The Importance of Differential Diagnosis in Splenogonadal Fusion: A Case Report.

Splenogonadal fusion is a rare, benign congenital malformation characterized by the association of splenic tissue and gonads (typically testicles). It is a condition of male predominance and can be classified into two types: continuous, if the spleen and gonad are united by a splenic cord or fibrous tissue, or discontinuous. Splenogonadal fusion is often associated with other congenital anomalies such as cryptorchidism, limb defects, and micrognathia. Differential diagnosis can be difficult and includes inguinal hernia, spermatic cord cyst, cryptorchidism, or testicular mass. Due to little knowledge of the pathology, unnecessary orchidectomies are often performed. A previously healthy five-year-old boy was sent to a pediatric surgery appointment due to testicular asymmetry. The physical examination showed a painless, nodular mass adhering to the upper pole of the left testicle, without any palpable inguinal masses. Tumor markers were negative, and a testicular ultrasound with Doppler revealed a mass suggestive of an accessory testicle. Left inguinal surgical exploration revealed the presence of a mass joined by fibrous tissue to the upper pole of the testicle, but no connection to the native spleen was found. Total excision was performed with the testicle's preservation. The anatomopathological analysis revealed morphological aspects compatible with splenic tissue with normal characteristics. The diagnosis of splenogonadal fusion is rare and complex, requires several differential diagnoses, and is often made intraoperatively.The prognosis is excellent as long as there are no associated malformations. A high level of suspicion for this pathology, with recognition of the anatomical structures, can avoid unnecessary orchidectomy.

Bridging the Gap between Field Experiments and Machine Learning: The EC H2020 B-GOOD Project as a Case Study towards Automated Predictive Health Monitoring of Honey Bee Colonies.

Honey bee colonies have great societal and economic importance. The main challenge that beekeepers face is keeping bee colonies healthy under ever-changing environmental conditions. In the past two decades, beekeepers that manage colonies of Western honey bees (Apis mellifera) have become increasingly concerned by the presence of parasites and pathogens affecting the bees, the reduction in pollen and nectar availability, and the colonies' exposure to pesticides, among others. Hence, beekeepers need to know the health condition of their colonies and how to keep them alive and thriving, which creates a need for a new holistic data collection method to harmonize the flow of information from various sources that can be linked at the colony level for different health determinants, such as bee colony, environmental, socioeconomic, and genetic statuses. For this purpose, we have developed and implemented the B-GOOD (Giving Beekeeping Guidance by computational-assisted Decision Making) project as a case study to categorize the colony's health condition and find a Health Status Index (HSI). Using a 3-tier setup guided by work plans and standardized protocols, we have collected data from inside the colonies (amount of brood, disease load, honey harvest, etc.) and from their environment (floral resource availability). Most of the project's data was automatically collected by the BEEP Base Sensor System. This continuous stream of data served as the basis to determine and validate an algorithm to calculate the HSI using machine learning. In this article, we share our insights on this holistic methodology and also highlight the importance of using a standardized data language to increase the compatibility between different current and future studies. We argue that the combined management of big data will be an essential building block in the development of targeted guidance for beekeepers and for the future of sustainable beekeeping.

Utility of Prophylactic Percutaneous Gastrostomy in Patients With Head and Neck Cancer Receiving Concurrent Chemoradiotherapy: A Multicenter Analysis.

