Risk classification of low-lying coral reef islands and their exposure to climate threats.

The bio-physical responses of low-lying coral islands to climate change are of concern. These islands exist across a broad range of bio-physical conditions, and vulnerabilities to rising and warming seas, ocean acidification and increased storminess. We propose a risk-based classification that scores 6 island eco-morphometric attributes and 6 bio-physical ocean/climate conditions from recent open-access data, to assign islands with respect to 5 risk classes (Very Low, Low, Moderate, High and Very High). The potential responses of 56 coral islands in Australia's jurisdiction (Coral Sea, NW Shelf and NE Indian Ocean) to climate change is considered with respect to their bio-physical attributes and eco-morphometrics. None of the islands were classed as Very Low risk, while 8 were classed as Low (14.3 %), 34 were Moderate (60.7 %), 11 were High (19.6 %), and 3 were Very High (5.4 %). Islands in the Very High risk class (located on the NW Shelf) are most vulnerable due to their small size (mean 10 Ha), low elevation (mean 2.6 m MSL), angular/elongated shape, unvegetated state, below average pH (mean 8.05), above average rates of sea-level rise (SLR; mean 4.6 mm/yr), isolation from other islands, and frequent tropical storms and marine heatwaves. In contrast, islands in the Low (and Very Low) risk class are less vulnerable due to their large size (mean 127 Ha), high elevation (mean 8.5 m MSL), sub-angular/round shape, vegetated state, near average pH (mean 8.06), near average SLR rates (mean 3.9 mm/yr), proximity to adjacent islands, and infrequent cyclones and marine heatwaves. Our method provides a risk matrix to assess coral island vulnerability to current climate change related risks and supports future research on the impacts of projected climate change scenarios. Findings have implications for communities living on coral islands, associated ecosystem services and coastal States that base their legal maritime zones on these islands.

A Re-emergence of Subacute Sclerosing Panencephalitis in the United Kingdom.

New pediatric and adult subacute sclerosing panencephalitis cases between 1996 and 2020 were reported based on an established UK registry with no evidence of under-ascertainment using a separate pediatric surveillance system. After 15 years with no pediatric UK-acquired cases, 3 cases arose from 2017 after increased measles. Modeling suggested this was in line with measles notifications, underreporting of laboratory-confirmed measles or increased subacute sclerosing panencephalitis risk.

Tailings facility disclosures reveal stability risks.

Tailings facility failures represent a significant risk to the environment and communities globally, but until now little data was available on the global distribution of risks and characteristics of facilities to ensure proper governance. We conducted a survey and compiled a database with information on tailings facilities disclosed by extractive companies at the request of institutional investors. Despite limitations in the data, this information disclosure request represents the most comprehensive survey of tailings facilities ever undertaken. The compiled dataset includes 1743 tailings facilities and provides insights into a range of topics including construction method, stability, consequence of failure, stored volume, and the rate of uptake of alternative technologies to dewater tailings and reduce geotechnical risk. Our analysis reveals that 10 per cent of tailings facilities reported notable stability concerns or failure to be confirmed or certified as stable at some point in their history, with distinct trends according to construction method, governance, age, height, volume and seismic hazard. Controversy has surrounded the safety of tailings facilities, most notably upstream facilities, for many years but in the absence of definitive empirical data differentiating the risks of different facility types, upstream facilities have continued to be used widely by the industry and a consensus has emerged that upstream facilities can theoretically be built safely under the right circumstances. Our findings reveal that in practice active upstream facilities report a higher incidence of stability issues (18.3%) than other facility types, and that this elevated risk persists even when these facilities are built in high governance settings. In-pit/natural landform and dry-stack facilities report lower incidence of stability issues, though the rate of stability issues is significant by engineering standards (> 2 per cent) across all construction methods, highlighting the universal importance of careful facility management and governance. The insights reported here can assist the global governance of tailings facility stability risks.

Differential diagnosis of progressive intellectual and neurological deterioration in children.

