Major Island Research Articles

Atypical Origin of Lateral Pectoral Nerve: A Case Report

In the present case, two Lateral Pectoral Nerves (LPN) were in the right axilla. The upper branch, superior LPN arose from the proximal part of the axilla deep to the clavicle from the anterior division of the upper trunk. This branch descends medially and enters the deep surface of the pectoralis major muscle. A larger LPN is seen originating from the distal part of the right lateral root of the median nerve at the lower part of the axilla, medial to the third part of the right axillary artery. This inferior LPN is 2 cm long, descends medially, and joins with the Medial Pectoral Nerve (MPN) forming ansa pectoralis. The branches from the ansa pierce the pectoralis minor muscle and enter the pectoralis major muscle. It supplies both the pectoral muscles. LPN fibers passing from the Lateral Cord (LC) through the lateral root of median have not been reported yet. The LPN is the main nerve of pectoralis major muscle. A thorough understanding of Pectoral Nerve (PN) anatomy is a must for surgeons practicing mastectomies, breast augmentation surgery, axillary dissection, harvesting pectoralis major muscle island flap, and dealing with trauma and fracture of the shoulder.

A Genomic Exploration of the Possible De-Extirpation of the Zanzibar Leopard.

The recently extirpated Zanzibar leopard was the only known African leopard (Panthera pardus spp.) population restricted exclusively to a major island habitat. Although its demise was driven through habitat change and conflict with humans, given its role as a keystone species for the Zanzibar Archipelago, its successful potential reintroduction might offer a means for helping preserve the natural biodiversity of its former habitat. Whether this is feasible, however, would be contingent on both whether closely related source populations can be identified on mainland Africa, and whether the Zanzibar form exhibited any special adaptations that might need to be considered when choosing such a source. In light of these questions, we genomically profiled two of the six known historic specimens, to explore whether they represent a realistic candidate for de-extirpation through reintroduction. Our analyses indicate that despite its geographical separation, the Zanzibar leopard shared a close genetic relationship with mainland East African individuals. Furthermore, although its uniqueness as an island population was emphasised by genomic signatures of high inbreeding and increased mutation load, the latter similar to the level of the critically endangered Amur leopard (P. p. orientalis), we find no evidence of functionally significant genetic diversity unique to Zanzibar. We therefore conclude that should attempts to restore leopards to Zanzibar be considered, then mainland East African leopards would provide a suitable gene pool.

The Current High Bird Colonisation Rate in a Major Mediterranean Island is Consistent With a More Intense Past Defaunation Compared to Nearby Mainland

ABSTRACTAimWe expand here previous own biogeographic work on the determinants of avian colonisation of a major land‐bridge Mediterranean island. So far we have explained mechanistically the high current rate of colonisation of the island which proceeds by overflow of mainland species with growing population trends and with prior experience as winter visitors. However, here we focus on the historical factors that have led to such a high colonisation rate.LocationMajorca Island and a nearby Iberian mainland coastal region with equivalent characteristics (Alicante province).Time PeriodTwenty‐five years (1991–2015).Major Taxa StudiedBirds.MethodsWe compared the pattern of species gain and loss in Majorca and Alicante during the study period.ResultsWe found that while Alicante only gained eight new species and lost one, Majorca lost none and gained 21 species as breeders (odds ratio 2.6). The process of species gains in 5‐year periods since 1991 showed a nonlinear pattern in both regions, with an abrupt decline in Alicante starting in 2006–2010 and final stagnation during 2011–2015, but just a smooth and recent pattern of slowdown in Majorca (2011–2015 on). Taxonomic diversity of colonising species at the family level, as well as habitat of colonisation, were quite similar between regions, but larger body size species were more common in Majorca.Main ConclusionsWe conclude that current differential colonisation rates between both regions are consistent with a more intense past defaunation of the resource‐poor region (Majorca) prior to modern rural flight that happened simultaneously in both regions. While Alicante could be approaching a theoretical carrying capacity in the number of species, Majorca is farther from it. We predict that the island will continue gaining species in the next few decades. Worldwide, further research on comparing wildlife recovery rates between regions with differential intensity of past wildlife defaunation is badly needed to understand biodiversity recovery processes.

