Publications by authors named "Brian Fry"

50 Publications

Association of Postoperative Opioid Prescription Size and Patient Satisfaction.

Ann Surg 2021 Feb 1. Epub 2021 Feb 1.

Department of Surgery, University of Michigan, Ann Arbor, MI Michigan Surgical Quality Collaborative, Ann Arbor, MI Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI.

Objective: To evaluate the association between postoperative opioid prescription size and patient-reported satisfaction among surgical patients.

Summary Background Data: Opioids are overprescribed after surgery, which negatively impacts patient outcomes. The assumption that larger prescriptions increase patient satisfaction has been suggested as an important driver of excessive prescribing.

Methods: This prospective cohort study evaluated opioid-naïve adult patients undergoing laparoscopic cholecystectomy, laparoscopic appendectomy, and minor hernia repair between January 1 and May 31, 2018. The primary outcome was patient satisfaction, collected via a 30-day postoperative survey. Satisfaction was measured on a scale of 0-10 and dichotomized into "highly satisfied" (9-10) and "not highly satisfied" (0-8). The explanatory variable of interest was size of opioid prescription at discharge from surgery, converted into milligrams of oral morphine equivalents (OME). Hierarchical logistic regression was performed to evaluate the association between prescription size and satisfaction while adjusting for clinical covariates.

Results: 1520 patients met the inclusion criteria. Mean age was 53 years and 43% of patients were female. 1279 (84.1%) patients were highly satisfied and 241 (15.9%) were not highly satisfied. After multivariable adjustment, there was no significant association between opioid prescription size and satisfaction (OR 1.00, 95% CI 0.99-1.00). The predicted probability of being highly satisfied ranged from 83% for the smallest prescription (25 mg OME) to 85% for the largest prescription (750 mg OME).

Conclusions: In a large cohort of patients undergoing common surgical procedures, there was no association between opioid prescription size at discharge after surgery and patient satisfaction. This implies that surgeons can provide significantly smaller opioid prescriptions after surgery without negatively affecting patient satisfaction.
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http://dx.doi.org/10.1097/SLA.0000000000004784DOI Listing
February 2021

Trainee Wellness and Safety in the Context of COVID-19: The Experience of One Institution.

Acad Med 2021 05;96(5):655-660

D.M. Coleman is associate professor of surgery, Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.

The COVID-19 pandemic has had significant ramifications for provider well-being. During these unprecedented and challenging times, one institution's Department of Surgery put in place several important initiatives for promoting the well-being of trainees as they were redeployed to provide care to COVID-19 patients. In this article, the authors describe these initiatives, which fall into 3 broad categories: redeploying faculty and trainees, ensuring provider safety, and promoting trainee wellness. The redeployment initiatives are the following: reframing the team mindset, creating a culture of grace and forgiveness, establishing a multidisciplinary wellness committee, promoting centralized leadership, providing clear communication, coordinating between departments and programs, implementing phased restructuring of the department's services, establishing scheduling flexibility and redundancy, adhering to training regulations, designating a trainee ombudsperson, assessing physical health risks for high-risk individuals, and planning for structured deimplementation. Initiatives specific to promoting provider safety are appointing a trainee safety advocate, guaranteeing personal protective equipment and relevant information about these materials, providing guidance regarding safe practices at home, and offering alternative housing options when necessary. Finally, the initiatives put in place to directly promote trainee wellness are establishing an environment of psychological safety, providing mental health resources, maintaining the educational missions, solidifying a sense of community by showing appreciation, being attentive to childcare, and using social media to promote community morale. The initiatives to carry out the department's strategy presented in this article, which were well received by both faculty and trainee members of the authors' community, may be employed in other departments and even outside the context of COVID-19. The authors hope that colleagues at other institutions and departments, independent of specialty, will find the initiatives described here helpful during, and perhaps after, the pandemic as they develop their own institution-specific strategies to promote trainee wellness.
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http://dx.doi.org/10.1097/ACM.0000000000003853DOI Listing
May 2021

Inorganic carbon uptake strategies in coralline algae: Plasticity across evolutionary lineages under ocean acidification and warming.

Mar Environ Res 2020 Oct 19;161:105107. Epub 2020 Aug 19.

School of Environment & Science and Australian Rivers Institute - Nathan Campus, Griffith University, 170 Kessels Road, Brisbane, Nathan, Queensland, 4111, Australia. Electronic address:

Dissolved inorganic carbon (DIC) assimilation is essential to the reef-building capacity of crustose coralline algae (CCA). Little is known, however, about the DIC uptake strategies and their potential plasticity under ongoing ocean acidification (OA) and warming. The persistence of CCA lineages throughout historical oscillations of pCO and temperature suggests that evolutionary history may play a role in selecting for adaptive traits. We evaluated the effects of pCO and temperature on the plasticity of DIC uptake strategies and associated energetic consequences in reef-building CCA from different evolutionary lineages. We simulated past, present, moderate (IPCC RCP 6.0) and high pCO (RCP 8.5) and present and high (RCP 8.5) temperature conditions and quantified stable carbon isotope fractionation (ε), organic carbon content, growth and photochemical efficiency. All investigated CCA species possess CO-concentrating mechanisms (CCMs) and assimilate CO via diffusion to varying degrees. Under OA and warming, CCA either increased or maintained CCM capacity, which was associated with overall neutral effects on metabolic performance. More basal taxa, Sporolithales and Hapalidiales, had greater capacity for diffusive CO use than Corallinales. We suggest that CCMs are an adaptation that supports a robust carbon physiology and are likely responsible for the endurance of CCA in historically changing oceans.
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http://dx.doi.org/10.1016/j.marenvres.2020.105107DOI Listing
October 2020

Supernova triggers for end-Devonian extinctions.

Proc Natl Acad Sci U S A 2020 09 18;117(35):21008-21010. Epub 2020 Aug 18.

Department of Physics and Astronomy, Washburn University, Topeka, KS 66621.

