Development and testing of a prototype indicator-based tool for identification of potential problem areas for marine litter in Europe's seas

We demonstrate a prototype multi-metric indicator-based assessment tool (i.e. Marine Litter Assessment Tool - MALT) for mapping and identification of ‘problem areas’ and ‘non-problem areas’ regarding the occurrence of marine litter in Europe's seas. The study is based on a European-wide data set consisting of three marine litter indicators: (1) litter at the seafloor, (2) beach litter and (3) floating micro-litter. This publicly available data allowed litter status to be determined in 1,957,081 km2 (19.1 %) of the total area of Europe's seas (10,243,474 km2). Of the area assessed, 25.8 % (505,030 km2) was found to be ‘non-problem areas’ whilst ‘problem areas’ accounted for 74.2 % (1,452,051 km2). This indicates that marine litter is a large-scale problem in Europe's seas.publishedVersio

Ikke-hjemmehørende arter i marine områder

Projektleder Jesper H. AndersenDenne rapport omhandler ikke-hjemmehørende arter i de danske farvande og består af to dele. Den første vedrører en opdate-ring af den nationale liste over ikke-hjemmhørende arter i de danske farvande – også kaldet NIS-listen. Den anden del er en ana-lyse af de foreliggede data og informationer om forekomst af ikke-hjemmehørende arter i de danske farvande. Datagrundlaget er væsentligt forbedret siden den første nationale NIS-liste blev udarbejdet. De fire væsentligste forbedringer er: (1) data fra Statens Naturhistoriske Museums Fiskeatlas er nu med, (2) data fra NOVANA-overvågningen omfatter nu flere år (til og med 2018), (3) data fra 2017 om forekomsten af ikke-hjemmehørende arter i 16 danske havne er tilføjet, og (4) data for 2017 og 2018, baseret på eDNA-analyser på 33 stationer i NOVANA-programmet, er nu med. Med den ny NIS-liste og den landsdæk-kende analyse foreligger der nu en opdatering af forekomster af ikke-hjemmehørende arter, herunder fisk, i de danske farvande.publishedVersio

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

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Overvågning af åbne danske farvande med FerryBox-systemer. Eksempler fra Indre Danske Farvande og Nordsøen

Projektleder Ciaran J. MurrayDette projekt har haft til formål at undersøge hvordan målinger fra FerryBox kan anvendes i moniteringen af det danske havmiljø, herunder (1) hvordan målinger af klorofyl-fluorescens kan supplere in situ-målinger som indikator for eutrofiering samt (2) vurdere kvaliteten af andre Ferry Box-målinger som pH og CDOM-fluorescens og deres potentiel for anvendelse. Projektet har været kraftigt påvirket af corona/covid-19-situationen – ikke kun i Danmark men også i Norge og Tyskland. Færgeruten mellem Oslo og Kiel, fra hvilken en stor del af projektets data skulle indsamles, har været indstillet i store perioder. Disse huller i prøvetagning har ført til en revurdering af projektet fokus, herunder analyser af ældre data i to case study-områder: (1) langs en transekt i de åbne dele af de indre danske farvande, og (2) de åbne farvande i den danske del af Nordsøen.publishedVersio

Overvågning af åbne danske farvande med FerryBox-systemer. Eksempler fra Indre Danske Farvande og Nordsøen

Dette projekt har haft til formål at undersøge hvordan målinger fra FerryBox kan anvendes i moniteringen af det danske havmiljø, herunder (1) hvordan målinger af klorofyl-fluorescens kan supplere in situ-målinger som indikator for eutrofiering samt (2) vurdere kvaliteten af andre Ferry Box-målinger som pH og CDOM-fluorescens og deres potentiel for anvendelse. Projektet har været kraftigt påvirket af corona/covid-19-situationen – ikke kun i Danmark men også i Norge og Tyskland. Færgeruten mellem Oslo og Kiel, fra hvilken en stor del af projektets data skulle indsamles, har været indstillet i store perioder. Disse huller i prøvetagning har ført til en revurdering af projektet fokus, herunder analyser af ældre data i to case study-områder: (1) langs en transekt i de åbne dele af de indre danske farvande, og (2) de åbne farvande i den danske del af Nordsøen

Monitoring of microplastics in Danish marine waters using the Oslo-Kiel ferry as a ship-of-opportunity

Project manager Jesper H. AndersenThe EU Marine Strategy Framework Directive require that EU Member States establish appropriate strategies and sampling programmes for microplastic in the marine environment. We report the results of a two-tiered pilot study consisting of a mini review focusing on sampling of microplastic in marine surface water and a test sampling of microplastic particles in the Inner Danish Waters using the FerryBox system on board the Oslo-Kiel ferry.Danish Environmental Protection Agency (Miljøstyrelsen)publishedVersio