INTRODUCTION: Patients with head and neck cancer (HNC) have an elevated incidence of cachexia and malnutrition due to the tumor's location interfering with oral feeding. Concurrent chemoradiation (CCRT) can have an emetic effect and cause dysphagia and oral mucositis. Adequate nutrition improves immunity, raises the response to therapy, reduces adverse effects, and improves survival. Numerous studies have suggested the utility of nutritional support from percutaneous endoscopic gastrostomy (PEG) in HNC patients. Although PEG is usually considered a safe procedure, it has a mortality rate of 0-2.2% and a risk of other procedure-related complications of 17-40%. Our work intends to evaluate the utility of PEG in patients with locally advanced HNC who underwent CCRT. METHODS: We performed a cohort study at three institutions. We included patients with HNC who underwent definitive CCRT treatment from January 2013 to December 2022. The study consisted of an observational, descriptive, retrospective analysis of prespecified clinical data. Descriptive statistics were used to compare the data between the PEG group and the non-PEG group. Analysis of covariance (ANCOVA) was used for covariance analysis. Fisher's exact test was used to compare proportional data and Student's t-test was used to assess the differences in continuous data. Survival analysis was performed using the Kaplan-Meier estimator. P-values of <0.05 were considered to be indicative of statistical significance. The SPSS Statistics version 28.0 (Armonk, NY: IBM Corp.) was used to perform all statistical evaluations. RESULTS:  We identified 90 eligible patients diagnosed with local advanced HNC who had received definitive CCRT with three weekly cycles of cisplatin as follows: 44 with a prophylactic PEG tube and 46 without a prophylactic PEG tube. Most patients were male (84.4%) and 50% of patients were diagnosed with stage IVa HNC at the time of diagnosis. There wasn't an effect of PEG placement on BMI at the end of CCRT after controlling for the effect of baseline BMI (F {1.84}=0.065 {p=0.799}). In the study population, BMI was significantly lower after CCRT (21.30 kg/m2 vs. 23.97 kg/m2), t (86)=12.389, p<0.001. In the subgroup with baseline BMI <18.5 kg/m2 (15 patients), 90% of patients with prophylactic PEG were able to complete the three planned cycles of chemotherapy vs. 66.7% in the non-PEG group. Ten patients in the PEG group (22.7%) referred feeding tube dependency. Patients with dysphagia were 3.2 times more likely to have placed prophylactic PEG (p=0.007). The difference in overall survival and progression-free survival between the two groups was not statistically significant (p=0.57 and p=0.497, respectively). CONCLUSION: In this study using real-world data, we found a potentially protective effect of PEG in underweight patients with locally advanced HNC performing CCRT in order to complete three cycles of treatment.

Massive blood loss from urethrorrhage in a 16-year-old boy: Case report and review of two rare causes.

Urethral varices and hemangiomas are rare, underreported conditions that can be asymptomatic or present with intermittent urethrorrhage that can start or worsen with erection, sexual intercourse and ejaculation. Diagnosis can be made with urethroscopy and there are a wide variety of possible treatments that can suit both conditions. We present a case of a pediatric patient with severe blood loss from urethral varices that was treated with electrofulguration after laser treatment with Holmium failed.

Beekeeping in Europe facing climate change: A mixed methods study on perceived impacts and the need to adapt according to stakeholders and beekeepers.

The beekeeping sector is suffering from the detrimental effects of climate change, both directly and indirectly. Despite numerous studies conducted on this subject, large-scale research incorporating stakeholders' and beekeepers' perspectives has remained elusive. This study aims to bridge this gap by assessing the extent to which stakeholders involved in the European beekeeping sector and European beekeepers perceive and experience the impacts of climate change on their operations, and whether they had to adapt their practices accordingly. To this end, a mixed-methods study including in-depth stakeholder interviews (n = 41) and a pan-European beekeeper survey (n = 844) was completed within the frame of the EU-funded H2020-project B-GOOD. The development of the beekeeper survey was informed by insights from literature and the stakeholder interviews. The results highlighted significant regional disparities in the perceived impacts of climate change, with beekeepers in Southern European regions expressing more negative outlooks, while Northern European beekeepers reported more favourable experiences. Furthermore, survey analysis revealed beekeepers who were classified as 'heavily impacted' by climate change. These beekeepers reported lower average honey yields, higher colony winter loss rates and a stronger perceived contribution of honey bees to pollination and biodiversity, underscoring climate change's detrimental impacts on the beekeeping sector. Multinomial logistic regression revealed determinants of the likelihood of beekeepers being classified as 'heavily impacted' by climate change. This analysis indicates that Southern European beekeepers experienced a 10-fold likelihood of being classified as heavily impacted by climate change compared to Northern European beekeepers. Other significant factors distinguishing 'winners' and 'losers' were self-reported level of professionalism as a beekeeper (ranging from pure hobbyist to fully professional, Odds Ratio (OR) = 1.31), number of years active in beekeeping (OR = 1.02), availability of floral resources throughout the bee season (OR = 0.78), beehives located in a forested environment (OR = 1.34), and the presence of local policy measures addressing climate change-related challenges (OR = 0.76).

Recurrent giant neobladder calculus extrusion after bladder exstrophy repair.