Frontlines and Crossroads: The Impact of COVID-19 on the Motivations of Medical Students from Selected Philippine Medical Schools in Pursuing Their Medical Studies

BACKGROUND: The onset of the COVID-19 pandemic made changes to the Philippine medical education system to transfer to an online setting, which meant the loss of practical skills needed for future clinical encounters. Most students consider the desire to serve others as their motivation to pursue medicine, but stated that online learning was more favorable for theoretical lessons and not for practical skills. These students had to cope with lifestyle changes which challenged their resolve, as well as deal with the technology and infrastructure required for online learning. The study aimed to compare the strength and nature of motivations of medical students to pursue their studies before and after the onset of the pandemic, and to propose recommendations to support them through the pandemic and beyond. METHODS: Semi-structured interviews were conducted using a study questionnaire that dealt with determining respondents’ motivations for pursuing a medical degree, the impact of the pandemic and how it may have changed their motivations, and what recommendations they can propose to motivate other medical students. Interview transcripts were then analyzed through a qualitative inductive thematic analysis. Pre-clinical and clinical students (clerks and postgraduate interns) enrolled during SY 2020-2021 from Metro Manila and from among the 3 major Philippine island groups were selected to approximate the distribution of medical schools across the country. A total of 17 eligible participants were selected through purposive sampling of different personal backgrounds. Recruitment and call for participants were coursed through the Association of Philippine Medical Colleges - Student Network as well as through social media. Data from interview transcripts were familiarized and ideas from important recurring patterns shared among respondents’ answers were made into codes, which were subsequently organized into themes both unique and generalizable across student groups. RESULTS: Six major themes arose: 1) Contextualizing the pre-clinical and clinical experiences, 2) Challenges of online learning; 3) Desire for lived experience; 4) Tensions between personal contexts and online learning; 5) Grit driven by a desire to serve; 6) Resilience over adversity and sunk cost. Most pre-clinical students were motivated to pursue medicine by a desire to serve, while clinical students were straightforward about financial reward as motivation. Despite the limitations of online education, lack of social interaction and skills training, medical students had strengthened motivations to continue their studies as the pandemic highlighted the need for physicians, reinforcing their intrinsic desire to serve others. Mental health and financial issues were a concern for some, but these students did not wish to quit so as not to lose momentum with their studies. CONCLUSION: While most medical students interviewed felt more motivated in pursuing their studies during the pandemic, there was a desire and a call for more support in their studies and training. Their personal stories suggested there is room for improvement in certain aspects of local medical education. Addressing their concerns through financial and educational support, and bridging clinical skills with online learning would thus help them create quality healthcare in the pandemic context and beyond.

Fine-scale phylogeography of the Japanese Genji firefly

Abstract The Japanese Archipelago consists of four major islands and numerous small islands. The Goto Islands are located near Kyushu, a major island in the Japanese Archipelago. We have previously reported that the population of the Japanese Genji firefly, Nipponoluciola cruciata, inhabiting the Goto Islands displays a unique flashing pattern that is used for pre-mating communication between males and females, indicating the possibility of genetic isolation of the Goto Islands population from neighbouring N. cruciata populations. In this study, we aimed to elucidate the gene flow between the Goto Islands N. cruciata population and its neighbouring island populations by molecular phylogenetic analyses based on the mitochondrial DNA regions of cytochrome c oxidase subunit II and ND5, also coupled to genome-wide analysis of nuclear DNA single nucleotide polymorphisms. Our results suggested that the Goto Islands N. cruciata population is genetically isolated from other populations of this species. Nuclear DNA-based population analyses indicated gene flow between the populations inhabiting the Kyushu and Iki Islands, situated at a distance approximately equal to that between the Goto and Kyushu Islands. Therefore, the genetic isolation of the Goto Islands N. cruciata population is largely affected by flashing pattern behaviour, underlining an ongoing speciation process.

