Al Ain Hospital

STUDY QUESTION: What is the recommended management of women with recurrent pregnancy loss (RPL) based on the best available evidence in the literature? SUMMARY ANSWER: The guideline development group formulated 77 recommendations answering 18 key questions on investigations and treatments for RPL, and on how care should be organized. WHAT IS KNOWN ALREADY: A previous guideline for the investigation and medical treatment of recurrent miscarriage was published in 2006 and is in need of an update. STUDY DESIGN SIZE DURATION: The guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 31 March 2017 and written in English were included. Cumulative live birth rate, live birth rate and pregnancy loss rate (or miscarriage rate) were considered the critical outcomes. PARTICIPANTS/MATERIALS SETTING METHODS: Based on the collected evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. A stakeholder review was organized after finalization of the draft. The final version was approved by the guideline group and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE: The guideline provides 38 recommendations on risk factors, prevention and investigations in couples with RPL, and 39 recommendations on treatments. These include 60 evidence-based recommendations - of which 31 were formulated as strong recommendations and 29 as conditional - and 17 good practice points. The evidence supporting investigations and treatment of couples with RPL is limited and of moderate quality. Of the evidence-based recommendations, only 10 (16.3%) were supported by moderate quality evidence. The remaining recommendations were supported by low (35 recommendations: 57.4%), or very low quality evidence (16 recommendations: 26.2%). There were no recommendations based on high quality evidence. Owing to the lack of evidence-based investigations and treatments in RPL care, the guideline also clearly mentions investigations and treatments that should not be used for couples with RPL. LIMITATIONS REASONS FOR CAUTION: Several investigations and treatments are offered to couples with RPL, but most of them are not well studied. For most of these investigations and treatments, a recommendation against the intervention or treatment was formulated based on insufficient evidence. Future studies may require these recommendations to be revised. WIDER IMPLICATIONS OF THE FINDINGS: The guideline provides clinicians with clear advice on best practice in RPL, based on the best evidence available. In addition, a list of research recommendations is provided to stimulate further studies in RPL. One of the most important consequences of the limited evidence is the absence of evidence for a definition of RPL. STUDY FUNDING/COMPETING INTERESTS: The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payment. J.E. reports position funding from CARE Fertility. S.L. reports position funding from SpermComet Ltd. S.M. reports research grants, consulting and speaker's fees from GSK, BMS/Pfizer, Sanquin, Aspen, Bayer and Daiichi Sankyo. S.Q. reports speaker's fees from Ferring. The other authors report no conflicts of interest.ESHRE Pages are not externally peer reviewed. This article has been approved by the Executive Committee of ESHRE.

Climate change will have far-reaching impacts on biodiversity, including increasing extinction rates. Current approaches to quantifying such impacts focus on measuring exposure to climatic change and largely ignore the biological differences between species that may significantly increase or reduce their vulnerability. To address this, we present a framework for assessing three dimensions of climate change vulnerability, namely sensitivity, exposure and adaptive capacity; this draws on species' biological traits and their modeled exposure to projected climatic changes. In the largest such assessment to date, we applied this approach to each of the world's birds, amphibians and corals (16,857 species). The resulting assessments identify the species with greatest relative vulnerability to climate change and the geographic areas in which they are concentrated, including the Amazon basin for amphibians and birds, and the central Indo-west Pacific (Coral Triangle) for corals. We found that high concentration areas for species with traits conferring highest sensitivity and lowest adaptive capacity differ from those of highly exposed species, and we identify areas where exposure-based assessments alone may over or under-estimate climate change impacts. We found that 608-851 bird (6-9%), 670-933 amphibian (11-15%), and 47-73 coral species (6-9%) are both highly climate change vulnerable and already threatened with extinction on the IUCN Red List. The remaining highly climate change vulnerable species represent new priorities for conservation. Fewer species are highly climate change vulnerable under lower IPCC SRES emissions scenarios, indicating that reducing greenhouse emissions will reduce climate change driven extinctions. Our study answers the growing call for a more biologically and ecologically inclusive approach to assessing climate change vulnerability. By facilitating independent assessment of the three dimensions of climate change vulnerability, our approach can be used to devise species and area-specific conservation interventions and indices. The priorities we identify will strengthen global strategies to mitigate climate change impacts.

Increasing the collective contribution of protected areas toward preventing species extinctions requires the strategic allocation of management efforts.

BACKGROUND: Fabry's disease, an X-linked disorder of lysosomal α-galactosidase deficiency, leads to substrate accumulation in multiple organs. Migalastat, an oral pharmacologic chaperone, stabilizes specific mutant forms of α-galactosidase, increasing enzyme trafficking to lysosomes. METHODS: The initial assay of mutant α-galactosidase forms that we used to categorize 67 patients with Fabry's disease for randomization to 6 months of double-blind migalastat or placebo (stage 1), followed by open-label migalastat from 6 to 12 months (stage 2) plus an additional year, had certain limitations. Before unblinding, a new, validated assay showed that 50 of the 67 participants had mutant α-galactosidase forms suitable for targeting by migalastat. The primary end point was the percentage of patients who had a response (≥50% reduction in the number of globotriaosylceramide inclusions per kidney interstitial capillary) at 6 months. We assessed safety along with disease substrates and renal, cardiovascular, and patient-reported outcomes. RESULTS: The primary end-point analysis, involving patients with mutant α-galactosidase forms that were suitable or not suitable for migalastat therapy, did not show a significant treatment effect: 13 of 32 patients (41%) who received migalastat and 9 of 32 patients (28%) who received placebo had a response at 6 months (P=0.30). Among patients with suitable mutant α-galactosidase who received migalastat for up to 24 months, the annualized changes from baseline in the estimated glomerular filtration rate (GFR) and measured GFR were -0.30±0.66 and -1.51±1.33 ml per minute per 1.73 m(2) of body-surface area, respectively. The left-ventricular-mass index decreased significantly from baseline (-7.7 g per square meter; 95% confidence interval [CI], -15.4 to -0.01), particularly when left ventricular hypertrophy was present (-18.6 g per square meter; 95% CI, -38.2 to 1.0). The severity of diarrhea, reflux, and indigestion decreased. CONCLUSIONS: Among all randomly assigned patients (with mutant α-galactosidase forms that were suitable or not suitable for migalastat therapy), the percentage of patients who had a response at 6 months did not differ significantly between the migalastat group and the placebo group. (Funded by Amicus Therapeutics; ClinicalTrials.gov numbers, NCT00925301 [study AT1001-011] and NCT01458119 [study AT1001-041].).

