The Ibadan Malimbe Malimbus ibadanensis is a globally Endangered but poorly known forest species endemic to a small region of south-western Nigeria, where almost all forest has been severely fragmented. We carried out the first comprehensive survey of Ibadan Malimbe, and tested whether forest fragmentation is important in determining the distribution of this and related species in south-west Nigerian forest patches. Ibadan Malimbes were found at 19 of 52 sites surveyed but these were all clustered in a relatively small part of what appears to have been the former range. Unlike other malimbes, Ibadan Malimbes were less abundant in, or absent from, relatively isolated forest patches. Red-headed Malimbe M. rubricollis , Red-vented Malimbe M. scutatus and Crested Malimbe M. malimbicus were significantly more abundant in forest patches that retained vegetation characteristic of primary forest (i.e. tall trees and high tree densities). The average density of Ibadan Malimbes was 0.22 birds/ha (95% confidence limits (CL): 0.14–0.34) across all sites, but varied with degree of isolation, with densities of 0.06 birds/ha (0.03–0.14) in the 50% of fragments that were most isolated, compared with 0.33 (0.19–0.56) in the 50% of fragments that were least isolated. This gives a population estimate of 2,469 individuals (1,401–4,365) for the remaining potentially occupied forest area of 112 km 2 . Given that our survey covered most forest patches within the majority of the historical range of Ibadan Malimbe this can probably be considered a reasonable maximum world population estimate. Ibadan Malimbes appear to be restricted to a small number of relatively small forest patches most of which are highly vulnerable to further destruction, degradation and fragmentation. Conservation effort should urgently focus on the protection of currently occupied sites and increasing the number and extent of forest patches within and around the existing range.
Pyruvate kinase deficiency is caused by mutations in PKLR and leads to congenital hemolytic anemia. Mitapivat is an oral, small-molecule allosteric activator of pyruvate kinase in red cells.In this uncontrolled, phase 2 study, we evaluated the safety and efficacy of mitapivat in 52 adults with pyruvate kinase deficiency who were not receiving red-cell transfusions. The patients were randomly assigned to receive either 50 mg or 300 mg of mitapivat twice daily for a 24-week core period; eligible patients could continue treatment in an ongoing extension phase.Common adverse events, including headache and insomnia, occurred at the time of drug initiation and were transient; 92% of the episodes of headache and 47% of the episodes of insomnia resolved within 7 days. The most common serious adverse events, hemolytic anemia and pharyngitis, each occurred in 2 patients (4%). A total of 26 patients (50%) had an increase of more than 1.0 g per deciliter in the hemoglobin level. Among these patients, the mean maximum increase was 3.4 g per deciliter (range, 1.1 to 5.8), and the median time until the first increase of more than 1.0 g per deciliter was 10 days (range, 7 to 187); 20 patients (77%) had an increase of more than 1.0 g per deciliter in the hemoglobin level at more than 50% of visits during the core study period, with improvement in markers of hemolysis. The response was sustained in all 19 patients remaining in the extension phase, with a median follow-up of 29 months (range, 22 to 35). Hemoglobin responses were observed only in patients who had at least one missense PKLR mutation and were associated with the red-cell pyruvate kinase protein level at baseline.The administration of mitapivat was associated with a rapid increase in the hemoglobin level in 50% of adults with pyruvate kinase deficiency, with a sustained response during a median follow-up of 29 months during the extension phase. Adverse effects were mainly low-grade and transient. (Funded by Agios Pharmaceuticals; ClinicalTrials.gov number, NCT02476916.).