Global diversity and biogeography of potential phytopathogenic fungi in a changing world

Phytopathogenic fungi threaten global food security but the ecological drivers of their global diversity and biogeography remain unknown. Here, we construct and analyse a global atlas of potential phytopathogenic fungi from 20,312 samples across all continents and major oceanic island regions, eleven land cover types, and twelve habitat types. We show a peak in the diversity of phytopathogenic fungi in mid-latitude regions, in contrast to the latitudinal diversity gradients observed in aboveground organisms. Our study identifies climate as an important driver of the global distribution of phytopathogenic fungi, and our models suggest that their diversity and invasion potential will increase globally by 2100. Importantly, phytopathogen diversity will increase largely in forest (37.27-79.12%) and cropland (34.93-82.51%) ecosystems, and this becomes more pronounced under fossil-fuelled industry dependent future scenarios. Thus, we recommend improved biomonitoring in forests and croplands, and optimised sustainable development approaches to reduce potential threats from phytopathogenic fungi.

REVIEW ANALYSIS ON BIYAHE NI DREW TRAVEL EPISODES AIRED IN 2019-2021

Biyahe ni Drew is a travel documentary show in the Philippines where the host and its production crew members travels to a different destination and takes the viewers to adventures and showcases the beauty of the destinations both locally and internationally. This study is focused on reviewing the top 15 full episodes of Biyahe ni Drew from the year 2019 up to 2021 selected based on the number of views, five destinations each from the three major island groups, Luzon, Visayas and Mindanao if it were able to showcase the 4as of tourism; attractions, activities, accommodation and accessibility which is important because it provides the overall need of a tourist when visiting a destination. The data was collected with the help of Likert Scale. The results revealed that Biyahe ni Drew is more focused on showcasing the tourist attractions, but it lacks information when it comes to the accessibility of the destination. The finding of this study is beneficial to the Biyahe ni Drew production team because it was able to discuss some areas that need improvements for their show from viewer’s point of view. Also, to the researcher and other tourism students because this study provides knowledge on how they can effectively showcase Philippine destinations.

Health status of the red-billed tropicbird (Phaethon aethereus) determined by hematology, biochemistry, blood gases, and physical examination.

The red-billed tropicbird, Phaethon aethereus, is a species of seabird native to the Galápagos archipelago, and widely distributed across the neotropics. General health, blood chemistry, and haematology parameters have not been published for this species. Blood analyses were performed on samples drawn from 51 clinically healthy red-billed tropicbirds captured from their burrows at Islote Pitt on San Cristóbal Island in July, 2016 (21) and Daphne Major Island in June, 2017 (30). In the field, a point of care blood analyser (iSTAT) was used to obtain results for HCO3-, pH, pCO2, pO2, TCO2, iCa, Na, K, Cl, Hb, HCT, anion gap, creatinine, glucose and urea nitrogen. Additionally, a portable Lactate PlusTM analyser was used to measure blood lactate, and blood smears were also created in situ. The blood slides were used to estimate leukocyte counts and 100-cell differentials. Alongside these biochemistry and haematology parameters, average heart rate, respiratory rate, body temperature and scaled mass index (calculated from weight and a body measurement) were compared to determine the standard measurements for a healthy individual. The baseline data, and reference intervals reported in this paper are essential to detecting changes in the health of red-billed tropicbirds in the future.

Allelic variation within the major APOE CpG island affects its methylation in the brain of targeted replacement mice expressing human APOE

•The number of cytosine-phosphate-guanine (CpG) sites differs due to sequence variation in the human apolipoprotein E (APOE) gene.•APOE DNA methylation is allele-dependently altered corresponding to the total number of CpG pairs in the brain of APOE targeted replacement mice (APOE εpsilon 4 > εpsilon 3 > εpsilon 2).•Binding of the methyl-CpG binding protein 2 to genomic APOE was in trend less pronounced in the brain of APOE4 mice.

