Background: The 11th revision of the International Classification of Diseases (ICD-11) includes a new diagnosis of complex posttraumatic stress disorder (CPTSD). The International Trauma Interview (ITI) is a novel clinician-administered diagnostic interview for the assessment of ICD-11 PTSD and CPTSD. Objective: The aim of this study was to evaluate the psychometric properties of the ITI in a Lithuanian sample in relation to interrater agreement, latent structure, internal reliability, as well as convergent and discriminant validity. Method: In total, 103 adults with a history of various traumatic experiences participated in the study. The sample was predominantly female (83.5%), with a mean age of 32.64 years (SD = 9.36). For the assessment of ICD-11 PTSD and CPTSD, the ITI and the self-report International Trauma Questionnaire (ITQ) were used. Mental health indicators, such as depression, anxiety, and dissociation, were measured using self-report questionnaires. The latent structure of the ITI was evaluated using confirmatory factor analysis (CFA). In order to test the convergent and discriminant validity of the ITI we conducted a structural equation model (SEM). Results: Overall, based on the ITI, 18.4% of participants fulfilled diagnostic criteria for PTSD and 21.4% for CPTSD. A second-order two-factor CFA model of the ITI PTSD and disturbances in self-organization (DSO) symptoms demonstrated a good fit. The associations with various mental health indicators supported the convergent and discriminant validity of the ITI. The clinician-administered ITI and self-report ITQ had poor to moderate diagnostic agreement across different symptom clusters. Conclusion: The ITI is a reliable and valid tool for assessing and diagnosing ICD-11 PTSD and CPTSD.
Background Despite calf muscle strain injuries (CMSI) being problematic in many sports, there is a dearth of research to guide clinicians dealing with these injuries. The aim of this study was to evaluate the current practices and perspectives of a select group of international experts regarding the assessment, management and prevention of CMSI using in-depth semi-structured interviews. Results Twenty expert clinicians working in elite sport and/or clinician-researchers specialising in the field completed interviews. A number of key points emerged from the interviews. Characteristics of CMSI were considered unique compared to other muscle strains. Rigor in the clinical approach clarifies the diagnosis, whereas ongoing monitoring of calf capacity and responses to loading exposure provides the most accurate estimate of prognosis. Athlete intrinsic characteristics, injury factors and sport demands shaped rehabilitation across six management phases, which were guided by key principles to optimise performance at return to play (RTP) while avoiding subsequent injury or recurrence. To prevent CMSI, periodic monitoring is common, but practices vary and data are collected to inform load-management and exercise selection rather than predict future CMSI. A universal injury prevention program for CMSI may not exist. Instead, individualised strategies should reflect athlete intrinsic characteristics and sport demands. Conclusions Information provided by experts enabled a recommended approach to clinically evaluate CMSI to be outlined, highlighting the injury characteristics considered most important for diagnosis and prognosis. Principles for optimal management after CMSI were also identified, which involved a systematic approach to rehabilitation and the RTP decision. Although CMSI were reportedly difficult to prevent, on- and off-field strategies were implemented by experts to mitigate risk, particularly in susceptible athletes.
Background 3D printing is revolutioning many industrial sectors and has the potential to enhance also the biotechnology and bioprocessing fields. Here, we propose a new flexible material formulation to 3D print support matrices with complex, perfectly ordered morphology and with tuneable properties to suit a range of applications in bioprocess engineering. Findings Supports were fabricated using functional monomers as the key ingredients, enabling matrices with bespoke chemistry, such as charged groups, chemical moieties for further functionalization, and hydrophobic/hydrophilic groups. Other ingredients, e.g. crosslinkers and porogens, can be employed to fabricate supports with diverse characteristics of their porous network, providing an opportunity to further regulate the mechanical and mass transfer properties of the supports. Through this approach, we fabricated and demonstrated the operation of Schoen gyroid columns with (I) positive and negative charges for ion exchange chromatography, (II) enzyme bioreactors with immobilized trypsin to catalyse hydrolysis, and (III) bacterial biofilm bioreactors for fuel desulphurization. Conclusions This study demonstrates a simple, cost-effective, and flexible fabrication of customized 3D printed supports for different biotechnology and bioengineering applications.
