Current Priorities Research Articles

Biodiversity and Climate Extremes: Known Interactions and Research Gaps

AbstractClimate extremes are on the rise. Impacts of extreme climate and weather events on ecosystem services and ultimately human well‐being can be partially attenuated by the organismic, structural, and functional diversity of the affected land surface. However, the ongoing transformation of terrestrial ecosystems through intensified exploitation and management may put this buffering capacity at risk. Here, we summarize the evidence that reductions in biodiversity can destabilize the functioning of ecosystems facing climate extremes. We then explore if impaired ecosystem functioning could, in turn, exacerbate climate extremes. We argue that only a comprehensive approach, incorporating both ecological and hydrometeorological perspectives, enables us to understand and predict the entire feedback system between altered biodiversity and climate extremes. This ambition, however, requires a reformulation of current research priorities to emphasize the bidirectional effects that link ecology and atmospheric processes.

МЕТОДОЛОГИЯ СНИЖЕНИЯ РАЗМЕРНОСТИ В ЗАДАЧАХ АНАЛИЗА РЕГИОНАЛЬНОГО ИННОВАЦИОННОГО ПОТЕНЦИАЛА: СОСТЯЗАТЕЛЬНЫЙ ПОДХОД

This study aims to develop a methodology for determining an effective mathematical toolkit for dimensionality reduction in terms of parameters of a complex property of a system expressed through integral indicators. This involves examining such methods of mathematical data processing as the principal component analysis, fuzzy logic method, and weighted moving average. Special attention is given to defining the innovation potential of a region and compiling a system of indicators characterizing it. The developed methodology consists of two sequential stages. The first stage involves the application of three data processing methods to normalized input data separately, while the second is associated with obtaining resultant integral values or their groups for each method separately. The first stage is related to solving the following tasks: identifying categories of complex property, determining category indicators, normalizing data, and aggregating integral indicators. The second stage involves defining integral indicators, hierarchical clustering, and identifying the current priority method of information processing through the analysis of the quality produced based on data clustering.

The role of load and distributed energy resources modeling in voltage recovery studies

Load modeling in power systems is crucial to stability studies. The analysis of certain dynamic phenomena requires proper load modeling. Fault Induced Delayed Voltage Recovery (FIDVR) relates directly to Residential Air Conditioner (RAC) stalling. Therefore, the modeling of induction motor (IM) loads is essential to this analysis. Delayed voltage recovery in the system can result in delayed power recovery in inverters connected to the transmission system, which connects photovoltaic and wind power plants to the Brazilian Interconnected Power System (BIPS). In the last few years, there has been a considerable growth of Distributed Energy Resources (DER) in Brazil. Modern and legacy ride-through settings coexist in power systems around the world. Inverters with legacy settings are more likely to disconnect in systemic events. This creates a context that has been assessed in this paper. The modeling of induction motors in the Acre-Rondonia system leads to a deterioration of this system’s dynamic performance, which can lead to collapse. DER’s voltage support can contribute to post-fault system voltage recovery, mitigating the delay caused by RAC stalling and avoiding collapse. Thus, more robust ride-through settings are required to avoid inverter disconnection. Moreover, dynamic voltage support and reactive current priority requirements are demands from inverters connected to the system. The results obtained show that this consideration enable more consistent results than the ones obtained by the classic ZIP load model.

Global environmental change policy priorities from the Americas and opportunities to bridge the science-policy gap

ABSTRACT Governments and intergovernmental organizations support scientific research to produce the knowledge and tools needed to monitor and mitigate global environmental changes (GEC). However, GEC-related policy decisions are often not based on scientific evidence, and GEC research is often not based on policy-relevant questions, resulting in a science-policy gap. Assessing the GEC policy priorities of researchers and policymakers is an essential step towards closing this gap. This task was undertaken by the Inter-American Institute for Global Change Research (IAI), an intergovernmental organization pursuing science and capacity building to reach the vision of a sustainable Americas. The assessment included survey consultations, listening sessions, and an analysis of policy documents for 17 countries of the Americas. Three key findings emerged from this assessment. First, the top current priority for policymakers was Climate action, and Biodiversity and ecosystem services for researchers, with a poor alignment between the priorities of these social actors at the country level. Second, clusters of non-neighboring countries had a profile of GEC priorities more similar than clusters of neighboring countries, although there were some sub-regional clusters around particular GEC goals. Third, researchers and policymakers agreed that the lack of cross-sectoral collaboration and communication between technical and non-technical actors are important barriers. A key opportunity for policymakers was the growing funding and international cooperation for GEC, while for researchers, the growing body of evidence to inform GEC decision-making. These findings have implications for the design of research and capacity-building actions targeted to the priorities and needs of the region.

