Long-term follow-up after implantation of the Shelhigh® No-React® complete biological aortic valved conduit†.

OBJECTIVES Long-term follow-up reports after implantation of the Shelhigh® (Shelhigh, Inc., NJ, USA) No-React® aortic valved conduit used for aortic root replacement do not exist. METHODS Between November 1998 and December 2007, the Shelhigh® No-React® aortic valved conduit was implanted in 291 consecutive patients with a mean age of 69.6 ± 9.1 years, and 33.7% were female (n = 98). Indications were annulo-aortic ectasia (n = 202), aortic valve stenosis combined with ascending aortic aneurysm (n = 67), acute type A aortic dissection (n = 29), endocarditis (n = 26) and other related pathologies (n = 48) including 62 patients with previous cardiac surgery. Data from two cardiac institutions were analysed retrospectively using SPSS (SPSS Software IBM, Inc., 2014, NY, USA). RESULTS Operative mortality was 10% (n = 29). Main cause of death was cardiac failure in 15 patients (51.8%), neurological events in 6 patients (20.7%), respiratory failure in 4 patients (13.8%), bleeding complications in 2 patients (6.9%) and gastrointestinal ischaemia in 2 cases (6.9%). There were 262 hospital survivors and all were entered in the follow-up study (100% complete). During the long-term follow-up (mean 70.3 ± 53.1 in months), a total of 126/262 patients (44.3%) died. Main causes of death in patients after discharge were cardiac (n = 37, 14.1%), neurological (n = 15, 5.7%) respiratory (n = 12, 4.6%), endocarditis (n = 12, 4.6%) and peripheral vascular disease (n = 5, 1.9%). In 29 (11.1%) patients, the cause of death could not be determined. Reoperation was required in 25 (8.6%) patients due to infection of the conduit (n = 9), aortoventricular disconnection (n = 4), pseudoaneurysm formation (n = 4) and structural valve degeneration (n = 8). Reoperations were performed 5.0 ± 3.8 (range 0.1-11.7) years after index surgery. CONCLUSIONS The Shelhigh® No-React® aortic valved conduit showed satisfactory short-term operative results. However, the long-term follow-up revealed a relatively high rate of deaths, which may be explained by the epidemiology of the patient group, but a substantial proportion of deaths could not be clarified. The overall rate of reoperation (8.6%) during the mid-term follow-up is worrisome and the failures due to aortoventricular disconnection, endocarditis and pseudoaneurysm formation remain unexplained. The redo-procedures were technically demanding. We recommend close follow-up of patients with the Shelhigh® No-React® aortic valved conduit, because besides classical structural valve degeneration, unexpected findings may be observed.

The Better Regulation Package: Creating better regulations, but for what kind of EU politics?. European Policy Brief No. 39, October 2015

Back in July 2015, we acknowledged the priorities established by the Luxembourg presidency, topped by ambitious cross-sectoral dossier of Better Regulation and the Interinstitutional Agreement negociations. We investigated these issues through the lens of their “A Union for the Citizens” pledge. With four months left, this promise to EU citizens still has much to deliver if it is to meet expectations. This paper is a mid-term look at the advances made with these dossiers.

Myopic foveoschisis:a clinical review

To review the literature on epidemiology, clinical features, diagnostic imaging, natural history, management, therapeutic approaches, and prognosis of myopic foveoschisis. A systematic Pubmed search was conducted using search terms: myopia, myopic, staphyloma, foveoschisis, and myopic foveoschisis. The evidence base for each section was organised and reviewed. Where possible an authors' interpretation or conclusion is provided for each section. The term myopic foveoschisis was first coined in 1999. It is associated with posterior staphyloma in high myopia, and is often asymptomatic initially but progresses slowly, leading to loss of central vision from foveal detachment or macular hole formation. Optical coherence tomography is used to diagnose the splitting of the neural retina into a thicker inner layer and a thinner outer layer, but compound variants of the splits have been identified. Vitrectomy with an internal limiting membrane peel and gas tamponade is the preferred approach for eyes with vision decline. There has been a surge of new information on myopic foveoschisis. Advances in optical coherence tomography will continually improve our understanding of the pathogenesis of retinal splitting, and the mechanisms that lead to macular damage and visual loss. Currently, there is a good level of consensus that surgical intervention should be considered when there is progressive visual decline from myopic foveoschisis.