AIM: To report the differential diagnosis in children with progressive intellectual and neurological deterioration (PIND) in the UK. METHOD: Since 1997 the PIND Study has searched for variant Creutzfeldt-Jakob disease (vCJD) in children, using the British Paediatric Surveillance Unit to perform prospective surveillance of those younger than 16 years with PIND. RESULTS: From May 1997 to October 2019, 2255 children meeting PIND criteria had been notified, of whom 2008 (1085 males, 923 females) had underlying diagnoses. There were over 220 different diseases, including six cases of vCJD. The numbers presenting in four age groups were: <1 year, 805 (40%); 1 to 4 years inclusive, 825 (41%); 5 to 9 years inclusive, 264 (13%); and 10 to 15 years inclusive, 114 (6%). The two largest ethnic groups were White and Pakistani (58.2% and 17% of diagnosed cases). The most common diseases in these two ethnic groups are shown for the four age groups. The distribution of diseases varied with age but was quite similar in White and Pakistani children. INTERPRETATION: This paper provides a unique guide to the complex differential diagnosis of childhood PIND, showing considerable differences between four age groups, but similarities between ethnic groups. The PIND Study still provides the only systematic surveillance for vCJD in children in the UK. WHAT THIS PAPER ADDS: The prevalence of diseases causing childhood progressive intellectual and neurological deterioration in the UK is low (approximately 0.1/1000 live births). There were more than 220 different disorders, mainly genetically determined. The majority of disorders presented early in childhood: 81% before the age of 5 years. There were similarities in the disease spectrum in White and Pakistani children.

Can We Improve the Monitoring of People With Multiple Sclerosis Using Simple Tools, Data Sharing, and Patient Engagement?

Technological innovation is transforming traditional clinical practice, enabling people with multiple sclerosis (pwMS) to contribute health care outcome data remotely between clinic visits. In both relapsing and progressive forms of multiple sclerosis (MS), patients may experience variable disability accrual and symptoms throughout their disease course. The potential impact on the quality of life (QoL) in pwMS and their families and carers is profound. The introduction of treatment targets, such as NEDA (no evidence of disease activity) and NEPAD (no evidence of progression or active disease), that guide clinical decision-making, highlight the importance of utilizing sensitive instruments to measure and track disease activity and progression. However, the gold standard neurological disability tool-expanded disability severity scale (EDSS)-has universally recognized limitations. With strides made in our understanding of MS pathophysiology and DMT responsiveness, maintaining the status quo of measuring disability progression is no longer the recommended option. Outside the clinical trial setting, a comprehensive monitoring system has not been robustly established for pwMS. A 21st-century approach is required to integrate clinical, paraclinical, and patient-reported outcome (PRO) data from electronic health records, local databases, and patient registries. Patient and public involvement (PPI) is critical in the design and implementation of this workflow. To take full advantage of the potential of digital technology in the monitoring and care and QoL of pwMS will require iterative feedback between pwMS, health care professionals (HCPs), scientists, and digital experts.

Phylogenetic separation in limb use in captive gibbons (Hylobatidae): a comparison across the primate order.

Although there have been few studies of self-scratching in primates, some have reported distinct differences in whether hands or feet are used, and these variations seem to reflect the evolutionary history of the Order. Monkeys and prosimians use both hands and feet to self-scratch while African great apes use hands almost exclusively. Gibbons represent an evolutionary divergence between monkeys and great apes and incidental observations at the Gibbon Conservation Center pointed to a difference in self-scratching among the four extant gibbon genera (Hoolock, Nomascus, Symphalangus, and Hylobates). To validate and further explore these preliminary observations, we collected systematic data on self-scratching from 32 gibbons, including nine species and all four genera. To supplement gibbon data, we also collected self-scratching information from 18 great apes (four species), five prosimians (two species), 26 New World Monkeys (nine species) and 20 Old World Monkeys (seven species). All monkeys and some prosimians used both hands and feet to self-scratch, whereas one prosimian species used only feet. All African great apes used hands exclusively (orangutans were an exception displaying occasional foot-use). This appears to represent a fundamental difference between monkeys and great apes in limb use. Interestingly, there was a clear difference in self-scratching between the four gibbon genera. Hylobates and Symphalangus self-scratched only with hands (like all African great apes), while Hoolock and Nomascus self-scratched with both hands and feet (like monkeys and prosimians). This difference in gibbon behavior may reflect the evolutionary history of gibbons as Hoolock and Nomascus are thought to have evolved before both Hylobates and Symphalangus. What evolutionary pressures led to this divergent pattern is currently opaque; however, this shift in limb preference may result from niche separation across the order facilitating differences in the behavioral repertoire associated with hind and forelimbs.

