A horizon scan of global conservation issues for 2014

This paper presents the output of our fifth annual horizon-scanning exercise, which aims to identify topics that increasingly may affect conservation of biological diversity, but have yet to be widely considered. A team of professional horizon scanners, researchers, practitioners, and a journalist identified 15 topics which were identified via an iterative, Delphi-like process. The 15 topics include a carbon market induced financial crash, rapid geographic expansion of macroalgal cultivation, genetic control of invasive species, probiotic therapy for amphibians, and an emerging snake fungal disease. © 2013 Elsevier Ltd

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

ACOSS Budget analysis 2015-16

Summary: The impacts of this Budget must be assessed in light of the previous Budget, which casts a long shadow. While the 2015-16 Budget delivered welcome new investment in early childhood education and care and charted a fairer path on pension reform, the combined effect of the two budgets is to leave people on low incomes to once again bear the burden of Budget restraint. ACOSS estimates that, combined, the two budgets strip approximately $15 billion over four years from basic services and supports affecting low and middle income households, with total projected cuts of$80 billion from health and schools funding to the states over the next decade. Disappointingly, the 2015-16 Budget retains severe cuts to payments and programs from the 2014-15 Budget, in some cases linking savings measures from 2014-15 to new spending measures, and delivers new cuts to child dental and community health programs. At the same time, despite some modest action towards revenue repair, the Budget failed to deliver the structural reform needed to ensure Budget sustainability into the future. The experience of the 2014-15 Budget shows that the alternative approach of eroding the social safety net through cuts to services and supports will not be accepted by the community or the Parliament. Despite a $5.5 billion package for small businesses, the Budget it unlikely to stimulate the kind of productive economic activity necessary to deliver significant jobs growth and fails to invest in skills. However, the investment in new youth transitions and mentoring programs is welcome and will partly address the gap left by the discontinuation of the previous Youth Connections program. Steps to consolidate existing wage subsidy programs to improve program flexibility are also welcome. Regrettably, instead of reversing last year\u27s proposal to make young unemployed people wait six months for income support, the waiting period is reduced to one month and applied to a younger cohort (under 25 years). There is no justification for this measure. The ‘families package’ includes necessary and overdue investment in early childhood education and care and effects structural reform to the current complex payment system. Yet key features leave it unbalanced and unfair, relying on cuts to family payments for low- income families, and providing generous subsidies to families on high incomes. Combined, the two budgets represent a$9 billion reduction in spending on family payments over the forward estimates of which approximately $6 billion in savings will adversely affect low-income households. Our analysis suggests that low-income and disadvantaged families will be significantly worse off if the 2014-15 and 15-16 Budget measures pass, notwithstanding the boost the child care investment discussed below. The impacts of payment rate freezes will be felt over time. In 2015-16, the impacts of restricting the Part B payment to families with children under 6 years will mean that a single parent with one 8 year old child stands to lose$48.50 per week and a single parent with one 12 year old child stands to lose $62.50 per week due to the loss of FTB Part B and end of year supplements. Many children in low-income families will also lose 12 hours a week of early childhood education that helps improve their life chances. Further, the changes to the Paid Parental Leave scheme announced two days before the Budget will leave many families worse off and further behind their overseas counterparts and the 26 week minimum leave period recommended to support maternal-child bonding and breastfeeding. The reforms to the pension assets and income tests present a welcome change in direction and a fairer approach to securing the future of the retirement incomes system. We now need a similar approach to superannuation reform, which is even more important in building a strong and durable retirement income system. The 2015-16 Budget failed to reverse the funding cuts to vital policy, advocacy and service delivery across social services, health and legal assistance and in Aboriginal and Torres Strait Islander communities. Disappointingly, it delivered new cuts to child dental health programs, community health programs and remote housing as well as a further round of cuts to the public service, with ‘Smaller Government’ measures across departments. This raises concerns about the capacity of the bureaucracy to provide an adequate standard of service to members of the community, especially where there is a direct interface with the community, and its capacity to provide sound policy advice to the Government. Finally and perhaps most importantly is the story of what was missing from the 2015-16 Budget. Three days before the Budget was delivered, the Councils of Social Service (COSS) Network released a report showing that 83% of people relying on the Newstart payment or Youth Allowance do not consider it to be enough to live on with nearly half of those surveyed having unsustainable levels of personal debt, and more than a third forced to skip dental and medical appointments or forego treatments as they cannot afford to pay for them. Nearly one in five reported missing meals in an effort to make ends meet. The Budget failed to take steps to invest in affordable housing programs or to address serious gaps in the social safety net including: the low rate of allowance payments; the inadequate indexation of allowances and family payments (which are still indexed to the CPI only); and the low rate of Commonwealth Rent Assistance, which has failed to keep pace with rent inflation. This Budget should have begun the work to safeguard the social safety net into the future, by trimming unfair tax concessions for superannuation and reforming negative gearing and capital gains tax breaks. Tax reform must be the next priority for responsible, fair and measured action

A novel prion disease associated with diarrhea and autonomic neuropathy

Human prion diseases, although variable in clinicopathological phenotype, generally present as neurologic or neuropsychiatric conditions associated with rapid multifocal central nervous system degeneration that is usually dominated by dementia and cerebellar ataxia. Approximately 15% of cases of recognized prion disease are inherited and associated with coding mutations in the gene encoding prion protein (PRNP). The availability of genetic diagnosis has led to a progressive broadening of the recognized spectrum of disease

Development of national consensus statements on food labelling interpretation and protein allocation in a low phenylalanine diet for PKU.

BACKGROUND In the treatment of phenylketonuria (PKU), there was disparity between UK dietitians regarding interpretation of how different foods should be allocated in a low phenylalanine diet (allowed without measurement, not allowed, or allowed as part of phenylalanine exchanges). This led to variable advice being given to patients. METHODOLOGY In 2015, British Inherited Metabolic Disease Group (BIMDG) dietitians (n = 70) were sent a multiple-choice questionnaire on the interpretation of protein from food-labels and the allocation of different foods. Based on majority responses, 16 statements were developed. Over 18-months, using Delphi methodology, these statements were systematically reviewed and refined with a facilitator recording discussion until a clear majority was attained for each statement. In Phase 2 and 3 a further 7 statements were added. RESULTS The statements incorporated controversial dietary topics including: a practical 'scale' for guiding calculation of protein from food-labels; a general definition for exchange-free foods; and guidance for specific foods. Responses were divided into paediatric and adult groups. Initially, there was majority consensus (≥86%) by paediatric dietitians (n = 29) for 14 of 16 statements; a further 2 structured discussions were required for 2 statements, with a final majority consensus of 72% (n = 26/36) and 64% (n = 16/25). In adult practice, 75% of dietitians agreed with all initial statements for adult patients and 40% advocated separate maternal-PKU guidelines. In Phase 2, 5 of 6 statements were agreed by ≥76% of respondents with one statement requiring a further round of discussion resulting in 2 agreed statements with a consensus of ≥71% by dietitians in both paediatric and adult practice. In Phase 3 one statement was added to elaborate further on an initial statement, and this received 94% acceptance by respondents. Statements were endorsed by the UK National Society for PKU. CONCLUSIONS The BIMDG dietitians group have developed consensus dietetic statements that aim to harmonise dietary advice given to patients with PKU across the UK, but monitoring of statement adherence by health professionals and patients is required