Analysis of sun-and-beach markets on large islands in the mediterranean using tourist acommodation prices as an indicators Edit Download

Purpose – This paper uses the prices of holiday accommodations on large Mediterranean islands specialising in sun and beach tourism to determine their initial state in 2015, their competitiveness and their further evolution until 2019. Methodology/Design/Approach – Following the process of each potential tourist, a total of 21,628 prices were collected from the Internet. Then, the collected data were used in the construction of charts and price indices and the application of a method of cluster analysis (HAC). Findings – Between 2015 and 2019, tourism prices in the Mediterranean region increased sharply. Moreover, the geographic segmentation already observed in 2015 between Western and Eastern Mediterranean destinations intensified. In addition, the paper shows that there is robust demand for sun and beach tourism in island destinations. Originality of the research – Major island markets specialising in sun and beach tourism were used to exclude any interference from professional travellers, people visiting friends or relatives, or tourists willing to bear the cost of travel to less visited destinations.

Report of three crypto-benthic reef fishes from Lakshadweep islands, India

Fishes of the genera Bathygobius and Enneapterygius are represented by small crypto-benthic fishes occurring in shallow intertidal and subtidal areas comprised of sandy or rocky substrata. These species typically occur in the Indo-Pacific region. Lakshadweep Islands are one of the major Island ecosystems in India with atoll reefs. During a survey to explore the marine faunal diversity of Lakshadweep Islands, fish samples were collected and three species among them were not hitherto reported from this region. Current work reports the occurrence of three fishes viz., Bathygobius cocosensis (Bleeker, 1854), Bathygobius cotticeps (Steindachner, 1879), and Enneapterygius clarkae Holleman, 1982 from Lakshadweep Islands in Western Indian Ocean .

Re-Starting the Cruise Sector during the COVID-19 Pandemic in Greece: Assessing Effectiveness of Port Contingency Planning.

Coronavirus disease (COVID-19) outbreaks on board cruise ships early in the pandemic highlighted gaps worldwide in public health emergency contingency plans (PHECPs) for responding to unknown threats. To restart cruise operations in 2021 and respond to potential COVID-19 outbreaks, a major tourist-based Greek island port (Port A) developed a COVID-19 PHECP. We assessed plan effectiveness by reviewing epidemiological data and monitoring outcomes, followed by an intra-action review (IAR) analyzing three event responses. From May to December 2021, 118 calls from 23 cruise ships with 119,930 passengers were recorded, with 29 COVID-19 cases in 11 cruises on board 7 ships. No outbreak was recorded during the study period. Strengths of the introduced PHECP included commitment of senior management; a core multi-disciplinary team of local authorities/ship agents involved in design and execution; interoperability agreements for port and ships’ PHECPs; cruise industry commitment to compliance; and pre-existing scenarios considering capacity needs. Central government coordination for preparedness planning at local ports is essential for successful responses. Monitoring local and country level response capacities is critical to inform planning, risk assessment, and decision-making. Immediately recording ports’ response actions provides the basis to capture lessons and improve contingency plans. To facilitate communication and common response protocols between European and non-European ports, IARs should be conducted between countries.

Modified harvesting technique for pedicled pectoralis major muscle flap after extended manubrial resection in case of recurrent cervicothoracic junction tumors.

The problem of the replacement after manubrial resection can be solved standardly through apedicled pectoralis major muscle flap (PMMF) defect coverage, harvested thought an accessory incision. We recently established an alternative and easier harvesting technique, also in critical cases (patients with recurrent tumor and after radio-chemotherapy), that improves aesthetic outcome and allows harvesting an adequate muscle flap for an optimal chest wall coverage. Asingle center retrospective analysis between 2017 and 2020 was performed. Flap harvest was performed subcutaneously using the same incision resections line, thereby sparing the clavicular and upper sternocostal aspects of the pectoralis muscle. Fifteen patients with recurrent tumors after radio-chemotherapy and involving the upper thoracic inlet underwent manubrial resection with associated extended upper mediastinal dissection and replacement using apectoralis major island flap following our harvesting technique. The majority (70%) of patients had an uneventful course of recovery and showed satisfying aesthetic results and low donor site morbidity. Four (26%) patients had major complications that required surgical revision. All patients had early postoperative shoulder mobilization without functional deficit or aesthetic deformity. Pedicled pectoralis major muscle flap (modified harvesting) provides an adequate replacement of the upper thoracic inlet, with excellent aesthetic and functional results, also in high risk patients.

