Current extent and future opportunities for living shorelines in Australia.

Living shorelines aim to enhance the resilience of coastlines to hazards while simultaneously delivering co-benefits such as carbon sequestration. Despite the potential ecological and socio-economic benefits of living shorelines over conventional engineered coastal protection structures, application is limited globally. Australia has a long and diverse coastline that provides prime opportunities for living shorelines using beaches and dunes, vegetation, and biogenic reefs, which may be either natural ('soft' approach) or with an engineered structural component ('hybrid' approach). Published scientific studies, however, have indicated limited use of living shorelines for coastal protection in Australia. In response, we combined a national survey and interviews of coastal practitioners and a grey and peer-reviewed literature search to (1) identify barriers to living shoreline implementation; and (2) create a database of living shoreline projects in Australia based on sources other than scientific literature. Projects included were those that had either a primary or secondary goal of protection of coastal assets from erosion and/or flooding. We identified 138 living shoreline projects in Australia through the means sampled starting in 1970; with the number of projects increasing through time particularly since 2000. Over half of the total projects (59 %) were considered to be successful according to their initial stated objective (i.e., reducing hazard risk) and 18 % of projects could not be assessed for their success based on the information available. Seventy percent of projects received formal or informal monitoring. Even in the absence of peer-reviewed support for living shoreline construction in Australia, we discovered local and regional increases in their use. This suggests that coastal practitioners are learning on-the-ground, however more generally it was stated that few examples of living shorelines are being made available, suggesting a barrier in information sharing among agencies at a broader scale. A database of living shoreline projects can increase knowledge among practitioners globally to develop best practice that informs technical guidelines for different approaches and helps focus attention on areas for further research.

Achieving conservation and restoration outcomes through ecologically beneficial aquaculture.

A range of conservation and restoration tools are needed to safeguard the structure and function of aquatic ecosystems. Aquaculture, the culturing of aquatic organisms, often contributes to the numerous stressors that aquatic ecosystems face, yet some aquaculture activities can also deliver ecological benefits. We reviewed the literature on aquaculture activities that may contribute to conservation and restoration outcomes, either by enhancing the persistence or recovery of one or more target species or by moving aquatic ecosystems toward a target state. We identified 12 ecologically beneficial outcomes achievable via aquaculture: species recovery, habitat restoration, habitat rehabilitation, habitat protection, bioremediation, assisted evolution, climate change mitigation, wild harvest replacement, coastal defense, removal of overabundant species, biological control, and ex situ conservation. This list may be expanded as new applications are discovered. Positive intentions do not guarantee positive ecological outcomes, so it is critical that potentially ecologically beneficial aquaculture activities be evaluated via clear and measurable indicators of success to reduce potential abuse by greenwashing. Unanimity on outcomes, indicators, and related terminology will bring the field of aquaculture-environment interactions into line with consensus standards in conservation and restoration ecology. Broad consensus will also aid the development of future certification schemes for ecologically beneficial aquaculture.

Se necesita una gama de herramientas de conservación y restauración para salvaguardar la estructura y función de los ecosistemas acuáticos. La acuacultura (el cultivo de organismos acuáticos) generalmente contribuye a los numerosos estresantes que soportan los ecosistemas acuáticos, aunque algunas actividades de la acuacultura también pueden proporcionar beneficios ecológicos. Revisamos la literatura sobre las actividades de acuacultura que pueden contribuir a los resultados de conservación y restauración, ya sea al incrementar la persistencia o recuperación de una o más especies objetivo o al llevar a los ecosistemas acuáticos hacia un estado objetivo. Identificamos doce resultados con beneficios ecológicos que pueden lograrse con la acuacultura: recuperación de la especie, recuperación del hábitat, restauración del hábitat, rehabilitación del hábitat, protección del hábitat, bioreparación, evolución asistida, mitigación del cambio climático, sustitución de la captura silvestre, defensa costera, eliminación de las especies sobreabundantes, control biológico y conservación ex situ. Esta lista puede expandirse conforme se descubren nuevas aplicaciones. Las intenciones positivas no garantizan resultados ecológicos positivos, así que es importante que se evalúen las actividades de acuacultura con un posible beneficio ecológico por medio de indicadores del éxito claros y medibles para reducir el abuso potencial por ecoblanqueo o greenwashing. La unanimidad en los resultados, indicadores y terminología relacionada armonizará las interacciones entre la acuacultura y el ambiente con los estándares de la conservación y la ecología de la restauración. Un consenso generalizado también ayudará con el desarrollo de futuros esquemas de certificación para la acuacultura con beneficios ecológicos. Obtención de resultados de conservación y restauración a través de la acuacultura con beneficios ecológicos.

