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Reassembling ecological communities and rebuilding habitats through active restoration treatments require curating the selection of plant species to use in seeding and planting mixes. Ideally, these mixes should be assembled based on attributes that support ecosystem function and services, promote plant and animal species interactions and ecological networks in restoration while balancing project constraints. Despite these critical considerations, it is common for species mixes to be selected opportunistically. Reframing the selection of seed mixes for restoration around ecological objectives is essential for success but accessible methods and tools are needed to support this effort. We developed a framework to optimize species seed mixes based on prioritizing plant species attributes to best support different objectives for ecosystem functions, services and trophic relationships such as pollination, seed dispersal and herbivory. We compared results to approaches where plant species are selected to represent plant taxonomic richness, dominant species and at random. We tested our framework in European alpine grasslands by identifying 176 plant species characteristic of the species pool, and identified 163 associated attributes affiliated to trophic relationships, ecosystem functions and services. In all cases, trophic relationships, ecosystem functions and services can be captured more efficiently through objective-based prioritization using the functional identity of plant species. Solutions (plant species lists) can be compared quantitatively, in terms of costs, species or objectives. We confirm that a random draw of plant species from the regional plant species pool cannot be assumed to support other trophic groups and ecosystem functions and services. Synthesis and Applications. Our framework is presented as a proof-of-concept to help restoration practitioners better apply quantitative decision support to plant species selection to efficiently meet ecological restoration outcomes. Our approach may be tailored to any restoration initiative, habitat or restoration targets where seeding or planting mixes will be applied in active treatments. As global priority and resources are increasingly placed into restoration, this approach could be advanced to help make efficient decisions for many stages of the restoration process.

The ocean contains unique biodiversity, provides valuable food resources and is a major sink for anthropogenic carbon. Marine protected areas (MPAs) are an effective tool for restoring ocean biodiversity and ecosystem services1,2, but at present only 2.7% of the ocean is highly protected3. This low level of ocean protection is due largely to conflicts with fisheries and other extractive uses. To address this issue, here we developed a conservation planning framework to prioritize highly protected MPAs in places that would result in multiple benefits today and in the future. We find that a substantial increase in ocean protection could have triple benefits, by protecting biodiversity, boosting the yield of fisheries and securing marine carbon stocks that are at risk from human activities. Our results show that most coastal nations contain priority areas that can contribute substantially to achieving these three objectives of biodiversity protection, food provision and carbon storage. A globally coordinated effort could be nearly twice as efficient as uncoordinated, national-level conservation planning. Our flexible prioritization framework could help to inform both national marine spatial plans4 and global targets for marine conservation, food security and climate action. Using a globally coordinated strategic conservation framework to plan an increase in ocean protection through marine protected areas can yield benefits for biodiversity, food provisioning and carbon storage.

Incentivized debt conversion is a financing mechanism that can assist countries with a heavy debt burden to bolster their long‐term domestic investment in nature conservation. The Nature Conservancy, an international conservation‐based nongovernmental organization, is adapting debt conversions to support marine conservation efforts by small island developing states and coastal countries. Prioritizing debt conversion opportunities according to their potential return on investment can increase the impact and effectiveness of this finance mechanism. We developed guidance on how to do so with a decision‐support approach that relies on a novel threat‐based adaptation of cost‐effectiveness analysis. We constructed scenarios by varying parameters of the approach, including enabling conditions, expected benefits, and threat classifications. Incorporating both abatable and unabatable threats affected priorities across planning scenarios. Similarly, differences in scenario construction resulted in unique solution sets for top priorities. We show how environmental organizations, private entities, and investment banks can adopt structured prioritization frameworks for making decisions about conservation finance investments, such as debt conversions. Our guidance can accommodate a suite of social, ecological, and economic considerations, making the approach broadly applicable to other conservation finance mechanisms or investment strategies that seek to establish a transparent process for return‐on‐investment decision‐making., Article Impact Statement: Prioritizations that explicitly incorporate abatable and unabatable threats can improve conservation return on investment decision‐making.

1. Globally, protected areas are being established to protect biodiversity and to promote ecosystem resilience. The typical spatial conservation planning process leading to the creation of these protected areas focuses on representation and replication of ecological features, often using decision support tools such as Marxan. Yet, despite the important role ecological connectivity has in metapopulation persistence and resilience, Marxan currently requires manual input or specialized scripts to explicitly consider connectivity. 2. ‘Marxan Connect’ is a new open source, open access Graphical User Interface (GUI) tool designed to assist conservation planners with the appropriate use of data on ecological connectivity in protected area network planning. 3. Marxan Connect can facilitate the use of estimates of demographic connectivity (e.g. derived from animal tracking data, dispersal models, or genetic tools) or structural landscape connectivity (e.g. isolation by resistance). This is accomplished by calculating metapopulation‐relevant connectivity metrics (e.g. eigenvector centrality) and treating those as conservation features or by including the connectivity data as a spatial dependency amongst sites in the prioritization process. 4. Marxan Connect allows a wide group of users to incorporate directional ecological connectivity into conservation planning with Marxan. The solutions provided by Marxan Connect, combined with ecologically relevant post‐hoc testing, are more likely to support persistent and resilient metapopulations (e.g. fish stocks) and provide better protection for biodiversity.

