High prevalence of diabetes in a regional Australian hospital highlights the need to prioritise inpatient diabetes care.

Regional centres have smaller workforces in acute diabetes care compared to their metropolitan counterparts. A cross-sectional audit performed at Albury Hospital identified a high prevalence (34%) of diabetes for inpatients compared with metropolitan centres. The high prevalence highlights the need for all healthcare services to consider appropriate resources for the management of diabetes in people admitted to hospital.

Remote Capacitive Sensing in Two-Dimensional Quantum-Dot Arrays.

We investigate gate-induced quantum dots in silicon nanowire field-effect transistors fabricated using a foundry-compatible fully depleted silicon-on-insulator (FD-SOI) process. A series of split gates wrapped over the silicon nanowire naturally produces a 2 × n bilinear array of quantum dots along a single nanowire. We begin by studying the capacitive coupling of quantum dots within such a 2 × 2 array and then show how such couplings can be extended across two parallel silicon nanowires coupled together by shared, electrically isolated, "floating" electrodes. With one quantum dot operating as a single-electron-box sensor, the floating gate serves to enhance the charge sensitivity range, enabling it to detect charge state transitions in a separate silicon nanowire. By comparing measurements from multiple devices, we illustrate the impact of the floating gate by quantifying both the charge sensitivity decay as a function of dot-sensor separation and configuration within the dual-nanowire structure.

Delayed versus Immediate Cord Clamping in Preterm Infants.

BACKGROUND: The preferred timing of umbilical-cord clamping in preterm infants is unclear. METHODS: We randomly assigned fetuses from women who were expected to deliver before 30 weeks of gestation to either immediate clamping of the umbilical cord (≤10 seconds after delivery) or delayed clamping (≥60 seconds after delivery). The primary composite outcome was death or major morbidity (defined as severe brain injury on postnatal ultrasonography, severe retinopathy of prematurity, necrotizing enterocolitis, or late-onset sepsis) by 36 weeks of postmenstrual age. Analyses were performed on an intention-to-treat basis, accounting for multiple births. RESULTS: Of 1634 fetuses that underwent randomization, 1566 were born alive before 30 weeks of gestation; of these, 782 were assigned to immediate cord clamping and 784 to delayed cord clamping. The median time between delivery and cord clamping was 5 seconds and 60 seconds in the respective groups. Complete data on the primary outcome were available for 1497 infants (95.6%). There was no significant difference in the incidence of the primary outcome between infants assigned to delayed clamping (37.0%) and those assigned to immediate clamping (37.2%) (relative risk, 1.00; 95% confidence interval, 0.88 to 1.13; P=0.96). The mortality was 6.4% in the delayed-clamping group and 9.0% in the immediate-clamping group (P=0.03 in unadjusted analyses; P=0.39 after post hoc adjustment for multiple secondary outcomes). There were no significant differences between the two groups in the incidences of chronic lung disease or other major morbidities. CONCLUSIONS: Among preterm infants, delayed cord clamping did not result in a lower incidence of the combined outcome of death or major morbidity at 36 weeks of gestation than immediate cord clamping. (Funded by the Australian National Health and Medical Research Council [NHMRC] and the NHMRC Clinical Trials Centre; APTS Australian and New Zealand Clinical Trials Registry number, ACTRN12610000633088 .).

How to use iron studies.

Iron studies are frequently requested in paediatric practice. They are useful both as a diagnostic tool and as a way of monitoring certain conditions, particularly those causing iron overload. This article outlines the physiology of iron metabolism and discusses laboratory aspects of performing iron studies, including factors influencing interpretation. Clinical scenarios are used to highlight how the tests can be used in different clinical situations.

Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis.

