A spatial prioritisation exercise for marine spatial planning implementation within the North-East MPA of the Maltese Islands

The cumulative pressure/risk posed to both Posidonia oceanica seagrass meadows and maerl beds by ongoing maritime activities as well as the cumulative user-user conflict within the NE MPA were quantified and mapped to serve as a decision-support tool for MPA managers implementing MSP provisions in the area.peer-reviewe

Changing Climate in the MENA Means Changing Energy Needs

The leading authority on climate change, the Intergovernmental Panel on Climate Change (IPCC) hasconcluded that warming of the climate system is unequivocal, and will continue for centuries. The regionsin the Middle East and Northern Africa (MENA) have experienced numerous extreme climate events overthe past few years including the 2009 flooding in Jeddah, Kingdom of Saudi Arabia; the 2005 dust stormin Al Asad, Iraq; water scarcity throughout the Arab MENA; and the rising sea levels on the Nile Deltacoast, Egypt. A climate baseline can be developed for regions in the MENA by locating climate stations inthe study area using observations made in the Global Climate Observing System (GCOS). For projectionsof future climate, global climate models (GCMs), mathematical equations that describe the physics, fluidmotion and chemistry of the atmosphere, are the most advanced science available. The Climate ResearchLab at the University of Prince Edward Island has a dataset available to researchers, called the Climate,Ocean and Atmosphere Data Exchange (COADE), that provides easy access to the output from fortyglobal climate models used in the deliberations of the Intergovernmental Panel on Climate Change’s(IPCC) Fifth Assessment Report (AR5) including monthly global climate model projections of future climatechange for a number of climate parameters including temperature and precipitation. Over the past 50years, climate changes in the MENA Region have led to increases in annual mean temperatures anddecreases in annual total precipitation. Applying all four greenhouse gas emission futures on a baseclimate normal of 1981-2010 to an ensemble of forty global climate models used in the Fifth AssessmentReport of the Intergovernmental Panel on Climate Change (IPCC AR5) results in future temperatureincreases for the MENA Region ranging from 1.6 to 2.3 degrees Celsius, and in a range of futureprecipitation changes from reductions of 11 percent to increases of 36 percent by the 2050s (2041-2070).These preliminary results should assist the MENA Region in planning its energy needs and its needs forrenewable energy through increasing the understanding of how climate has impacted the region in thepast, and how climate will impact in the future. </p

Spatiotemporal Changes of China's Carbon Emissions

Spatiotemporal changes in China's carbon emissions during the 11th and 12th Five‐Year Plan periods are quantified for the first time through a reconstructed nationwide high‐resolution gridded data set. The hot spots of carbon emissions in China have expanded by 28.5% (toward the west) in the north and shrunk by 18.7% in the south; meanwhile, the emission densities in North and South China have increased by 15.7% and 49.9%, respectively. This suggests a clear transition to a more intensive economic growth model in South China as a result of the energy conservation and emission reduction policies, while the expanded carbon hot spots in North China are mainly dominated by the Grand Western Development Program. The results also show that China's carbon emissions exhibit a typical spatially intensive, high‐emission pattern, which has undergone a slight relaxation (up to 3%) from 2007 to 2012 due to a typical urbanization process

"It can't be like last time" - Choices made in early pregnancy by women who have previously experienced a traumatic birth

Background: A significant number of women experience childbirth as traumatic. These experiences are often characterized by a loss of control coupled with a perceived lack of support and inadequate communication with health care providers. Little is known about the choices women make in subsequent pregnancy(s) and birth(s), or why they make these choices. This study aimed to understand these choices and explore the reasons behind them.Methods: A longitudinal grounded theory methods study involving nine women was conducted. Over half of the participants had a formal diagnosis of post-traumatic stress disorder (PTSD) and/or PND related to the previous birth. Interviews were carried out at three timepoints perinatally. These findings are from the first interviews at 12–20 weeks.Results: From the first days of pregnancy, this cohort of women were focused on concerns that this birth would be a repeated traumatic experience. The women were deliberately searching out and analyzing information about their choices in this pregnancy and birth, and making plans which had two aims; firstly to avoid a repeat of their previous birth experience and secondly to avoid a loss of control to other people during the birth. The women considered a range of birth choices, from elective cesareans to freebirth. Some women felt well supported by those around them, including care providers, partners, friends, and family. Others did not feel supported and were anticipating conflict in trying to assert their birth choices. Many early relationships with healthcare professionals were characterized by fear and mistrust.Discussion: If women who have previously experienced a traumatic birth become pregnant again, they have a strong desire to avoid a repeat experience and to feel in control of their birth choices. Access to robust information appears to help reduce uncertainty and arm women in their discussions with professionals. Similarly making plans and seeking to have them agreed with care providers at an early stage is used a way to reduce the risk of having a further traumatic experience. Implications for practice include supporting women in formulating and confirming pregnancy and birth plans at an early stage to reduce uncertainty and foster a sense of control

