Development and selection of operational management strategies to achieve policy objectives

Since the reform of the EU Common Fisheries Policy in 2002, effort has been devoted to addressing the governance, scientific, social and economic issues required to introduce an ecosystem approach to fisheries management (EAFM) in Europe. Fisheries management needs to support the three pillars of sustainability (ecological, social and economic) and Fisheries Ecosystem Plans (FEPs) have been developed as a tool to assist managers considering the ecological, social and economic implications of their decision. Building upon previous studies (e.g. the FP5-funded European Fisheries Ecosystem Plan project), the core concept of the Making the European Fisheries Ecosystem Plan Operational (MEFEPO) project is to deliver operational frameworks (FEPs) for three regional seas. The project focus is on how best to make current institutional frameworks responsive to an EAFM at regional and pan-European levels in accordance with the principles of good governance. The regional seas selected for the project are the North Sea (NS), North Western Waters (NWW) and South Western Waters (SWW) RAC regions. The aim of this work package (WP5) was to develop operational objectives to achieve the ecological objectives identified for the 3 regional seas in WP2. This report describes the development and implementation of a transparent and formal process that should lead to identification of the “best” operational management strategies for an EAFM, based on sound scientific information and stakeholder involvement (e.g. regional industry groups, citizen groups, managers and other interest groups)

Impact of source of infection and vancomycin AUC0–24/MICBMD targets on treatment failure in patients with methicillin-resistant Staphylococcus aureus bacteraemia

AbstractDespite recent controversies about toxicity and reduced efficacy, vancomycin remains the current treatment of choice for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. The parameter associated with treatment success is the vancomycin 24-h area under concentration-time curve to MIC ratio (AUC0–24/MIC). We aimed to determine the utility of calculated AUCs and explore the optimal AUC0–24/MIC targets associated with treatment success. In this single-centre retrospective observational cohort study of 127 patients with MRSA bacteraemia, forty-five (35.4%) did not respond to vancomycin treatment. Patient characteristics were essentially the same between those who did not respond to vancomycin treatment and those with treatment success, with independent predictors of treatment failure being source of bacteraemia (odds ratio (OR), 4.29; 95% confidence interval (CI), 1.50–12.26; p 0.007) and not achieving an AUC0–24/MICBMD (using broth microdilution) target of ≥398 (OR, 11.4; 95% CI, 4.57–28.46; p< 0.001). Bacteraemic source-specific thresholds were observed with a higher AUC0–24/MICBMD target of 440 required for high-risk sources (e.g. infective endocarditis) compared with 330 for low-risk sources (line related bacteraemia). Overall treatment success in patients with MRSA bacteraemia was associated with a vancomycin AUC0–24/MICBMD target of ≥398, with source-specific targets observed. Future vancomycin practice guidelines will need to take into account MIC methodology, source of bacteraemia and patient populations prior to setting targets and monitoring recommendations

Data availibility for the fisheries impact assessment of the FIMPAS project

The project Fisheries Measures in Protected Areas (FIMPAS) aims to introduce fisheries measures in the marine Natura 2000 sites within the Exclusive Economic Zone of the Dutch part of the North Sea by the end of 2011. The FIMPAS project covers three such areas, the Dogger Bank and the Cleaver Bank (both to be designated for protection under the Habitats Directive) and the Frisian Front (to be designated for protection under the Birds Directive). These sites are beyond the Dutch 12 nm zone and several EU Member States fish within these areas. Therefore fisheries measures must be implemented through the Common Fisheries Policy. These marine protected areas, as well as the potential fisheries measures, are a consequence of the implementation of the European Birds and Habitats Directives and will be proposed to the European Commission by the Dutch government. The Dutch Ministry for Agriculture, Nature and Food Quality (LNV), together with Dutch environmental NGOs and the Dutch fishing industry, are cooperating within the FIMPAS project to develop the necessary fisheries measures to achieve the conservation objectives for the Dutch Natura 2000 sites of the North Sea. LNV has asked the International Council for the Exploration of the Sea (ICES) to organize the necessary scientific processes and give advice on the desired fisheries measures involving the relevant stakeholders in this process

Using Artificial Intelligence to Predict Intracranial Hypertension in Patients After Traumatic Brain Injury:A Systematic Review

