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The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
Regulatory impact analyses (RIAs) weigh the benefits of regulations against the burdens they impose and are invaluable tools for informing decision makers. We offer 10 tips for nonspecialist policymakers and interested stakeholders who will be reading RIAs as consumers.
1. Core problem: Determine whether the RIA identifies the core problem (compelling public need) the regulation is intended to address.
2. Alternatives: Look for an objective, policy-neutral evaluation of the relative merits of reasonable alternatives.
3. Baseline: Check whether the RIA presents a reasonable “counterfactual” against which benefits and costs are measured.
4. Increments: Evaluate whether totals and averages obscure relevant distinctions and trade-offs.
5. Uncertainty: Recognize that all estimates involve uncertainty, and ask what effect key assumptions, data, and models have on those estimates.
6. Transparency: Look for transparency and objectivity of analytical inputs.
7. Benefits: Examine how projected benefits relate to stated objectives.
8. Costs: Understand what costs are included.
9. Distribution: Consider how benefits and costs are distributed.
10. Symmetrical treatment: Ensure that benefits and costs are presented symmetrically.
Physical activity and exercise have important health benefits for children and adolescents with CHD. The objective of this study was to survey the provision of advice and recommendations in United Kingdom paediatric CHD clinics.
A three-page questionnaire was sent out to paediatric cardiac consultants in the United Kingdom, paediatric consultants with expertise in cardiology, and nursing staff (Paediatricians with Expertise in Cardiology Special Interest Group), as well as all members of the British Congenital Cardiovascular Association. The aim of this questionnaire was to determine the extent and scope of current information provision and to assess the importance that clinicians place on this advice.
There were 68 responses in total, and the data showed that, of these, 24 (36%) clinicians had never provided paediatric CHD patients with written advice about exercise. Only 27 (39%) clinicians provided physical activity advice at every appointment. Lack of time during consultation (n=39, 56.9%), lack of training (n=38, 55.2%), and uncertainty about appropriate recommendations (n=38, 55.2%) were identified as the main factors preventing clinicians from providing patients with advice about physical activity.
Although healthcare providers consider physical activity to be very important, the provision of clear, specific advice and recommendations is underutilised; therefore, more education and provision of resources to support the promotion of exercise need to be provided to clinicians and their support teams.
Evidence exists that analgesics are underutilized, delayed, and insufficiently dosed for emergency department (ED) patients with acute abdominal pain. For physicians practicing in a Canadian paediatric ED setting, we (1) explored theoretical practice variation in the provision of analgesia to children with acute abdominal pain; (2) identified reasons for withholding analgesia; and (3) evaluated the relationship between providing analgesia and surgical consultation.
Physician members of Paediatric Emergency Research Canada (PERC) were prospectively surveyed and presented with three scenarios of undifferentiated acute abdominal pain to assess management. A modified Dillman’s Tailored Design method was used to distribute the survey from June to July 2014.
Overall response rate was 74.5% (149/200); 51.7% of respondents were female and mean age was 44 (SD 8.4) years. The reported rates of providing analgesia for case scenarios representative of renal colic, appendicitis, and intussusception, were 100%, 92.1%, and 83.4%, respectively, while rates of providing intravenous opioids were 85.2%, 58.6%, and 12.4%, respectively. In all 60 responses where the respondent indicated they would obtain a surgical consultation, analgesia would be provided. In the 35 responses where analgesia would be withheld, 21 (60%) believed pain was not severe enough, while 5 (14.3%) indicated it would obscure a surgical condition.
Pediatric emergency physicians self-reported rates of providing analgesia for acute abdominal pain scenarios were higher than previously reported, and appeared unrelated to request for surgical consultation. However, an unwillingness to provide opioid analgesia, belief that analgesia can obscure a surgical condition, and failure to take self-reported pain at face value remain, suggesting that the need exists for further knowledge translation efforts.
The concept of a mixing efficiency is widely used to relate the amount of irreversible diabatic mixing in a stratified flow to the amount of energy available to support mixing. This common measure of mixing in a flow is based on the change in the background potential energy, which is the minimum gravitational potential energy of the fluid that can be achieved by an adiabatic rearrangement of the instantaneous density field. However, this paper highlights examples of mixing that is primarily ‘buoyancy-driven’ (i.e. energy is released to the flow predominantly from a source of available potential energy) to demonstrate that the mixing efficiency depends not only on the specific characteristics of the turbulence in the region of the flow that is mixing, but also on the density profile in regions remote from where mixing physically occurs. We show that this behaviour is due to the irreversible and direct conversion of available potential energy into background potential energy in those remote regions (a mechanism not previously described). This process (here termed ‘relabelling’) occurs without requiring either a local flow or local mixing, or any other process that affects the internal energy of that fluid. Relabelling is caused by initially available potential energy, associated with identifiable parcels of fluid, becoming dynamically inaccessible to the flow due to mixing elsewhere. These results have wider relevance to characterising mixing in stratified turbulent flows, including those involving an external supply of kinetic energy.
