Ecological risk assessments to guide decision-making: Methodology matters

Ecological risk assessment is often applied to guide the decision-making process that underpins ecosystem-based management and prioritisation of risk factors for management. Several studies have recently used ecological risk assessment approaches to identify risk factors of greatest concern, but rarely are the underlying methodological decisions discussed in terms of the effect that those decisions have on the outcome of the assessment and ultimately, how that affects prioritisation of risk factors for management. This study therefore evaluates the effect of methodological decisions involving (1) the choice and definition of risk factors, and (2) the calculation of risk scores, providing, where possible, recommendations on what should be the most appropriate methodologies. The definition of risk factors is often determined by the policy context and could result in the comparison of one broadly defined risk meta-factor (e.g. Food Production) with corresponding specific risk factors defined more narrowly (i.e. Oil and Gas production or Offshore Wind). Depending on the method to calculate risk this may result in a systematic bias prioritising any risk meta-factor. For the calculation of individual impact chain risk scores we compared weighted scores with ordinal scores, where the former allows more flexibility to represent the qualitative categories that determine risk and provided results better supported by scientific evidence. A consideration of different risk assessment applications in EBM showed there is no one-size-fits-all solution to this as these methodological decisions need to be considered in concert and the preferred methodology may depend on the context in which the risk assessment is applied. The outcome of the risk assessment should always be accompanied by an explicit consideration of these methodological issues and description of the resulting methodological choices

Evaluation of ecosystem-based marine management strategies based on risk assessment

Abstract This study presents a comprehensive and generic framework that provides a typology for the identification and selection of consistently defined ecosystem-based management measures and allows a coherent evaluation of these measures based on their performance to achieve policy objectives. The performance is expressed in terms of their reduction of risk of an adverse impact on the marine ecosystem. This typology consists of two interlinked aspects of a measure, i.e. the “Focus” and the “Type”. The “Focus” is determined by the part of the impact chain (Driver–Pressure–State) the measure is supposed to mitigate or counteract. The “Type” represents the physical measure itself in terms of how it affects the impact chain directly; we distinguish Spatio-temporal distribution controls, Input and Output controls, Remediation and Restoration measures. The performance of these measures in terms of their reduction in risk of adverse impacts was assessed based on an explicit consideration of three time horizons: past, present and future. Application of the framework in an integrated management strategy evaluation of a suite of measures, shows that depending on the time horizon, different measures perform best. “Past” points to measures targeting persistent pressures (e.g. marine litter) from past activities. “Present” favors measures targeting a driver (e.g. fisheries) that has a high likelihood of causing adverse impacts. “Future” involves impacts that both have a high likelihood of an adverse impact, as well as a long time to return to pre-impacted condition after the implementation of appropriate management, e.g. those caused by permanent infrastructure or persistent pressures such as marine litter or specific types of pollution

Circulating Acylcarnitines Associated with Hypertrophic Cardiomyopathy Severity: an Exploratory Cross-Sectional Study in MYBPC3 Founder Variant Carriers

Hypertrophic cardiomyopathy (HCM) is a relatively common genetic heart disease characterised by myocardial hypertrophy. HCM can cause outflow tract obstruction, sudden cardiac death and heart failure, but severity is highly variable. In this exploratory cross-sectional study, circulating acylcarnitines were assessed as potential biomarkers in 124 MYBPC3 founder variant carriers (59 with severe HCM, 26 with mild HCM and 39 phenotype-negative [G + P-]). Elastic net logistic regression identified eight acylcarnitines associated with HCM severity. C3, C4, C6-DC, C8:1, C16, C18 and C18:2 were significantly increased in severe HCM compared to G + P-, and C3, C6-DC, C8:1 and C18 in mild HCM compared to G + P-. In multivariable linear regression, C6-DC and C8:1 correlated to log-transformed maximum wall thickness (coefficient 5.01, p = 0.005 and coefficient 0.803, p = 0.007, respectively), and C6-DC to log-transformed ejection fraction (coefficient -2.50, p = 0.004). Acylcarnitines seem promising biomarkers for HCM severity, however prospective studies are required to determine their prognostic value

BIO FOr CARE: biomarkers of hypertrophic cardiomyopathy development and progression in carriers of Dutch founder truncating MYBPC3 variants-design and status

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most prevalent monogenic heart disease, commonly caused by truncating variants in the MYBPC3 gene. HCM is an important cause of sudden cardiac death; however, overall prognosis is good and penetrance in genotype-positive individuals is incomplete. The underlying mechanisms are poorly understood and risk stratification remains limited. AIM: To create a nationwide cohort of carriers of truncating MYBPC3 variants for identification of predictive biomarkers for HCM development and progression. METHODS: In the multicentre, observational BIO FOr CARe (Identification of BIOmarkers of hypertrophic cardiomyopathy development and progression in Dutch MYBPC3 FOunder variant CARriers) cohort, carriers of the c.2373dupG, c.2827C > T, c.2864_2865delCT and c.3776delA MYBPC3 variants are included and prospectively undergo longitudinal blood collection. Clinical data are collected from first presentation onwards. The primary outcome constitutes a composite endpoint of HCM progression (maximum wall thickness ≥ 20 mm, septal reduction therapy, heart failure occurrence, sustained ventricular arrhythmia and sudden cardiac death). RESULTS: So far, 250 subjects (median age 54.9 years (interquartile range 43.3, 66.6), 54.8% male) have been included. HCM was diagnosed in 169 subjects and dilated cardiomyopathy in 4. The primary outcome was met in 115 subjects. Blood samples were collected from 131 subjects. CONCLUSION: BIO FOr CARe is a genetically homogeneous, phenotypically heterogeneous cohort incorporating a clinical data registry and longitudinal blood collection. This provides a unique opportunity to study biomarkers for HCM development and prognosis. The established infrastructure can be extended to study other genetic variants. Other centres are invited to join our consortium

