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1.
Sci Rep ; 14(1): 4100, 2024 03 14.
Article in English | MEDLINE | ID: mdl-38485970

ABSTRACT

Coastal ecosystems are highly vulnerable to the impacts of climate change and other stressors, including urbanization and overfishing. Consequently, distributions of coastal fish have begun to change, particularly in response to increasing temperatures linked to climate change. However, few studies have evaluated how natural and anthropogenic disturbances can alter species distributions in conjunction with geophysical habitat alterations, such as changes to land use and land cover (LU/LC). Here, we examine the spatiotemporal changes in the distribution of juvenile bull sharks (Carcharhinus leucas) using a multi-decadal fishery-independent survey of coastal Alabama. Using a boosted regression tree (BRT) modeling framework, we assess the covariance of environmental conditions (sea surface temperature, depth, salinity, dissolved oxygen, riverine discharge, Chl-a) as well as historic changes to LU/LC to the distribution of bull sharks. Species distribution models resultant from BRTs for early (2003-2005) and recent (2018-2020) monitoring periods indicated a mean increase in habitat suitability (i.e., probability of capture) for juvenile bull sharks from 0.028 to 0.082, concomitant with substantial increases in mean annual temperature (0.058°C/yr), Chl-a (2.32 mg/m3), and urbanization (increased LU/LC) since 2000. These results align with observed five-fold increases in the relative abundance of juvenile bull sharks across the study period and demonstrate the impacts of changing environmental conditions on their distribution and relative abundance. As climate change persists, coastal communities will continue to change, altering the structure of ecological communities and the success of nearshore fisheries.


Subject(s)
Ecosystem , Sharks , Animals , Conservation of Natural Resources , Fisheries , Sharks/physiology
2.
Mar Pollut Bull ; 200: 116038, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38278017

ABSTRACT

The commercial shrimping industry is subjected to myriad stressors that have led to financial hardships among industry members. One of these stressors is marine debris; however, there is limited understanding of the type and magnitude of impacts. Quantitative methods of estimating the economic impacts of marine debris on the commercial shrimping industry were developed. From June to December 2019, participating shrimpers submitted 393 daily summaries, including shrimping activities, marine debris encounters, damages, and impacts. The impacts of marine debris encounters were assessed from reports of daily damages to fishing assets, daily lost fishing time, daily loss-catch ratios, and daily catch losses. The results of this study demonstrate substantial negative economic impacts on commercial shrimpers related to marine debris encounters. About 17 % of shrimp caught were lost due to marine debris encounters, resulting in foregone total sales and job impacts of $3.2 million and 33 jobs in shrimping and associated businesses.


Subject(s)
Brachyura , Fisheries , Animals , Environmental Monitoring/methods , Seafood
3.
Nat Commun ; 14(1): 8500, 2023 Dec 22.
Article in English | MEDLINE | ID: mdl-38135682

ABSTRACT

Coastal vegetated ecosystems are acknowledged for their capacity to sequester organic carbon (OC), known as blue C. Yet, blue C global accounting is incomplete, with major gaps in southern hemisphere data. It also shows a large variability suggesting that the interaction between environmental and biological drivers is important at the local scale. In southwest Atlantic salt marshes, to account for the space occupied by crab burrows, it is key to avoid overestimates. Here we found that southern southwest Atlantic salt marshes store on average 42.43 (SE = 27.56) Mg OC·ha-1 (40.74 (SE = 2.7) in belowground) and bury in average 47.62 g OC·m-2·yr-1 (ranging from 7.38 to 204.21). Accretion rates, granulometry, plant species and burrowing crabs were identified as the main factors in determining belowground OC stocks. These data lead to an updated global estimation for stocks in salt marshes of 185.89 Mg OC·ha-1 (n = 743; SE = 4.92) and a C burial rate of 199.61 g OC·m-2·yr-1 (n = 193; SE = 16.04), which are lower than previous estimates.