BackgroundInterventions to modify school environments are effective in promoting young people’s health across outcomes, but mechanisms are poorly understood. We assessed mediation in a trial of the Learning Together intervention, building on the recent publication of results of effectiveness for reducing bullying and benefits across secondary outcomes and generally good implementation fidelity.MethodsWithin a cluster-randomised trial involving 40 English schools, we examined student-reported and staff-reported school climate and student-reported involvement with delinquent peers at 24-month and 36-month follow-up, assessing the reliability of measures and whether these mediated health outcomes at a final follow-up.ResultsResponse rates and reliability were good for student-reported but not staff-reported measures. The intervention increased student-reported but not staff-reported-positive school climate but, like effects on student health outcomes, these manifested only at a final follow-up. The intervention reduced student-reported contact with delinquent peers at an interim follow-up. Student-reported potential mediators measured at the interim follow-up were associated with most health outcomes at the final follow-up. Adjustment for student-reported school climate and contact with delinquent peers at the interim follow-up did not reduce the associations between trial arm and our health outcomes.ConclusionDespite being constrained by imperfect measures and by the late manifestation of impacts on student-reported school climate undermining ability to assess mediation, our study for the first time provides tentative evidence that mediation of intervention effects via improved climate and disengagement from delinquent peers is plausible. Our study provides the first evidence from a trial that whole-school interventions may work by modifying school environments and student relationships.Trial registration numberISRCTN10751359.

Aquaculture is the fastest growing food production industry in the world yet research and guidance demonstrating strategic multi-objective zoning for sector expansion is scarce. Quantifying and mitigating conflicts and impact on sensitive coastal environments through jointly-optimized objectives for aquaculture and biodiversity simultaneously has not been tested yet. We here develop and evaluate six alternative planning scenarios for one of the European Union’s highest priority mussel aquaculture areas, the Emilia-Romagna Region in Italy. We i) develop an aquaculture profitability surface as a function of the distance from main ports, and in parallel build a fine-scale aquaculture suitability distribution surface for important commercial species using multi-criteria analysis; ii) prioritize protected areas for biodiversity while testing how different considerations of human impacts influence priorities; iii) simultaneously plan for aquaculture and biodiversity while minimizing impacts on other maritime activities. We compare results from different scenarios according to how well they capture suitable aquaculture habitats and minimize impacts. We introduce a new evaluation method for scenario comparison in spatial optimization using a nearest-neighbour analysis for spatial pattern similarities. Lastly, we test the “value of information” provided by our investment in developing the fine-scale suitability surface to improve efficiencies. We find that an integrated multi-objective zoning approach, which simultaneously optimizes for biodiversity and aquaculture, supports more efficient planning than traditional sector specific growth strategies. We also discovered that the fine-scale suitability model delivered an 8% more efficient solution than the simple distance function, highlighting the role of proxy surfaces and diminished returns from investing in comprehensive habitat suitability analysis in regions without much variation in key parameters. We offer evidence of improved efficiency and practical guidance for integrated planning in Blue Growth agendas. Our analysis can be applied in any context where multiple objectives occur for aquaculture sector growth and biodiversity conservation., This is a preprint (pre-peer reviewed) version of the following paper: "Chiara Venier, Stefano Menegon, Hugh P. Possingham, Elena Gissi, Andrea Zanella, Daniel Depellegrin, Alessandro Sarretta, Andrea Barbanti, Jennifer McGowan, Multi-objective zoning for aquaculture and biodiversity", in Science of the Total Environment, Volume 785 (2021) 146997 https://doi.org/10.1016/j.scitotenv.2021.146997.

Reassembling ecological communities and rebuilding habitats through active restoration treatments requires curating the selection of plant species to use in seeding and planting mixes. Ideally, these mixes should be assembled based on attributes that support ecosystem function and services, promote plant and animal species interactions and ecological networks in restoration while balancing project constraints. Despite these critical considerations, it is common for species mixes to be selected opportunistically. Reframing the selection of seed mixes for restoration around ecological objectives is essential for success but accessible methods and tools are needed to support this effort.We developed a framework to optimize species seed mixes based on prioritizing plant species attributes to best support different objectives for ecosystem functions, services, and trophic relationships such as pollination, seed dispersal, and herbivory. We compared results to approaches where plant species are selected to represent plant taxonomic richness, dominant species, and at random. We tested our framework for 176 plant species found in European alpine grasslands and identified 163 associated attributes affiliated to trophic relationships, ecosystem functions, and services.In all cases, trophic relationships, ecosystem functions, and services can be captured more efficiently through objective-based prioritization using the functional identity of plant species. Solutions (plant species lists) can be compared quantitatively, in terms of costs, species, or objectives. We confirm that a random draw of plant species from the regional plant species pool cannot be assumed to support other trophic groups and ecosystem functions and services.Synthesis and Applications. Our framework is presented as a proof of concept to help restoration practitioners better apply quantitative decision–support to plant species selection in order to meet ecological restoration outcomes. Our approach may be tailored to any restoration initiative and habitat where seeding or planting mixes will be applied in active treatments. As global priority and resources are increasingly placed into restoration, this approach could be advanced to help make efficient decisions for many stages of the restoration process.

