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A growing awareness about brain health and Alzheimer's disease in the general population is leading to an increasing number of cognitively unimpaired individuals, who are concerned that they have reduced cognitive function, to approach the medical system for help. The term subjective cognitive decline (SCD) was conceived in 2014 to describe this condition. Epidemiological data provide evidence that the risk for mild cognitive impairment and dementia is increased in individuals with SCD. However, the majority of individuals with SCD will not show progressive cognitive decline. An individually tailored diagnostic process might be reasonable to identify or exclude underlying medical conditions in an individual with SCD who actively seeks medical help. An increasing number of studies are investigating the link between SCD and the very early stages of Alzheimer's disease and other neurodegenerative diseases.

أدركت المنظمات على اختلافها أن المخاطرة ليست في حد ذاتها عملا مستهجنا، ولكن الخطأ يكمن في مخاطرة لا تدرك أبعادها أو إدارتها، وأن المخاطرة من متطلبات الإبداع والابتكار، لكون ذلك سبيلا لتحقيق الميزة التنافسية وإنجاز الأهداف وضمان المنافع المتعددة؛ لذا فقد جعلت منها بعدا خامسا إلى جانب الأبعاد الأربعة المعروفة في بطاقة الأداء المتوازن. لقد قدم المؤلفان خبرتهما العملية والعلمية لمساعدة المنظمات على دمج إدارة المخاطر في تنفيذ إستراتيجيتها، والإفصاح عن كيفية ذلك في عالم سريع التطور والتغيير.

Previous studies have suggested that haemodynamic-guided management using an implantable pulmonary artery pressure monitor reduces heart failure hospitalisations in patients with moderately symptomatic (New York Heart Association [NYHA] functional class III) chronic heart failure and a hospitalisation in the past year, irrespective of ejection fraction. It is unclear if these benefits extend to patients with mild (NYHA functional class II) or severe (NYHA functional class IV) symptoms of heart failure or to patients with elevated natriuretic peptides without a recent heart failure hospitalisation. This trial was designed to evaluate whether haemodynamic-guided management using remote pulmonary artery pressure monitoring could reduce heart failure events and mortality in patients with heart failure across the spectrum of symptom severity (NYHA funational class II–IV), including those with elevated natriuretic peptides but without a recent heart failure hospitalisation. The randomised arm of the haemodynamic-GUIDEed management of Heart Failure (GUIDE-HF) trial was a multicentre, single-blind study at 118 centres in the USA and Canada. Following successful implantation of a pulmonary artery pressure monitor, patients with all ejection fractions, NYHA functional class II–IV chronic heart failure, and either a recent heart failure hospitalisation or elevated natriuretic peptides (based on a-priori thresholds) were randomly assigned (1:1) to either haemodynamic-guided heart failure management based on pulmonary artery pressure or a usual care control group. Patients were masked to their study group assignment. Investigators were aware of treatment assignment but did not have access to pulmonary artery pressure data for control patients. The primary endpoint was a composite of all-cause mortality and total heart failure events (heart failure hospitalisations and urgent heart failure hospital visits) at 12 months assessed in all randomly assigned patients. Safety was assessed in all patients. A pre-COVID-19 impact analysis for the primary and secondary outcomes was prespecified. This study is registered with ClinicalTrials.gov, NCT03387813. Between March 15, 2018, and Dec 20, 2019, 1022 patients were enrolled, with 1000 patients implanted successfully, and follow-up was completed on Jan 8, 2021. There were 253 primary endpoint events (0·563 per patient-year) among 497 patients in the haemodynamic-guided management group (treatment group) and 289 (0·640 per patient-year) in 503 patients in the control group (hazard ratio [HR] 0·88, 95% CI 0·74–1·05; p=0·16). A prespecified COVID-19 sensitivity analysis using a time-dependent variable to compare events before COVID-19 and during the pandemic suggested a treatment interaction (pinteraction=0·11) due to a change in the primary endpoint event rate during the pandemic phase of the trial, warranting a pre-COVID-19 impact analysis. In the pre-COVID-19 impact analysis, there were 177 primary events (0·553 per patient-year) in the intervention group and 224 events (0·682 per patient-year) in the control group (HR 0·81, 95% CI 0·66–1·00; p=0·049). This difference in primary events almost disappeared during COVID-19, with a 21% decrease in the control group (0·536 per patient-year) relative to pre-COVID-19, virtually no change in the treatment group (0·597 per patient-year), and no difference between groups (HR 1·11, 95% CI 0·80–1·55; p=0·53). The cumulative incidence of heart failure events was not reduced by haemodynamic-guided management (0·85, 0·70–1·03; p=0·096) in the overall study analysis but was significantly decreased in the pre-COVID-19 impact analysis (0·76, 0·61–0·95; p=0·014). 1014 (99%) of 1022 patients had freedom from device or system-related complications. Haemodynamic-guided management of heart failure did not result in a lower composite endpoint rate of mortality and total heart failure events compared with the control group in the overall study analysis. However, a pre-COVID-19 impact analysis indicated a possible benefit of haemodynamic-guided management on the primary outcome in the pre-COVID-19 period, primarily driven by a lower heart failure hospitalisation rate compared with the control group. Abbott.

