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The 2011 Fukushima disaster and the 2020 COVID-19 pandemic are two major 21st century events that were least expected while being highly disruptive, having an immediate as well as longer-term impact on shipping operations. However, while pandemics are a recurrent phenomenon of the “known-knowns” type, the combination of phenomena which led to Fukushima had no assigned probability; hence, no preparedness was in place, as this was practically a unique occurrence in shipping. Considering significant shipping incidents of various less or more uncommon etiologies, such as the capsizing of vessels, missile attacks on merchant ships or vessel-onto-bridge collisions, this conceptual paper puts forward a consequence-based approach for assessing and managing shocks in the maritime domain, especially the ones classified in the “unknown-unknowns” or “Black Swan” categories. In the context of preparedness theory, the authors propose the adoption by shipping businesses, in parallel to any other risk approaches and tools, of the Assessment-reaction-Recovery-Conversion (ArRC) framework for managing risk and of relevant key recovery indicators which may assist in (a) increasing resilience through focusing the recovery planning on consequence-oriented, root-neutral reactions and (b) in promoting a “bounce-back-better” frame of mind and action plan, contributing to faster and easier recovery after a shock of any type.

Background: Natriuretic peptide (NP) levels have been proposed for characterization and risk stratification of heart failure (HF) among patients with cardiovascular disease (CVD). However, their role in patients with diabetes mellitus type 2 (T2DM) has not been well studied and understood. The aim of this study was to assess phenotypical, functional characteristics and imaging parameters in relation to N-terminal pro b-type natriuretic peptide (NT-proBNP) values in T2DM patients without known CVD that may predispose to overt HF. Methods: This was a cross-sectional study of 100 consecutive T2DM patients (mean overall age of 67 ± 9 years, 40% women and 60% men) who were enrolled from the outpatient diabetic clinic. Patients underwent a cardiopulmonary exercise test (CPET), and echocardiographic and cardiac magnetic resonance imaging (CMR); serum NT-proBNP was also measured. Results: The mean (standard deviation) NT-proBNP was 149 (±186) pg/mL. Patients in the highest tertile of NT-proBNP values (>107 pg/mL) had lower values of predicted maximum oxygen consumption compared to the lowest quartile (p = 0.018) in the CPET and higher ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e′) (9.0 vs. 7.2, p = 0.05) in echocardiography. Finally, there was a negative correlation between right ventricle end diastolic volume in CMR and predicted maximum oxygen consumption (b = −0.225 ± 0.11, p = 0.046). Conclusions: NT-proBNP levels seemed to be a useful marker in people with T2DM, as elevated levels reflected ongoing appearance of HF with preserved ejection fraction and were related to CPET and echocardiographic indices of impaired left ventricular diastolic and right ventricular systolic function.

Automation in transport and digitalization will affect both transport users and its workforce. Focusing on the latter, this paper aims at analyzing barriers, gaps, opportunities, and success and failure factors of transport automation on the labor force, through the perceptions and contributions of employees and employers, as well as of stakeholders from the private, public, and private–public sectors. In a nutshell, the study aims to understand workforce-related barriers and facilitators associated with the implementation of automation. This has been achieved through input derived from the organization of five focus groups, one poll and one extensive questionnaire survey administered to the participants of the 2nd WE-TRANSFORM EU H2020 funded project Workshop, and to project partners’ stakeholder contacts. The analysis of the results indicated that the transport sector’s automation has been evolving at a different pace per sector. An interesting conclusion is that the challenges do not concern all categories among the workforce in the same way. Challenges related to loss of jobs and related repercussions are bound to affect groups within the workforce, which may be constrained by regulatory age limits, or vulnerable, if in part-time employment without access to retraining, which may be the case of workforce members near retirement age or of women limited due to family obligations to part-time employment. The study’s limitations are related to the size of the sample and how representative it is of all stakeholders in the transport sector, including policymakers, regulators, and unions. Future directions should focus on exploring the long-term impacts of automation on the labor force and identify strategies to mitigate the negative effects on vulnerable groups.