Subject(s)
Brachyura , Wetlands , Animals , Ecosystem , Carbon , Carbon Sequestration
4.
Mar Pollut Bull ; 186: 114406, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36470100

ABSTRACT

Improving awareness of marine debris could lead to large scale benefits. However, existing marine debris awareness approaches can often be limited in engagement. A more interactive and innovative educational method is needed to increase engagement and action. In this study, we use an immersive Virtual Reality (VR) approach and assess the efficacy and effectiveness of this approach. Three marine debris-related VR modules were developed. To validate the performance VR approach, we compared VR with traditional video-based education. Efficacy measured simulation sickness, system usability, and user experience; effectiveness evaluated knowledge gained and motivation. Twenty-five students were recruited in the study and randomly allocated into two groups. Within the current sample, the developed VR educational approach led to a significantly higher motivation for action and acceptable efficacy performance. These results indicate that VR-based education has the potential to lead to large scale prevention and management of marine debris.


Subject(s)
Virtual Reality , Humans , Computer Simulation , Motivation , Students
5.
Mar Pollut Bull ; 186: 114392, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36436272

ABSTRACT

Due to fishery-tailored gear, shrimpers are often affected by benthic marine debris, specifically derelict crab traps. To alleviate the impacts on the commercial shrimping industry in the Mississippi Sound, a team of natural resource professionals and stakeholders developed a derelict crab trap removal incentive program for commercial shrimpers. In three years, this program led to the removal of 2904 derelict crab traps from the north-central Gulf of Mexico at a total average cost of $35,595 per year to implement the program, or $53 per derelict crab trap. Results from this study showed the cost of the program could further be reduced while covering the same shrimping area, through the inclusion of fewer disposal locations and targeting active and engaged shrimpers. This program led to the removal of crab traps by non-registered shrimpers, indicating that the existence of the program and associated outreach could lead to improved environmental stewardship without an incentive.


Subject(s)
Brachyura , Water Pollutants , Animals , Water Pollutants/analysis , Motivation , Environmental Monitoring/methods , Conservation of Natural Resources/methods , Fisheries
6.
Mar Pollut Bull ; 186: 114417, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36502774

ABSTRACT

Commercial shrimpers frequently encounter marine debris in their nets, resulting in economic impacts. Currently, no information existed on the spatial and temporal distribution of marine debris that shrimpers encounter and the subsequent economic impact on commercial shrimping. Twenty commercial shrimpers participated in a comprehensive data collection program (July 2020 through December 2020) within the north-central Gulf of Mexico, USA to characterize the quantity and impacts of marine debris. Derelict crab traps were an overwhelming issue for shrimpers. The type of fishing gear used influenced the type of marine debris encountered and the subsequent economic impacts. Surveyed shrimpers encountered marine debris on 19 % of tows and lost an average of 18.21 min, 7.88 kg of catch, and $6.37 in gear damage per tow with encounters, resulting in average annual losses of $6601 per shrimper. The results of this study show that marine debris encounters can have a large impact on the commercial shrimping industry.


Subject(s)
Brachyura , Fisheries , Animals , Seafood , Gulf of Mexico , Environmental Monitoring/methods
7.
J Environ Manage ; 321: 116025, 2022 Nov 01.
Article in English | MEDLINE | ID: mdl-36029632

ABSTRACT

Human coastal occupation often leads to the degradation of the structural properties and environmental functions of natural coastlines. . Much research has been done on the cost-effectiveness of various living shorelines designs, however more work is needed for simple, small-scale designs that are typically adopted in waterfront residential or recreational properties. To contribute to this gap, we planted small-scale plots of black needlerush (Juncus roemerianus) in two sites, one in a residential property and another one in a recreational property in the Northern Gulf of Mexico that experienced significant wave energy. Plots were planted at two different densities (50% or 100% initial cover) or left unplanted (controls) and, along with monitoring the evolution of the planted salt marsh, we measured a number of functional metrics including soil slope, abundance of nekton within and in front of the plots, and cover of submerged aquatic vegetation (SAV) in front of the plots monthly over two years. In one of the sites plant cover decreased precipitously, and in the other site we did not observe any significant changes in plant cover over time (i.e. the initial 50% and 100% plantings remained at that level throughout the experiment) despite protecting the planted salt marsh with coir logs. We did not find any changes in soil slope or nekton abundance between planted and control plots. SAV growth was restrained in front of planted plots in relation to control plots, possibly due to deleterious impacts by the coir logs. Overall, the results suggest the protection against wave energy attained in this experiment is insufficient for adequate saltmarsh establishment and growth, thereby encountering decreasing or stationary plant density and no significant differences in soil slope or nekton abundance between planted and non-planted plots. Our results indicate the adoption of small-scale saltmarsh planting to reduce erosion and enhance coastal functionality needs to ensure that wave energy is sufficiently dampened for adequate saltmarsh growth and, concomitantly, the conceived saltmarsh protection mechanism does not negatively impact adjacent SAV.