BACKGROUND: The effects of delayed cord clamping of the umbilical cord in preterm infants are unclear. OBJECTIVE: We sought to compare the effects of delayed vs early cord clamping on hospital mortality (primary outcome) and morbidity in preterm infants using Cochrane Collaboration neonatal review group methodology. STUDY DESIGN: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Chinese articles, cross-referencing citations, expert informants, and trial registries to July 31, 2017, for randomized controlled trials of delayed (≥30 seconds) vs early (<30 seconds) clamping in infants born <37 weeks' gestation. Before searching the literature, we specified that trials estimated to have cord milking in >20% of infants in any arm would be ineligible. Two reviewers independently selected studies, assessed bias, and extracted data. Relative risk (ie, risk ratio), risk difference, and mean difference with 95% confidence intervals were assessed by fixed effects models, heterogeneity by I2 statistics, and the quality of evidence by Grading of Recommendations, Assessment, Development, and Evaluations. RESULTS: Eighteen randomized controlled trials compared delayed vs early clamping in 2834 infants. Most infants allocated to have delayed clamping were assigned a delay of ≥60 seconds. Delayed clamping reduced hospital mortality (risk ratio, 0.68; 95% confidence interval, 0.52-0.90; risk difference, -0.03; 95% confidence interval, -0.05 to -0.01; P = .005; number needed to benefit, 33; 95% confidence interval, 20-100; Grading of Recommendations, Assessment, Development, and Evaluations = high, with I2 = 0 indicating no heterogeneity). In 3 trials in 996 infants ≤28 weeks' gestation, delayed clamping reduced hospital mortality (risk ratio, 0.70; 95% confidence interval, 0.51-0.95; risk difference, -0.05; 95% confidence interval, -0.09 to -0.01; P = .02, number needed to benefit, 20; 95% confidence interval, 11-100; I2 = 0). In subgroup analyses, delayed clamping reduced the incidence of low Apgar score at 1 minute, but not at 5 minutes, and did not reduce the incidence of intubation for resuscitation, admission temperature, mechanical ventilation, intraventricular hemorrhage, brain injury, chronic lung disease, patent ductus arteriosus, necrotizing enterocolitis, late onset sepsis or retinopathy of prematurity. Delayed clamping increased peak hematocrit by 2.73 percentage points (95% confidence interval, 1.94-3.52; P < .00001) and reduced the proportion of infants having blood transfusion by 10% (95% confidence interval, 6-13%; P < .00001). Potential harms of delayed clamping included polycythemia and hyperbilirubinemia. CONCLUSION: This systematic review provides high-quality evidence that delayed clamping reduced hospital mortality, which supports current guidelines recommending delayed clamping in preterm infants. This review does not evaluate cord milking, which may also be of benefit. Analyses of individual patient data in these and other randomized controlled trials will be critically important in reliably evaluating important secondary outcomes.

An index to assess the health and benefits of the global ocean.

The ocean plays a critical role in supporting human well-being, from providing food, livelihoods and recreational opportunities to regulating the global climate. Sustainable management aimed at maintaining the flow of a broad range of benefits from the ocean requires a comprehensive and quantitative method to measure and monitor the health of coupled human­ocean systems. We created an index comprising ten diverse public goals for a healthy coupled human­ocean system and calculated the index for every coastal country. Globally, the overall index score was 60 out of 100 (range 36­86), with developed countries generally performing better than developing countries, but with notable exceptions. Only 5% of countries scored higher than 70, whereas 32% scored lower than 50. The index provides a powerful tool to raise public awareness, direct resource management, improve policy and prioritize scientific research.

Predicting climate effects on Pacific sardine.

For many marine species and habitats, climate change and overfishing present a double threat. To manage marine resources effectively, it is necessary to adapt management to changes in the physical environment. Simple relationships between environmental conditions and fish abundance have long been used in both fisheries and fishery management. In many cases, however, physical, biological, and human variables feed back on each other. For these systems, associations between variables can change as the system evolves in time. This can obscure relationships between population dynamics and environmental variability, undermining our ability to forecast changes in populations tied to physical processes. Here we present a methodology for identifying physical forcing variables based on nonlinear forecasting and show how the method provides a predictive understanding of the influence of physical forcing on Pacific sardine.

