Lowestoft Hospital

Artificial intelligence (AI) is a powerful and disruptive area of computer science, with the potential to fundamentally transform the practice of medicine and the delivery of healthcare. In this review article, we outline recent breakthroughs in the application of AI in healthcare, describe a roadmap to building effective, reliable and safe AI systems, and discuss the possible future direction of AI augmented healthcare systems.

The label 'chronic fatigue syndrome' (CFS) has persisted for many years because of the lack of knowledge of the aetiological agents and the disease process. In view of more recent research and clinical experience that strongly point to widespread inflammation and multisystemic neuropathology, it is more appropriate and correct to use the term 'myalgic encephalomyelitis' (ME) because it indicates an underlying pathophysiology. It is also consistent with the neurological classification of ME in the World Health Organization's International Classification of Diseases (ICD G93.3). Consequently, an International Consensus Panel consisting of clinicians, researchers, teaching faculty and an independent patient advocate was formed with the purpose of developing criteria based on current knowledge. Thirteen countries and a wide range of specialties were represented. Collectively, members have approximately 400 years of both clinical and teaching experience, authored hundreds of peer-reviewed publications, diagnosed or treated approximately 50 000 patients with ME, and several members coauthored previous criteria. The expertise and experience of the panel members as well as PubMed and other medical sources were utilized in a progression of suggestions/drafts/reviews/revisions. The authors, free of any sponsoring organization, achieved 100% consensus through a Delphi-type process. The scope of this paper is limited to criteria of ME and their application. Accordingly, the criteria reflect the complex symptomatology. Operational notes enhance clarity and specificity by providing guidance in the expression and interpretation of symptoms. Clinical and research application guidelines promote optimal recognition of ME by primary physicians and other healthcare providers, improve the consistency of diagnoses in adult and paediatric patients internationally and facilitate clearer identification of patients for research studies.

Abstract Variability of the North Atlantic Oscillation and the Tropical Atlantic dominate the climate of the North Atlantic sector, the underlying ocean and surrounding continents on interannual to decadal time scales. Here we review these phenomena, their climatic impacts and our present state of understanding of their underlying cause. Copyright © 2001 Royal Meteorological Society

There is increasing public, governmental and commercial interest in the welfare of intensively farmed fish and stocking density has been highlighted as an area of particular concern. Here we draw scientific attention and debate to this emerging research field by reviewing the evidence for effects of density on rainbow trout. Although no explicit reference to ‘welfare’ has been made, there are 43 studies which have examined the effects of density on production and physiological parameters of rainbow trout. Increasing stocking density does not appear to cause prolonged crowding stress in rainbow trout. However, commonly reported effects of increasing density are reductions in food conversion efficiency, nutritional condition and growth, and an increase in fin erosion. Such changes are indicative of a reduced welfare status—although the magnitude of the effects has tended to be dependent upon study‐specific conditions. Systematic observations on large scale commercial farms are therefore required, rather than extrapolation of these mainly small‐scale experimental findings. There is dispute as to the cause of the observed effects of increasing density, with water quality deterioration and/or an increase in aggressive behaviour being variously proposed. Both causes can theoretically generate the observed effects of increasing density, and the relative contribution of the two causes may depend upon the specific conditions. However, documentation of the relationship between density and the effects of aggressive behaviour at relevant commercial densities is lacking. Consequently only inferential evidence exists that aggressive behaviour generates the observed effects of increasing density, whereas there is direct experimental evidence that water quality degradation is responsible. Nevertheless, there are contradictory recommendations in the literature for key water quality parameters to ensure adequate welfare status. The potential for welfare to be detrimentally affected by non‐aggressive behavioural interactions (abrasion, collision, obstruction) and low densities (due to excessive aggressive behaviour and a poor feeding response) have been largely overlooked. Legislation directly limiting stocking density is likely to be unworkable, and a more practical option might be to prescribe acceptable levels of water quality, health, nutritional condition and behavioural indicators.

Large-scale transitions between alternative states in ecosystems are known as regime shifts. Once described as healthy and dominated by various marine predators, the Black Sea ecosystem by the late 20th century had experienced anthropogenic impacts such as heavy fishing, cultural eutrophication, and invasions by alien species. We studied changes related to these "natural experiments" to reveal the mechanisms of regime shifts. Two major shifts were detected, the first related to a depletion of marine predators and the second to an outburst of the alien comb jelly Mnemiopsis leidyi; both shifts were triggered by intense fishing resulting in system-wide trophic cascades. The complex nature of ecosystem responses to human activities calls for more elaborate approaches than currently provided by traditional environmental and fisheries management. This implies challenging existing practices and implementing explanatory models of ecosystem interactions that can better reconcile conservation and ecosystem management ideals.

