchronous mass spawning events to maximise fertilisation. However, as disturbances continue to thin population densities, the quantities of gametes released declines and colonies become more isolated, reducing the likelihood of cross-fertilisation. Local hydrodynamic conditions can promote or inhibit gamete contact; thus, the interaction between the abiotic environment and sperm density will determine the amount of time gametes interact. In this study, we investigated the sensitivity of reproduction to manipulations of two key limiting factors of fertilisation: sperm concentration and contact time between gametes. We explored fertilisation kinetics of phylogenetically and functionally similar and diverse coral taxa on the Great Barrier Reef and Western Australia (Acropora digitifera, A. tenuis; Coelastrea aspera, Platygyra daedalea). Results indicate that fertilisation is optimised at sperm concentrations > 103 sperm mL−1 and contact times > 30 s, but the extent of these relationships is species-specific. All species showed clear differences in fertilisation success across contact times, although these differences were less distinct for A. tenuis and P. daedalea at very high sperm concentrations. Acropora digitifera and P. daedalea exhibited nonlinear trends with steep slopes of increased fertilisation success once sperm concentration surpassed values of 104 sperm mL−1 and 102 sperm mL−1, respectively, followed by slight declines. Acropora tenuis and A. digitifera had the highest maximum fertilisation success, likely owing to beneficial evolved functional traits like large egg sizes. The present analysis underpins studies of fertilisation kinetics in natural reef populations to help inform management and restoration practices that assist population resilience and recovery. [ABSTRACT FROM AUTHOR]

Background: Long Covid is a widely recognised consequence of COVID-19 infection, but little is known about the burden of symptoms that patients present with in primary care, as these are typically recorded only in free text clinical notes. Aims: To compare symptoms in patients with and without a history of COVID-19, and investigate symptoms associated with a Long Covid diagnosis. Methods: We used primary care electronic health record data until the end of December 2020 from The Health Improvement Network (THIN), a Cegedim database. We included adults registered with participating practices in England, Scotland or Wales. We extracted information about 89 symptoms and 'Long Covid' diagnoses from free text using natural language processing. We calculated hazard ratios (adjusted for age, sex, baseline medical conditions and prior symptoms) for each symptom from 12 weeks after the COVID-19 diagnosis. Results: We compared 11,015 patients with confirmed COVID-19 and 18,098 unexposed controls. Only 20% of symptom records were coded, with 80% in free text. A wide range of symptoms were associated with COVID-19 at least 12 weeks post-infection, with strongest associations for fatigue (adjusted hazard ratio (aHR) 3.46, 95% confidence interval (CI) 2.87, 4.17), shortness of breath (aHR 2.89, 95% CI 2.48, 3.36), palpitations (aHR 2.59, 95% CI 1.86, 3.60), and phlegm (aHR 2.43, 95% CI 1.65, 3.59). However, a limited subset of symptoms were recorded within 7 days prior to a Long Covid diagnosis in more than 20% of cases: shortness of breath, chest pain, pain, fatigue, cough, and anxiety / depression. Conclusions: Numerous symptoms are reported to primary care at least 12 weeks after COVID-19 infection, but only a subset are commonly associated with a GP diagnosis of Long Covid. [ABSTRACT FROM AUTHOR]

