Pedagogical Considerations for Climate Change Education in Africa

Africa is very vulnerable to the adverse effects of climate change despite contributing the least to greenhouse gas emissions. This vulnerability is exacerbated by its limited capacity to predict climate change, mitigate and adapt to its impacts. Education is important for capacity building and mobilising requisite actions against climate change. This paper draws on relevant literature to discuss applicable educational pedagogical perspectives that can foster effective climate change education (CCE) and help the citizenry develop sustainability mindsets in Africa. It highlights the need for decolonised and decentred climate change pedagogies that address existing inequalities and promote context-driven capacity development and indigeneity. It contends that effective pedagogy for climate change education that will support Africa’s resilience to climate change should underscore the significance of Indigenous approaches in dealing with localised environmental issues

Peace Mediation in the Emerging Multipolar Order:Implications of China’s Growing Engagement in Myanmar’s Civil War

In the 21st century, peacemaking is subject to a changing international order in whichrising powers play a growing role. China’s mediation in Myanmar’s civil war is a case in point: since the international peace architecture has little access to the conflict. This paper contrasts divergent theoretical assumptions on the impact of multipolarity on peace processes with an in-depth examination of China’s strategy. For analysts of the emerging multipolar order, this research indicates that the optimistic assumptions of Mignolo’s pluriversal and Acharya’s multiplex theory might not be met by the rise of new actors in peacemaking. Instead, China’s mediation in Myanmar suggests that multipolarity favors geopolitics at the expense of emancipatory movements. China’s growing involvement in peace processes worldwide confirms recent scholarship on the lack of conflict resolution tools in the multipolar order, rendering multipolarity prone to instability and condemning emancipatory movements to permanent subjugation

Apical Size Reduction by Macropinocytosis Alleviates Tissue Crowding

Tissue crowding represents a critical challenge to epithelial tissues, which often respond via the irreversible process of live cell extrusion. We report cell size reduction via macropinocytosis as an alternative mechanism. Macropinocytosis is triggered by tissue crowding via mechanosensory signaling, leading to substantial internalization of apical membrane and driving a reduction in apical cell size that remodels the epithelium to alleviate crowding. We report that this mechanism regulates the long-term organization of developing epithelium in response to proliferation-induced crowding but also serves as an immediate response to acute external compression. In both cases, inhibiting macropinocytosis induces a dramatic increase in cell extrusion suggesting cooperation between cell extrusion and macropinocytosis in response to compression. Our findings implicate macropinocytosis as an important regulator of dynamic epithelial remodeling.<br/

Bi-allelic loss-of-function variants in POC5 cause a syndromic retinal, endocrine and neuromuscular ciliopathy

PurposeA homozygous loss-of-function (LoF) variant in POC5 was previously described in an individual with retinitis pigmentosa. We identified POC5 variants in 12 probands with a syndromic phenotype. We aim to define the phenotype spectrum and molecular mechanism associated with biallelic POC5 LoF variants.MethodsWe studied a cohort of 12 families with bi-allelic LoF POC5 variants and performed detailed phenotype analysis. POC5 localization studies were performed in 3 proband-derived fibroblast cell lines.ResultsDetailed phenotyping of probands with POC5 variants expands the phenotype spectrum beyond ocular manifestations. This syndrome causes not only rod-cone dystrophy but also diabetes mellitus with severe insulin resistance and partial lipodystrophy, kidney disease, and muscle cramps.The POC5 protein plays an essential role during cell cycle and cilium formation. Interestingly, POC5 localization studies in 3 proband-derived fibroblast cell lines show aberrant localization suggesting a ciliary defect. The phenotypes of the 12 families in this study fit well within the ciliopathy phenotype spectrum, except for lipodystrophy, which is not common in ciliopathies.ConclusionWe describe a multiorgan syndrome caused by bi-allelic LoF variants in POC5. This underscores the pleiotropic effects of POC5 variants and highlights the significance of adipose tissue and metabolic dysfunction in ciliopathies

Exploring the consistency, quality and challenges in manual and automated coding of free-text diagnoses from hospital outpatient letters