Abstract Governments have committed to conserving ≥17% of terrestrial and ≥10% of marine environments globally, especially “areas of particular importance for biodiversity” through “ecologically representative” Protected Area (PA) systems or other “area‐based conservation measures”, while individual countries have committed to conserve 3–50% of their land area. We estimate that PAs currently cover 14.6% of terrestrial and 2.8% of marine extent, but 59–68% of ecoregions, 77–78% of important sites for biodiversity, and 57% of 25,380 species have inadequate coverage. The existing 19.7 million km 2 terrestrial PA network needs only 3.3 million km 2 to be added to achieve 17% terrestrial coverage. However, it would require nearly doubling to achieve, cost‐efficiently, coverage targets for all countries, ecoregions, important sites, and species. Poorer countries have the largest relative shortfalls. Such extensive and rapid expansion of formal PAs is unlikely to be achievable. Greater focus is therefore needed on alternative approaches, including community‐ and privately managed sites and other effective area‐based conservation measures.

STUDY QUESTION: What are the updates for the recommended management of women with recurrent pregnancy loss (RPL) based on the best available evidence in the literature from 2017 to 2022? SUMMARY ANSWER: The guideline development group (GDG) updated 11 existing recommendations on investigations and treatments for RPL, and how care should be organized, and added one new recommendation on adenomyosis investigation in women with RPL. WHAT IS KNOWN ALREADY: A previous ESHRE guideline on RPL was published in 2017 and needs to be updated. STUDY DESIGN SIZE DURATION: The guideline was developed and updated according to the structured methodology for development and update of ESHRE guidelines. The literature searches were updated, and assessments of relevant new evidence were performed. Relevant papers published between 31 March 2017 and 28 February 2022 and written in English were included. Cumulative live birth rate, live birth rate, and pregnancy loss rate (or miscarriage rate) were considered the critical outcomes. PARTICIPANTS/MATERIALS SETTING METHODS: Based on the collected evidence, recommendations were updated and discussed until consensus was reached within the GDG. A stakeholder review was organized after the updated draft was finalized. The final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE: The new version of the guideline provides 39 recommendations on risk factors, prevention, and investigation in couples with RPL, and 38 recommendations on treatments. These includes 62 evidence-based recommendations-of which 33 were formulated as strong recommendations and 29 as conditional-and 15 good practice points. Of the evidence-based recommendations, 12 (19.4%) were supported by moderate-quality evidence. The remaining recommendations were supported by low (34 recommendations; 54.8%), or very low-quality evidence (16 recommendations; 25.8%). Owing to the lack of evidence-based investigations and treatments in RPL care, the guideline also clearly mentions those investigations and treatments that should not be used for couples with RPL. LIMITATIONS REASONS FOR CAUTION: The guidelines have been updated; however, several investigations and treatments currently offered to couples with RPL have not been well studied; for most of these investigations and treatments, a recommendation against using the intervention or treatment was formulated based on insufficient evidence. Future studies may require these recommendations to be revised. WIDER IMPLICATIONS OF THE FINDINGS: The guideline provides clinicians with clear advice on best practice in RPL, based on the best and most recent evidence available. In addition, a list of research recommendations is provided to stimulate further studies in RPL. Still, the absence of a unified definition of RPL is one of the most critical consequences of the limited scientific evidence in the field. STUDY FUNDING/COMPETING INTERESTS: The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payment.O.B.C. reports being a member of the executive board of the European Society for Reproductive Immunology and has received payment for honoraria for giving lectures about RPL in Australia in 2020. M.G. reports unconditional research and educational grant received by the Centre for Reproductive Medicine, Amsterdam UMC from Guerbet, Merck and Ferring, not related to the presented work. S.L. reports position funding from EXAMENLAB Ltd. and ownership interest by stock or partnership of EXAMENLAB Ltd (CEO). S.Q. reports being a deputy director of Tommy's National centre for miscarriage research, with payment received by the institution for research, staff time, and consumables for research. H.S.N. reports grants with payment to institution from Freya Biosciences ApS, Ferring Pharmaceuticals, BioInnovation Institute, the Danish ministry of Education, Novo Nordic Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, Ole Kirks Fond, and Independent Research Fund Denmark and speakers' fees for lectures from Ferring Pharmaceuticals, Merck A/S, Astra Zeneca, IBSA Nordic and Cook Medical. She also reports to be an unpaid founder and chairman of a maternity foundation. M.-L.v.d.H. received small honoraria for lectures on RPL care. The other authors have no conflicts of interest to declare. DISCLAIMER: This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained.Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type.ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. (Full disclaimer available at www.eshre.eu/guidelines.).