The Medtronic LINQ™ was inserted in an 11-month-old boy for close monitoring of rapid ventricular tachycardia. The device is much smaller than the conventional Medtronic loop recorder. The real advantage of the LINQ™ is that it automatically notifies Carelink if any ventricular tachycardia is seen, which is very advantageous for this particular type of patient. This device is ideal for close monitoring of asymptomatic yet potentially dangerous arrhythmias in smaller children.
Introduction: Cyanotic congenital heart disease is associated with functional limitation and vascular events. The nature and extent of endothelial dysfunction in cyanotic adults is poorly understood. We sought to characterise endothelial function in this setting. Methods: A total of fourteen adults with cyanotic congenital heart disease (40±3 years) together with age- and sex-matched healthy controls underwent assessment of nitric oxide-dependent vascular responses, including flow-mediated dilatation of the brachial artery and dynamic vessel analysis of the retina in response to flickering light. Plasma levels of the endothelium-derived vasoconstrictor endothelin-1 and the nitric oxide antagonist, asymmetric dimethylarginine, were measured. Circulating endothelial progenitor cells were assessed by flow cytometry. Results: Flow-mediated dilatation was significantly lower in cyanosed adults than controls (4.0±0.8 versus 7.2±1.0%, p=0.019, n=11 per group). Retinal arterial and venous dilatory responses were also impaired (2.9±0.8 versus 5.0±0.6%, p=0.05 and 3.4±0.3 versus 5.2±0.7%, p=0.04, n=13). Serum levels of endothelin-1 and asymmetric dimethylarginine were higher in cyanosed adults (3.0±0.6 versus 1.1±0.1 pg/ml, p=0.004 and 0.68±0.05 versus 0.52±0.02 μmol/L, p=0.03, n=11). Endothelial progenitor cells (CD34+CD45dimCD133+KDR+) were reduced in those with chronic cyanosis (17±4 versus 40±6 per million white blood cells, p=0.005, n=11). Conclusions: Endothelial function is impaired in the systemic arteries and retinal vessels in adults with cyanotic congenital heart disease, suggesting a widespread endotheliopathy. Diminished numbers of endothelial progenitor cells might potentially contribute to these observations.
In order to optimise care of the adult patients with complex congenital heart disease, there is a need to develop recommendations for interventions. This document is the work of representatives of the three relevant societies and provides recommendations for institutions and operators performing cardiac interventions in these patients.
This special issue of the journal, which is part of a global research initiative on psychology and poverty reduction, focuses specifically on the experiences of refugees and asylum seekers. Application of contemporary constructions of relative poverty and social exclusion to understanding asylum and humanitarian refuge emphasises the relative financial and social disadvantages experienced by many of these forced migrants, which may lead subsequently to them having negative experiences of resettlement and poor mental health and overall wellbeing. We argue that governments need to be cognisant of the poverty pitfalls of forced migration and to examine carefully their policies on social inclusion to ensure that current and future humanitarian and climate change refugees arriving on their shores are not forced into relative poverty.
Congenitally corrected transposition is a rare cardiac anomaly characterized by the combination of discordant atrioventricular and ventriculoarterial connections. Young patients with this lesion can present with congestive cardiac failure, usually secondary to a large ventricular septal defect or pulmonary stenosis. We report here our experience with a lady aged 79, admitted to our unit because of deterioration of her congestive cardiac failure as a consequence of uncorrected congenitally corrected transposition associated with degenerative severe aortic stenosis.