Role of egg predation by haddock in the decline of an Atlantic herring population.

Theoretical studies suggest that the abrupt and substantial changes in the productivity of some fisheries species may be explained by predation-driven alternate stable states in their population levels. With this hypothesis, an increase in fishing or a natural perturbation can drive a population from an upper to a lower stable-equilibrium population level. After fishing is reduced or the perturbation ended, this low population level can persist due to the regulatory effect of the predator. Although established in theoretical studies, there is limited empirical support for predation-driven alternate stable states in exploited marine fish populations. We present evidence that egg predation by haddock (Melanogrammus aeglefinus) can cause alternate stable population levels in Georges Bank Atlantic herring (Clupea harengus). Egg predation by haddock explains a substantial decoupling of herring spawning stock biomass (an index of egg production) from observed larval herring abundance (an index of egg hatching). Estimated egg survival rates ranged from <2-70% from 1971 to 2005. A population model incorporating egg predation and herring fishing explains the major population trends of Georges Bank herring over four decades and predicts that, when the haddock population is high, seemingly conservative levels of fishing can still precipitate a severe decline in the herring population. These findings illustrate how efforts to rebuild fisheries can be undermined by not incorporating ecological interactions into fisheries models and management plans.

Forecasting the dynamics of a coastal fishery species using a coupled climate--population model.

Marine fisheries management strives to maintain sustainable populations while allowing exploitation. However, well-intentioned management plans may not meet this balance as most do not include the effect of climate change. Ocean temperatures are expected to increase through the 21st century, which will have far-reaching and complex impacts on marine fisheries. To begin to quantify these impacts for one coastal fishery along the east coast of the United States, we develop a coupled climate-population model for Atlantic croaker (Micropogonias undulatus). The model is based on a mechanistic hypothesis: recruitment is determined by temperature-driven, overwinter mortality of juveniles in their estuarine habitats. Temperature forecasts were obtained from 14 general circulation models simulating three CO2 emission scenarios. An ensemble-based approach was used in which a multimodel average was calculated for a given CO2 emission scenario to forecast the response of the population. The coupled model indicates that both exploitation and climate change significantly affect abundance and distribution of Atlantic croaker. At current levels of fishing, the average (2010-2100) spawning biomass of the population is forecast to increase by 60-100%. Similarly, the center of the population is forecast to shift 50 100 km northward. A yield analysis, which is used to calculate benchmarks for fishery management, indicates that the maximum sustainable yield will increase by 30 100%. Our results demonstrate that climate effects on fisheries must be identified, understood, and incorporated into the scientific advice provided to managers if sustainable exploitation is to be achieved in a changing climate.

Habitat risk assessment for regional ocean planning in the U.S. Northeast and Mid-Atlantic.

Coastal habitats provide important benefits to people, including habitat for species targeted by fisheries and opportunities for tourism and recreation. Yet, such human activities also can imperil these habitats and undermine the ecosystem services they provide to people. Cumulative risk assessment provides an analytical framework for synthesizing the influence of multiple stressors across habitats and decision-support for balancing human uses and ecosystem health. To explore cumulative risk to habitats in the U.S. Northeast and Mid-Atlantic Ocean Planning regions, we apply the open-source InVEST Habitat Risk Assessment model to 13 habitats and 31 stressors in an exposure-consequence framework. In doing so, we advance the science priorities of EBM and both regional planning bodies by synthesizing the wealth of available data to improve our understanding of human uses and how they affect marine resources. We find that risk to ecosystems is greatest first, along the coast, where a large number of stressors occur in close proximity and secondly, along the continental shelf, where fewer, higher consequence activities occur. Habitats at greatest risk include soft and hard-bottom nearshore areas, tidal flats, soft-bottom shelf habitat, and rocky intertidal zones-with the degree of risk varying spatially. Across all habitats, our results indicate that rising sea surface temperatures, commercial fishing, and shipping consistently and disproportionally contribute to risk. Further, our findings suggest that management in the nearshore will require simultaneously addressing the temporal and spatial overlap as well as intensity of multiple human activities and that management in the offshore requires more targeted efforts to reduce exposure from specific threats. We offer a transparent, generalizable approach to evaluating cumulative risk to multiple habitats and illustrate the spatially heterogeneous nature of impacts along the eastern Atlantic coast and the importance of spatial scale in estimating such impacts. These results offer a valuable decision-support tool by helping to constrain the decision space, focus attention on habitats and locations at the greatest risk, and highlight effect management strategies.

