Research priorities for the sustainability of coral-rich western Pacific seascapes.

Nearly a billion people depend on tropical seascapes. The need to ensure sustainable use of these vital areas is recognised, as one of 17 policy commitments made by world leaders, in Sustainable Development Goal (SDG) 14 ('Life below Water') of the United Nations. SDG 14 seeks to secure marine sustainability by 2030. In a time of increasing social-ecological unpredictability and risk, scientists and policymakers working towards SDG 14 in the Asia-Pacific region need to know: (1) How are seascapes changing? (2) What can global society do about these changes? and (3) How can science and society together achieve sustainable seascape futures? Through a horizon scan, we identified nine emerging research priorities that clarify potential research contributions to marine sustainability in locations with high coral reef abundance. They include research on seascape geological and biological evolution and adaptation; elucidating drivers and mechanisms of change; understanding how seascape functions and services are produced, and how people depend on them; costs, benefits, and trade-offs to people in changing seascapes; improving seascape technologies and practices; learning to govern and manage seascapes for all; sustainable use, justice, and human well-being; bridging communities and epistemologies for innovative, equitable, and scale-crossing solutions; and informing resilient seascape futures through modelling and synthesis. Researchers can contribute to the sustainability of tropical seascapes by co-developing transdisciplinary understandings of people and ecosystems, emphasising the importance of equity and justice, and improving knowledge of key cross-scale and cross-level processes, feedbacks, and thresholds.

Inka Unku: Imperial or provincial? State-local relations.

Standardized Inka tunics, or unku, were created under the auspices of the state as symbolic expressions of its expansionist power. To ensure these textiles acquired the status of effective insignias of power and territorial control, the Inka established and imposed technical and stylistic canons for their production (techne) by means of highly-skilled state weavers. In the provinces, social groups that came under imperial rule, local expert weaving agents adopted the conventions of the state and included meaningful symbolic elements of the idiosyncrasies, traditions, and experiential knowledge of the local community (metis). We therefore propose that this was not a unidirectional process and that the Caleta Vitor Inka unku (hereon referred to as the CV unku), presented here, reflects a syncretism promoted by local weavers. In terms of methods, we have developed a decoding tool for the unku, with the aim of distinguishing state from local hallmarks, thereby revealing the syncretic complexity of these iconic tunics. This methodological tool is based on a series of standard analytical parameters and attributes linked to morphological, technological, and stylistic features, which we applied to the CV unku. Unlike others, this unku does come from a looted tomb but was scientifically excavated in a cemetery located in the Caleta Vitor Bay in northern Chile. By deconstructing the CV unku we determined the steps in the chaîne opératoire at which local technical and stylistic elements were incorporated, thus affecting or transforming, in part, its emblematic imperial imagery. This study also marks a step forward in our understanding of a syncretic landscape that combines the state worldview and organized production system (imperial Inka) with craft-production practices that were rooted in provincial and local communities (provincial Inka).

Does Double Reading of Screening Breast MRI Scans Impact Recall Rates and Cancer Detection?

Objective: To investigate the effect of double reads by a second radiologist on cancer detection rate (CDR), positive predictive value of recommendation for tissue diagnosis (PPV2), and the positive predictive value of biopsy performed (PPV3) for biopsy recommendations in high-risk screening breast MRIs. Methods: The policy of second reads on biopsies recommended for MRIs was prospectively implemented in October 2019. This IRB approved retrospective analysis compared consecutive high-risk screening breast MRI scans performed in a single academic institution between 06/01/2018 to 06/01/2019 (pre-intervention) with screening breast MRI scans performed between 10/31/2019 to 10/31/2020 (post-intervention). Pathology results after biopsy were recorded. Testing of association was performed using the Chi-square test. Results/Discussion: A total of 1124 screening breast MRIs in the pre-intervention and 1672 screening breast MRIs were performed in the post-intervention periods. Biopsies were recommended in 8.6% (97/1124) of pre-intervention and 5.5% (92/1672) of post-intervention MRIs (P = .0012). There was a non-significant increase in PPV2 from pre-intervention 10.3% (10/97) to post-intervention 18.4% (17/92) (P = .109) and in PPV3 from 14% (10/71) to 22.9% (17/74), respectively (P = .17). Similar cancer detection rates, 8.9/1000 (10/1124) and 10.2/1000 (17/1672) (P = .736) were diagnosed in pre-intervention and post-intervention periods, respectively. Conclusion: Double reading of screening breast MRI scans significantly reduced the number of unnecessary biopsies without significant impact in the PPVs or cancer detection rate.

