Search

Primary care providers are often the first to identify concerns for autism through routine screening in the first 2 years of life. However, most children do not receive a diagnosis until years later resulting in delays accessing appropriate intervention. Delays in diagnosis disproportionately impact those who are otherwise disadvantaged by society based on race or socioeconomic status. Embedding mental health clinicians into primary care clinics offers a promising opportunity to address barriers to accessing diagnostic and intervention services once primary care providers identify concerns. The goal of this study was to assess the Autism in Primary Care program through which embedded mental health professionals in an urban primary care setting, primarily serving Black and Latinx families with Medicaid, were trained to provide autism diagnostic evaluations. Two hundred and fifty children completed evaluations through Autism in Primary Care program. Wait times to access evaluations in primary care were found to be significantly shorter than through standard avenues of care (e.g. tertiary care clinics). Referring primary care providers and caregivers endorsed high levels of satisfaction with the program. Embedding autism evaluations into primary care settings offers a promising opportunity to improve earlier diagnosis and treatment access for families, reduce inequities in care, and increase caregiver and child well-being.

Co-location tools of urban economic development, such as accelerators and incubators, can facilitate entrepreneurship. Of these tools, accelerators have proliferated in number and variety over the past couple of decades. However, growing evidence suggests that these programs are not equally effective, varying in form and function with disparate outcomes. Initial evidence indicates that the effectiveness of accelerators varies by entrepreneurial ecosystem features, such as density and university involvement. Current scholarship is limited, however, in that it doesn't provide an adequate explanation for why that is the case. This paper uses creative class theory to explain the distinct advantages of an accelerator powered by an urban, metropolitan research university. Among these advantages are the dense and diverse networks comprising urban research universities and the value each network participant contributes. In addition, we posit that amplifying these collective contributions is critical to startup success and the overall vitality of the entrepreneurial ecosystem within the region. We support our logic by profiling the best practices, design features, and lessons learned of an accelerator powered by a public, metropolitan research university serving as an anchor institution for the St. Louis region. [The citation of v34 n4 on the PDF is incorrect, this article appears in v34 n3.]

Background: We now have sufficient evidence demonstrating inequalities in specific avoidable causes of death for adults with intellectual disability compared to their peers without intellectual disability. Apart from COVID-19, the largest differentials that disadvantage people with intellectual disability are in relation to pneumonia, aspiration pneumonia, epilepsy, cerebrovascular disease, ischaemic heart disease, deep vein thrombosis, diabetes and sepsis. The aim of this systematic review is to report on strategies at the individual, population or policy levels aimed at preventing these conditions that are applicable to adults with intellectual disability and that have been based on or recommended by research. Methods: Systematic review of PUBMED, EMBASE, CINAHL, PsychInfo, Social Care Online, International Bibliography of the Social Sciences (IBSS), Web of Science, Scopus, Overton, the Cochrane Library and Google Scholar databases was carried out. Searches were completed on 30 June 2023. Quantitative, qualitative and mixed-methods research; systematic, scoping or evidence-based reviews; and audit and reports of mortality reviews were included. Publications included in the review were about preventing the eight potentially avoidable causes of death. Findings: Ninety-four papers were included in the review (9 in relation to pneumonia; 11 for aspiration pneumonia; 18 for sudden unexpected death in epilepsy; 7 for cerebrovascular disease; 8 for ischaemic heart disease; 4 for deep vein thrombosis; 31 for diabetes; 6 for sepsis). The eight most frequently occurring potentially avoidable causes of death in people with intellectual disability are very different medical conditions, but they shared striking similarities in how they could be prevented. The literature overwhelmingly implicated the need to make lifestyle changes to address obesity, lack of exercise and poor nutrition, and to have regular medical reviews. In addition, 'whole-population' approaches are required that look beyond the individual to the social determinants of health. Conclusions: We found little peer-reviewed evidence specifically about preventing these conditions in people with intellectual disability. However, most of the literature about preventative strategies pertaining to the general population was applicable to people with intellectual disability, albeit that some 'reasonable adjustments' would be required.