The 2011 Fukushima disaster and the 2020 COVID-19 pandemic are two major 21st century events that were least expected while being highly disruptive, having an immediate as well as longer-term impact on shipping operations. However, while pandemics are a recurrent phenomenon of the "known-knowns" type, the combination of phenomena which led to Fukushima had no assigned probability; hence, no preparedness was in place, as this was practically a unique occurrence in shipping. Considering significant shipping incidents of various less or more uncommon etiologies, such as the capsizing of vessels, missile attacks on merchant ships or vessel-onto-bridge collisions, this conceptual paper puts forward a consequence-based approach for assessing and managing shocks in the maritime domain, especially the ones classified in the "unknown-unknowns" or "Black Swan" categories. In the context of preparedness theory, the authors propose the adoption by shipping businesses, in parallel to any other risk approaches and tools, of the Assessment-reaction-Recovery-Conversion (ArRC) framework for managing risk and of relevant key recovery indicators which may assist in (a) increasing resilience through focusing the recovery planning on consequence-oriented, root-neutral reactions and (b) in promoting a "bounce-back-better" frame of mind and action plan, contributing to faster and easier recovery after a shock of any type. [ABSTRACT FROM AUTHOR]

Background: Natriuretic peptide (NP) levels have been proposed for characterization and risk stratification of heart failure (HF) among patients with cardiovascular disease (CVD). However, their role in patients with diabetes mellitus type 2 (T2DM) has not been well studied and understood. The aim of this study was to assess phenotypical, functional characteristics and imaging parameters in relation to N-terminal pro b-type natriuretic peptide (NT-proBNP) values in T2DM patients without known CVD that may predispose to overt HF. Methods: This was a cross-sectional study of 100 consecutive T2DM patients (mean overall age of 67 ± 9 years, 40% women and 60% men) who were enrolled from the outpatient diabetic clinic. Patients underwent a cardiopulmonary exercise test (CPET), and echocardiographic and cardiac magnetic resonance imaging (CMR); serum NT-proBNP was also measured. Results: The mean (standard deviation) NT-proBNP was 149 (±186) pg/mL. Patients in the highest tertile of NT-proBNP values (>107 pg/mL) had lower values of predicted maximum oxygen consumption compared to the lowest quartile (<55 pg/mL) (84% vs. 92%, p = 0.018) in the CPET and higher ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e′) (9.0 vs. 7.2, p = 0.05) in echocardiography. Finally, there was a negative correlation between right ventricle end diastolic volume in CMR and predicted maximum oxygen consumption (b = −0.225 ± 0.11, p = 0.046). Conclusions: NT-proBNP levels seemed to be a useful marker in people with T2DM, as elevated levels reflected ongoing appearance of HF with preserved ejection fraction and were related to CPET and echocardiographic indices of impaired left ventricular diastolic and right ventricular systolic function. [ABSTRACT FROM AUTHOR]

The original version of this Article contained an error in the spelling of the author Emilien Etienne, which was incorrectly given as Emilien Ettiene. These errors have now been corrected in both the PDF and HTML versions of the Article.

Mucormycosis is a life-threatening respiratory fungal infection predominantly caused by Rhizopus species. Mucormycosis has incompletely understood pathogenesis, particularly how abnormalities in iron metabolism compromise immune responses. Here we show how, as opposed to other filamentous fungi, Rhizopus spp. establish intracellular persistence inside alveolar macrophages (AMs). Mechanistically, lack of intracellular swelling of Rhizopus conidia results in surface retention of melanin, which induces phagosome maturation arrest through inhibition of LC3-associated phagocytosis. Intracellular inhibition of Rhizopus is an important effector mechanism, as infection of immunocompetent mice with swollen conidia, which evade phagocytosis, results in acute lethality. Concordantly, AM depletion markedly increases susceptibility to mucormycosis. Host and pathogen transcriptomics, iron supplementation studies, and genetic manipulation of iron assimilation of fungal pathways demonstrate that iron restriction inside macrophages regulates immunity against Rhizopus. Our findings shed light on the pathogenetic mechanisms of mucormycosis and reveal the role of macrophage-mediated nutritional immunity against filamentous fungi.

