Ocean Medical Center

Two separately motivated implementations of the wavelet transform are brought together. It is observed that these algorithms are both special cases of a single filter bank structure, the discrete wavelet transform, the behavior of which is governed by the choice of filters. In fact, the a trous algorithm is more properly viewed as a nonorthonormal multiresolution algorithm for which the discrete wavelet transform is exact. Moreover, it is shown that the commonly used Lagrange a trous filters are in one-to-one correspondence with the convolutional squares of the Daubechies filters for orthonormal wavelets of compact support. A systematic framework for the discrete wavelet transform is provided, and conditions are derived under which it computes the continuous wavelet transform exactly. Suitable filter constraints for finite energy and boundedness of the discrete transform are also derived. Relevant signal processing parameters are examined, and it is observed that orthonormality is balanced by restrictions on resolution.< <ETX xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">&gt;</ETX>

The Paris agreement target of limiting global surface warming to 1.5-2°C compared to pre-industrial levels by 2100 will heavily impact the ocean. While ambitious mitigation and adaptation are both needed, the ocean provides major opportunities for action to reduce climate change globally and its impacts on vital ecosystems and ecosystem services. A comprehensive and systematic assessment of 13 global- and local-scale, ocean-based measures was performed to help steer the development and implementation of technologies and actions towards a sustainable outcome. We show that (1) all measures have tradeoffs and multiple criteria must be used for a comprehensive assessment of their potential, (2) greatest benefit is derived by combining global and local solutions, some of which could be implemented or scaled-up immediately, (3) some measures are too uncertain to be recommended yet, (4) political consistency must be achieved through effective cross-scale governance mechanisms, (5) scientific effort must focus on effectiveness, co-benefits, disbenefits, and costs of poorly tested as well as new and emerging measures.

We present 53 patients who underwent arthroscopic rotator cuff repair and had a minimum of 2-year follow-up. Most tears were avulsions of the supraspinatus from the greater tuberosity, some with associated longitudinal tears. Longitudinal tears were repaired with a side-to-side suturing technique. Avulsion tears from the tuberosity were repaired using nonretrievable suture anchors. Traditional open-mobilization techniques, such as elevating the cuff off the glenoid neck and scapular fossa, and cutting the coraco-humeral ligament, were performed arthroscopically as needed. All repairs were performed using O-PDS or 1-PDS suture and a 7-mm suture punch for suture delivery. Both simple and mattress suture configurations were used. An anterolateral operative portal was used in most cases. A modified UCLA rating system that included additional points for abduction range of motion and strength was adapted for clinical evaluation in this study (maximum score, 45 points). The average preoperative rating was 17 (range, 9 to 26). The average postoperative rating was 41 (range, 16 to 45). There were 36 excellent (41 to 45 points), 13 good (36 to 40 points), 1 fair (30 to 35 points), and 3 poor (< 30 points) results. We have seen intraoperative but no cases of postoperative anchor pullout. The simple sutures performed as well as, and in some ways better than, mattress configurations. All fair and good results were with O-PDS. To perform an arthroscopic repair, the tear must be well visualized and mobilizable back to the tuberosity with only moderate tension. The anterolateral operative portal has been very useful because it allows better angle of entry for instruments and anchors and improved visualization in the subacromial space. The use of PDS and simple suture configurations has made the repair technically easier to perform with the instruments that are currently available. We do recommend 1-PDS suture because it breaks less easily even though it is slightly more difficult to deliver and tie. Arthroscopic cuff mobilization is relatively simple and has allowed us to repair larger tears. Based on our experience, arthroscopic rotator cuff repair is technically achievable and a superior alternative in selected cases for an experienced shoulder arthroscopist. Patients who underwent arthroscopic repairs had less scarring and shorter hospital stays and, we believe, less postoperative pain and easier rehabilitation compared with open repairs.