BACKGROUND Disproportionally high rates of COVID-19 have been noted among communities with limited English proficiency (LEP), resulting in an unmet need for improved multilingual care and interpreter services. To enhance multilingual care, we created a freely available web app (RadTranslate™) that provides multilingual radiology exam instructions. The purpose of this study was to evaluate the implementation of this intervention in radiology. METHODS The device-agnostic web app leverages artificial-intelligence text-to-speech to provide standardized, human-like spoken exam instructions in the patient’s preferred language. Standardized phrases were collected from a consensus group consisting of technologists, radiologists, and ancillary staff. RadTranslate was piloted in Spanish for chest radiographs (CXR) performed at a COVID-19 triage outpatient center that served a predominantly Spanish-speaking Latine community. Implementation included a tablet displaying the app in the CXR room. Imaging appointment duration (IAD) was measured and compared between pre- and post-implementation groups. RESULTS In the 63-day test period following launch, there were 1267 app uses, with technologists voluntarily switching exclusively to RadTranslate for Spanish-speaking patients. The most used phrases were a general explanation of the exam (30% of total) followed by instructions to disrobe and remove any jewelry (12%). There was no significant difference in the IAD, 11±7 min (mean ± standard deviation) and 12±3 for standard-of-care versus RadTranslate, respectively; however, variability was significantly lower when RadTranslate was used (p=0.003). CONCLUSION AI-aided multilingual audio instructions were successfully integrated into imaging workflows, reducing strain on medical interpreters and variance in throughput resulting in more reliable average exam length., RadTranslate (www.radtranslate.com), a web-based tool, allows standardized audio imaging exam instructions to be given in a patient’s native language via a simple interface, and reduces variability in exam times among non-English patients receiving chest radiographs.

To meet the ambitious objectives of biodiversity and climate conventions, the international community requires clarity on how these objectives can be operationalized spatially and how multiple targets can be pursued concurrently. To support goal setting and the implementation of international strategies and action plans, spatial guidance is needed to identify which land areas have the potential to generate the greatest synergies between conserving biodiversity and nature’s contributions to people. Here we present results from a joint optimization that minimizes the number of threatened species, maximizes carbon retention and water quality regulation, and ranks terrestrial conservation priorities globally. We found that selecting the top-ranked 30% and 50% of terrestrial land area would conserve respectively 60.7% and 85.3% of the estimated total carbon stock and 66% and 89.8% of all clean water, in addition to meeting conservation targets for 57.9% and 79% of all species considered. Our data and prioritization further suggest that adequately conserving all species considered (vertebrates and plants) would require giving conservation attention to ~70% of the terrestrial land surface. If priority was given to biodiversity only, managing 30% of optimally located land area for conservation may be sufficient to meet conservation targets for 81.3% of the terrestrial plant and vertebrate species considered. Our results provide a global assessment of where land could be optimally managed for conservation. We discuss how such a spatial prioritization framework can support the implementation of the biodiversity and climate conventions.

Introduction: Higher levels of anxiety and depression have been found to be associated with greater difficulty in stopping smoking. This raises the question as to whether mood disturbance may be associated with exposure to, and use of, quitting support.Aims: This study examined whether General Practitioner (GP) advice and/or offer of support, or stop-smoking service use differed between smokers reporting or not reporting depression/anxiety.Methods: Data came from the Smoking Toolkit Study. Participants were 1,162 English adults who reported currently smoking or having stopped within the past 12 months, aged 40+ years, surveyed between April and September 2012. Anxiety/depression was assessed by the mood disturbance item of the EuroQol five dimensions questionnaire (EQ-5D). This was compared to recall of GP quit advice and/or support, and stop-smoking aid use adjusting for age, gender, and social grade.Results/Findings: Smokers reporting depression/anxiety were more likely to recall being offered advice and support to stop smoking by their GP (OR = 1.50, 95% C.I. = 1.05–2.13). However, there were no significant differences in use of stop-smoking aids during the past year.Conclusions: Smokers reporting depression/anxiety are more likely to be offered stop-smoking support by their GPs, but this does not appear to translate into stop-smoking aid use, despite high motivation to quit. Given higher nicotine dependence in this group, mental health specific support may need to be offered, and more needs to be done to make this offer of aid attractive.

© 2017 British HIV Association.Objectives: We sought to evaluate whether people living with HIV (PLWH) using effective antiretroviral therapy (ART) have worse respiratory health status than similar HIV-negative individuals. Methods: We recruited 197 HIV-positive and 93 HIV-negative adults from HIV and sexual health clinics. They completed a questionnaire regarding risk factors for respiratory illness. Respiratory health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and the Medical Research Council (MRC) breathlessness scale. Subjects underwent spirometry without bronchodilation. Results: PLWH had worse respiratory health status: the median SGRQ Total score was 12 [interquartile range (IQR) 6-25] in HIV-positive subjects vs. 6 (IQR 2-14) in HIV-negative subjects (P

Designing landscapes to accommodate both humans and nature poses huge challenges, but is increasingly recognised as an essential component of conservation and land management. The land-sparing land-sharing framework has been proposed as a tool to address this challenge. However, it has been largely criticised for its simplicity. We provide a new conceptual framework amenable to the application of structured decision-making that moves beyond the dichotomy of land-sparing or land-sharing. Using this new framework, we present a general system model that can be used to make land management decisions for the conservation of species, ecosystem services and production land at different spatial scales. The model can be parameterised for specific systems using information about: the current state of the landscape, the rates of change between landscape states, and the cost and effectiveness of taking actions. To demonstrate the utility of the model we apply it to three different landscape types. Across our three case studies, we show that investment into one of three management actions (varying degrees of management and restoration) can move the system towards more biodiversity or more managed land depending on the objectives of the land manager. We show that the dynamic and flexible nature of the landscape is important to take into account rather than a static snapshot in time. Rather than focusing on establishing the perfect landscape with a set proportion dedicated to production and to biodiversity conservation, we argue that a more useful approach is to establish incremental movements towards a landscape that meets the goals of multiple objectives. Our framework can be used to illustrate to decision makers the costs and trade-offs of different actions and help them determine land management policy.