IntroductionCoral species are negatively impacted by anthropogenic stressors worldwide. Nearshore coastal ecosystems provide an excellent study system for the investigation of the impacts of local land-based stressors such as nutrients on coral assemblages due to their proximity to land based sources of pollution. The nearshore environs of the Florida Keys are an intensively developed and intensively managed system; Florida Keys waters have been characterized by chronic eutrophication since 1999. Benthic communities are known to change or “shift” under chronic eutrophication.ObjectivesThis research examines the patterns of occurrence in stony corals correlating to detailed nearshore water quality measurements. The questions addressed are a) What are the coral assemblages within 500 meters of the shoreline, and which species are resilient to these environs? b) How does water quality impact coral occurrence?MethodsThis study examined the immediate nearshore (0-500m) areas of 13 sites using a randomized blocked experimental design for both water quality and benthic sampling. Water quality parameters measured included chlorophyll-a, nitrates + nitrites (NOx), total nitrogen, total Kjeldahl nitrogen, total phosphorus, Salinity, pH, temperature, and dissolved oxygen. Benthic surveys documented stony coral occurrence using belt transects with point intercept measurements.ResultsStony coral species occurrence was limited at most of the study sites. Siderastrea radians and Porites divaricata were the two common species that appear to have a higher tolerance to eutrophic conditions under these shallow water conditions. Of the 13 study sites, 2 sites had no coral species occurring; this analysis was based on the comparison between sites with and without stony coral species. Water column Chlorophyll-a, pH, dissolved oxygen saturation, temperature, NOx, N:P ratio, total nitrogen and total phosphorus were found to be significantly different between the sites with and without corals. Further multivariate analysis showed a clear clustering of the two groups.ConclusionThe low overall diversity and the higher occurrences of stress tolerant species provide evidence of the effects of coastal eutrophication on the coastal Florida Keys ecosystem. Our data suggest that more conservative water quality thresholds should be posed to improve nearshore biodiversity and ecological functioning of coastal systems.

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have been linked to changes in amino acid (AA) levels. The objective of the current study was to examine the relationship between MRI parameters that reflect inflammation and fibrosis and plasma AA concentrations in NAFLD patients. Plasma AA levels of 97 NAFLD patients from the MAST4HEALTH study were quantified with liquid chromatography. Medical, anthropometric and lifestyle characteristics were collected and biochemical parameters, as well as inflammatory and oxidative stress biomarkers, were measured. In total, subjects with a higher MRI-proton density fat fraction (MRI-PDFF) exhibited higher plasma AA levels compared to subjects with lower PDFF. The concentrations of BCAAs (p-Value: 0.03), AAAs (p-Value: 0.039), L-valine (p-Value: 0.029), L-tyrosine (p-Value: 0.039) and L-isoleucine (p-Value: 0.032) were found to be significantly higher in the higher PDFF group compared to lower group. Plasma AA levels varied according to MRI-PDFF. Significant associations were also demonstrated between AAs and MRI-PDFF and MRI-cT1, showing the potential utility of circulating AAs as diagnostic markers of NAFLD.

Despite high-quality evidence highlighting metabolic surgery as an effective treatment option for type 2 diabetes mellitus (T2DM), the number of patients receiving bariatric surgery (BS) remains low. Since the introduction of the Diabetes Surgery Summit II (DSS-II) eligibility criteria, data on eligibility rates for BS in T2DM cohorts remain scarce. The aims of the present study were to examine in a real-world clinical setting: (i) what is the percentage of T2DM patients visiting diabetes outpatient clinics who meet the DSS-II eligibility criteria, (ii) how many of these have been informed about the option of BS, and (iii) what are the characteristics associated with eligibility and awareness of BS. Demographic, anthropometric, clinical and socioeconomic data were obtained for all patients with T2DM who were consecutively examined in the outpatient clinics of three large-volume university hospitals (n = 1167). A medical registry form was completed to screen for BS eligibility. Patients were considered eligible if the recommendation by DSS-II criteria was either to “consider” or “recommend” BS. Eligible patients were further inquired whether they had ever been informed about the option of BS by their physicians. The advanced DiaRem score (ADRS) was applied to eligible patients to assess their probability of achieving postoperative T2DM remission. A significant percentage of T2DM patients who are routinely assessed in outpatient clinics meet the DSS-II eligibility criteria (15.3%). Eligible patients are younger and more obese, have a shorter T2DM duration, worse glycaemic control and better renal function, compared to non-eligible ones. Among eligible patients, only 39.3% have been medically informed about the option of BS. Informed patients are younger and more severely obese than non-informed ones. A significant percentage of non-informed patients (35%) have an ADRS ≤10, indicating a considerable probability for T2DM remission after BS, and are thus deprived of this opportunity due to lack of appropriate medical counseling. Screening and awareness of BS remain an unmet need in current T2DM management. Future research should focus on intensifying screening for BS eligibility at every medical visit and promoting evidence-based clinical recommendations for patients expected to benefit the most.