Bullying has been described as a dangerous, pervasive social problem (Rigby, 2008). Children and young people involved in bullying tend to demonstrate greater evidence of psychosocial issues than those who have not been involved, including conduct problems, emotional disturbances, and difficulties in peer relationships (Nansel et al., 2001; Smith, Talamelli, Cowie, Naylor & Chauhan, 2004). Victims of bullying may experience increased depression, stress and hopelessness, decreased self-esteem, and may be more likely to self-harm or attempt to commit suicide (Coggan, Bennett, Hooper & Dickinson, 2003). Bullying perpetration or victimisation in adolescence can predict an increased likelihood of mental health and social adjustment problems in adulthood (e.g., anxiety, personality disorders, substance dependence, aggressive offending) (Gibb, Horwood & Fergusson, 2011). To be classified as bullying the behaviour must be repeated, have the intention of causing harm, and involve a physical or social power imbalance (Olweus, 1993). This behaviour can take various forms including physical or verbal aggression, relational aggression (e.g., spreading gossip, socially excluding others), or cyber-bullying, which is bullying through the use of electronic communication devices (Craig, Pepler & Blais, 2007; Wang, Iannotti & Nansel, 2009). Approximately 10-12% of children worldwide report having experienced bullying (Craig et al., 2009; Cross et al., 2011; Liang, Flisher & Lombard, 2007; Nansel et al., 2001; Ortega et al., 2012) and there is some evidence to suggest that the prevalence of bullying in New Zealand may be higher than in other countries. In a survey of 3,265 New Zealand high school students, 27% reported having experienced 'chronic' bullying in the previous six months (i.e., five or more separate incidents) (Coggan et al., 2003). Furthermore, in a recent international study, New Zealand was ranked fourth-highest of 50 countries in terms of bullying prevalence for school students (Mullis, Martin, Foy & Arora, 2012). Nearly one third (31%) of Year Five students indicated that they were bullied 'about weekly', significantly higher than the international average of 20% (Mullis et al., 2012). This concerning statistic may be due in part to the structure of New Zealand's public school system, where each school is governed by a Board of Trustees, meaning that individual schools may not have an explicit anti-bullying administrative policy (Slee et al., in press). The social-ecological systems perspective on bullying (Swearer & Espelage, 2011) proposes that bullying is a complex social phenomenon, influenced by the interaction of multiple inter- and intra-individual factors. The perspective suggests that bullying among children and young people must be understood across individual, family, peer, school, and community contexts (Swearer & Espelage, 2011). In New Zealand, the majority of bullying research has involved children as participants (e.g., Coggan et al., 2003; Fenaughty & Harre, 2013; Jose, Kljakovic, Sheib & Notter, 2011; Marsh, McGee, Nada-Raja & Williams, 2010; Raskauskas, 2010; Raskauskas, Gregory, Harvey, Rifshana & Evans, 2010). The relatively few New Zealand studies involving adult participants have focused primarily on the perspectives of school staff. For example, Green, Harcourt, Mattioni, and Prior (2013) and Mattioni (2012) examined the experiences and perceptions of teachers and principals in relation to bullying, while Cushman, Clelland, and Hornby (2011) reported the perspectives of school staff on bullying as part of a wider study focusing on student mental health and wellbeing. These studies appear to have explored bullying within only one context, namely the school. Although bullying research in New Zealand does not appear to have included parents as participants, international research demonstrates the important role played by parents and families in the social-ecological network of influences on bullying. …
Abstract Isocitrate dehydrogenase (IDH) 1 and 2 mutations result in overproduction of D-2-hydroxyglutarate (2-HG) and impaired cellular differentiation. Ivosidenib, a targeted mutant IDH1 (mIDH1) enzyme inhibitor, can restore normal differentiation and results in clinical responses in a subset of patients with mIDH1 relapsed/refractory (R/R) acute myeloid leukemia (AML). We explored mechanisms of ivosidenib resistance in 174 patients with confirmed mIDH1 R/R AML from a phase 1 trial. Receptor tyrosine kinase (RTK) pathway mutations were associated with primary resistance to ivosidenib. Multiple mechanisms contributed to acquired resistance, particularly outgrowth of RTK pathway mutations and 2-HG–restoring mutations (second-site IDH1 mutations, IDH2 mutations). Observation of multiple concurrent mechanisms in individual patients underscores the complex biology of resistance and has important implications for rational combination therapy design. This trial was registered at www.clinicaltrials.gov as #NCT02074839
Abstract This article outlines an eight-week, co-facilitated psycho-educational grief support programme for adults bereaved by suicide. The programme's design and content draw on current theory and research on effective bereavement interventions, and on evaluations of what has worked well in similar suicide bereavement groups. Action research methods are used to inform its development, review and modification. The programme content has a dual focus on information and emotional support. It combines facilitation by experienced professionals who have personal experience of bereavement by suicide with opportunities for peer support. End-of-programme evaluation shows that these features are highly valued by participants.
