Time-Varying Stock-Recruitment Model For Estimating Population Characteristics of Green Turtles

The stock-recruitment relationship (SR), customarily used in fisheries assessment, can be used to analyze demographic data of sea turtles to infer changes in hatchling production (R) as a function of nester abundance (S), recruitment rates and the influence of environmental conditions on these population features. The SR Cushing model (R=aS^b), where a and b are the model parameters) is well-suited for representing the dynamics of recovering populations, such as the green turtle (Chelonia mydas) in Campeche, Mexico. This study aimed to explore the SR Cushing model using a time series of the abundance of nesters and hatchlings (1984–2020). By applying local regressions (9-yr moving windows), we found that the time series of parameter b (the change in R as a function of S) and the recruitment rate (hatchlings per nester) were inversely correlated with a 26-yr cycle of the Atlantic Multidecadal Oscillation –sea surface temperature (SST), over the Atlantic– (r^2=0.83) and (r^2=0.64), respectively, at a 3-yr lag). Model diagnostics using the time-dependent Cushing model substantiated that the log-normal distribution of hatchlings of C. mydas in Campeche depends on the abundance of nesting females and on a low frequency SST signal (r^2=0.98). The positive trend in nester numbers of green turtles in Campeche during the past 44 years may be the result of persistent conservation efforts, while the drastic and sporadic changes in the growth rate of annual arrivals and hatchling production are suggestive of population dynamics driven by low frequency, basin-wide environmental signals.

Ten years from propagule to mature plant of Butia purpurascens Glassman (Arecaceae): an endemic and endangered palm of the Brazilian Cerrado

With occurrence mainly in the southwest Goiás, Butia purpurascens has fruits and leaves widely extracted by the regional population. Coexists with exotic grasses, frequent burnings and cattle’s grazing and trampling. Young individuals are rarely seen. We aim to provide information about propagules, seedling formation and the monitoring of saplings of B. purpurascens until adults in reproductive phase. Fruits were selected, measured and benefited after harvest. Of 6,000 fruits collected 3,112 were discarded for being perforated by Conotrachelus weevils. The experiment divided 2,600 fruits into 13 treatments, distributed in ripe and immature fruits, with and without pulp. In addition, we adopt mechanical and chemical break dormancy mechanisms, different storage periods and seeding depths. After sixteen months of monitoring, the formation of eleven seedlings was obtained without distinction of any treatment. Seedlings and saplings developed slowly, taking two years to emit the first metaphyll. Over time, ten individuals died, most from fungal attack. After ten years, the only surviving palm generated two inflorescences, which produced fruit. The inefficient seedling production and the slow development of saplings, combined with the impact of the extractivism and the high rate of predation of the pyrenes, suggest the low recruitment rate of the species observed, in natural conditions. This type of data is one of the important tools for creating guidelines for the species conservation. Therefore, we suggest considering the reclassification of B. purpurascens as a Critically Endangered species in the Official List of Threatened Brazilian Species of Extinction.

Niche Shifts From Trees to Fecundity to Recruitment That Determine Species Response to Climate Change

Anticipating the next generation of forests requires understanding of recruitment responses to habitat change. Tree distribution and abundance depend not only on climate, but also on habitat variables, such as soils and drainage, and on competition beneath a shaded canopy. Recent analyses show that North American tree species are migrating in response to climate change, which is exposing each population to novel climate-habitat interactions (CHI). Because CHI have not been estimated for either adult trees or regeneration (recruits per year per adult basal area), we cannot evaluate migration potential into the future. Using the Masting Inference and Forecasting (MASTIF) network of tree fecundity and new continent-wide observations of tree recruitment, we quantify impacts for redistribution across life stages from adults to fecundity to recruitment. We jointly modeled response of adult abundance and recruitment rate to climate/habitat conditions, combined with fecundity sensitivity, to evaluate if shifting CHI explain community reorganization. To compare climate effects with tree fecundity, which is estimated from trees and thus is "conditional" on tree presence, we demonstrate how to quantify this conditional status for regeneration. We found that fecundity was regulated by temperature to a greater degree than other stages, yet exhibited limited responses to moisture deficit. Recruitment rate expressed strong sensitivities to CHI, more like adults than fecundity, but still with substantial differences. Communities reorganized from adults to fecundity, but there was a re-coalescence of groups as seedling recruitment partially reverted to community structure similar to that of adults. Results provide the first estimates of continent-wide community sensitivity and their implications for reorganization across three life-history stages under climate change.