Introduction: Vancomycin is used in intensive care unit (ICU) patients for the treatment of infections caused by gram-positive bacteria. The vancomycin pharmacokinetic/pharmacodynamic index is a ratio of the area under the concentration to the minimum inhibitory concentration ≥400–600 h*mg/L. This target can generally be achieved by a plasma concentration of 20–25 mg/L. Together with the pathophysiological alterations and pharmacokinetic variability associated with critical illness, the use of continuous renal replacement therapy (CRRT) may complicate the attainment of adequate vancomycin concentrations. The primary objective was the prevalence of attainment of vancomycin concentrations 20–25 mg/L after 24 h in adult ICU patients receiving CRRT. Secondary outcomes were to evaluate target attainment at days 2 and 3 and to calculate vancomycin clearance (CL) by CRRT and residual diuresis. Methods: We performed a prospective observational study in adult ICU patients on CRRT, which received at least 24 h continuous infusion of vancomycin. Between May 2020 and February 2021, daily vancomycin residual blood gas and dialysate samples were collected from 20 patients, every 6 h and if possible vancomycin urine samples. Vancomycin was analysed with an immunoassay method. The CL by CRRT was calculated by a different approach correcting for the downtime and providing insight into the degree of filter patency. Results: The proportion of patients with vancomycin concentrations <20 mg/L was 50% 24 h after starting vancomycin (n = 10). No differences were observed in patient characteristics. The target vancomycin concentration 20–25 mg/L was only achieved in 30% of the patients. On days 2 and 3, despite the use of TDM and albeit in lower percentages, sub- and supratherapeutic levels were still observed. Taking downtime and filter patency into account resulted in lower vancomycin CL. Conclusions: 50% of the studied ICU patients on CRRT showed subtherapeutic vancomycin concentrations 24 h after starting therapy. The results reveal that optimization of vancomycin dosage during CRRT therapy is needed. [ABSTRACT FROM AUTHOR]

Purpose of Review: Patients with acute neurologic injury require a specialized approach to critical care, particularly with regard to sedation and analgesia. This article reviews the most recent advances in methodology, pharmacology, and best practices of sedation and analgesia for the neurocritical care population. Recent Findings: In addition to established agents such as propofol and midazolam, dexmedetomidine and ketamine are two sedative agents that play an increasingly central role, as they have a favorable side effect profile on cerebral hemodynamics and rapid offset can facilitate repeated neurologic exams. Recent evidence suggests that dexmedetomidine is also an effective component when managing delirium. Combined analgo-sedation with low doses of short-acting opiates is a preferred sedation strategy to facilitate neurologic exams as well as patient-ventilator synchrony. Summary: Optimal care for patients in the neurocritical care population requires an adaptation of general ICU strategies that incorporates understanding of neurophysiology and the need for close neuromonitoring. Recent data continues to improve care tailored to this population. [ABSTRACT FROM AUTHOR]

Purpose. To summarize the most highly esteemed, peer-reviewed, infectious diseases (ID) pharmacotherapy articles published in 2020. Summary. Members of the Houston Infectious Diseases Network (HIDN) nominated articles that were deemed to have noteworthy contributions to ID pharmacotherapy in 2020, including those on coronavirus disease 2019 (COVID-19) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). To select the most significant articles of 2020, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP) to vote on their top 10 articles of general ID and COVID-19 pharmacotherapy and one noteworthy HIV/AIDS publication. A total of 40 articles were nominated by HIDN: 35 articles pertaining to general ID/COVID-19 pharmacotherapy and 5 articles with HIV/AIDS involvement. Of the 247 SIDP members who responded to the survey, 205 and 42 members voted for general ID/COVID-19 pharmacotherapy articles and HIV/AIDS related articles, respectively. The top publications are summarized. Conclusion. In a taxing year of a global pandemic, the abundant and rapid distribution of ID literature has made it challenging for clinicians to stay informed of significant publications across the ID spectrum. This review summarizes significant ID-related publications in 2020 with the goal of aiding clinicians in staying up to date on the most relevant publications in ID pharmacotherapy. [ABSTRACT FROM AUTHOR]

Bloodstream infections (BSIs) due to Gram‐positive organisms have traditionally been treated with prolonged courses of intravenous antimicrobials. However, this dogma is associated with substantial burden to the patient and health care system. Consequently, there is growing interest in the utilization of oral stepdown therapy, defined as the transition of intravenous therapy to an active oral agent, for this indication. This review highlights available literature examining oral stepdown in adult patients with BSI due to commonly encountered Gram‐positive pathogens, including Staphylococcus aureus, Streptococcus spp., and Enterococcus spp. Support for oral stepdown in this setting is primarily derived from observational studies subject to selection bias. Nevertheless, this treatment strategy exhibits promising potential in carefully selected patients as it is consistently associated with reductions in hospital length of stay without jeopardizing clinical cure or survivability. Prospective, randomized trials are needed for validation of oral stepdown in Gram‐positive BSI and to identify the optimal patient population and regimen. [ABSTRACT FROM AUTHOR]