Around the World of Vultures & VSG activitiesThis biannual newsletter of the IUCN Vulture Specialist Group mainly features updates by region but also mentions developments of VSG and we are aware that we still need to do much more.We now have the CMS Multi-Species Action plan (MsAP) (download this important resource for old world vultures if you haven't done so already), but the challenge to implement and coordinate the agreed actions remains as great as ever.VSG was approached regarding IUCN Green listing, and Eurasian griffon and Bearded vulture are being tested in some detail for possible qualification in a European context.
Patients with cancer have a substantial risk of recurrent thrombosis despite the use of oral anticoagulant therapy. We compared the efficacy of a low-molecular-weight heparin with that of an oral anticoagulant agent in preventing recurrent thrombosis in patients with cancer.Patients with cancer who had acute, symptomatic proximal deep-vein thrombosis, pulmonary embolism, or both were randomly assigned to receive low-molecular-weight heparin (dalteparin) at a dose of 200 IU per kilogram of body weight subcutaneously once daily for five to seven days and a coumarin derivative for six months (target international normalized ratio, 2.5) or dalteparin alone for six months (200 IU per kilogram once daily for one month, followed by a daily dose of approximately 150 IU per kilogram for five months).During the six-month study period, 27 of 336 patients in the dalteparin group had recurrent venous thromboembolism, as compared with 53 of 336 patients in the oral-anticoagulant group (hazard ratio, 0.48; P=0.002). The probability of recurrent thromboembolism at six months was 17 percent in the oral-anticoagulant group and 9 percent in the dalteparin group. No significant difference between the dalteparin group and the oral-anticoagulant group was detected in the rate of major bleeding (6 percent and 4 percent, respectively) or any bleeding (14 percent and 19 percent, respectively). The mortality rate at six months was 39 percent in the dalteparin group and 41 percent in the oral-anticoagulant group.In patients with cancer and acute venous thromboembolism, dalteparin was more effective than an oral anticoagulant in reducing the risk of recurrent thromboembolism without increasing the risk of bleeding.
Purpose Experimental studies and indirect clinical evidence suggest that low molecular weight heparins may have antineoplastic effects. We investigated the influence of a low molecular weight heparin dalteparin on the survival of patients with active cancer and acute venous thromboembolism. Patients and Methods Survival data were examined in a posthoc analysis in patients with solid tumors and venous thromboembolism who were randomly assigned to dalteparin or a coumarin derivative for 6 months in a multicenter, open-label, randomized, controlled trial. All-cause mortality at 12 months was compared between treatment groups in patients with and without metastatic malignancy. The effect of dalteparin on survival was compared between the two patient subgroups. Results During the 12-month follow-up period, 356 of 602 patients with solid tumors and acute venous thromboembolism died. Among patients without metastatic disease, the probability of death at 12 months was 20% in the dalteparin group, as compared with 36% in the oral anticoagulant group (hazard ratio, 0.50; 95% CI, 0.27 to 0.95; P = .03). In patients with metastatic cancer, no difference in mortality between the treatment groups was observed (72% and 69%, respectively; hazard ratio, 1.1; 95% CI, 0.87 to 1.4; P = .46). The observed effects of dalteparin on survival were statistically significantly different between patients with and without metastatic disease (P = .02). Conclusion The use of dalteparin relative to coumarin derivatives was associated with improved survival in patients with solid tumors who did not have metastatic disease at the time of an acute venous thromboembolic event. Additional studies are warranted to investigate these findings.
A Health Questionnaire serves as a screening form as part of our Hospital Preadmission process and is completed by all patients scheduled for elective surgery. We reviewed the completed Health Questionaires of 444 patients. Completion of the Health Questionnaire requires patients to record their height and weight. At the time of admission their actual height and weight was measured and recorded by nursing staff as part of the preoperative assessment. We compared their estimated body mass index (BMI) from self-reported height and weight, with their actual BMI calculated from height and weight measured upon admission. The measured BMI accorded well with that calculated from reported values and showed no systematic over- or under-reporting. Of 70 patients with a BMI greater than 35, only ten estimated their BMI less than 35 and only five of these had more than a two unit difference. Perioperative patients appear to be more accurate at providing height and weight than previously analysed non-patient groups. However there is not complete accuracy and some patients still provide unreliable information. Whether or not individual practitioners utilize BMI from self-reported height and weight will depend on the accuracy that they require for their purposes. Of note there was greater accuracy in prediction of height and weight than in the derived variable of BMI due to the calculations required.
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