'That's how we got around it': a qualitative exploration of healthcare professionals' experiences of care provision for asylum applicants' with limited English proficiency in UK contingency accommodation.

OBJECTIVES: The inadequate provision of language interpretation for people with limited English proficiency (LEP) is a determinant of poor health, yet interpreters are underused. This research explores the experiences of National Health Service (NHS) staff providing primary care for people seeking asylum, housed in contingency accommodation during COVID-19. This group often have LEP and face multiple additional barriers to healthcare access. Language discrimination is used as a theoretical framework. The potential utility of this concept is explored as a way of understanding and addressing inequities in care. DESIGN: Qualitative research using semistructured interviews and inductive thematic analysis. SETTING: An NHS primary care service for people seeking asylum based in contingency accommodation during COVID-19 housing superdiverse residents speaking a wide spectrum of languages. PARTICIPANTS: Ten staff including doctors, nurses, mental health practitioners, healthcare assistants and students participated in semistructured online interviews. Some staff were redeployed to this work due to the pandemic. RESULTS: All interviewees described patients' LEP as significant. Inadequate provision of interpretation services impacted the staff's ability to provide care and compromised patient safety. Discrimination, such as that based on migration status, was recognised and challenged by staff. However, inequity based on language was not articulated as discrimination. Instead, insufficient and substandard interpretation was accepted as the status quo and workarounds used, such as gesticulating or translation phone apps. The theoretical lens of language discrimination shows how this propagates existing social hierarchies and further disadvantages those with LEP. CONCLUSIONS: This research provides empirical evidence of how the inadequate provision of interpreters forces the hand of healthcare staff to use shortcuts. Although this innovative 'tinkering' allows staff to get the job done, it risks normalising structural gaps in care provision for people with LEP. Policy-makers must rethink their approach to interpretation provision which prioritises costs over quality. We assert that the concept of language discrimination is a valuable framework for clinicians to better identify and articulate unfair treatment on the grounds of LEP.

Involving patients and carers in patient safety in primary care: A qualitative study of a co-designed patient safety guide.

BACKGROUND: Involving patients is a key premise of national and international policies on patient safety, which requires understanding how patients or carers want to be involved and developing resources to support this. This paper examines patients' and carers' views of being involved in patient safety in primary care and their views of potentially using a co-designed patient safety guide for primary care (PSG-PC) to foster both involvement and their safety. METHODS: A qualitative study using semistructured face-to-face interviews with 18 patients and/or carers in primary care. Interviews were transcribed and analysis was conducted using an inductive thematic approach. RESULTS: Overall participants expressed enthusiasm for the PSG-PC as a tool to support patients and carers to be involved in patient safety in primary care. However, for some participants being involved in patient safety was seen as taking on the role of General Practitioner and had the potential to add an additional workload for patients. Participants' willingness or ability to be involved in patient safety was influenced by a range of factors including an invisible, often underacknowledged role of everyday safety for patients' interactions with primary care; the levels of involvement that patients wanted in their care and safety and the work of embedding the PSG-PC for patients into their routine interactions with primary care. Participants identified components of the PSG-PC that would be useful to them, in particular, if they had a responsibility for caring for a family member if they had more complex care or long-term conditions. CONCLUSION: Involving patients and carers in patient safety needs a tailored and personalized approach that enables patients and carers to use resources like the PSG-PC routinely and helps challenge assumptions about their willingness and ability to be involved in patient safety. Doing so would raise awareness of opportunities to be involved in safety in line with personal preference. PATIENT OR PUBLIC CONTRIBUTION: Patient and public involvement were central to the research study. This included working in partnership to develop the PSG-PC with patients and carers and throughout our study including in the design of the study, recruiting participants, interpretation of findings.