Background: The recent SARS‐CoV‐2 pandemic has resulted in significant morbidity and mortality worldwide. The healthcare systems, including pharmacies, faced unique challenges, such as managing an overwhelming patient influx, clinical workforce management, transitioning to remote or online work, medication procurement and several others. The purpose of this study is to describe our hospital pharmacy's experience dealing with the COVID-19 pandemic and to present solutions to the challenges that arose. Methodology: We retrospectively reviewed and consolidated strategies, interventions, and solutions that were implemented by our pharmaceutical institute in response to the challenges that arose during the COVID-19 pandemic. The study period was from March 1 to September 30, 2020. Results: We reviewed and organized our hospital pharmacy response to the COVID-19 pandemic into different categories. In inpatient and outpatient satisfaction surveys, physicians and patients expressed a high level of satisfaction with pharmacy services. The close collaboration between the pharmacy team and other clinicians was demonstrated through the number of pharmacist interventions, participation in the COVID-19 guidelines reviews, involvement in local and international research, and innovative solutions to inpatient and outpatient pharmacy medication management challenges. Conclusions: This study highlights the crucial role that our pharmacists and pharmaceutical institute played in ensuring continuity of care during the COVID-19 pandemic. We implemented several key initiatives, innovations, and collaborations with other clinical disciplines to successfully overcome the challenges faced. [ABSTRACT FROM AUTHOR]

Coastal cities are under severe threat from the impacts of climate change, such as sea-level rise, extreme weather events, coastal inundation, and ecosystem degradation. It is well known that the ocean, and in particular coastal environments, have been changing at an unprecedented rate, which poses increasing risks to people in small island developing states, such as Fiji. The Greater Suva Urban Area, the capital and largest metropolitan area of Fiji, is expected to be largely impacted by climate-related risks to its socio-economic, cultural, and political positions. In the face of these threats, creating a resilient city that can withstand and adapt to the impacts of climate change and promote sustainable development should be guided by a holistic approach, encompassing stakeholders from the government, the private sector, civil society organizations, and international institutions. This study assesses the risk profile of Suva city using an innovative risk information tool, the climate and ocean risk vulnerability index (CORVI), which applies structured expert judgment to quantify climate-related risks in data-sparse environments. Through comparative quantification of diverse risk factors and narrative analysis, this study identifies three priority areas for Suva's future climate-resilient actions: development of climate risk-informed urban planning, harmonized urban development and natural restoration, and enhancing the climate resilience to the tourism sector. [ABSTRACT FROM AUTHOR]

Background: Non-motor symptoms (NMS) are compulsory clinical features for the clinical diagnosis of multiple system atrophy (MSA), some of which precede motor symptoms onset. To date, few studies have systematically investigated NMS in MSA and the timing of presenting NMS as the disease progresses. Clinically, MSA is difficult to be differentiated from Parkinson's disease (PD) and progressive supranuclear palsy (PSP), and the differences in NMS between MSA and PD/PSP remain unclear. The aim of this study was to compare the burden of NMS between MSA and PD/PSP and to delineate the timing of NMS presentation relative to the onset of motor symptoms in MSA. Methods: A total of 61, 87, and 30 patients with MSA, PD, and PSP, respectively, were enrolled in this study. NMS was systematically assessed in all patients using the NMS scale (NMSS), and the onset of NMS relative to the onset of motor symptoms in MSA was investigated. Results: MSA group had higher total NMSS scores (82.15 ± 46.10) than the PD (36.14 ± 30.78) and PSP (50.30 ± 55.05) groups (p < 0.001 overall). The number distribution pattern of the NMS was significantly different among the three parkinsonian disorders (p < 0.001 overall). In total, 85.2% of patients with MSA had more than 10 NMS, which was significantly higher than PD (28.7%) and PSP (33.3%). The frequency and scores of many NMSS subdomains and symptoms were higher in MSA than in PD and PSP (all p < 0.05). Multivariate logistic regression analysis revealed that patients with fainting, lack of motivation, swallowing, and loss of sexual interest could be attributed to MSA rather than PD or PSP, while patients with loss of concentration and forgetfulness were characteristic features of PD or PSP rather than MSA. REM-sleep behavior disorder (RBD), constipation, problems having sex, and loss of sexual interest preceded the motor symptoms onset of MSA by 2.81 ± 4.51, 1.54 ± 6.32, 1.35 ± 4.70, and 0.45 ± 3.61 years, respectively. Conclusion: The NMS spectrum in MSA differs from that of PD and PSP. Patients with MSA have a higher NMS burden than patients with PD or PSP. RBD, constipation, problems having sex, and loss of sexual interest may become early diagnostic clinical markers of MSA. [ABSTRACT FROM AUTHOR]

