Metrics matter: Multiple diversity metrics at different spatial scales are needed to understand species diversity in urban environments.

Worldwide, natural habitats are being replaced by artificial structures due to urbanisation. Planning of such modifications should strive for environmental net gain that benefits biodiversity and ecosystems. Alpha (α) and gamma (γ) diversity are often used to assess 'impact' but are insensitive metrics. We test several diversity measures across two spatial scales to compare species diversity in natural and artificial habitats. We show γ-diversity indicates equivalency in biodiversity between natural and artificial habitats, but natural habitats support greater taxon (α) and functional richness. Within-site ß-diversity was also greater in natural habitats, but among-site ß-diversity was greater in artificial habitats, contradicting the commonly held view that urban ecosystems are more biologically homogenous than natural ecosystems. This study suggests artificial habitats may in fact provide novel habitat for biodiversity, challenges the applicability of the urban homogenisation concept and highlights a significant limitation of using just α-diversity (i.e., multiple metrics are needed and recommended) for assessing environmental net gain and attaining biodiversity conservation goals.

Invasiveness risks of naked goby, Gobiosoma bosc, to North Sea transitional waters.

In recent decades, gobies have dispersed or introduced from the Ponto-Caspian region of eastern Europe in a westerly direction to North American and western European waters. By contrast, the naked goby, Gobiosoma bosc, is the only known gobiid species to have been introduced in an easterly direction from North American to western Europe. The potential invasiveness of G. bosc was assessed using the Aquatic Species Invasiveness Screening Kit (AS-ISK) for rivers and transitional waters for the western and eastern sides of the North Sea. Using globally-derived thresholds, G. bosc was assessed as low-medium invasiveness risk for both sides of the North Sea under current climate conditions. Under future climate conditions, potential invasiveness will increase for both risk assessment areas. Environmental suitability assessment indicated an increase in environmental suitability for G. bosc on the eastern coastline of the North Sea under climate change scenarios and suitability remained unchanged on the western coastline, reflecting the authors' expectations of invasiveness risk.

The Power in Coming Together.

The role of the chief nursing officer is multifaceted and complex. These complexities can be exacerbated during times of turbulence, specifically the COVID-19 pandemic. Understanding communication and collaboration are core to achieving optimal outcomes, this article outlines the experience of 3 chief nursing officers through the COVID-19 pandemic and the value of a structured platform for peer shared learning and support.

Occurrence and assemblage composition of intertidal non-native species may be influenced by shipping patterns and artificial structures.

Habitat modification coupled with the spread of non-native species (NNS) are among the top threats to marine biodiversity globally. Species are known to be transported to new locations via international shipping and secondarily spread via regional vessels and artificial structures. Rapid Assessment Surveys (RAS) combining quantitative and semi-quantitative methods compared NNS richness and assemblage composition on intertidal natural rocky shores and artificial structures in harbours in different regions along the south coast of England. Quantitative data showed that artificial habitats supported higher richness than natural habitats, while semi-quantitative data found no difference in richness among habitat types. This result was attributed to additional species found in rock pools during searches of complex microhabitats in natural habitats. Assemblages on artificial structures differed among regions, with regions and harbours with greater numbers of vessels supporting greater richness. Results highlight the importance of shipping and artificial structures for NNS introduction and spread.

Toxicity of weathered Deepwater Horizon oil to bay anchovy (Anchoa mitchilli) embryos.

