Review of coast and marine ecosystems in temperate Australia demonstrates a wealth of ecosystem services

© Copyright © 2020 Gaylard, Waycott and Lavery. Temperate Australia has extensive and diverse coast and marine habitats throughout its inshore and offshore waters. The region includes the southernmost extent of mangroves, over 500 estuaries and coastal embayments, home to extensive meadows of seagrasses and tidal saltmarsh. In areas of hard substrate, rocky reefs are abundant and productive with large forests of macroalgae. Coastal regions can be densely populated by humans and often habitats can be degraded, polluted or lost, while some remain relatively isolated and pristine. These habitats provide services to society including provision of food, regulate our climate through sequestration of carbon, treating our waste and protecting our shorelines from damage from storms. Coastal areas are culturally importantly hubs for recreation and tourism. Habitat mapping demonstrates diverse habitats throughout temperate Australia, but a formal investigation of services provided by these habitats has been lacking. This review of ecosystem services provided by coast and marine environments throughout temperate Australia reveals vast and productive ecosystems that provide multiple ecosystem services, substantial value to the Australian economy and contribute to the health and well-being of people who live in, visit of benefit from services or products from these regions. Some of these are considered within traditional economic metrics such as provision of wild catch fisheries, but this review demonstrates that regulation and maintenance services including waste treatment and protecting shorelines from extreme events are under recognized, and their value is substantial. However, consistent with many locations globally, coast and marine habitats are under threat from increasing development, sewage, agricultural, industrial discharges, urban runoff and climate change. Resultantly, temperate Australian coast and marine habitat extent and condition is generally declining in many regions, putting the provision of services and benefits to the community at risk. Continued degraded or lost habitats indicate current management frameworks are not capturing the full risk from development and there are winners and losers in trade off decision making. Incorporating ecosystem services in decision making may allow an integrated approach to management, and acknowledgment of services provided could prevent habitats from being undervalued against economic and social interests, a practice that often results in environmental degradation

Seagrass soil archives reveal centennial-scale metal smelter contamination while acting as natural filters

The upper Spencer Gulf in South Australia hosts the world\u27s largest single stream Pb-Zn smelter, which has caused environmental and health issues related to elevated metal concentrations in the surrounding environment. The area also has extensive seagrass meadows, occupying \u3e4000 km2. We reconstructed the fluxes of heavy metals over the last ~3000 years through a multi-parameter study of the soil archives formed by the seagrass Posidonia australis. Pb, Zn and Cd concentrations increased up to 9-fold following the onset of smelter operations in the 1880s, and the stable Pb isotopic signatures confirmed the smelter has been the main source of lead pollution in the seagrass soils until present. Preliminary estimates suggest that over the past 15 years seagrass meadows within 70 km2 of the smelter accumulated ~7–15% of the smelter emissions in their soils. Here we demonstrate that seagrass meadows act as pollution filters and sinks while their soils provide a record of environmental conditions, allowing baseline conditions to be identified and revealing the time-course of environmental change

Challenges to select suitable habitats and demonstrate ‘additionality’ in Blue Carbon projects: A seagrass case study

