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Bustards comprise a highly threatened family of birds and, being relatively fast, heavy fliers with very limited frontal visual fields, are particularly susceptible to mortality at powerlines. These infrastructures can also displace them from immediately adjacent habitat and act as barriers, fragmenting their ranges. With geographically ever wider energy transmission and distribution grids, the powerline threat to bustards is constantly growing. Reviewing the published and unpublished literature up to January 2021, we found 2,774 records of bustard collision with powerlines, involving 14 species. Some studies associate powerline collisions with population declines. To avoid mortalities, the most effective solution is to bury the lines; otherwise they should be either routed away from bustard-frequented areas, or made redundant by local energy generation. When possible, new lines should run parallel to existing structures and wires should preferably be as low and thick as possible, with minimal conductor obstruction of vertical airspace, although it should be noted that these measures require additional testing. A review of studies finds limited evidence that ‘bird flight diverters’ (BFDs; devices fitted to wires to induce evasive action) achieve significant reductions in mortality for some bustard species. Nevertheless, dynamic BFDs are preferable to static ones as they are thought to perform more effectively. Rigorous evaluation of powerline mortalities, and effectiveness of mitigation measures, need systematic carcass surveys and bias corrections. Whenever feasible, assessments of displacement and barrier effects should be undertaken. Following best practice guidelines proposed with this review paper to monitor impacts and mitigation could help build a reliable body of evidence on best ways to prevent bustard mortality at powerlines. Research should focus on validating mitigation measures and quantifying, particularly for threatened bustards, the population effects of powerline grids at the national scale, to account for cumulative impacts on bustards and establish an equitable basis for compensation measures.
Systemic-to-pulmonary shunts are used as a source of pulmonary blood flow in palliated Congenital Heart Disease in neonates and young infants. Shunt thrombosis, often requiring shunt interventions during index hospitalisation, is associated with poor outcomes. We hypothesised that extensive use of perioperative pro-coagulant products may be associated with shunt thrombosis.
Children (≤18 years) undergoing systemic-to-pulmonary shunts with in-hospital shunt reinterventions between 2016 and 2020 were reviewed retrospectively. Perioperative associations to shunt thrombosis were examined by univariate logistic regression and Wilcoxon rank sum tests as appropriate. Cox and log transformed linear regression were used to analyse postoperative ventilation duration, length of stay, and cost.
Of 71 patients requiring in-hospital shunt intervention after systemic-to-pulmonary shunts, 10 (14%) had acute shunt thrombosis, and among them five (50%) died. The median age was four (interquartile range: 0-15) months. There were 40 (56%) males, 41 (58%) had single ventricle anatomy, and 29 (40%) were on preoperative anticoagulants. Patients with acute shunt thrombosis received greater volume of platelets (p = 0.04), cryoprecipitate (p = 0.02), and plasma (p = 0.04) postoperatively in the ICU; experienced more complications (p = 0.01) including re-exploration for bleeding (p = 0.008) and death (p = 0.02), had longer hospital length of stays (p = 0.004), greater frequency of other arterial/venous thrombosis (p = 0.02), and greater hospital costs (p = 0.002).
Patients who develop acute shunt thrombosis receive more blood products perioperatively and experience worse hospital outcomes and higher hospital costs. Future research on prevention/early detection of shunt thrombosis is needed to improve outcomes in infants after systemic-to-pulmonary shunt surgery.
To document laryngeal framework rupture following voluntary cough-holding as an airway complication of donning a personal protective equipment suit that was too small in size.
Clinical record and literature review, with proposition of plausible aerodynamics of the airway injury.
Whilst carrying out his duty in the coronavirus disease ward, a resident attempted to stifle a paroxysm of cough when wearing a personal protective equipment suit that was too small with his neck flexed and restricted. There was a sudden release of pressure, intense pain and swelling in the neck with crepitus. Imaging revealed a non-displaced fracture in the lower end of the partially ossified right thyroid lamina, a cricothyroid membrane tear and subcutaneous emphysema. The symptoms resolved gradually on conservative management.