Intracranial hypertension (IH) is a key driver of secondary brain injury in patients with traumatic brain injury. Lowering intracranial pressure (ICP) as soon as IH occurs is important, but a preemptive approach would be more beneficial. We systematically reviewed the artificial intelligence (AI) models, variables, performances, risks of bias, and clinical machine learning (ML) readiness levels of IH prediction models using AI. We conducted a systematic search until 12-03-2023 in three databases. Only studies predicting IH or ICP in patients with traumatic brain injury with a validation of the AI model were included. We extracted type of AI model, prediction variables, model performance, validation type, and prediction window length. Risk of bias was assessed with the Prediction Model Risk of Bias Assessment Tool, and we determined the clinical ML readiness level. Eleven out of 399 nonduplicate publications were included. A gaussian processes model using ICP and mean arterial pressure was most common. The maximum reported area under the receiver operating characteristic curve was 0.94. Four studies conducted external validation, and one study a prospective clinical validation. The prediction window length preceding IH varied between 30 and 60 min. Most studies (73%) had high risk of bias. The highest clinical ML readiness level was 6 of 9, indicating “real-time model testing” stage in one study. Several IH prediction models using AI performed well, were externally validated, and appeared ready to be tested in the clinical workflow (clinical ML readiness level 5 of 9). A Gaussian processes model was most used, and ICP and mean arterial pressure were frequently used variables. However, most studies showed a high risk of bias. Our findings may help position AI for IH prediction on the path to ultimate clinical integration and thereby guide researchers plan and design future studies.</p

Using Artificial Intelligence to Predict Intracranial Hypertension in Patients After Traumatic Brain Injury:A Systematic Review

Intracranial hypertension (IH) is a key driver of secondary brain injury in patients with traumatic brain injury. Lowering intracranial pressure (ICP) as soon as IH occurs is important, but a preemptive approach would be more beneficial. We systematically reviewed the artificial intelligence (AI) models, variables, performances, risks of bias, and clinical machine learning (ML) readiness levels of IH prediction models using AI. We conducted a systematic search until 12-03-2023 in three databases. Only studies predicting IH or ICP in patients with traumatic brain injury with a validation of the AI model were included. We extracted type of AI model, prediction variables, model performance, validation type, and prediction window length. Risk of bias was assessed with the Prediction Model Risk of Bias Assessment Tool, and we determined the clinical ML readiness level. Eleven out of 399 nonduplicate publications were included. A gaussian processes model using ICP and mean arterial pressure was most common. The maximum reported area under the receiver operating characteristic curve was 0.94. Four studies conducted external validation, and one study a prospective clinical validation. The prediction window length preceding IH varied between 30 and 60 min. Most studies (73%) had high risk of bias. The highest clinical ML readiness level was 6 of 9, indicating “real-time model testing” stage in one study. Several IH prediction models using AI performed well, were externally validated, and appeared ready to be tested in the clinical workflow (clinical ML readiness level 5 of 9). A Gaussian processes model was most used, and ICP and mean arterial pressure were frequently used variables. However, most studies showed a high risk of bias. Our findings may help position AI for IH prediction on the path to ultimate clinical integration and thereby guide researchers plan and design future studies.</p

Frontal plane roll-over analysis of prosthetic feet

In prosthetic walking mediolateral balance is compromised due to the lack of active ankle control, by moments of force, in the prosthetic limb. Active control is reduced to the hip strategy, and passive mechanical stability depends on the curvature of the prosthetic foot under load. Mediolateral roll-over curvatures of prosthetic feet are largely unknown. In this study we determined the mediolateral roll-over characteristics of various prosthetic feet and foot-shoe combinations. Characteristics were determined by means of an inverted pendulum-like apparatus. The relationship between the centre of pressure (CoP) and the shank angle was measured and converted to roll-over shape and effective radius of curvature. Further, hysteresis (i.e., lagging in CoP displacement due to material compliance or slip) at vertical shank angle was determined from the hysteresis curve. Passive mechanical stability varied widely, though all measured foot-shoe combinations were relatively compliant. Mediolateral motion of the CoP ranged between 4 mm and 40 mm, thereby remaining well within each foot's physical width. Derived roll-over radii of curvature are also small, with an average of 102 mm. Hysteresis ranges between 20% and 115% of total CoP displacement and becomes more pronounced when adding a shoe. This may be due to slipping of the foot core in its cosmetic cover, or the foot in the shoe. Slip may be disadvantageous for balance control by limiting mediolateral travel of the CoP. It may therefore be clinically relevant to eliminate mediolateral slip in prosthetic foot design

Duikers in de mist : wetenschappelijk onderzoek naar de mate van doorzicht rondom onderwaterhuis 'Aquavilla' in een diepe duikplas

Veiligheid staat bij Duikteam De Kaaiman hoog in het vaandel. Duiken in troebel water kan gevaarlijk zijn en is dus ongewenst. Ook verhoogt helder water het duikgenot. In het meer de Berendonck bij Wijchen, de vaste duikstek van De Kaaiman, ligt op een diepte van 17 meter een onderwaterhuis. Vooral rondom dit huis is sprake van slecht zicht. Waardoor komt dit en wat is er aan te doen