Knowledge, attitudes and practices of medical staff towards obesity management in patients with spinal cord injuries: an International survey of four western European countries

Objective: To (1) examine the opinions of medical staff working in spinal cord injury (SCI) centres (SCICs); (2) evaluate their knowledge, attitudes and practices towards obesity prevention and management; (3) report the number of beds and dietitians available at each SCIC. Methods: A 37-item questionnaire was sent to 23 SCICs in the UK, the Netherlands, Belgium and the Republic of Ireland between September 2012 and January 2013. Results: Eighteen SCICs returned the questionnaires for analysis. All respondents stated that they had an interest in obesity treatment but only 2.3% of the respondents received training in obesity management. Sixty-one percent of staff did not consider body mass index (BMI) to be appropriate for use in SCI patients and subsequently less than half of the respondents use BMI routinely. The majority of respondents reported that they are confident in dealing with overweight (74.5%) and obese (66.1%) SCI adults, less than half (44.1%) are confident in treating overweight and obese SCI children. Respondents also indicated the need for nationally adopted guidelines and a lack of physical activity provision. There were 17.5 whole-time equivalent (WTE) dietitians recorded in 22 SCICs, equivalent to 47.8 beds per WTE dietitians (range 10–420). Non-UK SCIC dietitians are significantly better resourced than in UK SCICs (beds per WTE dietitian: 36 vs 124, P=0.035). Conclusion: Medical staff expressed the need to participate in obesity prevention and management. Appropriate training should be considered for all medical staff and the development of specific weight management guidelines and dietetic provision should be considered

Effects of submerged vegetation on water clarity across climates

A positive feedback between submerged vegetation and water clarity forms the backbone of the alternative state theory in shallow lakes. The water clearing effect of aquatic vegetation may be caused by different physical, chemical, and biological mechanisms and has been studied mainly in temperate lakes. Recent work suggests differences in biotic interactions between (sub)tropical and cooler lakes might result in a less pronounced clearing effect in the (sub)tropics. To assess whether the effect of submerged vegetation changes with climate, we sampled 83 lakes over a gradient ranging from the tundra to the tropics in South America. Judged from a comparison of water clarity inside and outside vegetation beds, the vegetation appeared to have a similar positive effect on the water clarity across all climatic regions studied. However, the local clearing effect of vegetation decreased steeply with the contribution of humic substances to the underwater light attenuation. Looking at turbidity on a whole-lake scale, results were more difficult to interpret. Although lakes with abundant vegetation (>30%) were generally clear, sparsely vegetated lakes differed widely in clarity. Overall, the effect of vegetation on water clarity in our lakes appears to be smaller than that found in various Northern hemisphere studies. This might be explained by differences in fish communities and their relation to vegetation. For instance, unlike in Northern hemisphere studies, we find no clear relation between vegetation coverage and fish abundance or their diet preference. High densities of omnivorous fish and coinciding low grazing pressures on phytoplankton in the (sub)tropics may, furthermore, weaken the effect of vegetation on water clarity

Climate-dependent CO2 emissions from lakes

Inland waters, just as the world's oceans, play an important role in the global carbon cycle. While lakes and reservoirs typically emit CO2, they also bury carbon in their sediment. The net CO2 emission is largely the result of the decomposition or preservation of terrestrially supplied carbon. What regulates the balance between CO2 emission and carbon burial is not known, but climate change and temperature have been hypothesized to influence both processes. We analyzed patterns in carbon dioxide partial pressure (pCO2) in 83 shallow lakes over a large climatic gradient in South America and found a strong, positive correlation with temperature. The higher pCO2 in warmer lakes may be caused by a higher, temperature-dependent mineralization of organic carbon. This pattern suggests that cool lakes may start to emit more CO2 when they warm up because of climate ch

Abrupt Climate Change in an Oscillating World.

