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BackgroundDegenerative cervical myelopathy (DCM) is a chronic neurological condition estimated to affect 1 in 50 adults. Due to its diverse impact, trajectory and management options, patient-centred care and shared decision making are essential. In this scoping review, we aim to explore whether information needs in DCM are currently being met in available DCM educational resources. This forms part of a larger Myelopathy.org project to promote shared decision making in DCM.MethodsA search was completed encompassing MEDLINE, Embase and grey literature. Resources relevant to DCM were compiled for analysis. Resources were grouped into 5 information types: scientific literature, videos, organisations, health education websites and patient information leaflets. Resources were then further arranged into a hierarchical framework of domains and subdomains, formed through inductive analysis. Frequency statistics were employed to capture relative popularity as a surrogate marker of potential significance.ResultsOf 2674 resources, 150 information resources addressing DCM were identified: 115 scientific literature resources, 28 videos, 5 resources from health organisations and 2 resources from health education websites. Surgical management was the domain with the largest number of resources (66.7%, 100/150). The domain with the second largest number of resources was clinical presentation and natural history (28.7%, 43/150). Most resources (83.3%, 125/150) were designed for professionals. A minority (11.3% 17/150) were written for a lay audience or for a combined audience (3.3%, 5/150).ConclusionEducational resources for DCM are largely directed at professionals and focus on surgical management. This is at odds with the needs of stakeholders in a lifelong condition that is often managed without surgery, highlighting an unmet educational need.

Interactions between people and ecological systems, through leisure or tourism activities, form a complex socio-ecological spatial network. The analysis of the benefits people derive from their interactions with nature-also referred to as cultural ecosystem services (CES)-enables a better understanding of these socio-ecological systems. In the age of information, the increasing availability of large social media databases enables a better understanding of complex socio-ecological interactions at an unprecedented spatio-temporal resolution. Within this context, we model and analyze these interactions based on information extracted from geotagged photographs embedded into a multiscale socio-ecological network. We apply this approach to 16 case study sites in Europe using a social media database (Flickr) containing more than 150,000 validated and classified photographs. After evaluating the representativeness of the network, we investigate the impact of visitors' origin on the distribution of socio-ecological interactions at different scales. First at a global scale, we develop a spatial measure of attractiveness and use this to identify four groups of sites. Then, at a local scale, we explore how the distance traveled by the users to reach a site affects the way they interact with this site in space and time. The approach developed here, integrating social media data into a network-based framework, offers a new way of visualizing and modeling interactions between humans and landscapes. Results provide valuable insights for understanding relationships between social demands for CES and the places of their realization, thus allowing for the development of more efficient conservation and planning strategies.

OBJECTIVES:We developed clinical guidelines for the management of bone health in Rett syndrome through evidence review and the consensus of an expert panel of clinicians. METHODS:An initial guidelines draft was created which included statements based upon literature review and 11 open-ended questions where literature was lacking. The international expert panel reviewed the draft online using a 2-stage Delphi process to reach consensus agreement. Items describe the clinical assessment of bone health, bone mineral density assessment and technique, and pharmacological and non-pharmacological interventions. RESULTS:Agreement was reached on 39 statements which were formulated from 41 statements and 11 questions. When assessing bone health in Rett syndrome a comprehensive assessment of fracture history, mutation type, prescribed medication, pubertal development, mobility level, dietary intake and biochemical bone markers is recommended. A baseline densitometry assessment should be performed with accommodations made for size, with the frequency of surveillance determined according to individual risk. Lateral spine x-rays are also suggested. Increasing physical activity and initiating calcium and vitamin D supplementation when low are the first approaches to optimizing bone health in Rett syndrome. If individuals with Rett syndrome meet the ISCD criterion for osteoporosis in children, the use of bisphosphonates is recommended. CONCLUSION:A clinically significant history of fracture in combination with low bone densitometry findings is necessary for a diagnosis of osteoporosis. These evidence and consensus-based guidelines have the potential to improve bone health in those with Rett syndrome, reduce the frequency of fractures, and stimulate further research that aims to ameliorate the impacts of this serious comorbidity.