As the source providing units for several goods and services required for human survival (e.g. food, fuel, fiber, water provision and purification, etc.) ecosystems must be sustainably managed. This will require a globally comprehensive and detailed understanding of the distribution of ecosystems on Earth. While there have been several attempts to partition the planet into large ecologically meaningful areas (ecoregions), a high spatial resolution map of Earth's terrestrial ecosystems at the on-the-ground occurrences (patch) level has heretofore been lacking. A new, high resolution (250 m) map of data-derived World Terrestrial Ecosystems is characterized, and its utility for assessing policy-mandated ecosystem conservation targets is described.

Summary paragraphTo meet the ambitious objectives of biodiversity and climate conventions, countries and the international community require clarity on how these objectives can be operationalized spatially, and multiple targets be pursued concurrently1. To support governments and political conventions, spatial guidance is needed to identify which areas should be managed for conservation to generate the greatest synergies between biodiversity and nature’s contribution to people (NCP). Here we present results from a joint optimization that maximizes improvements in species conservation status, carbon retention and water provisioning and rank terrestrial conservation priorities globally. We found that, selecting the top-ranked 30% (respectively 50%) of areas would conserve 62.4% (86.8%) of the estimated total carbon stock and 67.8% (90.7%) of all clean water provisioning, in addition to improving the conservation status for 69.7% (83.8%) of all species considered. If priority was given to biodiversity only, managing 30% of optimally located land area for conservation may be sufficient to improve the conservation status of 86.3% of plant and vertebrate species on Earth. Our results provide a global baseline on where land could be managed for conservation. We discuss how such a spatial prioritisation framework can support the implementation of the biodiversity and climate conventions.

Background While employment and education rates have been extensively studied, little is known about how general well-being through early-late adolescence impacts well-being into adulthood. Utilising participant-led research, we mapped the presence and trajectories of ‘assets’ identified by young people (YP) as important during their adolescence to ‘success’ in early adulthood. Methods YP identified four ‘assets’: ‘appropriate skills’, ‘social capital’, ‘financial support’ and ‘emotional support’, which were mapped across early(T1: age 13–15), mid(T2: 16–17), and late(T3: 18–20) adolescence. Four adult (age 25–26) outcomes were also identified: ‘suitable/rewarding work’, ‘satisfactory housing’, ‘good relationships’, and ‘healthy habits’. The presence of these were identified using binary measures, developed from the ‘Next Steps’ dataset - a yearly longitudinal study following English individuals born in 1989/1990(N=15,770). Trajectories were categorised as an asset being ‘stable high’, ‘stable low’, ‘late rising’ (T3), ‘early rising’ (T2), ‘late falling’, ‘early falling’, and ‘unstable’. Results A complete case analysis was performed. Data was weighted using the standard LSYPE weightings. Assets were reported by 90% (emotional support) – 20% (confidence and connections) of young people, and generally decreased in prevalence over adolescence (ps Using regression analyses adjusted for sex and ethnicity, we identified that attaining ‘suitable/rewarding work’ at age 25/26 was associated with the presence of ‘skills’ (T1:Coef=1.36, 95% CI=1.18–1.58; T2:Coef=1.30, 95% CI=1.13–1.49); T3:Coef=1.29, 95%CI=1.10–1.51, ps Conclusion The assets available to adolescents impact their young adult outcomes across distinct pathways, but not all assets are commonly available to YP. The stability of these assets across adolescence is of particular importance to adult outcomes, as is their presence in early-mid adolescence.

Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and is characterized by insulin resistance and decreased circulating glucagon-like peptide-1 (GLP-1). GDM resolves rapidly after delivery implicating the placenta in the disease. This study examines the biological functions that cause this pathology. The placenta releases syncytiotrophoblast-derived extracellular vesicles (STB-EVs) into the maternal circulation, which is enhanced in GDM. Dipeptidyl peptidase IV (DPPIV) is known to play a role in type 2 diabetes by breaking down GLP-1, which in turn regulates glucose-dependent insulin secretion. STB-EVs from control and GDM women were analysed. We show that normal human placenta releases DPPIV-positive STB-EVs and that they are higher in uterine than paired peripheral blood, confirming placental origin. DPPIV-bound STB-EVs from normal perfused placentae are dose dependently inhibited with vildagliptin. DPPIV-bound STB-EVs from perfused placentae are able to breakdown GLP-1 in vitro. STB-EVs from GDM perfused placentae show greater DPPIV activity. Importantly, DPPIV-bound STB-EVs increase eightfold in the circulation of women with GDM. This is the first report of STB-EVs carrying a biologically active molecule that has the potential to regulate maternal insulin secretion.

