Enabling conditions for an equitable and sustainable blue economy.

The future of the global ocean economy is currently envisioned as advancing towards a 'blue economy'-socially equitable, environmentally sustainable and economically viable ocean industries1,2. However, tensions exist within sustainable development approaches, arising from differing perspectives framed around natural capital or social equity. Here we show that there are stark differences in outlook on the capacity for establishing a blue economy, and on its potential outcomes, when social conditions and governance capacity-not just resource availability-are considered, and we highlight limits to establishing multiple overlapping industries. This is reflected by an analysis using a fuzzy logic model to integrate indicators from multiple disciplines and to evaluate their current capacity to contribute to establishing equitable, sustainable and viable ocean sectors consistent with a blue economy approach. We find that the key differences in the capacity of regions to achieve a blue economy are not due to available natural resources, but include factors such as national stability, corruption and infrastructure, which can be improved through targeted investments and cross-scale cooperation. Knowledge gaps can be addressed by integrating historical natural and social science information on the drivers and outcomes of resource use and management, thus identifying equitable pathways to establishing or transforming ocean sectors1,3,4. Our results suggest that policymakers must engage researchers and stakeholders to promote evidence-based, collaborative planning that ensures that sectors are chosen carefully, that local benefits are prioritized, and that the blue economy delivers on its social, environmental and economic goals.

Finding logic models for sustainable marine development that deliver on social equity.

Sustainable development is often represented as contributing to desirable outcomes across economic, environmental, and social goals, yet policies and interventions attempting to deliver sustainable development often disagree on the order in which these categories of goals should be addressed. In this Essay, we identify and review 5 approaches (called logic models) for sustainable development in ocean systems based on existing policies and interventions and consider the evidence for their contributions to equity-the ultimate goal of sustainable development according to the UN Sustainable Development Goals (SDGs). Two of the 5 logic models prioritize economic growth and lead to social and environmental benefits, 2 prioritize environmental health as a prerequisite for sustainable economic and social benefits, and the final logic model is community driven and prioritizes social dimensions. Looking towards the 2030 maturation of the SDGs, we will need to understand what models are best suited to deliver on equity gains and prevent future inequities in development and how best to operationalize them.

Changing the narrative on fisheries subsidies reform: Enabling transitions to achieve SDG 14.6 and beyond.

The World Trade Organization (WTO) is in the final stages of negotiating an agreement to prohibit harmful fisheries subsidies, thereby achieving UN Sustainable Development Goal (SDG) 14.6. An effective agreement should be viewed as an opportunity for nations to proactively transition towards sustainable and equitable fisheries and pave the path for other SDGs. Supporting fishers does not require harmful subsidies, and we provide evidence-based options for reform that highlight equity needs while reducing environmental harm. Subsidy reforms need clear goals, co-design, transparency, and fair implementation. An agreement on SDG 14.6 could be a turning point for the oceans and for the well-being of those that depend on the oceans for livelihoods and nutrition. Responsible seafood production will require international cooperation not only at WTO, but among governments, fisher organizations, civil society, and the wider public.

Adaptation strategies to climate change in marine systems.

The world's oceans are highly impacted by climate change and other human pressures, with significant implications for marine ecosystems and the livelihoods that they support. Adaptation for both natural and human systems is increasingly important as a coping strategy due to the rate and scale of ongoing and potential future change. Here, we conduct a review of literature concerning specific case studies of adaptation in marine systems, and discuss associated characteristics and influencing factors, including drivers, strategy, timeline, costs, and limitations. We found ample evidence in the literature that shows that marine species are adapting to climate change through shifting distributions and timing of biological events, while evidence for adaptation through evolutionary processes is limited. For human systems, existing studies focus on frameworks and principles of adaptation planning, but examples of implemented adaptation actions and evaluation of outcomes are scarce. These findings highlight potentially useful strategies given specific social-ecological contexts, as well as key barriers and specific information gaps requiring further research and actions.

Improved Diagnosis of Adjacent Organ Invasion of Extrahepatic Cholangiocarcinoma by Adding Arterial and Delayed Phases.

