Understanding individual and population-level effects of plastic pollution on marine megafauna

This is the final version. Available on open access from Inter Research via the DOI in this recordPlastic pollution is increasing rapidly throughout the world’s oceans and is considered a major threat to marine wildlife and ecosystems. Although known to cause lethal or sub-lethal effects to vulnerable marine megafauna, population-level impacts of plastic pollution have not been thoroughly investigated. Here, we compiled and evaluated information from peer-reviewed studies that reported deleterious individual-level effects of plastic pollution on air-breathing marine megafauna (i.e. seabirds, marine mammals, and sea turtles) worldwide, highlighting those that assessed potential population-level effects. Lethal and sub-lethal individual-level effects included drowning, starvation, gastrointestinal tract damage, malnutrition, physical injury, reduced mobility, and physiological stress, resulting in reduced energy acquisition and assimilation, compromised health, reproductive impairment, and mortality. We found 47 studies published between 1969 and 2020 that considered population-level effects of plastic entanglement (n = 26), ingestion (n = 19), or both (n = 2). Of these, 7 inferred population-level effects (n = 6, entanglement; n = 1, ingestion), whereas 19 lacked evidence for effects (n = 12, entanglement; n = 6, ingestion; n = 1, both). However, no study in the past 50 yr reported direct evidence of population-level effects. Despite increased interest in and awareness of the presence of plastic pollution throughout the world’s oceans, the extent and magnitude of demographic impacts on marine megafauna remains largely unassessed and therefore unknown, in contrast to well-documented effects on individuals. Addressing this major assessment gap will allow researchers and managers to compare relative effects of multiple threats—including plastic pollution—on marine megafauna populations, thus providing appropriate context for strategic conservation priority-setting.Natural Environment Research Council (NERC

Conservation implications of sea turtle nesting trends: elusive recovery of a globally important loggerhead population

Abstract Understanding population status and trends is important for developing and evaluating management and conservation actions for threatened species. Monitoring population status of marine organisms is especially challenging. Because sea turtles come ashore to lay their eggs and nests are easily counted, these counts are commonly used as an index of abundance and population trends. Nest counts do not provide a direct index of adult female population abundance because females typically lay more than one nest per year and most do not reproduce every year. This study attempts for the first time to investigate the likelihood that observed fluctuations of nest counts represent inter‐annual changes of the adult female population by accounting for uncertainty in reproductive rate parameters. We analyzed 30 yr of reproductive data from the largest nesting loggerhead sea turtle population worldwide, breeding in Florida (USA), and for the three Recovery Units and seven Management Units therein. Nest counts followed a general non‐monotonic trend with wide fluctuations that corresponded to decreasing and increasing trends during short intervals. When we accounted for uncertainty in both clutch frequency and remigration interval, there was no evidence for an increasing or a declining trend in the breeding female population across the entire period. Despite extensive conservation efforts and protections for loggerheads in Florida and the wider USA, we did not find evidence of a strong population recovery. We recommend maintaining a high level of protection, addressing persistent anthropogenic threats, continued collection of rigorous nest‐count data, and monitoring reproductive parameters to better link nest counts to adult female population abundance. Our results demonstrate the need for caution in using nest counts as a direct proxy for adult female population status, as it may lead to unsupported conclusions potentially detrimental to conservation. Therefore, we recommend to always translating nest trends to at least adult female trends, including uncertainty in reproductive parameters. Our approach can be exported to other populations, even where reproductive parameters are not available. Applying high parameter uncertainty obtained from other populations can help identifying unequivocal population changes; that is, nest trends unlikely justified by uncertainty and poor knowledge of reproductive parameters

Orchiectomy as a result of ischemic orchitis after laparoscopic inguinal hernia repair: case report of a rare complication

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: Ischemic orchitis is an established complication after open inguinal hernia repair, but ischemic orchitis resulting in orchiectomy after the laparoscopic approach has not been reported. Case presentation: The patient was a thirty-three year-old man who presented with bilateral direct inguinal hernias, right larger than left. He was a thin, muscular male with a narrow pelvis who underwent bilateral extraperitoneal mesh laparoscopic inguinal hernia repair. The case was complicated by pneumoperitoneum which limited the visibility of the pelvic anatomy; however, the mesh was successfully deployed bilaterally. Cautery was used to resect the direct sac on the right. The patient was discharged the same day and doing well with minimal pain and swelling until the fourth day after surgery. That night he presented with sudden-onset pain and swelling of his right testicle and denied both trauma to the area and any sexual activity. Ultrasound of the testicle revealed no blood flow to the testicle which required exploration and subsequent orchiectomy. Conclusion: Ischemic orchitis typically presents 2–3 days after inguinal hernia surgery and can progress to infarction. This ischemic injury is likely due to thrombosis of the venous plexus, rathe

A descriptive exploratory study of how admissions caused by medication-related harm are documented within inpatients' medical records.

