A risk assessment for the remote ocean: the case of the South East Atlantic

Degradation of the natural world and associated ecosystem services is attributed to a historical failure to include its ‘value’ in decision-making. Uncertainty in the quantification of the relationship between natural capital ‘assets’ that give rise to critical societal benefits and people is one reason for the omission of these values from natural resource management. As this uncertainty increases in marine systems and further still with distance from the coast, the connection between society and natural capital assets is less likely to be included adequately in decision-making. Natural capital assets of Areas Beyond National Jurisdiction (ABNJ), including those of the deep sea, are distant but are known to generate many benefits for society, from the diffuse and broad-scale benefits of climate regulation to the provision of wild fish for food. While our understanding of the precise relationships (the status of asset stocks, ecosystem functions and processes) that control the availability of ecosystem services and the flows of benefits is limited, this does not preclude opening a discourse on how these natural capital assets could best be managed to continue to benefit society. Here we apply a natural capital approach to the South East Atlantic ABNJ, one of the least scientifically understood regions of the planet, and develop a framework for risk assessment. We do this by describing the benefit flows from the natural capital assets of the region, appraising how activities are creating pressures on these flows and whether the controls for these pressures protect them. Our risk register highlights how governance currently favours the protection of direct (extractive) benefit flows from natural capital assets of the region, which are primarily targeted for financial benefit. Without a systems-based framework that can account for the cumulative pressures on natural capital assets their status, associated ecosystem services and benefits are at risk. Such an approach is essential to capture and protect the foundational and often diffuse connections between marine natural capital and global society.</jats:p

A standardised ecosystem services framework for the deep sea

Despite its remoteness, human activity has impacted the deep sea and changes to the structure and function of deep-sea ecosystems are already noticeable. In terrestrial and shallow water marine environments, demonstrating how ecosystems support human well-being has been instrumental in setting policy and management objectives for sustainable resource use. Foundational to this approach is a framework of ecosystem service (ES) classification and a synthesis of the knowledge base, which can then be used to structure decision-support tools such as ecosystem accounts or Environmental Impact Assessments. At present, no such framework exists for the deep sea. There is thus an urgent need to determine and assess the ES provided by deep-sea habitats and species before (potentially irreversible) decisions are made about deep-sea habitat use and governance. As a first step towards the incorporation of ES in such decision-making, we undertake two systematic reviews of the scientific literature based on the principles of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) systematic process. This was to define a comparative ES framework and synthesise the current evidence base for how deep-sea habitats support ecosystem services. Our framework proposes four supporting services, three regulating services, four provisioning services and three cultural services for which there is an established and growing body of evidence for the role of deep-sea habitats. The ES framework presented here provides a structure for deep-sea ecosystem services. In its next phase of development, this could provide the foundation for the development of habitat-ecosystem service matrices, which are a critical component for truly accounting for ES in decision-making, particularly spatial management. This framework has significant implications for deep-sea management, conservation and policy, as it provides an ecosystem services-based tool that can be used in any deep-sea ecosystems management across the planet, and it also shows how critical these data gaps are for today’s decisions and how seriously they should be considered in decision-making processes