Abstract Background Anxiety disorders comprise some of the most common mental health conditions. This study examined the global and regional burden of anxiety disorders over the last three decades. The study was designed to help accurately target preventative and management efforts by highlighting trends and high-risk groups. Epidemiological data relating to anxiety disorders from the latest Global Burden of Disease dataset were analyzed to determine the prevalence, incidence, and disability adjusted life years (DALYs) rates from 1990 to 2019 for 204 countries and regions. Results An estimated 4.05% of the global population has an anxiety disorder, translating to 301 million people. The number of persons affected has increased by more than 55% from 1990 to 2019. Anxiety disorder metrics show a continuous increase in prevalence, incidence, and DALY rates. Portugal has the highest prevalence (8,671 cases per 100,000), followed by Brazil, Iran, and New Zealand. The prevalence is higher in high-income regions. Women are 1.66 times more likely to be affected by anxiety disorders than men. Age-standardized rates have remained stable, indicating the possible stability of risk factors. Conclusions The prevalence of anxiety disorders has been rising over the last three decades. The prevalence of anxiety appears to increase with socioeconomic development, a higher dependent older population, and urbanization. Future research on this topic could include the development of more accurate cross-cultural metrics to assess anxiety and its correlates, as well as population-based studies to assess trends in anxiety over time.

This study examines the frequency of consanguineous marriage and the coefficient of inbreeding in the United Arab Emirates (UAE). The study was conducted in Al Ain and Dubai cities between October 1994 and March 1995. A sample of 2033 married UAE females aged 15 years and over participated. The degree of consanguinity between each female and her spouse, and the degree of consanguinity between their parents were recorded. The rate of consanguinity in the present generation was high (50.5%) with a coefficient of inbreeding of 0.0222. The commonest type of consanguineous marriage was between first cousins (26.2%). Double first cousin marriages were common (3.5%) compared to other populations. The consanguinity rate in the UAE has increased from 39% to 50.5% in one generation. The level of consanguinity was higher in Al Ain (54.2%) than in Dubai (40%).

BACKGROUND: To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. METHODS: The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. RESULTS: Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p < 0.0001). The multivariate logistic regression model was highly significant (p < 0.0001, R2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4. CONCLUSIONS: WSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.