An exposure-effect approach for evaluating ecosystem-wide risks from human activities

Ecosystem-based management (EBM) is promoted as the solution for sustainable use. An ecosystem-wide assessment methodology is therefore required. In this paper, we present an approach to assess the risk to ecosystem components from human activities common to marine and coastal ecosystems. We build on: (i) a linkage framework that describes how human activities can impact the ecosystem through pressures, and (ii) a qualitative expert judgement assessment of impact chains describing the exposure and sensitivity of ecological components to those activities. Using case study examples applied at European regional sea scale, we evaluate the risk of an adverse ecological impact from current human activities to a suite of ecological components and, once impacted, the time required for recovery to pre-impact conditions should those activities subside. Grouping impact chains by sectors, pressure type, or ecological components enabled impact risks and recovery times to be identified, supporting resource managers in their efforts to prioritize threats for management, identify most at-risk components, and generate time frames for ecosystem recovery

CT angiography; useful in non-selected outpatients?

Dance has been a part of the physical education (PE) curriculum in several countries for a longtime. In spite of this, studies demonstrate that the position of dance in the subject of PE iscontested and that little time is devoted to dance. The overall aim of this article is to examine theposition of dance as a pedagogical discourse in Swedish steering documents over time. Theempirical material consists of five Swedish curricula for PE over a period of 50 years (1962–2011).Discourse analysis is used to identify organised systems of meaning, including privileged andprioritised values. Our theoretical frame of reference draws on Bernstein’s concept of codes. Threedifferent knowledge areas within dance are found in the text material: ‘dance as cultural preserver’,‘dance as bodily exercise’ and ‘dance as expression’. Three pedagogical discourses emerge fromthese knowledge areas: an identity formation discourse, a public health discourse and an aestheticdiscourse. The identity formation discourse in earlier curricula focuses on the perpetuation ofSwedish and Nordic cultural traditions, while in later curricula, it emphasises the construction of abroader multicultural identity formation related to the understanding of different cultures. Thepublic health discourse constitutes a prioritised understanding of dance as physical training relatedto a healthy lifestyle. The aesthetic discourse, which has the weakest position over time, representsthe valuing of embodied experiences and feelings expressed through movements. This discourse isclosely linked to the construction of gender. Over time, a new performance code came to surpassthe former competence code in the steering documents. The performance code positions dance inPE as mainly a physical activity with little artistic or aesthetic value. The pedagogical discourse ofdance remains within a highly disciplinary framework of social control

A Systematic Analysis of the Clinical Outcome Associated with Multiple Reclassified Desmosomal Gene Variants in Arrhythmogenic Right Ventricular Cardiomyopathy Patients

The presence of multiple pathogenic variants in desmosomal genes (DSC2, DSG2, DSP, JUP, and PKP2) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) has been linked to a severe phenotype. However, the pathogenicity of variants is reclassified frequently, which may result in a changed clinical risk prediction. Here, we present the collection, reclassification, and clinical outcome correlation for the largest series of ARVC patients carrying multiple desmosomal pathogenic variants to date (n = 331). After reclassification, only 29% of patients remained carriers of two (likely) pathogenic variants. They reached the composite endpoint (ventricular arrhythmias, heart failure, and death) significantly earlier than patients with one or no remaining reclassified variant (hazard ratios of 1.9 and 1.8, respectively). Periodic reclassification of variants contributes to more accurate risk stratification and subsequent clinical management strategy. [Figure not available: see fulltext.]

Development of the Pulmonary Vein and the Systemic Venous Sinus: An Interactive 3D Overview

Knowledge of the normal formation of the heart is crucial for the understanding of cardiac pathologies and congenital malformations. The understanding of early cardiac development, however, is complicated because it is inseparably associated with other developmental processes such as embryonic folding, formation of the coelomic cavity, and vascular development. Because of this, it is necessary to integrate morphological and experimental analyses. Morphological insights, however, are limited by the difficulty in communication of complex 3D-processes. Most controversies, in consequence, result from differences in interpretation, rather than observation. An example of such a continuing debate is the development of the pulmonary vein and the systemic venous sinus, or “sinus venosus”. To facilitate understanding, we present a 3D study of the developing venous pole in the chicken embryo, showing our results in a novel interactive fashion, which permits the reader to form an independent opinion. We clarify how the pulmonary vein separates from a greater vascular plexus within the splanchnic mesoderm. The systemic venous sinus, in contrast, develops at the junction between the splanchnic and somatic mesoderm. We discuss our model with respect to normal formation of the heart, congenital cardiac malformations, and the phylogeny of the venous tributaries

Gated myocardial SPECT imaging; true additional value in AMI?

Vascular Biology and Interventio