Mapping and Evaluating Marine Protected Areas and Ecosystem Services: A Transdisciplinary Delphi Forecasting Process Framework

Marine Protected Areas (MPAs) are an important tool for management and conservation and play an increasingly recognised role in societal and human well-being. However, the assessment of MPAs often lacks a simultaneous consideration of ecological and socio-economic outcomes, and this can lead to misconceptions on the effectiveness of MPAs. In this perspective, we present a transdisciplinary approach based on the Delphi method for mapping and evaluating Marine Protected Areas for their ability to protect biodiversity while providing Ecosystem Services (ES) and related human well-being benefits - i.e., the ecosystem outputs from which people benefit. We highlight the need to include the human dimensions of marine protection in such assessments, given that the effectiveness of MPAs over time is conditional on the social, cultural and institutional contexts in which MPAs evolve. Our approach supports Ecosystem-Based Management and highlights the importance of MPAs in achieving restoration, conservation, and sustainable development objectives in relation to EU Directives such as the Marine Strategy Framework Directive (MSFD), the Maritime Spatial Planning Directive (MSPD), and the Common Fisheries Policy (CFP)

Development of individualized surgical treatments for malignant melanoma

Background: Cutaneous melanoma is a malignancy with an increasing incidence worldwide, especially in northern Europe. The aim of this thesis is to scrutinize the results achieved by traditional surgery and the opportunities offered by translational research for the more advanced stages of the disease. Paper I analysed outcomes of sentinel node biopsy (SNB) performed on 769 con-secutive patients with cutaneous melanoma. Breslow thickness was the only pre-dictive factor for a positive SN. The 5-year melanoma specific survival (MSS) was 81% and in multivariate analysis the negative prognostic factors for survival were SN-status, followed by Breslow thickness and ulceration. Paper II reported on 290 consecutive patients who underwent 380 isolated limb perfusion (ILP), of which 90 were re-ILPs. The results between the 1st, the 2nd and the 3-5th were compared. Patients with a complete response at the first treat-ment were likely to have the same response at re-ILP without any increase in the risk for local toxicity or complications. Paper III BRAF mutational status as a predictive factor for response was studied in 98 patients who underwent ILP. In this consecutive series, 32 patients had a BRAF V600E/K mutation and 66 patients were BRAF wild type, and no significant correlation for response or survival was found. Paper IV was a translational study based on patient-derived xenograft models including 21 cutaneous melanoma biopsies transplanted into either NOG or IL-2 transgenic NOG (hIL2-NOG) mice. It was shown that the models reliably could be used to predict the effect of tumour-infiltrating lymphocytes against the tumours. Conclusions: The surgical approach and therapies for patients with cutaneous melanoma are becoming more targeted and personalized. A specialised multidisci-plinary approach can improve the understanding of the disease, support the deci-sion-making process towards the most advantageous treatment options for each individual patient at a specific time

Which is the Ideal Breast Size?: Some Social Clues for Plastic Surgeons

To provide plastic surgeons with more detailed information as to factors affecting the perception of female attractiveness, the present study was aimed to investigate whether the interaction effect of breast and body size on ratings of female attractiveness is moderated by sociodemographic variables and whether ratings of shapeliness diverge from those of attractiveness.A community sample of 958 Italian participants rated the attractiveness and the shapeliness of 15 stimuli (5 breast sizes 7 3 body sizes) in which frontal, 3/4, and profile views of the head and torso of a faceless woman were jointly shown.Bigger breast sizes obtained the highest attractiveness ratings, but the breast-by-body size interaction was also significant. Evidence was found of a moderator role of sex, marital status, and age. When the effects of breast and body size and their interaction had been ruled out, sex differences were at best very slight and limited to very specific combinations of breast and body sizes. Ratings of attractiveness and shapeliness were highly correlated and did not significantly differ.Results suggest that to address women's psychological needs, concerns, and expectations about their appearance, plastic surgeons should not simply focus on breast size but should carefully consider the 'big picture': the body in its entirety

Broadening the perspective on seafood production: Life cycle thinking and fisheries management

