Moonlight-driven biological choruses in Hawaiian coral reefs.

Sounds from fish and invertebrates in coral reefs can create persistent cacophonies that can be recorded for ecosystem monitoring, including during nighttime hours where visual surveys are typically not feasible. Here we use soundscape measurements in Hawaii to demonstrate that multiple coral reef communities are rapidly responsive to shifts in nighttime ambient light, with sustained changes in biological sound between moonrise and moonset. High frequency pulse train sounds from fish (0.5-1.5 kHz) are found to increase during moonlight hours, while low frequency fish vocalizations (0.1-0.3 kHz) and invertebrate sounds (2-20 kHz) are found to decrease during moonlight hours. These discoveries suggest that the rising and setting of the moon triggers regular shifts in coral reef ecosystem interactions. Future acoustic monitoring of reef health may be improved by comparing soundscapes during moonlight and non-moonlight hours, which may provide early indicators of shifts in the relative abundance of separate reef communities.

A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications in 2022.

Keeping abreast of the antimicrobial stewardship-related articles published each year is challenging. The Southeastern Research Group Endeavor identified antimicrobial stewardship-related, peer-reviewed literature that detailed an actionable intervention during 2022. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight actionable interventions used by antimicrobial stewardship programs to capture potentially effective strategies for local implementation.

Rethinking residency recruitment, application, and interview processes to benefit applicants and programs long-term.

Pharmacy residency recruitment and interviews have been significantly impacted by the COVID-19 pandemic. Many traditional recruitment events and interviews were transitioned from in-person to virtual, and new approaches to recruitment, such as virtual open houses, were developed. There are limited data on how these changes impacted pharmacy residency applicants and programs, and the future of virtual events is currently unknown. We highlight recommendations for virtual recruitment and interviews and provide suggestions for residency programs and national organizations to improve virtual processes in the future.

Evaluation of Pharmacy Residency Recruitment and Interview Processes during the COVID-19 Pandemic (2020-2021 Application Cycle).

Introduction: Due to the COVID-19 pandemic, most pharmacy residency programs changed to an all-virtual format for recruitment and interviews for the 2020-2021 application cycle. There are no data evaluating the experiences and perceptions of these changes from the perspective of pharmacy residency programs and applicants. Methods: An electronic cross-sectional survey was distributed via email to post-graduate year 1 (PGY1) and post-graduate year 2 (PGY2) pharmacy residency programs and applicants across the Southeastern United States. Results have been reported according to the Checklist for Reporting of Survey Studies (CROSS) guidelines (Enhancing the QUAlity and Transparency Of health Research [EQUATOR] Network). Results: 142 residency applicants and 104 residency programs responded to the survey. Most respondents participated in virtual recruitment and interviews. In 2020-2021, less residency programs participated in local/regional showcases and personal placement services, but social media engagement increased. Of the applicants who responded, over half felt the need to apply to more programs during this application cycle, and a corresponding increase in applications were seen by residency programs. Residency interviews appeared shorter than previous years, and less programs offered an informal time to get to know the applicants. Overall, applicants and residency programs preferred on-site interviews, but both parties reported feeling confident creating rank lists after virtual interviews. Conclusion: These results highlight the impact of COVID-19 on residency recruitment and the interview process. Residency programs should implement feedback for improving the virtual experience, as able. The ongoing pandemic may affect the 2022-2023 application cycle, and pharmacy leadership organizations should consider developing guidance for applicants and residency programs on navigating another year of virtual events.This article is protected by copyright. All rights reserved.

Evaluation of penicillin-gentamicin and dual beta-lactam therapies in Enterococcus faecalis infective endocarditis.

BACKGROUND: The American Heart Association endorses penicillin G or ampicillin with gentamicin (A+G) or dual beta-lactam therapy with ampicillin and ceftriaxone (A+C) as first-line regimens for Enterococcus faecalis infective endocarditis (EFIE) caused by penicillin-susceptible isolates. OBJECTIVES: To compare rates of treatment modifications and failures among individuals treated with A+C vs. A+G therapies for EFIE. METHODS: This study was a retrospective, single-centre cohort of adult patients with EFIE treated with A+G or A+C therapy between July 2009 and July 2019. The primary outcome was rate of adverse events requiring treatment modification. Secondary outcomes included rates of any event requiring treatment modification and treatment failure. RESULTS: Fifty-nine individuals with EFIE who received A+G (17 patients) or A+C (42 patients) therapy were included. Community-acquired EFIE from an unknown source was the most common (67.8%). Rates of adverse events requiring treatment modifications were 52.9% in A+G and 16.7% in A+C group (P = 0.005). Treatment modification was most frequently due to nephrotoxicity in the A+G group (90.0%). Incidence of acute kidney injury was 41.2% in A+G vs. 11.9% in the A+C group (P = 0.011). Rates of any event requiring treatment modifications were 58.8% in the A+G and 23.8% in A+C groups (P = 0.010). Treatment failure was observed in 23.5% in the A+G and 28.6% in A+C groups (P = 0.759). CONCLUSIONS: An A+C regimen may provide a tolerable and equally efficacious option for treatment of EFIE in adults and confirms the American Heart Association guideline recommendation.