The coastal protection and blue carbon benefits of hybrid mangrove living shorelines.

Hybrid living shorelines use a combination of engineered structures with natural ecosystems to achieve coastal protection and habitat restoration outcomes, with added co-benefits such as carbon sequestration. Rock fillets constructed along eroding estuarine banks are designed to accumulate sediment, establish mangroves, and stabilise the shoreline. There is, however, a lack of data to support whether rock fillets are achieving these goals. We used a chronosequence of rock fillets to determine their effect on mangrove development, bank stabilisation and carbon sequestration in four estuaries in New South Wales, Australia. Aboveground biomass and adult density increased with age of rock fillets, and mangrove structure was similar to a natural fringing mangrove after 15 years. The rock fillets accumulated sediment, which reduced the eroded estuary bank height, however, little effect of the fillets on bank slope was observed. Sediment carbon stocks were not different between rock fillets, eroding estuary banks and natural fringing mangroves. Rock fillet design had a significant effect on mangrove structure and coastal protection function, with greater wave transmission through lower rock fillets, suggesting design optimisation is needed. As the construction cost of the rock fillets was equal or less than traditional rock revetments, where suitable they present a more economic and environmentally sustainable solution to estuarine erosion management.

Nature-based solutions for atoll habitability.

Atoll societies have adapted their environments and social systems for thousands of years, but the rapid pace of climate change may bring conditions that exceed their adaptive capacities. There is growing interest in the use of 'nature-based solutions' to facilitate the continuation of dignified and meaningful lives on atolls through a changing climate. However, there remains insufficient evidence to conclude that these can make a significant contribution to adaptation on atolls, let alone to develop standards and guidelines for their implementation. A sustained programme of research to clarify the potential of nature-based solutions to support the habitability of atolls is therefore vital. In this paper, we provide a prospectus to guide this research programme: we explain the challenge climate change poses to atoll societies, discuss past and potential future applications of nature-based solutions and outline an agenda for transdisciplinary research to advance knowledge of the efficacy and feasibility of nature-based solutions to sustain the habitability of atolls. This article is part of the theme issue 'Nurturing resilient marine ecosystems'.

Supporting urban ecosystem services across terrestrial, marine and freshwater realms.

The terrestrial, freshwater and marine realms all provide essential ecosystem services in urban environments. However, the services provided by each realm are often considered independently, which ignores the synergies between them and risks underestimating the benefits derived collectively. Greater research collaboration across these realms, and an integrated approach to management decisions can help to support urban developments and restoration projects in maintaining or enhancing ecosystem services. The aim of this paper is to highlight the synergies and trade-offs among ecosystem services provided by each realm and to offer suggestions on how to improve current practice. We use case studies to illustrate the flow of services across realms. In our call to better integrate research and management across realms, we present a framework that provides a 6-step process for conducting collaborative research and management with an Australian perspective. Our framework considers unifying language, sharing, and understanding of desired outcomes, conducting cost-benefit analyses to minimise trade-offs, using multiple modes of communication for stakeholders, and applying research outcomes to inform regulation. It can be applied to improve collaboration among researchers, managers and planners from all realms, leading to strategic allocation of resources, increased protection of urban natural resources and improved environmental regulation with broad public support.

Testing the efficacy of sea urchin exclusion methods for restoring kelp.