Subject(s)
Plants , Wetlands , Ecosystem , Gulf of Mexico , Humans , Soil
8.
Sustainability ; 14(10): 6147, 2022 May.
Article in English | MEDLINE | ID: mdl-35909455

ABSTRACT

Increased generation of waste, production of plastics, and poor environmental stewardship has led to an increase in floating litter. Significant efforts have been dedicated to mitigating this globally relevant issue. Depending on the location of floating litter, removal methods would vary, but usually include manual cleanups by volunteers or workers, use of heavy machinery to rake or sweep litter off beaches or roads, or passive litter collection traps. In the open ocean or streams, a common passive technique is to use booms and a collection receptacle to trap floating litter. These passive traps are usually installed to intercept floating litter; however, identifying the appropriate locations for installing these collection devices is still not fully investigated. We utilized four common criteria and fifteen sub-criteria to determine the most appropriate setup location for an in-stream collection device (Litter Gitter-Osprey Initiative, LLC, Mobile, AL, USA). Bayesian Network technology was applied to analyze these criteria comprehensively. A case study composed of multiple sites across the U.S. Gulf of Mexico Coast was used to validate the proposed approach, and propagation and sensitivity analyses were used to evaluate performance. The results show that the fifteen summarized criteria combined with the Bayesian Network approach could aid location selection and have practical potential for in-stream litter collection devices in coastal areas.

9.
J Environ Manage ; 296: 113178, 2021 Oct 15.
Article in English | MEDLINE | ID: mdl-34225043

ABSTRACT

Formed at the confluence of marine and fresh waters, estuaries experience both the seaside pressures of rising sea levels and increasing storm severity, and watershed and precipitation changes that are shifting the quality and quantity of freshwater and sediments delivered from upstream sources. Boating, shoreline hardening, harvesting pressure, and other signatures of human activity are also increasing as populations swell in coastal regions. Given this shifting landscape of pressures, the factors most threatening to estuary health and stability are often uncertain. To identify the greatest contemporary threats to coastal wetlands and oyster reefs across the southeastern United States (Mississippi to North Carolina), we summarized recent population growth and land-cover change and surveyed estuarine management and science experts. From 1996 to 2019, human population growth in the region varied from a 17% decrease to a 171% increase (mean = +43%) with only 5 of the 72 SE US counties losing population, and nearly half growing by more than 40%. Individual counties experienced between 999 and 19,253 km2 of new development (mean: 5725 km2), with 1-5% (mean: 2.6%) of undeveloped lands undergoing development over this period across the region. Correspondingly, our survey of 169 coastal experts highlighted development, shoreline hardening, and upstream modifications to freshwater flow as the most important local threats facing coastal wetlands. Similarly, experts identified development, upstream modifications to freshwater flow, and overharvesting as the most important local threats to oyster reefs. With regards to global threats, experts categorized sea level rise as the most pressing to wetlands, and acidification and precipitation changes as the most pressing to oyster reefs. Survey respondents further identified that more research, driven by collaboration among scientists, engineers, industry professionals, and managers, is needed to assess how precipitation changes, shoreline hardening, and sea level rise are affecting coastal ecosystem stability and function. Due to the profound role of humans in shaping estuarine health, this work highlights that engaging property owners, recreators, and municipalities to implement strategies to improve estuarine health will be vital for sustaining coastal systems in the face of global change.