Gradientstudier af menneskelige presfaktorer i danske havområder

We report the first ever ranking of the relative importance of human stressors along land-sea gradients based on a cumulative impact assessment sensu the methodology developed and published by Halpern et al. in 2008 and 2015. The study is based on a comprehensive Danish data set, originating from a broad range of projects and activities and a subsequent mapping of potential cumulative impacts of multiple human stressors in the Danish marine environment. The study is based on 35 data layers representing human stressors and 47 data layers representing ecosystem components. Our results document that the Danish marine waters, which are impaired, are prone to a wide range of human stressors. When combining individual stressors into groups, the top 5 groups are: (1) nutrients, (2) climate anomalies, (3) non-indigenous species (NIS), 4) contaminants and (5) fisheries. Gradient studies have focused on 16 case studies (where estuarine/fjord systems are linked to coastal and open waters) and we document land-sea gradients for key groups of stressors and how the relative importance of these vary, in some cases substantially (e.g. for the stressors Nutrients, Contaminants, Fishing, Non-indigenous species, Noise and Shipping).Denne rapport omhandler kortlægning og rangordning af potentielt kumulative effekter af menneskelige aktiviteter i de danske farvande. Tidligere studier har vurderet de potentielle kumulative effekter af multiple menneskelige aktiviteter i såvel Østersøen (HELCOM HOLAS-projektet; se HELCOM 2010 og Korpinen et al. 2012) som i de østlige dele af Nordsøen (HARMONY-projektet; se Andersen & Stock 2013), men har kun på et overordnet plan vurderet de forskellige aktiviteters indbyrdes betydning. Undersøgelsesområdet er de danske farvande i overgangszonen mellem Nordsøen og Østersøen, hvorfra vi har indsamlet et robust datasæt baseret på eksisterende offentlig tilgængelig information hvad angår både presfaktorer (n = 35) og økosystem-komponenter (n = 47). Med udgangspunkt i ovennævnte datasæt har vi beregnet de potentielt kumulative effekter af multiple menneskelige aktiviteter samt gjort rede for betydningen af de forskellige presfaktorer. En rangordning baseret på en gruppering af presfaktorer er som følger (1) næringsstoffer, (2) klimaændringer, (3) ikkehjemmehørende arter, (4) miljøfarlige stoffer (5) fiskeri, (6) mikroplastik, (7) støj, (8) skibstrafik og (9) fysisk modifikation. Vi har desuden analyseret den relative betydning af menneskelige aktiviteter (eksklusiv klimaændringer) langs en gradient fra fjord til åbent hav i 16 case studies. Vi finder at den relative betydning varierer fra land til hav, og at nogle presfaktorer (bl.a. næringsstoffer, ikke-hjemmehørende arter og mikroplastik i sediment) betyder relativt mere i fjorde og kystvande, mens andre (bl.a. fiskeri og støj) betyder relativt mere i åbne farvande.Danish Agriculture and Food CouncilpublishedVersio

Statistical analyses of chlorophyll-a data sampled by a Ferrybox on the Oslo-Kiel ferry and by the NOVANA programme

This project has analysed a large chlorophyll-a data set sampled by the Ferrybox on the ferry between Oslo and Kiel and compared it with data sampled in the Danish NOVANA programme. A partnership consisting of NIVA Denmark Water Research, Norwegian Institute for Water (NIVA), Aarhus University and DHI has: (1) Collated relevant data (chlorophyll- a, salinity and temperature) from various sources (i.e. the Ferrybox on the Oslo-Kiel ferry, from the NOVANA programme, from satellite and from modelling activities), (2) assessed uncertainty for temperature, salinity and chlorophyll- a, and (3) transformed Ferrybox-based data to a data product aligned with chlorophyll-a data sampled under the NOVANA programme. The derived data product has been quality assured and submitted to the Danish EPA for their use regarding specific activities, e.g. Initial Assessments under the Marine Strategy Framework Directive and Water Framework Directive, Danish reporting to HELCOM and OSPAR and for reporting of NOVANA.Danish Environmental Protection Agency (MST)publishedVersio

Monitoring of microplastics in Danish marine waters using the Oslo-Kiel ferry as a ship-of-opportunity

The EU Marine Strategy Framework Directive require that EU Member States establish appropriate strategies and sampling programmes for microplastic in the marine environment. We report the results of a two-tiered pilot study consisting of a mini review focusing on sampling of microplastic in marine surface water and a test sampling of microplastic particles in the Inner Danish Waters using the FerryBox system on board the Oslo-Kiel ferry