Introduction: Patients with bladder exstrophy subjected to reconstructive surgeries are at risk of developing urinary calculus. Case presentation: We report the case of a 29-year-old male patient with bladder exstrophy who presented with a recurrent episode of extrusion of calculus through the neobladder and anterior abdominal wall. Calculus removal and reconstructive repair of the neobladder and abdominal wall were performed in 2010. Nine years following the procedure, the patient returned with new large neobladder calculus extrusion. Conclusion: Recurrence of large calculus should be seen as the new paradigm for the importance of close follow-up in bladder exstrophy patients.

Fetal Megacystis in the first trimester: Comparing management and outcomes between longitudinal bladder length groups.

Fetal megacystis is a sonographic sign, defined in first trimester as a longitudinal bladder length (LBD)>7 mm. Different causes may be associated with megacystis and outcomes vary with many factors. There are no international guidelines on how to manage megacystis cases, and invasive testing is controversial when no other abnormalities are found. The main objective of this study is to compare etiologies, management and outcomes of fetuses with first trimester megacystis, specifically between groups of LBD≤15 mm and >15 mm. This is a retrospective cohort study of megacystis cases managed in a Prenatal Diagnosis Center, between January 2009 and September 2020. Descriptive and bivariate analysis were performed. We studied 43 fetuses: 67.4% with LBD≤15 mm and 32.6% with LBD>15 mm. We found an association between LBD and isolated Low Urinary Tract Obstruction (LUTO) (3.4% vs 64.3%; p<0.001) and with isolated megacystis (44.8% vs 0.0%; p = 0.001). No differences were seen regarding the presence of aneuploidies (31.0% vs 14.3%; p = 0.213). Invasive testing was performed in 93.0% of cases. Overall, we report 41.9% of live births, 39.5% of pregnancy termination and 18.6% of intrauterine fetal demise. We found a higher rate of live births in fetuses with LBD≤15 mm (55.2% vs 14.3%; p = 0.011). For a mean follow-up time of 20.6 months, we report one neonatal death and one case of renal insufficiency. In conclusion, isolated LUTO is more frequent if LBD>15 mm whereas isolated megacystis is more frequently found if LBD≤15 mm. If LBD≤15 mm, live birth rates and long-term outcomes seem to be enhanced.

Impact of Human Epidermal Growth Factor Receptor 2 (HER2) Low Status in Response to Neoadjuvant Chemotherapy in Early Breast Cancer.

Introduction In clinical practice, there is a binary distinction between human epidermal growth factor receptor 2 (HER2)-positive and HER2-negative (HER2-) breast cancer (BC). However, within HER2- disease, there is significant heterogeneity. Particularly, HER2- tumors that express some level of HER2 by immunohistochemistry (IHC) score 1+ or 2+/in situ hybridization (ISH) non-amplified are currently defined as HER2-low. This subgroup has shown distinct biological features compared to HER2-zero (HER2-0) BC and additionally novel antibody-drug conjugate therapies have demonstrated a potential and promising activity in HER2-low BC population. This study aims to evaluate the impact of HER2-low status in response to neoadjuvant chemotherapy (NACT) in HER2- BC being HER2-low and HER2-0 status. Materials and methods In a single institution, we retrospectively reviewed clinical and pathological data of HER2 early-stage BC patients treated with NACT following definitive surgery from January 2015 to December 2020. Tumors with HER2 IHC 0 were classified as HER2-0 and IHC score 1+ and 2+/ISH non-amplified as HER2-low. The primary objective was to evaluate the rate of pathological complete response (pCR) using the definition of ypT0/Tis ypN0 according to HER2-low and HER2-0 subgroups. Secondary objectives were to evaluate biological features between the two subgroups, disease-free survival (DFS), and overall survival (OS). Pearson chi-square, Fisher's exact, and Mann-Whitney tests were performed. The Kaplan-Meier method was used to plot DFS and OS curves. A p-value of <0.05 was considered statistically significant. Results A total of 72 patients with HER2 BC were included with a median age at diagnosis of 52.5 years and a median follow-up time of 35.5 months. Of patients, 56.9% had HER2-low disease and 43.1% had HER2-0 disease. Significant differences between the two subgroups were detected regarding hormonal receptor status and proliferation grade (Ki67). In the HER2-low subgroup, 70% of tumors were luminal-like and 64.5% of HER2-0 patients had triple-negative BC (p = 0.03). There were statistically significant differences regarding estrogen (p = 0.00) and progesterone (p = 0.02) receptors. The median Ki67 rate was higher in the HER2-0 subset (mean rank = 43.9) compared to HER2-low (mean rank = 30.9) and this difference was statistically significant (p = 0.00). HER2-low patients presented more stage III tumors (65.9%) and HER2-0 patients were mainly stage II (61.3%), and this was statistically relevant (p = 0.03). The prevalence of other clinical and pathological features was comparable between both groups. HER2-low subgroup achieved lower pCR rates (14.6% vs. 29.0%) but this difference was not statistically significant (p = 0.15). Similarly, there was no difference between the two subgroups regarding DFS (p = 0.97) and OS (p = 0.35), although the data were immature. Conclusion As in prior studies, this study did not support a significant impact of HER2-low status on response to NACT in HER2- patients with early-stage BC. HER2-low patients had a lower pCR, which may suggest a worse response to classic chemotherapy regimen and may have clinical implications that should be further exploited. The prevalence of hormonal receptors in HER2-low tumors was consistent with previous data in the literature. Although retrospective, the data suggest that HER2-low tumors should be regarded as a distinct biological subtype and more research is warranted.