PURPOSE: To clarify the role of dynamic computed tomography (CT) in diagnosing extrahepatic cholangiocarcinoma (eCCA) involving adjacent organs. MATERIAL AND METHODS: We retrospectively analyzed patients diagnosed with eCCA in Iwate Medical University Hospital (Morioka, Japan) during January 2011-December 2021 who underwent dynamic contrast-enhanced CT before biliary intervention, surgery, or chemotherapy. For surgical cases, two radiologists independently reviewed CT images in the portal, dual (adding arterial phase), and triple (adding delayed phase) phases. The mean attenuations of the abdominal aorta, portal vein (PV), hepatic parenchyma, pancreatic parenchyma, and eCCA were measured. The biliary segment-wise longitudinal tumour extent, arterial and PV invasion, organ invasion (liver, pancreas, and duodenum), and regional lymph node metastasis were assessed on a five-point scale. Image performances were compared using the sensitivity, specificity, and area under the curve (AUC). RESULTS: We included 120 patients (mean age, 71.7 ± 8.9; 84 males). The PV and liver differed most from the bile duct tumour in the portal phase. The abdominal aorta and pancreas differed most from eCCA in the arterial phase. For 80 patients evaluated on the five-point scale, adding phases increased the AUC for pancreatic, duodenal, and arterial invasion for each observer (observer 1, 0.79-0.93, p<0.01, 0.71-0.86, p = 0.04, 0.74-0.99, p = 0.02; observer 2, 0.88-0.96, p = 0.01, 0.73-0.94, p<0.01, 0.80-0.99 p = 0.04; respectively). The AUC for biliary segment-wise longitudinal tumor extent, hepatic, and PV invasion remained unchanged with additional phases. CONCLUSIONS: Portal-phase information is sufficient to evaluate the segmental extent of bile duct and liver/PV invasion. Arterial- and delayed-phase information can help evaluate pancreatic, duodenal, and arterial invasion.

[From the position of a private sector hospital: ISO 15189 acquisition by a clinical laboratory, and quality management system deployment in the whole hospital].

St. Mary's Hospital Medical Inspecting Center acquired ISO 15189 authorization in December, 2007. In the process of authorization acquisition, measures were taken to improve various quality issues, and a marked effect was seen in patient services and medical safety control. Furthermore, we tried to improve ward nursing management using ISO, drew up standard operating procedures through detailed job analysis, and enabled ward operation standardization. In this paper, while describing the effect of ISO 15189 on clinical examinations, we refer to the significance of improving quality of hospital management which our clinical laboratory lead to.

Deep learning reconstruction allows low-dose imaging while maintaining image quality: comparison of deep learning reconstruction and hybrid iterative reconstruction in contrast-enhanced abdominal CT.

We aimed to compare the radiation dose and image quality of a low-dose abdominal computed tomography (CT) protocol reconstructed with deep learning reconstruction (DLR) with those of a routine-dose protocol reconstructed with hybrid-iterative reconstruction. This retrospective study enrolled 71 patients [61 men; average age, 71.9 years; mean body mass index (BMI), 24.3 kg/m2] who underwent both low-dose abdominal CT with DLR [advanced intelligent clear-IQ engine (AiCE)] and routine-dose abdominal CT with hybrid-iterative reconstruction [adaptive iterative dose reduction 3D (AIDR 3D)]. Radiation dose parameters included volume CT dose index (CTDIvol), effective dose (ED), and size-specific dose estimate (SSDE). Mean image noise and contrast-to-noise ratio (CNR) were calculated. Image noise was measured in the hepatic parenchyma and bilateral erector spinae muscles. Moreover, subjective assessment of perceived image quality and diagnostic acceptability was performed. The low-dose protocol helped reduce the CTDIvol by 44.3%, ED by 43.7%, and SSDE by 44.9%. Moreover, the noise was significantly lower and CNR significantly higher with the low-dose protocol than with the normal-dose protocol (P<0.001). In the subjective assessment of image quality, there was no significant difference between the protocols with regard to image noise. Overall, AiCE was superior to AIDR 3D in terms of diagnostic acceptability (P=0.001). The use of AiCE can reduce overall radiation dose by more than 40% without loss of image quality compared to routine-dose abdominal CT with AIDR 3D.

Focal seizures during adrenocorticotropic hormone therapy in a school-aged boy: a case report.

BACKGROUND: Adrenocorticotropic hormone therapy for infantile spasms, including West syndrome, has been previously reported to induce seizures. We present the findings for a school-aged child with epilepsy who developed new focal seizures during adrenocorticotropic hormone therapy. CASE PRESENTATION: The Japanese patient had posttraumatic epilepsy and developed intractable focal seizures at the age of 13 years. Adrenocorticotropic hormone therapy was administered when the patient was 14 years of age. On day 10 of treatment, he developed new focal seizures, which were characterized by left arm contractions followed by movements of touching things with his right hand and writhing and rocking his body left and right and back and forth as automatisms. The focal seizures clustered for 40 minutes and disappeared after suppository administration of 10 mg diazepam. These focal seizures did not reoccur after more than 2 years of follow-up. CONCLUSION: Adrenocorticotropic hormone-induced seizures can occur in children older than previously reported, and can occur in children with intractable seizures other than epileptic spasms.

Defining mangrove-fisheries: A typology from the Perancak Estuary, Bali, Indonesia.