Abstract Management strategy evaluation ( MSE ) involves using simulation to compare the relative effectiveness for achieving management objectives of different combinations of data collection schemes, methods of analysis and subsequent processes leading to management actions. MSE can be used to identify a ‘best’ management strategy among a set of candidate strategies, or to determine how well an existing strategy performs. The ability of MSE to facilitate fisheries management achieving its aims depends on how well uncertainty is represented, and how effectively the results of simulations are summarized and presented to the decision‐makers. Key challenges for effective use of MSE therefore include characterizing objectives and uncertainty, assigning plausibility ranks to the trials considered, and working with decision‐makers to interpret and implement the results of the MSE . This paper explores how MSE s are conducted and characterizes current ‘best practice’ guidelines, while also indicating whether and how these best practices were applied to two case‐studies: the B ering– C hukchi– B eaufort Seas bowhead whales ( B alaena mysticetus ; B alaenidae) and the northern subpopulation of P acific sardine ( S ardinops sagax caerulea; C lupeidae).

The climatically sensitive zone of the Arctic Ocean lies squarely within the domain of the North Atlantic oscillation (NAO), one of the most robust recurrent modes of atmospheric behavior. However, the specific response of the Arctic to annual and longer-period changes in the NAO is not well understood. Here that response is investigated using a wide range of datasets, but concentrating on the winter season when the forcing is maximal and on the postwar period, which includes the most comprehensive instrumental record. This period also contains the largest recorded low-frequency change in NAO activity—from its most persistent and extreme low index phase in the 1960s to its most persistent and extreme high index phase in the late 1980s/early 1990s. This long-period shift between contrasting NAO extrema was accompanied, among other changes, by an intensifying storm track through the Nordic Seas, a radical increase in the atmospheric moisture flux convergence and winter precipitation in this sector, an increase in the amount and temperature of the Atlantic water inflow to the Arctic Ocean via both inflow branches (Barents Sea Throughflow and West Spitsbergen Current), a decrease in the late-winter extent of sea ice throughout the European subarctic, and (temporarily at least) an increase in the annual volume flux of ice from the Fram Strait.

We examine the evolving concept of what constitutes a non-native (or alien) freshwater fish. In an attempt to distinguish between biogeographical and socio-political perspectives, we review the patterns in the introduction and dispersal of non-native fishes in Europe and North America, and especially the recent expansion of Ponto-Caspian gobies in Europe. We assess patterns in the development of national policy and legislation in response to the perceived threat of non-native fish introductions to native species and ecosystems. We review, and provide a glossary of, the terms and definitions associated with non-native species. Finally, we discuss perspectives as regards the future treatment of naturalized species.

Abstract The usefulness and relevance of size-based indicators (SBIs) to an ecosystem approach to fisheries (EAF) are assessed through a review of empirical and modelling studies. SBIs are tabulated along with their definitions, data requirements, potential biases, availability of time-series, and expected directions of change in response to fishing pressure. They include mean length in a population, mean length in a community, mean maximum length in a community, and the slope and intercept of size spectra. Most SBIs can be derived from fairly standard survey data on length frequencies, without the need for elaborate models. Possible fishing- and environment-induced effects are analysed to distinguish between the two causes, and hypothetical cases of reference directions of change are tabulated. We conclude that no single SBI can serve as an effective overall indicator of heavy fishing pressure. Rather, suites of SBI should be selected, and reference directions may be more useful than reference points. Further modelling and worldwide comparative studies are needed to provide better understanding of SBIs and the factors affecting them. The slow response to fishing pressure reflects the complexity of community interactions and ecosystem responses, and prohibits their application in the context of short-term (annual) tactical fisheries management. However, movement towards longer-term (5–10 years) strategic management in EAF should facilitate their use.

