Pelagic habitats under MSFD D1: current approaches and priorities

This report reviews the current situation as regards to the Marine Strategy Framework Directive (MSFD) Descriptor 1 (Biodiversity) for pelagic habitats and serves as a basis for a workshop with Member States experts and scientists that will be held on March 9-10 2021. Recommendations are in the concluding section. Pelagic habitats cover the 71% of Earth’s surface and play an essential role in regulating temperature on land, producing oxygen and food. They are also a management challenge where the alterations of their physical, chemical and biological characteristics negatively impact their ecosystem functioning and services (e.g. provisioning services). To address these challenges, the MSFD has required the assessment of pelagic habitats against environmental targets to reach Good Environmental Status (GES). A key step in the pelagic habitat assessment is a thorough understanding of its physical, chemical and biological processes and the drivers that underlie the spatiotemporal variability in its ecologically relevant ecosystem components. However, pelagic assessments to date have not sufficiently addressed the functional and structural characteristics of pelagic habitats processes, which is limiting our ability to inform on their environmental status and to disentangle the anthropogenic drivers. This report evaluates previously published work on pelagic habitats assessments considering the actions and targets to meet the MSFD requirements. To do this, the report (i) summarises the main drivers of variation in pelagic habitat characterization; (ii) reviews the common empirical approaches used to assess pelagic habitats, the advantages, and challenges; and finally (iii) exposes a set of recommendationsfor characterising pelagic habitats in EU waters. Since the pelagic habitats are made of a highly dynamic fluid, appropriate spatiotemporal scales regarding data and methods must be considered to assess their GES. This applies in particular to the selected indicators to propose the effective and quantifiable GES targets that need to be reached.JRC.D.2 - Water and Marine Resource

Status of pelagic habitats within the EU-Marine Strategy Framework Directive: Proposals for improving consistency and representativeness of the assessment

Anthropogenic activities have transformed the pelagic habitat in the last decades with profound implications for its essential functions. While the EU-Marine Strategy Framework Directive 2008/56/EC and the Commission Decision (EU) 2017/848 have set criteria and methodological standards for the assessment and determination of Good Environmental Status (GES) for pelagic habitats in EU waters, there is strong evidence that Member States have not yet harmonized the pelagic GES assessment across EU marine waters. Today, pelagic habitats are assessed by evaluating whether good status is achieved by each of the pelagic indicators, but this approach fails to observe the high variability of the pelagic environment. To this end, GES is not estimated at pelagic habitats scale but only for each individual indicator. This paper synthesises the latest developments on pelagic habitats assessment and identifies the main factors limiting the consistency of the assessment across Member States: i) coarse spatial and temporal scales of sampling effort as regards to the pelagic habitat dynamics, ii) little consideration of the whole range of plankton (and, to some extent, of zooplankton) size and trophic spectra, iii) lack of integrated hydro-biogeochemical and biological studies and collaboration among experts from different scientific fields, iv) limited availability of pressure-based indicators, and v) lack of integration methods of the pelagic indicators’ status for the GES determination. This analysis demonstrates the importance of maintaining a consistent sampling frequency and a spatially extensive network of stations across the gradient of anthropogenic pressures, where spatial environmental data can help objectively extrapolating field data.The authors would like to thank the Pelagic Habitats Experts, part of the MSFD Biodiversity Expert Network for the fruitful discussions on the harmonisation of the MSFD assessment and monitoring for pelagic habitats. CM, MP, JND, and AP were funded by the Joint Research Centre of Ispra (Italy). IV wishes to acknowledge support from the program “Monitoring and recording the situation of the marine sub-regions of Greece / Upgrading and functional updating of the MSFD monitoring network”, funded by national and EU funds under National Strategic Reference Framework 2014–2020 (MIS 5010880), and the European project ABIOMMED: Support coherent and coordinated assessment of biodiversity and measures across Mediterranean for the next 6-year cycle of MSFD implementation, funded by DG Environment (11.0661/2020/839620/SUB/ENV.C2), coordinator Dr. Kalliopi Pagou, HCMR.Peer reviewe

Prospective evaluation of NGS-based sequencing in epilepsy patients: results of seven NASGE-associated diagnostic laboratories