Long-Term Effects of Adding Nutrients to an Oligotrophic Coastal Environment

Management of ecological disturbances requires an understanding of the time scale and dynamics of community responses to disturbance events. To characterize long-term seagrass bed responses to nutrient enrichment, we established six study sites in Florida Bay, USA. In 24 plots (0.25 m2) at each site, we regularly added nitrogen (N) and phosphorus (P) in a factorial design for 7 years. Five of the six sites exhibited strong P limitation. Over the first 2 years, P enrichment increased Thalassia testudinum cover in the three most P-limited sites. After 3 years, Halodule wrightii began to colonize many of the P-addition plots, but the degree of colonization was variable among sites, possibly due to differences in the supply of viable propagules. Thalassia increased its allocation to aboveground tissue in response to P enrichment; Halodule increased in total biomass but did not appear to change its aboveground: belowground tissue allocation. Nutrient enrichment did not cause macroalgal or epiphytic overgrowth of the seagrass. Nitrogen retention in the study plots was variable but relatively low, whereas phosphorus retention was very high, often exceeding 100% of the P added as fertilizer over the course of our experiments. Phosphorus retentions exceeding 100% may have been facilitated by increases in Thalassia aboveground biomass, which promoted the settlement of suspended particulate matter containing phosphorus. Our study demonstrated that lowintensity press disturbance events such as phosphorus enrichment can initiate a slow, ramped successional process that may alter community structure over many years.

Temporally dependent C, N, and P dynamics associated with the decay of Rhizophora mangle L. leaf litter in oligotrophic mangrove wetlands of the Southern Everglades

We performed two litter decomposition experiments using nearly-senesced red mangrove (Rhizophora mangle L.) leaves collected from an Everglades dwarf mangrove wetland to understand the short-term (3 weeks) and long-term (1 year) changes in mass, as well as C-, N-, and P-content of decomposing leaf litter. We expected that leaves decomposing in this oligotrophic environment would be short-term sources of C, N, and P, but potential long-term sinks for N and P. In May 1998, we conducted a 3-week leaching experiment, incubating fresh, individual leaves in seawater for up to 21 days. From May 1997 to May 1998, leaf litter in mesh bags decomposed on the forest floor at two dwarf mangrove sites. Leaching accounted for about 33% loss of dry mass from R. mangle leaves after 3 weeks. Leaching losses were rapid, peaking by day 2, and large, with leachate concentrations of total organic carbon (TOC) and total phosphorus (TP) increasing by more than an order of magnitude after 3 weeks. Mean leaf C:N increased from 105 to 115 and N:P increased from a mean of 74 to 95 after 21 days, reflecting the relatively large leaching losses of N and P. Loss of mass in the litterbags leveled off after 4 months, with roughly 60%dry mass remaining (DMR) after nearly 1 year of decomposition. The mass of carbon in each litterbag declined significantly after 361 days, but the mass of nitrogen and phosphorus doubled, indicating long-term accumulation of these constituents into the detritus. Subsequently, the leaf C:N ratio dropped significantly from 90 to 34 after 361 days. Following an initial 44-day increase, leaf N:P decreased from 222 to 144, reflecting high accumulation of P relative to N. A review of several estuarine macrophyte decomposition studies reveals a trend in nitrogen accumulation through time regardless of site, but suggests no clear pattern for C and P. We believe that the increase in litter P observed in this study was indicative of the P-limited status of the greater Everglades ecosystem and that decomposing mangrove litter may represent a substantial phosphorus pool in the system.

Surprises and Insights from Long-Term Aquatic Data Sets and Experiments

long-term research on freshwater ecosystems provides insights that can be difficult to obtain from other approaches. Widespread monitoring of ecologically relevant water-quality parameters spanning decades can facilitate important tests of ecological principles. Unique long-term data sets and analytical tools are increasingly available, allowing for powerful and synthetic analyses across sites. long-term measurements or experiments in aquatic systems can catch rare events, changes in highly variable systems, time-lagged responses, cumulative effects of stressors, and biotic responses that encompass multiple generations. Data are available from formal networks, local to international agencies, private organizations, various institutions, and paleontological and historic records; brief literature surveys suggest much existing data are not synthesized. Ecological sciences will benefit from careful maintenance and analyses of existing long-term programs, and subsequent insights can aid in the design of effective future long-term experimental and observational efforts. long-term research on freshwaters is particularly important because of their value to humanity.