BackgroundThe theory of human functioning and school organisation proposes that schools with rigid ‘boundaries’ (weaker relationships), for example, between staff and students, or learning and broader development, engender weaker student school commitment and sense of belonging, particularly among disadvantaged students, leading to greater involvement in risk-behaviours. Existing studies provide some support but rely on a proxy exposure of ‘value-added education’ and have not explored effects by disadvantage.MethodsWe used longitudinal data from English secondary schools from the control arm of a trial, assessing school-level measures of rigid boundaries, and student commitment and belonging at age 11/12, and student risk-behaviours at age 14/15.ResultsOur direct measures were more strongly associated with risk-behaviours than was value-added education. School-level rigid boundaries were associated with increased alcohol use and bullying. Student belonging was more consistently associated with reduced risk-behaviours than was student commitment. Some school effects were greater for students from disadvantaged subgroups defined in terms of poverty, ethnicity and family structure.ConclusionOur results provide direct support for the theory of human functioning and school organisation and suggest a sense of belonging in school might be particularly protective factor among secondary school students. School effects on risk are generally stronger among disadvantaged students as theorised.Trial registration numberISRCTN10751359

BackgroundWe have previously reported benefits for reduced bullying, smoking, alcohol and other drug use and mental health from a trial of ‘Learning Together’, an intervention that aimed to modify school environments and implement restorative practice and a social and emotional skill curriculum.ObjectivesTo conduct post hoc theory-driven analyses of broader impacts.DesignCluster randomised trial.Settings40 state secondary schools in southern England.ParticipantsStudents aged 11/12 years at baseline.OutcomesStudent self-reported measures at 24 and 36 months of: cyberbullying victimisation and perpetration; observations of other students perpetrating aggressive behaviours at school; own perpetration of aggressive behaviours in and outside school; perceived lack of safety at school; participation in school disciplinary procedures; truancy and e-cigarette use.ResultsWe found evidence of multiple impacts on other health (reduced e-cigarette use, cyberbullying perpetration, perpetration of aggressive behaviours) and educational (reduced participation in school disciplinary procedures and truancy) outcomes.ConclusionThese analyses suggested that the intervention was effective in bringing about a broader range of beneficial outcomes, adding to the evidence that the intervention is a promising approach to promote adolescent health via an intervention that is attractive to schools.Trial registration numberISRCTN10751359.

Aim Mega-diverse coral reef ecosystems are declining globally, necessitating conservation prioritizations to protect biodiversity and ecosystem services of sites with high functional integrity to promote persistence. In practice however, the design of marine-protected area (MPA) systems often relies on broad classifications of habitat class and size, making the tacit assumption that all reefs are of comparable condition. We explored the impact of this assumption through a novel, pragmatic approach for incorporating variability in coral cover in a large-scale regional spatial prioritization plan. Location The Coral Triangle. Methods We developed a spatially explicit predictive model of hard coral cover based on freely available macro-ecological data to generate a complete regional map of coral cover as a proxy for reef condition. We then incorporate this information in spatial conservation prioritization software Marxan to design an MPA system that meets specific conservation objectives. Results We discover prioritizations using area-based representation of reef habitat alone may overestimate the conservation benefit, defined as the amount of hard coral cover protected, by up to 64%. We find substantial differences in conservation priorities and an overall increase in habitat quality metrics when accounting for predicted coral cover. Main conclusions This study shows that including habitat condition in a large-scale marine spatial prioritization is feasible within time and resource constraints, and calls for increased implementation, and evaluation, of such ecologically relevant planning approaches to enhance potential conservation effectiveness.

Representation of ecosystems in protected area networks and conservation strategies is a core principle of global conservation priority setting approaches and a commitment in Aichi Target 11 of the Convention on Biological Diversity. The 2030 Sustainable Development Goals (SDGs) explicitly call for the conservation of terrestrial, freshwater, and marine ecosystems. Accurate ecosystem distribution maps are required to assess representation of ecosystems in protected areas, but standardized, high spatial resolution, and globally comprehensive ecosystem maps have heretofore been lacking. While macroscale global ecoregions maps have been used in global conservation priority setting exercises, they do not identify distinct localized ecosystems at the occurrence (patch) level, and instead describe large ecologically meaningful areas within which additional conservation planning and management are necessary. We describe a new set of maps of globally consistent climate regions and ecosystems at a much finer spatial resolution (250 m) than existing ecological regionalizations. We then describe a global gap analysis of the representation of these ecosystems in protected areas. The new map of terrestrial World Ecosystems was derived from the objective development and integration of 1) global temperature domains, 2) global moisture domains, 3) global landforms, and 4) 2015 global vegetation and land use. These new terrestrial World Ecosystems do not include either freshwater or marine ecosystems, but analog products for the freshwater and marine domains are in development. A total of 431 World Ecosystems were identified, and of these a total of 278 units were natural or semi-natural vegetation/environment combinations, including different kinds of forestlands, shrublands, grasslands, bare areas, and ice/snow regions. The remaining classes were different kinds of croplands and settlements. Of the 278 natural and semi-natural classes, 9 were not represented in global protected areas with a strict biodiversity conservation management objective (IUCN management categories I-IV), and an additional 206 were less than 8.5% protected (half way to the 17% Aichi Target 11 goal). Forty four classes were between 8.5% and 17% protected (more than half way towards the Aichi 17% target), and only 19 classes exceeded the 17% Aichi target. However, when all protected areas (IUCN management categories I-VI plus protected areas with no IUCN designation) were included in a separate global gap analysis, representation of ecosystems increases substantially, with a third of the ecosystems exceeding the 17% Aichi target, and another third between 8.5% and 17%. The overall protection (representation) of global ecosystems in protected areas is considerably less when assessed using only strictly conserved protected areas, and more if all protected areas are included in the analysis. Protected area effectiveness should be included in further evaluations of global ecosystem protection. The ecosystems with the highest representation in protected areas were often bare or sparsely vegetated and found in inhospitable environments (e.g. cold mountains, deserts), and the eight most protected ecosystems were all snow and ice ecosystems. In addition to the global gap analysis of World Ecosystems in protected areas, we report on the representation results for the ecosystems in each biogeographic realm (Neotropical, Nearctic, Afrotropical, Palearctic, Indomalayan, Australasian, and Oceania).