The Late Devonian was a protracted period of low speciation resulting in biodiversity decline, culminating in extinction events near the Devonian-Carboniferous boundary. Recent evidence indicates that the final extinction event may have coincided with a dramatic drop in stratospheric ozone, possibly due to a global temperature rise. Here we study an alternative possible cause for the postulated ozone drop: a nearby supernova explosion that could inflict damage by accelerating cosmic rays that can deliver ionizing radiation for up to [Formula: see text] ky. We therefore propose that the end-Devonian extinctions were triggered by supernova explosions at [Formula: see text], somewhat beyond the "kill distance" that would have precipitated a full mass extinction. Such nearby supernovae are likely due to core collapses of massive stars; these are concentrated in the thin Galactic disk where the Sun resides. Detecting either of the long-lived radioisotopes [Formula: see text] or [Formula: see text] in one or more end-Devonian extinction strata would confirm a supernova origin, point to the core-collapse explosion of a massive star, and probe supernova nucleosynthesis. Other possible tests of the supernova hypothesis are discussed.
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http://dx.doi.org/10.1073/pnas.2013774117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474607PMC
September 2020

Preferential retention of algal carbon in benthic invertebrates: Stable isotope and fatty acid evidence from an outdoor flume experiment.

Freshw Biol 2020 Jul 2;65(7):1200-1209. Epub 2020 Mar 2.

WasserCluster Lunz - Inter-University Center for Aquatic Ecosystems Research Lunz am See Austria.

According to the River Continuum Concept, headwater streams are richer in allochthonous (e.g. terrestrial leaves) than autochthonous (e.g. algae) sources of organic matter for consumers. However, compared to algae, leaf litter is of lower food quality, particularly ω-3 polyunsaturated fatty acids (n-3 PUFA), and would constrain the somatic growth, maintenance, and reproduction of stream invertebrates. It may be thus assumed that shredders, such as , receive lower quality diets than grazers, e.g. , that typically feed on algae.The objective of this study was to assess the provision of dietary PUFA from leaf litter and algae to the shredder and the grazer . Three different diets (algae, terrestrial leaves, and an algae-leaf litter mix) were supplied to these macroinvertebrates in a flume experiment for 2 weeks. To differentiate how diet sources were retained in these consumers, algae were isotopically labelled with C.Both consumers became enriched with C in all treatments, demonstrating that both assimilated algae. For , n-3 PUFA increased, whereas n-6 PUFA stayed constant. By contrast, the n-3 PUFA content of decreased as a consequence of declining algal supply.Results from compound-specific stable isotope analysis provided evidence that the long-chain n-3 PUFA eicosapentaenoic acid (EPA) in both consumers was more enriched in C than the short-chain n-3 PUFA α-linolenic acid, suggesting that EPA was taken up directly from algae and not from heterotrophic biofilms on leaf litter. Both consumers depended on algae as their carbon and EPA source and retained their EPA from high-quality algae.
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http://dx.doi.org/10.1111/fwb.13492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317824PMC
July 2020

Development and Assessment of the Wisconsin Surgical Coaching Rubric.

JAMA Surg 2020 06;155(6):486-492

Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Madison.

Importance: Surgical coaching continues to gain momentum as an innovative method for continuous professional development. A tool to measure the performance of a surgical coach is needed to provide formative feedback to coaches for continued skill development and to assess the fidelity of a coaching intervention for future research and dissemination.

Objective: To evaluate the validity of the Wisconsin Surgical Coaching Rubric (WiSCoR), a novel tool to assess the performance of a peer surgical coach.

Design, Setting, And Participants: Surgical coaching sessions from November 2014 through February 2018 conducted by 2 statewide peer surgical coaching programs were audio recorded and transcribed. Twelve raters used WiSCoR to rate the performance of the surgical coach for each session. The study included peer surgical coaches in the Wisconsin Surgical Coaching Program (n = 8) and the Michigan Bariatric Surgery Collaborative coaching program (n = 15). The data were analyzed in 2019.

Interventions Or Exposures: Use of WiSCoR to rate peer surgical coaching sessions.

Main Outcomes And Measures: There were 282 WiSCoR ratings from the 106 coaching sessions included in the study. WiSCoR was evaluated using a framework, including inter-rater reliability assessed with Gwet weighted agreement coefficent. Descriptive statistics of WiSCoR were calculated.

Results: Eight coaches (35%) and 11 coachees (29%) were from the Wisconsin Surgical Program and 15 coaches (65%) and 27 coachees (71%) were from the Michigan Bariatric Surgery Collaborative. The validity of WiSCoR is supported by high interrater reliability (Gwet weighted agreement coefficient, 0.87) as well as a weakly positive correlation of WiSCoR to coachee ratings of coaches (r = 0.22; P = .04), rigorous content development, consistent rater training, and the association of WiSCoR with coach and coaching program development. The mean (SD) overall coach performance rating using WiSCoR was 3.23 (0.82; range, 1-5).

Conclusions And Relevance: WiSCoR is a reliable measure that can assess the performance of a surgical coach, inform fidelity to coaching principles, and provide formative feedback to surgical coaches. While coachee ratings may reflect coachee satisfaction, they are not able to determine the quality of a coach.
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http://dx.doi.org/10.1001/jamasurg.2020.0424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177649PMC
June 2020

Coaching as a Mechanism to Challenge Surgical Professional Identities.

Ann Surg 2019 Dec 2. Epub 2019 Dec 2.

Department of Surgery, University of Michigan and the Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, Michigan.

Background: The "surgical personality" is a mostly negative academic and cultural image of the surgeon as egotistical, paternalistic, and inflexible. Because of this image, surgeons have been viewed as resistant to change and some behaviors, vulnerability, for example, are viewed as "suspect" because they seemingly threaten professional competency. We report on exit interviews of surgeons who participated in a coaching program and demonstrate how their narratives challenge the surgical "personality" and forge an evolving and more open professional surgical identity.