Subject(s)
Ostreidae , Wetlands , Animals , Ecosystem , Estuaries , Humans , North Carolina
10.
Ecol Appl ; 31(6): e02382, 2021 09.
Article in English | MEDLINE | ID: mdl-34042243

ABSTRACT

One of the paramount goals of oyster reef living shorelines is to achieve sustained and adaptive coastal protection, which requires meeting ecological (i.e., develop a self-sustaining oyster population) and engineering (i.e., provide coastal defense) targets. In a large-scale comparison along the Atlantic and Gulf coasts of the United States, the efficacy of various designs of oyster reef living shorelines at providing wave attenuation was evaluated accounting for the ecological limitations of oysters with regard to inundation duration. A critical threshold for intertidal oyster reef establishment is 50% inundation duration. Living shorelines that spent less than one-half of the time (<50%) inundated were not considered suitable habitat for oysters, however, were effective at wave attenuation (68% reduction in wave height). Reefs that experienced >50% inundation were considered suitable habitat for oysters, but wave attenuation was similar to controls (no reef; ~5% reduction in wave height). Many of the oyster reef living shoreline approaches therefore failed to optimize the ecological and engineering goals. In both inundation regimes, wave transmission decreased with an increasing freeboard (difference between reef crest elevation and water level), supporting its importance in the wave attenuation capacity of oyster reef living shorelines. However, given that the reef crest elevation (and thus freeboard) should be determined by the inundation duration requirements of oysters, research needs to be refocused on understanding the implications of other reef parameters (e.g., width) for optimizing wave attenuation. A broader understanding of the reef characteristics and seascape contexts that result in effective coastal defense by oyster reefs is needed to inform appropriate design and implementation of oyster-based living shorelines globally.


Subject(s)
Ecosystem , Ostreidae , Water Movements , Animals
11.
Mar Pollut Bull ; 166: 112245, 2021 May.
Article in English | MEDLINE | ID: mdl-33721685

ABSTRACT

Commercial fishing is a fragile industry that is exposed to a multitude of stressors. Marine debris is known to be one of these stressors; however, the prevalence and impact is rarely assessed. Therefore, this analysis assessed the perceived encounter frequency and impacts of marine debris on commercial fishing through an end-of-the year survey of registered Mississippi commercial shrimpers. Ninety-eight percent (98%) of shrimpers indicated they encountered marine debris in 2018 with 85% encountering it frequently. The most common debris reported to be encountered was abandoned or derelict fishing gear (93% of shrimpers), primarily crab traps. Most shrimpers reported reduced catch (80%), lost fishing time (82%), and vessel repairs (75%) due to marine debris. Additionally, 93% of shrimpers categorized marine debris as destructive to their operations. These results indicate that marine debris does have significant direct impacts on the commercial shrimping industry in Mississippi and likely other regions.


Subject(s)
Brachyura , Fisheries , Animals , Environmental Monitoring , Mississippi , Seafood
12.
Pediatr Surg Int ; 37(3): 403-410, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33595685

ABSTRACT

PURPOSE: Delayed enteral feeding (DEF) contributes to postoperative complications among children undergoing intestinal surgery. Various recent studies indicate the benefits of early enteral nutrition after intestinal surgery in adults. This systematic review and meta-analysis evaluates whether early enteral feeding (EEF) is beneficial in children who underwent intestinal anastomosis. METHODS: MEDLINE, PubMed, the Cochrane Library, and Web of Science databases were searched for RCTs that addressed the effect of EEF in children (younger than 18 years old) undergoing intestinal anastomosis. EEF was defined as starting enteral feeding before the 3rd postoperative day. Studies were selected based on predetermined inclusion and exclusion criteria. A meta-analysis was performed using RevMan 5.3 to estimate odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Four RCT studies met the inclusion criteria, comprising 97 cases with EEF and 89 cases with DEF. Enteral feeding started significantly earlier in the EEF group compared to the DEF group (MD = - 2.80; 95% CI - 3.11 to - 2.49; p < 0.00001). Postoperative anastomotic leak rate was unchanged between EEF and DEF groups (OR = 0.86; 95% CI 0.17-4.46; p = 0.86). The EEF group had a shorter length of hospital stay (MD = - 3.38; 95% CI - 4.29 to - 2.48; p < 0.00001), earlier time to bowel movement return (MD = - 0.57; 95% CI - 0.79 to - 0.35; p < 0.00001), lower incidence of surgical infection (OR = 0.27; 95% CI 0.08-0.90; p = 0.03), and faster tolerance of full enteral feeding (MD = - 2.00; 95% CI - 3.01 to - 2.79; p < 0.00001). Incidence of fever (OR = 0.37; 95% CI 0.10-1.31; p = 0.12), emesis, and abdominal distention (OR = 0.63; 95% CI 0.13-3.16; p = 0.58) were not different between the two groups. CONCLUSIONS: Early enteral feeding after intestinal anastomosis in children does not increase the risk of postoperative anastomotic leak, fever, emesis, and abdominal distention. However, early enteral feeding is beneficial as it promotes the return of bowel function, reduces the length of hospital stay and the incidence of surgical infection in comparison to delayed enteral feeding.


