Assessing the cumulative environmental effects of marine renewable energy developments: establishing common ground

Assessing and managing the cumulative impacts of human activities on the environment remains a major challenge to sustainable development. This challenge is highlighted by the worldwide expansion of marine renewable energy developments (MREDs) in areas already subject to multiple activities and climate change. Cumulative effects assessments in theory provide decision makers with adequate information about how the environment will respond to the incremental effects of licensed activities and are a legal requirement in many nations. In practise, however, such assessments are beset by uncertainties resulting in substantial delays during the licensing process that reduce MRED investor confidence and limit progress towards meeting climate change targets. In light of these targets and ambitions to manage the marine environment sustainably, reducing the uncertainty surrounding MRED effects and cumulative effects assessment are timely and vital. This review investigates the origins and evolution of cumulative effects assessment to identify why the multitude of approaches and pertinent research have emerged, and discusses key considerations and challenges relevant to assessing the cumulative effects of MREDs and other activities on ecosystems. The review recommends a shift away from the current reliance on disparate environmental impact assessments and limited strategic environmental assessments, and a move towards establishing a common system of coordinated data and research relative to ecologically meaningful areas, focussed on the needs of decision makers tasked with protecting and conserving marine ecosystems and services

Sampling a Littoral Fish Assemblage: Comparison of Small-Mesh Fyke Netting and Boat Electrofishing

We compared small-mesh (4-mm) fyke netting and boat electrofishing for sampling a littoral fish assemblage in Muskegon Lake, Michigan. We hypothesized that fyke netting selects for small-bodied fishes and electrofishing selects for large-bodied fishes. Three sites were sampled during May (2004 and 2005), July (2005 only), and September (2004 and 2005). We found that the species composition of captured fish differed considerably between fyke netting and electrofishing based on nonmetric multidimensional scaling (NMDS). Species strongly associated with fyke netting (based on NMDS and relative abundance) included the brook silverside Labidesthes sicculus, banded killifish Fundulus diaphanus, round goby Neogobius melanostomus, mimic shiner Notropis volucellus, and bluntnose minnow Pimephales notatus, whereas species associated with electrofishing included the Chinook salmon Oncorhynchus tshawytscha, catostomids (Moxostoma spp. and Catostomus spp.), freshwater drum Aplodinotus grunniens, walleye Sander vitreus, gizzard shad Dorosoma cepedianum, and common carp Cyprinus carpio. The total length of fish captured by electrofishing was 12.8 cm (95% confidence interval ¼ 5.5– 17.2 cm) greater than that of fish captured by fyke netting. Size selectivity of the gears contributed to differences in species composition of the fish captured, supporting our initial hypothesis. Thus, small-mesh fyke nets and boat electrofishers provided complementary information on a littoral fish assemblage. Our results support use of multiple gear types in monitoring and research surveys of fish assemblages. Copyright by the American Fisheries Society 2007, Originally published in the North American Journal of Fisheries Management 27: 825-831, 2007

Differences in level of confidence in diabetes care between different groups of trainees: the TOPDOC diabetes study

Background There is an increasing prevalence of diabetes. Doctors in training, irrespective of specialty, will have patients with diabetes under their care. The aim of this further evaluation of the TOPDOC Diabetes Study data was to identify if there was any variation in confidence in managing diabetes depending on the geographical location of trainees and career aspirations. Methods An online national survey using a pre-validated questionnaire was administered to trainee doctors. A 4-point confidence rating scale was used to rate confidence in managing aspects of diabetes care and a 6-point scale used to quantify how often trainees would contribute to the management of patients with diabetes. Responses were grouped depending on which UK country trainees were based and their intended career choice. Results Trainees in Northern Ireland reported being less confident in IGT diagnosis, use of IV insulin and peri-operative management and were less likely to adjust oral treatment, contact specialist, educate lifestyle, and optimise treatment. Trainees in Scotland were less likely to contact a specialist, but more likely to educate on lifestyle, change insulin, and offer follow-up advice. In Northern Ireland, Undergraduate (UG) and Postgraduate (PG) training in diagnosis was felt less adequate, PG training in emergencies less adequate, and reporting of need for further training higher. Trainees in Wales felt UG training to be inadequate. In Scotland more trainees felt UG training in diagnosis and optimising treatment was inadequate. Physicians were more likely to report confidence in managing patients with diabetes and to engage in different aspects of diabetes care. Aspiring physicians were less likely to feel the need for more training in diabetes care; however a clear majority still felt they needed more training in all aspects of care. Conclusions Doctors in training have poor confidence levels dealing with diabetes related care issues. Although there is variability between different groups of trainees according to geographical location and career aspirations, this is a UK wide issue. There should be a UK wide standardised approach to improving training for junior doctors in diabetes care with local training guided by specific needs.</p

Structuring cumulative effects assessments to support regional and local marine management and planning obligations