Prognostic Impact of Baseline Neutrophil-to-Eosinophil Ratio in Patients With Metastatic Renal Cell Carcinoma Treated With Nivolumab Therapy in Second or Later Lines.

Background Inflammation is a crucial component in carcinogenesis. The neutrophil-to-eosinophil ratio (NER) has been studied as a biomarker of prognosis and predictive of response in metastatic renal cell carcinoma (mRCC). In the present study, we evaluated the relevance of baseline NER on the progression-free survival (PFS) and overall survival (OS) outcomes in real-world patients with mRCC treated with nivolumab in second or subsequent lines. We also assessed the association of baseline NER with objective response, as well as with toxicity and histology. Methods In this multicenter retrospective analysis of patients with mRCC treated with nivolumab, the last systemic absolute neutrophil and eosinophil count before treatment with nivolumab was used to calculate the NER. An additive Cox proportional hazards model was used to identify the cut-off point for NER considering PFS and the patients were allocated into low and high NER groups. Median OS and median PFS were estimated using the Kaplan-Meier estimator, and survival curves of groups were compared using the log-rank test. Univariable and multivariable Cox regression models were used to study OS and PFS and Fisher's exact test was performed to evaluate the association of NER with the response, toxicity, and histology. Results The 49 analyzed patients had a median follow-up of nine months. The NER cut-off was established at 48, locating 29 patients in the low NER group (NER < 48) and 20 in the high NER group (NER ≥ 48). Median PFS and median OS were significantly shorter in patients with high NER versus low NER (3 vs. 30 months (p < 0.001) and 6 vs. 24 months (p = 0.002), respectively). Multivariable analyses showed that NER (HR 3.92 (95% CI: 1.66-9.23), p = 0.002) was an independent factor for PFS and that NER (HR 3.85 (95% CI: 1.33-11.17), p = 0.013) and progressive disease (HR 5.62 (95% CI: 1.88-16.83), p = 0.002) were independent factors for OS. NER was significantly associated with objective response rate (ORR) (NER ≥ 48-12.5% vs. NER < 48-87.5%, p = 0.003), immune-related adverse events (irAEs) (NER ≥ 48-10.0% vs. NER < 48-42.9%, p = 0.014), and tumor's histology as patients of high NER group had more non-clear cell carcinoma than low NER group (35.0% vs. 7.4%, p = 0.017). Conclusion Our real-world data analysis of NER in patients with mRCC confirmed the prognostic value of this biomarker, supporting clinical utility in predicting survival. Results also suggested an association between lower NER and better ORR, and that irAEs occur more frequently in patients with a lower NER. However, further large-scale prospective studies are needed to confirm these findings and to validate this biomarker.

Cutaneous and Cerebral Metastases From Primary Peritoneal Clear Cell Carcinoma.

Peritoneal tumors are very uncommon and among them, primary peritoneal clear cell carcinoma is extremely rare and often misdiagnosed as others subtypes. There are only 13 cases of primary peritoneal clear cell carcinoma previously reported in the literature and there are no reports about cutaneous metastasis in this setting and only brain metastases were described to be associated with other primary peritoneal carcinoma subtypes. More information about this topic is needed and so we are presenting a new case of primary peritoneal clear cell carcinoma with cutaneous and cerebral metastases in a 34-year-old female.

Data about marine area-based management tools to assess their contribution to the UN sustainable development goals.