Abstract Rare cancers present significant challenges in diagnosis, treatment, and research, accounting for up to 25% of global cancer cases. Due to their rarity and atypical presentations, they are often misdiagnosed, resulting in late-stage detection and poor outcomes. Here, we describe a patient case with advanced metastatic nasopharynx NUT carcinoma, one of the rarest and most aggressive cancers. We conducted a comprehensive analysis of this patient’s tumor, including Tumor Mutation Burden, Microsatellite Instability, and genetic profiling to explore further putative druggable targets. The tumor exhibited high PD-L1 expression and showed a notable response to immune checkpoint inhibitors when combined with platinum-based radio-chemotherapy. Our findings indicate that checkpoint inhibitors could play a critical role in treating NUT carcinoma, offering new therapeutic avenues and hope for patients with this challenging diagnosis. Whether PD-L1 expression may be a useful predictor of immune checkpoint inhibitor efficacy warrants further research.

Abstract Accurate diagnosis and monitoring of neurodegenerative diseases require reliable biomarkers. Cerebrospinal fluid (CSF) proteins are promising candidates for reflecting brain pathology; however, their diagnostic utility may be compromised by natural variability between individuals, weakening their association with disease. Here, we measured the levels of 69 pre-selected proteins in cerebrospinal fluid using antibody-based suspension bead array technology in a multi-disease cohort of 499 individuals with neurodegenerative disorders including Alzheimer’s disease (AD), behavioral variant frontotemporal dementia, primary progressive aphasias, amyotrophic lateral sclerosis (ALS), corticobasal syndrome, primary supranuclear palsy, along with healthy controls. We identify significant inter-individual variability in overall CSF levels of brain-derived proteins, which could not be attributed to specific disease associations. Using linear modelling, we show that adjusting for median CSF levels of brain-derived proteins increases the diagnostic accuracy of proteins previously identified as altered in CSF in the context of neurodegenerative disorders. We further demonstrate a simplified approach for the adjustment using pairs of correlated proteins with opposite alteration in the diseases. With this approach, the proteins adjust for each other and further increase the biomarker performance through additive effect. When comparing the diseases, two proteins—neurofilament medium and myelin basic protein—showed increased levels in ALS compared to other diseases, and neurogranin showed a specific increase in AD. Several other proteins showed similar trends across the studied diseases, indicating that these proteins likely reflect shared processes related to neurodegeneration. Overall, our findings suggest that accounting for inter-individual variability is crucial in future studies to improve the identification and performance of relevant biomarkers. Importantly, we highlight the need for multi-disease studies to identify disease-specific biomarkers.

Abstract The proline-rich antimicrobial designer peptide Api137 inhibits protein expression in bacteria by binding simultaneously to the ribosomal polypeptide exit tunnel and the release factor (RF), depleting the cellular RF pool and leading to ribosomal arrest at stop codons. This study investigates the additional effect of Api137 on the assembly of ribosomes using an Escherichia coli reporter strain expressing one ribosomal protein per 30S and 50S subunit tagged with mCherry and EGFP, respectively. Separation of cellular extracts derived from cells exposed to Api137 in a sucrose gradient reveals elevated levels of partially assembled and not fully matured precursors of the 50S subunit (pre-50S). High-resolution structures obtained by cryogenic electron microscopy demonstrate that a large proportion of pre-50S states are missing up to five proteins (uL22, bL32, uL29, bL23, and uL16) and have misfolded helices in 23S rRNA domain IV. These data suggest a second mechanism for Api137, wherein it disrupts 50S subunit assembly by inducing the formation of misfolded precursor particles potentially incapable of evolving into active ribosomes, suggesting a bactericidal mechanism.

Background: Allogenic kidney transplantation has been the gold standard treatment for end-stage renal disease. In the research setting, rat models are widely utilized to refine surgical techniques and enhance graft viability. One critical factor affecting transplantation outcomes is the efficiency of the venous anastomosis. This study evaluates the utility of a microvascular coupling device for venous anastomosis in a rat kidney transplantation model. Material and methods: Experimental allogenic kidney transplantations were conducted in male Brown Norway rats (n = 10) as donors and Lewis rats as recipients (n = 17), housed according to institutional guidelines. A microvascular coupling device was used for renal venous anastomosis, and creatinine levels were measured postoperatively to assess kidney function. Procedure times, ischemia duration, and postoperative complications were recorded and analyzed. Results: The venous anastomosis time averaged 6.6 ± 2.2 min. Total ischemia time averaged 42.4 ± 4.9 min. Early postoperative serum creatinine levels were slightly elevated about references thresholds, which normalized by postoperative day 3. Four animals died after successful transplantation due to urethral complications and postrenal failure (23.5 %). Other postoperative mortality was primarily linked to complications unrelated to thrombosis (n = 3, 17.6 %). Conclusion: The use of a microvascular coupling device for venous anastomosis in rat kidney transplantation significantly reduces procedure time and ischemia duration, contributing to more consistent graft outcomes. The simplification of the venous anastomosis process and reduced operative time justify the use of coupling devices. This technique holds promise for advancing preclinical transplant research and improving reproducibility in microsurgical procedures.