Subject(s)
Anastomosis, Surgical , Enteral Nutrition , Adolescent , Adult , Anastomotic Leak , Child , Digestive System Surgical Procedures , Humans , Intestines/surgery , Length of Stay , Pediatrics , Postoperative Complications , Postoperative Period , Randomized Controlled Trials as Topic , Time Factors
13.
Environ Manage ; 67(2): 384-397, 2021 02.
Article in English | MEDLINE | ID: mdl-33432500

ABSTRACT

Tidal marshes are increasingly vulnerable to degradation or loss from eutrophication, land-use changes, and accelerating sea-level rise, making restoration necessary to recover ecosystem services. To evaluate effects of restoration planting density and sea-level rise on ecosystem function (i.e., nitrogen removal), we restored three marshes, which differed in elevation, at Weeks Bay National Estuarine Research Reserve, Alabama, USA and planted them with Juncus roemerianus sods at 0, 25, 50, 75, or 100% initial cover. We simulated future sea level using passive weirs that increased flooding during low tide. Because additional species emerged shortly after transplantation, we also tested for treatment effects on community structure. In all marshes, species richness increased following restoration, regardless of treatments, while relative abundances of new species tended to increase with increasing initial cover. Plant percent cover increased with increasing initial cover in all marshes, with similar vegetated cover at 50, 75, and 100% after 3 years in the highest elevation marsh. Porewater dissolved inorganic nitrogen concentrations ([DIN]) decreased with increasing initial cover in all marshes, and were significantly lower in 50, 75, and 100% treatments than 0 or 25% after 1 year. Furthermore, [DIN] was similarly low among 50, 75, and 100% treatments when elevation capital was highest. These results suggest that intermediate initial cover (50%) can recover plant cover and promote nitrogen removal when elevation capital is adequate at relatively lower labor and material costs than planting at higher cover, thereby maximizing restoration outcomes in the face of low to moderate sea-level rise.


Subject(s)
Ecosystem , Wetlands , Alabama , Gulf of Mexico , Sea Level Rise
14.
Ecol Evol ; 10(22): 12472-12481, 2020 Nov.
Article in English | MEDLINE | ID: mdl-33250987

ABSTRACT

The current COVID-19 pandemic has forced the global higher education community to rapidly adapt to partially or fully online course offerings. For field- or laboratory-based courses in ecological curricula, this presents unique challenges. Fortunately, a diverse set of active learning techniques exists, and these techniques translate well to online settings. However, limited guidance and resources exist for developing, implementing, and evaluating active learning assignments that fulfill specific objectives of ecology-focused courses. To address these informational gaps, we (a) identify broad learning objectives across a variety of ecology-focused courses, (b) provide examples, based on our collective online teaching experience, of active learning activities that are relevant to the identified ecological learning objectives, and (c) provide guidelines for successful implementation of active learning assignments in online courses. Using The Wildlife Society's list of online higher education ecology-focused courses as a guide, we obtained syllabi from 45 ecology-focused courses, comprising a total of 321 course-specific learning objectives. We classified all course-specific learning objectives into at least one of five categories: (a) Identification, (b) Application of Concepts/Hypotheses/Theories, (c) Management of Natural Resources, (d) Development of Professional Skills, or (e) Evaluation of Concepts/Practices. We then provided two examples of active learning activities for each of the five categories, along with guidance on their implementation in online settings. We suggest that, when based on sound pedagogy, active learning techniques can enhance the online student's experience by activating ecological knowledge.