The ratio of respiration to maximal photosynthesis in small diatoms is low so they can survive in weakly stratified water. In contrast, the same ratio for dinoflagellates is three times as high and they need waters that are strongly stratified. Some successional phenomena may be explicable in this way. The great fisheries depend on spring or autumn outbursts in temperate waters and on upwelh'ng areas in regions, equatorward of 40° latitude. It is suggested that they are linked to the small diatoms, in traditional food chains, in weakly stratified waters.

Metabarcoding has been used in a range of ecological applications such as taxonomic assignment, dietary analysis and the analysis of environmental DNA. However, after a decade of use in these applications there is little consensus on the extent to which proportions of reads generated corresponds to the original proportions of species in a community. To quantify our current understanding, we conducted a structured review and meta-analysis. The analysis suggests that a weak quantitative relationship may exist between the biomass and sequences produced (slope = 0.52 ± 0.34, p < 0.01), albeit with a large degree of uncertainty. None of the tested moderators, sequencing platform type, the number of species used in a trial or the source of DNA, were able to explain the variance. Our current understanding of the factors affecting the quantitative performance of metabarcoding is still limited: additional research is required before metabarcoding can be confidently utilized for quantitative applications. Until then, we advocate the inclusion of mock communities when metabarcoding as this facilitates direct assessment of the quantitative ability of any given study.

Dechlorane Plus (DP) is a high production volume, chlorinated flame retardant. Despite its long production history, it was only recently found in the environment. The first "sightings" of DP were in the North American Great Lakes, but subsequent work has indicated that DP is a global contaminant. For example, DP has recently been detected along a pole-to-pole transect of the Atlantic Ocean. Although it was initially thought that DP was produced only in North America, another DP production plant has recently been identified in China. During the course of characterizing DP in the environment, other "DP-like" compounds were identified. These DP analogs, some created from impurities contained in the starting materials during DP's synthesis, have also been detected globally. Screening-level modeling data are in general agreement with available environmental measurements, suggesting that DP and it analogs may be persistent, bioaccumulative, and subject to long-range transport and that these chemicals may be candidates for Annex D evaluation under the United Nations Stockholm Convention on Persistent Organic Pollutants. However, more research is required to better quantify the emissions, exposures, and toxicological effects of DP and its analogs in the environment. In particular, there is a need to obtain more monitoring, bioaccumulation, degradation rate, and toxicity information.

A versatile functional form relating recruitment to spawning stock biomass for fisheries is proposed. The non-negative, three-parameter form distinguishes resilience and degree of compensation as two aspects of the density dependence of recruitment, and permits the representation of non-asymptotic, asymptotic, and domed stock-recruitment relationships by parameter variation within the same functional form. Simple methods for parameter estimation are discussed.

Summary There are four methods of analysing the vertical migration of plankton in the field: (a) One day and one night observation at the surface. (b) One day and one night observation at depths between surface and the bottom. (c) Observations at long time intervals at all depths during day and night. (d) Observations at short time intervals at all depths during day and night. The last method, using horizontal closing tow‐nets with flow meters at measured depths, shows that migration consists of four parts: (a) ascent from the day depth; (b) midnight sinking; (c) dawn rise; (d) descent to the day depth. This pattern has been shown to be modified by wind (or state of sea), rain, sun on a calm sea, extremes of temperature, age of the individual animal and possibly by phytoplankton concentrations. These different parts of migration have been examined in detail and linked together in a single and continuous process. Ascent in the evening and descent in the morning become the continuous change of day depth with the changing penetration of light; the midnight sinking is assumed to be due to a passive state in full darkness; the dawn rise is a return by the animals to the mean optimum light intensity for the population. This is supported by the fact that the order in time of arrival at the surface for some fresh‐water species is the same as the order in depth of these species in full daylight. Theoretical interpretations of migration are reviewed. It is argued that the most likely theory has as its basic assumption the idea of an optimum light intensity. Experiments on migration are divided into three parts: (a) those showing that randomly oriented movement can take place; (b) those showing that the speeds of individual animals can vary with varying light intensities; (c) those showing that animals in full darkness will move at minimal speeds or not at all. It is concluded that the vertical migration of planktonic Crustacea is mediated by the change in light penetration throughout the day. Animals aggregate in an optimum band of light intensity. They have the capacity of moving phototactically, i.e. moving at constant speed towards or away from light; they also have the capacity of moving photokinetically, i.e. moving at speeds that vary with varying light intensity. In full darkness they move probably at minimal speeds. Migration between periods of full darkness may be operated by phototaxis, photokinesis or by a combination of these mechanisms.