BACKGROUND: Adverse drug reactions, poor patient adherence and errors, here collectively referred to as medication-related harm (MRH), cause around 2.7-8.0% of UK hospital admissions. Communication gaps between successive healthcare providers exist, but little is known about how MRH is recorded in inpatients' medical records. We describe the presence and quality of MRH documentation for patients admitted to a London teaching hospital due to MRH. Additionally, the international classification of disease 10th revision (ICD-10) codes attributed to confirmed MRH-related admissions were studied to explore appropriateness of their use to identify these patients. METHODS: Clinical pharmacists working on an admissions ward in a UK hospital identified patients admitted due to suspected MRH. Six different data sources in each patient's medical record, including the discharge summary, were subsequently examined for MRH-related information. Each data source was examined for statements describing the MRH: symptom and diagnosis, identification of the causative agent, and a statement of the action taken or considered. Statements were categorised as 'explicit' if unambiguous or 'implicit' if open to interpretation. ICD-10 codes attributed to confirmed MRH cases were recorded. RESULTS: Eighty-four patients were identified over 141 data collection days; 75 met our inclusion criteria. MRH documentation was generally present (855 of 1307 statements were identified; 65%), and usually explicit (705 of 855; 82%). The causative agent had the lowest proportion of explicit statements (139 of 201 statements were explicit; 69%). For two (3%) discharged patients, the causal agent was documented in their paper medical record but not on the discharge summary. Of 64 patients with a confirmed MRH diagnosis at discharge, only six (9%) had a MRH-related ICD-10 code. CONCLUSIONS: Availability of information in the paper medical record needs improving and communication of MRH-related information could be enhanced by using explicit statements and documenting reasons for changing medications. ICD-10 codes underestimate the true occurrence of MRH

Beyond the Shade of the Oak Tree: The Recent Growth of Johannine Studies

The recent growth within Johannine studies has developed as a result of several factors. First, the discovery of the Dead Sea Scrolls led to an appreciation of the Jewishness of John’s origin. Second, new approaches to John’s composition have emerged, followed by a larger set of inquiries as to the Johannine tradition’s relation to parallel traditions. This has been accompanied by a fourth interest: the history of the Johannine situation. Fifth, new literary studies have posed new horizons for interpretation, and sixth, theories continue to abound on the identity of the Beloved Disciple. A seventh development involves new ways of conceiving John’s theological features, leading to an eighth: reconsidering John’s historical features and re-envisioning its historical contributions in new perspective

Massive Consumption of Gelatinous Plankton by Mediterranean Apex Predators

Stable isotopes of carbon and nitrogen were used to test the hypothesis that stomach content analysis has systematically overlooked the consumption of gelatinous zooplankton by pelagic mesopredators and apex predators. The results strongly supported a major role of gelatinous plankton in the diet of bluefin tuna (Thunnus thynnus), little tunny (Euthynnus alletteratus), spearfish (Tetrapturus belone) and swordfish (Xiphias gladius). Loggerhead sea turtles (Caretta caretta) in the oceanic stage and ocean sunfish (Mola mola) also primarily relied on gelatinous zooplankton. In contrast, stable isotope ratios ruled out any relevant consumption of gelatinous plankton by bluefish (Pomatomus saltatrix), blue shark (Prionace glauca), leerfish (Lichia amia), bonito (Sarda sarda), striped dolphin (Stenella caerueloalba) and loggerhead sea turtles (Caretta caretta) in the neritic stage, all of which primarily relied on fish and squid. Fin whales (Balaenoptera physalus) were confirmed as crustacean consumers. The ratios of stable isotopes in albacore (Thunnus alalunga), amberjack (Seriola dumerili), blue butterfish (Stromaeus fiatola), bullet tuna (Auxis rochei), dolphinfish (Coryphaena hyppurus), horse mackerel (Trachurus trachurus), mackerel (Scomber scombrus) and pompano (Trachinotus ovatus) were consistent with mixed diets revealed by stomach content analysis, including nekton and crustaceans, but the consumption of gelatinous plankton could not be ruled out completely. In conclusion, the jellyvorous guild in the Mediterranean integrates two specialists (ocean sunfish and loggerhead sea turtles in the oceanic stage) and several opportunists (bluefin tuna, little tunny, spearfish, swordfish and, perhaps, blue butterfish), most of them with shrinking populations due to overfishing