Methods: We interviewed n = 34 bariatric surgeons at the end of a 2-year surgical coaching program. Transcribed interviews were analyzed in NVivo, computer-assisted qualitative data analysis software. Coding of transcripts was approached through iterative steps. We utilized an exploratory method; each member of our team independently examined 3 transcripts to evaluate emergent themes early in the investigation. The team met to discuss our independent themes and develop the codebook collectively. We created a descriptive framework for our first round of coding based on emerging themes and employed an interpretive framework to arrive at our themes.

Results: Three major themes emerged from our data. Participants in this study discussed the ways that participation in the coaching program initially conflicted with their identity as a competent professional. Surgeons were acutely aware of how participation might have destabilized their surgical identity because they might be viewed as vulnerable. Despite these concerns about image, surgeons found impetus for improvement because of poor outcome scores or because they desired early career affirmation. Finally, surgeons report that the safe spaces of intentional coaching contributed to their ideas about how surgeons, and ultimately surgery, can change.

Conclusions: Participation in a coaching program challenged how surgeons thought of themselves in relationship to social and peer expectations. Our results indicate that surgeons do feel peer and social pressures related to identity but are much more complex and nuanced than has been previously discussed. The safe space of intentional coaching allowed participants to practice vulnerability without the pressures of sometimes caustic professional norms. Participants in this study viewed coaching as the way to improve the culture of surgery.
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http://dx.doi.org/10.1097/SLA.0000000000003707DOI Listing
December 2019

Stable carbon isotope diagnostics of mammalian metabolism, a high-resolution isotomics approach using amino acid carboxyl groups.

PLoS One 2019 28;14(10):e0224297. Epub 2019 Oct 28.

Queensland Health Forensic and Scientific Services, Coopers Plains, Queensland, Australia.

The carbon isotopic compositions of amino acids are increasingly measured to characterize diets and metabolic response to diets. We report a new high-resolution system to measure the stable carbon isotopic composition of carboxyl atoms within amino acids. The automated system used HPLC to separate amino acids followed by addition of ninhydrin for decarboxylation and transfer of the evolved CO2 to a stable isotope ratio mass spectrometer for δ13CCARBOXYL measurement. The ninhydrin reaction was conducted at acidic pH (1.5) and elevated temperature (160 oC) giving yields close to 100% for most common amino acids. Eight mammalian keratin samples from herbivores (kudu and caribou), omnivores (humans) and carnivores (bowhead and humpback zooplanktivorous whales) were analysed with this new system. The data provide an initial calibration of reference materials to be used in studies of this type and is the first report of carboxyl carbon isotope distributions in mammals. Results showed widespread 13C enrichments in both essential and non-essential amino acid carboxyl groups, likely linked to decarboxylation of amino acids during normal metabolism. Analyses of non-essential amino acid isotope profiles showed (1) consistent and general taxon-level metabolic differences between the herbivore, human and whale samples, (2) marked differences among individual humans, ruminants and whales (3) evidence for gluconeogenesis in the wildlife samples, and (4) extensive 13C enrichment likely associated with fasting in the humpback whale sample. Future mammalian research related to the metabolism of growth, reproduction, aging and disease may benefit from using this technique. Values obtained for internationally available samples USGS42 and USGS43 (Tibetan and Indian human hair) provide a first characterization of reference materials for δ13CCARBOXYL profiles.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224297PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816566PMC
March 2020

Trends in tuna carbon isotopes suggest global changes in pelagic phytoplankton communities.

Glob Chang Biol 2020 02 11;26(2):458-470. Epub 2019 Nov 11.

CSIRO Oceans and Atmosphere, Hobart, Tas., Australia.

Considerable uncertainty remains over how increasing atmospheric CO and anthropogenic climate changes are affecting open-ocean marine ecosystems from phytoplankton to top predators. Biological time series data are thus urgently needed for the world's oceans. Here, we use the carbon stable isotope composition of tuna to provide a first insight into the existence of global trends in complex ecosystem dynamics and changes in the oceanic carbon cycle. From 2000 to 2015, considerable declines in δ C values of 0.8‰-2.5‰ were observed across three tuna species sampled globally, with more substantial changes in the Pacific Ocean compared to the Atlantic and Indian Oceans. Tuna recorded not only the Suess effect, that is, fossil fuel-derived and isotopically light carbon being incorporated into marine ecosystems, but also recorded profound changes at the base of marine food webs. We suggest a global shift in phytoplankton community structure, for example, a reduction in C-rich phytoplankton such as diatoms, and/or a change in phytoplankton physiology during this period, although this does not rule out other concomitant changes at higher levels in the food webs. Our study establishes tuna δ C values as a candidate essential ocean variable to assess complex ecosystem responses to climate change at regional to global scales and over decadal timescales. Finally, this time series will be invaluable in calibrating and validating global earth system models to project changes in marine biota.
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http://dx.doi.org/10.1111/gcb.14858DOI Listing
February 2020

Evaluating coral trophic strategies using fatty acid composition and indices.

PLoS One 2019 11;14(9):e0222327. Epub 2019 Sep 11.

Australian Research Council Centre of Excellence for Coral Reef Studies, The University of Queensland, St. Lucia, Queensland, Australia.