An estimated 19% of the world's 9,856 extant bird species are migratory, including some 1,600 species of land- and waterbirds. In 2008, 11% of migratory land- and waterbirds were classed by BirdLife International as threatened or near-threatened on the IUCN Red List. Red List indices show that these migrants have become more threatened since 1988, with 33 species deteriorating and just six improving in status. There is also increasing evidence of regional declines. Population trend data show that more Nearctic–Neotropical migrants have declined than increased in North America since the 1980s, and more Palearctic–Afrotropical migrants breeding in Europe declined than increased during 1970–2000. Reviews of the status of migratory raptors show unfavourable conservation status for 51% of species in the African–Eurasian region (in 2005), and 33% of species in Central, South and East Asia (in 2007). Land-use change owing to agriculture is the most frequently cited threat affecting nearly 80% of all threatened and near-threatened species. However, while agricultural intensification on the breeding grounds is often proposed as the major driver of declines in Palearctic–Afrotropical migrants, some species appear to be limited by the quantity and quality of available habitat in non-breeding areas, notably the drylands of tropical Africa. Forest fragmentation in breeding areas has contributed to the declines of Nearctic–Neotropical migrants with deforestation in non-breeding areas another possible factor. Infrastructure development including wind turbines, cables, towers and masts can also be a threat. Over-harvesting and persecution remain serious threats, particularly at key migration locations. Climate change is affecting birds already, is expected to exacerbate all these pressures, and may also increase competition between migratory and non-migratory species. The conservation of migratory birds thus requires a multitude of approaches. Many migratory birds require effective management of their critical sites, and Important Bird Areas (IBAs) provide an important foundation for such action; however to function effectively in conserving migratory species, IBAs need to be protected and the coherence of the network requires regular review. Since many migratory species (c. 55%) are widely dispersed across their breeding or non-breeding ranges, it is essential to address the human-induced changes at the wider landscape scale, a very considerable challenge. Efforts to conserve migratory birds in one part of the range are less effective if unaddressed threats are reducing these species' populations and habitats elsewhere. International collaboration and coordinated action along migration flyways as a whole are thus key elements in any strategy for the conservation of migratory birds.
Teouma, an archaeological site on Efate Island, Vanuatu, features the earliest cemetery yet discovered of the colonizers of Remote Oceania, from the late second millennium B.C. In order to investigate potential migration of seventeen human individuals, we measured isotopes of strontium (87Sr/86Sr), oxygen (δ18O), and carbon (δ13C), as well as barium (Ba) and strontium (Sr) concentrations, in tooth enamel from skeletons excavated in the first two field seasons. The majority of individuals cluster with similar isotope and Ba/Sr ratios, consistent with a diet of marine resources supplemented with plants grown on the local basaltic soils. Four outliers, with distinctive 87Sr/86Sr and δ18O, are probably immigrants, three of which were buried in a distinctive position (supine, with the head to the south) with higher Ba/Sr and δ13C, consistent with a terrestrial, nonlocal diet. Among the probable immigrants was a male buried with the crania of three of the locally raised individuals on his chest.
In spite of significant improvements in outcome, adults surviving the Mustard procedure continue to be at risk of premature death, cardiac failure, and arrhythmias. Primary ventricular fibrillation as a cause of sudden death in these patients may not be uncommon, and implantation of a defibrillator should be considered, particularly if there is systemic ventricular dysfunction and pre-existing heart block.
Black (Black Caribbean and Black African) patients are over-represented in admissions to general adult and medium-security psychiatric services in England.
To describe the socio-demographic, clinical and offence characteristics of patients in high-security psychiatric hospitals (HSPHs) in England, and to compare admission rates and unmet needs by ethnic group.
A total of 1255 in-patients were interviewed, and their legal status, socio-demographic characteristics and individual treatment needs were assessed.
Black patients in HSPHs are over-represented by 8.2 times (range 3.2–24.4, 95% CI 7.1–9.3), are more often male (P=0.037), and are more often diagnosed with a mental illness and less often diagnosed with a personality disorder or learning disability (P < 0.001) than White patients. Unmet needs were significantly less common among White than among Black patients (mean values of 2.22 v. 2.62, difference=0.40, 95% CI 0.06–0.73).
Compared with the proportion of Black patients in the general population in their region of origin, a much higher proportion of Black patients were admitted to HSPHs, and fewer of their needs were met.
We report a case where fetal echocardiography identified both complete heart block and ventricular tachycardia. The mother tested positive for anti-Ro antibodies. Prenatal detection of this unusual combination of arrhythmias prompted early postnatal evaluation, which revealed prolongation of the QT interval. Autoimmune mediated congenitally complete heart block associated with such prolongation of the QT interval has a poor prognosis. The child was successfully treated with beta blockers and implantation of a pacemaker.
Bakaninbreen is a polythermal glacier in southern Spitsbergen, Svalbard, which surged between 1985 and 1995. For 9 days in spring 1987, when the surge front was travelling at ∼2.5-3.0 m d–1, three single-component geophones and two accelerometers were deployed in a T-shaped array immediately downstream of the surge front to record seismic emissions. The events were characterized by their waveforms and spectral content. At least three different categories have been identified: impulsive P- and S-waveforms, surface P- and S-wave trains, and harmonic (75-130 Hz) events. We interpret the impulsive events to originate at the base of the glacier, at or downstream of the surge front; the surface P- and S-wave trains from near-surface brittle fracture associated with the surface expression of the surge front itself; and the harmonic events from deep sources that involve resonance in a water-filled fracture, associated with the base of the surge front. We believe the basal events are related to the activation of stagnant ice downstream of the surge front, which allows water to access the bed and provides the mechanism for its propagation.