Fisheries bycatch is considered the most serious threat globally to long‐lived marine megafauna (e.g., mammals, birds, turtles, elasmobranchs). However, bycatch assessments to date have not evaluated population‐level bycatch impacts across fishing gears. Here, we provide the first global, multi‐gear evaluation of population‐level fisheries bycatch impacts for marine turtles. To compare bycatch impacts of multiple gears within and among marine turtle populations (or regional management units, RMUs), we compiled more than 1,800 records from over 230 sources of reported marine turtle bycatch in longline, net, and trawl fisheries worldwide that were published between 1990–2011. The highest bycatch rates and levels of observed effort for each gear category occurred in the East Pacific, Northwest and Southwest Atlantic, and Mediterranean regions, which were also the regions of highest data availability. Overall, available data were dominated by longline records (nearly 60% of all records), and were non‐uniformly distributed, with significant data gaps around Africa, in the Indian Ocean, and Southeast Asia. We found that bycatch impact scores—which integrate information on bycatch rates, fishing effort, mortality rates, and body sizes (i.e., proxies for reproductive values) of turtles taken as bycatch—as well as mortality rates in particular, were significantly lower in longline fishing gear than in net and trawl fishing gears. Based on bycatch impact scores and RMU‐specific population metrics, we identified the RMUs most and least threatened by bycatch globally, and found wide variation among species, regions, and gears within these classifications. The lack of regional or species‐specific patterns in bycatch impacts across fishing gears suggests that gear types and RMUs in which bycatch has the highest impact depend on spatially‐explicit overlaps of fisheries (e.g., gear characteristics, fishing practices, target species), marine turtle populations (e.g., conservation status, aggregation areas), and underlying habitat features (e.g., oceanographic conditions). Our study provides a blueprint both for prioritizing limited conservation resources toward managing fishing gears and practices with the highest population impacts on sea turtles and for enhancing data collection and reporting efforts.

Introduction 1,25-dihydroxyvitamin D3 (cholecalciferol), the hormonally active form of vitamin D3, is a lipid-soluble compound that plays a significant role in clinical medicine due to its potent effects on calcium homeostasis and bone metabolism. Since foods containing natural vitamin D are rare, the primary source of the compound remains its nonenzymatic dermal synthesis through exposure to ultraviolet rays in sunlight. Although uncommon in most developed countries, recent literature has demonstrated that subclinical vitamin D deficiency can exist in certain populations and plays a role in downstream clinical consequences, including cardiovascular disease, cancer, diabetes, osteoporosis, and fractures. This study aims to identify the prevalence and change in the pattern of vitamin D deficiency in subpopulations throughout the United States to provide a foundation for further clinical studies correlating the clinical outcomes to vitamin deficiency. Methods Data analyzed in this study were collected through National Health and Nutrition Examination Survey (NHANES), specifically from a population of 4962 participants, age ≥20 years, who were hospitalized between 2011 and 2012. This cohort was stratified to divide the population into patients that were vitamin D sufficient (>50 nmol/L) versus patients who were vitamin D deficient (50 nmol/L). The risk factors were compared between the subpopulations in 2005-2006 and 2011-2012. Conclusions The prevalence of vitamin D deficiency is greater in certain clinical subpopulations, and the presence of associated characteristics should raise the index of suspicion for the practicing clinician with regard to conditions associated with vitamin D deficiency, such as osteoporosis and osteomalacia. Further research investigating the pathophysiology of hypovitaminosis D and its clinical consequences can help better understand and prevent the development of associated comorbidities.

