7 research outputs found

    Global gradients of coral exposure to environmental stresses and implications for local management

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    Background: The decline of coral reefs globally underscores the need for a spatial assessment of their exposure to multiple environmental stressors to estimate vulnerability and evaluate potential counter-measures. Methodology/Principal Findings: This study combined global spatial gradients of coral exposure to radiation stress factors (temperature, UV light and doldrums), stress-reinforcing factors (sedimentation and eutrophication), and stress-reducing factors (temperature variability and tidal amplitude) to produce a global map of coral exposure and identify areas where exposure depends on factors that can be locally managed. A systems analytical approach was used to define interactions between radiation stress variables, stress reinforcing variables and stress reducing variables. Fuzzy logic and spatial ordinations were employed to quantify coral exposure to these stressors. Globally, corals are exposed to radiation and reinforcing stress, albeit with high spatial variability within regions. Based on ordination of exposure grades, regions group into two clusters. The first cluster was composed of severely exposed regions with high radiation and low reducing stress scores (South East Asia, Micronesia, Eastern Pacific and the central Indian Ocean) or alternatively high reinforcing stress scores (the Middle East and the Western Australia). The second cluster was composed of moderately to highly exposed regions with moderate to high scores in both radiation and reducing factors (Caribbean, Great Barrier Reef (GBR), Central Pacific, Polynesia and the western Indian Ocean) where the GBR was strongly associated with reinforcing stress. Conclusions/Significance: Despite radiation stress being the most dominant stressor, the exposure of coral reefs could be reduced by locally managing chronic human impacts that act to reinforce radiation stress. Future research and management efforts should focus on incorporating the factors that mitigate the effect of coral stressors until long-term carbon reductions are achieved through global negotiations

    Opioid agonist maintenance treatment outcomes : the OPTIMUS international consensus towards evidence-based and patient-centred care, an interim report

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    Abstract: Non-medical opioid use is a major public health concern causing high mortality. While opioid agonist maintenance treatment (OMT) is a key life-saving intervention, there is (a) no international consensus on opioid treatment outcomes and (b) few opioid treatment outcome studies include key (public) health outcomes, such as overdose or HIV/hepatitis C. We report the rationale and study protocol for, and preliminary results of, an on-going international OMT outcomes consensus study that aims to address this double gap (n= 110 collaborating experts from 32 countries, plus a n = 477 Delphi evaluation panel from 26 of those countries: 58% male, 41% female; 47% OMT patients, 53% OMT professionals). We present a first draft of a patient interview guide (including a \u2018clinical form\u2019) to monitor OMT outcomes in six domains. The form appears to be well accepted and feasible in early testing. Through this, we aim to enhance the quality of and access to OMT and improve the survival, health, and quality of life of people who use opioids, while promoting nonstigmatising patient-physician relationships

    S3 guidelines: pilonidal sinus

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