Decisions made by fisheries managers strongly influence the overall resource use and environmental impacts associated with the seafood product from capture fisheries. These findings come from Life Cycle Assessments (LCA), a method that aims at quantifying all relevant resource use and environmental impacts throughout the life cycle of a product. In this way, important hot spots or improvement potentials can be found. The integrated systems perspective can assist to avoid shifts in impacts between production phases or environmental concerns. LCA is at present a well-established tool to assess environmental impacts of products, but there is no uptake of LCA-based methods or results in fishing policies. Methods for assessing fisheries-specific impacts within the LCA framework are however incomplete. One part of the research therefore addressed indicators related to pressures on marine ecosystems from discard to be used in seafood LCAs. Swedish fisheries on the west coast were evaluated using the trophic indicators mean trophic level (MTL) and primary production required (PPR). PPR could to some extent reflect properties of ecosystem resource use as PPR from the total catch, including discards, varied considerably between fisheries. Still, it was shown that it is difficult to interpret both indicators in relation to what is known about the ecosystems and the desired properties of the metrics. Complementing metrics of potential pressures on biodiversity are needed. The Swedish IUCN Red List of Threatened Species for fish was evaluated for this purpose. The Red List was found to be coherent with other assessments of vulnerability of fish to exploitation. Different fishing practices also showed different pressures on threatened fish species (aggregated as VEC). VEC together with PPR may thus be used in seafood LCA. Another part of the research explored LCA-based approaches as integrated decision support to form an overall sustainable fisheries management. Studies comprised of Swedish demersal trawling fleets. In the Nephrops fishery, a trade-off was found from promoting species-selective trawls. Local protection of depleted fish stocks comes with an increase in seafloor area swept, fuel use and associated emissions per landed kilo. Even if the overall fuel efficiency of the Swedish demersal trawling fleet has improved between 2002 and 2010, selective trawling required higher fuel use per kilo landing than the equivalent of less selective practices. Improved fuel efficiency was seen from stock rebuilding of the Eastern Baltic cod. However, in another study, the situation of the Eastern Baltic cod fishery was found to have deteriorated in recent years. Selection towards larger size classes has resulted in detrimental ecological consequences, reverberating into poor fish yield and economy. If overall improvements of the present situation are sought for, fisheries management needs to decrease mesh size and effort in the Eastern Baltic cod fishery, as well as include more metrics to assess sustainability. LCA-based methods can provide integrated decision support to inform various seafood policies, and integrate more objectives than is currently done in a fisheries policy context. To foster an overall sustainable seafood production, fisheries managers however need to acknowledge their role in this development. Altogether, stronger effort cuts and shifts in gear are proposed, while stressing the importance to use LCA-based assessments in order to avoid shifting from one environmental pressure to another

Pitfalls and fatal complications after iterative endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography management of biliary tract cysts. When to do open surgery (cyst resection; hepaticojejunostomy) or liver transplant?

Biliary tract cysts are a group of rare congenital diseases that have been classified by Todani in 8 types. Hepaticojejunostomy has been the preferred intervention for Type I and IV biliary cysts. It has been postulated that, due to the low incidence of cancerization of Types II and III biliary cysts, a less invasive approach could be suggested, namely cyst resection in Type II, and endoscopic sphincterotomy with opening of choledochocele in small (<3 cm) Type III cysts from old patients. Moreover, Caroli disease has been proposed to be treated by percutaneous biliary drainages. The aim of the present study is to propose the therapeutics strategies to follow for the management of biliary tract cysts, in case of failure of percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP). From 2008 to May 2014, three patients with congenital biliary tract cysts were followed. Two patients were found to be affected by bilateral liver Caroli disease and another young patient was found to be affected by a Type III biliary cyst (choledochocele). Patients affected by Caroli disease presented cholangitis, jaundice and fever and have been submitted to PTC. PTC, after an initial brief relief of the symptoms, failed in both cases. One of these patients with recurrent post PTC cholangitis was then successfully treated by orthotopic liver transplant. The other patient affected by Caroli disease died after multiple PTC. The young patient affected by choledochocele suffered from pancreatitis and jaundice and was submitted to ERCP. Endoscopic resection of choledochocele was followed by hemorrhagia and a fatal fungal sepsis. Minimally invasive approaches have been widely used in the management of biliary tract cysts. Diffuse bilateral Caroli disease of the liver can be initially managed by percutaneous drainage but if cholangitis recurs, in our opinion, it is useful to consider an open surgery procedure such as orthotopic liver transplant. Type III biliary cyst (choledococele) can be managed by ERCP if patient is old and the cyst is small (<3 cm) but when the cyst is larger than 3 cm, symptomatic, and the patient is young, one approach to take into consideration is open duodenostomy with choledochocele resection and reimplantation of the common bile and of Wirsung ducts into the duodenal mucosa