Fisheries observer programs are used around the world to collect crucial information and samples that inform fisheries management. However, observer error may misidentify similar-looking shark species. This raises questions about the level of error that species misidentifications could introduce to estimates of species' life history parameters. This study addressed these questions using the Grey Reef Shark Carcharhinus amblyrhynchos as a case study. Observer misidentification rates were quantified by validating species identifications using diagnostic photographs taken on board supplemented with DNA barcoding. Length-at-age and maturity ogive analyses were then estimated and compared with and without the misidentified individuals. Vertebrae were retained from a total of 155 sharks identified by observers as C. amblyrhynchos. However, 22 (14%) of these were sharks were misidentified by the observers and were subsequently re-identified based on photographs and/or DNA barcoding. Of the 22 individuals misidentified as C. amblyrhynchos, 16 (73%) were detected using photographs and a further 6 via genetic validation. If misidentified individuals had been included, substantial error would have been introduced to both the length-at-age and the maturity estimates. Thus validating the species identification, increased the accuracy of estimated life history parameters for C. amblyrhynchos. From the corrected sample a multi-model inference approach was used to estimate growth for C. amblyrhynchos using three candidate models. The model averaged length-at-age parameters for C. amblyrhynchos with the sexes combined were L∞ = 159 cm TL and L0 = 72 cm TL. Females mature at a greater length (l50 = 136 cm TL) and older age (A50 = 9.1 years) than males (l50 = 123 cm TL; A50 = 5.9 years). The inclusion of techniques to reduce misidentification in observer programs will improve the results of life history studies and ultimately improve management through the use of more accurate data for assessments.

Ecosystem service valuation (ESV) can inform land-use change policy and adaptation responses to climate change in Pacific Small Island Developing States. Despite Small Island Developing States communities relying acutely and directly on ecosystem service (ES) flows, methodologies must contend with limited valuation data and challenges. We undertake ESV to generate coefficients we then apply to mapped habitat extents for Vanuatu. We find the contribution of ESs to the people of Vanuatu is considerable and significantly larger than its gross domestic product. Therefore, policies that support ecologically sustainable exploitation of ESs are paramount in promoting community well-being. We also identify and discuss context-specific methodological challenges, which, if not addressed, risk distorting valuations, supporting perverse policy responses, and eroding confidence in ESV. We make recommendations to address the challenges of accounting for ecosystem condition, data gaps, and consideration of customary benefits, provide context to the interpretation of our results, and suggest where further research can ameliorate risks.

Regular exercise improves health but can also induce adverse responses. Although such episodes are rare, many guidelines for pre-participation exercise screening have historically had a low threshold for recommending medical clearance prior to the commencement of exercise, placing the responsibility for decision making about exercise participation on physicians. The ‘clearance to exercise’ model still occurs widely in practice, but creates cost burdens and barriers to the uptake of exercise. Moreover, many physicians are not provided the training, nor time in a standard consultation, to be able to effectively perform this role. We present a model for pre-participation exercise screening and the initial assessment of clients wishing to commence an exercise programme. It is designed to guide professional practice for the referral, assessment and prescription of exercise for people across the health spectrum, from individuals who are apparently healthy, through to clients with pre-existing or occult chronic conditions. The model removes the request that physicians provide a ‘clearance’ for patients to engage in exercise programmes. Instead the role of physicians is identified as providing relevant clinical guidance to suitably qualified exercise professionals to allow them to use their knowledge, skills and expertise in exercise prescription to assess and manage any risks related to the prescription and delivery of appropriate exercise programmes. It is anticipated that removing unjustified barriers to exercise participation, such as mandated medical review, will improve the uptake of exercise by the unacceptably high proportion of the population who do not undertake sufficient physical activity for health benefit.