The BP-contracted Deepwater Horizon Macondo well blowout occurred on 20 April 2010 and lasted nearly three months. The well released millions of barrels of crude oil into the northern Gulf of Mexico, causing extensive impacts on pelagic, benthic, and estuarine fish species. The bay anchovy (Anchoa mitchilli) is an important zooplanktivore in the Gulf, serving as an ecological link between lower trophic levels and pelagic predatory fish species. Bay anchovy spawn from May through November in shallow inshore and estuarine waters throughout the Gulf. Because their buoyant embryos are a dominant part of the inshore ichthyoplankton throughout the summer, it is likely bay anchovy embryos encountered oil in coastal estuaries during the summer and fall of 2010. Bay anchovy embryos were exposed to a range of concentrations of two field-collected Deepwater Horizon oils as high-energy and low-energy water accommodated fractions (HEWAFs and LEWAFs, respectively) for 48h. The median lethal concentrations (LC50) were lower in exposures with the more weathered oil (HEWAF, 1.48µg/L TPAH50; LEWAF, 1.58µg/L TPAH50) compared to the less weathered oil (HEWAF, 3.87µg/L TPAH50; LEWAF, 4.28µg/L TPAH50). To measure delayed mortality and life stage sensitivity between embryos and larvae, an additional 24h acute HEWAF exposure using the more weathered oil was run followed by a 24h grow-out period. Here the LC50 was 9.71µg/L TPAH50 after the grow-out phase, suggesting a toxic effect of oil at the embryonic or hatching stage. We also found that exposures prepared with the more weathered Slick B oil produced lower LC50 values compared to the exposures prepared with Slick A oil. Our results demonstrate that even relatively acute environmental exposure times can have a detrimental effect on bay anchovy embryos.

Are oysters being bored to death? Influence of Cliona celata on Crassostrea virginica condition, growth and survival.

The boring sponge Cliona celata is a nuisance species that can have deleterious effects on eastern oyster Crassostrea virginica growth, condition, and survival. Surprisingly, however, these effects have not been well documented and when examined, results have been equi-vocal. In this study, we provide a direct comparison of growth, condition, and survival of sponge-colonized and uncolonized oysters in southeast North Carolina in 2 separate experiments. In the first experiment, sponge-colonized oysters exhibited significantly slower growth rates, reduced condition, and lower survival relative to uncolonized oysters, although results may have been confounded by oyster source. In the second experiment, using smaller oysters from the same source population, growth rate was again significantly reduced in colonized oysters relative to uncolonized oysters, however neither condition nor survival differed. In field surveys of the same population, colonized individuals across a range of sizes demonstrated significantly reduced condition. Further, condition index was negatively correlated with sponge biomass, which was positively correlated with oyster size, suggesting that the impact of the sponge changes with ontogeny. By investigating clearance rates, tissue isotopic and nutrient content, as well as caloric value, this study provides further evidence that sponge presence causes the oysters to divert energy into costly shell maintenance and repair at the expense of shell and somatic growth. Thus, although variable, our results demonstrate negative impacts of sponge infestation on oyster demographics, particularly as oysters grow larger.

Prevalence of the invasive Rhizocephalan parasite Loxothylacus panopaei in Eurypanopeus depressus in South Carolina and genetic relationships of the parasite in North and South Carolina.

The rhizocephalan barnacle Loxothylacus panopaei is a parasitic castrator of xanthid crabs that has invaded the U.S. Atlantic coast. It was transported to the Chesapeake Bay in the mid-1960s with mud crabs associated with Gulf coast oysters and has since spread north to Long Island Sound, New York, and south to Cape Canaveral, Florida. Here we report parasite prevalence at 3 South Carolina sites--2 from which the parasite had not been previously reported--and examine the genetic relationships of North and South Carolina L. panopaei populations relative to Gulf of Mexico and other Atlantic coast parasite populations. Total L. panopaei prevalence was 24.2% among all 3 sites, with monthly prevalence as high as 51.6% at Waties Island, South Carolina. Sequence analyses of North and South Carolina specimens revealed the presence of 4 cytochrome c oxidase subunit I haplotypes--3 commonly found in other invasive populations and 1 new haplotype found in a single specimen from the Rachel Carson Reserve in Carteret County, North Carolina--and indicate that the Carolina populations are a result of range expansion from the original Atlantic coast invasion.

Assessing the impact of electronic health records as an enabler of hospital quality and patient satisfaction.