Earthquake, flood and resilience management through spatial planning, decision and information system

Assessment and planning of crisis management with the natural disasters approach include many components. In this regard, floods and earthquakes are some of the fundamental pillars in this field. With this view, paying attention to the current and future planning and research priorities of the world shows that crisis management in flood-prone and earthquake-prone areas and increasing resilience are the most important priorities for sustainable development studies and planning in the world. The western region of Iran (Lorestan province) has a special place due to the prominent features of flood and seismicity. This study aims to investigate the current situation regarding floods and earthquakes and increase the resilience of settlements with emphasis on the study area. After studying the current structure of flood and earthquake zoning according to multi-factor criteria, zoning was performed based on the integration of GIS and AHP information systems, and at the output of the work, high-risk settlements were determined separately for rural and urban areas with geographical coordinates, and then areas with low, very low, medium, high, and very high resilience were presented separately for rural and urban settlements. Also, after analyzing the SWOT model, strategies to increase the resilience of settlements to floods and earthquakes were presented. The study method of this research and the results, strategies, and operational options presented while being used in the study area are also applicable in other areas.

Aligning paleobiological research with conservation priorities using elasmobranchs as a model

Abstract Humans have dramatically transformed ecosystems over the previous millennia and are potentially causing a mass extinction event comparable to the others that shaped the history of life. However, only a fraction of these impacts has been directly recorded, limiting conservation actions. Conservation paleobiology leverages geohistorical records to offer a long-term perspective on biodiversity change in the face of anthropogenic stressors. Nevertheless, the field's on-the-ground contributions to conservation outcomes are still developing. Here, we present an overview of directions in which paleobiological research could progress to aid conservation in the coming decades using elasmobranchs (sharks, rays, and skates)—a highly threatened group with a rich fossil record—as a model. These research directions are guided by areas of overlap between an expert-led list of current elasmobranch conservation priorities and available fossil and historical records. Four research topics emerged for which paleobiological research could address open questions in elasmobranch science and conservation: (1) baselines, (2) ecological roles, (3) threats, and (4) conservation priorities. Increasingly rich datasets and novel analytical frameworks present exciting opportunities to apply the elasmobranch fossil record to conservation practice. A similar approach could be extended to other clades. Given the synthetic nature of these research topics, we encourage collaboration across timescales and with conservation practitioners to safeguard the future of our planet's rapidly disappearing species.

A framework for studying the effects of offshore wind energy development on birds and bats in the Eastern United States

Offshore wind energy development (OWED), while a key strategy for reducing carbon emissions, has potential negative effects to wildlife that should be examined to inform decision making and adaptive management as the industry expands. We present a conceptual framework to guide the long-term study of potential effects to birds and bats from OWED. This framework includes a focus on exposure and vulnerability as key determinants of risk. For birds and bats that are exposed to OWED, there are three main effects of interest that may impact survival and productivity: 1) collision mortality, 2) behavioral responses, including avoidance, displacement, and attraction, and 3) habitat-mediated effects to prey populations. If these OWED effects cause changes in survival and/or breeding success (e.g., fitness), they have the potential for population-level consequences, including changes in population size and structure. Understanding the influence of ecological drivers on exposure and effect parameters can help to disentangle the potential impacts of OWED from other stressors. We use this theoretical framework to summarize existing relevant knowledge and identify current priority research questions (n=22) for the eastern United States, where large-scale development of OWED is primarily in the planning and early construction phase. We also identify recommendations for study design and further prioritization of research topics.

Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities.