Previous studies show that conservation actions have prevented extinctions, recovered populations, and reduced declining trends in global biodiversity. However, all studies to date have substantially underestimated the difference conservation action makes because they failed to account fully for what would have happened in the absence thereof. We undertook a scenario-based thought experiment to better quantify the effect conservation actions have had on the extinction risk of the world's 235 recognized ungulate species. We did so by comparing species’ observed conservation status in 2008 with their estimated status under counterfactual scenarios in which conservation efforts ceased in 1996. We estimated that without conservation at least 148 species would have deteriorated by one International Union for Conservation of Nature (IUCN) Red List category, including 6 species that now would be listed as extinct or extinct in the wild. The overall decline in the conservation status of ungulates would have been nearly 8 times worse than observed. This trend would have been greater still if not for conservation on private lands. While some species have benefited from highly targeted interventions, such as reintroduction, most benefited collaterally from conservation such as habitat protection. We found that the difference conservation action makes to the conservation status of the world's ungulate species is likely to be higher than previously estimated. Increased, and sustained, investment could help achieve further improvements. La Diferencia que Hace la Conservación en el Riesgo de Extinción de los Ungulados del Mundo Los estudios previos muestran que las acciones de conservación han prevenido extinciones, recuperado poblaciones y reducido las tendencias de declinación en la biodiversidad mundial. Sin embargo, todos los estudios a la fecha han subestimado sustancialmente la diferencia que hace la acción de conservación ya que fallaron en representar de lleno lo que podría pasar en ausencia de esta. Emprendimos un experimento reflexivo con base en escenarios para cuantificar de mejor manera el efecto que las acciones de conservación han tenido sobre el riesgo de extinción de las 235 especies reconocidas de ungulados en el mundo. Hicimos esto al comparar el estado de conservación de la especie observado en 2008 con su estado estimado bajo escenarios contrafáctico en los cuales los esfuerzos de conservación cesaron en 1996. Estimamos que sin la conservación, al menos 148 especies habrían empeorado su categoría en la Lista Roja de la Unión para la Conservación de la Naturaleza (UICN), incluidas seis especies que ahora aparecerían como extintas o extintas en estado silvestre. La declinación general en el estado de conservación de los ungulados habría sido casi ocho veces peor de lo que se observó. Esta tendencia habría sido mayor si no fuera por la conservación en tierras privadas. Mientras algunas especies se han beneficiado de intervenciones altamente enfocadas, como la reintroducción, la mayoría se benefició colateralmente de la conservación, como la protección de hábitat. Encontramos que la diferencia que hace la acción de conservación en el estado de conservación de las especies de ungulados probablemente sea mayor de lo que se estimó previamente. Una inversión aumentada, y sostenida, podría ayudar a obtener más mejorías. Current evidence indicates a growing mismatch between increasing pressures to biodiversity and conservation responses (Tittensor et al. 2014). Success, however, is not uncommon in the field of biodiversity conservation (Sodhi et al. 2011; Balmford 2012). Extinctions of some species have been prevented (Butchart et al. 2006; Brooke et al. 2008), population trajectories have improved (Donald et al. 2007; Deinet et al. 2013; Chapron et al. 2014), and the risk of extinction of wild species has decreased (Hoffmann et al. 2010). There have been increased calls for evidence-based conservation to actively demonstrate this effectiveness to funders, policy formers, and the public (Sutherland et al. 2004). However, while other policy fields of global importance undertake extensive evaluations of success (Ferraro & Pattanayak 2006), evaluations of the outcomes of conservation actions were until recently relatively rare (Sutherland et al. 2004; Kapos et al. 2009). Therefore, opportunities to efficiently allocate limited resources, encourage the application of effective policies, and inspire people to become involved in biodiversity conservation may be missed (Ferraro & Pattanayak 2006). Understanding what difference conservation makes is difficult because conservationists are generally preoccupied with reacting to emergencies rather than with quantifying their actions and impacts and it is inherently difficult to know what would have happened without intervention (Rodrigues 2006). Tests of conservation interventions in controlled experiments akin to those in medicine are extremely rare in conservation and often not possible except for small-scale interventions (given the need to ensure everything else remains equal in the control setting). Instead, the impact of specific interventions on biodiversity have been tested using a posteriori analyses of natural experiments through comparisons of biodiversity condition with and without the intervention (e.g., inside and outside protected areas [Joppa & Pfaff 2010; Geldmann et al. 2013]; with and without law enforcement guards [Tranquilli et al. 2012]) or through correlations between the magnitude of the intervention and of biodiversity condition (e.g., protected area coverage vs. changes in extinction risk [Butchart et al. 2012]). However, conservation takes places through a diversity of actions (e.g., protected areas and legislation), with various degrees of synergy among them, and measuring the overall impact of these actions cannot be done by simply summing the impacts of individual actions (Rodrigues 2006). One way to explore what would have happened without conservation actions is to construct a counterfactual scenario – a hypothetical scenario that estimates what would have happened if conservation actions had not actually taken place (Ferraro & Pattanayak 2006; Ferraro 2009). Hoffmann et al. (2010) previously documented 68 species of mammals, birds, and amphibians known to have improved in conservation status in recent decades due to conservation efforts. They found that, if such conservation successes had not occurred, the overall deterioration in conservation status in these 3 taxa would have been one-fifth worse again than that observed. However, these authors cautioned that their study underestimated true conservation impact because it only examined species that improved in conservation status. In practice, in the absence of conservation, some species that remained unchanged in status may have actually deteriorated or species that deteriorated over the time period considered may have deteriorated further (or even gone extinct). These, too, are conservation successes, but they are less straightforward to identify. In a different study, Butchart et al. (2006) identified at least 16 critically endangered bird species that likely would have gone extinct between 1994 and 2004 without conservation action. These authors also underestimated conservation impact because they focused solely on the avoidance of species extinctions. However, conservation is not only about preventing highly threatened species from becoming extinct, but also about keeping common species from becoming threatened (Gaston 2010). We explored further the difference conservation makes by focusing on ungulates as a case study. We investigated how conservation efforts affected their extinction risk by comparing their observed International Union for Conservation of Nature (IUCN) Red List categories between 1996 and 2008 with the conservation status that we estimated they would have had under a hypothetical scenario where all conservation actions ceased at the start of the period. We then used the IUCN Red List Index (RLI), an established method (e.g., Tittensor et al. 2014) that tracks trends over time in overall extinction risk of species, to compare the observed RLI with that resulting from our hypothetical scenario. Individual species are likely to differ in terms of how they actually benefit from