This report underlines the importance of donning appropriately sized personal protective equipment and encouraging its proper use amongst coronavirus disease 2019 caregivers. Non-traumatic laryngeal injury, itself a rare event, has never been reported as a posture-related complication of wearing personal protective equipment.
Meta-granites of the South Delhi Fold Belt, northwestern India, contain spectacular reaction textures formed during the metamorphic replacement of primary minerals. Textural relationships imply that amphibole was replaced sequentially in two stages. Epidote + titanite + quartz symplectite formed syn-tectonically on amphibole grain boundaries/fractures, followed by post-deformational growth of euhedral garnet overprinting amphibole grains. Besides occurring as symplectite grown during deformation, titanite in this rock also developed as a post-tectonic corona around magnetite. Parent magnetite contains exsolutions of ilmenite and/or ultrafine lamellae of Ti-rich oxide (Ti-oxd). Textures involving coronal titanite suggest their formation through a magnetite + ilmenite(/Ti-oxd) + plagioclase → titanite reaction. Compositional attributes and the calculation of the gain versus loss of components during the reaction suggest that the Mn2+ for garnet (XSpss = 0.23–0.29) that grew replacing amphibole was supplied by ilmenite (Mn2+ is 0.118–0.128 apfu) as it disintegrated to form coronal titanite. The redistribution of components between the metamorphic reaction sites connects the texturally unrelated domains and suggests that these zones were in chemical equilibrium during metamorphism. We estimated the P–T conditions of metamorphism for these post-tectonic assemblages as ∼650–700 °C from pseudosection modelling and conventional thermometry. Zircon data from this study suggest that the granitic rock crystallized at 988.8 ± 8.8 Ma. We propose that the metamorphic phases replaced the primary minerals during the mid Neoproterozoic tectonic activity reported from this terrane. The syn-tectonic symplectitic assemblage formed as the temperature increased during prograde metamorphism, and the post-tectonic minerals developed at peak conditions following the cessation of deformation.
Self-harm in pregnancy or the year after birth (‘perinatal self-harm’) is clinically important, yet prevalence rates, temporal trends and risk factors are unclear.
A cohort study of 679 881 mothers (1 172 191 pregnancies) was conducted using Danish population register data-linkage. Hospital treatment for self-harm during pregnancy and the postnatal period (12 months after live delivery) were primary outcomes. Prevalence rates 1997–2015, in women with and without psychiatric history, were calculated. Cox regression was used to identify risk factors.
Prevalence rates of self-harm were, in pregnancy, 32.2 (95% CI 28.9–35.4)/100 000 deliveries and, postnatally, 63.3 (95% CI 58.8–67.9)/100 000 deliveries. Prevalence rates of perinatal self-harm in women without a psychiatric history remained stable but declined among women with a psychiatric history. Risk factors for perinatal self-harm: younger age, non-Danish birth, prior self-harm, psychiatric history and parental psychiatric history. Additional risk factors for postnatal self-harm: multiparity and preterm birth. Of psychiatric conditions, personality disorder was most strongly associated with pregnancy self-harm (aHR 3.15, 95% CI 1.68–5.89); psychosis was most strongly associated with postnatal self-harm (aHR 6.36, 95% CI 4.30–9.41). For psychiatric disorders, aHRs were higher postnatally, particularly for psychotic and mood disorders.
Perinatal self-harm is more common in women with pre-existing psychiatric history and declined between 1997 and 2015, although not among women without pre-existing history. Our results suggest it may be a consequence of adversity and psychopathology, so preventative intervention research should consider both social and psychological determinants among women with and without psychiatric history.
The early phase of the coronavirus disease 2019 (COVID-19) pandemic and ongoing efforts for mitigation underscore the importance of universal travel and symptom screening. We analyzed adherence to documentation of travel and symptom screening through a travel navigator tool with clinical decision support to identify patients at risk for Middle East Respiratory Syndrome.