Recent global and regional reports consistently confirm the high and increasing prevalence of hypertension in sub-Saharan Africa (SSA), with poor detection, treatment, and control rates. This narrative review summarises the burden of hypertension in SSA and recent findings from community-based hypertension management strategies. We further outline prominent risk factors according to recent data and associated underlying mechanisms for hypertension development. An extensive review of literature showed that most countries have reported on the prevalence of hypertension during 2017-2023, despite limitations linked to the lack of nationally representative studies, heterogeneity of sampling and data collection methods. Task-shifting approaches that assign roles to model patients and community health workers reported improved linkage to healthcare services and adherence to medication, with inconsistent findings on blood pressure (BP)-lowering effects over time. The regularly reported risk factors include unhealthy diet, sedentary lifestyle, increased adiposity and underweight, ageing, level of education, and/or income as well as psychosocial factors. Newer data on the pathophysiological mechanisms leading to hypertension and potential areas of intervention are reported from children and adults and include, among others, salt-handling and volume overload, endothelial function, BP dipping patterns and the role of human immunodeficiency virus. To conclude, significant strides have been made in data reporting from SSA on the burden of hypertension in the region as well as biomarker research to improve understanding and identification of areas of intervention. However, gaps remain on linkage between knowledge generation, translation, and implementation research. Coordinated studies addressing both discovery science and public health are crucial to curb hypertension development and improve management in SSA.

Male elephant management in AZA institutions: Current status and priorities for the future.

Asian elephant (Elephas maximus) and African savanna elephant (Loxodonta africana) populations collectively managed by ex-situ facilities accredited by the Association of Zoos and Aquariums (AZA)face sustainability challenges. Among the priorities to strengthen animal wellbeing and population sustainability is male elephant management. We conducted a survey of AZA facilities currently housing male elephants to assess the status, challenges, and priorities in three areas of male elephant management: musth, socialization, and semen collection. Surveys were administered to elephant care teams at AZA-accredited institutions between November 2022 and February 2023, and we received responses from 34 institutions (91.9% of AZA-accredited facilities holding adult male elephants), housing 32 adult male Asians and 26 adult male Africans. Most facilities prioritized breeding and male socialization over musth management and semen collection (although most facilities acknowledged that all these efforts are important), citing leadership support and staffing as most important to achieve male management goals. Behaviors most commonly accompanying musth included reduced appetite, difficulty training or shifting, human-directed aggression, and interest in females. Musth timing was variable between males and facilities. Most males were well-socialized with females and/or other males, though elephant compatibility and facility design were limiting factors in managing socialization. Although 60.6% of facilities collected semen or were training for semen collection, very few male elephants could reliably provide viable semen samples, challenging assisted reproductive efforts that could bolster population sustainability in both species. Together, our results provide a better understanding of the state of male elephant management, offering specific areas deserving of research and development to enhance wellbeing and sustainability.

Abstract PO1-01-01: ECOG-ACRIN EA1211: Interim FDG-PET/CT for predicting response of HER2-positive breast cancer to neoadjuvant therapy (DIRECT Trial)