Abstract Background Schizophrenia (SCZ) is associated with increased risk of type 2 diabetes (T2D). The potential diabetogenic effect of concomitant application of psychotropic treatment classes in patients with SCZ has not yet been evaluated. The overarching goal of the Genetic Overlap between Metabolic and Psychiatric disease (GOMAP) study is to assess the effect of pharmacological, anthropometric, lifestyle and clinical measurements, helping elucidate the mechanisms underlying the aetiology of T2D. Methods The GOMAP case-control study (Genetic Overlap between Metabolic and Psychiatric disease) includes hospitalized patients with SCZ, some of whom have T2D. We enrolled 1653 patients with SCZ; 611 with T2D and 1042 patients without T2D. This is the first study of SCZ and T2D comorbidity at this scale in the Greek population. We retrieved detailed information on first- and second-generation antipsychotics (FGA, SGA), antidepressants and mood stabilizers, applied as monotherapy, 2-drug combination, or as 3- or more drug combination. We assessed the effects of psychotropic medication, body mass index, duration of schizophrenia, number of hospitalizations and physical activity on risk of T2D. Using logistic regression, we calculated crude and adjusted odds ratios (OR) to identify associations between demographic factors and the psychiatric medications. Results Patients with SCZ on a combination of at least three different classes of psychiatric drugs had a higher risk of T2D [OR 1.81 (95% CI 1.22–2.69); p = 0.003] compared to FGA alone therapy, after adjustment for age, BMI, sex, duration of SCZ and number of hospitalizations. We did not find evidence for an association of SGA use or the combination of drugs belonging to two different classes of psychiatric medications with increased risk of T2D [1.27 (0.84–1.93), p = 0.259 and 0.98 (0.71–1.35), p = 0.885, respectively] compared to FGA use. Conclusions We find an increased risk of T2D in patients with SCZ who take a combination of at least three different psychotropic medication classes compared to patients whose medication consists only of one or two classes of drugs.

Mucormycosis is a life-threatening respiratory fungal infection that typically occurs in patients with abnormalities in iron metabolism. Here the authors show that iron restriction inside the phagosome of macrophages is an essential component of the host defense against Rhizopus, the main species causing mucormycosis.

Shallow rocky reef fish assemblages were studied in sites of low versus high fishing pressure (FP) across the Aegean Sea, in order to assess community structure at a large scale and investigate spatial variability in relation to FP, depth, and geographic location. A total of 15 pairs of high and low FP sites were selected (18 sites in North Aegean, 12 in South Aegean). The level of FP was defined based on a fishing pressure index specifically developed for coastal small-scale fisheries in the region. In each site, fish communities were investigated at two depth zones (5 and 15 m). Number of species, fish size (Total Length; TL) and abundance were recorded along strip transects through underwater visual surveys. Abundance and TL were used to estimate biomass, and fish species were assigned to distinct trophic and commercial status groups. An 8-fold range in fish density and a 14-fold range in fish biomass were detected, while community structure was affected by all variables considered (FP, depth, geographic location). The N Aegean sites scored higher in number of species and biomass of carnivorous fish, whereas the S Aegean had a higher biomass of several allochthonous and thermophilous species. Abundance and biomass estimates were higher in low FP sites, and primarily at the 15 m depth zone, where low FP sites had the double abundance and 2.8 times higher biomass. Biomass of carnivores was generally very low, except at deep sites of low FP. Given that sites of lower FP represent areas of lower conflicting interests for fisheries whilst providing enhanced biomass levels, they should be included in future marine conservation planning schemes, as they could contribute to the replenishment of fisheries and the boosting of conservation benefits provided by MPAs, once properly managed.