Background Studies on football and the coronavirus disease 2019 (COVID-19) have mainly focused on the lockdown consequences for player fitness, the resumption of football training, and how to safely restart the league play, but injury data are scarce. Objective To describe the injury incidence and injury burden in men’s professional football teams during the pandemic year of 2020 . Methods Nineteen teams in 12 countries prospectively registered data on player-exposure and time-loss injuries throughout 2020. All major football leagues were paused as a direct response to the pandemic in March 2020 and were thereafter completely cancelled or restarted after a lockdown interval of at least two months. Historical data from 43 teams in the same cohort during the five preceding years (2015–2019) were used as reference. Between-season and within-season comparisons were made for injury incidence (number of injuries per 1000 h) and injury burden (number of absence days per 1000 h) with 95% confidence intervals and interquartile ranges. Results There was no increased match injury incidence or injury burden following the restart in 2020 compared with other time periods of 2020 and the corresponding periods 2015–2019. There was an increased training injury incidence and injury burden immediately during the lockdown in 2020, and they remained elevated also following the restart, being higher in 2020 compared with 2015–2019, respectively. The injury characteristics during the first months of the new 2020/21 season (August/September–December) were similar between the five teams that cancelled their 2019/20 season in March 2020 and the 14 teams that restarted their season in May/June 2020. Conclusions There was no increased match injury incidence or injury burden following the COVID-19 lockdown and restart of the football season in 2020, but training injury incidence and injury burden were elevated and higher than in 2015–2019.
Environmental transmission of Chlamydia abortus as a result of enzootic disease or disease outbreaks and the threats posed by this pathogen has been previously reported, however a state-of-the-science review of these reports and the identification of future research priorities in this area is still lacking. This study provides an overview of the current knowledge of host–pathogen–environment interactions, addressing public health risks and identifying critical questions and research gaps. We performed a systematic PubMed and Web of Science search for publications related to Chlamydia abortus in the past four decades, and we reviewed and combined the evidence critically discussing and commenting the results. A total of 182 studies, 5 chapters of specific books and the “OIE terrestrial manual” were included in this review. There were substantial variations between the studies in topic addressed and experimental design. Overall, the literature largely supports the crucial role played by environmental exposure on the acquisition of zoonotic disease caused by Chlamydia abortus . We also identify the paucity of information related to interspecies transmission and pathogen adaptation in relation to environmental dissemination and zoonotic risk. This analysis further highlights the need for additional research given that environmental transmission represents a serious risk not only to susceptible patients (pregnant women and immunocompromised individuals), but also for other species including wildlife.
This study uses material flow analysis to estimate the material stocks and flows and associated upfront embodied carbon emissions for gravity building structural systems in the United States. Seven scenarios that align with the shared-socioeconomic pathways are conceptualized and used to estimate floor space and structural material demands through 2100. These scenarios consider aggressive, moderate, and low adoption rates of timber-based structural materials. Under all scenarios, total floor space is projected to increase to a maximum upper-bound of 202% (162,187 m²) between 2020 and 2100. The results indicate that the associated increase demand for structural materials cannot be met solely by urban mining of decommissioned buildings. Assuming present-day carbon emissions intensities of structural materials, the average upfront embodied carbon intensity for gravity superstructures in the building stock decreases from 49 kg CO2e/m² in 2020 to 29 kg CO2e/m² in 2100 under the scenario with aggressive adoption of timber-based systems.