Digital mental health intervention for orthopedic patients with symptoms of depression and/or anxiety: Pilot feasibility study (Preprint)

BACKGROUND Depression and anxiety commonly coexist with chronic musculoskeletal pain, and when this occurs, standard orthopedic treatment is less effective. Nevertheless, addressing mental health is not yet a routine part of standard orthopedic treatment, in part due to access related barriers. Digital mental health intervention offers the potential to be a scalable resource that could feasibly be incorporated into orthopedic care. OBJECTIVE The primary purpose of this study was to assess the feasibility of introducing a digital mental health intervention (Wysa) within an outpatient orthopedic setting to patients who endorse coexisting symptoms of depression and/or anxiety. The secondary purpose was to perform a preliminary effectiveness analysis of the intervention. METHODS In this single-arm, prospective cohort study, participants included adult patients (18 years and older) who presented to a non-surgical orthopedic specialist at a single tertiary care academic center for evaluation of a musculoskeletal condition and who self-reported symptoms of depression and/or anxiety (Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and/or Anxiety score ≥ 55). Enrollment was performed face-to-face by a research coordinator immediately after the participant’s encounter with an orthopedic clinician. Participants were provided two months of access to a mobile app called Wysa, which is an established, multi-component digital mental health intervention that uses chatbot technology and text-based access to human counselors to deliver cognitive behavioral therapy, mindfulness training, and sleep tools, among other features. For this study, Wysa access also included novel, behavioral activation based features specifically developed for users with chronic pain. Primary feasibility outcomes included the study recruitment rate, retention rate, and engagement rate with Wysa (defined as engaging with a therapeutic Wysa tool at least once during the study period). Secondary effectiveness outcomes were between-group differences in mean longitudinal PROMIS mental and physical health score changes at two-month follow-up between high Wysa users and low Wysa users, defined by a median split. RESULTS The recruitment rate was 61/208 (29%), retention rate was 51/61 (84%), and engagement rate was 44/61 (72%). Compared to low users, high Wysa users achieved greater improvement in PROMIS Anxiety (between-group difference -4.2 points [95% CI -8.1 to -0.2], P=.044) at two-month follow-up. Between-group differences in PROMIS Depression (-3.2 points [-7.5 to 1.2], P=.15) and Pain Interference (-2.3 points [-6.3 to 1.7], P=.26) favored high users but did not meet statistical significance. Improvements in PROMIS Physical Function were comparable between groups. CONCLUSIONS Delivery of a digital mental health intervention within the context of orthopedic care is feasible and demonstrates potential to improve mental health and pain-related impairment to a clinically meaningful degree. Participants’ engagement rates exceeded industry standards, and additional opportunities to improve recruitment and retention were identified. Further pilot study followed by a definitive, randomized controlled trial is warranted. CLINICALTRIAL ClinicalTrials.gov NCT202005219

Feasibility and preliminary efficacy of acupuncture for angina in an underserved diverse population

Purpose: Stable angina is ischemic chest pain on exertion or with emotional stress. Despite guideline-directed therapy, up to 30% of patients have suboptimal pain relief. The aims of this study were to: (1) determine the feasibility and acceptability of a randomized controlled trial (RCT) of acupuncture; and (2) evaluate preliminary efficacy of acupuncture with respect to reduction of pain and increased functional status and health-related quality of life (HRQoL). Methods: Participants with stable angina for ⩾1 month received either a standardized acupuncture protocol, twice per week for 5 weeks, or an attention control protocol. Measures included the McGill Pain Questionnaire (average pain intensity (API), pain now) and the Seattle Angina Questionnaire–7 (functional status, symptoms, and HRQoL). Feasibility was defined as ⩾80% recruitment, ⩾75% retention following enrollment, and ⩾80% completion. Descriptive statistics and mixed-effects linear regression were used for analysis. Results: The sample (n = 24) had a mean age of 59 ± 12 years, was predominantly female (63%), and represented minority groups (8% White, 52% Black, 33% Hispanic, and 8% Other). Feasibility was supported by 79% retention and 89% completion rates. The recruitment rate (68%) was slightly lower than expected. Acceptability scores were 87.9% for the acupuncture group and 51.7% for the control group. Outcomes were significantly better for the acupuncture versus control groups (API, b = −2.1 (1.1), p = 0.047; functional status, b = 27.6 (7.2), p < 0.001; and HRQoL, b = 38.8 (11.9), p = 0.001). Conclusions and implications: Acupuncture was feasible and acceptable in our diverse sample. We were slightly under the recruitment target of 80%, but participants who started the study had a high likelihood of completing it. Acupuncture shows promise for stable angina, but its effectiveness needs to be confirmed by a larger, adequately powered RCT. Trial registration number: NCT02914834 (ClinicalTrials.gov).