The ecological success of shallow water reef-building corals has been linked to the symbiosis between the coral host and its dinoflagellate symbionts (herein 'symbionts'). As mixotrophs, symbiotic corals depend on nutrients 1) transferred from their photosynthetic symbionts (autotrophy) and 2) acquired by host feeding on particulate organic resources (heterotrophy). However, coral species differ in the extent to which they depend on heterotrophy for nutrition and these differences are typically poorly defined. Here, a multi-tracer fatty acid approach was used to evaluate the trophic strategies of three species of common reef-building coral (Galaxea fascicularis, Pachyseris speciosa, and Pocillopora verrucosa) whose trophic strategies had previously been identified using carbon stable isotopes. The composition and various indices of fatty acids were compared to examine the relative contribution of symbiont autotrophy and host heterotrophy in coral energy acquisition. A linear discriminant analysis (LDA) was used to estimate the contribution of polyunsaturated fatty acids (PUFA) derived from various potential sources to the coral hosts. The total fatty acid composition and fatty acid indices revealed differences between the more heterotrophic (P. verrucosa) and more autotrophic (P. speciosa) coral hosts, with the coral host G. fascicularis showing overlap with the other two species and greater variability overall. For the more heterotrophic P. verrucosa, the fatty acid indices and LDA results both indicated a greater proportion of copepod-derived fatty acids compared to the other coral species. Overall, the LDA estimated that PUFA derived from particulate resources (e.g., copepods and diatoms) comprised a greater proportion of coral host PUFA in contrast to the lower proportion of symbiont-derived PUFA. These estimates provide insight into the importance of heterotrophy in coral nutrition, especially in productive reef systems. The study supports carbon stable isotope results and demonstrates the utility of fatty acid analyses for exploring the trophic strategies of reef-building corals.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222327PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739055PMC
April 2020

Ten-year Trends in Surgical Mortality, Complications, and Failure to Rescue in Medicare Beneficiaries.

Ann Surg 2020 05;271(5):855-861

University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor, MI.

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http://dx.doi.org/10.1097/SLA.0000000000003193DOI Listing
May 2020

Uptake and accumulation of cadmium, manganese and zinc by fisheries species: Trophic differences in sensitivity to environmental metal accumulation.

Sci Total Environ 2019 Nov 3;690:867-877. Epub 2019 Jul 3.

Australia's Nuclear Science and Technology Organisation, New Illawarra Rd, Lucas Heights, NSW, 2234, Australia.

Fishery targeted species living in estuaries face multiple anthropogenic pressures including habitat contamination. However, trace metal concentrations in aquatic organisms can be highly variable, making it difficult to interpret accumulation responses. Understanding sources for metal accumulation in these organisms and their biokinetics is important for management of local fisheries and ensuring safety and quality of consumed seafood, particularly in urbanised areas. In this study, we exposed Australian sand clams, school prawns and sand whiting to a combination of cadmium (Cd), manganese (Mn) and zinc (Zn) radioisotopes 1) dissolved in seawater, 2) adsorbed to suspended sediment particles and 3) in radiolabelled food. Sand clams were sensitive to Cd, Mn and Zn uptake and accumulation from all sources because of their filter feeding physiology. Mean Cd and Zn assimilation efficiencies (AE) were higher in clams fed benthic diatoms (51, 43, 63% for Cd, Mn and Zn, respectively) than clams fed an algal flagellate species (22, 32, 33% for Cd, Mn and Zn, respectively). Metal uptake by prawns from seawater was low, whereas assimilation from diet was high (67, 59, 64% mean AEs from Cd, Mn and Zn, respectively). Sand whiting did not accumulate metals from seawater, even after concentrations were increased. Assimilation from diet (labelled prawns) was also low for sand whiting, particularly for Cd and Zn (11, 26, 14% mean AEs from Cd, Mn and Zn, respectively). These results may help explain the persistence of sand whiting in contaminated estuaries. Suspended sediment exposures showed that prawns and fish are less likely than clams to be negatively affected by disturbance events such as floods, which can bring metals into estuaries. The findings of this study have implications for fisheries management, both for protection and remediation of important habitats, and to ensure safe standards for seafood consumption by humans.
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http://dx.doi.org/10.1016/j.scitotenv.2019.07.016DOI Listing
November 2019

Feeding strategies for the acquisition of high-quality food sources in stream macroinvertebrates: Collecting, integrating, and mixed feeding.

Limnol Oceanogr 2018 Sep 6;63(5):1964-1978. Epub 2018 May 6.

WasserCluster Lunz-Inter-University Centre for Aquatic Ecosystem Research Lunz am See Austria.

Aquatic macroinvertebrates play an important functional role in energy transfer in food webs, linking basal food sources to upper trophic levels that include fish, birds, and humans. However, the trophic coupling of nutritional quality between macroinvertebrates and their food sources is still poorly understood. We conducted a field study in subalpine streams in Austria to investigate how the nutritional quality (measured by long-chain polyunsaturated fatty acids, LC-PUFAs) in macroinvertebrates changes relative to their basal food sources. Samples of macroinvertebrates, periphyton, and leaves were collected from 17 streams in July and October 2016 and their fatty acid (FA) composition was analyzed. Periphyton FA varied strongly with time and space, and their trophic effect on macroinvertebrate FA differed among functional feeding groups. The match between periphyton FA and macroinvertebrate FA decreased with increasing trophic levels, but LC-PUFA content increased with each trophic step from periphyton to grazers and finally predators. Macroinvertebrates fed selectively on, assimilated, and/or actively controlled their LC-PUFA, especially eicosapentaenoic acid (EPA, 20 : 5ω3) relative to their basal food sources in the face of spatial and temporal changes. Grazer FA profiles reflected periphyton FA with relatively good fidelity, and especially their EPA feeding strategy was primarily linked to periphyton FA variation across seasons. In contrast, shredders appeared to preferentially assimilate more EPA over other FA, which was determined by the availability of high-quality food over seasons. Predators may more actively control their LC-PUFA distribution with respect to different quality foods and showed less fidelity to the basal FA profiles in plants and prey. Overall, grazers and shredders showed relatively good fidelity to food FA profiles and performed as both "collectors" and "integrators" for LC-PUFA requirements across seasons, while predators at higher trophic levels were more "integrators" with added metabolic complexity leading to somewhat more divergent FA profiles. These results are potentially applicable for other aquatic consumers in freshwater and marine ecosystems.
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http://dx.doi.org/10.1002/lno.10818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283091PMC
September 2018

Catchment soils supply ammonium to the coastal zone - Flood impacts on nutrient flux in estuaries.

Sci Total Environ 2019 Mar 8;654:583-592. Epub 2018 Nov 8.

Australian Rivers Institute, Griffith University, 170 Kessels Rd, Nathan, Brisbane, Australia.