Kelps are ecosystem engineers, which collectively form forests that provide a variety of important ecosystem services for humans and other organisms. Kelp forests are threatened by multiple local and global stressors, one of the most notable is herbivory. Overabundant sea; urchins can consume kelp, leading to a phase shift from productive forests to unproductive; rocky barrens. Reducing sea urchin densities by directly removing them can reverse this; phase shift. However, maintaining low densities of sea urchins, is logistically and financially; challenging. Following a review of herbivore exclusion methods to date, we tested the efficacy of three different methods for excluding sea urchins from kelp in the laboratory: flexible fences; electricity; and copper anti-fouling paint. The results from the laboratory; experiment showed that flexible fencing was the most successful method for excluding sea urchins. To test the efficacy of this method in the field, sea urchins were removed from 1m2 patches in barrens and intact kelp beds, and the effectiveness of flexible fences of two different heights (30 cm and 60 cm) at excluding sea urchins were tested. The results from the field study demonstrated that flexible fences of both heights were effective at maintaining low sea urchin densities in barrens but not in intact kelp beds, relative to unmanipulated; rocky barrens. These findings suggest that flexible fencing could be an important tool in restoring kelp in barrens, however the costs of fencing are likely to place limits on the scale at which this management strategy can be implemented.

Large-scale variation in wave attenuation of oyster reef living shorelines and the influence of inundation duration.

One of the paramount goals of oyster reef living shorelines is to achieve sustained and adaptive coastal protection, which requires meeting ecological (i.e., develop a self-sustaining oyster population) and engineering (i.e., provide coastal defense) targets. In a large-scale comparison along the Atlantic and Gulf coasts of the United States, the efficacy of various designs of oyster reef living shorelines at providing wave attenuation was evaluated accounting for the ecological limitations of oysters with regard to inundation duration. A critical threshold for intertidal oyster reef establishment is 50% inundation duration. Living shorelines that spent less than one-half of the time (<50%) inundated were not considered suitable habitat for oysters, however, were effective at wave attenuation (68% reduction in wave height). Reefs that experienced >50% inundation were considered suitable habitat for oysters, but wave attenuation was similar to controls (no reef; ~5% reduction in wave height). Many of the oyster reef living shoreline approaches therefore failed to optimize the ecological and engineering goals. In both inundation regimes, wave transmission decreased with an increasing freeboard (difference between reef crest elevation and water level), supporting its importance in the wave attenuation capacity of oyster reef living shorelines. However, given that the reef crest elevation (and thus freeboard) should be determined by the inundation duration requirements of oysters, research needs to be refocused on understanding the implications of other reef parameters (e.g., width) for optimizing wave attenuation. A broader understanding of the reef characteristics and seascape contexts that result in effective coastal defense by oyster reefs is needed to inform appropriate design and implementation of oyster-based living shorelines globally.

Predicting poor outcomes in children aged 1-12 with respiratory tract infections: A systematic review.

BACKGROUND: Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. AIM: To identify symptoms, signs, and investigation results associated with good and poor prognosis, and clinical decision making in children aged 1-12 years with RTI symptoms, at home and presenting to ambulatory care. DESIGN AND SETTING: Systematic literature review. METHODS: We searched MEDLINE, EMBASE, Cinahl, Web of Science and the Cochrane database of systematic reviews for studies of children aged 1 to 12 years with a RTI or related condition reporting symptoms, signs and investigation results associated with prognostic outcomes. Quality was assessed using the QUIPS tool. RESULTS: We included 27 studies which included 34802 children and measured 192 factors. Nine studies explored future outcomes and the remainder explored clinical management from the initial consultation with the health services. None were conducted in a home setting. Respiratory signs, vomiting, fever, dehydration and tachycardia at the initial contact were associated with future hospitalisation. Little evidence was available for other outcomes. CONCLUSION: Some evidence is available to clinicians to stratify risk of, future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home.

A qualitative exploration of patients' experiences, needs and expectations regarding online access to their primary care record.

OBJECTIVES: Primary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients' needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need. DESIGN: Focus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach. SETTING: Focus groups and interviews were conducted in community settings in the UK. PARTICIPANTS: Fifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else. RESULTS: Participants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated. CONCLUSIONS: Discussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.

Protocol for a non-randomised feasibility study evaluating a codesigned patient safety guide in primary care.

