Looking after each other in a crisis-Lessons from Novichok and the parallels with Covid-19.

BACKGROUND: In March 2018, three patients were admitted to the Emergency Department of a District General Hospital. Originally suspected of having suffered an opiate overdose, it became clear that they were the victims of anti-cholinesterase poisoning-the Soviet era poison Novichok. Twenty-five days later, two further patients were admitted with the same symptoms. One of these patients died 8 days later and the second remained in hospital for 3 weeks. A Clinical Psychologist was present on the unit throughout the major incident and all staff directly involved received psycho-educational support regarding self-care. AIMS: To examine the psychological impact of the longest running major incident in NHS history on the staff directly involved. DESIGN: A cross-sectional design was used, with structured questionnaires administered retrospectively. METHODS: A link to an electronic survey was emailed to every member of staff in the organization. The survey included the Hospital Anxiety and Depression Scale, the Maslach Burnout Inventory, the Impact of Events Scale-Revised (to both the March and June events). RESULTS: 540/4000 hospital staff responded (13.5% response rate) with a 29/59 (49%) response rate in intensive care staff. Frontline staff had significantly lower scores on anxiety (P < .05 for the June incident), depressive symptoms (P < .05 March and June) and subscales of burnout than managers (depersonalization P < .05). On the remaining two burnout subscales and on anxiety scores for those involved in March, results trended towards significance (P < .1). CONCLUSIONS: Staff in management roles during major incidents may experience higher levels of psychological distress than staff in front line clinical roles and should be encouraged to seek psychological support. RELEVANCE TO CLINICAL PRACTICE: This article informs teams of the psychological impact of major incidents on staff in intensive care settings.

Warming world, changing ocean: mitigation and adaptation to support resilient marine systems.

Proactive and coordinated action to mitigate and adapt to climate change will be essential for achieving the healthy, resilient, safe, sustainably harvested and biodiverse ocean that the UN Decade of Ocean Science and sustainable development goals (SDGs) seek. Ocean-based mitigation actions could contribute 12% of the emissions reductions required by 2030 to keep warming to less than 1.5 ºC but, because substantial warming is already locked in, extensive adaptation action is also needed. Here, as part of the Future Seas project, we use a "foresighting/hindcasting" technique to describe two scenarios for 2030 in the context of climate change mitigation and adaptation for ocean systems. The "business-as-usual" future is expected if current trends continue, while an alternative future could be realised if society were to effectively use available data and knowledge to push as far as possible towards achieving the UN SDGs. We identify three drivers that differentiate between these alternative futures: (i) appetite for climate action, (ii) handling extreme events, and (iii) climate interventions. Actions that could navigate towards the optimistic, sustainable and technically achievable future include:(i)proactive creation and enhancement of economic incentives for mitigation and adaptation;(ii)supporting the proliferation of local initiatives to spur a global transformation;(iii)enhancing proactive coastal adaptation management;(iv)investing in research to support adaptation to emerging risks;(v)deploying marine-based renewable energy;(vi)deploying marine-based negative emissions technologies;(vii)developing and assessing solar radiation management approaches; and(viii)deploying appropriate solar radiation management approaches to help safeguard critical ecosystems. Supplementary Information: The online version contains supplementary material available at 10.1007/s11160-021-09678-4.

Swallowing rehabilitation following spinal injury: A case series.

Context/objective: Swallowing difficulties (dysphagia) are well recognized after spinal injury. There are no published rehabilitation efficacy studies to date. This study explored viability and outcomes of swallowing rehabilitation programs for four patients with persisting dysphagia.Design: Prospective, quantitative experimental longitudinal case series.Setting: Spinal rehabilitation unit or patients' homes.Interventions: Four patients engaged in a 6-week (3×weekly) individualized progressive rehabilitation program.Outcome measures: Objective videofluoroscopic measures of timing and displacement and a validated self-reported questionnaire - the Eating Assessment Tool (EAT-10) were taken pre-therapy, immediately post-therapy and EAT-10 was repeated at 3 months. Feeling and fatigue scale scores were taken before and after each therapy session.Results: Patients (63, 67 yr, 67 yr, 76 yr; 3 male) had varying spinal diagnoses (2 traumatic, all involving the C-spine) and length of dysphagia (6 weeks, 6 weeks, 12 weeks, 10 yr). Common physiological impairments across all patients were: reduced maximum hyoid displacement, reduced pharyngeal constriction and reduced pharyngoesophageal segment maximum opening. Therapy programs were well received with 100% compliance. Participants made quantitative improvements in their videofluoroscopic measures of timing and displacement. Three out of four participants were able to have their percutaneous endoscopic gastrostomies (PEG) removed. EAT-10 scores significantly improved for all patients (P < .001). Poor upper limb function and restricted neck flexion prohibited some exercises.Conclusions: For many patients following spinal injury, dysphagia resolves during the acute phase of post-surgery recovery. For some, significant pharyngeal impairments persist. This case series demonstrates potential to regain functional swallowing following a 6-week tailored rehabilitation program. High-quality research exploring efficacy of rehabilitation programs are warranted.