Toward a Harm-Based Account of Microaggressions.

In this article, we critique the dominant understanding of microaggressions introduced by Derald Wing Sue and his colleagues-what we call the act-based account of microaggressions-by identifying its theoretical and practical shortcomings. On the basis of this critique, we introduce and defend an alternative, ameliorative account of microaggressions, what we call the harm-based account of microaggressions. Instead of understanding microaggressions on the basis of the acts committed by the microaggressing agent, we call for a reorientation of the concept so that the recipients of microaggressions and the harms they experience become the focal point.

Assessment of Electrolyte Replacement in Critically Ill Patients During a Drug Shortage.

Purpose: The purpose of this study was to determine if national drug shortages of electrolyte replacement products negatively impact patient care. Methods: This study was a single-center, retrospective, observational cohort of adults admitted to the medical, surgical, or trauma intensive care unit (ICU) that were ordered or would have qualified for the general or continuous renal replacement therapy electrolyte replacement protocol (ERP) between April 2017 and August 2018. In October 2017, ERP use was suspended and enteral replacement was promoted due to inability to maintain consistent inventory of intravenous replacement products. The primary objective was to compare the percentage of patient days that at least 1 critically low value of potassium, magnesium, and/or phosphorus existed between protocolized and nonprotocolized electrolyte replacement. Secondary objectives included characterizing the ratio of enteral replacement to duration of critically low electrolyte values during protocolized and nonprotocolized electrolyte replacement. Results: A total of 288 patients were included. The mean percentage of ICU days with low electrolyte levels in the protocolized period was significantly higher than in the nonprotocolized period (21.4% vs 17.5%, P = .0238). There was a negative relationship between the total electrolyte replacement that was given enterally and the percentage of patient days with critically low values indicating that as enteral replacement increased, percentage of days with low values decreased. The association between percentage of enteral replacement and days with critically low electrolyte values was significantly lower in the protocolized period. Conclusion: Intravenous electrolyte replacement product shortages did not result in an increased incidence of critically low electrolyte values. Enteral replacement was associated with a decreased incidence of low electrolyte values.

Deep embedded clustering of coral reef bioacoustics.

Deep clustering was applied to unlabeled, automatically detected signals in a coral reef soundscape to distinguish fish pulse calls from segments of whale song. Deep embedded clustering (DEC) learned latent features and formed classification clusters using fixed-length power spectrograms of the signals. Handpicked spectral and temporal features were also extracted and clustered with Gaussian mixture models (GMM) and conventional clustering. DEC, GMM, and conventional clustering were tested on simulated datasets of fish pulse calls (fish) and whale song units (whale) with randomized bandwidth, duration, and SNR. Both GMM and DEC achieved high accuracy and identified clusters with fish, whale, and overlapping fish and whale signals. Conventional clustering methods had low accuracy in scenarios with unequal-sized clusters or overlapping signals. Fish and whale signals recorded near Hawaii in February-March 2020 were clustered with DEC, GMM, and conventional clustering. DEC features demonstrated the highest accuracy of 77.5% on a small, manually labeled dataset for classifying signals into fish and whale clusters.

Automated two-dimensional localization of underwater acoustic transient impulses using vector sensor image processing (vector sensor localization).

Detecting acoustic transients by signal-to-noise ratio (SNR) becomes problematic in nonstationary ambient noise environments characteristic of coral reefs. An alternate approach presented here uses signal directionality to automatically detect and localize transient impulsive sounds collected on underwater vector sensors spaced tens of meters apart. The procedure, which does not require precise time synchronization, first constructs time-frequency representations of both the squared acoustic pressure (spectrogram) and dominant directionality of the active intensity (azigram) on each sensor. Within each azigram, sets of time-frequency cells associated with transient energy arriving from a consistent azimuthal sector are identified. Binary image processing techniques then link sets that share similar duration and bandwidth between different sensors, after which the algorithm triangulates the source location. Unlike most passive acoustic detectors, the threshold criterion for this algorithm is bandwidth instead of pressure magnitude. Data collected from shallow coral reef environments demonstrate the algorithm's ability to detect SCUBA bubble plumes and consistent spatial distributions of somniferous fish activity. Analytical estimates and direct evaluations both yield false transient localization rates from 3% to 6% in a coral reef environment. The SNR distribution of localized pulses off Hawaii has a median of 7.7 dB and interquartile range of 7.1 dB.

