A review of the combined effects of climate change and other local human stressors on the marine environment

Climate change (CC) is a key, global driver of change of marine ecosystems. At local and regional scales, other local human stressors (LS) can interact with CC and modify its effects on marine ecosystems. Understanding the response of the marine environment to the combined effects of CC and LS is crucial to inform marine ecosystem-based management and planning, yet our knowledge of the potential effects of such interactions is fragmented. At a global scale, we explored how cumulative effect assessments (CEAs) have addressed CC in the marine realm and discuss progress and shortcomings of current approaches. For this we conducted a systematic review on how CEAs investigated at different levels of biological organization ecological responses, functional aspects, and the combined effect of CC and HS. Globally, the effects of 52 LS and of 27 CC-related stressors on the marine environment have been studied in combination, such as industrial fisheries with change in temperature, or sea level rise with artisanal fisheries, marine litter, change in sediment load and introduced alien species. CC generally intensified the effects of LS at species level. At trophic groups and ecosystem levels, the effects of CC either intensified or mitigated the effects of other HS depending on the trophic groups or the environmental conditions involved, thus suggesting that the combined effects of CC and LS are context-dependent and vary among and within ecosystems. Our results highlight that large-scale assessments on the spatial interaction and combined effects of CC and LS remain limited. More importantly, our results strengthen the urgent need of CEAs to capture local-scale effects of stressors that can exacerbate climate-induced changes. Ultimately, this will allow identifying management measures that aid counteracting CC effects at relevant scales

Thinking outside the ocean-climate nexus : Towards systems-informed decision making in a rapidly changing world

Despite repeated calls for more inclusive practices, approaches used to address current challenges within the ocean-climate nexus do not sufficiently account for the complexity of the human-social-ecological system. So far, this has prevented efficient and just decision-making and policies. We propose to shift towards systems-informed decision making, which values transdisciplinary system-thinking and cumulative impact assessments, and encourages multi-system collaboration among decision-makers in order to address the recurring technicality of policies and to foster just solutions that account for the needs of varied actors across the sustainable development spectrum

The Status of Coastal Benthic Ecosystems in the Mediterranean Sea: Evidence From Ecological Indicators

The Mediterranean Sea is subject to multiple human pressures increasingly threatening its unique biodiversity. Spatially explicit information on the ecological status of marine ecosystems is therefore key to an effective maritime spatial planning and management, and to help the achievement of environmental targets. Here, we summarized scientific data on the ecological status of a selection of marine ecosystems based on a set of ecological indicators in more than 700 sites of the Mediterranean Sea. For Posidonia oceanica seagrass beds, rocky intertidal fringe, and coastal soft bottoms, more than 70% of investigated sites exhibited good to high ecological conditions. In contrast, about two-thirds of sites for subtidal rocky reefs were classified to be in moderate to bad conditions, stressing the need for prioritizing conservation initiatives on these productive and diverse environments. Very little quantitative information was available for the southern Mediterranean Sea, thus monitoring programs and assessments in this area are essential for a representative assessment of the health of marine coastal ecosystems in the whole basin. This overview represents a first step to implement a baseline that, through georeferenced data on ecological status, could help identifying information gaps, directing future research priorities, and supporting improvements to spatial models of expected cumulative impacts on marine ecosystems

Twelve recommendations for advancing marine conservation in European and contiguous seas

Like most ocean regions today, the European and contiguous seas experience cumulative impacts from local human activities and global pressures. They are largely in poor environmental condition with deteriorating trends. Despite several success stories, European policies for marine conservation fall short of being effective. Acknowledging the challenges for marine conservation, a 4-year multi-national network, MarCons, supported collaborative marine conservation efforts to bridge the gap between science, management and policy, aiming to contribute in reversing present negative trends. By consolidating a large network of more than 100 scientists from 26 countries, and conducting a series of workshops over 4 years (2016–2020), MarCons analyzed challenges, opportunities and obstacles for advancing marine conservation in the European and contiguous seas. Here, we synthesize the major issues that emerged from this analysis and make 12 key recommendations for policy makers, marine managers, and researchers. To increase the effectiveness of marine conservation planning, we recommend (1) designing coherent networks of marine protected areas (MPAs) in the framework of marine spatial planning (MSP) and applying systematic conservation planning principles, including re-evaluation of existing management zones, (2) designing MPA networks within a broader transboundary planning framework, and (3) implementing integrated land-freshwater-sea approaches. To address inadequate or poorly informed management, we recommend (4) developing and implementing adaptive management plans in all sites of the Natura 2000 European conservation network and revising the Natura 2000 framework, (5) embedding and implementing cumulative effects assessments into a risk management process and making them operational, and (6) promoting actions to reach ‘good environmental status’ in all European waters. To account for global change in conservation planning and management, we further recommend (7) developing conservation strategies to address the impacts of global change, for example identifying climate-change refugia as high priority conservation areas, and (8) incorporating biological invasions in conservation plans and prioritizing management actions to control invasive species. Finally, to improve current practices that may compromise the effectiveness of conservation actions, we recommend (9) reinforcing the collection of high-quality open-access data, (10) improving mechanisms for public participation in MPA planning and management, (11) prioritizing conservation goals in full collaboration with stakeholders, and (12) addressing gender inequality in marine sciences and conservation

Renal colic due to spontaneous perirenal haematoma secondary to antiplatelet medication: Two case reports

We present two cases of spontaneous unilateral perirenal haematoma, following the administration of antiplatelet medication. Both patients reported no history of trauma. One patient was managed conservatively whereas the second patient needed an urgent nephrectomy. A spontaneous haematoma is a rare diagnosis that is easy to be missed. It is important to have a high index of suspicion as a prompt diagnosis can improve the morbidity and mortality of patients. The causes of spontaneous perirenal haematoma are quite varied and a bleeding diathesis can only be accepted as a cause only when all other causes have been excluded. © 2008 Wolters Kluwer Health Lippincott Williams & Wilkins

Problems faced by relatives caring for cancer patients at home

The care of patients suffering from advanced cancer is not limited in the hospital setting. It continues at home where the burden of care is borne by specific individuals. The aim of the present study was to survey and record the various problems faced by those who care for cancer patients at home. The study was conducted in our hospital during the summer of 2007. All participants completed, during a personal interview, a questionnaire which covered pathologic, social, psychological, spiritual/religious and financial problems. Seventy-six carers returned fully completed questionnaires. The most frequent problems reported were: anxiety regarding the patient's future (61.8%), troublesome symptoms such as pain (54%), increased economic burden-financial difficulty (51.3%), problems with patient's feeding (50%), unhappiness or depression (48,7%), emotional upset (47.4%), worsening of the patient's behaviour and personality (38.2%), difficulty of establishing a positive attitude regarding their current status (34.2%), transport to hospital (32.9%), assistance from the wider family circle (25%). Taking care of cancer patients at home creates several problems among carers. Many of them remain undetected. The acknowledgement and recognition of these problems by health-care professionals might contribute to finding solutions in order to assist the difficult task of these individuals. © 2009 Blackwell Publishing Asia Pty Ltd