Evidence supporting intravenous‐to‐oral (IV‐to‐PO) antibiotic deescalation for uncomplicated streptococcal bloodstream infections (BSIs) are limited. The objective of this study was to compare clinical outcomes of patients treated with IV‐only versus IV‐to‐PO antibiotic therapy for uncomplicated streptococcal BSIs. This was a single‐center, retrospective study of patients aged ≥18 years who received treatment for uncomplicated streptococcal BSIs from January 2017 to December 2019. Patients were excluded if they had a polymicrobial BSI, endocarditis, osteomyelitis, septic arthritis, or received antibiotic therapy for >14 days. The primary outcome was clinical failure, defined as persistent bacteremia, recurrence of bacteremia, or mortality at 30 days. Secondary outcomes included length of hospital stay, all‐cause readmissions, development of Clostridioides difficile infection, and adverse antibiotic reactions. There were 98 patients who met the inclusion criteria: 51 patients in the IV‐to‐PO therapy group and 47 patients who received IV‐only antibiotics. Streptococcus pneumoniae and beta‐hemolytic streptococci were the most common pathogens. Patients received an average of 4.4 days of IV antibiotics before being stepped down to an oral agent. Hospital length of stay (6.3 vs 12.6 days; P <.001) and total antibiotic duration of therapy (11.8 vs 13.9 days; P =.002) were significantly shorter in patients receiving IV‐to‐PO therapy. There were no clinical failures observed in patients who received IV‐to‐PO antibiotic therapy. IV‐to‐PO step‐down therapy for uncomplicated streptococcal BSIs was not associated with worse clinical outcomes compared to patients receiving IV‐only antibiotic therapy. [ABSTRACT FROM AUTHOR]

Objectives Pharmacy practice journals are considered the main player in promoting pharmacy practice research and the pharmacy profession globally. The current study aimed to explore and analyze literature on the COVID-19 pandemic published in pharmacy practice journals. Methods COVID-19 research articles were extracted from 32 pharmacy practice journals indexed in Scopus for the study period from 01 January 2020, up until 31 December 2021 Key findings A total of 581 documents were found with an average of 4.5 authors per article and 4.8 citations per document. The retrieved documents were published in 28 pharmacy practice-related journals with the Research in Social and Administrative Pharmacy and the American Journal of Health System Pharmacy journals being the leaders in this field. The major findings of the analysis indicated (1) a limited number of contributing countries with limited author-author interactions and cross country collaboration; (2) specific topics were encountered, mainly hospital pharmacy services, survey studies on knowledge, and pharmacy education; (3) several contributing countries in the Middle East, mainly Saudi Arabia; Egypt, and Jordan contributed to the retrieved documents, and (4) the highly-cited documents discussed issues related to pharmacy services and role of the community pharmacists during the pandemic. Conclusion Research activity on COVID-19 in pharmacy practice journals represents the commitment of researchers and professionals to transform and promote the profession of pharmacy. Research on pharmacy practice and pharmacists in low- and middle-income countries during pandemics needs to be prioritized by scholars and journal editors. [ABSTRACT FROM AUTHOR]