The addition of hydrogen peroxide and steam to a hydrogen-fuelled HCCI engine was investigated at various fuel lean conditions (ϕeff = 0.2–0.6) and compression ratios (15–20) using a 0-dimensional numerical model. The use of hydrogen peroxide as an ignition promoter demonstrated increased IMEP (16%–39%), thermal efficiency (up to 2%), and reduced NOx (50%–76%) when compared to the conventional method of intake charge heating. When hydrogen peroxide was used as an ignition promoter, a 15% addition of steam was sufficient to reduce NOx by 93%–97%, though this reduced IMEP and thermal efficiency slightly. When heat transfer was considered and steam addition was increased from 0%–10%, no increase in intake air heating was able to match the IMEP of 5% hydrogen peroxide addition without an increase in the equivalence ratio (up to 40%). The parametric space of hydrogen peroxide (0%–25%) and steam (0%–40%) addition was explored in view of engine performance metrics, showing the complete range of conditions possible through control of both inputs. A three-order reduction in NOx was possible through steam addition. An optimal balance of performance and emissions occurred at 5%–10% hydrogen peroxide and 10%–15% steam addition. In a study of compression ratio, very little hydrogen peroxide addition (<5%) was required to achieve 98% of the maximum efficiency at higher compression ratios (19–20), though at lower compression ratios (<17) impractical quantities of hydrogen peroxide were required. The 10% steam addition present at these conditions led to extremely low NOx levels for ϕeff of 0.3 and 0.4, though at ϕeff of 0.5 NOx levels would require some after-treatment. Maintaining constant a high or low load across steam additions was possible through reasonable adjustment of hydrogen peroxide addition.
Wind is an environmentally friendly energy source that can be harnessed as an on-shore and off-shore resource. Wind energy, combined with other renewable energy systems, has resulted in a more reliable, feasible, and efficient stand-alone system, known as a hybrid renewable energy system, in which excess energy is stored in batteries. To make hybrid renewable energy systems more efficient using economical energy storage, even in off-grid mode, various other energy combinations have been implemented. In analysing the various combinations of hybrid renewable energy systems, economic factors, such as fuel cost, cost of energy, net present cost, and capital cost, as well as technical factors, namely duty factor, excess energy, average energy production, and unmet load, are considered. The consideration of both economic and technical factors provides comprehensive guidance in determining the optimum load combination, storage type and capacity, off-grid and on-grid simulation details, energy balancing, scale of optimum production, risk assessments, and investor confidence. Accordingly, the operation of hybrid renewable energy systems has improved and become more reliable. Furthermore, the improvement of hybrid renewable energy system performance owing to techno-economic assessments has significantly reduced the costs of battery energy storage used in hybrid renewable energy systems as a backup system. In addition, such improvements in hybrid renewable energy system operation have enabled enhanced applications of these systems in the off-grid mode and resulted in the reduction of high grid upgrading and extension costs in various locations. Hybrid renewable energy systems facilitate the economical distribution of distributed electricity generation in various isolated areas with low density. The analytical methods described in the literature cover various aspects and factors considered in the techno-economic assessments of hybrid renewable energy systems in several countries. This study reviews the penetration of wind power into hybrid renewable energy systems as a solution to current energy deficiencies in different countries around the world. The review is conducted based on the available technical and economic factors of different countries to analyse the wind power penetration in various hybrid systems. Asian countries are noted to have the potential to penetrate wind energy into hybrid systems, yet some constraints, such as lack of experience and information, are a major limitation. Furthermore, in European countries, curtailment, high -wake effects, and financial difficulties are common. The technical development of wind power is insufficient in African countries. European countries are ahead in terms of the technical development of wind power penetration into hybrid systems. In some developed countries, such as Germany, hydrogen is used for energy storage, while batteries and generators are used in most Asian countries. In European, Asian, and North and South American countries, the solar/wind combination was identified as economical whereas photovoltaic and diesel/wind were in African countries. Despite these challenges, almost all countries have identified the potential for wind power generation using the available wind energy resources.