ObjectiveTo explore and evaluate the quality and consistency of manual and automated clinical coding of diagnoses from hospital outpatient letters.Materials and MethodsUsing a sample of 100 randomly selected outpatient clinic letters, two clinically-trained human coders performed manual coding of diagnosis lists to SNOMED CT.  Automated coding of all diagnoses was performed using a commercial algorithm (IMO’s Concept Tagger). A subset of 130 of the resulting annotated diagnoses that had been independently coded by both human coders were subject to a further evaluation with a panel of clinicians, with disagreements resolved through discussion, to decide upon a gold standard coding for each diagnosis. This gold standard dataset was used to evaluate the quality and consistency of coding performed by  both human coders and computer software. Comparisons were made i) between the codes provided by each human coder, ii) between the human coders and the gold standard, and iii) between the computer software and the gold standard. An automated comparison was performed using a distance-based metric to quantify matches and to determine how many codes fell within certain distances of one another. A qualitative evaluation was then performed with the panel to decide whether each coding was “Good”, “Acceptable” or “Not acceptable” in capturing the given diagnosis text. Correlation between the distance-based and qualitative metrics were also evaluated. Results were stratified according to whether the free-text diagnosis description contained one or multiple clinical findings.ResultsIndependent coding by two human annotators led to exact matches in 73% of cases, increasing to 81% or 90% within a distance of one or two edges in SNOMED CT, respectively. Compared to the gold standard codes, human annotators had an exact match 78% of the time, with 86% within one position. This improved to 88% and 93%, respectively, when limited to text entries that included only a single clinical finding. The automated coding had an exact match of 61% compared to the gold standard, with 76% within one position. When limited to single diagnoses, this improved to 77% and 91% respectively. On average across the two human coders, 98% of codes were considered good or acceptable, as opposed to 88% of the computer-generated codes. DiscussionResults have demonstrated that only three in every four free-text diagnoses were mapped to the exact same code by two independent annotators. In an equivalent task of comparing human and computer-generated codes to a gold standard code, humans slightly outperformed the computer, with both performing notably better when there was only a single diagnosis contained in the free-text description rather than multiple separate findings. Automated coding by the computer was considered acceptable in around nine in ten occasions.ConclusionClinical coding is an inexact science, with full agreement between coders difficult to achieve even when provided codes capture the clinical intent to a high level. An automated process to convert free-text information about diagnoses to clinical codes performed nearly as well as humans and was considered acceptable 90% of the time.

The Manchester Charcot Ankle Neuroarthropathy (M-CAN) Classification:A Radiographic-Based System for Assessing Charcot Ankle Neuroarthropathy

Background Charcot neuroarthropathy (CN) is a complication of long-standing, poorly controlled diabetes, associated with increased risks of amputation and mortality. Currently, there is no dedicated classification system specifically for ankle CN, nor a standardized description of the possible deformities involving the ankle in relation to CN. This study aims to develop and propose the Manchester Charcot Ankle Neuroarthropathy (M-CAN) classification - a descriptive, radiograph-based system designed to categorize ankle deformities and patterns of bone loss in patients with diabetic CN. The M-CAN classification may aid clinicians in early identification of deformities, facilitating more effective treatment planning and improved outcomes. Methods This retrospective review included 71 patients with diabetic ankle CN who were managed at the Manchester University NHS Foundation Trust over a 10-year period. Patterns of ankle deformity and bone loss were assessed using weight-bearing radiographs, and this information formed the basis for developing the classification system. The proposed classification is structured as follows: "A" refers to the alignment of the ankle joint - Type 1: varus ankle, Type 2: valgus ankle, Type 3: anterior angulation, Type 4: posterior angulation, Type 5: combined plane deformity, and Type N: neutral ankle. "B" denotes bone loss around the ankle joint - Subtype a: tibial bone loss, Subtype b: talar bone loss, Subtype c: calcaneal bone loss, and Subtype d: combined bone loss. "C" represents the cutaneous condition around the ankle, including ulceration and infection. "D" reflects diabetic control, measured by glycated hemoglobin levels. "E" captures the modified Eichenholtz stage of Charcot - Stages 0, 1, 2, and 3. "F" indicates foot perfusion status as assessed by Doppler studies. The classification primarily describes the deformity pattern "A", bone loss "B", and CN stage "E" using standard weight-bearing ankle radiographs, with optional supplementary information from the cutaneous condition "C", glycemic control "D", and pedal perfusion status "F". Results A total of 75 ankle X-rays from CN patients were reviewed. The coronal and sagittal planes of deformity "A" were assessed, and the patterns of bone loss "B" were documented, along with the Eichenholtz stage "E". Based on this A+B+E framework, the most common classification among patients was Type 1-d Stage 3, indicating a varus ankle with combined tibial, talar, and calcaneal bone loss in the consolidation stage of CN. Inter- and intra-observer agreement for components A and B showed near-perfect reliability, with a Kappa value of 0.94. Conclusions This new classification system for ankle CN facilitates the understanding of deformity patterns using plain radiographs and serves as a descriptive tool. It allows the condition to be categorized based on the specific deformities and associated osseous loss.</p

Spousal characteristics and unmet care needs: A longitudinal national study of adults aged 50 and over in England

This paper investigates unmet needs among dyads of people aged 50 and over in England. Understanding the extent and patterns of unmet needs for long-term care across different social groups is critical for understanding care-related experiences and inequalities and planning the long-term care system. Although spouses are a main source of care support, little is known about how spouses' characteristics relate to one's experience of unmet care needs. This study adopts a dyadic perspective, investigating the association between unmet care needs and spouses' characteristics, including socioeconomic status, health status and the quality of spousal relationships. Drawing on data from the English Longitudinal Study of Ageing (ELSA) (N = 3439), we matched the information of individuals who have care needs to the characteristics of their spouses and used random effects modelling to account for the longitudinal nature of the data. The results show that having a spouse with poorer functional abilities was associated with a higher risk of experiencing objective and subjective unmet needs. Men were more likely to experience objective unmet care needs if their spouses engaged in paid work, but this is not the case for women. Women faced a lower risk of subjective and objective unmet needs when having a closer relationship with their spouse, whereas this pattern was not observed among men. The findings highlight the importance of considering the interpersonal care relationships and gendered dynamics of caregiving, providing insights into designing gender-sensitive intervention programmes to better support people in care needs and their families.</p