PURPOSE: Although stiffness of the shoulder has been evaluated after rotator cuff repair, it has not been studied in patients with cuff tears that occurred before repair. The primary purpose of this study was to determine whether preoperative stiffness persists after cuff repair. We also evaluated the incidence and possible causes of stiffness in patients who underwent arthroscopic rotator cuff repair. METHODS: This was a retrospective evaluation of 72 arthroscopic patients who underwent rotator cuff repair. Preoperative range-of-motion (ROM) deficits in abduction, forward flexion, external rotation, and internal rotation were recorded and were added together to determine the total ROM deficit (TROMD). Patients were then divided into 3 groups on the basis of TROMD. Group 1 comprised 42 patients with 0 degrees to 20 degrees TROMD. Group 2 consisted of 24 patients with 25 degrees to 70 degrees TROMD, and group 3 included 6 patients with a TROMD greater than 70 degrees. Preoperative medical history, intraoperative condition of the capsule and bursa, and cuff tear size were recorded. RESULTS: Capsular and bursal abnormalities were more common in stiffer patients, but arthroscopic evidence of adhesive capsulitis was found only in group 3 (3 of 6 patients). Postoperatively, average TROMD deficit decreased from 10 degrees to 4 degrees in group 1, from 36 degrees to 12 degrees in group 2, and from 89 degrees to 31 degrees in group 3. No reoperations or postoperative manipulations were reported in group 1 or 2. In group 3, 3 patients (the only 3 with adhesive capsulitis) showed no or minimal improvement in postoperative ROM. These 3 patients required a secondary arthroscopic capsular release. After all 3 repairs had completely healed, the TROMD averaged 35 degrees in this subgroup. CONCLUSIONS: Preoperative stiffness is common in patients who undergo rotator cuff repair. Mild and moderate stiffness generally resolve after surgery followed by routine therapy. Patients with a TROMD of 70 degrees or more may have adhesive capsulitis as well as a cuff tear and may not do well with cuff repair alone. LEVEL OF EVIDENCE: Level IV, case series.

The field of marine tagging and tracking has grown rapidly in recent years as tag sizes have decreased and the diversity of sensors has increased. Tag data provide a unique view on individual movement patterns, at different scales than shipboard surveys, and have been used to discover new habitat areas, characterize oceanographic features, and delineate stock structures, among other purposes. Due to the necessity for small tag-to-body size ratio, tags have largely been deployed on adult animals, resulting in a relative paucity of data on earlier life history stages. In this study, we reviewed tagging efforts on multiple life history stages for seabirds, marine mammals, marine turtles, and fish and enumerated studies focusing on each guild that targeted larvae, juveniles or hatchlings. We found that turtles and fish had higher proportion of studies focusing on juveniles (> 20%) than seabirds and marine mammals (<10%). On both juveniles and adults, tags were used in a targeted manner with passive and transmitting tags as the main tools for population demography and connectivity studies, while GPS and archival tags were used more frequently for habitat analyses and foraging ecology. These findings identify the need to focus on novel approaches in tagging multiple life history stages both to study marine predator ecology and to effectively manage marine populations.

The status of tropospheric radio propagation assessment is reviewed and recent advances in this area are described. Special emphasis is given to anomalous propagation in a marine environment. Modeling and measurements of ducting phenomena caused by the oceanic evaporation duct and by elevated refractive layers are discussed. The modeling involves extensive numerical calculations of waveguide propagation, ray-tracing techniques, and empirical relationships. Effects such as sea-surface roughness and horizontal inhomogeneity are also addressed. The models have been compared with extensive measurements in a variety of geographic locations. Worldwide radio refractivity climatologies have been compiled. A propagation assessment system, called the "Integrated Refractive Effects Prediction System" (IREPS), has been developed and successfully tested. It uses a small computer with interactive graphic displays and provides the user with performance assessment of communications and radar equipment based on prevailing atmospheric conditions. Environmental inputs into the system consist of surface measurements and profiles of atmospheric refractivity either calculated from radiosonde balloon data or measured by microwave refractometers. Status and shortcomings of direct and remote sensing techniques for measurement of atmospheric refractivity are also discussed.