This is the final version of the article. Available from Nature Publishing Group via the DOI in this record.The notion that small changes can have large consequences in the climate or ecosystems has become popular as the concept of tipping points. Typically, tipping points are thought to arise from a loss of stability of an equilibrium when external conditions are slowly varied. However, this appealingly simple view puts us on the wrong foot for understanding a range of abrupt transitions in the climate or ecosystems because complex environmental systems are never in equilibrium. In particular, they are forced by diurnal variations, the seasons, Milankovitch cycles and internal climate oscillations. Here we show how abrupt and sometimes even irreversible change may be evoked by even small shifts in the amplitude or time scale of such environmental oscillations. By using model simulations and reconciling evidence from previous studies we illustrate how these phenomena can be relevant for ecosystems and elements of the climate system including terrestrial ecosystems, Arctic sea ice and monsoons. Although the systems we address are very different and span a broad range of time scales, the phenomena can be understood in a common framework that can help clarify and unify the interpretation of abrupt shifts in the Earth system.This work was carried out under the program of the Netherlands Earth System Science Centre (NESSC), financially supported by the Ministry of Education, Culture and Science (OCW). We are grateful to Chris Huntingford for his constructive comments that helped us to improve the manuscript. We would also like to acknowledge Michel Crucifix, Henk Dijkstra, and Peter Cox for their helpful comments. S.B. is eternally grateful to Nina Engelhardt and the University of Edinburgh for the inspiring working conditions

Statistical indicators of Arctic sea-ice stability-prospects and limitations

This is the final version of the article. Available from the European Geosciences Union via the DOI in this record.We examine the relationship between the mean and the variability of Arctic sea-ice coverage and volume in a large range of climates from globally ice-covered to globally ice-free conditions. Using a hierarchy of two column models and several comprehensive Earth system models, we consolidate the results of earlier studies and show that mechanisms found in simple models also dominate the interannual variability of Arctic sea ice in complex models. In contrast to predictions based on very idealised dynamical systems, we find a consistent and robust decrease of variance and autocorrelation of sea-ice volume before summer sea ice is lost. We attribute this to the fact that thinner ice can adjust more quickly to perturbations. Thereafter, the autocorrelation increases, mainly because it becomes dominated by the ocean water's large heat capacity when the ice-free season becomes longer. We show that these changes are robust to the nature and origin of climate variability in the models and do not depend on whether Arctic sea-ice loss occurs abruptly or irreversibly. We also show that our climate is changing too rapidly to detect reliable changes in autocorrelation of annual time series. Based on these results, the prospects of detecting statistical early warning signals before an abrupt sea-ice loss at a "tipping point" seem very limited. However, the robust relation between state and variability can be useful to build simple stochastic climate models and to make inferences about past and future sea-ice variability from only short observations or reconstructions.This work was carried out under the programme of the Netherlands Earth System Science Centre (NESSC), financially supported by the Ministry of Education, Culture and Science (OCW). We also acknowledge the World Climate Research Programme’s Working Group on Coupled Modelling, which is responsible for CMIP, and we thank the climate modelling groups for producing and making available their model output. We thank Vasilis Dakos for helping to apply his early warnings R package and Chao Li for making available the MPI-ESM model output. S. B. gratefully acknowledges Arie Staal for his fruitful and revealing approaches to savour scientific achievements. We are also indebted to Till Wagner and Ian Eisenman for their valuable comments and their very amiable and cooperative spirit. Finally, we acknowledge two anonymous reviewers who helped us to improve the manuscript

Exit time as a measure of ecological resilience

Ecological resilience is the magnitude of the largest perturbation from which a system can still recover to its original state. However, a transition into another state may often be invoked by a series of minor synergistic perturbations rather than a single big one. We show how resilience can be estimated in terms of average life expectancy, accounting for this natural regime of variability. We use time series to fit a model that captures the stochastic as well as the deterministic components. The model is then used to estimate the mean exit time from the basin of attraction. This approach offers a fresh angle to anticipating the chance of a critical transition at a time when high-resolution time series are becoming increasingly available.</p