496 research outputs found

    Using nexus thinking to identify opportunities for mangrove management in the Klang Islands, Malaysia

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    Despite wide recognition of the multiple ecosystem services provided by mangroves, they continue to experience decline and degradation especially in the face of urbanization. Given the interplay between multiple resources and stakeholders in the fate of mangroves, mangrove management can be framed as a nexus challenge and nexus thinking used to identify potential solutions. Using the Klang Islands, Malaysia, as a case study site, this paper characterizes the mangrove nexus and stakeholders visions for the future to identify potential options for future management. Through a series of stakeholder workshops and focus group discussions conducted over two years results show that local communities can identify benefits from mangroves beyond the provisioning of goods and significant impacts to their lives from mangrove loss. While better protected and managed mangroves remained a central part of participants' visions for the islands, participants foresaw a limited future for fishing around the islands, preferring instead alternative livelihood opportunities such as eco-tourism. The network of influencers of the Klang Islands’ mangroves extends far beyond the local communities and many of these actors were part of the visions put forward. Stakeholders with a high interest in the mangroves typically have a low influence over their management and many high influence stakeholders (e.g. private sector actors) were missing from the engagement. Future nexus action should focus on integrating stakeholders and include deliberate and concerted engagement with high influence stakeholders while at the same time ensuring a platform for high interest/low influence groups. Fortifying existing plans to include mangroves more explicitly will also be essential. Lessons learnt from this study are highly relevant for coastal mangrove systems elsewhere in the Southeast Asian region

    New Record of Edible Chicken of the Wood Mushroom, Laetiporus versisporus (Lloyd) Imazeki (Fomitopsidaceae, Polyporales) from Sabah (Northern Borneo), Malaysia

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    The genus Laetiporus has been previously reported from Mesilau in Sabah, Northern Borneo in 1964. To date, no further documentation of the Laetiporus genus has been reported in Sabah, Malaysia. This study provides an overview of recent literature on taxonomic updates, distribution and sequence data of Laetiporus in Malaysia. During the period March – June 2020, two Laetiporus specimens were collected in Maliau Basin Conservation Area and Sipitang. These two specimens were identified as L. versisporus based on morphological characteristics and molecular methods. Interestingly, no sequence data for this particular species have been documented for Malaysian Borneo. This study represents the initial documentation of L. versisporus in Sabah (Northern Borneo) that have potential applications in medicine and food industry and provide insights into its phylogenetic relationship within the genus Laetiporus

    Access to the next wave of biologic therapies (Abatacept and Tocilizumab) for the treatment of rheumatoid arthritis in England and Wales: Addressing treatment outside the current NICE guidance

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    Patients in England and Wales with rheumatoid arthritis (RA) receive treatment from the National Health Service (NHS) with therapies approved by the European Medicines Agency (EMA), under guidance from the National Institute for Health and Clinical Excellence (NICE). This document overviews the current NICE guidelines for the treatment of RA and identifies scenarios when such guidance may not represent the optimum management strategy for individual patients. Specifically, we consider the use of tocilizumab or abatacept as the most appropriate treatments for some patients. In such scenarios, it may be possible for the clinician to secure access to the required therapy through an application procedure known as an ‘individual funding request’, the process of which is described in detail here. At present, it is unclear the extent to which the proposed reform of the NHS will affect the role of NICE in providing guidance and setting standards of care. Until the full impact of the proposed changes are realized, individual funding requests will remain a valuable way of securing the optimal treatment for all patients suffering from RA

    Does CT colonography have a role for population-based colorectal cancer screening?