The virtual haptic back: A simulation for training in palpatory diagnosis

<p>Abstract</p> <p>Background</p> <p>Models and simulations are finding increased roles in medical education. The Virtual Haptic Back (VHB) is a virtual reality simulation of the mechanical properties of the human back designed as an aid to teaching clinical palpatory diagnosis.</p> <p>Methods</p> <p>Eighty-nine first year medical students of the Ohio University College of Osteopathic Medicine carried out six, 15-minute practice sessions with the VHB, plus tests before and after the sessions in order to monitor progress in identifying regions of simulated abnormal tissue compliance. Students palpated with two digits, fingers or thumbs, by placing them in gimbaled thimbles at the ends of PHANToM 3.0^®haptic interface arms. The interface simulated the contours and compliance of the back surface by the action of electric motors. The motors limited the compression of the virtual tissues induced by the palpating fingers, by generating counterforces. Users could see the position of their fingers with respect to the back on a video monitor just behind the plane of the haptic back. The abnormal region varied randomly among 12 locations between trials. During the practice sessions student users received immediate feedback following each trial, indicating either a correct choice or the actual location of the abnormality if an incorrect choice had been made. This allowed the user to feel the actual abnormality before going on to the next trial. Changes in accuracy, speed and Weber fraction across practice sessions were analyzed using a repeated measures analysis of variance.</p> <p>Results</p> <p>Students improved in accuracy and speed of diagnosis with practice. The smallest difference in simulated tissue compliance users were able to detect improved from 28% (SD = 9.5%) to 14% (SD = 4.4%) during the practice sessions while average detection time decreased from 39 (SD = 19.8) to 17 (SD = 11.7) seconds. When asked in anonymous evaluation questionnaires if they judged the VHB practice to be helpful to them in the clinical palpation and manual medicine laboratory, 41% said yes, 51% said maybe, and 8% said no.</p> <p>Conclusion</p> <p>The VHB has potential value as a teaching aid for students in the initial phases of learning palpatory diagnosis.</p

Using Habitat Classification to Assess Representativity of a Protected Area Network in a Large, Data-Poor Area Targeted for Deep-Sea Mining

Extractive activities in the ocean are expanding into the vast, poorly studied deep sea, with the consequence that environmental management decisions must be made for data-poor seafloor regions. Habitat classification can support marine spatial planning and inform decision-making processes in such areas. We present a regional, top–down, broad-scale, seafloor-habitat classification for the Clarion-Clipperton Fracture Zone (CCZ), an area targeted for future polymetallic nodule mining in abyssal waters in the equatorial Pacific Ocean. Our classification uses non-hierarchical, k-medoids clustering to combine environmental correlates of faunal distributions in the region. The classification uses topographic variables, particulate organic carbon flux to the seafloor, and is the first to use nodule abundance as a habitat variable. Twenty-four habitat classes are identified, with large expanses of abyssal plain and smaller classes with varying topography, food supply, and substrata. We then assess habitat representativity of the current network of protected areas (called Areas of Particular Environmental Interest) in the CCZ. Several habitat classes with high nodule abundance are common in mining exploration claims, but currently receive little to no protection in APEIs. There are several large unmanaged areas containing high nodule abundance on the periphery of the CCZ, as well as smaller unmanaged areas within the central CCZ, that could be considered for protection from mining to improve habitat representativity and safeguard regional biodiversity.</jats:p

Prevention of Liver Fibrosis and Cancer in Africa: The PROLIFICA project – a collaborative study of hepatitis B-related liver disease in West Africa

Hepatitis B virus (HBV) infection causes a spectrum of acute and chronic liver disease ranging from inactive chronic carrier status to progressive chronic hepatitis, culminating in end-stage cirrhosis and liver cancer. In sub-Saharan Africa, HBV infection is endemic and the HBV-related disease burden is high, making HBV a signficant threat to health in the African continent. The European Union-funded Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) project was established in 2011, with the central directive to reduce the incidence of HBV-related liver cancer in West Africa. In this editorial, we outline some of the achievements and challenges of the PROLIFICA platform in West Africa, highlighting the the importance of collaborative studies in Africa

An Inhibitory Antibody Blocks Interactions between Components of the Malarial Invasion Machinery

Host cell invasion by apicomplexan pathogens such as the malaria parasite Plasmodium spp. and Toxoplasma gondii involves discharge of proteins from secretory organelles called micronemes and rhoptries. In Toxoplasma a protein complex comprising the microneme apical membrane antigen 1 (AMA1), two rhoptry neck proteins, and a protein called Ts4705, localises to the moving junction, a region of close apposition between parasite and host cell during invasion. Antibodies against AMA1 prevent invasion and are protective in vivo, and so AMA1 is of widespread interest as a malaria vaccine candidate. Here we report that the AMA1 complex identified in Toxoplasma is conserved in Plasmodium falciparum. We demonstrate that the invasion-inhibitory monoclonal antibody (mAb) 4G2, which recognises P. falciparum AMA1 (PfAMA1), cannot bind when PfAMA1 is in a complex with its partner proteins. We further show that a single completely conserved PfAMA1 residue, Tyr251, lying within a conserved hydrophobic groove adjacent to the mAb 4G2 epitope, is required for complex formation. We propose that mAb 4G2 inhibits invasion by preventing PfAMA1 from interacting with other components of the invasion complex. Our findings should aid the rational design of subunit malaria vaccines based on PfAMA1