conservation. For example, some species may benefit from directly targeted conservation actions (such as reintroduction efforts) that mitigate species-specific threats (e.g., Dobson & Lyles 2000), while others may benefit collaterally from more general conservation actions (such as habitat protection). To better understand how ungulate species benefited from conservation, we classified all ungulates according to a typology that related the specificity of actions to the specificity of the threat. We included in our analysis all 235 ungulates assessed on the IUCN Red List in 2008 in data sufficient (i.e., non-data deficient) categories in the orders Cetartiodactyla (Cervidae, Moschidae, Tragulidae, Giraffidae, Camelidae, Antilocapridae, Suidae, Tayassuidae, Hippopotamidae, Bovidae) and Perissodactyla (Rhinocerotidae, Equidae, Tapiridae). We followed the same species concept adopted for the purposes of assessments in 2008, recognizing that many species await reassessment to account for taxonomic revisions. Several new species described recently (e.g., Philantomba walkeri [Colyn et al. 2010]) await formal assessment by IUCN, so they have not been included in these analyses. We followed the standard RLI method (Butchart et al. 2004, 2007) that combines information on species’ red-list status at a given time to obtain an aggregated measure of extinction risk for a group of species. Changes in the RLI over time result from genuine changes in species red-list status between assessments: improvements in status contribute to an increase, whereas deteriorations contribute to a decline in the RLI. Thus, RLI trends reflect the net outcome of these improvements and deteriorations. An RLI has been previously derived for all mammals based on genuine observed changes in extinction risk between 1996 and 2008 (Hoffmann et al. 2010, 2011). The year 2008 corresponds to the date when mammals were last assessed globally (Schipper et al. 2008). The 1996 and 2008 red-list categories for ungulates from Hoffmann et al. (2010, 2011) are hereafter termed the 1996 observed red-list category and 2008 observed red-list category, respectively (modifying the categories for 6 species where new information suggested a change was required to previously published categories; see Supporting We used these categories to an observed RLI for ungulates as a measure of their conservation between 1996 and To our counterfactual we estimated what species’ red-list category would have been in 2008 if all conservation actions had ceased in 1996 the 2008 counterfactual red-list This may but to an of the difference global conservation is it is to a where such are by based on a of what however, whereas scenarios are (e.g., et al. 2000), our scenario was least one recent study has an of conservation impact based on a scenario and et al. 2014). scenario of no conservation action that all for conservation to in 1996. is to to formal protected areas but for ungulates in the private also a in conservation We 2008 counterfactual red-list categories under scenario where private is not considered as to conservation, and scenario where private for conservation purposes were as if they were formal protected to scenario as our counterfactual because private is not of conservation were not to population to quantify of extinction in the absence of conservation action. Instead, the used by Butchart et al. we used information to on population and of of their and and conservation interventions to as as possible how the extinction risk of species would have had conservation action ceased in 1996 Supporting We used information in the for ungulates published on the IUCN Red List IUCN action (e.g., & et al. 2004; et al. status (e.g., et al. and (e.g., & Hoffmann with our and with with species In species’ 2008 counterfactual red-list category, we in to our an and category for species Supporting The for scenarios were using the 2008 counterfactual red-list categories; however, using the and categories to the of our by an and counterfactual RLI under We did not all species’ be better with than without conservation. some species could have benefited from the absence of conservation (e.g., by increasing in due to the decline of our is that species would have no change without conservation we had to We conservation action as action that could be according to the of conservation actions et al. 2008). We did not we these often have conservation This many to in or not a intervention be included in the 2008 counterfactual red-list actions that have species may or may not have a true biodiversity conservation or For example, we did not actions (e.g., as conservation they have been as in the of conservation and not for public some or have a impact in terms of biodiversity conservation (e.g., from in but has been in but we did not these as conservation actions because these generally are not included in conservation and the effect of of conservation is the The result of such (i.e., actions and difficult to quantify such as is a more as individual species may be directly affected by targeted threats or collaterally affected by more general so species are likely to benefit directly from targeted conservation actions and collaterally from less specific We 6 of species based on the to which they were the of targeted conservation action to the to which they were directly targeted by threats in We then ungulate species to of these 6 or species are affected by targeted but they also benefit from targeted conservation These are species may also species of that have been affected (e.g., because of their or because their is in with and are highly but they have also been to targeted conservation actions (such as reintroduction and and species-specific species are affected collaterally by threats and benefit collaterally from conservation These species are not directly However, they may be generally affected by threats (i.e., the in keeping with the of et al. is at the or not at the and are not to conservation efforts rather benefit from more general such as habitat or in place for other species are affected collaterally by but they benefit from targeted conservation actions their has been species are affected by targeted but they benefit only collaterally from conservation with species, these species are directly targeted by threats or (i.e., the is at the species and in or to the However, species, they are not to conservation efforts. they benefit from more general such as habitat or in place for other species. species are or affected by directly or They may benefit directly from targeted conservation benefit or not benefit at These species may in or a of or to and of species not conservation action. They may be affected by affected collaterally by or be or affected by This category all species by conservation and those for which conservation interventions are (e.g., because they in a of even they may be affected by The observed trend in the RLI for ungulates that their overall status deteriorated from 1996 to by This the observed for all mammals, where the RLI by from 1996 to 2008 (Hoffmann et al. 2010). In scenario conservation we identified ungulate species that we estimated would have deteriorated in conservation status by one or more IUCN Red List categories over the period with that actually these species, nearly would have deteriorated from least to threatened 3 that or threatened that The counterfactual RLI under this scenario would have by at least and between and for the most and assessments scenario conservation action including conservation on private we estimated that species would have deteriorated in conservation status by one or more The counterfactual RLI would have by between 1996 and 2008 (or and between and for the most and The trends in RLI described in of the scenarios be more directly if a more or of the of ungulate species by one IUCN Red List category between 1996 and in the observed 148 in scenario and in scenario than of all ungulate species or were to targeted threats these only a benefited from conservation action but many more benefited from conservation. In at least species and were affected by threats habitat due to or including 3 that conservation and that benefited collaterally from conservation species were not substantially affected by threats The to the difference between the