Arthroscopic biceps tenodesis is indicated for the treatment of severe biceps tendonopathy, partial- or full-thickness tendon tears, or biceps instability typically associated with rotator cuff tear, although there has been considerable debate on tenotomy versus tenodesis. We advocate tenodesis, for the following reasons: to re-establish the resting muscle length so as to avoid scaring and spasm, to allow biceps use for complex elbow motion, and to avoid cosmetic defects in cases in which deformity can sometimes equal disability. This technical note provides illustrations and detailed descriptions of our arthroscopic tenodesis technique using a Arthrex (Naples, FL) biotenodesis system.

Despite optimal medical management (OMM), low back pain (LBP) can be disabling, particularly after spinal surgery. Spinal cord stimulation (SCS) is effective in reducing neuropathic leg pain; however, evidence is limited for LBP. This prospective, open-label, parallel-group trial randomized (1:1) failed back surgery syndrome (FBSS) patients with predominant LBP to SCS plus OMM (SCS group) or OMM alone (OMM group) at 28 sites in Europe and the Americas. If trial stimulation was successful, a multicolumn SCS system was implanted. Outcomes were assessed at baseline (before randomization) and at 1, 3, 6, and 12 months after randomization. Patients could change treatment groups at 6 months. The primary outcome was the proportion of patients with ≥50% reduction in LBP (responder) at 6 months. Secondary outcomes included change in pain intensity, functional disability, and health-related quality of life (HRQoL). The results are posted at ClinicalTrials.gov under registration number NCT01697358. In the intent-to-treat analysis, there were more responders in the SCS group than in the OMM group (13.6%, 15/110 vs 4.6%, 5/108, difference 9% with 95% confidence interval 0.6%-17.5%, P = 0.036) at 6 months. The SCS group improved in all secondary outcomes compared with the OMM group. The OMM group only improved in HRQoL. In the SCS group, 17.6% (18/102) experienced SCS-related adverse events through 6 months, with 11.8% (12/102) requiring surgical reintervention. Adding multicolumn SCS to OMM improved pain relief, HRQoL, and function in a traditionally difficult-to-treat population of failed back surgery syndrome patients with predominant LBP. Improvements were sustained at 12 and 24 months.

Classically, biomass partitioning across trophic levels was thought to add up to a pyramidal distribution. Numerous exceptions have, however, been noted including complete pyramidal inversions. Elevated levels of biomass top-heaviness (i.e. high consumer/resource biomass ratios) have been reported from Arctic tundra communities to Brazilian phytotelmata, and in species assemblages as diverse as those dominated by sharks and ants. We highlight two major pathways for creating top-heaviness, via: (1) endogenous channels that enhance energy transfer across trophic boundaries within a community and (2) exogenous pathways that transfer energy into communities from across spatial and temporal boundaries. Consumer-resource models and allometric trophic network models combined with niche models reveal the nature of core mechanisms for promoting top-heaviness. Outputs from these models suggest that top-heavy communities can be stable, but they also reveal sources of instability. Humans are both increasing and decreasing top-heaviness in nature with ecological consequences. Current and future research on the drivers of top-heaviness can help elucidate fundamental mechanisms that shape the architecture of ecological communities and govern energy flux within and between communities. Questions emerging from the study of top-heaviness also usefully draw attention to the incompleteness and inconsistency by which ecologists often establish definitional boundaries for communities.

Abstract The link between secular changes in the lunar semidiurnal ocean tide (M 2 ) and relative sea level rise is examined based on numerical tidal modeling and the analysis of long‐term sea level records from Europe, Australia, and the North American Atlantic coasts. The study sets itself apart from previous work by using a 1/12° global tide model that incorporates the effects of self‐attraction and loading through time‐step‐wise spherical harmonic transforms instead of iteration. This novel self‐attraction and loading implementation incurs moderate computational overheads (some 50%) and facilitates the simulation of shelf sea tides with a global root mean square error of 14.6 cm in depths shallower than 1,000 m. To reproduce measured tidal changes in recent decades, the model is perturbed with realistic water depth changes, compiled from maps of altimetric sea level trends and postglacial crustal rebound. The M 2 response to the adopted sea level rise scenarios exhibits peak sensitivities in the North Atlantic and many marginal seas, with relative magnitudes of 1–5% per century. Comparisons with a collection of 45 tide gauge records reveals that the model reproduces the sign of the observed amplitude trends in 80% of the cases and captures considerable fractions of the absolute M 2 variability, specifically for stations in the Gulf of Mexico and the Chesapeake‐Delaware Bay system. While measured‐to‐model disparities remain large in several key locations, such as the European Shelf, the study is deemed a major step toward credible predictions of secular changes in the main components of the ocean tide.