Concurrent use of prescription drugs and herbal medicinal products in older adults: A systematic review

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.The use of herbal medicinal products (HMPs) is common among older adults. However, little is known about concurrent use with prescription drugs as well as the potential interactions associated with such combinations. Objective Identify and evaluate the literature on concurrent prescription and HMPs use among older adults to assess prevalence, patterns, potential interactions and factors associated with this use. Methods Systematic searches in MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, Web of Science and Cochrane from inception to May 2017 for studies reporting concurrent use of prescription medicines with HMPs in adults (≥65 years). Quality was assessed using the Joanna Briggs Institute checklists. The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) three stage approach to mixed method research was used to synthesise data. Results Twenty-two studies were included. A definition of HMPs or what was considered HMP was frequently missing. Prevalence of concurrent use by older adults varied widely between 5.3% and 88.3%. Prescription medicines most combined with HMPs were antihypertensive drugs, beta blockers, diuretics, antihyperlipidemic agents, anticoagulants, analgesics, antihistamines, antidiabetics, antidepressants and statins. The HMPs most frequently used were: ginkgo, garlic, ginseng, St John’s wort, Echinacea, saw palmetto, evening primrose oil and ginger. Potential risks of bleeding due to use of ginkgo, garlic or ginseng with aspirin or warfarin was the most reported herb-drug interaction. Some data suggests being female, a lower household income and less than high school education were associated with concurrent use. Conclusion Prevalence of concurrent prescription drugs and HMPs use among older adults is substantial and potential interactions have been reported. Knowledge of the extent and manner in which older adults combine prescription drugs will aid healthcare professionals can appropriately identify and manage patients at risk.Peer reviewedFinal Published versio

Evaluation of the current knowledge limitations in breast cancer research: a gap analysis

BACKGROUND A gap analysis was conducted to determine which areas of breast cancer research, if targeted by researchers and funding bodies, could produce the greatest impact on patients. METHODS Fifty-six Breast Cancer Campaign grant holders and prominent UK breast cancer researchers participated in a gap analysis of current breast cancer research. Before, during and following the meeting, groups in seven key research areas participated in cycles of presentation, literature review and discussion. Summary papers were prepared by each group and collated into this position paper highlighting the research gaps, with recommendations for action. RESULTS Gaps were identified in all seven themes. General barriers to progress were lack of financial and practical resources, and poor collaboration between disciplines. Critical gaps in each theme included: (1) genetics (knowledge of genetic changes, their effects and interactions); (2) initiation of breast cancer (how developmental signalling pathways cause ductal elongation and branching at the cellular level and influence stem cell dynamics, and how their disruption initiates tumour formation); (3) progression of breast cancer (deciphering the intracellular and extracellular regulators of early progression, tumour growth, angiogenesis and metastasis); (4) therapies and targets (understanding who develops advanced disease); (5) disease markers (incorporating intelligent trial design into all studies to ensure new treatments are tested in patient groups stratified using biomarkers); (6) prevention (strategies to prevent oestrogen-receptor negative tumours and the long-term effects of chemoprevention for oestrogen-receptor positive tumours); (7) psychosocial aspects of cancer (the use of appropriate psychosocial interventions, and the personal impact of all stages of the disease among patients from a range of ethnic and demographic backgrounds). CONCLUSION Through recommendations to address these gaps with future research, the long-term benefits to patients will include: better estimation of risk in families with breast cancer and strategies to reduce risk; better prediction of drug response and patient prognosis; improved tailoring of treatments to patient subgroups and development of new therapeutic approaches; earlier initiation of treatment; more effective use of resources for screening populations; and an enhanced experience for people with or at risk of breast cancer and their families. The challenge to funding bodies and researchers in all disciplines is to focus on these gaps and to drive advances in knowledge into improvements in patient care