Erosion of soil from catchments during floods can deliver large quantities of sediment to the coastal zone. The transformations and processes of nutrient release from catchment soils during flooding are not well understood. To test the hypothesis that catchment soils supply nutrients to the coastal zone, we examined nutrient release and transformation following wetting of soils formed from three distinct rock types (basalt, granite and sandstone) with fresh and marine water. The soil samples were collected from eroding areas of a subtropical river catchment. We simulated runoff, transport and deposition by tumbling the fine fraction of the soils in freshwater for three days and settling in seawater for four weeks. We also collected and incubated cores from an adjacent coastal bay and added a layer of catchment soil to simulate deposition of new sediment following flood plume settling. Dissolved nutrients were measured in both simulations. Basalt soils were relatively nutrient rich and released substantial quantities of organic and inorganic dissolved nutrients, particularly phosphate. However when soils were added to estuarine sediment cores and incubated, there was a net influx of phosphate from the overlying water. All soils continually released ammonium in both experiments, indicating that catchment soils may be an important source of ammonium to fuel productivity within the coastal zone. This study provides new insights into increased nitrogen availability in a nitrogen-depauperate coastal zone and identifies catchment geology as an important influence in coastal productivity through delivery of soil nitrogen to downstream estuaries.
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http://dx.doi.org/10.1016/j.scitotenv.2018.11.077DOI Listing
March 2019

Association of Opioid Prescribing With Opioid Consumption After Surgery in Michigan.

JAMA Surg 2019 01 16;154(1):e184234. Epub 2019 Jan 16.

Department of Surgery, University of Michigan, Ann Arbor.

Importance: There is growing evidence that opioids are overprescribed following surgery. Improving prescribing requires understanding factors associated with opioid consumption.

Objective: To describe opioid prescribing and consumption for a variety of surgical procedures and determine factors associated with opioid consumption after surgery.

Design, Setting, And Participants: A retrospective, population-based analysis of the quantity of opioids prescribed and patient-reported opioid consumption across 33 health systems in Michigan, using a sample of adults 18 years and older undergoing surgery. Patients were included if they were prescribed an opioid after surgery. Surgical procedures took place between January 1, 2017, and September 30, 2017, and were included if they were performed in at least 25 patients.

Exposures: Opioid prescription size in the initial postoperative prescription.

Main Outcomes And Measures: Patient-reported opioid consumption in oral morphine equivalents. Linear regression analysis was used to calculate risk-adjusted opioid consumption with robust standard errors.

Results: In this study, 2392 patients (mean age, 55 years; 1353 women [57%]) underwent 1 of 12 surgical procedures. Overall, the quantity of opioid prescribed was significantly higher than patient-reported opioid consumption (median, 30 pills; IQR, 27-45 pills of hydrocodone/acetaminophen, 5/325 mg, vs 9 pills; IQR, 1-25 pills; P < .001). The quantity of opioid prescribed had the strongest association with patient-reported opioid consumption, with patients using 0.53 more pills (95% CI, 0.40-0.65; P < .001) for every additional pill prescribed. Patient-reported pain in the week after surgery was also significantly associated with consumption but not as strongly as prescription size. Compared with patients reporting no pain, patients used a mean (SD) 9 (1) more pills if they reported moderate pain and 16 (2) more pills if they reported severe pain (P < .001). Other significant risk factors included history of tobacco use, American Society of Anesthesiologists class, age, procedure type, and inpatient surgery status. After adjusting for these risk factors, patients in the lowest quintile of opioid prescribing had significantly lower mean (SD) opioid consumption compared with those in the highest quintile (5 [2] pills vs 37 [3] pills; P < .001).

Conclusions And Relevance: The quantity of opioid prescribed is associated with higher patient-reported opioid consumption. Using patient-reported opioid consumption to develop better prescribing practices is an important step in combating the opioid epidemic.
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http://dx.doi.org/10.1001/jamasurg.2018.4234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439853PMC
January 2019

A benthic bioindicator reveals distinct land and ocean-Based influences in an urbanized coastal embayment.

PLoS One 2018 11;13(10):e0205408. Epub 2018 Oct 11.

Australian Rivers Institute, School of the Environment, Griffith University, Nathan, Queensland, Australia.

Biogeochemical maps of coastal regions can be used to identify important influences and inputs that define nearshore environments and biota. Biogeochemical tracers can also track animal movement and their diet, monitor human coastal development, and evaluate the condition of habitats and species. However, the beneficial applications of spatial biogeochemical analysis are hindered by a limited understanding of how tracer distribution is affected by different land and ocean-based influences. To help address these knowledge gaps, we determined the spatial trends of three stable isotopes (δ13C-carbon, δ15N-nitrogen, δ34S-sulfur) and 13 major and trace elements in an urbanized coastal embayment (Moreton Bay, Australia), as incorporated into the muscle tissue of a marine consumer, the eastern king prawn Melicertus plebejus. Results were used to identify unique biochemical regions within the bay and to discuss how spatial patterns in tracers could be used to indicate the relative importance of catchment, urban and offshore drivers in coastal bays. Discriminant analysis identified seven biogeochemical regions that were likely distinguished by variation in catchment, urban, and offshore input, and habitat type. δ13C and δ15N patterns suggested nearshore areas could be distinguished by increased sediment resuspension and higher wastewater inputs from catchments. High inshore lead (Pb) and copper (Cu) concentrations were likely the result of urban input. Arsenic (As) and cadmium (Cd) increased further from shore. This trend implied oceanic influences were a significant control over As and Cd bioavailability. Cobalt (Co) and rare earths were also used to differentiate some nearshore areas, but incongruent distribution patterns in Co suggested it may be less reliable. Overall, results indicated that δ15N, δ13C, Cd, Cu, Pb and rare earth elements were the most reliable tracers to differentiate nearshore and offshore environments, and catchment-based effects. We encourage future studies to consider using a similar multivariate approach in coastal spatial analysis, and to include unrelated tracers that reflect distinct coastal influences.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205408PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181360PMC
March 2019

Moving Toward Every Patient Training for Surgery.