Globally, protected areas are being established to protect biodiversity and to promote ecosystem resilience. The typical spatial conservation planning process leading to the creation of these protected areas focuses on representation and replication of ecological features, often using decision support systems such as Marxan. Unfortunately, Marxan currently requires manual input or specialised scripts to explicitly consider ecological connectivity, a property critical to metapopulation persistence and resilience. "Marxan Connect" is a new open source, open access Graphical User Interface (GUI) designed to assist conservation planners in the systematic operationalization of ecological connectivity in protected area network planning. Marxan Connect is able to incorporate estimates of demographic connectivity (e.g. derived from tracking data, dispersal models, or genetics) or structural landscape connectivity (e.g. isolation by resistance). This is accomplished by calculating metapopulation-relevant connectivity metrics (e.g. eigenvector centrality) and treating those as conservation features, or using the connectivity data as a spatial dependency amongst sites to be included in the prioritization process. Marxan Connect allows a wide group of users to incorporate directional ecological connectivity into conservation plans. The least-cost conservation solutions provided by Marxan Connect, combined with ecologically relevant post-hoc testing, are more likely to support persistent and resilient metapopulations (e.g. fish stocks) and provide better protection for biodiversity than if connectivity is ignored.

Important Bird and Biodiversity Areas (IBAs) are sites identified as globally important for bird species conservation. Marine IBAs are one of the few comprehensive multi-species datasets available for the marine environment, and their use in conservation planning will likely increase as countries race to protect 10% of their territorial waters by 2020. We tested 15 planning scenarios for Australia's Exclusive Economic Zone to guide best practice on integrating marine IBAs into spatial conservation prioritization. We found prioritizations based solely on habitat protection failed to protect IBAs, and prioritizations based solely on IBAs similarly failed to meet basic levels of habitat representation. Further, treating all marine IBAs as irreplaceable sites produced the most inefficient plans in terms of ecological representativeness and protection equality. Our analyses suggest that marine spatial planners who wish to use IBAs treat them like any other conservation feature by assigning them a specific protection target.

World-wide, tobacco use is a leading cause of morbidity and mortality. However, the health effects of smoking are reversible, making smoking cessation an important target for public health policy. ‘Tobacco control’ is a field of public health science which is dedicated to reducing tobacco use, and thereby reducing cigarette-related morbidity and mortality. In order for tobacco control to be effective, it is necessary for policy-makers to understand the personal and interpersonal factors which encourage people to smoke, factors which motivate smokers to quit (e.g. health, social pressure, cost), and the personal and population-level methods which are most effective at encouraging and prolonging quit attempts. Research has identified that social norms, mental health, and individual personality factors are most associated with smoking uptake and so interventions which reduce social smoking (e.g. smoking bans, plain packaging) would be most effective at preventing uptake. Conversely, the use of cigarettes is maintained by nicotine addiction and quit attempts are often motivated by health concerns, social pressure and the cost of tobacco products. As such, interventions which address physiological and behavioural addiction inherent in tobacco product use (such as nicotine replacement therapy combined with counselling), create social pressure to stop (such as mass media campaigns), or increase the cost of tobacco products, are most likely to be effective at encouraging quit attempts.

A dose non-inferiority study comparing 100 mg, 300 mg and 600 mg of aspirin for cancer prevention among Lynch Syndrome carriers is underway (Colorectal Adenoma/Carcinoma Prevention Programme trial 3, CaPP3). To guide implementation of the findings, we investigated general practitioner (GP) attitudes towards aspirin prescribing for Lynch Syndrome carriers. We surveyed 1007 UK GPs (9.6% response rate). Using a within-subjects design, GPs read a statement on harms and benefits of aspirin and indicated their willingness to prescribe aspirin at three doses (100 mg, 300 mg, 600 mg). Approximately two-thirds (70.8%) of GPs had heard of Lynch Syndrome or its associated names, and among those 46.7% were aware of the cancer preventive effects of aspirin among carriers. Two-thirds (68.1%) of GPs reported feeling comfortable discussing harms and benefits of aspirin with a Lynch Syndrome patient. Willingness to prescribe was 91.3% at 100 mg, and declined to 81.8% at 300 mg and 62.3% at 600 mg (p

Animal-borne telemetry has revolutionized our ability to study animal movement, species physiology, demography and social structures, changing environments and the threats that animals are experiencing. While there will always be a need for basic ecological research and discovery, the current conservation crisis demands we look more pragmatically at the data required to make informed management decisions. Here, we define a framework that distinguishes how research using animal telemetry devices can influence conservation. We then discuss two critical questions which aim to directly connect telemetry-derived data to applied conservation decision-making: (i) Would my choice of action change if I had more data? (ii) Is the expected gain worth the money and time required to collect more data? Policy implications. To answer questions about integrating telemetry-derived data with applied conservation, we suggest the use of value of information analysis to quantitatively assess the return-on-investment of animal telemetry-derived data for conservation decision-making.

Supplement. This section describes the surface-only model results including comparison statistics, and the relationship between humpback whale counts and oceanographic variables. For both models, the tenfold cross-validation results are provided as well as the standard error of the prediction and coefficient of variation results. As supplementary information, the yearly prediction maps for the surface + midwater model have been included.