Saccharomyces cerevisiae is the micro-organism of choice for the conversion of monomeric sugars into bioethanol. Industrial bioethanol fermentations are intrinsically stressful environments for yeast and the adaptive protective response varies between strain backgrounds. With the aim of identifying quantitative trait loci (QTL's) that regulate phenotypic variation, linkage analysis on six F1 crosses from four highly divergent clean lineages of S. cerevisiae was performed. Segregants from each cross were assessed for tolerance to a range of stresses encountered during industrial bioethanol fermentations. Tolerance levels within populations of F1 segregants to stress conditions differed and displayed transgressive variation. Linkage analysis resulted in the identification of QTL's for tolerance to weak acid and osmotic stress. We tested candidate genes within loci identified by QTL using reciprocal hemizygosity analysis to ascertain their contribution to the observed phenotypic variation; this approach validated a gene (COX20) for weak acid stress and a gene (RCK2) for osmotic stress. Hemizygous transformants with a sensitive phenotype carried a COX20 allele from a weak acid sensitive parent with an alteration in its protein coding compared with other S. cerevisiae strains. RCK2 alleles reveal peptide differences between parental strains and the importance of these changes is currently being ascertained.

Growth and maturity of the silvertip shark Carcharhinus albimarginatus from Papua New Guinea were estimated to form the basis of future population assessments. Samples were collected from commercial longline vessels targeting sharks in the Bismarck and Solomon Seas. A total of 48 C. albimarginatus —28 males (95–219 cm total length, TL) and 20 females (116–250 cm TL)—provided data for the analyses. Employing back-calculation techniques accounted for missing juvenile length classes and supplemented the sample size. A multi-model framework incorporating the Akaike information criterion was used to estimate growth parameters. The von Bertalanffy growth function (VBGF) provided the best-fit growth estimates. Parameter estimates were L 0  = 72.1 cm TL, k  = 0.04 yr −1 and L ∞  = 311.3 cm TL for males; and L 0  = 70.8 cm TL, k  = 0.02 yr −1 and L ∞  = 497.9 cm TL for females. The biologically implausible L ∞ occurred for females as their growth did not asymptote; a typical trait of large shark species. The maximum age estimated from vertebral analysis was 18 yr for both sexes, while the calculated longevity from the VBGF parameters was 27.4 yr for males and 32.2 yr for females. Males matured at 174.7 cm TL and 10.5 yr old, while females matured at 208.9 cm TL and 14.8 yr old.

Over recent decades, substantial funding from a variety of sources has been directed towards climate change adaptation projects in Pacific Island countries. There remains, however, considerable uncertainty about which factors influence adaptation project completion, as a pre-cursor to effective adaptation. In this study, we empirically establish the links between project attributes (duration, funding, cash co-financing, in-kind contributions, location, and adaptation approach) and whether a project is likely to complete or be terminated. We examine this issue by developing a logistic regression model to predict the probability of completion for small-scale climate change adaptation projects using a new dataset of 190 projects in the South Pacific (with end dates ranging from November 1995 to May 2016) that were financed through the Global Environment Facility Small Grants Programme. Empirical results suggest that all else equal, such a project was more likely to complete if it was shorter, received more co-financing cash input and in-kind support from other donors and project partners, was explicitly targeted towards climate change adaptation, focused on a single adaptation approach, and was undertaken in Micronesia or Fiji. Our results can be used to help funders and project proponents design projects to mitigate the risks of non-completion, particularly in high-risk settings. These findings should not be misinterpreted to undermine the importance of continued investment in adaptation projects across the whole of South Pacific region.