Global Conservation Priorities for Marine Turtles

Where conservation resources are limited and conservation targets are diverse, robust yet flexible priority-setting frameworks are vital. Priority-setting is especially important for geographically widespread species with distinct populations subject to multiple threats that operate on different spatial and temporal scales. Marine turtles are widely distributed and exhibit intra-specific variations in population sizes and trends, as well as reproduction and morphology. However, current global extinction risk assessment frameworks do not assess conservation status of spatially and biologically distinct marine turtle Regional Management Units (RMUs), and thus do not capture variations in population trends, impacts of threats, or necessary conservation actions across individual populations. To address this issue, we developed a new assessment framework that allowed us to evaluate, compare and organize marine turtle RMUs according to status and threats criteria. Because conservation priorities can vary widely (i.e. from avoiding imminent extinction to maintaining long-term monitoring efforts) we developed a “conservation priorities portfolio” system using categories of paired risk and threats scores for all RMUs (n = 58). We performed these assessments and rankings globally, by species, by ocean basin, and by recognized geopolitical bodies to identify patterns in risk, threats, and data gaps at different scales. This process resulted in characterization of risk and threats to all marine turtle RMUs, including identification of the world's 11 most endangered marine turtle RMUs based on highest risk and threats scores. This system also highlighted important gaps in available information that is crucial for accurate conservation assessments. Overall, this priority-setting framework can provide guidance for research and conservation priorities at multiple relevant scales, and should serve as a model for conservation status assessments and priority-setting for widespread, long-lived taxa

Regional Management Units for Marine Turtles: A Novel Framework for Prioritizing Conservation and Research across Multiple Scales

Background: Resolving threats to widely distributed marine megafauna requires definition of the geographic distributions of both the threats as well as the population unit(s) of interest. In turn, because individual threats can operate on varying spatial scales, their impacts can affect different segments of a population of the same species. Therefore, integration of multiple tools and techniques - including site-based monitoring, genetic analyses, mark-recapture studies and telemetry - can facilitate robust definitions of population segments at multiple biological and spatial scales to address different management and research challenges. Methodology/Principal Findings: To address these issues for marine turtles, we collated all available studies on marine turtle biogeography, including nesting sites, population abundances and trends, population genetics, and satellite telemetry. We georeferenced this information to generate separate layers for nesting sites, genetic stocks, and core distributions of population segments of all marine turtle species. We then spatially integrated this information from fine-to coarse-spatial scales to develop nested envelope models, or Regional Management Units (RMUs), for marine turtles globally. Conclusions/Significance: The RMU framework is a solution to the challenge of how to organize marine turtles into units of protection above the level of nesting populations, but below the level of species, within regional entities that might be on independent evolutionary trajectories. Among many potential applications, RMUs provide a framework for identifying data gaps, assessing high diversity areas for multiple species and genetic stocks, and evaluating conservation status of marine turtles. Furthermore, RMUs allow for identification of geographic barriers to gene flow, and can provide valuable guidance to marine spatial planning initiatives that integrate spatial distributions of protected species and human activities. In addition, the RMU framework - including maps and supporting metadata - will be an iterative, user-driven tool made publicly available in an online application for comments, improvements, download and analysis

Evaluating the Connect with Pharmacy web-based intervention to reduce hospital readmission for older people

YesBackground The patient transition from a hospital to a post-discharge healthcare setting has potential to disrupt continuity of medication management and increase the risk of harm. “Connect with Pharmacy” is a new electronic web-based transfer of care initiative employed by Leeds Teaching Hospitals NHS Trust. This allows the sharing of discharge information between the hospital and a patient’s chosen community pharmacy. Objective We investigated whether the timely sharing of discharge information with community pharmacies via “Connect with Pharmacy” reduced hospital readmission rates in older patients. Method To evaluate intervention efficacy, hospital admission data was retrospectively collected. For primary analysis, admission rates were tracked 6-months prior (baseline) and 6-months post-intervention. Secondary measures included effect on total length of stay if readmitted, emergency department attendance and duration, and impact of polypharmacy. Main outcome measure The rate of non-elective hospital readmissions, 6-months post-intervention. Results In the sample (n = 627 patients; Mean age = 81 years), emergency readmission rates following the intervention (M = 1.1, 95% CI [0.98, 1.22]) reduced by 16.16% relative to baseline (M = 1.31, 95% CI [1.21, 1.42]) (W = 54,725; p < 0.001). There was no reduction in total length of stay. Subsidiary analysis revealed a post-intervention reduction in number of days spent in hospital lasting more than three days (χ2 = 13.37, df = 1, p < 0 .001). There were no statistically reliable differences in the remaining secondary measures. Conclusion The results showed a reduction in readmissions and potential post-intervention length of stay, indicating there may be further benefits for our older patients’ experiences and hospital flow