16.
Eur J Pediatr Surg ; 30(2): 181-186, 2020 Apr.
Article in English | MEDLINE | ID: mdl-32241029

ABSTRACT

Minimally invasive procedures have seen increasing utilization in the pediatric patient population since the 1990s. Most thoracic and abdominal operations in pediatric surgery can be performed in a minimally invasive manner including those performed in neonates and infants. Thoracoscopic or laparoscopic operations can reduce hospital length of stay, minimize postoperative pain, and lead to more aesthetic results. However, it is important to be aware of the inherent risks, limitations, and adverse effects associated with these thoracoscopic and laparoscopic techniques, particularly in special populations. In this article, we will review the risks and limitations of laparoscopy in pediatric patients such as cost, operative time, reduced effectiveness, air embolism, hypercarbia, hypothermia, and access-related injuries.


Subject(s)
Laparoscopy/adverse effects , Postoperative Complications/etiology , Thoracoscopy/adverse effects , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Laparoscopy/economics , Laparoscopy/standards , Learning Curve , Operative Time , Risk Assessment , Thoracoscopy/economics , Thoracoscopy/standards
17.
Mar Environ Res ; 153: 104814, 2020 Jan.
Article in English | MEDLINE | ID: mdl-31606143

ABSTRACT

Grasshopper herbivory can vary substantially among locations within a salt marsh or among marshes, but its variability along the marsh intertidal gradient (extending from the shoreline to the upland fringing forest) is not well reported. Previous papers have shown that grasshopper herbivory may affect nutrient processes in salt marsh ecosystems, but how such effects are tied up to the intensity of herbivory and how they vary spatially is poorly known. To help address these gaps, we evaluated whether grasshopper herbivory intensity and herbivore abundance together with other plant characteristics (such as total leaf length, plant live and dead biomass, plant nutrient content and plant nutrient standing stocks) varied along the intertidal gradient of two black needlerush marshes in the Northern Gulf of Mexico. Our results show that in one marsh grazing intensity decreased from the shoreline to the forest tree line, but in the other there was similar grazing intensity across the entire intertidal gradient. None of the measured plant characteristics followed the differences in herbivory found along the intertidal gradient and between salt marshes. We also found that, in the salt marsh with decreasing herbivory towards the upland edge, the combination of herbivory, plant nutrient content and plant nutrient standing stocks suggest two different functional zones along the intertidal gradient, one of nutrient availability and recycling near the shoreline and another one of nutrient inmobilization near the upland fringing forest. In concert, the results suggest that grasshopper herbivory intensity may vary along the intertidal gradient in some marshes, but not in others. In turn, spatial differences in herbivory along the intertidal gradient, if they occur, may influence nutrient processes, such as recycling and storage, leading to associated spatial differences in nutrient dynamics in the salt marsh.

18.
PLoS One ; 14(1): e0210144, 2019.
Article in English | MEDLINE | ID: mdl-30615652

ABSTRACT

The expansion of black mangrove Avicennia germinans into historically smooth cordgrass Spartina alterniflora-dominated marshes with warming temperatures heralds the migration of the marsh-mangrove ecotone northward in the northern Gulf of Mexico. With this shift, A. germinans is expected to outcompete S. alterniflora where it is able to establish, offering another prevalent food source to first order consumers. In this study, we find A. germinans leaves to be preferable to chewing herbivores, but simultaneously, chewing herbivores cause more damage to S. alterniflora leaves. Despite higher nitrogen content, A. germinans leaves decomposed slower than S. alterniflora leaves, perhaps due to other leaf constituents or a different microbial community. Other studies have found the opposite in decomposition rates of the two species' leaf tissue. This study provides insights into basic trophic process, herbivory and decomposition, at the initial stages of black mangrove colonization into S. alterniflora salt marsh.