Cumulative effects assessments are a legal requirement in many jurisdictions and are key to informing marine policy. However, practice does not yet deliver fit-for-purpose assessments relative to sustainable development and environmental protection obligations. The complexity of cumulative effect questions, which are embedded in complex social-ecological systems, makes multiple, methodologically diverse assessments a necessity. Using the expansion of marine renewable energy developments in European Union waters as a case study, this paper explores how social-ecological systems thinking and cumulative effects assessment theory can combine to structure CEAs that better support the management and regulation of maritime activities at regional scales. A general perspective for cumulative effects assessment is proposed to remove ambiguity of intent and to orient assessments towards a common objective. Candidate principles for practice are presented for consideration. These principles are integrated into a stepped assessment approach that seeks to improve cumulative effects assessments of localised activities relative to the information needs of decision-makers implementing the ecosystem approach

Non-European Union doctors in the National Health Service: why, when and how do they come to the United Kingdom of Great Britain and Northern Ireland?

BACKGROUND: As many as 30% of doctors working for the National Health System (NHS) of the United Kingdom of Great Britain and Northern Ireland (UK) have obtained their primary qualifications from a country outside the European Union. However, factors driving this migration of doctors to the UK merit continuing exploration. Our objective was to obtain training and employment profile of UK doctors who obtained their primary medical qualification outside the European Union (non-European doctors) and to assess self-reported reasons for their migration. METHODS: We conducted an online survey of non-European doctors using a pre-validated questionnaire. RESULTS: One thousand six hundred and nineteen doctors of 26 different nationalities completed the survey. Of the respondents, 90.1% were from India and over three-quarters migrated to the UK mainly for 'training'. Other reasons cited were 'better pay' (7.2%), 'better work environment' (7.1%) and 'having family and friends in the UK' (2.8%). Many of the respondents have been in the UK for more than a year (88.8%), with 31.3% having spent more than 3 years gaining experience of working in the NHS. Most respondents believe they will be affected by recent changes to UK immigration policy (86.6%), few report that they would be unaffected (3.7%) and the rest are unsure (9.8%). CONCLUSION: The primary reason for many non-European doctors to migrate to the UK is for training within the NHS. Secondary reasons like better pay, better work environment and having friends and family in the UK also play a role in attracting these doctors, predominantly from the Indian subcontinent and other British Commonwealth countries

RHAMNETIN IS A BETTER INHIBITOR OF SARS-COV-2 2’-O-METHYLTRANSFERASE THAN DOLUTEGRAVIR: A COMPUTATIONAL PREDICTION

Background: The 2’-O-methyltransferase is responsible for the capping of SARS-CoV-2 mRNA and consequently the evasion of the host’s immune system. This study aims at identifying prospective natural inhibitors of the active site of SARS-CoV-2 2’O-methyltransferase (2’-OMT) through an in silico approach. Materials and Method: The target was docked against a library of natural compounds obtained from edible African plants using PyRx - virtual screening software. The antiviral agent, Dolutegravir which has a binding affinity score of -8.5 kcal mol−1 with the SARS-CoV-2 2’-OMT was used as a standard. Compounds were screened for bioavailability through the SWISSADME web server using their molecular descriptors. Screenings for pharmacokinetic properties and bioactivity were performed with PKCSM and Molinspiration web servers respectively. The PLIP and Fpocket webservers were used for the binding site analyses. The Galaxy webserver was used for simulating the time-resolved motions of the apo and holo forms of the target while the MDWeb web server was used for the analyses of the trajectory data. Results: The Root-Mean-Square-Deviation (RMSD) induced by Rhamnetin is 1.656A0 as compared to Dolutegravir (1.579A0). The average B-factor induced by Rhamnetin is 113.75 while for Dolutegravir is 78.87; the Root-Mean-Square-Fluctuation (RMSF) for Rhamnetin is 0.75 and for Dolutegravir is 0.67. Also at the active site, Rhamnetin also has a binding affinity score of -9.5 kcal mol−1 and forms 7 hydrogen bonds as compared to Dolutegravir which has -8.5 kcal mol−1 and forms 4 hydrogen bonds respectively. Conclusion: Rhamnetin showed better inhibitory activity at the target’s active site than Dolutegravir

Vitamin D prescribing practices among clinical practitioners during the COVID-19 pandemic