The dataset presented in this article contains information about marine Area-Based Management Tools (ABMTs) used to assess their contribution to the United Nations 2030 Sustainable Development Goals. Following the scope of the analysis, ABMTs were identified by scrutinizing international and regional legal sources related to ocean management in the fields of marine conservation, fisheries, deep sea bed mining, underwater natural and cultural heritage, environmental conservation, and marine spatial planning. Legal sources were screened to depict the following characteristics of individual ABMTs: i) management objectives; ii) authorities responsible for delivering such objectives; iii) the system of management and planning entailed in the ABMT including the zoning type; and iv) the specific spatial scope and domain each ABMT refer to in vertical depth and horizontal domain. Data were generated through an internal expert elicitation. Experts, initially trained in the data analysis and related protocol, contributed to the data production because of their specific knowledge and experience in ocean management. This dataset represents a unique source of information for advancing research about monitoring and assessment of the achievement of sustainable development goals that encompasses different types of ABMTs.

The Nutritional Content of Rescued Food Conveyed by a Food Aid Organization.

BACKGROUND: The number of food-insecure families in the European Union has increased, resulting in an increasing number of households depending on food assistance programs. The aim in this study was to evaluate the nutrient content of food rescued by a food aid organization that rescues and redistributes fresh or freshly cooked food to low-income households. METHODS: To determine the nutritional content of food hampers provided by our case study organization, we weighed all items of food hampers in three weighing rounds over a period of four months. The Food Insecurity Experience Scale (FIES) was applied to measure households' food insecurity. RESULTS: Our results show that, at our case study food aid organization, food donations substantially contribute to energy, macro, and micronutrient dietary recommendation intake (DRI). CONCLUSIONS: When evaluating how these nutrients contribute to alleviating food insecurity of the beneficiary households, we found that the perception of food insecurity is independent of the amount of nutrients served. To the best of our knowledge, this is the first study measuring the nutritional content of fresh or freshly cooked rescued food conveyed by a food aid organization.

The impacts of the early outset of the COVID-19 pandemic on climate change research: Implications for policy-making.

Since January 2020, the COVID-19 pandemic has dominated the media and exercises pressure on governments worldwide. Apart from its effects on economies, education systems and societies, the pandemic has also influenced climate change research. This paper examines the extent to which COVID-19 has influenced climate change research worldwide during the first wave at the beginning of 2020 and how it is perceived to exploit it in the future. This study utilised an international survey involving those dedicated to climate change science and management research from Academia, Government, NGOs, and international agencies in 83 countries. The analysis of responses encompasses four independent variables: Institutions, Regions, Scientific Areas, and the level of economic development represented by the Human Development Index (HDI). Results show that: (1) COVID-19 modified the way the surveyed researchers work, (2) there are indicators that COVID-19 has already influenced the direction of climate change and adaptation policy implementation, and (3) respondents perceived (explicitly concerning the COVID-19 lockdowns of March-April 2020), that the pandemic has drawn attention away from climate policy. COVID- 19 has influenced the agenda of climate change research for more than half of the respondents and is likely to continue in the future, suggesting that the impacts on their research will still be felt for many years. The paper concludes by outlining critical implications for policy-making.

From Theory to Practice: Bone Health in Women with Early Breast Cancer Treated with Aromatase Inhibitors.

Aromatase inhibitors (AI) are extensively used as adjuvant endocrine therapy in post-menopausal women with hormone receptor-positive early breast cancer (HR+ EBC), but their impact on bone health is not negligible. This work aimed to assess bone loss, fracture incidence, and risk factors associated with these events, as well as the prognostic influence of fractures. We have conducted a retrospective cohort study of women with HR+ EBC under adjuvant therapy with AI, during a 3-year period. Four-hundred-and-fifty-one eligible women were reviewed (median age 68 years). Median time under AI was 40 months. A fracture event occurred in 8.4%, mostly in the radium and femoral neck and in older women (mean 74 vs. 68 years, p = 0.006). Age (OR 1.01, 95% CI 1.01-1.07, p = 0.024) and time under AI (OR 1.02, 95% CI 1.00-1.04, p = 0.037) were independent predictors of fracture, with a fair discrimination (AUC 0.71). Analysis of disease-free survival according to fracture event varied between groups, disfavoring the fracture cohort (at 73 months, survival 78.6%, 95% CI, 47.6-92.4 vs. 95.6%, 95% CI, 91.2-97.8, p = 0.027). The multivariate model confirmed the prognostic impact of fracture occurrence (adjusted HR of 3.17, 95% CI 1.10-9.11; p = 0.032). Bone health is often forgotten, despite its great impact in survivorship. Our results validate the pathophysiologic link between EBC and bone metabolism, which translates into EBC recurrence. Further research in this area may help refine these findings. Moreover, early identification of women at higher risk for fractures is warranted.