A Matter of Justice: "Fat" Is Not Necessarily a Bad Word.

This essay argues that the discrimination that fat patients face is an issue of health justice. Insofar as this is the case, bioethicists and health care providers should not only care about it but also work to dismantle the systematic, institutional, social, and individual factors that are contributing to it to ensure that fat patients receive high-quality health care, free of stigma and discrimination. The essay discusses a variety of ways in which fat patients are discriminated against and considers the false assumptions that fuel such discrimination. It concludes by considering the structural and social issues that contribute to fatness and pushes health care providers to abandon the assumption that being fat is an individual moral failing. Ultimately, the paper argues, "fat" is not necessarily a bad word, nor one that health care providers should avoid.

Multidisciplinary Authorship Among Infectious Diseases Society of America Clinical Practice Guidelines: Examining the Contributions of Infectious Diseases Pharmacists.

We describe the proportion of pharmacist representation among current and corresponding prior editions of Infectious Diseases Society of America (IDSA) clinical practice guidelines (CPGs). Pharmacist representation was 13% and 21% in previous and current editions, respectively, increasing significantly since 2011. We advocate for continued collaborations between IDSA and pharmacy organizations to enhance multidisciplinary representation in CPGs.

Photosynthesis by marine algae produces sound, contributing to the daytime soundscape on coral reefs.

We have observed that marine macroalgae produce sound during photosynthesis. The resultant soundscapes correlate with benthic macroalgal cover across shallow Hawaiian coral reefs during the day, despite the presence of other biological noise. Likely ubiquitous but previously overlooked, this source of ambient biological noise in the coastal ocean is driven by local supersaturation of oxygen near the surface of macroalgal filaments, and the resultant formation and release of oxygen-containing bubbles into the water column. During release, relaxation of the bubble to a spherical shape creates a monopole sound source that 'rings' at the Minnaert frequency. Many such bubbles create a large, distributed sound source over the sea floor. Reef soundscapes contain vast quantities of biological information, making passive acoustic ecosystem evaluation a tantalizing prospect if the sources are known. Our observations introduce the possibility of a general, volumetrically integrative, noninvasive, rapid and remote technique for evaluating algal abundance and rates of primary productivity in littoral aquatic communities. Increased algal cover is one of the strongest indicators for coral reef ecosystem stress. Visually determining variations in algal abundance is a time-consuming and expensive process. This technique could therefore provide a valuable tool for ecosystem management but also for industrial monitoring of primary production, such as in algae-based biofuel synthesis.

Sex Categorization in Medical Contexts: A Cautionary Tale.

The goal of this paper is to problematize the use of sex categories in medical contexts. We question the benefits of categorizing all individuals as either male or female in medical contexts and argue that we should focus instead on the relevant sex-related properties of patients. Contrary to what many people believe, the classificatory system by which sexed bodies are neatly divided into male and female is anything but clear. An abundance of evidence shows that a binary sex system does not accurately describe the reality of human bodies. Given the complexity of sex with its many markers, variations, and combinations, why is medicine still based on the assumption that there are only two sexes? Why is binary sex still systematically used as a proxy in medical contexts, even when it doesn't help, but can actually hinder diagnoses, care, and treatments? The complexity and heterogeneity of sexed bodies is critical in medical contexts. We argue that the use of female/male categories overlooks and obscures this complexity and variety, thereby resulting in a variety of harms, poor health care, oversimplification, and over-pathologization.

Microaggressions in Clinical Medicine.

This paper proposes a victim-centered account of microaggressions within the context of clinical medicine. In so doing, it argues that microaggressions can undermine physician-patient relationships, preclude relationships of trust, and therefore compromise the kind and quality of care that patients deserve. Ultimately, by focusing on the experiences of victims of microaggressions, the paper demonstrates how harmful microaggressions in clinical medical contexts can be, and thus provides strong reasons why healthcare providers ought to know about them and actively work to avoid committing them.

Robust Performance of Marginal Pacific Coral Reef Habitats in Future Climate Scenarios.

Coral reef ecosystems are under dual threat from climate change. Increasing sea surface temperatures and thermal stress create environmental limits at low latitudes, and decreasing aragonite saturation state creates environmental limits at high latitudes. This study examines the response of unique coral reef habitats to climate change in the remote Pacific, using the National Center for Atmospheric Research Community Earth System Model version 1 alongside the species distribution algorithm Maxent. Narrow ranges of physico-chemical variables are used to define unique coral habitats and their performance is tested in future climate scenarios. General loss of coral reef habitat is expected in future climate scenarios and has been shown in previous studies. This study found exactly that for most of the predominant physico-chemical environments. However, certain coral reef habitats considered marginal today at high latitude, along the equator and in the eastern tropical Pacific were found to be quite robust in climate change scenarios. Furthermore, an environmental coral reef refuge previously identified in the central south Pacific near French Polynesia was further reinforced. Studying the response of specific habitats showed that the prevailing conditions of this refuge during the 20th century shift to a new set of conditions, more characteristic of higher latitude coral reefs in the 20th century, in future climate scenarios projected to 2100.