PURPOSE: To assess the impact of using an advanced electronic health record (EHR) on hospital quality and patient satisfaction. METHOD: This retrospective, cross-sectional analysis was conducted in 2012 to evaluate the association between advanced EHR use (Healthcare Information Management Systems Society [HIMSS] Stage 6 or 7 as of December 2012) and estimated process and experience of care scores for hospitals under the Medicare Hospital Value-Based Purchasing Program, using data from the American Hospital Association for 2008 to 2010. Generalized linear regression models were fit to test the association between advanced EHR use with process of care and experience of care, controlling for hospital characteristics. In a second analysis, the models included variables to account for HIMSS stage of advanced EHR use. RESULTS: The study included 2,988 hospitals, with 248 (8.3%) classified as advanced EHR users (HIMSS Stage 6 or 7). After controlling for hospital characteristics, advanced EHR use was associated with a 4.2-point-higher process of care score (P < .001). Hospitals with Stage 7 EHRs had 11.7 points higher process of care scores, but Stage 6 users had scores that were not substantially different from those of nonadvanced users. There was no significant difference in estimated experience of care scores by level of advanced EHR use. CONCLUSIONS: This study evaluated the effectiveness of the U.S. federal government's investment in hospital information technology infrastructure. Results suggest that the most advanced EHRs have the greatest payoff in improving clinical process of care scores, without detrimentally impacting the patient experience.

Clinical evaluation of a microwave device for treating axillary hyperhidrosis.

BACKGROUND: A third-generation microwave-based device has been developed to treat axillary hyperhidrosis by selectively heating the interface between the skin and underlying fat where the sweat glands reside. MATERIALS AND METHODS: Thirty-one (31) adults with primary axillary hyperhidrosis were enrolled. All subjects had one to three procedure sessions over a 6-month period to treat both axillae fully. Efficacy was assessed using the Hyperhidrosis Disease Severity Scale (HDSS), gravimetric weight of sweat, and the Dermatologic Life Quality Index (DLQI), a dermatology-specific quality-of-life scale. Subject safety was assessed at each visit. Subjects were followed for 12 months after all procedure sessions were complete. RESULTS: At the 12-month follow-up visit, 90.3% had HDSS scores of 1 or 2, 90.3% had at least a 50% reduction in axillary sweat from baseline, and 85.2% had a reduction of at least 5 points on the DLQI. All subjects experienced transient effects in the treatment area such as swelling, discomfort, and numbness. The most common adverse event (12 subjects) was the presence of altered sensation in the skin of the arm that resolved in all subjects. CONCLUSION: The device tested provided efficacious and durable treatment for axillary hyperhidrosis.

A randomized, blinded clinical evaluation of a novel microwave device for treating axillary hyperhidrosis: the dermatologic reduction in underarm perspiration study.

BACKGROUND: Duration of effect and effectiveness limit current options for treating axillary hyperhidrosis. A new microwave procedure for treatment of axillary hyperhidrosis has been tested. STUDY DESIGN/MATERIALS AND METHODS: Adults with primary axillary hyperhidrosis were enrolled in a randomized, sham-controlled, blinded study. Subjects were required to have a Hyperhidrosis Disease Severity Scale (HDSS) score of 3 or 4 and baseline sweat production greater than 50 mg/5 min. Procedures were administered using a proprietary microwave energy device that isolates and heats target tissue. Responders were defined as subjects reporting a HDSS score of 1 or 2. Subjects were followed for 6 months (sham group) or 12 months (active group). RESULTS: Thirty days after treatment, the active group had a responder rate of 89% (72/81), and the sham group had a responder rate of 54% (21/39) (P < .001). Treatment efficacy was stable from 3 months (74%) to 12 months (69%), when follow-up ended. Adverse events were generally mild, and all but one resolved over time. CONCLUSIONS: The procedure demonstrated statistically significant, long-term efficacy in sweat reduction. As with any new procedure, findings from this first investigational device study identified optimization strategies for the future.

Microwave thermolysis of sweat glands.