Abstract Background: Strategies to optimize treatment decision-making in early stage HER2-positive breast cancer are a current priority for the oncology and patient advocacy community. Recent studies suggest that early metabolic changes on FDG-PET/CT (imaging biomarker) predict response to HER2-directed therapy. The TBCRC026 trial showed that participants not obtaining a 40% reduction in SULmax by cycle 1 day 15 (C1D15) following neoadjuvant trastuzumab/pertuzumab (HP) were unlikely to obtain pCR [negative predictive value (NPV) 91%]. The ECOG-ACRIN EA1211/DIRECT trial aims to validate FDG-PET/CT as a neoadjuvant interim (niFDG-PET/CT) imaging integral biomarker in patients treated with standard HER2-directed regimens (NCT05710328). Design: EA1211/DIRECT is a multicenter, single-arm, primary imaging phase 2 study enrolling patients with stage II/III HER2-positive breast cancer. Patients undergo standard skull base-thigh FDG-PET/CT at baseline and C1D15 and receive standard of care pertuzumab-based neoadjuvant therapy followed by surgery. Eligibility: Age ≥18 years, ECOG performance status 0-2, stage IIa-IIIc, untreated HER2-positive breast cancer with known hormone receptor status, suitable to undergo FDG-PET/CT imaging and neoadjuvant therapy. Methods: ΔSULmaxD15 will be computed as: (D15 SULmax – baseline SULmax)/baseline SULmax. The primary objective is to estimate the NPV of niFDG-PET/CT for pCR using ΔSULmaxD15 of the primary breast cancer at a threshold of 40%, in patients treated with neoadjuvant HER2-directed therapy. NPV is defined as the probability that pCR will not be achieved by participants with ΔSULmaxD15 < 40%. Secondary endpoints include evaluating the sensitivity, specificity, and positive predictive value of ΔSULmaxD15 of the primary breast cancer at a threshold of 40% and the ability of the niFDG-PET/CT biomarker to predict 3-year event free survival (EFS). Sample Size: We expect that 50% of patients will not reach the ΔSULmax threshold of 40% and a pCR rate of 40-60%. The proposed sample size is 210 participants, adjusted to 235 to account for missing data in 10% of cases. Computation of exact, two-sided 95% confidence intervals (CI) for NPV determined the lower limit of the CI is at least 80% when the true NPV is at least 88%. The lower limit is 84% when the true NPV has the value of 91%, which was estimated in the TBCRC026 study. Current Status: EA1211/DIRECT was activated in May 2023 across the NCI National Clinical Trials Network (NCTN), and accrual is anticipated to complete in March 2025. Those interested in the clinical trial can email ea1211team@ecog-acrin.org. Conclusion: The EA1211/DIRECT trial is the first step in implementing a Response-Guided Treatment Strategy by validating the ΔSULmax threshold of 40% as the optimum cut point across standard of care HER2-directed neoadjuvant regimens. If EA1211/DIRECT meets its objectives, the results will be used to design clinical utility studies, and thus hoping to change practice. Citation Format: Heather Jacene, Constantine Gatsonis, Roisin Connolly, Brian Burnette, Erica Stringer-Reasor, Maeve Hennessy, Justin Romanoff, Alexander Taurone, Ciara O'Sullivan, H. T. Carisa Le-Petross, Courtney Lawhn Heath, Vered Stearns, Amy Fowler, Shou-Ching Tang, Karla A Sepulveda, Angela DeMichele, David Mankoff, Antonio Wolff. ECOG-ACRIN EA1211: Interim FDG-PET/CT for predicting response of HER2-positive breast cancer to neoadjuvant therapy (DIRECT Trial) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-01-01.

Towards sustainable development in the European Union: a critical raw materials perspective

Sustainability is a key goal of the European Union, which is seen as a global leader of change in tackling climate change, as well as building green economic sustainability, leading to greater social prosperity. A milestone of sustainable development to support the European Union in achieving climate neutrality is the European Green Deal. Its initiatives aim to build a competitive and innovative EU economy while respecting and protecting the environment. According to current priorities, the European Union aims to become the first climate-neutral continent by 2050, thanks to critical raw materials. The purpose of this article is to analyse and assess the impact of critical raw materials on the sustainability of the European Union. The study uses a scoping review methodology and statistical analysis based on the Shapiro-Wilk test and Spearman correlation coefficient. The results show that critical raw materials are important for achieving sustainable development and implementing the EU economy towards climate neutrality. This paper contributes to the literature on sustainability. It can also provide important information for policymakers to understand how to shape green policies in the context of the strategic importance of critical raw materials in the transformation of an eco-innovative economy.

American Board of Internal Medicine Nephrology Procedure Requirements for Initial Certification: Time for a Change and Pursuing Consensus in the Nephrology Community

In 1988, the American Board of Internal Medicine (ABIM) defined essential procedural skills in nephrology, and candidates for ABIM certification were required to present evidence of possessing the skills necessary for placement of temporary dialysis vascular access, hemodialysis, peritoneal dialysis, and percutaneous renal biopsy. In 1996, continuous renal replacement therapy was added to the list of nephrology requirements. These procedure requirements have not been modified since 1996 while the practice of nephrology has changed dramatically. In March 2021, the ABIM Nephrology Board embarked on a policy journey to revise the procedure requirements for nephrology certification. With the guidance of nephrology diplomates, training program directors, professional and patient organizations, and other stakeholders, the ABIM Nephrology Board revised the procedure requirements to reflect current practice and national priorities. The approved changes include the Opportunity to Train standard for placement of temporary dialysis catheters, percutaneous kidney biopsies, and home hemodialysis which better reflects the current state of training in most training programs, and the new requirements for home dialysis therapies training will align with the national priority to address the underuse of home dialysis therapies. This perspective details the ABIM process for considering changes to the certification procedure requirements and how ABIM collaborated with the larger nephrology community in considering revisions and additions to these requirements.