INTRODUCTION: Patients and carers should be active partners in patient safety with healthcare professionals and be empowered to use personalised approaches to identify safety concerns and work together to prevent them. This protocol paper details a study to examine the feasibility of a multicomponent intervention to involve patients and/or carers in patient safety in primary care in the UK. METHODS AND ANALYSIS: This is a two-phase, non-randomised feasibility mixed methods pragmatic study of a patient safety guide for primary care (PSG-PC). 8 general practices will recruit 120 patient and/or carer participants. All patient and/or carer participants will receive the PSG-PC. It will examine the feasibility and acceptability of the PSG-PC in primary care settings in patients aged 18 years or older who attend appointments at general practice with health professionals four or more times per year as either patients or carers. It will identify secondary outcomes for improving patient safety, health status and patient empowerment, and reducing health service utilisation over 6 months between baseline and 6-month follow-ups. The findings will inform whether a main effectiveness trial is feasible and, if so, how it should be designed, and how many patients and practices will be needed. The study will be undertaken between January 2020 and September 2021. ETHICS AND DISSEMINATION: Ethical approval was obtained from the National Health Service London-West London and Gene Therapy Advisory Committee Research Ethics Committee (reference: 19/LO/1289). Research findings will be disseminated with participating general practices and shared in a range of different ways to engage different audiences, including presenting at international and national conferences, publishing in open-access, peer-reviewed journals and facilitating dissemination workshops within local communities with patients, carers and healthcare professionals. TRIAL REGISTRATION NUMBER: ISRCTN90222092.

Developing a patient safety guide for primary care: A co-design approach involving patients, carers and clinicians.

BACKGROUND: Patients and carers should be actively involved in patient safety and empowered to use person-centred approaches where they are asked to both identify safety concerns and partner in preventing them. OBJECTIVES: The aim of this study was to co-design a patient safety guide for primary care (PSG-PC) to support patients and carers to address key patient safety questions and identify key points where they can make their care safer. The objectives were to i) identify when and how patients and carers can be involved in primary care patient safety, and ii) identify the relevant information to include in the PSG-PC. DESIGN: An experience-based co-design approach. SETTING AND PARTICIPANTS: We conducted three workshops with patients, carers, community pharmacists and general practitioners to develop and refine the PSG-PC. RESULTS: Participants identified both explicit and implicit issues of primary care patient safety especially relating to technical and relational components of involving patients and carers. The importance of communication, understanding roles and responsibilities, and developing partnerships between patients and health-care providers were considered essential for actively involving patients in patient safety. Co-developing the PSG-PC provided insight to improve care to develop the PSG-PC. DISCUSSION: The PSG-PC is the first guide to be developed for primary care, co-designed with patients, carers, general practitioners and pharmacists. The PSG-PC will support patients and carers to partner with health-care professionals to improve patient safety addressing international and national priorities to continuously improve patient safety.

Respiratory infections in children: an appropriateness study of when parents should home care or seek medical help.

BACKGROUND: Children with respiratory tract infections (RTIs) use more primary care appointments than any other group, but many parents are unsure if, and when, they should seek medical help and report that existing guidance is unclear. AIM: To develop symptom-based criteria to support parental medical help seeking for children with RTIs. DESIGN AND SETTING: A research and development/University of California Los Angeles (RAND/UCLA) appropriateness study to obtain consensus on children's RTI symptoms appropriate for home, primary, or secondary health care in the UK. METHOD: A multidisciplinary panel of 12 healthcare professionals - six GPs, two pharmacists, two NHS 111 nurses, and two emergency paediatric consultants - rated the appropriateness of care setting for 1134 scenarios in children aged >12 months. RESULTS: Panellists agreed that home care would be appropriate for children with ≤1 week of 'normal' infection symptoms (cough, sore throat, ear pain, and/or runny nose, with or without eating adequately and normal conscious level). The presence of ≥2 additional symptoms generally indicated the need for a same-day GP consultation, as did the presence of shortness of breath. Assessment in the emergency department was considered appropriate when ≥3 symptoms were present and included shortness of breath or wheezing. CONCLUSION: The authors have defined the RTI symptoms that parents might regard as 'normal' and therefore suitable for care at home. These results could help parents decide when to home care and when to seek medical help for children with RTIs.