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    Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related deaths in Europe. CRC screening has been proven to reduce disease-specific mortality and several European countries employ national screening programmes. These almost exclusively rely on stool tests, with endoscopy used as an adjunct in some countries. Computed tomographic colonography (CTC) is a potential screening test, with an estimated sensitivity of 88 % for advanced neoplasia ≥10 mm. Recent randomised studies have shown that CTC and colonoscopy have similar yields of advanced neoplasia per screened invitee, indicating that CTC is potentially viable as a primary screening test. However, the evidence is not fully elaborated. It is unclear whether CTC screening is cost-effective and the impact of extracolonic findings, both medical and economic, remains unknown. Furthermore, the effect of CTC screening on CRC-related mortality is unknown, as it is also unknown for colonoscopy. It is plausible that both techniques could lead to decreased mortality, as for sigmoidoscopy and gFOBT. Although radiation exposure is a drawback, this disadvantage may be over-emphasised. In conclusion, the detection characteristics and acceptability of CTC suggest it is a viable screening investigation. Implementation will depend on detection of extracolonic disease and health-economic impact

    CT colonography with limited bowel preparation for the detection of colorectal neoplasia in an FOBT positive screening population

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    Item does not contain fulltextPURPOSE: Aim was to evaluate the accuracy of computed tomography colonography (CTC) for detection of colorectal neoplasia in a Fecal Occult Blood Test (FOBT) positive screening population. METHODS: In three different institutions, consecutive FOBT positives underwent CTC after laxative free iodine tagging bowel preparation followed by colonoscopy with segmental unblinding. Each CTC was read by two experienced observers. For CTC and for colonoscopy the per-polyp sensitivity and per-patient sensitivity and specificity were calculated for detection of carcinomas, advanced adenomas, and adenomas. RESULTS: In total 22 of 302 included FOBT positive participants had a carcinoma (7%) and 137 had an adenoma or carcinoma >/=10 mm (45%). CTC sensitivity for carcinoma was 95% with one rectal carcinoma as false negative finding. CTC sensitivity for advanced adenomas was 92% (95% CI: 88-96) vs. 96% (95% CI: 93-99) for colonoscopy (P = 0.26). For adenomas and carcinomas >/=10 mm the CTC per-polyp sensitivity was 93% (95% CI: 89-97) vs. 97% (95% CI: 94-99) for colonoscopy (P = 0.17). The per-patient sensitivity for the detection of adenomas and carcinomas >/=10 mm was 95% (95% CI: 91-99) for CTC vs. 99% (95% CI: 98-100) for colonoscopy (P = 0.07), while the per-patient specificity was 90% (95% CI: 86-95) and 96% (95% CI: 94-99), respectively (P < 0.001). CONCLUSION: CTC with limited bowel preparation performed in an FOBT positive screening population has high diagnostic accuracy for the detection of adenomas and carcinomas and a sensitivity similar to that of colonoscopy for relevant lesions.1 december 201

    Race and Inflammatory Bowel Disease in an Urban Healthcare System

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    Inflammatory bowel disease (IBD) is increasingly common among non-Caucasian populations, but interracial differences in disease characteristics and management are not well-characterized. We tested the hypothesis that disease characteristics and management vary by race among IBD patients in an ethnically diverse healthcare system. A retrospective study of the safety net healthcare system of San Francisco, CA, from 1996 to 2009 was undertaken. Patient records with International Classification of Diseases, 9th Revision (ICD9) codes 555.xx, 556.xx, and 558.xx were reviewed. Adult patients with confirmed IBD diagnoses were included. Interracial variations in disease characteristics and management were assessed broadly; focused between-race comparisons identified specific differences. The 228 subjects included 77 (33.4%) with Crohn’s disease (CD), 150 (65.8%) with ulcerative colitis, and 1 (0.4%) with IBD, type unclassified. The race distribution included 105 (46.1%) white, 34 (14.9%) black, 35 (15.4%) Hispanic, and 51 (22.4%) Asian subjects. Asians and Hispanics were diagnosed at older ages (41.0 and 37.1 years, respectively) and had shorter disease durations (5.4 and 5.2 years, respectively) than whites (30.5 years at diagnosis and 8.6 years duration, P &lt; 0.05) and blacks (31.7 years at diagnosis and 12.1 years duration, P &lt; 0.05). CD was more common among blacks (50% of subjects) than Asians (25.5% of subjects, P = 0.015). The Montreal classification of IBD was similar among races. Hispanics were less likely than others to be treated with 5-aminosalicylates (5-ASA), immunomodulators, and steroids. Medical and surgical management was otherwise similar among races. Modest race-based differences in IBD characteristics exist in this racially diverse healthcare system, but the management of IBD is similar among race groups
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