European native oysters and associated species richness in the presence of non-native species in a southern North Sea estuary complex

There are growing calls to restore populations of European native oysters (Ostrea edulis), on the premise that restored populations will support a range of ecosystem services with an emphasis placed on restored oyster habitats promoting biological diversity, however benefits associated with naturally occurring O. edulis remain unclear. We undertook biannual surveys in the Blackwater, Crouch, Roach and Colne Estuaries Marine Conservation Zone (BCRC.MCZ), a highly sedimented estuary complex in the southern North Sea, to investigate links between natural densities of O. edulis (0-4.2 m-2), the prevalence of other dominant habitat features such as non-native slipper limpet (Crepidula fornicata), dead shell abundance and epibenthic macroinvertebrate species richness. Increased epibenthic species richness was associated with O. edulis, even at densities below the OSPAR Commission recognised definition of an oyster bed (5 oysters m-2). Our analysis predicts increased associated species richness with density of native oysters (e.g. +1.6 additional species at 1 oyster m-2 or + 2.8 species at 5 oysters m-2), but only in areas with lower density of C. fornicata. Where C. fornicata are at higher density, the potential benefits of oyster restoration for associated species were curtailed. This may explain the observed asymptotic relationship between oyster density and diversity at 1 oyster m-2. In these and other high Crepidula density areas we recommend extending native oyster habitat even at low density. This may be of particular interest to areas with the protozoan oyster parasite Bonamia ostreae, which spreads more easily in high density areas. These lower density thresholds should also be considered for future management decisions – closing harvests so they do not reduce density further and impair biodiversity services of the habitats. In conclusion, while C. fornicata may be a useful oyster settlement substrate, we find that it limits the potential increases in associated species gains of oyster restoration

Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study

Background: To date, 750 000 patients with COVID-19 worldwide have required mechanical ventilation and thus are at high risk of acute brain dysfunction (coma and delirium). We aimed to investigate the prevalence of delirium and coma, and risk factors for delirium in critically ill patients with COVID-19, to aid the development of strategies to mitigate delirium and associated sequelae. Methods: This multicentre cohort study included 69 adult intensive care units (ICUs), across 14 countries. We included all patients (aged 6518 years) admitted to participating ICUs with severe acute respiratory syndrome coronavirus 2 infection before April 28, 2020. Patients who were moribund or had life-support measures withdrawn within 24 h of ICU admission, prisoners, patients with pre-existing mental illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug overdose, suicide attempt, or those who were blind or deaf were excluded. We collected de-identified data from electronic health records on patient demographics, delirium and coma assessments, and management strategies for a 21-day period. Additional data on ventilator support, ICU length of stay, and vital status was collected for a 28-day period. The primary outcome was to determine the prevalence of delirium and coma and to investigate any associated risk factors associated with development of delirium the next day. We also investigated predictors of number of days alive without delirium or coma. These outcomes were investigated using multivariable regression. Findings: Between Jan 20 and April 28, 2020, 4530 patients with COVID-19 were admitted to 69 ICUs, of whom 2088 patients were included in the study cohort. The median age of patients was 64 years (IQR 54 to 71) with a median Simplified Acute Physiology Score (SAPS) II of 40\ub70 (30\ub70 to 53\ub70). 1397 (66\ub79%) of 2088 patients were invasively mechanically ventilated on the day of ICU admission and 1827 (87\ub75%) were invasively mechanical ventilated at some point during hospitalisation. Infusion with sedatives while on mechanical ventilation was common: 1337 (64\ub70%) of 2088 patients were given benzodiazepines for a median of 7\ub70 days (4\ub70 to 12\ub70) and 1481 (70\ub79%) were given propofol for a median of 7\ub70 days (4\ub70 to 11\ub70). Median Richmond Agitation\u2013Sedation Scale score while on invasive mechanical ventilation was \u20134 (\u20135 to \u20133). 1704 (81\ub76%) of 2088 patients were comatose for a median of 10\ub70 days (6\ub70 to 15\ub70) and 1147 (54\ub79%) were delirious for a median of 3\ub70 days (2\ub70 to 6\ub70). Mechanical ventilation, use of restraints, and benzodiazepine, opioid, and vasopressor infusions, and antipsychotics were each associated with a higher risk of delirium the next day (all p 640\ub704), whereas family visitation (in person or virtual) was associated with a lower risk of delirium (p<0\ub70001). During the 21-day study period, patients were alive without delirium or coma for a median of 5\ub70 days (0\ub70 to 14\ub70). At baseline, older age, higher SAPS II scores, male sex, smoking or alcohol abuse, use of vasopressors on day 1, and invasive mechanical ventilation on day 1 were independently associated with fewer days alive and free of delirium and coma (all p<0\ub701). 601 (28\ub78%) of 2088 patients died within 28 days of admission, with most of those deaths occurring in the ICU. Interpretation: Acute brain dysfunction was highly prevalent and prolonged in critically ill patients with COVID-19. Benzodiazepine use and lack of family visitation were identified as modifiable risk factors for delirium, and thus these data present an opportunity to reduce acute brain dysfunction in patients with COVID-19. Funding: None. Translations: For the French and Spanish translations of the abstract see Supplementary Materials section