Modeling the environmental impacts of Asparagopsis as feed, a cow toilet and slurry acidification in two synthetic dairy farms

Intensive dairy farming, particularly enteric fermentation and manure management, is a major contributor to negative impacts on the local and global environment. A wide range of abatement measures has been proposed to reduce livestock-related emissions, yet the individual and combined effects of these innovations are often unknown. In this study, we performed an attributional life cycle assessment of three innovative measures modeled in two synthetic German dairy farm systems: Feeding of the seaweed Asparagopsis, installing an in-house cow toilet system, and performing on-field slurry acidification. These measures were modeled both individually and in combination to account for single and cumulative effects and compared to a reference scenario under current practices. Our results showed that feeding high levels of Asparagopsis and the combination of all three measures were most effective at reducing global warming potential (20–30 %), while only the latter mitigated eutrophication (6–9%) and acidification potential (14–17 %). The cow toilet required additional adapted manure management (separated storage and injection of urine) to effectively reduce eutrophication (8–10 %) and acidification potential (19–23 %) and to decrease global warming potential (3–4%) and abiotic depletion (4–5%). Slurry acidification slightly affected all considered environmental impact categories. All three measures involved trade-offs, either between LCA impact categories (global warming potential vs. abiotic depletion), the location of impacts (off- vs. on-farm), or the emission reduction in individual gases (ammonia vs. nitrous oxide). Measure combinations could compensate for the observed trade-offs. Our study highlights the potential of novel abatement measures but also shows the interdependencies of measures in different stages. This calls for a revisiting of current priorities in funding and legislation, which often focus on single objectives and measures (e.g. ammonia reduction) toward the preferential use of measures that are effective without driving trade-offs or improving resource efficiency.

Investigation of old waste dump composition of lean gold-bearing ores from the Golden Pride Project (GPP) mining operation in Nzega district, Tanzania

The search for alternative sources of useful minerals is a pressing issue. One such possible source is the processing of lean gold-bearing ores, which previously did not seem feasible to exploit for subsoil users, leading to their disposal in off-balance ore dumps. Processing these resources becomes economically viable as gold prices rise and processing technologies improve over time. This paper presents the elemental and mineralogical composition of lean gold-bearing ore dumps from the Golden Pride Project (GPP) mining operation in Tanzania’s Lihendo district. This area contains an old dump of lean gold-bearing ores, weighing approximately 1.4 million tons. Extracting valuable components from lean mineral raw materials is a current priority. Sampling was conducted to study the dumps. Boreholes were drilled to a depth of 1 m, covering a total sampling area of 20 ha; 18 samples, each averaging 3 kg in weight, were collected. The results of X-ray fluorescence analysis (XRF) indicated the presence of Fe, S, Si, Ca, Ca, Mn, Cu, Al, Cr, Ti, As, and Ag in the collected samples. X-ray diffraction (XRD) analysis revealed that the main minerals in the dumps are muscovite, kaolinite, quartz, montimorillonite, and goethite. The average gold grade in the selected samples is 0.72 g/t. Studies of the grain-size distribution and gold distribution by grain-size classes after ore grinding demonstrated that the majority of gold (74%) is in the −75 μm class. In the initial mineral material of the dumps, the share of the +30-50 mm grain-size class is 81%. The paper proposes potential methods for processing lean dumps of gold-bearing ores. One such methods involves crushing the dump material, separating the −75 μm class, and subjecting it to direct leaching or leaching using “carbon-in-pulp” technique. Heap leaching appears to be the most promising method for extracting gold from such dumps in terms of technical and economic feasibility. Positive experience has been reported in applying this process to ores of similar mineralogical type.