Subject(s)
Avicennia/physiology , Climate Change , Plant Dispersal , Poaceae/physiology , Wetlands , Avicennia/chemistry , Gulf of Mexico , Herbivory , Islands , Nitrogen/analysis , Plant Leaves/chemistry , Poaceae/chemistry , Tropical Climate
19.
J Pharm Pract ; 32(2): 158-162, 2019 Apr.
Article in English | MEDLINE | ID: mdl-29233053

ABSTRACT

OBJECTIVE: To evaluate the impact of a pharmacist-driven initiative to optimize aldosterone antagonist use in patients with heart failure with reduced ejection fraction (HFrEF) at a large community hospital. METHODS: This single-center, retrospective cohort study compared patients with heart failure before and after the implementation of the initiative. Data for pre- and postinitiative patients were retrospectively collected to assess patient characteristics and aldosterone antagonist use. The primary outcome was a composite of eligible patients with heart failure discharged on aldosterone antagonist therapy or with a documented reason for ineligibility before and after commencement of pharmacist-driven aldosterone antagonist initiative. RESULTS: The preinitiative cohort included 96 patients and the postinitiative cohort contained 92 patients. When the 3 month pre- and postinitiative groups were assessed, the primary outcome was noted in 60 (63%) of 96 patients in the preinitiative group and 87 (95%) of 92 patients in the postinitiative group ( P < .0001). CONCLUSION: In patients with HFrEF, a pharmacist-driven aldosterone antagonist optimization initiative significantly increased appropriate prescribing and documentation for aldosterone antagonist therapy.


Subject(s)
Heart Failure/drug therapy , Mineralocorticoid Receptor Antagonists/administration & dosage , Adult , Aged , Aged, 80 and over , Aldosterone/metabolism , Cohort Studies , Female , Heart Failure/metabolism , Heart Failure/physiopathology , Humans , Male , Middle Aged , Pharmacists , Retrospective Studies , Stroke Volume/drug effects
20.
JPEN J Parenter Enteral Nutr ; 42(2): 361-370, 2018 02.
Article in English | MEDLINE | ID: mdl-29443397

ABSTRACT

BACKGROUND: We used the 15 N glycine urinary end-product enrichment technique to quantify whole body protein turnover following thoracic surgery. MATERIALS AND METHODS: A single dose of 15 N glycine (2 mg/kg) was administered orally on postoperative day 1 to children (1-18 years) following thoracic surgery. 15 N enrichment of ammonia and urea was measured in mixed urine after 12 and 24 hours, respectively, and protein synthesis, breakdown, and net balance determined. Nitrogen balance (dietary intake minus urinary excretion) was calculated. Urinary 3-methylhistidine:creatinine ratio was measured as a marker of skeletal muscle protein breakdown. RESULTS: We enrolled 19 subjects-median (interquartile range): age, 13.8 years (12.2-15.1); weight, 49.2 kg (38.4-60.8)-who underwent thoracotomy (n = 12) or thoracoscopic (n = 7) surgery. Protein synthesis and breakdown by 15 N enrichment were 7.1 (5.5-9) and 7.1 (5.6-9) g·kg-1 ·d-1 with ammonia (12 hours) as the end product, and 5.8 (3.8-6.7) and 6.7 (4.5-7.6) with urea (24 hours), respectively. Net protein balance by the 15 N glycine and urinary urea nitrogen methods were -0.34 (-0.47, -0.3) and -0.48 (-0.65, -0.28) g·kg-1 ·d-1 , respectively (rs = 0.828, P < .001). Postoperative change in 3-methylhistidine:creatinine ratio did not correlate significantly with protein breakdown or balance. CONCLUSION: The single-dose oral administration of 15 N glycine stable isotope with measurement of urinary end-product enrichment is a feasible and noninvasive method to investigate whole body protein turnover in children. After major surgery, children manifest increased protein turnover and net negative balance due to increased protein breakdown.


Subject(s)
Creatinine/urine , Glycine/administration & dosage , Methylhistidines/urine , Postoperative Complications/urine , Proteins/metabolism , Thoracic Surgical Procedures/adverse effects , Adolescent , Ammonia/urine , Biomarkers/urine , Child , Child, Preschool , Female , Humans , Infant , Male , Nitrogen Isotopes/administration & dosage , Pilot Projects , Reproducibility of Results , Urea/urine
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