Protecting the global ocean for biodiversity, food and climate.

The ocean contains unique biodiversity, provides valuable food resources and is a major sink for anthropogenic carbon. Marine protected areas (MPAs) are an effective tool for restoring ocean biodiversity and ecosystem services1,2, but at present only 2.7% of the ocean is highly protected3. This low level of ocean protection is due largely to conflicts with fisheries and other extractive uses. To address this issue, here we developed a conservation planning framework to prioritize highly protected MPAs in places that would result in multiple benefits today and in the future. We find that a substantial increase in ocean protection could have triple benefits, by protecting biodiversity, boosting the yield of fisheries and securing marine carbon stocks that are at risk from human activities. Our results show that most coastal nations contain priority areas that can contribute substantially to achieving these three objectives of biodiversity protection, food provision and carbon storage. A globally coordinated effort could be nearly twice as efficient as uncoordinated, national-level conservation planning. Our flexible prioritization framework could help to inform both national marine spatial plans4 and global targets for marine conservation, food security and climate action.

Prioritizing debt conversion opportunities for marine conservation.

Incentivized debt conversion is a financing mechanism that can assist countries with a heavy debt burden to bolster their long-term domestic investment in nature conservation. The Nature Conservancy, an international conservation-based nongovernmental organization, is adapting debt conversions to support marine conservation efforts by small island developing states and coastal countries. Prioritizing debt conversion opportunities according to their potential return on investment can increase the impact and effectiveness of this finance mechanism. We developed guidance on how to do so with a decision-support approach that relies on a novel threat-based adaptation of cost-effectiveness analysis. We constructed scenarios by varying parameters of the approach, including enabling conditions, expected benefits, and threat classifications. Incorporating both abatable and unabatable threats affected priorities across planning scenarios. Similarly, differences in scenario construction resulted in unique solution sets for top priorities. We show how environmental organizations, private entities, and investment banks can adopt structured prioritization frameworks for making decisions about conservation finance investments, such as debt conversions. Our guidance can accommodate a suite of social, ecological, and economic considerations, making the approach broadly applicable to other conservation finance mechanisms or investment strategies that seek to establish a transparent process for return-on-investment decision-making.

Priorización de las Oportunidades de Conversión de Deudas para la Conservación Marina Resumen La incentivación de la conversión de deudas es un mecanismo financiero que puede apoyar a los países con una gran carga deudora a impulsar su inversión doméstica a largo plazo en la conservación de la naturaleza. The Nature Conservancy, una organización internacional no gubernamental basada en la conservación está adaptando las conversiones de deudas para que apoyen a los esfuerzos de conservación marina realizados por países en desarrollo ubicados en pequeñas islas y por los países costeros. La priorización de las oportunidades de conversión de deudas según su rendimiento potencial de la inversión puede incrementar el impacto y la efectividad de este mecanismo financiero. Desarrollamos una guía de cómo lograr esto con una estrategia de respaldo a las decisiones que depende de una adaptación novedosa basada en amenazas de un análisis de rentabilidad. Construimos escenarios por medio de la variación de los parámetros de alcance (incluyendo a las condiciones de habilitación), los beneficios esperados y las clasificaciones de las amenazas. La incorporación de las amenazas abatibles e imbatibles afectó a las prioridades en todos los escenarios de planeación. De manera similar, las diferencias en la construcción de los escenarios resultaron en un conjunto de soluciones únicas para las principales prioridades. Así demostramos cómo las organizaciones ambientales, entidades privadas y los bancos de inversión pueden adoptar marcos de trabajo de priorización estructurada para la toma de decisiones sobre la inversión en el financiamiento de la conservación, como lo son las conversiones de deudas. Nuestra guía puede satisfacer un conjunto de consideraciones sociales, ecológicas y económicas, lo que vuelve a la estrategia en general pertinente para otros mecanismos de financiamiento de la conservación o estrategias de inversión que busquen establecer un proceso transparente para la toma de decisiones de rendimiento de la inversión.

Effects of the Learning Together intervention on bullying and aggression in English secondary schools (INCLUSIVE): a cluster randomised controlled trial.