Randomized trial of surveillance with abbreviated MRI in women with a personal history of breast cancer- impact on patient anxiety and cancer detection.

BACKGROUND: Abbreviated breast MRI (A-MRI) substantially reduces the image acquisition and reading times and has been reported to have similar diagnostic accuracy as a full diagnostic protocol but has not been evaluated prospectively with respect to impact on psychological distress in women with a prior history of breast cancer (PHBC). This study aimed to determine if surveillance mammography (MG) plus A-MRI reduced psychological distress and if A-MRI improved cancer detection rates (CDR) as compared to MG alone. METHODS: This prospective controlled trial of parallel design was performed at a tertiary cancer center on asymptomatic women with PHBC who were randomized into two groups: routine surveillance with MG or intervention of MG plus A-MRI in a 1:1 ratio. Primary outcome was anxiety measured by four validated questionnaires at three different time-points during the study. Other parameters including CDR and positive predictive value for biopsy (PPV3) were compared between imaging modalities of MG and A-MRI. Tissue diagnoses or 1 year of follow-up were used to establish the reference standard. Linear mixed models were used to analyze anxiety measures and Fisher's exact test to compare imaging outcomes. RESULTS: One hundred ninety-eight patients were allocated to either MG alone (94) or MG plus A-MRI (104). No significant group difference emerged for improvement in trait anxiety, worry and perceived health status (all Time-by-surveillance group interaction ps > .05). There was some advantage of A-MRI in reducing state anxiety at Time 2 (p < .05). Anxiety scores in all questionnaires were similarly elevated in both groups (50.99 ± 4.6 with MG alone vs 51.73 ± 2.56 with MG plus A-MRI, p > 0.05) and did not change over time. A-MRI detected 5 invasive cancers and 1 ductal carcinoma in situ (DCIS), and MG detected 1 DCIS. A-MRI had higher incremental CDR (48/1000(5/104) vs MG 5/1000(1/198, p = 0.01)) and higher biopsy rates (19.2% (20/104) vs MG 2.1% (2/94), p < 0.00001) with no difference in PPV3 (A-MRI 28.6% (6/21) vs MG 16.7% (1/6, p > .05). CONCLUSION: There was no significant impact of A-MRI to patient anxiety or perceived health status. Compared to MG alone, A-MRI had significantly higher incremental cancer detection in PHBC. Despite a higher rate of biopsies, A-MRI had no demonstrable impact on anxiety, worry, and perceived health status. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02244593 ). Prospectively registered on Sept. 14, 2014.

An experimental look at trust, bargaining, and public goods in fishing communities.

Pro-social behavior is crucial to the sustainable governance of common-pool resources such as fisheries. Here, we investigate how key socioeconomic characteristics influence fishers' pro-social and bargaining behavior in three types of experimental economic games (public goods, trust, and trade) conducted in fishing associations in Chile. Our games revealed high levels of cooperation in the public goods game, a high degree of trust, and that sellers rather than buyers had more bargaining power, yet these results were strongly influenced by participants' socioeconomic characteristics. Specifically, gender, having a secondary income source, age, and being the main income provider for the household all had a relationship to multiple game outcomes. Our results highlight that engagement in pro-social behaviors such as trust and cooperation can be influenced by people's socioeconomic context.

COVID-19 impacts on coastal communities in Kenya.