The life expectancy gap between people with severe mental illness (SMI) and the general population persists and may even be widening. This study aimed to estimate contributions of specific causes of death to the gap. Age of death and primary cause of death were used to estimate life expectancy at birth for people with SMI from a large mental healthcare case register during 2007–2012. Using data for England and Wales in 2010, death rates in the SMI cohort for each primary cause of death category were replaced with gender- and age-specific norms for that cause. Life expectancy in SMI was then re-calculated and, thus, the contribution of that specific cause of death estimated. Natural causes accounted for 79.2% of lost life-years in women with SMI and 78.6% in men. Deaths from circulatory disorders accounted for more life-years lost in women than men (22.0% versus 17.4%, respectively), as did deaths from cancer (8.1% versus 0%), but the contribution from respiratory disorders was lower in women than men (13.7% versus 16.5%). For women, cancer contributed more in those with non-affective than affective disorders, while suicide, respiratory and digestive disorders contributed more in those with affective disorders. In men, respiratory disorders contributed more in non-affective disorders. Other contributions were similar between gender and affective/non-affective groups. Loss of life expectancy in people with SMI is accounted for by a broad range of causes of death, varying by gender and diagnosis. Interventions focused on multiple rather than individual causes of death should be prioritised accordingly.
We affirm that intersex people are real, and we exist in all regions and all countries around the world. Thus, intersex people must be supported to be the drivers of social, political and legislative changes that concern them. We reaffirm the principles of the First and Second International Intersex Fora and extend the demands aiming to end discrimination against intersex people and to ensure the right of bodily integrity, physical autonomy and self-determination.
• To put an end to mutilating and “ normalizing “ practices such as genital surgeries, psychological and other medical treatments through legislative and other means. Intersex people must be empowered to make their own decisions affecting own bodily integrity, physical autonomy and self-determination.
• To put an end to preimplantation genetic diagnosis, pre-natal screening and treatment, and selective abortion of intersex foetuses.
• To put an end to infanticide and killings of intersex people.
• To put an end to non-consensual sterilisation of intersex people.
• To depathologise variations in sex characteristics in medical guidelines, protocols and classifications, such as the World Health Organization's International Classification of Diseases.
• To register intersex children as females or males, with the awareness that, like all people, they may grow up to identify with a different sex or gender.
• To ensure that sex or gender classifications are amendable through a simple administrative procedure at the request of the individuals concerned. All adults and capable minors should be able to choose between female (F), male (M), non-binary or multiple options. In the future, as with race or religion, sex or gender should not be a category on birth certificates or identification documents for anybody.
• To raise awareness around intersex issues and the rights of intersex people in society at large.
• To create and facilitate supportive, safe and celebratory environments for intersex people, their families and surroundings.
• To ensure that intersex people have the right to full information and access to their own medical records and history.
• To ensure that all professionals and healthcare providers that have a specific role to play in intersex people's wellbeing are adequately trained to provide quality services.
On the 30th – 31st of March 2017 in Vienna, Austria the first OII Europe community event took place. During the community event 28 Intersex people from 16 Council of Europe member states, some activists and some not, came together to share their experiences, and their varied objectives and strategies for the full implementation of human rights, bodily integrity, self-determination and societal acceptance of intersex people within Europe.
We affirm that intersex people are real, and we exist in all regions and all countries around the world.
We reaffirm the Malta Declaration and its demands, formulated at the 3rd International Intersex Forum (2013), as well as the objectives formulated by the 1st European Intersex Meeting in the Riga Statement (2014).
We also stress the fact, that until this day more than 50 times UN bodies, regional and national human rights bodies have called on governments, policy makers and stakeholders to put an end to human rights violations faced by intersex people – including taking the necessary legislative, administrative and other measures to guarantee respect for the physical integrity and autonomy of intersex persons and to ensure that no one is subjected during infancy or childhood to non-urgent medical or surgical procedures intended to decide the sex of the child.
Ensuring the right of intersex people of bodily integrity, physical autonomy and self-determination must be a priority in all action taken. Intersex people must be supported to be the drivers of social, political and legislative changes that concern them.