Filipino Students’ Standpoint on Going Back to Traditional Schooling in the New Normal

Schools worldwide have started opening doors to welcome back students who, for almost two years, have been stuck studying at home. This study looks at the standpoint of Filipino students on going back to regular face-to-face schooling. There were 2,274 students of different tiers of education (high school, collegiate, graduate) from different major island groups of the Philippines (Luzon, Visayas, Mindanao) who participated in the study. The study used a mixed-method of descriptive statistics to present the quantitative data gathered and thematic analysis of qualitative responses from the subjects. The majority of all the respondents favored going back to the physical classroom, and little only favored staying using the distance mode. In the qualitative analysis, the recurring reasons of the students varied from personal, economic, and fear of getting the virus. It was concluded that Filipino students want to go back to schooling. Moreover, a sizeable amount preferred hybrid while a small number preferred to stay in online or distance mode. Educational institutions should always observe the covid 19 protocol when students go back.

The brain of the tree pangolin (Manis tricuspis). VIII. The subpallial telencephalon.

The current study provides a detailed architectural analysis of the subpallial telencephalon of the tree pangolin. In the tree pangolin, the subpallial telencephalon was divided into septal and striatopallidal regions. The septal region contained the septal nuclear complex, diagonal band of Broca, and the bed nuclei of the stria terminalis. The striatopallidal region comprised of the dorsal (caudate, putamen, internal and external globus pallidus) and ventral (nucleus accumbens, olfactory tubercle, ventral pallidum, nucleus basalis, basal part of the substantia innominata, lateral stripe of the striatum, navicular nucleus, and the major island of Calleja) striatopallidal complexes. In the tree pangolin, the organization and numbers of nuclei forming these regions and complexes, their topographical relationships to each other, and the cyto‐, myelo‐, and chemoarchitecture, were found to be very similar to that observed in commonly studied mammals. Minor variations, such as less nuclear parcellation in the bed nuclei of the stria terminalis, may represent species‐specific variations, or may be the result of the limited range of stains used. Given the overall similarity across mammalian species, it appears that the subpallial telencephalon of the mammalian brain is highly conserved in terms of evolutionary changes detectable with the methods used. It is also likely that the functions associated with these nuclei in other mammals can be translated directly to the tree pangolin, albeit with the understanding that the stimuli that produce activity within these regions may be specific to the life history requirements of the tree pangolin.

Global Patterns in Island Colonization during the Holocene

Analysis of the spatial and temporal structure of global island colonization allows us to frame the extent of insular human cultural diversity, model the impact of common environmental factors cross-culturally, and understand the contribution of island maritime societies to big historical processes. No such analysis has, however, been undertaken since the 1980s. In this paper we review and update global patterns in island colonization, synthesizing data from all the major island groups and theaters and undertaking quantitative and qualitative analysis of these data. We demonstrate the continued relevance of certain biogeographic and environmental factors in structuring how humans colonized islands during the Holocene. Our analysis also suggests the importance of other factors, some previously anticipated—such as culturally ingrained seafaring traditions and technological enhancement of dispersal capacity—but some not, such as the relationship between demographic growth and connectivity, differing trophic limitations impinging on colonizing farmers versus hunter-gatherer-foragers, and the constraining effects of latitude. We also connect colonization with continental dynamics: both the horizontal transmission of farming lifestyles earlier in the Holocene, and subsequent centrifugal processes associated with early state formation later in the Holocene.

Phylogeography and Prevalence of Hemoparasites (Apicomplexa: Eucoccidiorida) in Galápagos Marine Iguanas, Amblyrhynchus cristatus (Reptilia: Iguanidae).