BACKGROUND AND OBJECTIVES: Hyperhidrosis is a condition that affects a large percentage of the population and has a significant impact on peoples' lives. This report presents a technical overview of a new noninvasive, microwave-based device for creating thermolysis of sweat glands. The fundamental principles of operation of the device are presented, as well as the design and optimization of the device to target the region where the sweat glands reside. MATERIALS AND METHODS: An applicator was designed that consists of an array of four waveguide antennas, a cooling system, and a vacuum acquisition system. Initially, the performance of the antenna array was optimized via computer simulation such that microwave absorption was maximized near the dermal/hypodermal interface. Subsequently, hardware was implemented and utilized in pre-clinical testing on a porcine model to optimize the thermal performance and analyze the ability of the system to create thermally affected zones of varying size yet centered on the target region. RESULTS: Computer simulation results demonstrated absorption profiles at a frequency of 5.8 GHz that had low amounts of absorption at the epidermis and maximal absorption at the dermal/hypodermal interface. The targeted zone was shown to be largely independent of skin thickness. Gross pathological and histological response from pre-clinical testing demonstrated the ability to generate thermally affected zones in the desired target region while providing protection to the upper skin layers. CONCLUSIONS: The results demonstrate that microwave technology is well suited for targeting sweat glands while allowing for protection of both the upper skin layers and the structures beneath the subcutaneous fat. Promising initial results from simulation and pre-clinical testing demonstrate the potential of the device as a noninvasive solution for sweat gland thermolysis.

Computer-aided detection in diagnostic mammography: detection of clinically unsuspected cancers.

OBJECTIVE: We had two objectives: to determine the percentage of women presenting with clinical findings whose diagnostic mammogram led to detection of a breast cancer at a site distant from the original clinical complaint and to assess the performance of computer-aided detection (CAD) on diagnostic mammography. MATERIALS AND METHODS: Three institutions contributed consecutive cases in which a mammogram was obtained to evaluate a clinical finding, after which a histologic diagnosis of breast cancer was made. Clinical data and the mammograms were reviewed to determine the nature of the clinical findings and to document the location and characteristics of 212 biopsy-proven cancers in 197 patients who met the study criteria. Standard four-view breast mammograms were then analyzed by a CAD system. RESULTS: The most common clinical finding was a palpable mass (90%, 177/197), with nipple discharge (5%, 9/197), focal tenderness or pain (2%, 5/197), and miscellaneous complaints (3%, 6/197) also noted. Two separate cancers were found in 7.6% (15/197) of the cases. In another 7.6% (15/197) of the cases, the single diagnosed cancer was not at the location of the specific clinical finding. The CAD system correctly marked 87% (26/30) of those cancers that were clinically unsuspected (i.e., not at the location of the clinical finding). CONCLUSION: Breast cancers occurred at locations other than the site of the presenting clinical finding in 15% (30/197) of patients undergoing diagnostic mammography in whom a cancer was detected. CAD identified 87% of these incidentally detected cancers and may therefore be useful as a detection aid to the radiologist when interpreting diagnostic mammograms.

Computer-aided detection output on 172 subtle findings on normal mammograms previously obtained in women with breast cancer detected at follow-up screening mammography.

PURPOSE: To evaluate, by using a computer-aided detection (CAD) program, the nonspecific findings on normal screening mammograms obtained in women in whom breast cancer was later detected at follow-up screening mammography. MATERIALS AND METHODS: Four hundred ninety-three mammogram pairs-an initial negative screening mammogram and a subsequently obtained screening mammogram showing cancer-were collected. The mean interval between examinations was 14.6 months. In 169 cases, in which 172 cancers were later depicted, findings on the initial mammogram were subtle enough that either none or only one or two of five blinded radiologists recommended screening recall. On the initial negative mammograms, of the 172 areas where cancer later developed, 137 (80%) had subtle nonspecific findings and were retrospectively judged as having a benign or normal appearance. The mammograms with these subtle findings were evaluated with a commercially available CAD program, and the numbers of CAD marks on these nonspecific findings were analyzed. RESULTS: Of the 172 cancers, 129 (75%) were invasive and 43 (25%) were ductal carcinoma in situ. The CAD program marked 72 (42%) of the 172 findings that subsequently developed into cancer: 24 (29%) of 82 findings recalled by none, 25 (49%) of 51 findings recalled by one, and 23 (59%) of 39 findings recalled by two of the five radiologists. Among the 137 areas with nonspecific normal or benign findings, 41 (30%) areas where cancer subsequently developed were marked by the CAD program. CONCLUSION: A subset of cancers have perceptible but nonspecific mammographic findings that may be marked by a CAD program, even when the findings do not warrant recall as judged at blinded and unblinded radiologist review. The authors believe failure to act on such nonspecific but CAD-marked findings prospectively does not constitute interpretation below a reasonable standard of care.