How mHealth can facilitate collaboration in diabetes care: qualitative analysis of co-design workshops.

BACKGROUND: Individuals with diabetes are using mobile health (mHealth) to track their self-management. However, individuals can understand even more about their diabetes by sharing these patient-gathered data (PGD) with health professionals. We conducted experience-based co-design (EBCD) workshops, with the aim of gathering end-users' needs and expectations for a PGD-sharing system. METHODS: N = 15 participants provided feedback about their experiences and needs in diabetes care and expectations for sharing PGD. The first workshop (2017) included patients with Type 2 Diabetes (T2D) (n = 4) and general practitioners (GPs) (n = 3). The second workshop (2018) included patients with Type 1 Diabetes (T1D) (n = 5), diabetes specialists (n = 2) and a nurse. The workshops involved two sessions: separate morning sessions for patients and healthcare providers (HCPs), and afternoon session for all participants. Discussion guides included questions about end-users' perceptions of mHealth and expectations for a data-sharing system. Activities included brainstorming and designing paper-prototypes. Workshops were audio recorded, transcribed and translated from Norwegian to English. An abductive approach to thematic analysis was taken. RESULTS: Emergent themes were mHealth technologies' impacts on end-users, and functionalities of a data-sharing system. Within these themes, similarities and differences between those with T1D and T2D, and between HCPs, were revealed. Patients and providers agreed that HCPs could use PGD to provide more concrete self-management recommendations. Participants' paper-prototypes revealed which data types should be gathered and displayed during consultations, and how this could facilitate shared-decision making. CONCLUSION: The diverse and differentiated results suggests the need for flexible and tailorable systems that allow patients and providers to review summaries, with the option to explore details, and identify an individual's challenges, together. Participants' feedback revealed that both patients and HCPs acknowledge that for mHealth integration to be successful, not only must the technology be validated but feasible changes throughout the healthcare education and practice must be addressed. Only then can both sides be adequately prepared for mHealth data-sharing in diabetes consultations. Subsequently, the design and performance of the joint workshop sessions demonstrated that involving both participant groups together led to efficient and concrete discussions about realistic solutions and limitations of sharing mHealth data in consultations.

Email Consultations Between Patients and Doctors in Primary Care: Content Analysis.

BACKGROUND: Increasingly, consultations in health care settings are conducted remotely using a range of communication technologies. Email allows for 2-way text-based communication, occurring asynchronously. Studies have explored the content and nature of email consultations to understand the use, structure, and function of email consultations. Most previous content analyses of email consultations in primary care settings have been conducted in North America, and these have shown that concerns and assumptions about how email consultations work have not been realized. There has not been a UK-based content analysis of email consultations. OBJECTIVE: This study aims to explore and delineate the content of consultations conducted via email in English general practice by conducting a content analysis of email consultations between general practitioners (GPs) and patients. METHODS: We conducted a content analysis of anonymized email consultations between GPs and patients in 2 general practices in the United Kingdom. We examined the descriptive elements of the correspondence to ascertain when the emails were sent, the number of emails in an email consultation, and the nature of the content. We used a normative approach to analyze the content of the email consultations to explore the use and function of email consultation. RESULTS: We obtained 100 email consultations from 85 patients, which totaled 262 individual emails. Most email users were older than 40 years, and over half of the users were male. The email consultations were mostly short and completed in a few days. Emails were mostly sent and received during the day. The emails were mostly clinical in content rather than administrative and covered a wide range of clinical presentations. There were 3 key themes to the use and function of the email consultations: the role of the GP and email consultation, the transactional nature of an email consultation, and the operationalization of an email consultation. CONCLUSIONS: Most cases where emails are used to have a consultation with a patient in general practice have a shorter consultation, are clinical in nature, and are resolved quickly. GPs approach email consultations using key elements similar to that of the face-to-face consultation; however, using email consultations has the potential to alter the role of the GP, leading them to engage in more administrative tasks than usual. Email consultations were not a replacement for face-to-face consultations.

Seahorse Hotels: Use of artificial habitats to support populations of the endangered White's seahorse Hippocampus whitei.

