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Purpose: Acute heart failure (AHF) causes high burden of mortality, morbidity, and repeated hospitalizations worldwide. This guidance paper describes the tailored treatment approaches of different clinical scenarios of AHF and CS, focusing on the needs of professionals working in intensive care settings.Results: Tissue congestion and hypoperfusion are the two leading mechanisms of end-organ injury and dysfunction, which are associated with worse outcome in AHF. Diagnosis of AHF is based on clinical assessment, measurement of natriuretic peptides, and imaging modalities. Simultaneously, emphasis should be given in rapidly identifying the underlying trigger of AHF and assessing severity of AHF, as well as in recognizing end-organ injuries. Early initiation of effective treatment is associated with superior outcomes. Oxygen, diuretics, and vasodilators are the key therapies for the initial treatment of AHF. In case of respiratory distress, non-invasive ventilation with pressure support should be promptly started. In patients with severe forms of AHF with cardiogenic shock (CS), inotropes are recommended to achieve hemodynamic stability and restore tissue perfusion. In refractory CS, when hemodynamic stabilization is not achieved, the use of mechanical support with assist devices should be considered early, before the development of irreversible end-organ injuries.Conclusion: A multidisciplinary approach along the entire patient journey from pre-hospital care to hospital discharge is needed to ensure early recognition, risk stratification, and the benefit of available therapies. Medical management should be planned according to the underlying mechanisms of various clinical scenarios of AHF. [ABSTRACT FROM AUTHOR]

Owing to the collapse of several groundfish stocks in the Scotia–Fundy area of Atlantic Canada, the fisheries-management system has been critically reviewed and changes introduced. A fisheries-management model with eight components was used to structure the recommendations for change. The components are strategic planning, annual planning, fishing entitlements, catch and effort monitoring, enforcement, service delivery, socio-economic analysis, and resource analysis. For each component, a brief synopsis of the major problems identified during the review is provided, and subsequent changes (1995–1998) to address problems are summarized. In spite of unclear and conflicting objectives, the conservation objectives under a rebuilding strategy are generally being met for the open fisheries, at least recently. This is a direct result of improvements in the overall management system. By transferring responsibilities for several aspects of management to the fishing industry, there has been a reduction in institutional uncertainty. Introduction of a combination of enterprise allocations, individual transferable quotas and community quotas has permitted a reduction of fishing capacity without government assistance. However, the reduction in participation level in the open groundfish fisheries has led to social unrest as some participants received small quota shares. For fisheries that have been closed since 1993, little progress has been made in improving the management system. The resource base is not recovering owing to continued levels of poor recruitment, and there is a lack of scientific consensus on the relative contributions of fishing and ecosystem changes to the poor recruitment observed during the past decade. The groundfish fisheries-management system of the Scotia–Fundy area provides an interesting case history on the degree to which conservation objectives can be achieved despite considerable institutional and ecosystem uncertainty. [ABSTRACT FROM PUBLISHER]