JAMA Surg 2018 12;153(12):1089

University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor.

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http://dx.doi.org/10.1001/jamasurg.2018.1658DOI Listing
December 2018

Stable isotopes demonstrate the effectiveness of a tidally-staged sewage release system.

Mar Pollut Bull 2018 Aug 25;133:233-239. Epub 2018 May 25.

Australian Rivers Institute - Coasts and Estuaries, Griffith University, QLD 4222, Australia; Griffith School of Environment and Science, Gold Coast Campus, Griffith University, QLD 4222, Australia.

Nutrient loading from sewage wastewater discharge contributes to the eutrophication of coastal waters. Wastewater from the Gold Coast, Australia is discharged into the Gold Coast Seaway (GCS) for 13.5 h d primarily on the ebbing tide to disperse wastewater seawards. Nitrogen stable isotopes were used to assess how effectively the tidally staged release system dispersed wastewater out of the GCS and identified pathways by which sewage-N was incorporated into food webs. Turf algae, limpets and barnacles were sampled at the GCS, at two coastal sites and at the mouth of a control estuary that lacked point-source discharge. In the GCS δN values of algae and limpets returned to coastal baseline levels within 250 m of the diffusers. In contrast, δN of filter-feeding barnacles did not significantly vary indicating wastewater-N does not dominate the pelagic food web. Nitrogen stable isotopes clearly demonstrated that the tidally-staged wastewater release system effectively disperses wastewater offshore.
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http://dx.doi.org/10.1016/j.marpolbul.2018.05.020DOI Listing
August 2018

Using experience sampling to examine links between compassion, eudaimonia, and pro-social behavior.

J Pers 2019 06 1;87(3):690-701. Epub 2018 Oct 1.

Psychology Department, Indiana Wesleyan University, Marion, Indiana.

Objective: Compassion has been associated with eudaimonia and pro-social behavior, and it has been regarded as a virtue, both historically and cross-culturally. However, the psychological study of compassion has been limited to laboratory settings and/or standard survey assessments. Here, we use an experience sampling method (ESM) to compare naturalistic assessments of compassion with standard assessments, and to examine compassion, its variability, and associations with eudaimonia and pro-social behavior.

Method: Undergraduate students (n = 200) took a survey that included standard assessments of compassion and eudaimonia. Then, over 4 days, they were repeatedly asked about their level of compassion, eudaimonia, and situational factors within the moments of daily life. Finally, pro-social behavior was tested using the Dual Gamble Task and an opportunity to donate task winnings.

Results: Analyses revealed within-person associations between ESM compassion and eudaimonia. ESM compassion also predicted eudaimonia at the next ESM time point. While not impervious to situational factors, considerable consistency was observed in ESM compassion in comparison with eudaimonia. Further, ESM compassion along with eudaimonia predicted donating behavior. Standard assessments did not.

Conclusions: Consistent with virtue theory, some individuals' reports were indicative of a probabilistic tendency toward compassion, and ESM compassion predicted ESM eudaimonia and pro-social behavior toward those in need.
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http://dx.doi.org/10.1111/jopy.12426DOI Listing
June 2019

Using Patient-reported Outcomes to Enhance Appropriateness in Low-risk Elective General Surgery.

Ann Surg 2019 01;269(1):41-42

University of Michigan Center for Healthcare Outcomes & Policy, Ann Arbor, MI.

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http://dx.doi.org/10.1097/SLA.0000000000002864DOI Listing
January 2019

Estuarine crocodiles in a tropical coastal floodplain obtain nutrition from terrestrial prey.

PLoS One 2018 6;13(6):e0197159. Epub 2018 Jun 6.

Australian Rivers Institute, Griffith University, Nathan, QLD, Australia.

The estuarine crocodile (Crocodylus porosus) is one of the largest and most widespread crocodilians in the world. Although considered an apex species, the role of the estuarine crocodile in aquatic foodwebs is poorly understood; we know what crocodiles ingest, but not what nourishes them. In this study, we used a combination of stable isotope measurements (δ13C, δ15N, and δ34S) and direct feeding observations to identify the source of nutrition of estuarine crocodiles in Kakadu National Park, Northern Australia. Our results show that most crocodiles sampled (size 850 - 4200mm, with 76% of them being > 2.5 m) consume a large variety of prey, however a large proportion of their nutrition is derived from terrestrial prey. Introduced species such as water buffaloes (Bubalus bubalis) and pigs (Sus scrofa) could contribute between 53 and 84% to the nutrition of the sampled crocodiles. The isotopic composition of large crocodiles (total length > 3 m) suggested possible increase in marine prey consumption with size (R2 = 0.30; p = 0.005). Additionally, we found crocodiles sampled in the dry season had on average higher terrestrial contributions compared to crocodiles sampled during the wet season (84.1 ± 2.4% versus 55.4 ± 7.0%). Overall, we found that terrestrial prey are important source of nutrition for many crocodiles in this region where introduced herbivorous mammals are abundant.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197159PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991389PMC
November 2018

Smartphone delivery of a hope intervention: Another way to flourish.

PLoS One 2018 1;13(6):e0197930. Epub 2018 Jun 1.

Psychology Department, Behavioral Sciences Division, Indiana Wesleyan University, Marion, Indiana, United States of America.

Positive interventions have shown promise for fostering hedonic (happiness) and eudaimonic (flourishing) well-being. However, few studies have focused on positive interventions that target hope as a means of increasing well-being, and none have examined the use of smartphone app-based systems for delivering interventions in the moments and contexts of daily life-an approach called ecological momentary intervention (EMI). We conducted a quasi-experimental pilot study using a pretest and posttest design to examine the feasibility and potential impact of a mobile app-based hope EMI. Participants appeared to engage with the intervention and found the experience to be user-friendly, helpful, and enjoyable. Relative to the control group, those receiving the intervention demonstrated significantly greater increases in hope; however, there were no between-group differences in hedonic and eudaimonic well-being. The authors recommend future research to examine the potential of EMI mobile apps to cultivate hope and promote flourishing.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197930PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5983435PMC
December 2018

Position-specific C/ C analysis of amino acid carboxyl groups - automated flow-injection analysis based on reaction with ninhydrin.