This study develops a definition of what mangrove-fisheries can encompass, incorporating a broad range of their possible characteristics. A detailed case study was conducted to develop a typology of mangrove-fishing in the Perancak Estuary, Bali, Indonesia, using interview surveys to investigate the fishing activities associated with mangroves. This case study demonstrated the complexity that a mangrove-fishery can entail, where fishing is connected to the mangrove forest by fishers of multiple sectors, functions, locations and temporal scales. Through a comparison with other mangrove-fishing communities in Bali, it also highlighted that mangrove-fisheries are variable even when in close proximity. With particular reference to this case study, a framework was developed as a flexible tool for identifying the multiple dimensions of a mangrove-fishery in a local context. Following this framework should encourage researchers and managers to look outside of the groups of fishers traditionally expected to benefit from mangrove fishing. This will enable the development of a broader definition of mangrove-fisheries in a site specific way. Identifying the full scope of fishers that contribute to or benefit from a mangrove-fishery is the first step towards building management measures that reflect the interests of groups of fishers that may otherwise remain under-represented. This is in line with international efforts for sustainability, especially in promoting small-scale fishers' access to sustainable resources under the UN Sustainable Development Goals.

Superior objective and subjective image quality of deep learning reconstruction for low-dose abdominal CT imaging in comparison with model-based iterative reconstruction and filtered back projection.

OBJECTIVE: This study aimed to conduct objective and subjective comparisons of image quality among abdominal computed tomography (CT) reconstructions with deep learning reconstruction (DLR) algorithms, model-based iterative reconstruction (MBIR), and filtered back projection (FBP). METHODS: Datasets from consecutive patients who underwent low-dose liver CT were retrospectively identified. Images were reconstructed using DLR, MBIR, and FBP. Mean image noise and contrast-to-noise ratio (CNR) were calculated, and noise, artifacts, sharpness, and overall image quality were subjectively assessed. Dunnett's test was used for statistical comparisons. RESULTS: Ninety patients (67 ± 12.7 years; 63 males; mean body mass index [BMI], 25.5 kg/m2) were included. The mean noise in the abdominal aorta and hepatic parenchyma of DLR was lower than that in FBP and MBIR (p < .001). For FBP and MBIR, image noise was significantly higher for obese patients than for those with normal BMI. The CNR for the abdominal aorta and hepatic parenchyma was higher for DLR than for FBP and MBIR (p < .001). MBIR images were subjectively rated as superior to FBP images in terms of noise, artifacts, sharpness, and overall quality (p < .001). DLR images were rated as superior to MBIR images in terms of noise (p < .001) and overall quality (p = .03). CONCLUSIONS: Based on objective and subjective comparisons, the image quality of DLR was found to be superior to that of MBIR and FBP on low-dose abdominal CT. DLR was the only method for which image noise was not higher for obese patients than for those with a normal BMI. ADVANCES IN KNOWLEDGE: This study provides previously unavailable information on the properties of DLR systems and their clinical utility.

The Retail Food Sector and Indigenous Peoples in High-Income Countries: A Systematic Scoping Review.

Indigenous Peoples in high-income countries experience higher burdens of food insecurity, obesity, and diet-related health conditions compared to national averages. The objective of this systematic scoping review is to synthesize information from the published literature on the methods/approaches, findings, and scope for research and interventions on the retail food sector servicing Indigenous Peoples in high-income countries. A structured literature search in two major international databases yielded 139 relevant peer-reviewed articles from nine countries. Most research was conducted in Oceania and North America, and in rural and remote regions. Several convergent issues were identified across global regions including limited grocery store availability/access, heightened exposure to unhealthy food environments, inadequate market food supplies (i.e., high prices, limited availability, and poor quality), and common underlying structural factors including socio-economic inequality and colonialism. A list of actions that can modify the nature and structure of retailing systems to enhance the availability, accessibility, and quality of healthful foods is identified. While continuing to (re)align research with community priorities, international collaboration may foster enhanced opportunities to strengthen the evidence base for policy and practice and contribute to the amelioration of diet quality and health at the population level.

Feasibility of thin-slice abdominal CT in overweight patients using a vendor neutral image-based denoising algorithm: Assessment of image noise, contrast, and quality.

The purpose of this study was to investigate whether the novel image-based noise reduction software (NRS) improves image quality, and to assess the feasibility of using this software in combination with hybrid iterative reconstruction (IR) in image quality on thin-slice abdominal CT. In this retrospective study, 54 patients who underwent dynamic liver CT between April and July 2017 and had a body mass index higher than 25 kg/m2 were included. Three image sets of each patient were reconstructed as follows: hybrid IR images with 1-mm slice thickness (group A), hybrid IR images with 5-mm slice thickness (group B), and hybrid IR images with 1-mm slice thickness denoised using NRS (group C). The mean image noise and contrast-to-noise ratio relative to the muscle of the aorta and liver were assessed. Subjective image quality was evaluated by two radiologists for sharpness, noise, contrast, and overall quality using 5-point scales. The mean image noise was significantly lower in group C than in group A (p < 0.01), but no significant difference was observed between groups B and C. The contrast-to-noise ratio was significantly higher in group C than in group A (p < 0.01 and p = 0.01, respectively). Subjective image quality was also significantly higher in group C than in group A (p < 0.01), in terms of noise and overall quality, but not in terms of sharpness and contrast (p = 0.65 and 0.07, respectively). The contrast of images in group C was greater than that in group A, but this difference was not significant. Compared with hybrid IR alone, the novel NRS combined with a hybrid IR could result in significant noise reduction without sacrificing image quality on CT. This combined approach will likely be particularly useful for thin-slice abdominal CT examinations of overweight patients.