Background: Court Mental Health Liaison and Diversion Services (CMHLDS) have developed in some countries as a response to the over-representation of mental illness and other vulnerabilities amongst defendants presenting to criminal justice (or correctional) systems. This study examined the characteristics and rates of mental disorder of 9088 defendants referred to CMHLDS. Method: The study analysed service level data, obtained from the National Health Service's mental health data set, to examine characteristics relating to gender, ethnicity and comorbidity of common mental and neurodevelopmental disorders at five CMHLDS across London between September 2015 and April 2017. Results: The sample included 7186 males (79.1%) and 1719 females (18.9%), the gender of 183 (2%) were not recorded. Of those referred, 6616 (72.8%) presented with an identifiable mental disorder and 503 (5.5%) with a neurodevelopmental disorder (NDD). Significantly higher rates of schizophrenia were reported amongst Black defendants (n = 681; 37.2%) and Asian defendants (n = 315; 29%), while higher rates of depression were found amongst White defendants (n = 1007; 22.1%). Substance misuse was reported amongst 2813 defendants (31%), and alcohol misuse amongst 2111 (23.2%), with significantly high rates of substance and alcohol misuse amongst defendants presenting with schizophrenia or personality disorder. Conclusions: This is one of the largest studies to examine mental health needs and vulnerabilities amongst defendants presenting to CMHLDS. It will enable an improved understanding of the required service designs and resources required to manage the healthcare pathways for people attending CMHLDS. [ABSTRACT FROM AUTHOR]

Purpose: Early clinical failure criteria (ECFC) were recently introduced to predict unfavorable outcomes in patients with Gram-negative bloodstream infections (BSI). ECFC include hypotension, tachycardia, tachypnea or mechanical ventilation, altered mental status, and leukocytosis evaluated at 72–96 h after BSI. The aim of this retrospective cohort study was to assess performance of ECFC in predicting 28-day mortality in Enterococcus species BSI. Methods: Hospitalized adults with Enterococcus species BSI at Prisma Health hospitals from 1 January 2015 to 31 July 2018 were identified. Multivariate logistic regression was used to determine the association between ECFC and 28-day mortality. Area under the receiver operating characteristic (AUROC) curve was used to measure model discrimination. Results: Among 157 patients, 28 (18%) died within 28 days of BSI. After adjustments in multivariate model, the risk of 28-day mortality increased in the presence of each additional ECFC (OR 1.6, 95% CI 1.2–2.3, p = 0.005). Infective endocarditis (OR 3.9, 95% CI 1.4–10.7, p = 0.01) was independently associated with 28-day mortality. AUROC curve of ECFC model in predicting 28-day mortality was 0.74 with ECFC of 2 identified as the best breakpoint. Mortality was 8% in patients with ECFC < 2 compared to 33% in those with ECFC ≥ 2 (p < 0.001). Conclusion: ECFC had good discrimination in predicting 28-day mortality in patients with Enterococcus species BSI. These criteria may have utility in future clinical investigations. [ABSTRACT FROM AUTHOR]

The global decline of coral reefs has driven considerable interest in active coral restoration. Despite their importance and dominance on mature reefs, relatively few coral restoration projects use slower growth forms like massive and encrusting coral species. Micro-fragmentation can increase coral cover by orders of magnitude faster than natural growth, which now allows cultivation of slow growing massive forms and shows promise and flexibility for active reef restoration. However, the major causes of variation in growth and survival of outplanted colonies remain poorly understood. Here, we report simple outplanting assays to aid in active reef restoration of slower growing species and increase the likelihood of restoration success. We used two different micro-fragmentation assays. Pyramid assays were used to examine variation associated with fragment size (ranging from ≈1-9 cm2), nursery residence time (for both in-situ and ex-situ nurseries), and 2D vs. 3D measurements of growth. Block assays were used to examine spatial variation among individual performance at outplanting sites in the field. We found 2D and 3D measurements correlated well, so measured survivorship and growth using top-down planar images for two of the main Hawaiian reef building corals, the plating Montipora capitata and the massive Porites compressa. Pyramid assays housed and outplanted from the in-situ nursery showed no effect of residence time or size on overall survivorship or growth for either species. Results from the ex-situ nursery, however, varied by species, with P. compressa again showing no effect of nursery residence time or size on survivorship or growth. In contrast, nursery culture resulted in improved survivorship of small M. capitata fragments, but net growth showed a weak positive effect of nursery time for medium fragments. Small fragments still suffered higher mortality than either medium or large fragments. Due to their lower mortality, medium fragments (≈3 cm2) appear to be the best compromise between growth and survivorship for outplanting. Likewise, given weak positive gains relative to the investment, our results suggest that it could be more cost-effective to simply outplant medium fragments as soon as possible, without intermediate culture in a nursery. Furthermore, the block assay revealed significant differences in survivorship and growth among sites for individuals of both species, emphasizing the importance of considering spatial variation in coral survival and growth following outplanting. These results highlight the value of using short-term micro-fragmentation assays prior to outplanting to assess size, and location specific performance, optimizing the efficiency of active reef restoration activities and maximizing the probability of success for active coral restoration projects. [ABSTRACT FROM AUTHOR]