BACKGROUND: Bullying, aggression, and violence among children and young people are some of the most consequential public mental health problems. We tested the Learning Together intervention, which involved students in efforts to modify their school environment using restorative practice and by developing social and emotional skills. METHODS: We did a cluster randomised trial, with economic and process evaluations, of the Learning Together intervention compared with standard practice (controls) over 3 years in secondary schools in south-east England. Learning Together consisted of staff training in restorative practice; convening and facilitating a school action group; and a student social and emotional skills curriculum. Primary outcomes were self-reported experience of bullying victimisation (Gatehouse Bullying Scale; GBS) and perpetration of aggression (Edinburgh Study of Youth Transitions and Crime (ESYTC) school misbehaviour subscale) measured at 36 months. We analysed data using intention-to-treat longitudinal mixed-effects models. This trial was registered with the ISRCTN registry (10751359). FINDINGS: We included 40 schools (20 in each group); no schools withdrew. 6667 (93·6%) of 7121 students participated at baseline and 5960 (83·3%) of 7154 at 36 months. Mean GBS bullying score at 36 months was 0·34 (SE 0·02) in the control group versus 0·29 (SE 0·02) in the intervention group, with a significant adjusted mean difference (-0·03, 95% CI -0·06 to -0·001; adjusted effect size -0·08). Mean ESYTC score at 36 months was 4·33 (SE 0·20) in the control group versus 4·04 (0·21) in the intervention group, with no evidence of a difference between groups (adjusted difference -0·13, 95% CI -0·43 to 0·18; adjusted effect size -0·03). Costs were an additional £58 per pupil in intervention schools than in control schools. INTERPRETATION: Learning Together had small but significant effects on bullying, which could be important for public health, but no effect on aggression. Interventions to promote student health by modifying the whole-school environment are likely to be one of the most feasible and efficient ways of addressing closely related risk and health outcomes in children and young people. FUNDING: National Institute for Health Research, Educational Endowment Foundation.

Does My Emergency Department Doctor Sleep? The Trouble With Recovery From Night Shift.

BACKGROUND: Previous research has shown that emergency physicians have an increased risk of shift work sleep disorder, potentially compromising their health, wellness, and effectiveness as a physician. OBJECTIVES: This study explores the effect of shift work on sleep in emergency doctors. The hypothesis of the evaluation is that daytime sleep onset would lead to the poorest sleep, implying poor recovery after a night shift. METHODS: Sleep patterns were examined in emergency physicians in an academic emergency department. Twenty-seven individuals completed data collection, wearing wrist actigraphy devices over 3 months. Time of sleep onset was categorized as falling into 1 of 3 ranges: interval 1-day sleepers (6:00 am-2:00 pm), interval 2-evening sleepers (2:00 pm-10:00 pm), or interval 3-night sleepers (10:00 pm-6:00 am). Data from each interval were analyzed for median duration, sleep latency, and night-time interruptions. RESULTS: Daytime sleep sessions had a median total sleep duration of 5.3 ± 2 h, much less than 7.3 ± 1.8 h (interval 2-evening), and 7.0 ± 1.1 h (interval 3-night). Interval 2 sleepers experienced the highest number of nightly awakenings (1.5) and the longest sleep latency (36.5 min). Day sleepers (interval 1), assumed to be predominantly physicians recovering from night shifts, had significantly less sleep than both evening and night sleepers (p < 0.01), experiencing a 23.0% decrease in overall median sleep duration. CONCLUSIONS: This study provides statistical findings that those working the night shift experience significantly less sleep than emergency physicians working other shifts.

Resilience and Physical and Mental Well-Being in Adults with and Without HIV.

Resilience has been related to improved physical and mental health, and is thought to improve with age. No studies have explored the relationship between resilience, ageing with HIV, and well-being. A cross sectional observational study performed on UK HIV positive (N = 195) and HIV negative adults (N = 130). Associations of both age and 'time diagnosed with HIV' with resilience (RS-14) were assessed, and the association of resilience with depression, anxiety symptoms (PHQ-9 and GAD-7), and problems with activities of daily living (ADLs) (Euroqol 5D-3L). In a multivariable model, HIV status overall was not related to resilience. However, longer time diagnosed with HIV was related to lower resilience, and older age showed a non-significant trend towards higher resilience. In adults with HIV, high resilience was related to a lower prevalence of depression, anxiety, and problems with ADLs. It may be necessary to consider resilience when exploring the well-being of adults ageing with HIV.

