Abstract Marine ecosystem-based management (EBM) is recognized as the best practice for managing multiple ocean-use sectors, explicitly addressing tradeoffs among them. However, implementation is ...perceived as challenging and often slow. A poll of over 150 international EBM experts revealed progress, challenges, and solutions in EBM implementation worldwide. Subsequent follow-up discussions with over 40 of these experts identified remaining impediments to further implementation of EBM: governance; stakeholder engagement; support; uncertainty about and understanding of EBM; technology and data; communication and marketing. EBM is often portrayed as too complex or too challenging to be fully implemented, but we report that identifiable and achievable solutions exist (e.g., political will, persistence, capacity building, changing incentives, and strategic marketing of EBM), for most of these challenges and some solutions can solve many impediments simultaneously. Furthermore, we are advancing in key components of EBM by practitioners who may not necessarily realize they are doing so under different paradigms. These findings indicate substantial progress on EBM, more than previously reported.
Blue crabs
Callinectes sapidus
have expanded their geographic range northward in the NW Atlantic with possible trophodynamic effects on benthic communities. In this study, we examined the blue crab’s ...diet in 2 southern New England tidal rivers (USA) and expounded on their predator-prey interaction with juvenile winter flounder
Pseudopleuronectes americanus
. Blue crabs (8-185 mm carapace width CW; n = 1835) were collected from the Seekonk River, Rhode Island, and Taunton River, Massachusetts, between May and August 2012 to 2016, and their feeding habits were assessed via stomach content, stable isotope, and molecular genetic analyses. Blue crabs were found to be generalist carnivores-omnivores with diets varying throughout ontogeny, yet shifts in prey composition had no effect on size-based nitrogen isotope signatures and trophic position (3.50 ± 0.35, mean ± SD). Carbon isotope values indicated that detritus-macroalgae were the dominant carbon source to the food web, with additional contributions from terrestrially derived organic matter and phytoplankton in oligohaline and polyhaline waters, respectively. The main prey of blue crabs ≤49 mm CW were amphipods, shrimp, and unidentified crustaceans, and larger conspecifics fed on bivalves, crabs, and fish. Winter flounder remains, e.g. sagittal otoliths, were identified in the diet of 2.5% of field-collected blue crabs, whereas PCR-based assays detected winter flounder DNA in 17.7% of crab stomachs. Blue crabs 23 to 160 mm CW preyed on winter flounder ranging from 26 to 66 mm total length, with occurrences of predation most closely associated with increases in crab size. Blue crab predation on winter flounder also varied spatially in the rivers, reflecting site-specific differences in flounder densities, abundances of other preferred prey, and dissolved oxygen concentrations that altered predator-prey dynamics. Lastly, the current predatory impact of blue crabs on juvenile winter flounder is nearly equivalent to other portunid crab species. Anticipated temperature-mediated increases in blue crab densities at northern latitudes, however, will intensify the predator-induced mortality of winter flounder and likely hinder their recovery in southern New England.
Vestibular schwannoma surgery has evolved as new therapeutic options have emerged, patients' expectations have risen, and the psychological effect of facial nerve paralysis has been studied. For ...large vestibular schwannomas for which extirpation is the primary therapy, the goals remain complete tumor resection and maintenance of normal neurological function. Improved microsurgical techniques and intraoperative facial nerve monitoring have decreased the complication rate and increased the likelihood of normal to near-normal postoperative facial function. Nevertheless, the impairment most frequently reported by patients as an adverse effect of surgery continues to be facial nerve paralysis. In addition, patient assessment has provided a different, less optimistic view of outcome. The authors evaluated the extent of facial function, timing of facial nerve recovery, patients' perceptions of this recovery and function, and the prognostic value of intraoperative facial nerve monitoring following resection of large vestibular schwannomas; they then analyzed these results with respect to different surgical approaches.
The authors retrospectively reviewed a database of 67 patients with 71 vestibular schwannomas measuring 3 cm or larger in diameter. The patients had undergone surgery via translabyrinthine, retrosigmoid, or combined approaches. Clinical outcomes were analyzed with respect to intraoperative facial nerve activity, responses to intraoperative stimulation, and time course of recovery. Eighty percent of patients obtained normal to near-normal facial function (House-Brackmann Grades I and II). Patients' perceptions of facial nerve function and recovery correlated well with the clinical observations.