Ecosystem Structure and Function Still Altered Two Decades After Short-Term Fertilization of a Seagrass Meadow

An oligotrophic phosphorus (P) limited seagrass ecosystem in Florida Bay was experimentally fertilized in a unique way. Perches were installed to encourage seabirds to roost and deliver an external source of nutrients via defecation. Two treatments were examined: (1) a chronic 23-year fertilization and (2) an earlier 28-month fertilization that was discontinued when the chronic treatment was initiated. Because of the low mobility of P in carbonate sediments, we hypothesized long-term changes to ecosystem structure and function in both treatments. Structural changes in the chronic treatment included a shift in the dominant seagrass species from Thalassia testudinum to Halodule wrightii, large increases in epiphytic biomass and sediment chlorophyll-a, and a decline in species richness. Functional changes included increased benthic metabolism and quantum efficiency. Initial changes in the 28-month fertilization were similar, but after 23 years of nutrient depuration T. testudinum has reestablished itself as the dominant species. However, P remains elevated in the sediment and H. wrightii has maintained a presence. Functionally the discontinued treatment remains altered. Biomass exceeds that in the chronic treatment and indices of productivity, elevated relative to control, are not different from the chronic fertilization. Cessation of nutrient loading has resulted in a superficial return to the pre-disturbance character of the community, but due to the nature of P cycles functional changes persist.

A Conceptual Framework to Develop Long-Term Ecological Research and Management Objectives in the Wider Caribbean Region

The Caribbean Sea and its watersheds show signs of environmental degradation. These fragile coastal ecosystems are susceptible to environmental impacts, in part because of their oligotrophic conditions and their critical support of economic development. Tourism is one of the major sources of income in the Caribbean, making the region one of the most ecotourism dependent in the world. Yet there are few explicit, long-term, comprehensive studies describing the structure and function of Caribbean ecosystems. We propose a conceptual framework using the environmental signature hypothesis of tropical coastal settings to develop a series of research questions for the reef–sea-grass–wetland seascape. We applied this approach across 13 sites throughout the region, including ecosystems in a variety of coastal settings with different vulnerabilities to environmental impacts. This approach follows the strategy developed by the Long Term Ecological Research program of the National Science Foundation to establish ecological research questions best studied over decades and large spatial areas.

Short-term changes in phosphorus storage in an oligotrophic Everglades wetland ecosystem receiving experimental nutrient enrichment

Natural, unenriched Evergladeswetlands are known to be limited by phosphorus(P) and responsive to P enrichment. However,whole-ecosystem evaluations of experimental Padditions are rare in Everglades or otherwetlands. We tested the response of theEverglades wetland ecosystem to continuous,low-level additions of P (0, 5, 15, and30 μg L−1 above ambient) in replicate,100 m flow-through flumes located in unenrichedEverglades National Park. After the first sixmonths of dosing, the concentration andstanding stock of phosphorus increased in thesurface water, periphyton, and flocculentdetrital layer, but not in the soil or macrophytes. Of the ecosystem components measured, total P concentration increased the most in the floating periphyton mat (30 μg L−1: mean = 1916 μg P g−1, control: mean =149 μg P g−1), while the flocculentdetrital layer stored most of the accumulated P(30 μg L−1: mean = 1.732 g P m−2,control: mean = 0.769 g P m−2). Significant short-term responsesof P concentration and standing stock wereobserved primarily in the high dose (30 μgL−1 above ambient) treatment. Inaddition, the biomass and estimated P standingstock of aquatic consumers increased in the 30and 5 μg L−1 treatments. Alterationsin P concentration and standing stock occurredonly at the upstream ends of the flumes nearestto the point source of added nutrient. Thetotal amount of P stored by the ecosystemwithin the flume increased with P dosing,although the ecosystem in the flumes retainedonly a small proportion of the P added over thefirst six months. These results indicate thatoligotrophic Everglades wetlands respondrapidly to short-term, low-level P enrichment,and the initial response is most noticeable inthe periphyton and flocculent detrital layer.