Addressing transboundary conservation challenges through marine spatial prioritization.

The Adriatic and Ionian Region is an important area for both strategic maritime development and biodiversity conservation in the European Union (EU). However, given that both EU and non-EU countries border the sea, multiple legal and regulatory frameworks operate at different scales, which can hinder the coordinated long-term sustainable development of the region. Transboundary marine spatial planning can help overcome these challenges by building consensus on planning objectives and making the trade-offs between biodiversity conservation and its influence on economically important sectors more explicit. We address this challenge by developing and testing 4 spatial prioritization strategies with the decision-support tool Marxan, which meets targets for biodiversity conservation while minimizing impacts to users. We evaluated these strategies in terms of how priority areas shift under different scales of target setting (e.g., regional vs. country level). We also examined the trade-off between cost-efficiency and how equally solutions represent countries and maritime industries (n = 14) operating in the region with the protection-equality metric. We found negligible differences in where priority conservation areas were located when we set targets for biodiversity at the regional versus country scale. Conversely, the prospective impacts on industries, when considered as costs to be minimized, were highly divergent across scenarios and biased the placement of protection toward industries located in isolation or where there were few other industries. We recommend underpinning future marine spatial planning efforts in the region through identification of areas of national significance, transboundary areas requiring cooperation between countries, and areas where impacts on maritime industries require careful consideration of the trade-off between biodiversity conservation and socioeconomic objectives.

Standardized reporting of the costs of management interventions for biodiversity conservation.

Effective conservation management interventions must combat threats and deliver benefits at costs that can be achieved within limited budgets. Considerable effort has focused on measuring the potential benefits of conservation interventions, but explicit quantification of the financial costs of implementation is rare. Even when costs have been quantified, haphazard and inconsistent reporting means published values are difficult to interpret. This reporting deficiency hinders progress toward a collective understanding of the financial costs of management interventions across projects and thus limits the ability to identify efficient solutions to conservation problems or attract adequate funding. We devised a standardized approach to describing financial costs reported for conservation interventions. The standards call for researchers and practitioners to describe the objective and outcome, context and methods, and scale of costed interventions, and to state which categories of costs are included and the currency and date for reported costs. These standards aim to provide enough contextual information that readers and future users can interpret the cost data appropriately. We suggest these standards be adopted by major conservation organizations, conservation science institutions, and journals so that cost reporting is comparable among studies. This would support shared learning and enhance the ability to identify and perform cost-effective conservation.

Exploring resilience in nursing and midwifery students: a literature review.

AIM: The aim of this study was to explore the concepts of 'resilience' and 'hardiness' in nursing and midwifery students in educational settings and to identify educational interventions to promote resilience. BACKGROUND: Resilience in healthcare professionals has gained increasing attention globally, yet to date resilience and resilience education in nursing and midwifery students remain largely under-researched. DESIGN: An integrative literature review was planned, however, only quantitative evidence was identified therefore, a review of quantitative studies was undertaken using a systematic approach. DATA SOURCES: A comprehensive search was undertaken using Medline, CINAHL, Embase, PsycINFO and Maternity and Infant Care databases January 1980-February 2015. REVIEW METHODS: Data were extracted using a specifically designed form and quality assessed using an appropriate checklist. A narrative summary of findings and statistical outcomes was undertaken. RESULTS: Eight quantitative studies were included. Research relating to resilience and resilience education in nursing and midwifery students is sparse. There is a weak evidence that resilience and hardiness is associated with slightly improved academic performance and decreased burnout. However, studies were heterogeneous in design and limited by poor methodological quality. No study specifically considered student midwives. CONCLUSION: A greater understanding of the theoretical underpinnings of resilience in nursing and midwifery students is essential for the development of educational resources. It is imperative that future research considers both nursing and midwifery training cohorts and should be of strong methodological quality.

