Harbour seals (Phoca vitulina) around an operational tidal turbine in Strangford Narrows : no barrier effect but small changes in transit behaviour

Funding: NERC Marine Renewable Energy Knowledge Exchange Programme (Contract 4060038637) and NERC grant SMRU1001.1. Data were obtained from 32 electronic tags that were glued to the fur of harbour seals (Phoca vitulina) in and around Strangford Lough, Northern Ireland, during the environmental monitoring of the SeaGen tidal turbine. 2. This study provides the first detailed information on the behaviour of marine mammals close to a commercial-scale tidal energy device. The turbine did not prevent transit of the animals through the channel and therefore did not result in a ‘barrier’ effect. 3. However, the animals' behaviour did change when the turbine was operating, demonstrating the importance of allowing for behavioural responses when estimating collision risks associated with tidal turbines. 4. Tagged animals passed the location of the device more frequently during slack water than when the current was running. In 2010 the frequency of transits by tagged seals reduced by 20% (95% CI: 10–50%) when the turbine was on, relative to when it was off. This effect was stronger when considering daylight hours only with a reduction of transit rate of 57% (95% CI: 25–64%). Seals tagged during the operational period transited approximately 250 m either side of the turbine suggesting some degree of local avoidance compared with the pre-installation results. 5. The results presented here have implications for monitoring and managing the potential interactions between tidal turbines and marine wildlife. Principally that the design of telemetry studies for measuring change in response to developments should seek to understand and take into account variability in seal behaviour. 6. This study only looked at the effects of a single turbine rather than an array, and mitigation limited the ability to determine close range interactions. However, the study indicates that the effect of the turbine on Strangford Lough harbour seals was minor and that collision risk was reduced by the behaviour of the seals.Publisher PDFPeer reviewe

Costs and Treatment Pathways for Type 2 Diabetes in the UK:A Mastermind Cohort Study

This is the author accepted manuscript. The final version is available from Springer Verlag via the DOI in this record.INTRODUCTION: Medication therapy for type 2 diabetes has become increasingly complex, and there are few reliable data on the current state of clinical practice. We report treatment pathways and associated costs of medication therapy for people with type 2 diabetes in the UK, their variability and changes over time. METHODS: Prescription and biomarker data for 7159 people with type 2 diabetes were extracted from the GoDARTS cohort study, covering the period 1989-2013. Average follow-up was 10 years. Individuals were prescribed on average 2.4 (SD: 1.2) drugs with average annual costs of £241. We calculated summary statistics for first- and second-line therapies. Linear regression models were used to estimate associations between therapy characteristics and baseline patient characteristics. RESULTS: Average time from diagnosis to first prescription was 3 years (SD: 4.0 years). Almost all first-line therapy (98%) was monotherapy, with average annual cost of £83 (SD: £204) for 3.8 (SD: 3.5) years. Second-line therapy was initiated in 73% of all individuals, at an average annual cost of £219 (SD: £305). Therapies involving insulin were markedly more expensive than other common therapies. Baseline HbA1c was unrelated to future therapy costs, but higher average HbA1c levels over time were associated with higher costs. CONCLUSIONS: Medication therapy has undergone substantial changes during the period covered in this study. For example, therapy is initiated earlier and is less expensive than in the past. The data provided in this study will prove useful for future modelling studies, e.g. of stratified treatment approaches.The authors gratefully acknowledge funding by the Medical Research Council (MRC) and the Association of the British Pharma Industry (ABPI) for “Mastermind” (MRC APBI STratification and Extreme Response Mechanism IN Diabetes–MASTERMIND. Grant Ref.: MRIK005707/1). ERP holds Wellcome Trust New Investigator award 102820/Z/13/Z. GoDARTS was funded by the Wellcome Trust as the Wellcome Trust Type 2 diabetes case control study

Relationship between Symptoms, Exacerbations, and Treatment Response in Bronchiectasis

RATIONALE: Bronchiectasis guidelines regard treatment to prevent exacerbation and treatment of daily symptoms as separate objectives. OBJECTIVE: We hypothesized that patients with greater symptoms would be at higher risk of exacerbations and therefore a treatment aimed at reducing daily symptoms would also reduce exacerbations in highly symptomatic patients. METHODS: An observational cohort of 333 patients from the East of Scotland(2012-2016). Symptoms were either modelled as a continuous variable or patients were classified as high, moderate and low symptom burden(>70, 40-70 and <40 using the SGRQ symptom score). We hypothesised that exacerbation would be reduced in highly symptomatic patients. This was tested in a post-hoc analysis of a randomized trial of inhaled mannitol (N=461 patients) Measurement and Main Results: In the observational cohort daily symptoms were a significant predictor of future exacerbations (rate ratio [RR] 1.10, 95% confidence interval[CI] 1.03-1.17, P=0.005). Patients with high symptom scores had higher exacerbation rates (RR 1.74, 95% CI 1.12-2.72,P=0.01) over 12 months follow-up compared to those with lower symptoms. Inhaled mannitol treatment improved the time to first exacerbation (hazard ratio [HR] 0.56; 95% CI 0.40-0.77; P<0.001) and the proportion of patients remaining exacerbation free for 12 months treatment was higher in the mannitol group (32.7% vs. 14.6%; RR 2.84, 95% CI 1.40-5.76; P=0.003) only in highly symptomatic patients. In contrast no benefit was evident in patients with lower symptom burden. CONCLUSIONS: Highly symptomatic patients are at increased risk of exacerbations, and exacerbation benefit with inhaled mannitol was only evident in patients with high symptom burden