Context: Antipsychotics and benzodiazepines do not improve delirium. Valproic acid (VPA) has been used recently to treat agitation in delirium. Objectives: To review the evidence for VPA in the management of Delirium. Methods: Systematic review. English language, age 19 and above, from 1946 to January 12, 2021. Mesh Terms: "Valproic acid", "valproate", "sodium valproate", "delirium", "acute mania with delirium" in PubMed and Ovid. Exclusion: Studies of VPA used for diagnoses other than delirium. Results: 21 abstracts were identified and 10 studies were included in the review (252 patients): One prospective open label study (n: 7), 2 case series (n: 22), 4 retrospective studies (n: 219) and 3 case reports (n: 4). No randomized controlled trial (RCT) evaluates the effect of VPA in delirium. 237/250 (94.8%) patients were in the ICU. Mean age was 59.7 (27-87). 153/204 (74%) were male. The mean starting dose was 733 mg/day in 148 patients and the mean dose at follow up was 1061 mg/day in 205 patients. CAM ICU was used to diagnose delirium in 6 reviews. Delirium improved in case series in 19/22 patients. Delirium improved in retrospective studies at day 3 compared to day 1. VPA levels were not consistently reported. Hyperammonemia (12-19%) and thrombocytopenia (9-13%) were the most common side effects. No deaths were attributed to VPA. Conclusion: VPA is being used more frequently for delirium. The evidence is limited to retrospective studies and case series. There is a need for RCT to evaluate the effect of VPA in delirium compared to other alternatives and placebo. [ABSTRACT FROM AUTHOR]

The cushion seastar Culcita schmideliana has gained major attention in the last few years because of its selective predation on juvenile corals, as well as its ability to generate large demographic assemblages, causing delays in coral recovery after large mortality events in the Republic of Maldives. However, a lack of data regarding the factors affecting its distribution and habitat selection still persists in this area. Here, we adopted a novel approach in the study of corallivorous seastar habitat selection that combined ecological and digital photogrammetry data. In this regard, we tested 3 different parameters as factors influencing seastar habitat choice in the South-East region of Faafu Atoll, Republic of Maldives, namely prey abundance, Linear Rugosity Index (LRI), and Average Slope (AS). The analysis of selectivity coefficient (Ei) of seastars for different habitat types showed a preference for reefs characterized by medium AS values (Ei = 0.268), a LRI included between 2 and 2.5 (Ei = 0.180), and a juvenile coral density ranging between 10 and 20 colonies m−2 (Ei = 0.154). A multiple linear regression analysis showed that different AS and LRI values explained the 43.1% (R2 = 0.431, P = 0.007) and the 48.1% (R2 = 0.481, P = 0.024) of variance in seastars abundance, respectively, while juvenile coral densities did not significantly affect this (R2 = 0.132, P = 0.202). These results provide new information on the distribution and behaviour of an important corallivore of Maldivian reefs, such as C. schmideliana. [ABSTRACT FROM AUTHOR]