Scotland once had the largest herring fishery globally, generating local income, identity, and societal change. Following historic stock collapse, in spring 2018/2019 large herring shoals were observed on the west coast for the first time in decades, at a formerly important spawning ground. This highlights the urgency of maintaining historic (and contemporary) benthic spawning habitat, which these fish rely upon, in good condition. However, information on exact location, characteristics, and status of historic and contemporary spawning grounds, if existing, is not easily accessible. We searched over 1190 literature sources, dating back to 1884, using scientific databases and web-based searches, and ran a query for automated search of comprehensive historic reports. We present current knowledge on Scottish herring spawning grounds, retrieved through these searches and fisher interviews, maps showing historic and contemporary spawning grounds, and discuss challenges arising from the methods used to recognize these grounds. Knowledge gaps regarding location and environmental status of past and current spawning grounds, particularly relevant for Scotland’s west coast, are identified. Based on the importance of specific environmental and physical variables for herring reproductive success, we advocate the inclusion of essential spawning grounds into herring management plans. This will require additional data on spawning grounds, including historic local ecological knowledge rarely considered. An inclusive ecosystem-based approach to herring management would allow more targeted actions to conserve (and potentially restore) essential spawning habitat. More effective management strategies will also call for reversing the (global) issue of the disconnect between different stakeholder groups. Graphical abstract
Migratory species make use of different habitats and pathways at different life stages, and in different seasons. Ecological management strategies proposed for migratory species should acknowledge the importance of each component of the migratory cycle. Metapopulation approaches used to assess the quality of habitats do not capture key features of migratory populations. In recent years, contribution metrics – roughly, the annual contribution to a population from a single individual – that are suitable for migratory species and quantify the quality of habitats and pathways have been developed. However, existing contribution metrics are either not suitable for use on species that experience complex life histories or movement strategies; or are only able to differentiate between pathways taken during the first season of the annual cycle. Here, we develop a modelling framework to calculate contribution metrics that quantify the contribution of individuals migrating along specific pathways over any number of seasons in the annual cycle. Our framework yields easily-computable formulae, even for population models with complex migratory patterns. We illustrate our framework using hypothetical examples as well as a model inspired by the monarch butterfly, and highlight ecological insights that could not have been found using existing contribution metrics. We envisage our framework being used to identify the most important or vulnerable components of the migratory cycle, such that appropriate conservation strategies may be applied.
The environmental impact of metals and non-degradable plastics in printed electrodes has highlighted the need of employing sustainable materials in environmental monitoring. In this work, we developed a new sustainable graphite-based paste (G-PE) printed on a bioderived and biodegradable polyhydroxybutyrate polyhydroxyvalerate substrate for tap water and seawater monitoring. We compared its performance against two standard screen-printed electrodes (SPEs) fabricated using commercial silver and carbon pastes (Ag-SPEs and C-SPEs) printed on a polyvinyl chloride substrate. The Ag-SPEs exhibited the lowest sheet resistance (RS = 0.053 Ω/sq), however they were also less reliable as silver oxidised and reacted with ions present in seawater. Meanwhile, the C-SPEs and G-PE presented similar RS (26.9 and 30.1 Ω/sq, respectively), were inert in different media and showed relatively stable response during cyclic bending studies (less than 2.3% relative resistance variation for the C-SPE). Physical and chemical degradation studies of the sustainable G-PE in seawater demonstrated relatively quick ultrasound induced dissolution (less than5 min) while the SPEs did not dissolve even after 30 min of sonication, highlighting the suitability of this new, eco-friendly G-PE for single use or short-term water quality monitoring applications.
Representation learning impacts the performance of Machine Learning (ML) models. Feature extraction-based methods such as Auto-Encoders (AEs) are used to find new, more accurate data representations from original ones. They perform efficiently on a specific task, in terms of: (1) high accuracy, (2) large short-term memory and (3) low execution time. The Echo-State Network (ESN) is a recent specific kind of a Recurrent Neural Networks (RNN), that presents very rich dynamics on account of its reservoir-based hidden layer. It is widely used in dealing with complex non-linear problems and has been shown to outperform classical approaches in a number of benchmark tasks. In this paper, the powerful dynamism and large memory provided by the ESN and complementary strengths of AEs in feature extraction are integrated, to develop a novel Echo-State Recurrent Autoencoder (ES-RA). In order to devise more robust alternatives to conventional reservoir-based networks, both single- (SL-ES-RA) and multi-layer (ML-ES-RA) models are formulated. The new features, once extracted from ESN’s hidden layer, are applied to various benchmark ML tasks including classification, time series prediction and regression. A range of evaluation metrics are shown to improve considerably compared to those obtained when applying original data features. An accuracy-based comparison is performed between our proposed recurrent AEs and two variants of ELM feed-forward AEs (Single and ML), for both noise free and noisy data. In summary, a comparative empirical study reveals the key contribution of exploiting recurrent connections in improving benchmark performance results.