Diatom-based paleolimnological reconstruction of regional climate and local land-use change from a protected sinkhole lake in southern Florida, USA

Despite their sensitivity to climate variability, few of the abundant sinkhole lakes of Florida have been the subject of paleolimnological studies to discern patterns of change in aquatic communities and link them to climate drivers. However, deep sinkhole lakes can contain highly resolved paleolimnological records that can be used to track long-term climate variability and its interaction with effects of land-use change. In order to understand how limnological changes were regulated by regional climate variability and further modified by local land-use change in south Florida, we explored diatom assemblage variability over centennial and semi-decadal time scales in an ~11,000-yr and a ~150-yr sediment core extracted from a 21-m deep sinkhole lake, Lake Annie, on the protected property of Archbold Biological Station. We linked variance in diatom assemblage structure to changes in water total phosphorus, color, and pH using diatom-based transfer functions. Reconstructions suggest the sinkhole depression contained a small, acidic, oligotrophic pond ~11000–7000 cal yr BP that gradually deepened to form a humic lake by ~4000 cal yr BP, coinciding with the onset of modern precipitation regimes and the stabilization of sea-level indicated by corresponding palynological records. The lake then contained stable, acidophilous planktonic and benthic algal communities for several thousand years. In the early AD 1900s, that community shifted to one diagnostic of an even lower pH (~5.6), likely resulting from acid precipitation. Further transitions over the past 25 yr reflect recovery from acidification and intensified sensitivity to climate variability caused by enhanced watershed runoff from small drainage ditches dug during the mid-twentieth Century on the surrounding property.

Challenges in using siliceous subfossils as a tool for inferring past water level and hydroperiod in Everglades marshes

Successfully rehabilitating drained wetlands through hydrologic restoration is dependent on defining restoration targets, a process that is informed by pre-drainage conditions, as well as understanding linkages between hydrology and ecosystem structure. Paleoecological records can inform restoration goals by revealing long-term patterns of change, but are dependent on preservation of biomarkers that provide meaningful interpretations of environmental change. In the Florida Everglades, paleohydrological hind-casting could improve restoration forecasting, but frequent drying of marsh soils leads to poor preservation of many biomarkers. To determine the effectiveness of employing siliceous subfossils in paleohydrological reconstructions, we examined diatoms, plant and sponge silico-sclerids from three soil cores in the central Everglades marshes. Subfossil quality varied among cores, but the abundance of recognizable specimens was sufficient to infer 1,000–3,000 years of hydrologic change at decadal to centennial resolution. Phytolith morphotypes were linked to key marsh plant species to indirectly measure fluctuations in water depth. A modern dataset was used to derive diatom-based inferences of water depth and hydroperiod (R2 = 0.63, 0.47; RMSE = 14 cm, 120 days, respectively). Changes in subfossil quality and abundances at centennial time-scales were associated with mid-Holocene climate events including the Little Ice Age and Medieval Warm Period, while decadal-scale fluctuations in assemblage structure during the twentieth century suggested co-regulation of hydrology by cyclical climate drivers (particularly the Atlantic Multidecadal Oscillation) and water management changes. The successful reconstructions based on siliceous subfossils shown here at a coarse temporal scale (i.e., decadal to centennial) advocate for their application in more highly resolved (i.e., subdecadal) records, which should improve the ability of water managers to target the quantity and variability of water flows appropriate for hydrologic restoration.

Impact of Late Holocene climate variability and anthropogenic activities on Biscayne Bay (Florida, U.S.A.): Evidence from diatoms