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Stimulating a Canadian narrative for climate

ABSTRACT: This perspective documents current thinking around climate actions in Canada by synthesizing scholarly proposals made by Sustainable Canada Dialogues (SCD), an informal network of scholars from all 10 provinces, and by reviewing responses from civil society representatives to the scholars' proposals. Motivated by Canada's recent history of repeatedly missing its emissions reduction targets and failing to produce a coherent plan to address climate change, SCD mobilized more than 60 scholars to identify possible pathways towards a low-carbon economy and sustainable society and invited civil society to comment on the proposed solutions. This perspective illustrates a range of Canadian ideas coming from many sectors of society and a wealth of existing inspiring initiatives. Solutions discussed include climate change governance, low-carbon transition, energy production, and consumption. This process of knowledge synthesis/creation is novel and important because it provides a working model for making connections across academic fields as well as between academia and civil society. The process produces a holistic set of insights and recommendations for climate change actions and a unique model of engagement. The different voices reported here enrich the scope of possible solutions, showing that Canada is brimming with ideas, possibilities, and the will to act

Inventory of current EU paediatric vision and hearing screening programmes

Background: We examined the diversity in paediatric vision and hearing screening programmes in Europe. Methods: Themes relevant for comparison of screening programmes were derived from literature and used to compile three questionnaires on vision, hearing and public-health screening. Tests used, professions involved, age and frequency of testing seem to influence sensitivity, specificity and costs most. Questionnaires were sent to ophthalmologists, orthoptists, otolaryngologists and audiologists involved in paediatric screening in all EU fullmember, candidate and associate states. Answers were cross-checked. Results: Thirty-nine countries participated; 35 have a vision screening programme, 33 a nation-wide neonatal hearing screening programme. Visual acuity (VA) is measured in 35 countries, in 71% more than once. First measurement of VA varies from three to seven years of age, but is usually before the age of five. At age three and four picture charts, including Lea Hyvarinen are used most, in children over four Tumbling-E and Snellen. As first hearing screening test otoacoustic emission (OAE) is used most in healthy neonates, and auditory brainstem response (ABR) in premature newborns. The majority of hearing testing programmes are staged; children are referred after one to four abnormal tests. Vision screening is performed mostly by paediatricians, ophthalmologists or nurses. Funding is mostly by health insurance or state. Coverage was reported as >95% in half of countries, but reporting was often not first-hand. Conclusion: Largest differences were found in VA charts used (12), professions involved in vision screening (10), number of hearing screening tests before referral (1-4) and funding sources (8)

Highwater Mark Collection after Post Tropical Storm Dorian and Implications for Prince Edward Island, Canada

Prince Edward Island (PEI), Canada has been experiencing the consequences of a rising sea level and intense storms on its coasts in recent years. The most recent severe event, Post Tropical Storm Dorian (Dorian), began impacting Prince Edward Island on 7 September 2019 and lasted for over 20 h until the morning of 8 September 2019. The measurement of highwater marks (HWM) from the storm was conducted between 25 September and 25 October 2019 using a high precision, survey grade methodology. The HWM measured included vegetation lines, wrack lines, beach, cliff, and dune morphological features, and tide gauge data at 53 locations in the Province along coastal areas that are exposed to high tides, storm surge, high winds, and wave runup. Photos were taken to provide evidence on the nature of the HWM data locations. The data reveal that Dorian caused extensive coastal floods in many areas along the North and South Coast of Prince, Queens and Western Kings Counties of Prince Edward Island. The floods reached elevations in excess of 3.4 m at some locations, posing threats to local infrastructure and causing damage to natural features such as sand dunes in these areas. The HWM data can provide useful information for community and emergency response organizations as plans are developed to cope with the rising sea level and increased frequency of highwater events as predicted by researchers. As Dorian has caused significant damage in several coastal areas in PEI, better planning using an enhanced storm forecasting and coastal flood warning system, in conjunction with flood stage values, could possibly have reduced the impacts of the storm in the impacted areas. This could help enhance public understanding of the potential impacts in local areas and how they can prepare and adapt for these events in the future