High burden of rheumatic heart disease confirmed by echocardiography among Pacific adults living in New Zealand

Background Despite numerous echocardiographic screening studies of children in high incidence acute rheumatic fever (ARF)/rheumatic heart disease (RHD) communities, little is known about the prevalence of RHD in adults in these populations.We sought to determine the prevalence of RHD in an urban area of South Auckland, New Zealand, where previous studies had shown the prevalence of RHD in children to be around 2%.Methods A cross-sectional screening study was conducted between 2014 and 2016. Echocardiography clinics were conducted at an urban Pacific-led primary healthcare clinic in New Zealand. Eligible persons aged 16–40 years were recruited according to a stratified randomised approach. Echocardiograms were performed with a standardised image acquisition protocol and reported by cardiologists.Results There were 465 individuals who underwent echocardiograms. The overall prevalence of RHD (define and borderline) was 56 per 1000 (95% CI 36 to 78 per 1000). Definite RHD was found in 10 individuals (4 of whom were already under cardiology review at a hospital clinic) with a prevalence of 22 per 1000 (95% CI 9 to 36 per 1000). Non-rheumatic cardiac abnormalities were found in 29 individuals.Conclusions There is a high burden of both rheumatic and non-rheumatic cardiac abnormalities in this population. Rates described in New Zealand are as high as lower-middle-income countries in Africa. Addressing knowledge gaps regarding the natural history of RHD detected by echocardiography in adults is a priority issue for the international RHD community

Perspectives on Harmful Speech Online

This collection of essays includes perspectives on and approaches to harmful speech online from a wide range of voices within the Berkman Klein Center community. Recognizing that harmful speech online is an increasingly prevalent issue within society, we intend for the collection to highlight diverse views and strands of thought and to make them available to a wide range of audiences. We issued an open call to our community for short pieces that respond to issues related to harmful speech online. Through this collection, we sought to highlight ongoing research and thinking within our extended community that would be available to readers in a way that is more accessible than traditional academic research. The 16 short essays compiled in this collection are authored by a global group of friends, colleagues, and collaborators. We hope that this diverse mix of perspectives, viewpoints, and data points provokes thought and debate, and inspires further exploration. Evidence of the complexity of the issue is that no two writers sought to cover the same topic from a similar point of view; from legal perspectives to research results to paradigm-shifting provocations, a multitude of topics, opinions, and approaches are included. Many pieces draw from research, while others are more opinion-based, indicating that discourse around this topic can be inherently opinionated and passionate as well as scholarly and academic. Some pieces are written in a style evocative of advocacy, whereas others are written with scholarly communities in mind. The range of perspectives and opinions found here—and the lack of consensus on some topics—highlight the dynamic complexity of the issues and how competing values are frequently entangled. The pieces  are organized into three categories: Framing the Problem, International Perspectives, and Approaches, Interventions, and Solutions. The first and last sections include essays that build upon our understanding of their categories, and the section on International Perspectives addresses specific geopolitical contexts and ways in which the regulation of harmful speech may or may not be serving the citizens of a particular country or region.

Core and Supplementary Studies to Assess the Safety of Genetically Modified (GM) Plants Used for Food and Feed

Genetically modified (GM) plants used for food and feed have an established history of safe use over more than 25 years of their commercialization. Developers and regulatory authorities have accumulated extensive experience in evaluating their safety over time. The studies required for the safety assessment of GM plants used for food and feed should now be re-defined to leverage this experience and increased scientific knowledge. This paper, a companion paper for Waters et al. also published in this issue, presents a systematic approach for the safety assessment of newly expressed proteins (NEPs) in GM plants by evaluating the two components of risk: hazard and exposure. Although the paper focuses on NEPs, the principles presented could also apply to other expression products that do not result in a NEP. A set of core studies is recommended, along with supplementary studies, if needed, to evaluate whether the GM plant poses risk. Core studies include molecular and protein characterization and hazard identification encompassing toxicity and allergenicity. In the absence of hazard, core studies are sufficient to conclude that GM plants are as safe as their conventional counterparts. Depending on the GM trait and intended use, supplementary studies should be performed to characterize hazard and exposure when a hazard is identified. Problem formulation should be used to identify hypothesis-driven supplementary studies. Acute toxicity studies, compositional assessment, and dietary exposure assessment are recommended to be hypothesis-driven supplementary studies. Further discussion on the current food and feed safety assessment landscape for GM plants and the use of problem formulation as a tool for identifying supplementary studies can be found in the companion paper [62]. doi: 10.21423/jrs-v09i1brun