Spatially discrete metapopulation models with directional dispersal.

We use an age-structured discrete-time metapopulation model linking two sub-populations through larval transport and directed movements of adults to study the implications of linkages among subpopulations for the stability and resilience of exploited species. Our two-habitat model, a generalization of Fogarty's inshore-offshore lobster population model, includes isolated habitats under compensatory (monotone) or overcompensatory (oscillatory) dynamics [M.J. Fogarty, Implications of migration and larval interchange in American lobster (Homarus americanus) stocks: spatial structure and resilience, in: G.S. Jamieson, A. Campbell (Eds.), Proc. of North Pacific Symposium on Invertebrate Stock Assessment and Management, Can. Spec. Publ. Fish. Aquat. Sci. 125 (1998) 273]. Pre-migration local dynamics are selected from general classes of functions that capture the effects of competition for resources via contest (compensatory) and scramble (overcompensatory) intraspecific competitions. We explore the implications of these mechanisms on the long-term survival of exploited species. In particular, we use threshold parameters R(d)1 for Habitat 1 and R(d)2 for Habitat 2 together with precise mathematical definitions to prove that species persistence is possible at high levels of fishing in one habitat and low to moderate levels of fishing in the other. Our results support Fogarty's conclusion that conservative management of larval source populations could contribute to the resilience of exploited species.

The Effects of Sub-Regional Climate Velocity on the Distribution and Spatial Extent of Marine Species Assemblages.

Many studies illustrate variable patterns in individual species distribution shifts in response to changing temperature. However, an assemblage, a group of species that shares a common environmental niche, will likely exhibit similar responses to climate changes, and these community-level responses may have significant implications for ecosystem function. Therefore, we examine the relationship between observed shifts of species in assemblages and regional climate velocity (i.e., the rate and direction of change of temperature isotherms). The assemblages are defined in two sub-regions of the U.S. Northeast Shelf that have heterogeneous oceanography and bathymetry using four decades of bottom trawl survey data and we explore temporal changes in distribution, spatial range extent, thermal habitat area, and biomass, within assemblages. These sub-regional analyses allow the dissection of the relative roles of regional climate velocity and local physiography in shaping observed distribution shifts. We find that assemblages of species associated with shallower, warmer waters tend to shift west-southwest and to shallower waters over time, possibly towards cooler temperatures in the semi-enclosed Gulf of Maine, while species assemblages associated with relatively cooler and deeper waters shift deeper, but with little latitudinal change. Conversely, species assemblages associated with warmer and shallower water on the broad, shallow continental shelf from the Mid-Atlantic Bight to Georges Bank shift strongly northeast along latitudinal gradients with little change in depth. Shifts in depth among the southern species associated with deeper and cooler waters are more variable, although predominantly shifts are toward deeper waters. In addition, spatial expansion and contraction of species assemblages in each region corresponds to the area of suitable thermal habitat, but is inversely related to assemblage biomass. This suggests that assemblage distribution shifts in conjunction with expansion or contraction of thermal habitat acts to compress or stretch marine species assemblages, which may respectively amplify or dilute species interactions to an extent that is rarely considered. Overall, regional differences in climate change effects on the movement and extent of species assemblages hold important implications for management, mitigation, and adaptation on the U.S. Northeast Shelf.