Childhood verbal abuse as a child maltreatment subtype: A systematic review of the current evidence.

BACKGROUND: In recent years, the prevalence of childhood emotional abuse has surpassed other forms of maltreatment. Childhood verbal abuse (CVA) is a key attribute of emotional abuse, yet CVA is not recognized as its own form of maltreatment and thus, has not received adequate attention. Clear terminology, definitions, and measures are needed to aid in assessing the occurrence and impact of CVA for its recognition and prevention. OBJECTIVE: We aim to synthesize the evidence on the terms, definitions, and measurements of CVA and identify outcomes associated with CVA. PARTICIPANTS AND SETTING: A systematic review focused on adult perpetration of CVA among children and adolescents using clinical, community-based, and population-based samples. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed and four databases were utilized in May 2022: PsycINFO, MEDLINE, EMBASE, and ProQuest. A total of 149 quantitative and 17 qualitative studies were identified. RESULTS: Across studies reviewed, the most common perpetrators of CVA were parents, mothers, and teachers. Definitional themes for CVA included negative speech volume, tone, and speech content, and their immediate impact. The most frequent measures cited were Adverse Childhood Experiences Study (ACE) Questionnaire and the Conflict Tactics Scale (CTS); 50 % used self-created measures. CVA was associated with a range of internalizing and externalizing outcomes across the lifespan. CONCLUSIONS: Recognizing CVA as a form of maltreatment will be a starting point for its identification and prevention. Primary prevention of CVA using trauma-informed approaches must include adult training on the importance of safety, support, and nurturance during verbal communication with children.

A globally integrated structure of taxonomy to support biodiversity science and conservation.

All aspects of biodiversity research, from taxonomy to conservation, rely on data associated with species names. Effective integration of names across multiple fields is paramount and depends on the coordination and organization of taxonomic data. We assess current efforts and find that even key applications for well-studied taxa still lack commonality in taxonomic information required for integration. We identify essential taxonomic elements from our interoperability assessment to support improved access and integration of taxonomic data. A stronger focus on these elements has the potential to involve taxonomic communities in biodiversity science and overcome broken linkages currently limiting research capacity. We encourage a community effort to democratize taxonomic expertise and language in order to facilitate maximum interoperability and integration.

Co-occurrence of biodiversity, carbon storage, coastal protection, and fish and invertebrate production to inform global mangrove conservation planning.

Mangrove forests support unique biodiversity and provide a suite of ecosystem services (ES) that benefit people. Decades of continual mangrove loss and degradation have necessitated global efforts to protect and restore this important ecosystem. Generating and evaluating asset maps of biodiversity and ES is an important precursor to identifying locations that can deliver conservation outcomes across varying scales, such as maximising the co-occurrence of specific ES. We bring together global datasets on mangrove-affiliated biodiversity, carbon stocks, fish and invertebrate production, and coastal protection to provide insight into potential trade-offs, synergies and opportunities from mangrove conservation. We map opportunities where high ES provision co-occurs with these areas that could be leveraged in conservation planning, and identify potential high-value opportunities for single ES that might otherwise be missed with a biodiversity focus. Hotspots of single ES, co-occurrence of multiple ES, and opportunities to simultaneously leverage biodiversity and ES occurred throughout the world. For example, efforts that focus on conserving or restoring mangroves to store carbon can be targed to deliver multiple ES benefits. Some nations, such as Vietnam, Oman, Ecuador and China, showed consistent (although not necessarily strong) correlations between ES pairs. A lack of clear or consistent spatial trends elsewhere suggests that some nations will likely benefit more from complementarity-based approaches that focus on multiple sites with high provision of different services. Individual sites within these nations, however, such as Laguna de Terminos in Mexico still provide valuable opportunities to leverage co-benefits. Ensuring that an ES focused approach is complemented by strategic spatial planning is a priority, and our analyses provide a precursor towards decisions about where and how to invest.

Demystifying ecological connectivity for actionable spatial conservation planning.

