The hits and misses of Namibia’s attempt to implement the Ecosystem Approach to Fisheries (EAF) Management.

Ecosystem Approach to Fisheries (EAF) management is a concept aimed at the conservation and sustainable use of the entire ecosystem. While EAF is a noble approach, its implementation has been challenging. Although Namibia has committed to the implementation of EAF, only limited assessment has been done of Namibian fisheries management processes and instruments concerning EAF. This assessment aimed to qualitatively ascertain if the Namibian fisheries management processes and instruments conform to the EAF principles. Although this assessment found that Namibian fisheries management processes and instruments largely conform to the EAF principles, it also identified notable areas needing improvements. The conformities were pronounced in the total allowable catch setting, rebuilding depleted stocks, minimizing bycatch, and fishing impact minimization. The polluter pays, and user pays principles were also applied. Areas that were found lacking in this study included setting the indicators for EAF and ecosystem integrity. The assessment also noted the absence of guidelines for the precautionary approach principle and a transparent policy for quota and right allocation processes. The strategies for managing transboundary fish species are also not formulated. Overall, this assessment showed the complexities and challenges of the fisheries management instruments that Namibia and other countries need to overcome to implement EAF successfully

Multivessel versus culprit vessel percutaneous coronary intervention in ST-elevation myocardial infarction: is more worse?

Aims: We examined what type of STEMI patients are more likely to undergo multivessel PCI (MPCI) in a "real-world" setting and whether MPCI leads to worse or better outcomes compared with single-vessel PCI (SPCI) after stratifying patients by risk. Methods and results: Among STEMI patients enrolled in the Swiss AMIS Plus registry between 2005 and 2012 (n=12,000), 4,941 were identified with multivessel disease. We then stratified patients based on MPCI use and their risk. High-risk patients were identified a priori as those with: 1) left main (LM) involvement (lesions, n=263); 2) out-of-hospital cardiac arrest; or 3) Killip class III/IV. Logistic regression models examined for predictors of MPCI use and the association between MPCI and in-hospital mortality. Three thousand eight hundred and thirty-three (77.6%) patients underwent SPCI and 1,108 (22.4%) underwent MPCI. Rates of MPCI were greater among high-risk patients for each of the three categories: 8.6% vs. 5.9% for out-of-hospital cardiac arrest (p<0.01); 12.3% vs. 6.2% for Killip III/IV (p<0.001); and 14.5% vs. 2.7% for LM involvement (p<0.001). Overall, in-hospital mortality after MPCI was higher when compared with SPCI (7.3% vs. 4.4%; p<0.001). However, this result was not present when patients were stratified by risk: in-hospital mortality for MPCI vs. SPCI was 2.0% vs. 2.0% (p=1.00) in low-risk patients and 22.2% vs. 21.7% (p=1.00) in high-risk patients. Conclusions: High-risk patients are more likely to undergo MPCI. Furthermore, MPCI does not appear to be associated with higher mortality after stratifying patients based on their risk