Poleward bound: adapting to climate-driven species redistribution.

One of the most pronounced effects of climate change on the world's oceans is the (generally) poleward movement of species and fishery stocks in response to increasing water temperatures. In some regions, such redistributions are already causing dramatic shifts in marine socioecological systems, profoundly altering ecosystem structure and function, challenging domestic and international fisheries, and impacting on human communities. Such effects are expected to become increasingly widespread as waters continue to warm and species ranges continue to shift. Actions taken over the coming decade (2021-2030) can help us adapt to species redistributions and minimise negative impacts on ecosystems and human communities, achieving a more sustainable future in the face of ecosystem change. We describe key drivers related to climate-driven species redistributions that are likely to have a high impact and influence on whether a sustainable future is achievable by 2030. We posit two different futures-a 'business as usual' future and a technically achievable and more sustainable future, aligned with the Sustainable Development Goals. We then identify concrete actions that provide a pathway towards the more sustainable 2030 and that acknowledge and include Indigenous perspectives. Achieving this sustainable future will depend on improved monitoring and detection, and on adaptive, cooperative management to proactively respond to the challenge of species redistribution. We synthesise examples of such actions as the basis of a strategic approach to tackle this global-scale challenge for the benefit of humanity and ecosystems. Supplementary Information: The online version contains supplementary material available at 10.1007/s11160-021-09641-3.

Developing achievable alternate futures for key challenges during the UN Decade of Ocean Science for Sustainable Development.

The oceans face a range of complex challenges for which the impacts on society are highly uncertain but mostly negative. Tackling these challenges is testing society's capacity to mobilise transformative action, engendering a sense of powerlessness. Envisaging positive but realistic visions of the future, and considering how current knowledge, resources, and technology could be used to achieve these futures, may lead to greater action to achieve sustainable transformations. Future Seas (www.FutureSeas2030.org) brought together researchers across career stages, Indigenous Peoples and environmental managers to develop scenarios for 12 challenges facing the oceans, leveraging interdisciplinary knowledge to improve society's capacity to purposefully shape the direction of marine social-ecological systems over the UN Decade of Ocean Science for Sustainable Development (2021-2030). We describe and reflect on Future Seas, providing guidance for co-developing scenarios in interdisciplinary teams tasked with exploring ocean futures. We detail the narrative development for two futures: our current trajectory based on published evidence, and a more sustainable future, consistent with the UN's Sustainable Development Goals, which is technically achievable using existing and emerging knowledge. Presentation of Business-as-usual and More Sustainable futures-together-allows communication of both trajectories, whilst also highlighting achievable, sustainable versions of the future. The advantages of the interdisciplinary approach taken include: (1) integrating different perspectives on solutions, (2) capacity to explore interactions between Life Under Water (Goal 14) and other SDGs, and (3) cross-disciplinary learning. This approach allowed participants to conceptualise shared visions of the future and co-design transformative pathways to achieving those futures. Supplementary Information SI: The online version contains supplementary material available at (10.1007/s11160-020-09629-5) contains supplementary material, which is available to authorized users.

Distinct neuronal populations in the basolateral and central amygdala are activated with acute pain, conditioned fear, and fear-conditioned analgesia.

Fear-conditioned analgesia (FCA) is modulated by brain areas involved in the descending inhibitory pain pathway such as the basolateral (BLA) and central amygdala (CEA). The BLA contains Ca2+/calmodulin-dependent protein kinase II (CaMKII) and parvalbumin (PV) neurons. CEA neurons are primarily inhibitory (GABAergic) that comprise enkephalin (ENK) interneurons and corticotropin-releasing factor (CRF) - neurons that project to the periaqueductal grey. The purpose of our experiment was to determine the pattern of activation of CaMKII/PV and ENK/CRF neurons following the expression of acute pain, conditioned fear, and FCA. A significant reduction was observed in nociceptive behaviors in mice re-exposed to a contextually-aversive environment. Using NeuN and cFos as markers for activated neurons, CaMKII, PV, ENK, or CRF were used to identify neuronal subtypes. We find that mice expressing conditioned fear displayed an increase in c-Fos/CaMKII co-localization in the lateral amygdala and BLA compared to controls. Additionally a significant increase in cFos/CRF co-localization was observed in mice expressing FCA. These results show that amygdala processing of conditioned contextual aversive, nociceptive, and FCA behaviors involve different neuronal phenotypes and neural circuits between, within, and from various amygdala nuclei. This information will be important in developing novel therapies for treating pain and emotive disorders in humans.