Liquid Biopsies in Progressing Metastatic Colorectal Cancer- Application and their Therapeutic Implications According to the RAS Status.

Introduction The treatment of metastatic colorectal cancer (mCRC) now includes therapy with biological agents inthe first line of treatment. The advances of our knowledge in molecular biology of these tumors allowed the identification of signaling pathways involved in tumorigenesis as potential therapeutic targets. In this field, monoclonal antibodies against epidermal growth factor receptor (anti-EGFR) added to a chemotherapy doublet have demonstrated improved overall survival for these patients. However, mutations in oncogenes NRAS/KRAS are predictive of absence of response to these treatments. Therefore, genotyping in mCRC is essential to personalized treatment. It is known that tumoral heterogeneity and selective pression by targeted therapies can lead to changes in RAS mutational status, along the course of the disease. This opens the possibility of different targeted therapies. Tumor analysis through liquid biopsies allows for the detection of genetic alterations in a less invasive way than common solid tumor biopsy and is currently being validated in different settings, with promising results in mCRC. The main goal of this study was to assess therapeutic implications of Liquid Biopsy (LB) in treatment of progressive mCRC and its potential impact on survival.  Material and methods A retrospective, observational, unicentric study of patients diagnosed with progressive mCRC and who underwent LB after several lines of treatment, was performed. Analysis of patient and tumor characteristics, as well as LB results was performed with descriptive statistics and survival analysis according to Kaplan-Meier methods and COX analysis with STATA/IC software.  Results We included 18 patients on whom LB were performed (median age 61 years; 55% (n=10) men). The median follow-up was 37.4 months. At diagnosis, 12 patients had a KRAS mutation. In the LB reassessment, there was a change in the RAS status in six patients, who initially had a mutation and later showed KRASwt (wild type RAS). LB led to a change in the therapeutic plan in these six patients, allowing the use of anti-EGFR therapy. Progression Free Survival (PFS) and Overall Survival (OS) could not be calculated at this time. Conclusion LB can revolutionize the approach to mCRC by optimizing therapeutic sequencing in a continuum of care strategy. The search for genetic changes over the course of the disease allows a better therapeutic approach to each patient. In the study presented, the realization of LB allowed an increase in therapeutic options in 1/3 of the patients. It is important to continue these studies with larger samples in order to better validate this strategy.

Mapping the future: Pressures and impacts in the Portuguese maritime spatial planning.

Maritime Spatial Planning (MSP) is bringing new challenges to planning and management in the marine realm, namely on the environmental assessment of the new plans and projects. Portugal is developing its first MSP instrument, PSOEM (Plano de Situação do Ordenamento do Espaço Marítimo), since 2015 and published it on December 2019. This paper focuses on a particular stage of the Strategic Environmental Assessment (SEA) of PSOEM regarding the assessment of the activities/uses that may significantly affect Natura 2000 marine network during the Plan's implementation in the Mainland subdivision. Over the years, progress has been made in researching and assessing the environmental impacts of maritime activities/uses. However, its application to practice raised several challenges and limitations. The methodological approach presented in this paper was developed to overcome knowledge, data and time constraints. Some of the limitations are a consequence of the MSP approach itself adopted in Portugal, namely the low technical detail on future uses and activities, which is required and desirable at this level of planning. Others relate with the lack of spatially explicit data on marine habitats and species distribution preserved under Natura 2000 network, which is not fully established in the marine environment. The adopted methodology started with the characterization and mapping of the conservation values and the pressures arising from the potential activities/uses. It followed with the assessment of their impacts and finally with the identification of mitigation measures, which were then adopted by the PSOEM as good practices. As new knowledge is generated and more information is collected, this tailor-made approach can be easily adapted and improved to keep supporting decision-making throughout PSOEM's implementation. The method can be easily adapted and transferred to other contexts, not only within the Portuguese maritime area, and could be made available to stakeholders that wish to invest in blue growth.