Applied areas of entrepreneurship are growing in popularity due to the ongoing need for students to gain specialised skills to find employment after graduation. This study explores how educational scaffolding can facilitate the delivery of online experiential activities to improve the entrepreneurial learning experience and the performance of music management students by using information and communications technology tools within the virtual learning environment. A case study methodology was adopted to present two scenarios of innovative online learning delivered in a postgraduate programme in music management. This research takes into consideration the difficult transitional journey for some students from studying to being immediately thrust into the workplace, which often requires different types of knowledge, experience, skills and competences. The findings show that, by strengthening industry links, tutors can build a portfolio of online practical activities that represent the 'real-life' industry, helping to forge long-term, collaborative partnerships to facilitate learners' acquisition of more meaningful knowledge and opportunities.
This study presents empirical research examining how economic and political imperatives impact prospects for successful use of Public-Private Partnerships (PPP) to deliver projects in Saudi Arabia. A conceptual model and several hypotheses are developed. A questionnaire survey obtains data from two hundred and fifty-seven (257) project management practitioners involved in projects being procured using PPP within Saudi Arabia. Data is analysed using Structural Equation Modelling (SEM). The conclusion is that economic, but not political imperatives moderate the relationship between Critical Success Factors (CSFs) and PPP project success in Saudi Arabia. To an extent, these findings offer a risk-focussed typology for exploring conditions for PPP project success.
Insects provide key pollination services in most terrestrial biomes, but this service depends on a multi‐step interaction between insect and plant. An insect needs to visit a flower, receive pollen from the anthers, move to another conspecific flower, and finally deposit the pollen on a receptive stigma. Each of these steps may be affected by climate change, and focusing on only one of them (e.g., flower visitation) may miss important signals of change in service provision. In this study, we combine data on visitation, pollen transport, and single‐visit pollen deposition to estimate functional outcomes in the high‐Arctic plant‐pollinator network of Zackenberg, Northeast Greenland, a model system for global warming‐associated impacts in pollination services. Over two decades of rapid climate warming, we sampled the network repeatedly: in 1996, 1997, 2010, 2011 and 2016. While the flowering plant and insect communities and their interactions varied substantially between years, as expected based on highly variable Arctic weather, there was no detectable directional change in either the structure of flower‐visitor networks or estimated pollen deposition. For flower‐visitor networks compiled over a single week, species phenologies caused major within‐year variation in network structure despite consistency across years. Weekly networks for the middle of the flowering season emerged as especially important, as most pollination service can be expected to be provided by these large, highly‐nested networks. Our findings suggest that pollination ecosystem service in the High Arctic is remarkably resilient. This resilience may reflect the plasticity of Arctic biota as an adaptation to extreme and unpredictable weather. However, most pollination service was contributed by relatively few fly taxa (Diptera: Spilogona sanctipauli and Drymeia segnis [Muscidae] and species of Rhamphomyia [Empididae]). If these key pollinators are negatively affected by climate change, network structure and the pollination service that depends on it would be seriously compromised.