The role of human rights in implementing socially responsible seafood.

Sustainability standards for seafood mainly address environmental performance criteria and are less concerned with the welfare of fisheries workers who produce the seafood. Yet human rights violations such as slavery and human trafficking are widespread in fisheries around the world, and underscore the need for certification bodies and other seafood supply chain actors to improve social performance, in addition to addressing environmental challenges. Calls for socially responsible seafood have referenced human rights law and policy frameworks to shape the guiding principles of socially responsible seafood and to provide the legal machinery to implement these aspirations, but practical guidance on how to achieve this is lacking. To provide clarity on this challenge, we reviewed the literature concerning human rights in the seafood supply chain, and prepared an analysis of opportunities and challenges to implement socially responsible seafood through relevant human rights, legal and policy instruments. We observe that human rights laws are generally framed in favour of addressing violations of civil and political rights, but there remains considerable scope for applying economic, social and cultural (ESC) rights in this context. Other challenges include weakly defined ESC rights infringements, a lack of straightforward mechanisms to enforce human rights entitlements, and practical difficulties such as resources to support and secure rights. On the positive side, governments can draw on international instruments to inspire national policies and legislation to eliminate illegalities from the seafood supply chain. However, for socially responsible seafood principles to translate into tangible actions, these objectives must be rooted in clear legal obligations and be supported by sufficient national capacity and political will.

A Global Estimate of Seafood Consumption by Coastal Indigenous Peoples.

Coastal Indigenous peoples rely on ocean resources and are highly vulnerable to ecosystem and economic change. Their challenges have been observed and recognized at local and regional scales, yet there are no global-scale analyses to inform international policies. We compile available data for over 1,900 coastal Indigenous communities around the world representing 27 million people across 87 countries. Based on available data at local and regional levels, we estimate a total global yearly seafood consumption of 2.1 million (1.5 million-2.8 million) metric tonnes by coastal Indigenous peoples, equal to around 2% of global yearly commercial fisheries catch. Results reflect the crucial role of seafood for these communities; on average, consumption per capita is 15 times higher than non-Indigenous country populations. These findings contribute to an urgently needed sense of scale to coastal Indigenous issues, and will hopefully prompt increased recognition and directed research regarding the marine knowledge and resource needs of Indigenous peoples. Marine resources are crucial to the continued existence of coastal Indigenous peoples, and their needs must be explicitly incorporated into management policies.

Projected Scenarios for Coastal First Nations' Fisheries Catch Potential under Climate Change: Management Challenges and Opportunities.

Studies have demonstrated ways in which climate-related shifts in the distributions and relative abundances of marine species are expected to alter the dynamics and catch potential of global fisheries. While these studies assess impacts on large-scale commercial fisheries, few efforts have been made to quantitatively project impacts on small-scale subsistence and commercial fisheries that are economically, socially and culturally important to many coastal communities. This study uses a dynamic bioclimate envelope model to project scenarios of climate-related changes in the relative abundance, distribution and richness of 98 exploited marine fishes and invertebrates of commercial and cultural importance to First Nations in coastal British Columbia, Canada. Declines in abundance are projected for most of the sampled species under both the lower (Representative Concentration Pathway [RCP] 2.6) and higher (RCP 8.5) emission scenarios (-15.0% to -20.8%, respectively), with poleward range shifts occurring at a median rate of 10.3 to 18.0 km decade(-1) by 2050 relative to 2000. While a cumulative decline in catch potential is projected coastwide (-4.5 to -10.7%), estimates suggest a strong positive correlation between the change in relative catch potential and latitude, with First Nations' territories along the northern and central coasts of British Columbia likely to experience less severe declines than those to the south. Furthermore, a strong negative correlation is projected between latitude and the number of species exhibiting declining abundance. These trends are shown to be robust to alternative species distribution models. This study concludes by discussing corresponding management challenges that are likely to be encountered under climate change, and by highlighting the value of joint-management frameworks and traditional fisheries management approaches that could aid in offsetting impacts and developing site-specific mitigation and adaptation strategies derived from local fishers' knowledge.