Cross-correlation, triangulation, and curved-wavefront focusing of coral reef sound using a bi-linear hydrophone array.

A seven element, bi-linear hydrophone array was deployed over a coral reef in the Papahãnaumokuãkea Marine National Monument, Northwest Hawaiian Islands, in order to investigate the spatial, temporal, and spectral properties of biological sound in an environment free of anthropogenic influences. Local biological sound sources, including snapping shrimp and other organisms, produced curved-wavefront acoustic arrivals at the array, allowing source location via focusing to be performed over an area of 1600 m(2). Initially, however, a rough estimate of source location was obtained from triangulation of pair-wise cross-correlations of the sound. Refinements to these initial source locations, and source frequency information, were then obtained using two techniques, conventional and adaptive focusing. It was found that most of the sources were situated on or inside the reef structure itself, rather than over adjacent sandy areas. Snapping-shrimp-like sounds, all with similar spectral characteristics, originated from individual sources predominantly in one area to the east of the array. To the west, the spectral and spatial distributions of the sources were more varied, suggesting the presence of a multitude of heterogeneous biological processes. In addition to the biological sounds, some low-frequency noise due to distant breaking waves was received from end-fire north of the array.

Confronting diminished epistemic privilege and epistemic injustice in pregnancy by challenging a "panoptics of the womb".

This paper demonstrates how the problematic kinds of epistemic power that physicians have can diminish the epistemic privilege that pregnant women have over their bodies and can put them in a state of epistemic powerlessness. This result, I argue, constitutes an epistemic injustice for many pregnant women. A reconsideration of how we understand and care for pregnant women and of the physician-patient relationship can provide us with a valuable context and starting point for helping to alleviate the knowledge/power problems that are symptomatic of the current system and structure of medicine. I suggest that we can begin to confront this kind of injustice if medicine adopts a more phenomenological understanding of bodies and if physicians and patients--in this case, pregnant women--become what I call "epistemic peers."

Coral reef habitat response to climate change scenarios.

Coral reef ecosystems are threatened by both climate change and direct anthropogenic stress. Climate change will alter the physico-chemical environment that reefs currently occupy, leaving only limited regions that are conducive to reef habitation. Identifying these regions early may aid conservation efforts and inform decisions to transplant particular coral species or groups. Here a species distribution model (Maxent) is used to describe habitat suitable for coral reef growth. Two climate change scenarios (RCP4.5, RCP8.5) from the National Center for Atmospheric Research's Community Earth System Model were used with Maxent to determine environmental suitability for corals (order Scleractinia). Environmental input variables best at representing the limits of suitable reef growth regions were isolated using a principal component analysis. Climate-driven changes in suitable habitat depend strongly on the unique region of reefs used to train Maxent. Increased global habitat loss was predicted in both climate projections through the 21(st) century. A maximum habitat loss of 43% by 2100 was predicted in RCP4.5 and 82% in RCP8.5. When the model is trained solely with environmental data from the Caribbean/Atlantic, 83% of global habitat was lost by 2100 for RCP4.5 and 88% was lost for RCP8.5. Similarly, global runs trained only with Pacific Ocean reefs estimated that 60% of suitable habitat would be lost by 2100 in RCP4.5 and 90% in RCP8.5. When Maxent was trained solely with Indian Ocean reefs, suitable habitat worldwide increased by 38% in RCP4.5 by 2100 and 28% in RCP8.5 by 2050. Global habitat loss by 2100 was just 10% for RCP8.5. This projection suggests that shallow tropical sites in the Indian Ocean basin experience conditions today that are most similar to future projections of worldwide conditions. Indian Ocean reefs may thus be ideal candidate regions from which to select the best strands of coral for potential re-seeding efforts.

Fragment screening using capillary electrophoresis (CEfrag) for hit identification of heat shock protein 90 ATPase inhibitors.

CEfrag is a new fragment screening technology based on affinity capillary electrophoresis (ACE). Here we report on the development of a mobility shift competition assay using full-length human heat shock protein 90α (Hsp90α), radicicol as the competitor probe ligand, and successful screening of the Selcia fragment library. The CEfrag assay was able to detect weaker affinity (IC(50) >500 µM) fragments than were detected by a fluorescence polarization competition assay using FITC-labeled geldanamycin. The binding site of selected fragments was determined by co-crystallization with recombinant Hsp90α N-terminal domain and X-ray analysis. The results of this study confirm that CEfrag is a sensitive microscale technique enabling detection of fragments binding to the biological target in near-physiological solution.