Background: HIV infection is associated with increased risk of smoking-related illness, yet people living with HIV (PLWH) are more likely to smoke than the general population in the UK. Aims: To explore attitudes towards smoking and readiness to quit in adult PLWH compared to HIV negative individuals. Methods: Cross-sectional observational study: PLWH were recruited from a metropolitan HIV care service; HIV negative participants were recruited from Sexual Health clinics. Participants completed a questionnaire including details of tobacco smoking, attitudes towards smoking cessation and beliefs regarding HIV-related respiratory illness. Results: 402 individuals were invited, of whom 197 PLWH and 93 HIV negative participants of similar demographic and socioeconomic backgrounds agreed. 30% and 33% respectively were current smokers and 28% vs 25% ex-smokers (p=0.94). 65% of PLWH and 59% of HIV negative smokers either intended to, or wished to, stop smoking (p=0.56). When asked to rate the importance of stopping smoking on a 1-10 scale, there was no significant difference in mean scores between HIV positive and negative participants. Only 33% of PLWH agreed with the statement that there is an increased risk of developing lung cancer and 21% agreed that HIV is associated with the early onset of smoking-related lung disease. Conclusions: Our data suggest that PLWH should be priority group for smoking cessation services and HIV status does not adversely affect desire to quit smoking. Most PLWH were unaware of an increased risk of non-communicable respiratory illness associated with HIV, so provision of information regarding this might help to reduce tobacco use in this population.

Aims and objectives. This study examined practices of health care providers who thicken oral fluids for patients with impaired swallowing (dysphagia). It contrasts viscosity (thickness) of nectar-like and honey-thick consistencies prepared and measured in a laboratory setting to actual practices in health care settings and to guidelines of the National Dysphagia Diet. Background. The care plans for many patients include changes to fluid thickness to maintain safe intake of oral fluids. Serving patients improperly prepared beverages may contribute to medical complications such as dehydration if patients consume less fluid, or aspiration of overly thin or thickened liquids, which may increase the risk of pneumonia. Design. Descriptive analysis of group trends for viscosity measurements of liquids prepared by health care providers in four care settings to laboratory measurements and the National Dysphagia Diet. Methods. Forty-two health care providers participated. Each prepared thickened samples in their natural work environment using typical procedures. Results. Viscosity measurements of modified liquids prepared by health care providers did not compare favourably to published findings of laboratory viscosity measures or to the ranges of the National Dysphagia Diet. Participants who prepared overly thick or overly thin nectar-like liquids followed a similar pattern with honey-like samples. Many participants failed to use product label information in sample preparation. Conclusions. Results suggest that many patients are served modified liquids that are too thick or too thin in relation to their target level of thickness, possibly increasing risk of further medical complications for those who consume them. Product directions that are too vague or general also may contribute to inaccurate results. Relevance to clinical practice. The patient’s nursing staff typically oversees nutritional care plans that may include modifications to oral fluids to enable their patients to safely drink by mouth. Additional consideration should be given to training procedures and possible noncompliance with preparation guidelines.

The first international goal for establishing marine protected areas (MPAs) to conserve the ocean’s biodiversity was set in 2002. Since 2006, the Convention on Biological Diversity (CBD) has driven MPA establishment, with 193 parties committed to protecting >10% of marine environments globally by 2020, especially ‘areas of particular importance for biodiversity’ (Aichi target 11). This has resulted in nearly 10 million km2 of new MPAs, a growth of ~360% in a decade. Unlike on land, it is not known how well protected areas capture marine biodiversity, leaving a significant gap in our understanding of existing MPAs and future protection requirements. We assess the overlap of global MPAs with the ranges of 17,348 marine species (fishes, mammals, invertebrates) and find that 97.4% of species have

Multinational conservation initiatives that prioritize investment across a region invariably navigate trade-offs among multiple objectives. It seems logical to focus where several objectives can be achieved efficiently, but such multi-objective hotspots may be ecologically inappropriate, or politically inequitable. Here we devise a framework to facilitate a regionally cohesive set of marine-protected areas driven by national preferences and supported by quantitative conservation prioritization analyses, and illustrate it using the Coral Triangle Initiative. We identify areas important for achieving six objectives to address ecosystem representation, threatened fauna, connectivity and climate change. We expose trade-offs between areas that contribute substantially to several objectives and those meeting one or two objectives extremely well. Hence there are two strategies to guide countries choosing to implement regional goals nationally: multi-objective hotspots and complementary sets of single-objective priorities. This novel framework is applicable to any multilateral or global initiative seeking to apply quantitative information in decision making., Conservation initiatives that span multiple countries often face conflicting national priorities. Here, Beger et al. develop a framework for integrating regional priorities and national plans by identifying multi-objective and complementary conservation hotspots, and apply it to the Coral Triangle Initiative.

Objective To describe and compare sensory characteristics of six beverages prepared with four commercial thickeners used in dysphagia diets. Design The study used a completely randomized design within a test of each beverage. Subjects/setting Five highly trained descriptive sensory analysis panelists conducted the testing in a laboratory environment. Intervention Coffee, milk, apple juice, orange juice, Ensure (Abbott Laboratories, Abbott Park, IL), and water were thickened using two starch-based and two gum-based commercial thickeners according to manufacturers' instructions to achieve nectar-like and honey-like consistencies. Main Outcome Measures Sensory attributes of the original beverages and the thickened samples were defined and scored. Statistical Analyses Performed Sensory scores were analyzed by analysis of variance using general linear models and Fisher's least significant difference test to determine specific differences. Results All thickeners suppressed the main flavors of the base beverages and imparted slight off-flavors (bitter, sour, metallic, or astringent) in some beverages. Starch-based thickeners imparted a starchy flavor and grainy texture, whereas gum-based thickeners gave added slickness to the beverages. Although thickeners mixed well with some beverages, they were difficult to disperse in others, making some thickened beverages lumpy. Conclusions All thickeners added either a starchy, grainy, or slick flavor or texture and tended to suppress the base flavor of beverages, especially at honey-like consistencies. Thus, individual decisions about which characteristics are more negative (eg, slick vs grainy texture) for specific patients must be made. Additional development of thickening agents seems necessary for improved sensory properties. Information from this article should help professionals and their patients with dysphagia better understand the sensory issues associated with the use of commercial thickening agents in various beverages.