COVID-19 is continuing to have far-reaching impacts around the world, including on small-scale fishing communities. This study details the findings from 39 in-depth interviews with community members, community leaders, and fish traders in five communities in Kenya about their experiences since the beginning of the COVID-19 pandemic in March, 2020. The interviews were conducted by mobile phone between late August and early October 2020. In each community, people were impacted by curfews, rules about gathering, closed travel routes, and bans on certain activities. Fish trade and fisheries livelihoods were greatly disrupted. Respondents from all communities emphasized how COVID-19 had disrupted relationships between fishers, traders, and customers; changed market demand; and ultimately made fishing and fish trading livelihoods very difficult to sustain. While COVID-19 impacted different groups in the communities-i.e., fishers, female fish traders, and male fish traders-all experienced a loss of income and livelihoods, reduced cash flow, declining food security, and impacts on wellbeing. As such, although small-scale fisheries can act as a crucial safety net in times of stress, the extent of COVID-19 disruptions to alternative and informal livelihoods stemmed cash flow across communities, and meant that fishing was unable to fulfil a safety net function as it may have done during past disruptions. As the pandemic continues to unfold, ensuring that COVID-19 safe policies and protocols support continued fishing or diversification into other informal livelihoods, and that COVID-19 support reaches the most vulnerable, will be critical in safeguarding the wellbeing of families in these coastal communities.

Preliminary lessons from COVID-19 disruptions of small-scale fishery supply chains.

The ongoing COVID-19 pandemic and associated mitigation measures have disrupted global systems that support the health, food and nutrition security, and livelihoods of billions of people. These disruptions have likewise affected the small-scale fishery (SSF) sector, disrupting SSF supply chains and exposing weaknesses in the global seafood distribution system. To inform future development of adaptive capacity and resilience in the sector, it is important to understand how supply chain actors are responding in the face of a macroeconomic shock. Comparing across seven SSF case studies in four countries, we explore how actors are responding to COVID-19 disruptions, identify constraints to adaptive responses, and describe patterns of disruption and response across cases. In all cases examined, actors shifted focus to local and regional distribution channels and particularly drew on flexibility, organization, and learning to re-purpose pre-existing networks and use technology to their advantage. Key constraints to reaching domestic consumers included domestic restrictions on movement and labor, reduced spending power amongst domestic consumers, and lack of existing distribution channels. In addition, the lack of recognition of SSFs as essential food-producers and inequities in access to technology hampered efforts to continue local seafood supply. We suggest that the initial impacts from COVID-19 highlight the risks in of over-reliance on global trade networks. The SSFs that were able to change strategies most successfully had local organizations and connections in place that they leveraged in innovative ways. As such, supporting local and domestic networks and flexible organizations within the supply chain may help build resilience in the face of future macroeconomic shocks. Importantly, bolstering financial wellbeing and security within the domestic market both before and during such large-scale disruptions is crucial for supporting ongoing supply chain operations and continued food provision during macroeconomic crises.

Three lessons for gender equity in biodiversity conservation.

Amid a growing global agenda, biodiversity conservation has embraced gender equity as a pillar of equitable and effective practice. Gender equity has become enshrined in the global environment and development agenda through global commitments, policy and funding. However, for various reasons, conservation biodiversity often takes a simplistic view of gender as synonymous with women or as a dualism between women and men. This narrow view risks promoting inequitable processes and ineffective outcomes. Deeper engagement with feminist theory, and feminist political ecology in particular, could help advance biodiversity conservation's approach to how gender is understood, framed and integrated. Engaging with lessons from feminist political ecology can help advance gender equity in conservation through attention to power dynamics, intersectionality, and subjectivity.

Obesity Prevention Laws and the Australian Constitution.

The idea of using law and regulation to prevent obesity in Australia is complicated by federalism. This article analyses in detail the powers of Commonwealth and State governments to determine which level(s) of government would be able to pass laws of the types recommended by the National Preventative Health Taskforce, namely marketing regulation, labelling regulation, content regulation, fiscal measures, built environment regulation and school regulation. The article considers the types of law that the Commonwealth could pass under the trade and commerce, taxation, communications and corporations powers, along with the power to make tied grants to the States. It then considers how the States could pass such laws but avoid levying any duty of excise, restricting freedom of interstate trade and passing any law that would be inconsistent with a Commonwealth law.

The Yield of Pre-operative Breast MRI in Patients According to Breast Tissue Density.

