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AimTo give evidence‐based recommendations on the application of ketogenic diet parenteral nutrition (KD‐PN) in emergency situations.MethodAn international group of experts (n=14) researched the literature and distributed a survey among 150 expert centers. International accepted guidelines (European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition and the American Society for Parenteral and Enteral Nutrition) and handbooks for parenteral nutrition were considered general standards of care.ResultsIn the literature, we identified 35 reports of patients treated by KD‐PN. International guidelines and handbooks provided some conflicting information. Twenty‐four expert teams from nine countries responded to the survey, reflecting the limited clinical experience.InterpretationThis paper highlights 23 consensus‐based recommendations for safe and effective KD‐PN (e.g. diet initiation, calculation, application, monitoring, and evaluation) based on the best evidence available and expert opinions.What this paper adds In acute settings, ketogenic diet therapy (KDT) can be administered parenterally.Parenteral administration of KDT should be started only at the intensive care unit.Initiate ketogenic parenteral nutrition stepwise to the highest ratio possible with the lowest level of complications.Evaluate the risk–benefit ratio of parenteral administration continuously.Restart enteral feeding as soon as appropriate.

Southern stingrays (Hypanus americanus) represent a multimillion dollar ecotourism operation in Grand Cayman, interacting with over a million visitors annually. Over 30 years of stingray provisioning by tour operators has provided a predictable aggregation at the Stingray City Sandbar (SCS). Despite potentially negative effects of provisioning and concerns about declining stingray numbers at SCS, there has never been a formal assessment of the aggregation. In the present study we analysed tagging data from 2002 to 2015 and established structured censuses monitoring the aggregation. The consistently female-dominated aggregation declined between 2008 and 2012, from >100 to <60 stingrays, but has increased since 2012, stabilising at ~90 stingrays. Female site fidelity was high, with ~20% of females resident for ≥10 years, compared with only 3 years for most males. Stingrays were also found to have growth rates similar to those in captivity. The results of the present study suggest the SCS aggregation is highly dependent on individuals arriving from the island-wide stingray population, susceptible to perturbation, and that successful management of activities at SCS will benefit from regular monitoring of the stingray aggregation. We chronicle the historical status of this well-known and economically valuable marine resource and provide suggestions applicable towards sustainable human–marine wildlife interactions for similar resources.

Background Social interactions, reproductive demands and intrinsic constraints all influence foraging decisions in animals. Understanding the relative importance of these factors in shaping the way that coexisting species within communities use and partition resources is central to knowledge of ecological and evolutionary processes. However, in marine environments, our understanding of the mechanisms that lead to and allow coexistence is limited, particularly in the tropics. Methods Using simultaneous data from a suite of animal-borne data loggers (GPS, depth recorders, immersion and video), dietary samples and stable isotopes, we investigated interspecific and intraspecific differences in foraging of two closely-related seabird species (the red-footed booby and brown booby) from neighbouring colonies on the Cayman Islands in the Caribbean. Results The two species employed notably different foraging strategies, with marked spatial segregation, but limited evidence of interspecific dietary partitioning. The larger-bodied brown booby foraged within neritic waters, with the smaller-bodied red-footed booby travelling further offshore. Almost no sex differences were detected in foraging behaviour of red-footed boobies, while male and female brown boobies differed in their habitat use, foraging characteristics and dietary contributions. We suggest that these behavioural differences may relate to size dimorphism and competition: In the small brown booby population (n < 200 individuals), larger females showed a higher propensity to remain in coastal waters where they experienced kleptoparasitic attacks from magnificent frigatebirds, while smaller males that were never kleptoparasitised travelled further offshore, presumably into habitats with lower kleptoparasitic pressure. In weakly dimorphic red-footed boobies, these differences are less pronounced. Instead, density-dependent pressures on their large population (n > 2000 individuals) and avoidance of kleptoparasitism may be more prevalent in driving movements for both sexes. Conclusions Our results reveal how, in an environment where opportunities for prey diversification are limited, neighbouring seabird species segregate at-sea, while exhibiting differing degrees of sexual differentiation. While the mechanisms underlying observed patterns remain unclear, our data are consistent with the idea that multiple factors involving both conspecifics and heterospecifics, as well as reproductive pressures, may combine to influence foraging differences in these neighbouring tropical species.