Aims. Multiple sclerosis treatment strategies are changing in the Czech Republic. According to data from 2013-2021, the proportion of patients starting high-efficacy disease-modifying therapies is increasing. In this survey, we describe the actual data trends in multiple sclerosis (MS) patients beginning their first disease‑modifying therapies (DMTs) from 2013 to 2021. The secondary objective was to present the history, data collection, and scientific potential of the Czech National MS registry (ReMuS). Methods. First, using descriptive statistics, we analysed the data for patients starting their first DMTs, either platform (including dimethyl fumarate) or high-efficacy DMTs (HE-DMTs), for each successive year. Second, a detailed description of the history, data collection, completeness, quality optimising procedures, and legal policies of ReMuS is provided. Results. Based on the dataset from December 31, 2021, the total number of monitored patients with MS in ReMuS increased from 9,019 in 2013 (referred from 7 of 15 MS centres) to 12,940 in 2016 (referred from all 15 Czech MS centres) to 17,478 in 2021. In these years, the percentage of patients treated with DMTs in the registry ranged from 76 to 83%, but the proportion of patients treated with HE-DMTs changed from 16.2% in 2013 to 37.1% in 2021. During the follow-up period, a total of 8,491 treatment-naive patients received DMTs. The proportion of patients (all MS phenotypes) starting HE-DMTs increased from 2.1% in 2013 to 18.5% in 2021. Conclusion. Patient registries, including ReMuS, provide an essential quality data source, especially in light of the increasing percentage of patients on HE-DMTs. Although early initiation of HE-DMT can provide considerable benefits, it also carries greater potential risks. Consistent long-term follow-up of patients in real‑world clinical practice, which only registries allow, is therefore crucial to evaluate the efficacy and safety of therapeutic strategies, for epidemiological research and to assist decision making by healthcare providers and regulatory bodies.

This article describes how and why the Dunning-Kruger effect, in which novice students fail to recognize their own lack of research skills, often occurs with the one-shot library instruction mode. In contrast, we offer a holistic model of instruction that emphasizes closer information literacy connections to higher education curricula. Through collaboration, embedded librarianship, and using class time to address ACRL Framework concepts, such instruction promotes deeper, student-centered, authentic inquiry. A case study using research logs and a learning community approach indicated that students acquired a deeper understanding of the research process. The collaborative use of research logs highlights one approach to avoiding the Dunning-Kruger effect, even with limited class time.

Summary: Background: Short interpregnancy interval (IPI) following caesarean delivery is associated with uterine rupture in subsequent pregnancies. However, the interval required to minimise this risk is unknown. We investigated how the interval between pregnancies and induction or augmentation of labour affect the likelihood of uterine rupture among parturients with one previous livebirth by caesarean delivery who had a subsequent trial of labour. Methods: In this population-based cohort study, we used data from U.S National Vital Statistics System from 2011 to 2021. Multiple pregnancies and births of infants with congenital abnormalities were excluded. A linear spline logistic regression with one knot was used to assess the relationship between uterine rupture and interpregnancy interval for spontaneous and for induced/augmented labours. Multivariable logistic regression was performed with multiple imputation and stepwise backward elimination to adjust for maternal demographic and clinical factors including maternal age, height, and BMI and gestational age. The predicted risk of uterine rupture was tabulated for interpregnancy intervals between zero and 21 months. Adverse outcomes were compared between labours with and without uterine rupture. Findings: We examined 491,998 trials of labour among parturients with one previous livebirth by caesarean delivery and no previous vaginal births. The odds ratio (OR) of uterine rupture per three months interpregnancy interval was 0.91 (95% CI 0.88–0.94) between zero and 21 months after adjusting for confounders, with no further change in risk detected beyond 21 months. The OR was 2.51 (95% CI 2.27–2.78) for induced or augmented labours compared with spontaneous labours. Other factors associated with uterine rupture included older maternal age, shorter maternal height, more advanced gestational age (from 35 to 43 weeks), and heavier birthweight. Predicted rates of uterine rupture ranged from 0.36% at zero to 0.19% at 21 months’ interpregnancy interval for spontaneous labours and from 0.91% to 0.47% for induced/augmented labours for parturients with a typical clinical and demographic background. When uterine rupture occurred, the rates of unplanned hysterectomy, intrapartum or neonatal death, and neonatal seizures were 4.0% (95% CI 3.2–5.1%), 3.7% (95% CI 2.7–5.1%), and 2.6% (95% CI 1.8–3.3%) respectively. Interpretation: The risk of uterine rupture progressively decreases as IPI increases until about 21 months and then stabilises. Counselling should advise that for women choosing between a planned TOLAC or a planned caesarean delivery after one previous caesarean delivery and no previous vaginal births waiting until 21 months or longer after a prior low transverse caesarean delivery might minimise the risk of uterine rupture. The absolute risk of certain serious maternal and fetal/neonatal complications such as unplanned hysterectomy and perinatal death is low. Funding: No funding.