Trends in the data lead the authors to suggest that a retrosigmoid exposure, alone or in combination with a translabyrinthine approach, offers the best chance of facial nerve preservation in patients with large vestibular schwannomas.
Venous thromboembolism (VTE) remains one of the principal causes of morbidity and death in trauma patients that survive the first 24 h. Recent literature on VTE prevention focuses on choice of ...chemoprophylaxis, specifically unfractionated heparin (UFH) versus low molecular weight heparin (LMWH). This singular focus on a multifactorial process may be inadequate to fully understand the optimal approach to VTE prevention. We hypothesized that variations in care between trauma centers could be used to identify key components of VTE prevention associated with better outcomes.
A 50 question survey of VTE management for years 2014–2016 was sent to 15 trauma centers. The survey included: demographics of the trauma centers, type and timing of chemoprophylaxis, ambulation expectations, and complementary services (geriatric trauma service (GTS), mobility teams, physical and occupational therapy (PT/OT)). Each center submitted their American College of Surgeons Trauma Quality Improvement Program (TQIP) Benchmark Report for Spring 2017. TQIP data included: mortality, observed rates of deep vein thrombosis (DVT) and pulmonary embolus (PE), and time to VTE prophylaxis. The survey and TQIP reports were blinded for analysis; descriptive statistics were utilized. The top DVT & PE TQIP performers were used to identify potential aspects of better care on the survey responses. The institutions’ DVT and PE rates were then compared for these responses using Wilcoxon-Rank-Sum test.
Fifteen trauma centers (13 Level-1, 2 Level-2) completed the survey; the centers admitted 1050–7200 trauma patients per year (median 3000). The majority of centers were University-affiliated (11 of 15) with general surgery residencies (14 of 15), Acute Care Surgery or Surgical Critical Care Fellowships, (9 of 15) and critical care boarded-surgeons only on-call (9 of 15). Few have geriatric trauma services (3 of 15) or mobility teams (1 of 15). Half the trauma centers have dedicated PT/OT teams for trauma or weekend coverage. With a total of 20,878 TQIP patients analyzed, the average observed DVT and PE rates were 1.27% (range 0.1–5.2%) and 0.68% (range 0–1.6%), respectively. Weekly lower extremity surveillance duplex (2 of 15) increased DVT detection (4.15% vs 0.80%, p = 0.034) but did not decrease PE rates (1.05% vs 0.62%, p = 0.229). Great variance was seen in choice, dosing and timing of chemoprophylaxis: UFH,4 LMWH daily,1 LMWH twice-daily,5 LMWH weight-based dosing,4 and LMWH anti-Xa dosing.1 The top 3 performers for DVT and PE all used different types of chemoprophylaxis. These top performers had a prominent culture of mobility: dedicated PT/OT teams for trauma or weekends and an expectation to ambulate 3-times per day. Weekend PT/OT teams were associated with lower DVT rates (median 0.40%, range 0.10–1.10% vs 1.30%, 0.60–5.20%, p = 0.018), and ambulation 3-times per day was associated with lower PE rates (median 0.20%, range 0.00–0.20% vs 0.80%, 0.40–1.60%, p < 0.005).
Considerable variation in VTE chemoprophylaxis exists among trauma centers. “Best practices” in this area requires further investigation. An expectation of mobility and investment in mobility resources may serve to decrease VTE rates in trauma patients compared to a singular focus on type of chemoprophylaxis administered.
•Survey of trauma centers revealed great variation in VTE chemoprophylaxis.•Choice of VTE chemoprophylaxis was not associated with lower VTE rates.•TID ambulation of trauma patients was associated with lower PE rates.•Weekend mobility or PT/OT teams were associated with lower DVT rates.
This paper analyzes the indentured servitude labor market of colonial America. It is argued that this system developed endogenous market responses to such things as limitations of the legal system ...and changes in contemporary labor market conditions. In particular, this paper shows the role that so-called positive incentives played as a calibrating device, allowing the economic system to run more smoothly. The analysis uses a model of choice under uncertainty, hence expanding the rationality inherent in the indenture system.
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