Shallow marine ecosystems are experiencing significant environmental alterations as a result of changing climate and increasing human activities along coasts. Intensive urbanization of the southeast Florida coast and intensification of climate change over the last few centuries changed the character of coastal ecosystems in the semi-enclosed Biscayne Bay, Florida. In order to develop management policies for the Bay, it is vital to obtain reliable scientific evidence of past ecological conditions. The long-term records of subfossil diatoms obtained from No Name Bank and Featherbed Bank in the Central Biscayne Bay, and from the Card Sound Bank in the neighboring Card Sound, were used to study the magnitude of the environmental change caused by climate variability and water management over the last ~ 600 yr. Analyses of these records revealed that the major shifts in the diatom assemblage structures at No Name Bank occurred in 1956, at Featherbed Bank in 1966, and at Card Sound Bank in 1957. Smaller magnitude shifts were also recorded at Featherbed Bank in 1893, 1942, 1974 and 1983. Most of these changes coincided with severe drought periods that developed during the cold phases of El Niño Southern Oscillation (ENSO), Atlantic Multidecadal Oscillation (AMO) and Pacific Decadal Oscillation (PDO), or when AMO was in warm phase and PDO was in the cold phase. Only the 1983 change coincided with an unusually wet period that developed during the warm phases of ENSO and PDO. Quantitative reconstructions of salinity using the weighted averaging partial least squares (WA-PLS) diatom-based salinity model revealed a gradual increase in salinity at the three coring locations over the last ~ 600 yr, which was primarily caused by continuously rising sea level and in the last several decades also by the reduction of the amount of freshwater inflow from the mainland. Concentration of sediment total nitrogen (TN), total phosphorus (TP) and total organic carbon (TOC) increased in the second half of the 20th century, which coincided with the construction of canals, landfills, marinas and water treatment plants along the western margin of Biscayne Bay. Increased magnitude and rate of the diatom assemblage restructuring in the mid- and late-1900s, suggest that large environmental changes are occurring more rapidly now than in the past.

Correspondence of historic salinity fluctuations in Florida Bay, USA, to atmospheric variability and anthropogenic changes

Florida Bay is a highly dynamic estuary that exhibits wide natural fluctuations in salinity due to changes in the balance of precipitation, evaporation and freshwater runoff from the mainland. Rapid and large-scale modification of freshwater flow and construction of transportation conduits throughout the Florida Keys during the late nineteenth and twentieth centuries reshaped water circulation and salinity patterns across the ecosystem. In order to determine long-term patterns in salinity variation across the Florida Bay estuary, we used a diatom-based salinity transfer function to infer salinity within 3.27 ppt root mean square error of prediction from diatom assemblages from four ~130 year old sediment records. Sites were distributed along a gradient of exposure to anthropogenic shifts in the watershed and salinity. Precipitation was found to be the primary driver influencing salinity fluctuations over the entire record, but watershed modifications on the mainland and in the Florida Keys during the late-1800s and 1900s were the most likely cause of significant shifts in baseline salinity. The timing of these shifts in the salinity baseline varies across the Bay: that of the northeastern coring location coincides with the construction of the Florida Overseas Railway (AD 1906–1916), while that of the east-central coring location coincides with the drainage of Lake Okeechobee (AD 1881–1894). Subsequent decreases occurring after the 1960s (east-central region) and early 1980s (southwestern region) correspond to increases in freshwater delivered through water control structures in the 1950s–1970s and again in the 1980s. Concomitant increases in salinity in the northeastern and south-central regions of the Bay in the mid-1960s correspond to an extensive drought period and the occurrence of three major hurricanes, while the drop in the early 1970s could not be related to any natural event. This paper provides information about major factors influencing salinity conditions in Florida Bay in the past and quantitative estimates of the pre- and post-South Florida watershed modification salinity levels in different regions of the Bay. This information should be useful for environmental managers in setting restoration goals for the marine ecosystems in South Florida, especially for Florida Bay.

A Review of the Effects of Altered Hydrology and Salinity on Vertebrate Fauna and Their Habitats in Northeastern Florida Bay

Estuarine productivity is highly dependent on the freshwater sources of the estuary. In Florida Bay, Taylor Slough was historically the main source of fresh water. Beginning in about 1960, and culminating with the completion of the South Dade Conveyance System in 1984, water management practice began to change the quantity and distribution of flow from Taylor Slough into Northeastern Florida Bay. These practices altered salinity and hydrologic parameters that had measurable negative impacts on vertebrate fauna and their habitats. Here, I review those impacts from published and unpublished literature and anecdotal observations. Almost all vertebrates covered in this review have shown some form of population decline since 1984; most of the studies implicate declines in food resources as the main stressor on their populations. My conclusion is that the diversion of fresh water resulted in an ecological cascade starting with hydrologic stresses on primary then secondary producers culminating in population declines at the top of the food web.