OBJECTIVE: To determine the yield of pre-operative breast MRI according to breast tissue density. METHODS: We performed a retrospective review of 665 consecutive patients who underwent breast MRI in 2012 for pre-operative staging of biopsy-proven breast cancer, 582 of whom had digital mammograms available within 6 months of the MRI were evaluated for breast tissue density and additional lesions seen on breast MRI not identified on mammography. Lesions that could change surgical management if positive were confirmed by percutaneous biopsy. RESULTS: MRI identified additional lesions changing surgical management in 19 of 61 patients (31%) with fat density, 94/269 (35%) with scattered fibroglandular parenchyma, 89/210 (42%) with heterogeneously dense breasts, and 26/42 (62%) with dense breasts. There was a significant difference between breast density and number of additional findings on MRI (p<0.0001). Patients with dense breasts were 5.1x more likely to have additional findings on MRI in comparison to patients with fat density breasts (95% CI 2.2-12.1, p=0.0001). CONCLUSION: Patients with dense breasts are more likely to have additional findings on pre-operative breast MRI in comparison to patients with fat tissue density breasts; if selective use of pre-operative MRI is necessary, patients with dense breast tissue density seem to show the maximal benefit. HIGHLIGHTS: • Preoperative MRI detects many additional lesions not seen on mammography. • Increased breast density correlates with more findings on preoperative breast MRI (p<0.0001). • Extremely dense breasts are more likely to have additional findings on MRI. • Increased breast density is associated with more MRI findings that changed management.

Malignant invasion of sternotomy incision after cardiac operation.

Neoplastic involvement of the sternotomy incision has rarely been described after cardiac operations. We present 3 patients with sternotomy incisions that were initially suspected to be infected but were subsequently found to involve metastatic spread of a distant primary tumor. These patients presented with renal cell carcinoma, multiple myeloma, and endometrial cancer, malignancies known to invade bone, within 12 months of their cardiac operation. The immediacy of presentation after the operation suggests that these patients may have had subclinical cancer at the time of the procedure. Seeding of the surrounding tissue may therefore have occurred with the sternotomy. Neoplastic involvement should, therefore, remain part of the differential diagnosis for incisional drainage or induration, especially beyond the initial postoperative period.

Placental pathology and clinical outcomes in a cohort of infants admitted to a neonatal intensive care unit.

BACKGROUND: Placental pathology predicts persistent neurological impairment, even in normally grown infants. However, few studies have linked placental pathology with neonatal outcomes in a large population. METHODS: We matched the clinical outcomes of a cohort of neonates admitted to a neonatal intensive care unit (NICU) with placental pathology, where available, and examined (by multivariable logistic regression) the relationship between placental pathologies and these outcomes. The outcomes included neonatal death, necrotizing enterocolitis, and intraventricular hemorrhage > or = grade 3. A forward selection model (10% significance level for entry) was used after adjusting for onfounding factors. RESULTS: A detailed gross and microscopic pathological report was available for 1296 eligible infants (64%). Specific placental features were associated with specific neonatal outcomes. The Canadian Neonatal Network has previously determined that specific changes in the pattern of neonatal care can alter the incidence and severity of these outcomes. In the placentas from pregnancies delivering small for gestational age infants who were subsequently admitted to NICU, two different patterns of placental pathologies were found, one ischemic and the other inflammatory. CONCLUSION: Frozen section examination of placentas may facilitate more timely delivery of tailored neonatal therapy.

Chorioamnionitis with a fetal inflammatory response is associated with higher neonatal mortality, morbidity, and resource use than chorioamnionitis displaying a maternal inflammatory response only.

OBJECTIVE: This study was undertaken to evaluate whether the proximity of infection of the chorion/amnion and fetal vessels affects neonatal outcomes. STUDY DESIGN: We examined all (n=2012) infants admitted to the British Columbia's Children's Hospital Neonatal Intensive Care Unit, from January 1996 to October 1997. We included infants with a placental examination (n=1296), and stratified those with histologic chorioamnionitis into cases displaying a maternal inflammatory response only and cases also displaying a fetal inflammatory response (funisitis and/or fetal surface vessel angiitis). RESULTS: Histologic evidence of chorioamnionitis was present in 31% of placentas. Of those, 38% exhibited maternal inflammation only, whereas 62% also exhibited fetal inflammation. Neonatal mortality (9.2% vs 7.2%), morbidity, and resource use were significantly (P < .05) higher when fetal inflammation was present compared with when only maternal inflammation was present. CONCLUSION: Chorioamnionitis with a fetal inflammatory response is associated with higher neonatal mortality, morbidity, and resource use than when only a maternal inflammatory response is present.