The Guidelines for Development of the Organizational Health of Schools Under the Kalasin Primary Educational Service Area Office 2

Background and Aims: The organizational health of schools was conditions of operations according to the mission of schools. schools can survive and develop continuously, problem-solving, smooth internal administrative processes, and no stress. Therefore, this research aims to study the current state, the desirable state, and the priority needs and study the guidelines for the development of the organizational health of schools under the Kalasin primary educational service area office 2. Methodology: The research is divided into 2 phases: Phase 1 studies the current state, desirable state, and priority needs of development and the organizational health of schools, A sample group of 278 school administrators and teachers, was randomly selected using a stratified sampling method. The research instrument is a questionnaire with a 5-level with a confidence value of 0.81 and data analysis by mean and standard deviation. phase 2 study of the guidelines for the development of the organizational health of schools. The target group comprises 3 best practice schools and 9 experts for assessment of the development guideline. The research instrument was a semi-structured interview form and assessment form the suitability and feasibility of development guidelines. Results: The current state overall was moderate level, and the desirable state overall was at the highest level. The priority needs ranked from high to low level were teacher friendliness, colleague leadership, morale, communication, and resource utilization respectively. The development guideline of organizational health of schools under the Kalasin primary educational service area office 2 was a method for developing using a manual consisting of 1) principles and reasons 2) objectives, 3) content 4) development methods 5) measurement and evaluation. The development guidelines are divided into 6 learning units: 1) resource utilization, 2) teacher friendliness, 3) communication, 4) morale 5) colleague leadership. The results of the evaluation of the suitability and feasibility of development guidelines overall were at the highest level. Conclusion: Organizational health Organizational health is important for schools, administrators, teachers, educational personnel, and students. Because of the quality and efficiency in schools organization on the organizational health. Organizational health consists of factors, resource utilization, teacher friendliness, communication, morale, and colleague leadership.

Priorities in school eye health in low and middle-income countries a scoping review.

School eye health (SEH) has been on the global agenda for many years, and there is mounting evidence available to support that school-based visual screenings are one of the most effective and cost-efficient interventions to reach children over five years old. A scoping review was conducted in MEDLINE, Web of Science, PubMed, and CINHAL between February and June 2023 to identify current priorities in recent literature on school eye health in low- and middle-income countries (LMICs). Selection of relevant publications was performed with Covidence, and the main findings were classified according to the WHO Health Promoting Schools framework (HPS). A total of 95 articles were included: cross-sectional studies (n = 55), randomised controlled trials (n = 7), qualitative research (n = 7) and others. Results demonstrate that multi-level action is required to implement sustainable and integrated school eye health programmes in low and middle-income countries. The main priorities identified in this review are: standardised and rigorous protocols; cost-effective workforce; provision of suitable spectacles; compliance to spectacle wear; efficient health promotion interventions; parents and community engagement; integration of programmes in school health; inter-sectoral, government-owned programmes with long-term financing schemes. Even though many challenges remain, the continuous production of quality data such as the ones presented in this review will help governments and other stakeholders to build evidence-based, comprehensive, integrated, and context-adapted programmes and deliver quality eye care services to children all over the world.

Science Shops as key intermediary structures to respond to the current health research agenda bias: Evidence from the InSPIRES project.

To increase the likelihood of research responding to societal needs, intermediary structures such as Science Shops are being created. Science Shops respond to research needs identified and prioritized through participatory processes involving civil society. However, these are not mainstream structures, and most research needs addressed by the scientific community are not defined by a diversity of stakeholders (including citizens) but are mostly prioritized by researchers and funders. Literature shows this often leads to bias between the research topics investigated and the research needs of other relevant stakeholders. This studyanalyses how 14Science Shops contribute to decreasing bias in health research agenda setting. We compare the research priorities identified through participatory processes by the Science Shops, which participated in theEuropean Union-funded project InSPIRES (2017-2021), to the available research addressed in the literature (identified in Web of Science), which we use as a proxy for current research priorities. Science Shop projects contributed to decreasing the existing bias in health research agenda setting: (1) between drug and nondrug treatments and (2) between clinical trials of treatments for illnesses affecting high-income versus middle- and low-income countries, which leads to a lack of local strategies for high disease burdens in nonhigh-income regions. This study provides the first evidence of Science Shops'effectiveness in addressing current biases in health research agenda setting. We conclude they could play a key role in shaping local, nationaland international research policies.