HAPPi Kneecaps! A double-blind, randomised, parallel group superiority trial investigating the effects of sHoe inserts for adolescents with patellofemoral PaIn: phase II feasibility study

Background Patellofemoral pain (PFP) affects one-third of adolescents and can persist into adulthood, negatively impacting health and quality of life. Foot orthoses are a recommended treatment for adults with PFP, but have not been evaluated in adolescents. The primary objective was to determine the feasibility of conducting a full-scale randomised controlled trial (RCT) evaluating effects of contoured, prefabricated foot orthoses on knee pain severity and patient-perceived global change, compared to flat insoles. The secondary objective was to describe outcomes on a range of patient-reported outcome measures. Methods We recruited adolescents aged 12–18 years with PFP of ≥2 months duration into a double-blind, randomised, parallel-group feasibility trial. Participants were randomised to receive prefabricated contoured foot orthoses or flat shoe insoles, and followed for 3 months. Participants and outcome assessors were blinded to group allocation. Primary outcomes were feasibility of a full-scale RCT (number of eligible/enrolled volunteers; recruitment rate; adherence with the intervention and logbook completion; adverse effects; success of blinding; drop-out rate), and credibility and expectancy of interventions. Secondary outcomes were patient-reported measures of pain, symptoms, function, quality of life, global rating of change, patient acceptable symptom state, and use of co-interventions. Results 36 out of 279 (12.9%) volunteers (27 female, mean (SD) age 15 (2) years, body mass 60 (13) kg) were eligible and enrolled, at a recruitment rate of 1.2 participants/week. 17 participants were randomised to receive foot orthoses, and 19 to flat insoles. 15 participants returned logbooks; 7/15 (47%) adhered to the intervention. No serious adverse events were reported. 28% (10/36, 4 pandemic-related) of participants dropped out before 3 months. Blinding was successful. Both groups found the inserts to be credible. Conclusions Based on a priori criteria for feasibility, findings suggest that a full-scale RCT comparing contoured foot orthoses to flat insoles in adolescents with PFP would not be feasible using the current protocol. Prior to conducting a full-scale RCT, feasibility issues should be addressed, with protocol modifications to facilitate participant retention, logbook completion and shoe insert wear. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000957190. Date registered: 8/07/2019.

Intravenous albumin for the prevention of hemodynamic instability during sustained low-efficiency dialysis: a randomized controlled feasibility trial (The SAFER-SLED Study)

Background Hemodynamic instability is a frequent complication of sustained low-efficiency dialysis (SLED) treatments in the ICU. Intravenous hyperoncotic albumin may prevent hypotension and facilitate ultrafiltration. In this feasibility trial, we sought to determine if a future trial, powered to evaluate clinically relevant outcomes, is feasible. Methods This single-center, blinded, placebo-controlled, randomized feasibility trial included patients with acute kidney injury who started SLED in the ICU. Patients were randomized to receive 25% albumin versus 0.9% saline (control) as 100 mL boluses at the start and midway through SLED, for up to 10 sessions. The recruitment rate and other feasibility outcomes were determined. Secondary exploratory outcomes included ultrafiltration volumes and metrics of hemodynamic instability. Results Sixty patients (271 SLED sessions) were recruited over 10 months. Age and severity of illness were similar between study groups. Most had septic shock and required vasopressor support at baseline. Protocol adherence occurred for 244 sessions (90%); no patients were lost to follow-up; no study-related adverse events were observed; open label albumin use was 9% and 15% in the albumin and saline arms, respectively. Ultrafiltration volumes were not significantly different. Compared to the saline group, the albumin group experienced less hemodynamic instability across all definitions assessed including a smaller absolute decrease in systolic blood pressure (mean difference 10.0 mmHg, 95% confidence interval 5.2–14.8); however, there were significant baseline differences in the groups with respect to vasopressor use prior to SLED sessions (80% vs 61% for albumin and saline groups, respectively). Conclusions The efficacy of using hyperoncotic albumin to prevent hemodynamic instability in critically ill patients receiving SLED remains unclear. A larger trial to evaluate its impact in this setting, including evaluating clinically relevant outcomes, is feasible. Trial registration ClinicalTrials.gov (NCT03665311); First Posted: Sept 11th, 2018. https://clinicaltrials.gov/ct2/show/NCT03665311?term=NCT03665311&draw=2&rank=1