Rapid Commun Mass Spectrom 2018 Jun;32(12):992-1000

Thermo Fisher Scientific, 28199, Bremen, Germany.

Rationale: The fundamental level of stable isotopic knowledge lies at specific atomic positions within molecules but existing methods of analysis require lengthy off-line preparation to reveal this information. An automated position-specific isotope analysis (PSIA) method is presented to determine the stable carbon isotopic compositions of the carboxyl groups of amino acids (δ C values). This automation makes PSIA measurements easier and routine.

Methods: An existing high-performance liquid chromatography (HPLC) gas handling interface/stable isotope ratio mass spectrometry system was modified by the addition of a post-column derivatisation unit between the HPLC system and the interface. The post-column reaction was optimised to yield CO from the carboxyl groups of amino acids by reaction with ninhydrin.

Results: The methodology described produced δ C values with typical standard deviations below ±0.1 ‰ and consistent differences (Δ C values) between amino acids over a 1-year period. First estimates are presented for the δ C values of a number of internationally available amino acid reference materials.

Conclusions: The PSIA methodology described provides a further dimension to the stable isotopic characterisation of amino acids at a more detailed level than the bulk or averaged whole-molecule level. When combined with on-line chromatographic separation or off-line fraction collection of protein hydrolysates the technique will offer an automated and routine way to study position-specific carboxyl carbon isotope information for amino acids, enabling more refined isotopic studies of carbon uptake and metabolism.
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http://dx.doi.org/10.1002/rcm.8126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032851PMC
June 2018

Signals from the south; humpback whales carry messages of Antarctic sea-ice ecosystem variability.

Glob Chang Biol 2018 04 28;24(4):1500-1510. Epub 2018 Jan 28.

Southern Ocean Persistent Organic Pollutants Program, The Environmental Futures Research Institute, Griffith University, Brisbane, Qld, Australia.

Southern hemisphere humpback whales (Megaptera novaeangliae) rely on summer prey abundance of Antarctic krill (Euphausia superba) to fuel one of the longest-known mammalian migrations on the planet. It is hypothesized that this species, already adapted to endure metabolic extremes, will be one of the first Antarctic consumers to show measurable physiological change in response to fluctuating prey availability in a changing climate; and as such, a powerful sentinel candidate for the Antarctic sea-ice ecosystem. Here, we targeted the sentinel parameters of humpback whale adiposity and diet, using novel, as well as established, chemical and biochemical markers, and assembled a time trend spanning 8 years. We show the synchronous, inter-annual oscillation of two measures of humpback whale adiposity with Southern Ocean environmental variables and climate indices. Furthermore, bulk stable isotope signatures provide clear indication of dietary compensation strategies, or a lower trophic level isotopic change, following years indicated as leaner years for the whales. The observed synchronicity of humpback whale adiposity and dietary markers, with climate patterns in the Southern Ocean, lends strength to the role of humpback whales as powerful Antarctic sea-ice ecosystem sentinels. The work carries significant potential to reform current ecosystem surveillance in the Antarctic region.
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http://dx.doi.org/10.1111/gcb.14035DOI Listing
April 2018

Quality Improvement in Bariatric Surgery: The Impact of Reducing Postoperative Complications on Medicare Payments.

Ann Surg 2018 07;268(1):22-27

University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor, MI.

Objective: To determine the temporal relationship between reducing surgical complications and costs, using the study population of bariatric surgery.

Background: Understanding the relationship between quality and costs has significant implications for the business case of investing in performance improvement. An unprecedented focus on safety in bariatric surgery has led to substantial reductions in complication rates over time, making it an ideal patient population in which to examine this relationship.

Methods: We performed a retrospective review of Medicare beneficiaries undergoing bariatric surgery in the years 2005 to 2006 and 2013 to 2014 (total N = 37,329 patients, 562 hospitals). Hospitals were ranked into quintiles based on their degree of improvement in risk and reliability-adjusted 30-day rates of serious complications across the time periods. Multivariable regression was used to calculate corresponding changes in average price-standardized payments for each quintile of hospitals.

Results: We found a strong association between reductions in complications and decreased Medicare payments. The top 20% of hospitals had a decrease in average serious complication rate of 7.3% (10.0%-2.7%; P < 0.001) and an average per-patient savings of $4861 (95% confidence interval $3921-5802). Conversely, the bottom 20% of hospitals had smaller decrease in complication rate of 0.8% (4.4% to 3.6%; P < 0.001) and a smaller average savings of $2814 (95% confidence interval $2139-3490).

Conclusions: When analyzing Medicare patients undergoing bariatric surgery, hospitals with the largest reductions in serious postoperative complications had the greatest decrease in per-patient payments. This study demonstrates the potential savings associated with quality improvement in high-risk surgical procedures.
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http://dx.doi.org/10.1097/SLA.0000000000002613DOI Listing
July 2018

Radiocarbon as a Novel Tracer of Extra-Antarctic Feeding in Southern Hemisphere Humpback Whales.

Sci Rep 2017 06 29;7(1):4366. Epub 2017 Jun 29.

Griffith University, Environmental Futures Research Institute (EFRI), Southern Ocean Persistent Organic Pollutants (SOPOPP), Brisbane, QLD 4111, Australia.