The provision of temporary, specially designed artificial habitat may help support populations of the Endangered Whites' seahorse Hippocampus whitei in the face of rapid coastal urbanisation and declining natural habitats. Three designs of artificial habitat (Seahorse Hotels) were installed in Port Stephens, New South Wales, Australia, where natural habitats had significantly declined. Mark recapture surveys were used to assess seahorse site fidelity and population parameters, and the effect of Seahorse Hotel design on seahorse abundance, epibiotic growth and mobile epifaunal seahorse prey was determined. The Seahorse Hotels sustained a substantial population of seahorses (64; 57-72 95% confidence intervals) in comparison to recent local population estimates. There were no significant differences in seahorse abundance, mobile epifauna or epibiotic growth among the three different hotel designs. This research demonstrated that H. whitei will inhabit Seahorse Hotels in absence of natural habitat, and additional complexity in these artificial structures was not necessary to support seahorse populations. Temporary structures such as Seahorse Hotels will be a valuable tool in supporting H. whitei and other Syngnathid populations through infrastructure maintenance or habitat modification.

Patient priorities in relation to surgery for gastric cancer: qualitative interviews with gastric cancer surgery patients to inform the development of a core outcome set.

OBJECTIVE: The reporting of outcomes in surgical trials for gastric cancer is inconsistent. The GASTROS study (GAstric Cancer Surgery TRials Reported Outcome Standardisation) aims to address this by developing a core outcome set (COS) for use in all future trials within this field. A COS should reflect the views of all stakeholders, including patients. We undertook a series of interviews to identify outcomes important to patients which would be considered for inclusion in a COS. SETTING: All interviews took place within the UK. Interviews were carried out face-to-face at hospitals and cancer support centres or via the telephone. PARTICIPANTS: Twenty participants at varying stages of recovery following surgery for gastric cancer with curative intent. DESIGN: Qualitative design using semistructured interviews, supported by an interview guide which was iteratively modified; thematic analysis was used to explore patient priorities. RESULTS: Six themes enveloping 38 outcomes were identified; surviving and controlling cancer, technical aspects of surgery, adverse events from surgery, recovering from surgery, long-term problems following surgery and long-term life impact of surgery. The 'most important' patient priority was to be 'cured of cancer'. CONCLUSION: Surgical trials for gastric cancer should consider broader priorities of patients when choosing which outcomes to report. This study highlighted the importance of longer-term outcomes such as cancer survival. Outcomes identified in this study will be used to inform an international Delphi survey to develop a COS in this field.

Kelp beds as coastal protection: wave attenuation of Ecklonia radiata in a shallow coastal bay.

BACKGROUND AND AIMS: Coastal protection from erosion and flooding is a significant ecosystem service provided by vegetated marine systems. Kelp beds are a dominant habitat-forming species on temperate reefs worldwide. While they are valued as hotspots of biodiversity, there is a paucity of information that supports their use in nature-based coastal defence. This includes the effectiveness of kelp beds in attenuating waves approaching the shore and how this influences sediment transport. METHODS: Wave loggers were deployed at paired kelp bed and control (urchin barren) treatments at four sites in Port Phillip Bay, Australia. The significant wave height offshore (exposed side) to onshore (sheltered side) of the treatment were compared to determine wave attenuation. KEY RESULTS: At three sites, the wave attenuation of kelp beds was significantly less than that of the control. This result was consistent across the environmental conditions recorded in this study. At the fourth site, on average there was no significant difference in wave transmission between kelp and control. However, wave attenuation at kelp beds was 10 % greater than the control during periods of northerly winds. We highlight the importance of disentangling the effects of the reef substratum and kelp when evaluating the efficacy of kelp at providing coastal protection. CONCLUSIONS: We have highlighted a significant gap in the research on ecosystem services provided by kelp beds. A greater understanding is needed on which kelp species are able to provide coastal protection, and under what conditions. Such future research is essential for providing managers and policy makers with actionable information on sustainable and cost-effective solutions for coastal defence when faced with a changing climate.