Analysis of 172 subtle findings on prior normal mammograms in women with breast cancer detected at follow-up screening.

PURPOSE: To retrospectively review nonspecific findings on prior screening mammograms to determine what features were most often deemed normal or benign despite the development of breast cancer in the same location detected at follow-up screening. MATERIALS AND METHODS: Four hundred ninety-three pairs of consecutive mammographic findings were collected from 13 institutions, consisting of initial normal screening findings and a subsequent finding of cancer at screening (mean interval between examinations, 14.6 months). One designated radiologist reviewed each pair of mammograms and determined that 286 findings were judged visible at prior examination in locations where cancer later developed. Five blinded radiologists independently reviewed the prior findings in these 286 cases, identifying 169 mammograms (172 cancers) with findings so subtle that none or only one or two of the five radiologists recommended screening recall. Two unblinded radiologists reviewed the initial and subsequent findings and recorded descriptors and assessments for each finding and subjective factors influencing why, although the lesion was perceptible, it might have been undetected or not recalled. RESULTS: Of 172 cancers, 129 (75%) were invasive (112 T1 tumors and 17 T2 tumors or higher; median diameter, 10 mm), and 43 (25%) were ductal carcinoma in situ (median size, 10 mm). On the prior mammograms, 80% (137 of 172) of these cancers had subtle nonspecific findings where cancer later developed, and most were assessed as being normal or benign in appearance. CONCLUSION: There is a subset of cancers that display perceptible but nonspecific mammographic findings that do not warrant recall, as judged by both a majority of blinded radiologists and by unblinded reviewers. We believe failure to act on these nonspecific findings prospectively does not necessarily constitute interpretation below a reasonable standard of care.

Invasive lobular carcinoma of the breast: mammographic characteristics and computer-aided detection.

PURPOSE: To characterize the mammographic appearance of invasive lobular carcinoma in a large series of screening-detected consecutive breast cancers and to evaluate the ability of a computer-aided detection system to mark these carcinomas. MATERIALS AND METHODS: Investigators used the Breast Imaging Reporting and Data System lexicon to characterize lesions as part of a retrospective review of 90 screening mammographic examinations that led to biopsy-proved diagnosis of 94 invasive lobular carcinoma lesions. The 40 available prior mammographic examinations (obtained 9-24 months earlier) were also reviewed to characterize any visible findings. The results of a computer-aided detection analysis were compared with the images, and the sensitivity of the algorithm was calculated for correct detection of the lesions. RESULTS: Fifty-six (60%) of 94 lesions manifested as masses, of which 40 (71%) were described as irregular and spiculated; 20 (21%) of 94, as architectural distortions; and the remainder, 18 (20%), as either asymmetric densities or calcifications. On the screening mammograms showing biopsy-proved cancers, the sensitivity of the computer-aided detection system was 86 (91%) of 94 lesions. Thirty-one of the 40 prior mammograms showed retrospectively visible findings, and 24 (77%) of 31 were marked by the computer-aided detection system. CONCLUSION: Spiculated masses and architectural distortions are the predominant appearances of invasive lobular carcinoma, and a computer-aided detection system correctly marked a high percentage of invasive lobular carcinoma lesions.