The potential use of hydrogen peroxide as an ignition promoter to enable the use of ammonia in compression ignition engines is explored in the current study. A simplified numerical HCCI engine model within the Chemkin Pro suite is employed. The numerical investigation reveals that the proposed use of hydrogen peroxide is significantly more advantageous against the more conventional method of preheating the intake charge to achieve ignition, whilst using a glow plug. In particular, the IMEP, power and torque exhibit an increase greater than 65% along with a spectacular decrease of NOx emissions reaching in certain cases a 9-fold decrease. The thermal efficiency exhibits a more moderate, yet non-negligible increase, around 5%. Generally, the incremental increase of hydrogen peroxide leads to the increase of the IMEP, power and torque as well as the maximum temperature and, hence, NOx emissions. These increases are largely linear with the hydrogen peroxide addition. Finally, the introduction of hydrogen peroxide leads to a two-stage ignition process, where the first ignition stage was found to be instrumental to the control of the ignition process, and, therefore, the system’s efficiency. Further research is required to substantiate further the feasibility and the the limitations of the proposed technology which can enable the rapid decarbonization of heavy duty applications, such as marine ships and trucks.
Background More than half of people who use antipsychotic medication for psychosis report having sexual dysfunction. The REMEDY trial aimed to find out if switching antipsychotic medication provides an effective way to reduce sexual dysfunction among people with psychosis. We set out to recruit 216 participants over a two-year period, but recruitment was stopped after an extended 12-month pilot phase, during which we recruited only 10 participants. As part of a nested process evaluation, we conducted qualitative interviews with front-line clinicians to examine barriers to recruitment to the trial. Methods We developed a semi-structured interview schedule to explore staff views on factors that influenced whether they referred potential participants to the study. We interviewed a purposive sample of 51 staff from four National Health Service (NHS) Trusts in England, ensuring a range of different backgrounds, seniority, and levels of involvement in the trial. Audio recordings of interviews were transcribed for verbatim, and data were analysed using an inductive approach to thematic analysis. Results Nine interconnected themes were generated. Six themes concerned barriers to recruitment; including; prioritising patients’ mental stability, mutual discomfort and embarrassment about discussing a “taboo” subject, and concerns about unintended consequences of asking people with psychosis about their sexual functioning. Three themes, including the quality of treatment relationships and strategies for opening dialogue suggested ways to improve recognition of these “hidden” side effects. Conclusion The identification and management of sexual dysfunction among people with psychosis are not priorities for mental health services in England at this time. Many staff working in front-line services feel unprepared and uncomfortable asking people with psychosis about these problems. While greater use of screening tools may improve the identification of sexual dysfunction among people with psychosis, the evaluation and implementation of interventions to manage them will continue to be challenging unless NHS leaders and senior clinicians demonstrate greater commitment to changing current clinical practice. Trial registration Current Controlled Trials ISRCTN12307891.
Background The International Trauma Questionnaire—Child and Adolescent version (ITQ-CA) is a self-report measure that assesses posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) based on the diagnostic formulation of the 11th version of the International Classification of Diseases (ICD-11). This study aimed to provide a Chinese translation and psychometric evaluation of the ITQ-CA using a sample of mental-health service seeking adolescents in Mainland China. Methods The ITQ-CA was translated and back-translated from English to simplified Chinese and finalized with consensus from an expert panel. Adolescents ages 12–17 were recruited via convenience sampling from an outpatient psychiatric clinic in Mainland China. Participants completed the ITQ-CA; measures of four criterion variables (depression, anxiety, stress, adverse childhood experiences); and the PTSD Checklist for DSM-5 (PCL-5). Construct validity, concurrent validity, and comparison of PTSD caseness between ICD-11 and DSM-5 measures were assessed. Results The final sample consisted of 111 Chinese adolescents (78% female; mean age of 15.23), all diagnosed with a major depressive disorder. Confirmatory factor analysis indicated the two-factor second-order model provided optimal fit. All criterion variables were positively and significant correlated with the six ITQ-CA symptom cluster summed scores. In the present sample, 69 participants (62.16%) met symptom criteria for ICD-PTSD or CPTSD using the ITQ-CA, and 73 participants (65.77%) met caseness for DSM-5 PTSD using the PCL-5. Rates of PTSD symptom cluster endorsement and caseness deriving from both diagnostic systems were comparable. Conclusions The Chinese ITQ-CA has acceptable psychometric properties and confers additional benefits in identifying complex presentations of trauma-related responses in younger people seeking mental health services.