Bulk stable isotope analysis provides information regarding food web interactions, and has been applied to several cetacean species for the study of migration ecology. One limitation in bulk stable isotope analysis arises when a species, such as Southern hemisphere humpback whales, utilises geographically distinct food webs with differing isotopic baselines. Migrations to areas with different baselines can result in isotopic changes that mimic changes in feeding relations, leading to ambiguous food web interpretations. Here, we demonstrate the novel application of radiocarbon measurement for the resolution of such ambiguities. Radiocarbon was measured in baleen plates from humpback whales stranded in Australia between 2007 and 2013, and in skin samples collected in Australia and Antarctica from stranded and free-ranging animals. Radiocarbon measurements showed lower values for Southern Ocean feeding than for extra-Antarctic feeding in Australian waters. While the whales mostly relied on Antarctic-derived energy stores during their annual migration, there was some evidence of feeding within temperate zone waters in some individuals. This work, to our knowledge, provides the first definitive biochemical evidence for supplementary feeding by southern hemisphere humpback whales within temperate waters during migration. Further, the work contributes a powerful new tool (radiocarbon) for tracing source regions and geographical feeding.
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http://dx.doi.org/10.1038/s41598-017-04698-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491506PMC
June 2017

Recruitment and connectivity influence the role of seagrass as a penaeid nursery habitat in a wave dominated estuary.

Sci Total Environ 2017 Apr 26;584-585:622-630. Epub 2017 Jan 26.

Port Stephens Fisheries Institute, New South Wales Department of Primary Industries, Taylors Beach Rd, Taylors Beach, New South Wales, Australia; School of Environmental and Life Sciences, University of Newcastle, New South Wales, Australia.

Estuaries provide a diverse mosaic of habitats which support both juveniles and adults of exploited species. In particular, estuaries play an important role in the early life history of many penaeid prawn species. This study used a combination of stable isotope ecology and quantitative sampling to examine recruitment and the nursery function of seagrass habitats for Eastern King Prawn (Penaeus [Melicertus] plebejus), and the processes that contributed to this nursery role. Stable isotopes were used to assign prawns joining the adult stock to putative nursery habitat areas within the estuary. Emigrating prawns originated from only 11 of the 20 sites surveyed. Of these, 8 sites were designated as Effective Juvenile Habitat (EJH), and 5 sites designated as Nursery Habitat (NH). The contribution of individuals from different nursery areas to the adult stock was related to both the abundance of prawns within an area and the distance to the mouth of the estuary, and with the exception of 1 site all EJH and NH were located in the northern section of the estuary. Quantitative sampling in this area indicated that prawns were present at an average density of 165±11 per 100m, and density formed non-linear relationships with the distance to the mouth of the estuary, seagrass cover and temperature. Prawn size also formed non-linear relationships with prawn density and seagrass cover. Spatial patterns in abundance were consistent with wind-driven recruitment patterns, which in turn affected the nursery role of particular areas within the system. These findings have implications for targeted fishery restoration efforts for both Eastern King Prawn and other ocean spawned species in wave dominated estuaries where circulation is primarily wind-driven.
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http://dx.doi.org/10.1016/j.scitotenv.2017.01.087DOI Listing
April 2017

Barriers to efficiency in robotic surgery: the resident effect.

J Surg Res 2016 10 4;205(2):296-304. Epub 2016 Jul 4.

Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California; Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address:

Background: Robotic surgery offers advantages over conventional operative approaches but may also be associated with higher costs and additional risks. Analyzing surgical flow disruptions (FDs), defined as "deviations from the natural progression of an operation," can help target training techniques and identify opportunities for improvement.

Materials And Methods: Thirty-two robotic surgery operations were observed over a 6-wk period at one 900-bed surgical center. FDs were recorded in detail and classified into one of 11 different categories. Procedure type, robot model, and resident involvement were also recorded. Linear regression analyses were used to evaluate the effects of these parameters on FDs and operative duration.

Results: Twenty-one prostatectomies, eight sacrocolpopexies, and three nephrectomies were observed. The mean number of FDs was 48.2 (95% confidence interval [CI] 38.6-54.8 FDs), and mean operative duration was 163 min (95% CI 148-179 min). Each FD added 2.4 min (P = 0.025) to a case's total operative duration. The number and rate of FDs were significantly affected by resident involvement (P = 0.008 and P = 0.006, respectively). Resident cases demonstrated mostly training, equipment, and robot switch FDs, whereas nonresident cases demonstrated mostly equipment, instrument changes, and external factor FDs.

Conclusions: Although the FDs encountered in resident training are more frequent, they may not significantly increase operative duration. Other FDs, such as equipment or external factors, may be more impactful. Limiting these specific FDs should be the focus of performance improvement efforts.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074561PMC
http://dx.doi.org/10.1016/j.jss.2016.06.092DOI Listing
October 2016

Isotopic Evidence of a Wide Spectrum of Feeding Strategies in Southern Hemisphere Humpback Whale Baleen Records.

PLoS One 2016 31;11(5):e0156698. Epub 2016 May 31.

Environmental Futures Research Institute, Griffith University, Brisbane QLD 4111, Australia.

Our current understanding of Southern hemisphere humpback whale (Megaptera novaeangliae) ecology assumes high-fidelity feeding on Antarctic krill in Antarctic waters during summer, followed by fasting during their annual migration to and from equatorial breeding grounds. An increase in the number of reported departures from this feeding/fasting model suggests that the current model may be oversimplified or, alternatively, undergoing contemporary change. Information about the feeding and fasting cycles of the two Australian breeding populations of humpback whales were obtained through stable isotope analysis of baleen plates from stranded adult individuals. Comparison of isotope profiles showed that individuals from the West Australian breeding population strongly adhered to the classical feeding model. By contrast, East Australian population individuals demonstrated greater heterogeneity in their feeding. On a spectrum from exclusive Antarctic feeding to exclusive feeding in temperate waters, three different strategies were assigned and discussed: classical feeders, supplemental feeders, and temperate zone feeders. Diversity in the inter-annual feeding strategies of humpback whales demonstrates the feeding plasticity of the species, but could also be indicative of changing dynamics within the Antarctic sea-ice ecosystem. This study presents the first investigation of trophodynamics in Southern hemisphere humpback whales derived from baleen plates, and further provides the first estimates of baleen plate elongation rates in the species.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156698PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4887117PMC
July 2017