We therefore call on governments to:
• Recognise intersex people as a community that has specific and vital needs and that their human rights need protection.
To this aim governments should take decisive action to:
• Install legislative protections that ban medical interventions on children with variations of sex characteristics, on social, psychosocial, cultural or cosmetic grounds. A ban on Intersex genital mutilation is necessary as IGM is equatable with female genital mutilation that takes place within hospital settings. Th is may include installing legislative measures that penalise medical professionals that commit or assist in IGM.
The idea for this book began as a workshop supported by the DAAD Cambridge Research Hub with funds from the German Federal Foreign Office (FFO), the University of Regensburg and Cambridge Family Law.
The workshop was held at the University of Cambridge/Gonville and Caius College on 21 – 22 July 2016, jointly organised by the editors of this book. The workshop was attended not only by academics from Australia, Germany, the UK, Ireland, New Zealand, Spain and Italy, but also by representatives of the Law Commission of England and Wales, the German Federal Ministry of Justice and Consumer Protection (Berlin), the German Institute for Human Rights (Berlin) and the Ministry for Social Dialogue, Consumer Affairs and Civil Liberties (Malta). While the focus was on legal developments and regulation, there also were contributions from theology, medicine and psychology. There was an intense and productive interdisciplinary and interjurisdictional debate over the two days, and much of this is now reflected in this book. After the workshop, and indeed as a result of it, the research project leading to this book was started, and many additional chapters were commissioned in order to present an even broader discussion of the issues.
However, all major research projects face difficulties of varying kinds, and this one certainly was no exception. Several people who had promised to participate dropped out or failed to deliver. Houses were flooded, illnesses overcome, jobs changed, and children born during the period it took to put this book together. But in the end things came together, and we are pleased with the outcome and the broad range of contributions. We truly hope that this book will contribute to the national and international debates and lead to a focus on the autonomy of the people concerned.
We also are very grateful to many institutions and persons supporting the research project and publication of the book: the Ludwig Maximilian University of Munich for supporting the significant editorial work that needed to be undertaken, and which was handled expertly by Intersentia Publishing; Dafni Lima for her help with the initial editorial work; the Gonville and Caius Conference Office, and particularly Laura Webb, for ensuring that the workshop could take place in such a pleasant and well-organised environment; Ingrid Hobbis of the Cambridge Research Hub for her administrative support; Prof.
The Legal Status of Intersex Persons provides a basis for discussion regarding all legal aspects concerning persons born with sex characteristics that do not belong strictly to male or female categories, or that belong to both at the same time. It contains contributions from medical, psychological and theological perspectives, as well as national legal perspectives from Germany, Australia, India, the Netherlands, Columbia, Sweden, France and the USA. It explores international human rights aspects of intersex legal recognition and also features chapters on private international law and legal history.The book is a timely one. Until very recently, the legal gender of a person – both at birth and later in life – in virtually all jurisdictions had to be recorded as either male or female; the laws simply did not allow any other option, and, in many cases, changing the recorded gender was difficult or impossible. However, there are many cases where this gender binary is unable to capture the reality of a person’s physical presentation and/or perception of self. Consequently, this gender binary is increasingly being challenged and several jurisdictions have begun to reform their gender status laws.For example, in 2013 Germany became the first Western jurisdiction in modern times to introduce legislation allowing a person’s gender to be recorded as ‘indeterminate’ at birth and thus give them a legal gender status other than male or female for all intents and purposes. However, this legislation has proved problematic in many ways and rightly was subject to pertinent criticism. In 2017 the German Constitutional Court then held that these rules were in violation of the German constitution as they only allowed a non-recognition, as opposed to a positive recognition of a gender other than male or female, and mandated law reform. Similarly, the Austria Constitutional Court held in June 2018 that current civil status laws had to be interpreted to allow registration of alternative gender identities. Therefore two European jurisdictions will now have legal gender recognition beyond the binary.This book looks at law reform taking place around the world, with diverse perspectives from relevant fields, to provide the reader with a comprehensive analysis of the legal status of intersex persons and related issues.