Background Smoking poses a serious risk of early preventable death and disease especially for women living with socio-economic disadvantage (SED). A smoking cessation programme, ‘We Can Quit’, was developed in Ireland tailored to SED women. This includes group-based support delivered by trained lay local community facilitators (CFs) and free nicotine replacement therapy (NRT). The intervention was pilot tested in a cluster randomised controlled trial, ‘We Can Quit 2’. This paper reports on the WCQ2 process evaluation which assessed feasibility and acceptability of the programme and trial processes. Methods Embedded qualitative design using the UK Medical Research Council’s process evaluation framework. Semi-structured interviews with trial participants (N = 21) and CFs (N = 8). Thematic analysis was utilised. Results Peer-modelling, a non-judgemental environment, CFs facilitation of group support were viewed as acceptable programme related factors. Some participants expressed concerns about NRT side effects. Provision of free NRT was welcomed and accepted by participants, although structural barriers made access challenging. Pharmacists took on a role that became larger than originally envisaged – and the majority provided additional support to women in their quit attempts between group meetings which augmented and supplemented the intervention sessions provided by the CFs. Participants reported good acceptance of repeated measures for data collection, but mixed acceptability of provision of saliva samples. Low literacy affected the feasibility of some women to fully engage with programme and trial-related materials. This was despite efforts made by intervention developers and the trial team to make materials (e.g., participant intervention booklet; consent forms and participant information leaflets) accessible while also meeting requirements under 2018 European General Data Protection Regulation legislation. Hypothetical scenarios of direct (e.g., researcher present during programme delivery) and indirect (e.g., audio recordings of programme sessions) observational fidelity assessments for a future definitive trial (DT) were acceptable. Conclusions Intervention and trial-related processes were generally feasible and acceptable to participants and CFs. Any future DT will need to take further steps to mitigate structural barriers to accessing free NRT; and the established problem of low literacy and low educational attainment in SED areas, while continuing to comply within the contemporary legislative research environment. Trial registration WCQ2 pilot trial (ISRCTN74721694).
Protecting existing mangrove forests is a priority for global conservation because of the wide range of services that these coastal forests provide to humankind. Despite the recent reduction in global rates of mangrove loss, high historical loss rates mean that there are at least 800,000 ha globally that are potentially suitable for mangrove re-establishment. Recently deposited mud banks or intertidal, previously terrestrial, land might provide additional habitat for expanding mangrove areas locally. There is a long history of mangrove rehabilitation. However, despite numerous good examples of, and growing expertise in, natural or assisted (re-)establishment activities, most mangrove planting efforts, for instance, either fail entirely or meet with only limited success. Exposed to waves and currents and subject to tidal inundation, mangroves differ from terrestrial forests, and approaches to, or tools for, terrestrial forest restoration cannot easily be transferred to mangrove forests. Successful mangrove (re-)establishment usually requires a robust understanding of the abiotic and biotic conditions of the chosen site, the ecological requirements of the mangrove species used or facilitated, the reasons for previous mangrove loss or degradation, as well as the barriers–both societal and ecological–that have prevented natural recovery to date. Because most mangrove forests are socio-ecological systems, with which local human populations are intimately engaged, (re-)establishment will normally require the support of, and engagement with, local communities and other local stakeholders. Here, we summarize where, when and why (re-)establishment of mangroves is needed and how to assess this need. We discuss a range of potential aims and goals of mangrove (re-)establishment along with potential pitfalls along the way from conceiving the initial idea to its realization. We compare different technical and conceptual approaches to mangrove (re-)establishment, their challenges and opportunities, and their design and financial requirements, as well as potential solutions. We ground our final outlook and recommendations on examples of successful efforts and the factors that rendered (re-)establishment successful in the past.
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