Simple SummaryIt is estimated that a vast diversity of parasites populate our planet, many of them still to be discovered. Blood parasites (hemoparasites) of the phylum Apicomplexa may infect both vertebrates and invertebrates. Here, we used molecular methods to characterize the diversity of hemoparasites in the emblematic Galápagos marine iguana. We examined major island populations of marine iguanas across the Galápagos archipelago, performing the largest biogeographical study on the topic in this species. In addition, ticks were collected from marine iguana’s body to screen for hemoparasites. Our genetic analysis revealed two distinct clusters of hemoparasites belonging to Hepatozoon and/or Hemolivia. The occurrence of hemoparasites differed dramatically across islands, indicating that some populations may have mechanisms to reduce infection rates. The infection status of ticks did not match with their marine iguana hosts, suggesting that this method cannot be used to reliably know whether or not marine iguanas are infected. Given that apicomplexan blood parasites may cause important zoonotic diseases, studies like this one focusing on the relationship between parasites, their hosts and transmitting vectors, may help to shed light on the underlying mechanisms that wild animals employ to cope with pathogen infection. Parasitism is among the most common forms of coexistence of organisms of different species. Hemoparasites live in the bloodstream of the host where they complete different life-cycle stages. Members of the phylum Apicomplexa constitute a large portion of all hemoparasites infecting reptiles and their parasite transmitting vectors, including arthropods. In this study, we carried out a survey and molecular identification of hemoparasites in blood samples of the iconic Galápagos marine iguana (Amblyrhynchus cristatus). Major island populations of marine iguanas were sampled to examine large-scale biogeographic patterns of parasite diversity and prevalence. Nested PCRs were used to amplify segments of the 18S rRNA-gene of hemoparasites. Furthermore, ticks attached to marine iguanas were collected and analyzed in the same way to assess their potential use as a non-invasive method for the detection of hemoparasites in vertebrate host species. PCR products were sequenced and a phylogenetic analysis was carried out showing the presence of two genetically distinct clusters of hemoparasites, one more commonly distributed than the other one, belonging to the genera Hepatozoon and/or Hemolivia (Apicomplexa: Eucoccidiorida). Overall, 25% of marine iguanas were infected by hemoparasites. However, infection rates varied strongly among particular island populations (from 3.45% to 50%). Although marine iguanas are an extremely mobile species that has colonized all islands in the Galápagos archipelago, parasite occurrence was not related to geographical distance, suggesting that dispersal behavior has a minor role in parasite transmission. On most islands, females tended to have higher infection rates than males, but this relationship was only significant on one island. Overall, ticks and marine iguanas had similar prevalence and diversity of parasites. However, the infection profiles of ticks and their corresponding hosts (marine iguanas) did not mirror one another, indicating that this method cannot be used reliably to assess marine iguana infection status. Interestingly, we found that hemoparasite prevalence in marine iguanas and ticks tended to be positively correlated across islands. Our results indicate that certain populations of marine iguanas may have special mechanisms and adaptations to cope with parasite infection. In addition, other factors such as vector density, anthropogenic-related activities or the immunological state of marine iguanas could potentially affect the striking variation in hemoparasite prevalence across island populations.

Obesity Risk-Factor Variation Based on Island Clusters: A Secondary Analysis of Indonesian Basic Health Research 2018.

Obesity has become a rising global health problem affecting quality of life for adults. The objective of this study is to describe the prevalence of obesity in Indonesian adults based on the cluster of islands. The study also aims to identify the risk factors of obesity in each island cluster. This study analyzes the secondary data of Indonesian Basic Health Research 2018. Data for this analysis comprised 618,910 adults (≥18 years) randomly selected, proportionate to the population size throughout Indonesia. We included 20 variables for the socio-demographic and obesity-related risk factors for analysis. The obesity status was defined using Body Mass Index (BMI) ≥ 25 kg/m2. Our current study defines 7 major island clusters as the unit analysis consisting of 34 provinces in Indonesia. Descriptive analysis was conducted to determine the characteristics of the population and to calculate the prevalence of obesity within the provinces in each of the island clusters. Multivariate logistic regression analyses to calculate the odds ratios (ORs) was performed using SPSS version 27. The study results show that all the island clusters have at least one province with an obesity prevalence above the national prevalence (35.4%). Six out of twenty variables, comprising four dietary factors (the consumption of sweet food, high-salt food, meat, and carbonated drinks) and one psychological factor (mental health disorders), varied across the island clusters. In conclusion, there was a variation of obesity prevalence of the provinces within and between island clusters. The variation of risk factors found in each island cluster suggests that a government rethink of the current intervention strategies to address obesity is recommended.