Liver transplantation from a living donor involves removal of part of the donor liver in a fashion that does not endanger its vascular supply or metabolic function. The radiologist plays an important role in evaluation of the living donor to define the conditions under which graft donation is contraindicated and to identify anatomic variations that may alter the surgical approach. In the past, diagnostic work-up of the donor involved costly and invasive tests. Currently, dynamic contrast material–enhanced computed tomography and magnetic resonance (MR) imaging are the imaging tests performed, each of which has advantages and limitations. MR imaging performed with liver-specific and extravascular contrast agents may be used as a single imaging test for comprehensive noninvasive evaluation of living liver transplant donors. MR imaging provides valuable information about variations in the vascular and biliary anatomy and allows evaluation of the hepatic parenchyma for diffuse or focal abnormalities. © RSNA, 2004

Protected Areas (PAs) are a central part of biodiversity conservation strategies around the world. Today, PAs cover c15% of the Earth’s land mass and c3% of the global oceans. These numbers are expected to grow rapidly to meet the Convention on Biological Diversity’s Aichi Biodiversity target 11, which aims to see 17% and 10% of terrestrial and marine biomes protected, respectively, by 2020. This target also requires countries to ensure that PAs protect an “ecologically representative” sample of their biodiversity. At present, there is no clear definition of what desirable ecological representation looks like, or guidelines of how to standardize its assessment as the PA estate grows. We propose a systematic approach to measure ecological representation in PA networks using the Protection Equality (PE) metric, which measures how equally ecological features, such as habitats, within a country’s borders are protected. Extending research in Barr et al. (2011), we present an R package and two Protection Equality (PE) measures; proportional to area PE, and fixed area PE, which measure the representativeness of a country’s PA network. We illustrate the PE metrics with two case studies: coral reef protection across countries and ecoregions in the Coral Triangle, and representation of ecoregions of six of the largest countries in the world. Our results provide repeatable transparency to the issue of representation in PA networks and provide a starting point for further discussion, evaluation and testing of representation metrics. They also highlight clear shortcomings in current PA networks, particularly where they are biased towards certain assemblage types or habitats. Our proposed metrics should be used to report on measuring progress towards the representation component of Aichi Target 11. The PE metrics can be used to measure the representation of any kind of ecological feature including: species, ecoregions, processes or habitats.

INTRODUCTION: The evolving HIV epidemic, coupled with advances in HIV treatment, has resulted in an ageing HIV-diagnosed population. It has been suggested that adverse physical and psychological effects of HIV may be higher among older people. However, few studies have examined the effect of older age on well-being for people with HIV. MATERIALS AND METHODS: The ASTRA study included 3258 HIV-diagnosed individuals (2248 MSM; 373 heterosexual men; 637 women) recruited from eight UK clinics in 2011-12 (64% response rate). Participants completed a questionnaire that included standard inventories on symptoms and health-related quality of life (HrQoL). Associations of age group with: physical symptom distress (reporting significant distress for ≥1 of 26 symptoms), depression and anxiety (score ≥10 on PHQ-9 and GAD-7, respectively) and HrQoL problem (reporting problems on ≥1 of 5 Eurqol-5D domains) were assessed; adjustment was made for gender/sexuality and time with diagnosed HIV. RESULTS: Of all participants, 87% were taking ART, 76% had VL ≤50c/mL and 19% had CD4

Background The widespread use of antiretroviral therapy (ART) has led to a reduction in HIV related opportunistic infections. An increase in chronic non-HIV related co-morbidities has been observed in stable HIV positive individuals receiving ART. The extent to which HIV infection remains an independent risk factor for respiratory disease despite the use of antiretroviral therapy is uncertain and few studies have systematically evaluated respiratory disease in HIV-infected populations with access to antiretroviral therapy. Aims We sought to evaluate the frequency of (a) smoking and (b) respiratory symptoms and (c) spirometric impairment in the ambulatory UK adult HIV infected population, compared to HIV uninfected controls. Methods HIV-positive participants were recruited from a large HIV care service, HIV uninfected participants were recruited from Sexual Health services (where recruitment was stratified by age to approximate that of the HIV positive subjects). Participants completed a questionnaire which included questions on smoking history and respiratory health status using the St George’s Respiratory Questionnaire (SGRQ), and undertook spirometry without bronchodilation. Results 249 participants were recruited between April and July 2015 (Table 1). 28% of HIV positive and 33% of HIV negative participants were current smokers (p = 0.22). 9% of HIV positive and 7% of HIV negative participants had an FEV 1 /FVC of Significantly higher SGRQ scores were observed in HIV positive participants than HIV-negative participants with a median total SGRQ score of 12 for those with HIV infection and 8 for the HIV negative participants (p = 0.03). In a linear regression (log scale) model, HIV infection was associated with a 62% increase (95% CI 1.19–2.21, p Conclusions Despite widespread use of ART, HIV infection is independently associated with impaired respiratory health status. This does not appear to result from current smoking or obstructive lung disease.