Ecological Meltdown in the Firth of Clyde, Scotland: Two Centuries of Change in a Coastal Marine Ecosystem

BACKGROUND: The Firth of Clyde is a large inlet of the sea that extends over 100 km into Scotland\u27s west coast. METHODS: We compiled detailed fisheries landings data for this area and combined them with historical accounts to build a picture of change due to fishing activity over the last 200 years. FINDINGS: In the early 19th century, prior to the onset of industrial fishing, the Firth of Clyde supported diverse and productive fisheries for species such as herring (Clupea harengus, Clupeidae), cod (Gadus morhua, Gadidae), haddock (Melanogrammus aeglefinus, Gadidae), turbot (Psetta maxima, Scophthalmidae) and flounder (Platichthys flesus, Pleuronectidae). The 19th century saw increased demand for fish, which encouraged more indiscriminate methods of fishing such as bottom trawling. During the 1880s, fish landings began to decline, and upon the recommendation of local fishers and scientists, the Firth of Clyde was closed to large trawling vessels in 1889. This closure remained in place until 1962 when bottom trawling for Norway lobster (Nephrops norvegicus, Nephropidae) was approved in areas more than three nautical miles from the coast. During the 1960s and 1970s, landings of bottomfish increased as trawling intensified. The trawl closure within three nautical miles of the coast was repealed in 1984 under pressure from the industry. Thereafter, bottomfish landings went into terminal decline, with all species collapsing to zero or near zero landings by the early 21st century. Herring fisheries collapsed in the 1970s as more efficient mid-water trawls and fish finders were introduced, while a fishery for mid-water saithe (Pollachius virens, Gadidae) underwent a boom and bust shortly after discovery in the late 1960s. The only commercial fisheries that remain today are for Nephrops and scallops (Pecten maximus, Pectinidae). SIGNIFICANCE: The Firth of Clyde is a marine ecosystem nearing the endpoint of overfishing, a time when no species remain that are capable of sustaining commercial catches. The evidence suggests that trawl closures helped maintain productive fisheries through the mid-20th century, and their reopening precipitated collapse of bottomfish stocks. We argue that continued intensive bottom trawling for Nephrops with fine mesh nets will prevent the recovery of other species. This once diverse and highly productive environment will only be restored if trawl closures or other protected areas are re-introduced. The Firth of Clyde represents at a small scale a process that is occurring ocean-wide today, and its experience serves as a warning to others

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Variable energy pricing in stand alone community hybrid energy systems

Satisfying the demand for a more efficient and sustainable energy supply model has presented a new challenge for the energy industry. It has also created an opportunity for alternative and renewable sources of energy generation, which has led to a significant increase in the deployment of renewable technologies in many countries. Recent years have also seen these technologies deployed at a community scale, with remote and isolated communities in particular being regarded as ideal locations. Such systems are capable of providing increasingly viable, standalone alternatives to the centralised energy supply model.This thesis investigates the extent to which the viability of these stand-alone hybrid energy systems could be further improved by implementing domestic demand response, promoted via variable domestic energy pricing. A high resolution,disaggregated model of domestic energy demand at the community level is then developed, supported by the findings of a targeted consumer attitudes survey. This model is combined with a series of demand response algorithms which replicate the response of domestic consumers to energy price variation. Three variable pricing approaches are then applied to the model under a range of conditions, and the impacts examined from both a community-wide and household level perspective.The thesis demonstrates the relevance and potential of stand-alone hybrid applications and the remote/isolated communities in which they are typically deployed. The results find variable domestic energy pricing based on renewable energy supply to be capable of achieving modest yet significant levels of demand response under a broad range of conditions (83% of the scenarios modelled).Further sensitivity analysis shows the pricing strategies to be resilient to changes in supply conditions, thereby illustrating the broad ranging potential of such an approach. However, susceptibility to free-rider behaviour and insensitivity to household elasticity levels suggest the need for additional/supplementary forms of financial incentivisation.Satisfying the demand for a more efficient and sustainable energy supply model has presented a new challenge for the energy industry. It has also created an opportunity for alternative and renewable sources of energy generation, which has led to a significant increase in the deployment of renewable technologies in many countries. Recent years have also seen these technologies deployed at a community scale, with remote and isolated communities in particular being regarded as ideal locations. Such systems are capable of providing increasingly viable, standalone alternatives to the centralised energy supply model.This thesis investigates the extent to which the viability of these stand-alone hybrid energy systems could be further improved by implementing domestic demand response, promoted via variable domestic energy pricing. A high resolution,disaggregated model of domestic energy demand at the community level is then developed, supported by the findings of a targeted consumer attitudes survey. This model is combined with a series of demand response algorithms which replicate the response of domestic consumers to energy price variation. Three variable pricing approaches are then applied to the model under a range of conditions, and the impacts examined from both a community-wide and household level perspective.The thesis demonstrates the relevance and potential of stand-alone hybrid applications and the remote/isolated communities in which they are typically deployed. The results find variable domestic energy pricing based on renewable energy supply to be capable of achieving modest yet significant levels of demand response under a broad range of conditions (83% of the scenarios modelled).Further sensitivity analysis shows the pricing strategies to be resilient to changes in supply conditions, thereby illustrating the broad ranging potential of such an approach. However, susceptibility to free-rider behaviour and insensitivity to household elasticity levels suggest the need for additional/supplementary forms of financial incentivisation

The emergence of low carbon energy autonomy in isolated communities

This study examines the concept of switching from a centralised energy supply model, which prevails in the developed world, towards a more autonomous model based on the use of low carbon technologies, from the viewpoint of isolated communities. The study begins by establishing the importance of isolated communities within the field of energy research, and examining the concept of low carbon energy autonomy. It then analyses a number of desktop case studies from across Europe, all of which have adopted (or are in the process of adopting) a highly autonomous energy supply model based on the use of low carbon technologies. The various resulting social, technical and economic impacts are then examined. This study illustrates the importance of providing high level policy to support innovative projects and encourage a broader dissemination of energy autonomy theory. The research also stresses the need for clearer routes to funding for off-grid energy projects which have great potential for utilising autonomous energy supply as a catalyst for rural socio-economic development

Energy autonomy in sustainable communities—a review of key issues

Recent years have seen the successful development and deployment of a range of small scale renewable energy systems. Driven in part by improving technical capability and by ambitious carbon emissions reduction targets, there has been the beginning of a shift towards a more distributed energy generation model, capable of delivering a range of potential benefits, but also presenting a number of social and technical challenges. One area of society where the benefits can be seen as being both highly applicable and highly relevant is at the community level and at this scale in particular, increased levels of energy autonomy can deliver a host of social, financial and environmental benefits. Therefore, the concept of energy autonomy is widely regarded as an effective tool in the push towards sustainable development, with ‘sustainable communities' often highlighted as particularly relevant for applying its principles. Given its significance and its broad interdisciplinary relevance, the issue, and the challenges it poses, has been the subject of a significant level of research interest in recent years. This study therefore presents a state of the art review of current research relating to energy autonomy in sustainable communities and identifies a number of central issues which are regarded as being of critical importance. Demand Side Management is identified as one particular area in need of further research and development, along with the need for receptive social, political and regulatory environments