Internal investigations into regulatory misconduct: Key issues for individuals

This paper will address key issues for individuals in respect of internal investigations prompted by significant, non-criminal, financial regulatory issues. For the purposes of the paper, the authors will focus on firms authorised and regulated by the Financial Conduct Authority (FCA) and internal investigations conducted as a result of a breach or suspected breach of FCA rules. The paper will cover matters relevant to individuals such as: (i) duty to participate, (ii) rights and obligations, (iii) access to materials, (iv) legal advice and (v) costs/the availability of insurance coverage. The analysis will be framed in the context of current FCA enforcement trends and priorities regarding both entities and individuals.

Climate Change and Stroke: A Topical Narrative Review.

The impacts of accumulating atmospheric greenhouse gases on the earth's climate are now well established. As a result, there have been increases in ambient temperatures and resultant higher frequency and duration of temperature extremes and other extreme weather events, which have been linked to a wide range of adverse health outcomes. This topical narrative review provides a summary of published evidence on the links between climate change and stroke. There is consistent evidence of associations between stroke incidence and mortality and increasing ambient temperature and air pollution. Associations have also been shown for changes in barometric pressure, wildfires, and desert dust and sandstorms, but current evidence is limited. Flooding and other extreme weather events appear to primarily cause service disruption, but more direct links to stroke may emerge. Synergies between dietary changes that reduce stroke risk and may also reduce carbon footprint are being explored. We also discuss the impact on vulnerable populations, proposed pathophysiologic mechanisms, mitigation strategies, and current research priorities. In conclusion, climate change increasingly impacts the stroke community, warranting elevated attention.

Challenges, opportunities, and priorities for tier-1 emergency medical services (EMS) development in low- and middle-income countries: A modified Delphi-based consensus study among the global prehospital consortium

IntroductionThough the disease burden addressable by prehospital and out-of-hospital emergency care(OHEC) spans communicable diseases, maternal conditions, chronic conditions and injury, the single largest disability-adjusted life year burden contributor is injury, primarily driven by road traffic injuries(RTIs). Establishing OHEC for RTIs and other common emergencies in low- and middle-income countries(LMICs) where the injury burden is disproportionately greatest is a logical first step toward more comprehensive emergency medical services(EMS). However, with limited efforts to formalize and expand existing informal bystander care networks, there is a lack of consensus on how to develop and maintain bystander-driven Tier-1 EMS systems in LMICs. Resultantly, Tier-1 EMS development is fragmented among non-governmental organizations and the public sector globally. MethodsA steering committee coordinated a 9-round, modified Delphi-based expert discussion to identify current challenges, opportunities, and priorities in Tier-1 EMS development globally. 11 panelists represented seven Global Prehospital Consortium(GPC) member organizations with a mean 9.57 years of organizational Tier-1 EMS development/implementation experience(median = 9 years). The consortium represents the largest collaboration between organizations directing Tier-1 EMS programs globally across 12 countries on 3 continents(Americas, sub-Saharan Africa, and South Asia) with 22,000 first responders. ResultsThe GPC identified seven priority areas for Tier-1 EMS development: infrastructure/operations, communication, education/training, impact evaluation, financing, governance/legal, and transportation/equipment. A high level of consensus exists regarding priorities for investigation, including Tier-1 responder density/distribution, Tier-1 patient data variable standardization for trauma registries/quality improvement, dispatch technologies/protocols, modular curricula, broader cost-effectiveness and impact evaluation indices capturing secondary impacts of EMS, standardizing legal protections for first responders, and transportation/equipment standards. DiscussionConsensus is necessary to avoid duplicative and disorganized efforts due to the fragmented nature of parallel Tier-1 EMS efforts globally. A Delphi-like multi-round expert discussion among the members of the largest collaboration between organizations directing Tier-1 EMS programs globally generated relevant priorities to direct future efforts.