Over the past 4 decades there has been a growing concern for the conservation status of elasmobranchs (sharks and rays). In 2002, the first elasmobranch species were added to Appendix II of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES). Less than 20 yr later, there were 39 species on Appendix II and 5 on Appendix I. Despite growing concern, effective conservation and management remain challenged by a lack of data on population status for many species, human−wildlife interactions, threats to population viability, and the efficacy of conservation approaches. We surveyed 100 of the most frequently published and cited experts on elasmobranchs and, based on ranked responses, prioritized 20 research questions on elasmobranch conservation. To address these questions, we then convened a group of 47 experts from 35 institutions and 12 countries. The 20 questions were organized into the following broad categories: (1) status and threats, (2) population and ecology, and (3) conservation and management. For each section, we sought to synthesize existing knowledge, describe consensus or diverging views, identify gaps, and suggest promising future directions and research priorities. The resulting synthesis aggregates an array of perspectives on emergent research and priority directions for elasmobranch conservation.

Ecological data sets rarely extend back more than a few decades, limiting our understanding of environmental change and its drivers. Marine historical ecology has played a critical role in filling these data gaps by illuminating the magnitude and rate of ongoing changes in marine ecosystems. Yet despite a growing body of knowledge, historical insights are rarely explicitly incorporated in mainstream conservation and management efforts. Failing to consider historical change can have major implications for conservation, such as the ratcheting down of expectations of ecosystem quality over time, leading to less ambitious targets for recovery or restoration. We discuss several unconventional sources used by historical ecologists to fill data gaps – including menus, newspaper articles, cookbooks, museum collections, artwork, benthic sediment cores – and novel techniques for their analysis. We specify opportunities for the integration of historical data into conservation and management, and highlight the important role that these data can play in filling conservation data gaps and motivating conservation actions. As historical marine ecology research continues to grow as a multidisciplinary enterprise, great opportunities remain to foster direct linkages to conservation and improve the outlook for marine ecosystems.

INTRODUCTION AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has been a challenge globally. In severe acute respiratory syndrome (SARS) epidemic 60% of patients had hepatic injury, due to phylogenetic similarities of the viruses it is assumed that COVID-19 is associated with acute liver injury. In this meta-analysis, we aim to study the occurrence and association of liver injury, comorbid liver disease and elevated liver enzymes in COVID-19 confirmed hospitalizations with outcomes. MATERIALS AND METHODS: Data from observational studies describing comorbid chronic liver disease, acute liver injury, elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT) levels and outcomes of COVID-19 hospitalized patients from December 1, 2019, to June 30, 2020 was extracted following PRISMA guidelines. Adverse outcomes were defined as admission to intensive care unit (ICU), oxygen saturation <90%, invasive mechanical ventilation (IMV), severe disease and in-hospital mortality. Odds ratio (OR) and 95% confidence interval (95% CI) were obtained. RESULTS: 24 studies with 12,882 confirmed COVID-19 patients were included. Overall prevalence of CM-CLD was 2.6%, COVID-19-ALI was 26.5%, elevated AST was 41.1% and elevated ALT was 29.1%. CM-CLD had no significant association with poor outcomes (pooled OR: 0.96; 95% CI: 0.71-1.29; p=0.78). COVID-19-ALI (1.68;1.04-2.70; p=0.03), elevated AST (2.98; 2.35-3.77; p<0.00001) and elevated ALT (1.85;1.49-2.29; p<0.00001) were significantly associated with higher odds of poor outcomes. CONCLUSION: Our meta-analysis suggests that acute liver injury and elevated liver enzymes were significantly associated with COVID-19 severity. Future studies should evaluate changing levels of biomarkers amongst liver disease patients to predict poor outcomes of COVID-19 and causes of liver injury during COVID-19 infection.