A procedure previously used for sex steroids was adapted to extract free cortisol and cortisone from water samples taken from rainbow trout Oncorhynchus mykiss tanks. Both corticosteroids could be readily detected by radioimmunoassay (RIA), with cortisol being predominant. All stages of the sampling, extraction and RIA procedure were validated for cortisol. An intermittent problem with poor replication was traced to the use of diethyl ether during the extraction procedure, and was overcome by the use of ethyl acetate. Other modifications were also introduced to speed up the procedure. The concentration and time course of release of both corticosteroids were shown to be related to the degree of stress that the fish had been subjected to. It was confirmed that cortisol concentrations in water and estimated cortisol release rates increased in response to handling stress, and that both were correlated with plasma cortisol concentrations. The potential for using water cortisol concentration and release rates to assess the primary stress response of fishes as a non‐invasive alternative to blood sampling is discussed.

Abstract Kell, L. T., Mosqueira, I., Grosjean, P., Fromentin, J-M., Garcia, D., Hillary, R., Jardim, E., Mardle, S., Pastoors, M. A., Poos, J. J., Scott, F., and Scott, R. D. 2007. FLR: an open-source framework for the evaluation and development of management strategies. – ICES Journal of Marine Science, 64: 640–646. The FLR framework (Fisheries Library for R) is a development effort directed towards the evaluation of fisheries management strategies. The overall goal is to develop a common framework to facilitate collaboration within and across disciplines (e.g. biological, ecological, statistical, mathematical, economic, and social) and, in particular, to ensure that new modelling methods and software are more easily validated and evaluated, as well as becoming widely available once developed. Specifically, the framework details how to implement and link a variety of fishery, biological, and economic software packages so that alternative management strategies and procedures can be evaluated for their robustness to uncertainty before implementation. The design of the framework, including the adoption of object-orientated programming, its feasibility to be extended to new processes, and its application to new management approaches (e.g. ecosystem affects of fishing), is discussed. The importance of open source for promoting transparency and allowing technology transfer between disciplines and researchers is stressed.