Marine taxa track local climate velocities.

Organisms are expected to adapt or move in response to climate change, but observed distribution shifts span a wide range of directions and rates. Explanations often emphasize biological distinctions among species, but general mechanisms have been elusive. We tested an alternative hypothesis: that differences in climate velocity-the rate and direction that climate shifts across the landscape-can explain observed species shifts. We compiled a database of coastal surveys around North America from 1968 to 2011, sampling 128 million individuals across 360 marine taxa. Climate velocity explained the magnitude and direction of shifts in latitude and depth much more effectively than did species characteristics. Our results demonstrate that marine species shift at different rates and directions because they closely track the complex mosaic of local climate velocities.

Detecting causality in complex ecosystems.

Identifying causal networks is important for effective policy and management recommendations on climate, epidemiology, financial regulation, and much else. We introduce a method, based on nonlinear state space reconstruction, that can distinguish causality from correlation. It extends to nonseparable weakly connected dynamic systems (cases not covered by the current Granger causality paradigm). The approach is illustrated both by simple models (where, in contrast to the real world, we know the underlying equations/relations and so can check the validity of our method) and by application to real ecological systems, including the controversial sardine-anchovy-temperature problem.

Pathways between primary production and fisheries yields of large marine ecosystems.

The shift in marine resource management from a compartmentalized approach of dealing with resources on a species basis to an approach based on management of spatially defined ecosystems requires an accurate accounting of energy flow. The flow of energy from primary production through the food web will ultimately limit upper trophic-level fishery yields. In this work, we examine the relationship between yield and several metrics including net primary production, chlorophyll concentration, particle-export ratio, and the ratio of secondary to primary production. We also evaluate the relationship between yield and two additional rate measures that describe the export of energy from the pelagic food web, particle export flux and mesozooplankton productivity. We found primary production is a poor predictor of global fishery yields for a sample of 52 large marine ecosystems. However, chlorophyll concentration, particle-export ratio, and the ratio of secondary to primary production were positively associated with yields. The latter two measures provide greater mechanistic insight into factors controlling fishery production than chlorophyll concentration alone. Particle export flux and mesozooplankton productivity were also significantly related to yield on a global basis. Collectively, our analyses suggest that factors related to the export of energy from pelagic food webs are critical to defining patterns of fishery yields. Such trophic patterns are associated with temperature and latitude and hence greater yields are associated with colder, high latitude ecosystems.

Periodic versus constant harvesting of discretely reproducing fish populations.

We use a single-species discrete-time model to demonstrate changes that introduction of the strong Allee mechanism and periodic exploitations have on compensatory and overcompensatory stock dynamics through comparison with corresponding models that lack such constraints. Periodic and constant exploitations simplify complex overcompensatory stock dynamics with or without the Allee effect. Both constant and periodic exploitations force a sudden collapse to extinction of fisheries systems that exhibit the Allee mechanism. However, in the absence of the Allee effect, fisheries systems decline to zero smoothly under high exploitation.

Rebuilding global fisheries.

After a long history of overexploitation, increasing efforts to restore marine ecosystems and rebuild fisheries are under way. Here, we analyze current trends from a fisheries and conservation perspective. In 5 of 10 well-studied ecosystems, the average exploitation rate has recently declined and is now at or below the rate predicted to achieve maximum sustainable yield for seven systems. Yet 63% of assessed fish stocks worldwide still require rebuilding, and even lower exploitation rates are needed to reverse the collapse of vulnerable species. Combined fisheries and conservation objectives can be achieved by merging diverse management actions, including catch restrictions, gear modification, and closed areas, depending on local context. Impacts of international fleets and the lack of alternatives to fishing complicate prospects for rebuilding fisheries in many poorer regions, highlighting the need for a global perspective on rebuilding marine resources.