BackgroundEpilepsy is one of the most common and disabling neurological disorders. It is highly prevalent in children with neurodevelopmental delay and syndromic diseases. However, epilepsy can also be the only disease-determining symptom. The exact molecular diagnosis is essential to determine prognosis, comorbidity, and probability of recurrence, and to inform therapeutic decisions.Methods and materialsHere, we describe a prospective cohort study of patients with epilepsy evaluated in seven diagnostic outpatient centers in Germany. Over a period of 2 months, 07/2022 through 08/2022, 304 patients (317 returned result) with seizure-related human phenotype ontology (HPO) were analyzed. Evaluated data included molecular results, phenotype (syndromic and non-syndromic), and sequencing methods.ResultsSingle exome sequencing (SE) was applied in half of all patients, followed by panel (P) testing (36%) and trio exome sequencing (TE) (14%). Overall, a pathogenic variant (PV) (ACMG cl. 4/5) was identified in 22%; furthermore, a significant number of patients (12%) carried a reported clinically meaningful variant of unknown significance (VUS). The average diagnostic yield in patients ≤ 12 y was higher compared to patients >12 y cf. Figure 2B vs. Figure 3B. This effect was more pronounced in cases, where TE was applied in patients ≤ 12 vs. >12 y [PV (PV + VUS): patients ≤ 12 y: 35% (47%), patients > 12 y: 20% (40%)]. The highest diagnostic yield was achieved by TE in syndromic patients within the age group ≤ 12 y (ACMG classes 4/5 40%). In addition, TE vs. SE had a tendency to result in less VUS in patients ≤ 12 y [SE: 19% (22/117) VUS; TE: 17% (6/36) VUS] but not in patients >12 y [SE: 19% (8/42) VUS; TE: 20% (2/10) VUS]. Finally, diagnostic findings in patients with syndromic vs. non-syndromic symptoms revealed a significant overlap of frequent causes of monogenic epilepsies, including SCN1A, CACNA1A, and SETD1B, confirming the heterogeneity of the associated conditions.ConclusionIn patients with seizures—regardless of the detailed phenotype—a monogenic cause can be frequently identified, often implying a possible change in therapeutic action (36.7% (37/109) of PV/VUS variants); this justifies early and broad application of genetic testing. Our data suggest that the diagnostic yield is highest in exome or trio-exome-based testing, resulting in a molecular diagnosis within 3 weeks, with profound implications for therapeutic strategies and for counseling families and patients regarding prognosis and recurrence risk

Pelagic habitats under the MSFD D1: scientific advice of policy relevance

Pelagic habitats are a policy priority below Descriptor 1 (Biodiversity) of the Marine Strategy Framework Directive (MSFD). They are addressed under the D1C6 criterion, stating “the condition of the habitat type, including its biotic and abiotic structure and its functions…, is not adversely affected due to anthropogenic pressures”. The evaluation of pelagic habitats status is challenged by the functional and structural characteristics of pelagic habitat diversity and processes. To date, pelagic habitats assessments are lacking in common criteria and methodologies that characterize the habitat while accounting for the effects of anthropogenic pressures to achieve the Good Environmental Status (GES). It is therefore necessary to prioritise communication between scientific and policy communities and frame pelagic research to agree on common methods and approaches at regional or EU scale. This is key for achieving harmonised and comparable pelagic assessments for the MSFD. This report summarizes the outcomes on the assessment workflow of pelagic habitats of the JRC “MSFD pelagic habitats” workshop (9th and 10th March 2021), and the need for coordinated evaluations of the scientific challenges of policy relevance. Recommendations on the MSFD implementation of D1C6, that were generated from the experts during the workshop, will be communicated to the MSFD policy groups and the EU Member States competent authorities to support future harmonised assessment of pelagic habitats.JRC.D.2 - Water and Marine Resource

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Worldwide trends in underweight and obesity from 1990 to 2022 : a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

A list of authors and their affiliations appears online. A supplementary appendix is herewith attached.Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.peer-reviewe

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Modeling of Water Quality Indicators in the Western Baltic Sea: Seasonal Oxygen Deficiency

Hypoxia in coastal seas is a severe threat to marine ecosystems, with the Baltic Sea exhibiting the largest hypoxic areas worldwide. While perennial oxygen deficiency in the deep basins is a component of environmental assessments, seasonal oxygen deficiency in shallow areas is not routinely assessed. Current measurements alone cannot provide the spatio-temporal resolution needed for highly dynamic seasonal oxygen deficiency, making estimations on its duration and extent uncertain. Utilizing long-term 3D model simulations with a horizontal resolution of 3 nautical miles, we analyzed the development of seasonal oxygen deficiency in the western Baltic Sea. Different metrics (near-bottom area, water volume, duration, and frequency) and critical oxygen concentrations were analyzed for exemplary sub-basins as defined by the Helsinki Commission. Our results indicate that the extent of seasonal oxygen deficiency has continually increased in the second half of the twentieth century until the end of the 1980s and slightly decreased in the last two decades. In the 1950s, the spatial extent of oxygen deficiency was still at a low plateau before increasing, indicating that this period could be suitable as a reference period representing a good status, including naturally occurring oxygen deficiency. Overall, seasonal oxygen deficiency is a suitable indicator for describing the ecological status of the western Baltic Sea. For an application as eutrophication indicator in shallow areas, a sufficient spatio-temporal resolution of seasonal oxygen deficiency is needed which can be gained by a combination of model simulations and measurements. Further analysis is needed to integrate in situ measurements and model results to obtain the most reliable approach