Marine Spatial Planning in the Benguela Current Large Marine Ecosystem.

The Benguela Current Large Marine Ecosystem (BCLME) in the south-east Atlantic covers the territorial waters and Exclusive Economic Zones (EEZ's) of Angola and Namibia and partly of South Africa. Increasing demands, user-user and user-environment conflicts occur throughout the area. The three countries, which are parties to the Benguela Current Convention (BCC), have begun to implement Marine Spatial Planning (MSP) to support the sustainable development of the area and enhance ocean governance. This makes the region one of the first in a developing economies context and on the African continent to introduce MSP. The article (1) traces the origin of MSP in the region and describes the reasons for its development, (2) reviews the status of MSP processes to date at the regional and national level, and (3) reflects on the regional and individual country processes in terms of differences and similarities in approach and process governance, shared opportunities and difficulties. The study finds that MSP in the region is introduced because of both strong interests to use it as a means to help grow the blue/ocean economy and as a mechanism to further the implementation of the ecosystem approach. Similar steps have been taken so far and alike approaches to MSP exist across the three countries, with the BCC as regional convention facilitating knowledge sharing and assisting to improve cross-border coherence and consistency on MSP from the outset. Although challenges, such as limited finances and data gaps exist both at national and regional level, the MSP processes to-date have created an enabling environment to develop the first marine spatial plans in each country and to exchange knowledge and experiences within the region and with other regions.

Against the Environment. Problems in Society/Nature Relations.

The dominant manners in which environmental issues have been framed by sociology are deeply problematic. Environmental sociology is still firmly rooted in the Cartesian separation of Society and Nature. This separation is one of the epistemic foundations of Western modernity-one which is inextricably linked to its capitalist, colonial, and patriarchal dimensions. This societal model reifies both humanity and nature as entities that exist in an undeniably anthropocentric cosmos in which the former is the only true actor. Anthropos makes himself and the world around him. He conquers, masters, and appropriates the non-human, turning it into the mere environment of his existence, there solely for his use. If sociology remains trapped in this paradigm it continues to be blind to the multiple space-time specific interrelations of life-elements through which heterogeneous and contingent ontologies of humans and extra-humans are enacted. If these processes of interconnection are not given due attention, the socioecological worlds in which we-human as well as others-live cannot be adequately understood. But misunderstandings are not the only issue at stake. When dealing with life-or-death phenomena such as climate change, to remain trapped inside the Society/Nature divide is to be fundamentally unable to contribute to world reenactments that do not oppress-or, potentially, extinguish-life, both human and extra-human. From the inside of Anthropos' relation to his environment the only way of conceiving current socioecological problems is by framing them in terms of an environmental crisis which could, hypothetically, be solved by the very same societal model that created it. But if the transformation of some of the world(s)' life-elements into the environment of the Human is part of the problem, then, socioecological issues cannot be adequately understood or addressed if they are framed as an environmental crisis. Instead, these problems need to be conceived as a crisis of Western modernity itself and of the kind of worlds that are possible and impossible to build within it.

Psychosocial drivers for change: Understanding and promoting stakeholder engagement in local adaptation to climate change in three European Mediterranean case studies.

Stakeholder engagement in the processes of planning local adaptation to climate change faces many challenges. The goal of this work was to explore whether or not the intention of engaging could be understood (Study 1) and promoted (Study 2), by using an extension of the theory of planned behaviour. In Study 1, stakeholders from three European Mediterranean case studies were surveyed: Baixo Vouga Lagunar (Portugal), SCOT Provence Méditerranée (France), and the island of Crete (Greece) (N = 115). Stakeholders' intention of engaging was significantly predicted by subjective norm (which was predicted by injunctive normative beliefs towards policy-makers and stakeholders) and by perceived behavioural control (which was predicted by knowledge of policy and instruments). Study 2 was conducted in the Baixo Vouga Lagunar case study and consisted of a two-workshop intervention where issues on local and regional adaptation, policies, and engagement were presented and discussed. A within-participants comparison of initial survey results with results following the workshops (NT1 = 12, NT2 = 15, NT3 = 12) indicated that these were successful in increasing stakeholders' intention of engaging. This increase was paired with a) an increase in injunctive normative beliefs towards policy-makers and consequently in subjective norm, and to b) a decrease in perceived complexity of planning local adaptation and an increase in knowledge regarding adaptation to climate change.