O-EGS06 Trials and Tribulations: Educational Impact and Recommendations from the Implementation of Student-Led Recruitment in a Clinical Trial

Background Medical students have an essential role in medical research, yet often feel unprepared and lack opportunities for involvement as recruiters within research studies. This study aimed to understand the educational effect of involvement in clinical trial recruitment on medical students, and to derive generalisable future recommendations. Methods Tracking wound infection with smartphone technology (TWIST) was a randomised controlled trial enrolling adult emergency abdominal surgery patients across two university teaching hospitals. All recruiters underwent pre-recruitment training based on “Generating Student Recruiters for Randomised Trials” (GRANULE) principles, and completed pre-and post-recruitment surveys. Respondent agreement with statements were assessed using 5-point Likert scales (from 1 [“strongly disagree”] to 5 [“strongly agree”]). Quantitative data were analysed using paired t-tests to compare differences pre- and post-involvement, and a thematic analysis approach adopted for anonymised free-text answers. Results Of 492 patients recruited to TWIST from 2016 to 2020, 86.0% (n = 423) were recruited by medical students. Following student involvement, the monthly recruitment rate tripled (4.8 to 15.7 patients). Thirty student recruiters (96.8%), completed both surveys, reporting significant improvements in clinical and academic competencies. This included increased confidence in gaining and documenting consent, as well as interest in pursuing a clinical-academic career. Over half (58.2%) felt the undergraduate curriculum had not prepared them for involvement in clinical trials (mean:2.47, SD: 0.94). There were three emergent themes regarding recommendations for involvement of students, based on their engagement, preparation, and support during recruitment. Conclusions Student recruitment in clinical trials is feasible and provides a route to developing a research-active medical workforce. It also accelerates recruitment to clinical trials, as well as benefiting students through development of clinical competencies and provision of additional exposure to research. Adequate training, support, and selection of suitable trials are essential for successful student engagement.

Testing a newly developed activity pacing framework for chronic pain/fatigue: a feasibility study

ObjectivesTo test the feasibility of using a new activity pacing framework to standardise healthcare professionals’ instructions of pacing, and explore whether measures of activity pacing/symptoms detected changes following treatment.DesignSingle-arm, repeated measures study.SettingOne National Health Service (NHS) Pain Service in Northern England, UK.ParticipantsAdult patients with chronic pain/fatigue, including chronic low back pain, chronic widespread pain, fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis.InterventionsSix-week rehabilitation programme, standardised using the activity pacing framework.Outcome measuresFeasibility was explored via patients’ recruitment/attrition rates, adherence and satisfaction, and healthcare professionals’ fidelity. Questionnaire data were collected from patients at the start and end of the programme (T1 and T2, respectively) and 3 months’ follow-up (T3). Questionnaires included measures of activity pacing, current/usual pain, physical/mental fatigue, depression, anxiety, self-efficacy, avoidance, physical/mental function and quality of life. Mean changes in activity pacing and symptoms between T1-T2, T2-T3 and T1-T3 were estimated.ResultsOf the 139 eligible patients, 107 patients consented (recruitment rate=77%); 65 patients completed T2 (T1-T2 attrition rate=39%), and 52 patients completed T3 (T1-T3 attrition rate=51%). At T2, patients’ satisfaction ratings averaged 9/10, and 89% attended ≥5 rehabilitation programme sessions. Activity pacing and all symptoms improved between T1 and T2, with smaller improvements maintained at T3.ConclusionThe activity pacing framework was feasible to implement and patients’ ability to pace and manage their symptoms improved. Future work will employ a suitable comparison group and test the framework across wider settings to explore the effects of activity pacing in a randomised controlled trial.Trial registration numberNCT03497585.