Experience implementing electronic health records in three East African countries.

INTRODUCTION: Efficient use of health care resources in low-income countries by providers and local and national managers requires timely access to patient data. OBJECTIVE: To implement electronic health records (EHRs) in HIV clinics in Kenya, Tanzania, and Uganda. RESULTS: We initially developed and implemented an EHR in Kenya through a mature academic partnership. The EHR was then implemented in six HIV clinics in Tanzania and Uganda in collaboration with their National AIDS Control Programmes. All implementations were successful, but the system's use and sustainability varied depending on who controlled clinic funding. CONCLUSIONS: Successful EHR use and sustainability were enhanced by local control of funds, academic partnerships (mainly by leveraging research funds), and in-country technology support.

The OpenMRS Implementers Network.

OBJECTIVE: OpenMRS (www.openmrs.org) is a configurable open source electronic medical record application developed and maintained by a large network of open source developers coordinated by the Regenstrief Institute and Partners in Health and mainly used for HIV patient and treatment information management in Africa. Our objective is to develop an open Implementers Network for OpenMRS to provide regional support for the growing number of OpenMRS implementations in Africa and to include African developers and implementers in the future growth of OpenMRS. METHODS: We have developed the OpenMRS Implementers Network using a dedicated Wiki site and e-mail server. We have also organized annual meetings in South Africa and regional training courses at African locations where OpenMRS is being implemented. An OpenMRS Internship program has been initiated and we have started collaborating with similar networks and projects working in Africa. To evaluate its potential, OpenMRS was implemented initially at one site in South Africa by a single implementer using a downloadable OpenMRS application and only the OpenMRS Implementers Network for support. RESULTS: The OpenMRS Implementers Network Wiki and list server have grown into effective means of providing implementation support and forums for exchange of implementation experiences. The annual OpenMRS Implementers meeting has been held in South Africa for the past three years and is attracting successively larger numbers of participants with almost 200 implementers and developers attending the 2008 meeting in Durban, South Africa. Six African developers are presently registered on the first intake of the OpenMRS Internship program. Successful collaborations have been started with several African developer groups and projects initiated to develop interoperability between OpenMRS and various applications. The South African OpenMRS Implementer group successfully configured, installed and maintained an integrated HIV/TB OpenMRS application without significant programming support. Since then, this model has been replicated in several other African sites. The OpenMRS Implementers Network has contributed substantially to the growth and sustainability of OpenMRS in Africa and has become a useful way of including Africans in the development and implementation of OpenMRS in developing countries. The Network provides valuable support and enables a basic OpenMRS application to be implemented in the absence of onsite programmers.

Correlates of early overt and covert sexual behaviors in heterosexual women.

We used data provided by 417 Kinsey-0 and Kinsey-1 heterosexual women using an anonymous computerized survey to determine the adult correlates of two female-female behaviors that occurred before age 18; 25.4% of participants reported engaging in one or both behaviors. Sexual experimentation with females and masturbating using images of females before age 18 were statistically significant predictors of four different female-female behaviors in adulthood: sexual contact with females, masturbating using images of females, preferring a female fantasy partner while having sex with a favorite (male) partner, and voyeurism directed at females; 27.3% of the participants reported engaging in one or more of the latter four behaviors. The analogous early female-male behaviors were not statistically significant predictors of female-female behaviors in adults. Conditioning resulting from participation in these early female-female behaviors might explain the correlations between the two early behaviors and the subsequent four adult same-gender behaviors. The earliest and latest ages that participants engaged in each early behavior and case-by-case analysis showed that the sequence of events leading to the female-female adult behaviors was initial sexual experimentation with similar age females (at a median age of 9 years) followed by masturbating using images of females (at a median age of 15). These results suggest that conditioning and other forms of learning play an important role in establishing coexisting same-gender orientations in heterosexual women.

Intimacy, orgasm likelihood, and conflict predict sexual satisfaction in heterosexual male and female respondents.

Anonymous data provided by 417 female and 179 male sexually active heterosexual respondents showed that in long term sexual relationships, sexual satisfaction was positively correlated with two different intimacy variables, the respondent's orgasm likelihood, and negatively correlated with conflict in the relationship. Multiple linear regression permitted us to measure the effect sizes of these variables as predictors of sexual satisfaction. These findings have important implications for treatment of symptomatic couples.