© 2020 Elsevier Ltd Seagrass restoration has been suggested as a Blue Carbon (BC) strategy for climate change mitigation. For Nationally Determined Contributions (NDC) and carbon crediting schemes, BC projects need to demonstrate ‘additionality’, that is enhanced CO2 sequestration and/or avoided greenhouse gas emissions following management actions. This typically requires determining soil carbon accumulation rates (CAR), which is often done using radionuclides or surface elevation tables to estimate sedimentation rates. Here we undertook a case study, using 210Pb and 14C dating, to detect possible changes in Corg stocks and CAR following the loss and partial recovery of Posidonia seagrass meadows in South Australia since 1980–90s. The 210Pb data revealed a lack of accumulation of excess 210Pb in most sites, suggesting negligible accumulation of sediments, intense mixing of the upper layers, or accumulation of reworked sediments, precluding the estimation of reliable CAR at decadal time scales. This limitation was also encountered with 14C. The inability to compare sites over analogous periods of time prevented quantifying differences in soil Corg sequestration, thereby to demonstrate additionality. The lack of significant differences in soil Corg stocks among sites which never suffered seagrass loss, those showing recovery and those with no recovery (5.7 ± 1.2, 4.5 ± 0.7 and 3.3 ± 0.3 kg Corg m-2 within the top meter, respectively) also precluded estimates of soil Corg gains or losses. Our findings demonstrate that, while 210Pb and 14C provide important information on sediment deposition dynamics, it is not straightforward to demonstrate additionality using radionuclides in low depositional seagrass habitats exposed to hydrodynamic energy, features which may be encountered in seagrass sites. We provide insights for the selection of suitable habitats for seagrass BC projects, suggest possible alternative methods for estimating additionality, and discuss the implications of the findings for the implementation of seagrass BC strategies to mitigate greenhouse gas emissions

Challenges to select suitable habitats and demonstrate ‘additionality’ in Blue Carbon projects: A seagrass case study

© 2020 Elsevier Ltd Seagrass restoration has been suggested as a Blue Carbon (BC) strategy for climate change mitigation. For Nationally Determined Contributions (NDC) and carbon crediting schemes, BC projects need to demonstrate ‘additionality’, that is enhanced CO2 sequestration and/or avoided greenhouse gas emissions following management actions. This typically requires determining soil carbon accumulation rates (CAR), which is often done using radionuclides or surface elevation tables to estimate sedimentation rates. Here we undertook a case study, using 210Pb and 14C dating, to detect possible changes in Corg stocks and CAR following the loss and partial recovery of Posidonia seagrass meadows in South Australia since 1980–90s. The 210Pb data revealed a lack of accumulation of excess 210Pb in most sites, suggesting negligible accumulation of sediments, intense mixing of the upper layers, or accumulation of reworked sediments, precluding the estimation of reliable CAR at decadal time scales. This limitation was also encountered with 14C. The inability to compare sites over analogous periods of time prevented quantifying differences in soil Corg sequestration, thereby to demonstrate additionality. The lack of significant differences in soil Corg stocks among sites which never suffered seagrass loss, those showing recovery and those with no recovery (5.7 ± 1.2, 4.5 ± 0.7 and 3.3 ± 0.3 kg Corg m-2 within the top meter, respectively) also precluded estimates of soil Corg gains or losses. Our findings demonstrate that, while 210Pb and 14C provide important information on sediment deposition dynamics, it is not straightforward to demonstrate additionality using radionuclides in low depositional seagrass habitats exposed to hydrodynamic energy, features which may be encountered in seagrass sites. We provide insights for the selection of suitable habitats for seagrass BC projects, suggest possible alternative methods for estimating additionality, and discuss the implications of the findings for the implementation of seagrass BC strategies to mitigate greenhouse gas emissions

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

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

An integrative method for the evaluation, monitoring, and comparison of seagrass habitat structure

Assessing environmental condition is essential for the management of coasts and their resources, but better management decisions occur when large databases are simplified into more manageable units of information. Here we present the habitat structure index (HSI), which enables rapid assessment and direct comparison of seagrass habitat structure using scores of 0 (poor) to 100 (excellent) based on integrating five habitat variables: area, continuity, proximity, percentage cover, and species identity. Acquiring data to calculate the HSI can be done in situ or from video recordings, and requires relatively simple methodology of belt transects, estimating percentage cover, and basic taxonomy. Spatiotemporal comparisons can usefully identify locations and periods of seagrass habitat change, potentially providing an early warning indicator of habitat damage and decline in environmental quality. Overall, the integrative approach of the HSI represents a step toward simplifying the exchange of environmental information among researchers, coastal managers, and governing bodies