Multi-proxy characterization of storm deposits on Sanibel Island, Florida: A modern analog for paleotempestology

Hurricanes have serious impacts on human lives and infrastructure, especially as a result of flooding caused by storm surge and precipitation. To better prepare coastal populations for future hurricanes due to an increasingly warming world, a better understanding of hurricane storm surge is key. Southwest Florida is particularly vulnerable to hurricane storm surge where most of the coastline is within 2.5 m of sea level and population is on the rise (2.5% between 2019 and 2020 in Lee County). This study presents a geologic record of intense hurricane strikes from Sanibel Island dating back to approximately ca. 1920. Based on sedimentary proxies such as grain size, organics, moisture content, and calcium carbonate, three tempestites were identified in cores from the Sanibel Island Marsh. Radiometric dating constrained Tempestite 1 as Hurricane Donna (1960) and Tempestites 2 and 3 as the 1926 Great Miami Hurricane and the Tampa Bay hurricane of 1921. Of the eight intense hurricanes (category 3–5) taking place between ~1920–2016, only three hurricanes were recorded in the geologic record. Tempestites 1, 2, and 3 were deposited by intense, large radius storms with significant storm surge, which would indicate that at least three storms made significant impact on the Southwest Florida region between ~1920–1960. Since 1960 no storms have breached the Sanibel Island barrier. It is important for the public to recognize that even though this region has not experienced significant storm surge in the last ~60 years, several hurricanes occurring between 1920 and 1960 produced storms surges greater than ~10 ft. that were able to breach a major barrier island (Sanibel Island). Human-induced climate change is predicted to increase storminess and sea level rise in Southwest Florida with concomitant risk for future storm surge.

Constructing a Trauma Scoring System from Databases of Road Crash Patients in Philippine Hospitals (2009–2019)

Introduction. Trauma scoring standardizes the severity of injuries of patients brought to trauma centers and is predictive of the outcome or prognosis among trauma victims. Hence, creating a trauma score allows for proper prioritization as well as proper management of patients in the emergency departments.
 Objectives. The objective of the study is to come up with a trauma scoring system that correlates to the probability of survival of a patient using the patient databases in major hospitals in the Philippines representing the three major island groups, Luzon, Visayas, and Mindanao. The study will also compare this proposed trauma scoring system with the gold standard (Revised Trauma Score) developed by Champion in 1989.
 Methods. The proposed Philippine Trauma Scoring System (PTSS) was based on data from the eight largest tertiary hospitals catering to trauma patients. A total of 40,286 patient charts were reviewed. The proposed trauma scoring system integrates concepts used in the Revised Trauma Score (RTS), with addition of age (from Kampala Trauma Scoring), as well as the Injury Score (based on the number of body parts injured). This proposed scoring system was weighted, using logistic regression to come up with coefficients for the components of the PTSS for a more accurate prediction of patient survival. The Receiver Operating Characteristic (ROC) was used to plot Sensitivity vs. 1-Specificity. In this analysis, ROC was used to evaluate and compare how good the models are in predicting patient recovery.
 Results. The components of GCS, RR, SBP, age, and body parts injured were significant predictors of patient outcomes for patients with trauma, specifically the road crash patients in this Philippine study. This study showed that both the PTSS and RTS have a significantly greater area under the curve than the diagonal reference line, which means that both the scoring system have a significant predictive value. The best predictive value, however, comes from the proposed scoring system that is developed from this study in the Philippines. Compared to the gold standard, PTSS Model 1 is a better predictor of outcomes than the gold standard RTS (ROC-AUC = 0.659 vs. 0.633) using only 22,214 valid subject population that contained all the variables needed for the PTSS analysis.
 Conclusion. In a developing country like the Philippines, there are limited resources especially in the healthcare setting. Therefore, it is important to lessen errors in triaging which may result in resource waste and a higher risk of adverse outcomes for the patients. Thus, the PTSS developed in this study can be used by Philippine hospitals as it is uniquely based on Filipino patients using a large database representative of the eight largest tertiary hospitals in the Philippines. The proposed PTSS is shown in this study as the best classifier for patient outcome compared to the gold standard – RTS of Champion.