The Mediterranean Rhodes Gyre: modelled impacts of climate change, acidification and fishing

The Mediterranean Rhodes Gyre is a cyclonic gyre with high primary production due to local upwelling of nutrients and occasional deep overturning up to 1 km depth. This nutrient-rich state is in sharp contrast to other parts of the Eastern Mediterranean which are oligotrophic. Here we investigated the upwelling system central to the Rhodes Gyre and the impact of different stressors like meteorological changes, acidification and fishing pressure up to the year 2100. A water column model spanning the physical, chemical and biological system up to top predators (GOTM-ERSEM-BFM-EwE) was used to simulate the pelagic environment under single and combined stressors. Results show that due to increasing winter temperatures, deep overturning events will become more rare in the future until they stop occurring around 2060 under the Paris-agreement climate scenario (RCP4.5) or around 2040 under the business-as-usual climate scenario (RCP8.5). Stratification will become stronger as temperature effects outweigh salinity effects in the surface mixed layer. Together with the lack of deep overturning, this stronger stratification limits the nutrient supply to the euphotic zone, significantly reducing primary production. Phytoplankton species shift towards smaller species as nutrients become more scarce, mimicking the situation found currently on the edge of the gyre. Climatic changes and fishing pressure will affect higher trophic levels in an additive way for some species (sardines, dolphins), while in a synergistic way for others (anchovy, mackerel). Acidification impacts are negligible. Fish stocks will reduce significantly under all scenarios involving climate change effects: ~30% under scenarios imposing RCP4.5 and ~40% under scenarios imposing RCP8.5. The beneficial impact of maximum sustained yield-level fishing is very limited, indicating a need for mitigating measures beyond fleet control

Outcomes and costs of skilled support for people with severe or profound intellectual disability and complex needs

Background With increasing reductions in funding for social care across many countries, the need to ensure that resources are used to best effect is becoming increasingly important, in particular for those with severe and complex needs. Methods In order to explore the outcomes and costs of skilled support for this group of people, quality of life was assessed for 110 people in 35 services in England. Information on costs was also collected. Results People who received consistently good active support experienced better outcomes in terms of several quality of life domains. Good support did not require significantly more staff time, and there was no evidence of higher total costs for those receiving good support. Conclusions The inclusion of active support in government guidance and local commissioning practices related to people with severe intellectual disabilities is likely to improve user outcomes. Observation should be an important element in measuring service quality

Climate change, marine resources and a small Chilean community: making the connections

Climate change is affecting large-scale oceanic processes. How and when these changes will impact those reliant on marine resources is not yet clear. Here we use end-to-end modeling to track the impacts of expected changes through the marine ecosystem on a specific, small community: Cochamó, in the Gulf of Ancud wider area, Chile. This area is important for Chilean fisheries and aquaculture, with Cochamó reliant on both lower and upper trophic level marine resources. We applied the GOTM-ERSEM-BFM coupled hydro-biogeochemical water-column model to gauge lower-trophic level marine ecological community response to bottom-up stressors (climate change, ocean acidification), coupled to an existing Ecopath with Ecosim model for the area, which included top-down stressors (fishing). Social scientists also used participatory modeling (Systems Thinking and Bayesian Belief Networking) to identify key resources for Cochamó residents and to assess the community’s vulnerability to possible changes in key resources. Modeling results suggest that flagellate phytoplankton abundance will increase at the cost of other species (particularly diatoms), resulting in a greater risk of harmful algae blooms. Both climate change and acidification slightly increased primary production in the model. Higher trophic level results indicate that some targeted pelagic resources will decline (while benthic ones may benefit), but that these effects might be mitigated by strong fisheries management efforts. Participatory modeling suggests that Cochamó inhabitants anticipate marine ecosystem changes but are divided about possible adaptation strategies. For climate change impact quantification, detailed experimental studies are recommended based on the dominant threats identified here, with specific local species

Percutaneous Interventional Radiology-Operated Endoscopy for Foreign Body Removal

Image-guided retrieval of endovascular devices such as inferior vena cava filters, guidewires, and stents is well reported, though there is a paucity of published reports on biliary, genitourinary, or gastrointestinal foreign body retrieval utilizing percutaneous endoscopy, particularly when it is performed solely by interventional radiologists. In cases of failed traditional endoscopic techniques or to evade more invasive surgical options, percutaneous endoscopy can be an adjunctive tool employed by interventional radiologists to extract foreign bodies. In this article, clinical evaluation, perioperative management, and procedural techniques for biliary, genitourinary, and gastrointestinal endoscopy for foreign body retrieval are reviewed

Billing, Coding, and Credentialing for Interventional Radiology-Operated Endoscopy

A sound understanding of billing and coding is essential to start a successful interventional radiology endoscopy practice. While the codes utilized are similar to gastrointestinal and genitourinary endoscopy codes, physicians and institutional coders need to be familiar with the codes used for these types of procedures in the interventional radiology setting. The following manuscript gives a brief overview of aspects relating to credentialing, billing, and coding in interventional radiology endoscopy

Alcohol and Its Relationship to Family Work Conflict

Alcohol has tension reducing properties, and there is evidence that people consume alcohol to reduce stressors in their lives. Conflict between work and family is a common stressor for workers. This project analyzes the relationship between work-family conflict and alcohol consumption in a sample of 81 non-professional working parents. Contrary to our hypothesis, work-family conflict was not related to either the quantity or frequency of alcohol consumption. In contrast, family-to-work conflict was related to lower alcohol consumption

On the Use of 'Glyphmaps' for Analysing the Scale and Temporal Spread of COVID-19 Reported Cases

Recent analysis of area-level COVID-19 cases data attempts to grapple with a challenge familiar to geovisualization: how to capture the development of the virus, whilst supporting analysis across geographic areas? We present several glyphmap designs for addressing this challenge applied to local authority data in England whereby charts displaying multiple aspects related to the pandemic are given a geographic arrangement. These graphics are visually complex, with clutter, occlusion and salience bias an inevitable consequence. We develop a framework for describing and validating the graphics against data and design requirements. Together with an observational data analysis, this framework is used to evaluate our designs, relating them to particular data analysis needs based on the usefulness of the structure they expose. Our designs, documented in an accompanying code repository, attend to common difficulties in geovisualization design and could transfer to contexts outside of the UK and to phenomena beyond the pandemic

Collaboration is Key – Bridging the Gap and Building an IR Endoscopy Practice

While the tools and techniques employed by interventional radiologists on a day-to-day basis translate well to learning the skills required to perform basic endoscopic interventions, collaboration with other specialties is crucial to the success of an interventional radiology endoscopy program. As in any field in medicine, the paramount goal is to improve patient care. Adding the ability to directly visualize structures through an endoscope to certain interventional radiologic procedures may greatly augment the efficacy, safety, and success of interventional radiology procedures. Colleagues in urology, gastroenterology, and surgery should be involved in decision-making and treatment planning to ensure that a shared vision for optimal patient care is achieved