observed RLI and the counterfactual RLI as under scenario was by species of for of the impact species had a more (i.e., less 2008 observed red-list category in 2008 than they would have had in the absence of conservation The of the was by species which 16 had a more 2008 observed red-list category than the followed by of the and species had no difference between their 2008 observed and counterfactual red-list categories and no to the of the counterfactual RLI. of all species in had a better conservation status in their observed categories than in the We observed trends in the world's ungulate species between 1996 and 2008 would have been different if all conservation interventions ceased at the start of this period. suggested that the overall decline in the conservation status of ungulates would have been nearly 8 times worse than to an of ungulate species by one red-list category year from 1996 to 2008 with the observed of than species that actually did a deterioration over this of all species would have deteriorated in status by one category between 1996 and 2008 and would have deteriorated by or more categories The of ungulates as threatened would have increased from the of non-data species observed in 2008 to to an species from least or threatened to a threatened The estimated of decline increased further when the of private to conservation was our counterfactual species deteriorated by one red-list category the biodiversity of private 2014). For one species, the common we estimated that conservation actions prevented a deterioration from least to critically the population of the for some of population and we estimated that of (e.g., by the of et al. and increased pressures (e.g., of the et al. would have to in this for this species, without habitat likely would have been sufficient to as critically endangered in 2008, based on a decline over 3 We estimated that conservation actions have prevented the and extinction of at least species, and greater The species has been from in the period we an to the of conservation efforts in the to et al. 2014). pressures due to no conservation would we have the possible of the listed as critically endangered in 1996 and We estimated further that 3 species would have been listed as extinct in the wild were it not for conservation action The did extinct in the the last were in in the but it has been to extensive and reintroduction efforts the and was recently classified as The of conservation actions in 1996 would have in the reintroduction efforts would not have been from extinct in the wild in 1996 to observed category of critically endangered in 2008 if and had The species, likely would have been from highly due to and habitat but it would have in some private The of species in our data was not that ungulates are a for and to would be that the overall impact of conservation on such species would not be given that, in the threats are not and species only benefit in a from conservation (e.g., through habitat or efforts However, our that conservation a for example, to to are to of for or with at While have been or no species-specific interventions targeted at these protected areas have to because they areas for at least some of enforcement (e.g., et al. among a group as as species targeted are relatively in However, they account for a of the difference between the observed and counterfactual RLI. these highly species, conservation action is targeted and often to mitigate between the higher categories (e.g., critically endangered to extinct in the In the absence of for example, would not have from extinct in the wild to and greater would be and species are even in and account for to of the difference between the species, conservation action could result in in red-list categories as species are from threats that could be For such species, and critically we than that would have gone extinct without however, is that without conservation interventions, the status of would be and species no to the difference between the observed and counterfactual species included many species that have a higher of for or and a of For these species, the impact of conservation was because by if are no threats is no even if be or conservation. species did not benefit from conservation action. These included species in the of where protected areas are and are no targeted For of ungulate species, we estimated that their 2008 counterfactual red-list categories would have been the same as their 2008 observed red-list categories conservation did not their risk of extinction in the wild. However, red-list categories are and so our method cannot population changes to change between For example, under of the IUCN Red List and a population decline and over 3 an endangered a conservation action the of a species’ population decline from to over 3 the species classified as endangered in would have no difference to the counterfactual RLI. This to our an of conservation Hoffmann et al. (2010) that the RLI would have by an for mammals in the absence of conservation that conservation efforts are a their to ungulates the RLI would have by an from that observed Supporting based on a method that takes account not only the of conservation actions on species’ but also for their on preventing show that the RLI would have by an in the absence of conservation These cannot be directly to mammals in we found that different species to the impact of conservation actions and ungulates are by species that are to be of species conservation were the most common in our data it is likely that most are by species one habitat is the among mammals (Schipper et al. 2008), and most species are collaterally by protected areas (Rodrigues et al. 2004). the other species in the most orders (e.g., are a targeted by conservation actions and so most are likely to be In species targeted are likely to be rare among these even if they be more in a with higher species (e.g., and we that for mammals in general trends in the counterfactual RLI under the same scenario that we would not be as as those we estimated for ungulates because the have more species that benefit from targeted conservation However, because we show that species that benefit collaterally from conservation actions also substantially to the difference between the observed and counterfactual we that the application of our to all mammals would that conservation a difference to observed trends in extinction this by our to a group of species. The with our is that a counterfactual for species a analysis of the of the threats they are to and conservation actions they benefit An way of our method to a group would be to a (i.e., of species has been done for the of a RLI et al. and the counterfactual for this from which of conservation impact could be The to our study is the of our estimates of extinction risk under a no conservation scenario. This may but the was not to a but rather a hypothetical one that would to measure the overall impact of conservation. We used the information to to the likely of species in this scenario. This involved a of the hypothetical of our study, we to on the of in our estimates of the 2008 counterfactual red-list categories in not to our of the decline in the RLI for scenario substantially to the than to the one and is more likely to be an of conservation impact than an demonstrate that conservation actions have to common species or at least prevented deteriorations in extinction risk from to higher categories of while to highly threatened species from We also that while conservation has to species from extinct, through species-specific interventions, the of species have from conservation efforts we an improved of conservation it remains an We our study is an to help one of conservation most difficult our further evidence that conservation action is a difference to trends in biodiversity. a in investment et al. in such efforts is to global efforts and achieve global biodiversity We are to the for data and the of the counterfactual red-list categories possible in our our the and We to the many of in the and and of the IUCN all of their and time to the of data on the IUCN Red Butchart many and that improved the as did 3 This is to the of the IUCN most of for the of threatened species. have been but not The is not for the or of information by the than be to the for the