Connectivity underpins the persistence of life; it needs to inform biodiversity conservation decisions. Yet, when prioritising conservation areas and developing actions, connectivity is not being operationalised in spatial planning. The challenge is the translation of flows associated with connectivity into conservation objectives that lead to actions. Connectivity is nebulous, it can be abstract and mean different things to different people, making it difficult to include in conservation problems. Here, we show how connectivity can be included in mathematically defining conservation planning objectives. We provide a path forward for linking connectivity to high-level conservation goals, such as increasing species' persistence. We propose ways to design spatial management areas that gain biodiversity benefit from connectivity.

Multi-objective zoning for aquaculture and biodiversity.

Aquaculture is the fastest growing food production industry in the world yet research and guidance demonstrating strategic multi-objective zoning for sector expansion is scarce. Quantifying and mitigating conflicts and impact on sensitive coastal environments through jointly-optimized objectives for aquaculture and biodiversity simultaneously has not been tested yet. We here develop and evaluate six alternative planning scenarios for one of the European Union's highest priority bivalve shellfish aquaculture areas, the Emilia-Romagna Region in Italy. We i) develop an aquaculture profitability surface as a function of the distance from main ports, and in parallel build a fine-scale aquaculture suitability distribution surface for important commercial species using multi-criteria analysis; ii) prioritize protected areas for biodiversity while testing how different considerations of human impacts influence priorities; iii) simultaneously plan for aquaculture and biodiversity while minimizing impacts on other maritime activities. We compare results from different scenarios according to how well they capture suitable aquaculture habitats and minimize impacts. We introduce a new evaluation method for scenario comparison in spatial optimization using a nearest-neighbor analysis for spatial pattern similarities. Lastly, we test the "value of information" provided by our investment in developing the fine-scale suitability surface to improve efficiencies. We find that an integrated multi-objective zoning approach, which simultaneously optimizes for biodiversity and aquaculture, supports more efficient planning than traditional sector specific growth strategies. We also discovered that the fine-scale suitability model delivered a 5% more efficient solution than the simple distance function, highlighting the role of proxy cost surfaces and diminished returns from investing in comprehensive habitat suitability analysis in regions without much variation in key parameters. We offer evidence of improved efficiency and practical guidance for integrated planning in Blue Growth agendas. Our analysis can be applied in any context where multiple objectives occur for aquaculture sector growth and biodiversity conservation.

RadTranslate: An Artificial Intelligence-Powered Intervention for Urgent Imaging to Enhance Care Equity for Patients With Limited English Proficiency During the COVID-19 Pandemic.

PURPOSE: Disproportionally high rates of coronavirus disease 2019 (COVID-19) have been noted among communities with limited English proficiency, resulting in an unmet need for improved multilingual care and interpreter services. To enhance multilingual care, the authors created a freely available web application, RadTranslate, that provides multilingual radiology examination instructions. The purpose of this study was to evaluate the implementation of this intervention in radiology. METHODS: The device-agnostic web application leverages artificial intelligence text-to-speech technology to provide standardized, human-like spoken examination instructions in the patient's preferred language. Standardized phrases were collected from a consensus group consisting of technologists, radiologists, and ancillary staff members. RadTranslate was piloted in Spanish for chest radiography performed at a COVID-19 triage outpatient center that served a predominantly Spanish-speaking Latino community. Implementation included a tablet displaying the application in the chest radiography room. Imaging appointment duration was measured and compared between pre- and postimplementation groups. RESULTS: In the 63-day test period after launch, there were 1,267 application uses, with technologists voluntarily switching exclusively to RadTranslate for Spanish-speaking patients. The most used phrases were a general explanation of the examination (30% of total), followed by instructions to disrobe and remove any jewelry (12%). There was no significant difference in imaging appointment duration (11 ± 7 and 12 ± 3 min for standard of care versus RadTranslate, respectively), but variability was significantly lower when RadTranslate was used (P = .003). CONCLUSIONS: Artificial intelligence-aided multilingual audio instructions were successfully integrated into imaging workflows, reducing strain on medical interpreters and variance in throughput and resulting in more reliable average examination length.