Summary (1) The fluid properties of air and water enable animals to orientate to flow and this behaviour in water is termed rheotaxis . Fish, however, have a wide range of responses to currents, extending beyond simple orientation, and the term rheotropism is therefore used as a ‘portmanteau’ word to describe all such reactions. (2) Fish detect currents directly by flow over the body surface or indirectly by other stimuli. Indirect responses are more common and occur in response to visual, tactile and inertial stimuli resulting from displacement of the fish by the current. Reactions to displacement of visual images are called optomotor reactions . The lateral line is not involved except in the detection of small localized jets of water. It has not been demonstrated that any fish can detect the current by electrical stimuli, although it is theoretically possible for some to do so. (3) In the basic form of rhotaxis the fish heads upstream and maintains station by stemming the current. Current detection thresholds fall within the range 0.4 to 10 cm/s for tactile stimuli but may be as low as 0.03 cm/s for visual stimuli. (4) Visual responses have been studied by simulating displacement by the current in optomotor apparatus. Fish respond to a rotating black‐and‐white‐striped background by compensatory movements of the head and eyes ‐ optokinetic nystagmus ‐ or by the optomotor reaction , in which the fish swims with the background. (5) Fish show an orthokinesis in optomotor apparatus, their mean swimming speed increasing with the speed of rotation of the background. The precise form of the relationship varies between species and there is also considerable individual variation in performance. Fish accelerate and decelerate relative to the background, fixating on a particular stripe for short periods. (6) Factors limiting the appearance of the optomotor response are contrast, illuminance, acuity, critical flicker fusion frequency and spectral sensitivity. (7) Fish tolerate retinal image movements equivalent to those received when they are carried forwards by the current but not to those received when they are carried backwards. There are ganglion cells in the optic tectum which are sensitive to the direction of movement of targets across the visual field. In the goldfish there are significantly more units sensitive to movements in the temporo‐nasal than in the opposite direction. (8) There are close parallels between the behaviour of fish in schools and in an optomotor apparatus. The optomotor response is apparently innate, occurring in newly hatched fry. (9) Physical and chemical factors can modify rheotaxis. Temperature and olfactory stimuli affect both the sign of the taxis and the kinetic component of the behaviour. (10) Thyroid hormones which are involved in the control of migration have been shown to affect the kinetic component of rheotaxis. (11) Fish show a number of hydrodynamic adaptations to life in currents. Morphological modifications are greatest in fish from torrential streams, which show extreme dorsoventral flattening and have specialized adhesive organs. Other fish select areas of low velocity or decrease their buoyancy with increasing current speed. (12) Rheotropic behaviour plays an important role in the distribution of fish within stream systems, in the maintenance of territory and station and in feeding behaviour. Territory, station and spawning sites in salmonids are all selected in relation to water velocity. (13) Water currents are thought to provide either a transport system or directional clues for fish on migration. The fish either does not respond to the current and is carried passively downstream, or it makes an orientated movement, swimming up‐ or downstream. (14) Eggs and larvae are known to drift passively downstream from their spawning grounds and some adult fish may also drift passively. In the sea both adult and juvenile fish use a form of modulated drift associated with vertical migration. Fish move up into midwater either by direct tidal selection or in relation to the diel cycle of illuminance. In fresh water the downstream migrations of salmonid fry, and smolts under some conditions, occur by modulated drift. (15) There is no evidence that fish migrating in the sea orientate to the current, but in fresh water the upstream migrations of diadromous fish are clearly orientated movements. (16) Water velocity is a major factor for salmonids migrating upstream. For fry it limits the occurrence of upstream migrations and for adults it can also prevent upstream movement. But migrations are often initiated by freshets, and changing water velocity is thought to be the most important factor associated with a freshet. (17) Both environmental and genetic factors affect the direction of migration in relation to the current. In some sockeye salmon fry direction is determined by temperature, but in others the overall direction of movement is genetically determined and environmental factors only modify the behaviour. (18) Rheotropic behaviour has a number of important practical applications in the capture of fish and in guiding them past dams and power stations. (19) The optomotor response plays a basic role in the capture of roundfish by trawls under conditions when the fish can see the gear. Many fish are caught because they become fatigued after a prolonged period of swimming at the same speed as the trawl. (20) Most success in guiding fish away from hazardous areas and bypassing them round dams has been achieved with mechanical barriers which depend on rheotropic reactions of the fish. (21) Louvre screens are very successful in deflecting juvenile salmonids migrating downstream past small dams but are impracticable at large dams. Instead, the turbine intakes are commonly sited at a considerable depth and fish are bypassed by mechanical screens either at the surface of the forebay or into the gatewells immediately upstream of the turbine intakes. (22) With upstream migrants the basic problem is to attract fish to the lower end of the fishways. An adequate ‘attraction velocity’ is an important feature of fishways, which must be sited so that the fish avoid the high velocity discharges from spillways and turbines.

Abstract The ability of management strategies to achieve the fishery management goals are impacted by environmental variation and, therefore, also by global climate change. Management strategies can be modified to use environmental data using the “dynamic B0” concept, and changing the set of years used to define biomass reference points. Two approaches have been developed to apply management strategy evaluation to evaluate the impact of environmental variation on the performance of management strategies. The “mechanistic approach” estimates the relationship between the environment and elements of the population dynamics of the fished species and makes predictions for population trends using the outputs from global climate models. In contrast, the “empirical approach” examines possible broad scenarios without explicitly identifying mechanisms. Many reviewed studies have found that modifying management strategies to include environmental factors does not improve the ability to achieve management goals much, if at all, and only if the manner in which these factors drive the system is well known. As such, until the skill of stock projection models improves, it seems more appropriate to consider the implications of plausible broad forecasts related to how biological parameters may change in the future as a way to assess the robustness of management strategies, rather than attempting specific predictions per se.

A long-term increase in northerly wind componentl over the eastern North Atlantic and European Seaboard between 1950 and 1980 is associated both with a decline of phytoplankton and zooplankton biomass in sea-areas around the British Isles, and with an increase in upwelling intensity along the Iberian west coast. The implications for certain pelagic fish stocks in the area are assessed.

. Using data from larval surveys in the Sargasso Sea, we show that spawning likely begins in December and peaks in February. Synthesizing these results, we show that the timing of autumn escapement and the rate of migration are inconsistent with the century-long held assumption that eels spawn as a single reproductive cohort in the springtime following their escapement. Instead, we suggest that European eels adopt a mixed migratory strategy, with some individuals able to achieve a rapid migration, whereas others arrive only in time for the following spawning season. Our results have consequences for eel management.