Detailed, country-specific epidemiological data are needed to characterize the burden of chronic hepatitis C virus (HCV) infection around the world. With new treatment options available, policy makers and public health officials must reconsider national strategies for infection control. In this study of 15 countries, published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates were gathered from the literature and validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Iran and Lebanon to 4.2% in Pakistan. The largest viraemic populations were in Pakistan (7 001 000 cases) and Indonesia (3 187 000 cases). Injection drug use (IDU) and a historically unsafe blood supply were major risk factors in most countries. Diagnosis, treatment and liver transplant rates varied widely between countries. However, comparison across countries was difficult as the number of cases changes over time. Access to reliable data on measures such as these is critical for the development of future strategies to manage the disease burden.

Peste des petits ruminants virus was suspected to be the cause of a disease outbreak in a zoological collection at Al Ain in the Arabian Gulf. Clinically the outbreak affected gazelles (Gazellinae), ibex and sheep (Caprinae) and gemsbok (Hippotraginae); subclinical involvement of Nilgai (Tragelaphinae) was suspected. A morbillivirus was isolated and using monoclonal antibodies and biological tests in cattle, sheep and goats the virus of peste des petits ruminants was identified.

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OBJECTIVES: To analyze the concept of "case series" in the medical literature compared with case reports. METHODS: A PubMed search for articles published during 2009 which had "case series" in their title was performed. A total number of 621 articles were retrieved. 586 papers were included in the analysis and 35 were excluded (18 were commentary letters, 5 were not in English, and twelve could not be retrieved by our Library). The number of patients and category of these articles were analyzed. RESULTS: The median (range) of the number of cases of articles having "case series" in their title was 7 (1-6432) cases. 186/ 586 articles had less than 5 cases (31.7%, 95% CI (28.3-35.1%)). The median (range) of the number of cases of articles having "case report" as their publication type was 4 (1-178) cases. Out of the 219 articles categorized as case reports 114 (52.1%, 95% CI (45.6-58.6%)) had less than five cases. CONCLUSIONS: The concept of "case series" is not well defined in the literature and does not reflect a specific research design. We suggest that a case series should have more than four patients while four paitents or less should be reported individually as case reports.

The performance of the Fungitell assay was investigated in 100 patients with haematological malignancy undergoing chemotherapy who developed antibiotic-unresponsive neutropenic fever (AUNF). Serum beta-D-glucan (BG) concentrations were significantly elevated on the first day of AUNF and all subsequent alternate days to day 10 in 38 patients who developed an invasive fungal infection (IFI) compared to 42 patients remaining free of such infections. The mean and median values of BG were 171.9+/-29.6 and 95.8 pg ml(-1), respectively, for patients with IFI and 64.4+/-17.1 and 32.9 pg ml(-1) for patients with only AUNF (P<0.0001). The differences remained significant over the 10 days despite antifungal therapy. The occurrence of > or =2 sequential concentrations of > or =80 pg ml(-1) ('positive' test) was found to give the best overall option for diagnosis, with an accuracy of 81.3%, sensitivity of 86.8%, positive predictive value of 76.7% and negative predictive value of 86.5%. Of the patients with an IFI, 78% developed a positive test at or before the clinical diagnosis was made -- this occurred at a mean (range) of 1.25 (-14 to +14) days prior to the IFI diagnosis. By starting sampling of blood from the first day of neutropenia rather than from the first day of AUNF, 50% of the patients with subsequent IFI would have been identified 5 days earlier. Increasing sampling to daily from alternate-day frequency did not further improve this earlier timing of an IFI diagnosis. A greater proportion of patients with persistent high levels of BG without overt IFI had severe enterocyte damage or mucositis than those with lower levels of BG without IFI (P=0.002). If the results of the initial BG test had been acted on to change antifungal therapy, discontinuation would have been inappropriate in 30% of patients and would have delayed definitive antifungal therapy. Although the findings for the cohort of patients studied are very useful, there is inter-patient variability in the test's performance. An holistic diagnostic approach is therefore necessary to interpret the test results optimally. Future studies should address this in further detail as well as the impact of empirical antifungal drug use and patient outcome.

This study examined a possible aetiological agent, namely, Helicobacter pylori, in perforated peptic ulcer disease and its relationship to persisting ulcer. Twenty-nine patients with perforated peptic ulcer underwent simple closure of the perforation at laparotomy. A 13C urea breath test carried out on the eighth day after operation was positive in 24 patients. Fourteen of 17 patients who underwent upper gastrointestinal endoscopy 6 weeks after discharge from hospital had a positive 13C urea breath test. The biopsy urease test performed on mucosal samples taken at endoscopy was positive in 12 of these 14 patients, indicating continuing active infection with H. pylori. Seven patients with positive 13C urea breath and biopsy urease tests had persisting duodenal ulceration. None of the three patients with a negative 13C urea breath test had evidence of duodenal ulceration at endoscopy. The association between a high rate of duodenal ulcer persistence and a high incidence of H. pylori infection suggests that antibiotic therapy to eradicate this microorganism should be given to all patients with perforated peptic ulcer disease.

BACKGROUND: To date, few studies have been published reporting the 5-year follow-up of clinical and radiological outcomes for chondral defects treated with matrix-induced autologous chondrocyte implantation (MACI). HYPOTHESIS: A significant improvement in clinical and radiological outcomes after treatment of symptomatic, traumatic chondral defects of the knee with the MACI implant will be maintained up to 5 years after surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A prospective evaluation of the MACI procedure was performed in 21 patients with chondral defects of the knee. After the MACI procedure, patients were clinically assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS), the Tegner-Lysholm score, the International Knee Documentation Committee (IKDC) Subjective Knee Form, and the modified Cincinnati score at years 1, 2, and 5. The quality of repair tissue was assessed by magnetic resonance imaging using the magnetic resonance observation of cartilage repair tissue (MOCART) score at months 3 and 6 and years 1, 2, and 5. RESULTS: Significant improvements (P < .05) were observed for all 5 KOOS subcategories at year 1 and were maintained through year 5 in 90.5% of patients (19/21). Treatment failure occurred in only 9.5% of patients (2/21). Significant improvements (P < .05) from baseline to year 5 were also observed for the IKDC score (30.1 to 74.3), the modified Cincinnati score (38.1 to 79.6), and the Tegner-Lysholm activity score (1.8 to 4.3). Similarly, the MOCART score significantly improved (P < .001) from baseline to year 5 (52.9 to 75.8). After 5 years, complete filling (83%) and integration (82%) of the graft were seen in the majority of patients. Signs of subchondral bone edema were still present in 47% of patients at 5 years. No product-specific adverse events were reported over the 5-year follow-up period. CONCLUSION: Patients treated with a MACI implant demonstrated significant clinical improvement and good quality repair tissue 5 years after surgery. The MACI procedure was shown to be a safe and effective treatment for symptomatic, traumatic chondral knee defects in this study.