In 2008, the Kilauea Volcano on the island of Hawai'i increased eruption activity and emissions of sulfurous volcanic air pollution called vog. The purpose of this study was to promptly assess for a relative increase in cases of medically diagnosed acute illnesses in an exposed Hawaiian community. Using a within-clinic retrospective cohort design, comparisons were made for visits of acute illnesses during the 14 wk prior to the increased volcanic emissions (low exposure) to 14 wk of high vog exposure when ambient sulfur dioxide was threefold higher and averaged 75 parts per billion volume per day. Logistic regression analysis estimated effect measures between the low- and high-exposure cohorts for age, gender, race, and smoking status. There were statistically significant positive associations between high vog exposure and visits for medically diagnosed cough, headache, acute pharyngitis, and acute airway problems. More than a sixfold increase in odds was estimated for visits with acute airway problems, primarily experienced by young Pacific Islanders. These findings suggest that the elevated volcanic emissions in 2008 were associated with increased morbidity of acute illnesses in age and racial subgroups of the general Hawaiian population. Continued investigation is crucial to fully assess the health impact of this natural source of sulfurous air pollution. Culturally appropriate primary- and secondary-level health prevention initiatives are recommended for populations in Hawai'i and volcanically active areas worldwide.

The midsagittal surface area of the corpus callosum was determined by computer-assisted morphometry in juvenile and adult members of 13 species of the cetacean family Delphinidae. In 57 brains, absolute callosal areas ranged from 104 to 829 mm2. When compared to other mammal groups possessing a corpus callosum, callosal area in dolphins was smaller in relation to brain mass with a ratio range (mm2/g) of 0.08-0.31. The corpus callosum was decreased relative to brain mass in the larger-brained odontocetes, suggesting that increases in brain size were not necessarily allied with needs for equivalent increases in callosal linkage. One delphinid species, Tursiops truncatus, for which the largest single-species sample was available, was examined for sex differences in callosal size relative to brain mass. Among 10 males and 5 females the averaged ratio was not distinguishable between sexes.

We derive the Green’s function solution to the heat equation for a two-layer structure and describe how to extend the technique to derive the Green’s function for N-layer structures. The Green’s function is applied to the interaction of a two-layer structure with scanning circular energy beams. The mathematics necessary to reduce the resultant solutions from a quintuple integral to a double integral are presented. Numerical integration of the remaining integrals leads to temperature profiles generated during laser irradiation of two-layer structures. These profiles are shown to reduce, in the appropriate limits, to previously reported profiles for the single-material case. Normalized linear temperature profiles as well as actual temperature profiles for silicon on sapphire are presented and discussed.

An arthroscopic technique for coracohumeral ligament release from a retracted supraspinatus tendon is presented. The procedure is technically simple and can greatly improve the mobility of retracted rotator cuff tears, thus expanding the application of arthroscopic repair to larger tears.

Existing sea clutter models are in general agreement on the trends and magnitudes of sea reflectivity at low (1 degrees -10 degrees ) grazing angles. However, at extremely low grazing angles (<1 degrees ), models, theory, and measurements show considerable differences. The effects of the oceanic evaporation duct on grazing angle are investigated. Significant changes in grazing angle due to the evaporation duct are found and the illumination of the sea surface by the radar is shown to extend well beyond the standard (4/3 earth) radar horizon range. A series of sea clutter model comparisons shows that much of the difference between models can be attributed to evaporation duct effects.< <ETX xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">&gt;</ETX>