Background and Aims: COVID-19 has caused devastation globally. Low vitamin D status, particularly during the winter months, remains commonplace around the world, and it is thought to be one of the contributing factors toward causation and severity of COVID-19. Many guidelines do not recommend vitamin D for the treatment or prevention of the disease. Hence, we set out to conduct a global survey to understand the use and prescribing habits of vitamin D among clinicians for COVID-19. Methods: An online anonymous questionnaire was sent to clinicians enquiring about their prescribing habits of vitamin D and personal use of vitamin D. Data of the survey were collected between January 15, 2021, and February 13, 2021. Results: Four thousand four hundred forty practicing clinicians were included in the analysis, with the majority of those responding from Asia, followed by Europe. 82.9% prescribed vitamin D before COVID-19, more commonly among general practitioners (GPs) in comparison with medical specialists, and Asian clinicians were more likely to prescribe vitamin D in comparison with Caucasian physicians (p < 0.01). GPs were also more likely to prescribe vitamin D prophylactically to prevent COVID-19 in comparison with medical specialists (OR 1.47, p < 0.01). Most GPs (72.8%) would also prescribe vitamin D to treat COVID-19 in comparison with medical specialists (OR 1.81, p < 0.01), as well as more Asian in comparison with Caucasian physicians (OR 4.57, p < 0.01). 80.4% of respondents were taking vitamin D, more so in the 45–54 and 65–74 age groups in comparison with the 18–24 years category (OR 2.15 and 2.40, respectively, both p < 0.05), many of whom did so before COVID-19 (72.1%). Conclusion: This survey has shown that many clinicians would prescribe vitamin D for the prevention and treatment of COVID-19. The majority would also recommend measuring vitamin D levels, but not so in patients with COVID-19

Relationship Between Vitamin D Status and Vitamin D Receptor Gene Polymorphisms With Markers of Metabolic Syndrome Among Adults

Introduction: Recent studies have demonstrated that vitamin D deficiency contributes to the development of metabolic disorders, including obesity and type 2 diabetes mellitus (T2DM). Several vitamin D receptor (VDR) gene polymorphisms had been described to play a role in these conditions since vitamin D receptors were found in many tissues. The aim of this study was to assess the relationship between vitamin D status and VDR gene polymorphisms with metabolic syndrome (MS) parameters in Russian middle-aged women.Materials and Methods: A total of 697 women aged between 30 to 55 years were included in this cross-sectional study. Serum 25-hydroxyvitamin D (25(OH)D) level and four VDR gene polymorphisms rs1544410 (BsmI), rs7975232 (ApaI), rs731236 (TaqI), and rs2228570 (FokI) were measured. We applied the International Diabetes Federation (IDF) criteria to identify subjects with MS.Results: 9.3% of subjects had normal vitamin D level, while 90.7% were insufficient or deficient. Abdominal obesity (AO) was seen in 75.5%, impaired glucose tolerance (IGT) or T2DM was observed in 33.3%, reduced high-density lipoprotein cholesterol (HDL-C) level in 32.2% and hypertriglyceridemia in 23.4%. Serum 25(OH)D level in women with or without MS did not differ (48.6 ± 1.8 and 51.1 ± 1.5 nmol/l, p &gt; 0.05). Subjects with vitamin D deficiency showed an increased risk of AO [CI 95% 2.23; 1.15–4.30] and low HDL-C [CI95% 2.60; 1.04–6.49] compared to subjects with normal 25(OH)D level. IGT and T2DM risk was increased only when 25(OH)D concentration was less than 39.0 nmol/l [CI 95% 7.17; 2.99–17.7], but risk of MS did not differ in normal vitamin D status subjects and insufficient/deficient ones (p &gt; 0.05). T allele carriers (A) of rs7975232 had higher total cholesterol and low-density lipoprotein cholesterol levels compared with the GG (aa) genotypes. Similarly, GG (BB) genotype carriers of rs1544410 had higher triglyceride levels than subjects with A (b) allele carriers. However VDR gene polymorphisms did not seem to be associated with an increased risk of MS.Conclusions: Vitamin D deficiency, rs7975232, and rs1544410 VDR gene variants are associated with MS parameters in Russian middle-aged women

Diabetes foot complications and standardized mortality rate in type 2 diabetes

Aim: To quantify the impact of foot complications on mortality outcomes in people with type 2 diabetes (T2D), and how routinely measured factors might modulate that risk. Materials and Methods: Data for individuals with T2D for 2010-2020, from the Salford Integrated Care Record (Salford, UK), were extracted for laboratory and clinical data, and deaths. Annual expected deaths were taken from Office of National Statistics mortality data. An index of multiple deprivation (IMD) adjusted the standardized mortality ratio (SMR_IMD). Life years lost per death (LYLD) was estimated from the difference between expected and actual deaths. Results: A total of 11 806 T2D patients were included, with 5583 new diagnoses and 3921 deaths during 2010-2020. The number of expected deaths was 2135; after IMD adjustment, there were 2595 expected deaths. Therefore, excess deaths numbered 1326 (SMR_IMD 1.51). No foot complications were evident in n = 9857. This group had an SMR_IMD of 1.13 and 2.74 LYLD. In total, 2979 patients had any foot complication recorded. In this group, the SMD_IMR was 2.29; of these, 2555 (75%) had only one foot complication. Patients with a foot complication showed little difference in percentage HbA1c more than 58 mmol/mol. In multivariate analysis, for those with a foot complication and an albumin-to-creatinine ratio of more than 3 mg/mmol, the odds ratio (OR) for death was 1.93, and for an estimated glomerular filtration rate of less than 60 mL/min/1.73m2, the OR for death was 1.92. Conclusions: Patients with T2D but without a foot complication have an SMR_IMD that is only slightly higher than that of the general population. Those diagnosed with a foot complication have a mortality risk that is double that of those without T2D