AIMS AND OBJECTIVES: The aim of the review was to identify intimate partner violence screening interventions used in emergency departments and to explore factors affecting intimate partner violence screening in emergency departments. BACKGROUND: Intimate partner violence against women is now clearly recognised as a global health and societal issue. Nurses working in emergency and urgent care settings can play a crucial role in identification, prevention and management of intimate partner violence. Research exploring optimal methods of intimate partner violence screening and factors affecting intimate partner violence screening in emergency departments are relatively limited. DESIGN: Literature review: Rapid Evidence Synthesis. METHODS: Literature published between 2000-2015 was reviewed using the principles of rapid evidence assessment. Six electronic databases: CINAHL, MEDLINE, EMBASE, Psych Info, the Cochrane Library and Joanna Briggs Library. RESULTS: Twenty-nine empirical studies meeting the eligibility criteria were independently assessed by two authors using appropriate Critical Appraisal Skills Programme Checklists. Intimate partner violence screening in emergency departments is usually performed using electronic, face to face or pen- and paper-based instruments. Routine or universal screening results in higher identification rates of intimate partner violence. Women who screen positive for intimate partner violence in emergency departments are more likely to experience abuse in subsequent months. Factors that facilitate partner violence screening can be classified as healthcare professionals related factors, organisational factors and patient-related factors. CONCLUSIONS: Emergency departments provide a unique opportunity for healthcare professionals to screen patients for intimate partner violence. Competence in assessing the needs of the patients appears to be a very significant factor that may affect rates of intimate partner violence disclosure. RELEVANCE TO CLINICAL PRACTICE: Knowledge of appropriate domestic violence screening methods and factors affecting intimate partner violence screening in emergency can help nurses, and other healthcare professionals provide patient-centred and effective care to victims of abuse attending emergency department.

The world's governments have committed to preventing the extinction of threatened species and improving their conservation status by 2020. However, biodiversity is not evenly distributed across space, and neither are the drivers of its decline, and so different regions face very different challenges. Here, we quantify the contribution of regions and countries towards recent global trends in vertebrate conservation status (as measured by the Red List Index), to guide action towards the 2020 target. We found that.50% of the global deterioration in the conservation status of birds, mammals and amphibians is concentrated in ,1% of the surface area, 39/1098 ecoregions (4%) and eight/195 countries (4%) -Australia, China, Colombia, Ecuador, Indonesia, Malaysia, Mexico, and the United States. These countries hold a third of global diversity in these vertebrate groups, partially explaining why they concentrate most of the losses. Yet, other megadiverse countries -most notably Brazil (responsible for 10% of species but just 1% of deterioration), plus India and Madagascar -performed better in conserving their share of global vertebrate diversity. Very few countries, mostly island nations (e.g. Cook Islands, Fiji, Mauritius, Seychelles, and Tonga), have achieved net improvements. Per capita wealth does not explain these patterns, with two of the richest countries -United States and Australia -fairing conspicuously poorly. Different countries were affected by different combinations of threats. Reducing global rates of biodiversity loss will require investment in the regions and countries with the highest responsibility for the world's biodiversity, focusing on conserving those species and areas most in peril and on reducing the drivers with the highest impacts.

AIM: The aim of this study was to investigate the impact of a pharmacist-led pharmaceutical care programme, involving optimization of drug treatment and intensive education and self-monitoring of patients with heart failure (HF) within the United Arab Emirates (UAE), on a range of clinical and humanistic outcome measures. METHODS: The study was a randomized, controlled, longitudinal, prospective clinical trial at Al-Ain Hospital, Al-Ain, UAE. Patients were recruited from the general medical wards and from cardiology and medical outpatient clinics. HF patients who fulfilled the entrance criteria, and had no exclusion criteria present, were identified for inclusion in the study. After recruitment, patients were randomly assigned to one of two groups: intervention group or control group. Intervention patients received a structured pharmaceutical care service while control patients received traditional services. Patient follow-up took place when patients attended scheduled outpatient clinics (every 3 months). A total of 104 patients in each group completed the trial (12 months). The patients were generally suffering from mild to moderate HF (NYHA Class 1, 29.5%; Class 2, 50.5%; Class 3, 16%; and Class 4, 4%). RESULTS: Over the study period, intervention patients showed significant (P < 0.05) improvements in a range of summary outcome measures [AUC (95% confidence limits)] including exercise tolerance [2-min walk test: 1607.2 (1474.9, 1739.5) m.month in intervention patients vs. 1403.3 (1256.5, 1549.8) in control patients], forced vital capacity [31.6 (30.8, 32.4) l.month in the intervention patients vs. 27.8 (26.8, 28.9) in control patients], health-related quality of life, as measured by the Minnesota living with heart failure questionnaire [463.5 (433.2, 493.9) unit.month in intervention patients vs. 637.5 (597.2, 677.7) in control patients; a lower score in this measure indicates better health-related quality of life]. The number of individual patients who reported adherence to prescribed medications was higher (P < 0.05) in the intervention group (85 vs. 35), as was adherence to lifestyle advice (75 vs. 29) at the final assessment (12 months). There was a tendency to have a higher incidence of casualty department visits by intervention patients, but a lower rate of hospitalization. CONCLUSIONS: The research provides clear evidence that the delivery of pharmaceutical care to patients with HF can lead to significant clinical and humanistic benefits.