Abstract Efficient foraging plays a critical role in fitness, yet food choices and underlying nutritional goals vary among animals. To understand those choices and therefore the importance of different food resources, many studies estimate food preferences by applying electivity indices that account for resource availabilities. However, the general applicability of electivity indices in biologically relevant foraging scenarios is unclear. Our major aims were to find effective methods to estimate animals' food choices and to investigate long‐term food choices and underlying nutritional goals of the red colobus monkey (Piliocolobus tephrosceles) in Kibale National Park, Uganda, an endangered folivore. We used simulations of different foraging conditions to evaluate the applicability of electivity indices in biologically relevant scenarios to help interpret our results. Then, we used long‐term data collected between 2006 and 2016 on the feeding behavior and ecology of red colobus to determine the consumption frequencies of different foods and their food preferences. Based on these results and nutritional concentrations of young leaves of frequently consumed tree species, we investigated the importance of the protein‐to‐fiber ratio in their diet. Our simulations highlight limitations of electivity indices in biologically relevant foraging scenarios. Further, red colobus clearly chose young leaves over other plant parts, and, considering species and plant part, red colobus fed on many different items, but few dominated their diet. The availability and spatial distribution varied across the most consumed foods, but red colobus preferences remained mostly stable over time. Protein‐to‐fiber ratio had no association with preference but with consumption frequencies of different young leaves. The limitations of electivity indices in different foraging conditions underline the importance of comparing food preferences with consumption frequencies to assess the importance of different food resources. Our results provide a robust understanding of the food choices and nutritional goals of a leaf‐eating animal that can ultimately be used for implementing more effective conservation measures by directing habitat protection or restoration efforts toward these resources.

Background: Cladribine tablets are contraindicated during pregnancy; therefore, safety data on pregnancies exposed to this treatment are limited. CLEAR collects and describes pregnancy outcomes in this understudied population. Objectives: To describe the main features of the CLEAR study design, including the data sources and the methodological approach, and provide a status update. Design: CLEAR is a non-interventional, multi-database, comparative cohort study. Four cohorts are included: pregnancies of women with multiple sclerosis (MS) exposed to cladribine tablets (maternal cohort exposed); pregnancies of women with MS unexposed to any disease-modifying therapy (DMT; maternal cohort unexposed); pregnancies fathered by men with MS exposed to cladribine tablets; and pregnancies fathered by men with MS unexposed to any DMT. Methods: A staggered methodological approach, using data from Denmark, Finland, France, Germany, Norway, Scotland, and Sweden, will be applied to analyze the occurrence of major congenital anomalies (primary outcome) and selected pregnancy outcomes. The first interim analysis (performed using German pregnancy cohorts) was conducted when ⩾75 pregnant women (including 25 women from the maternal cohort exposed) were cumulatively reached across all participating countries. The end of the study period will be established once pregnancy counts reach 149 in the maternal cohort exposed and 298 in the maternal cohort unexposed in all countries combined, or 5 years after pregnancy counts are first assessed (whichever occurs first). Results: As of January 2024, data on pregnancies of women exposed to cladribine tablets ( n = 28–36 (numbers are approximate due to masking of some counts)), and pregnancies of women unexposed to cladribine tablets ( n = 2834) were available from Denmark, Finland, Germany, Scotland, and Sweden. Conclusion: The CLEAR study, using a staggered methodological approach, aims to provide further insight into the safety outcome data for cladribine tablets in pregnant women, as a regulatory commitment with the European Medicines Agency. Trial registration: EU PAS Register number, EUPAS25027.

Introduction Delirium is a neuropathological syndrome that is associated with several negative outcomes. Nursing home residents are vulnerable to developing delirium. Valid prevalence data and associated factors are not yet available for Germany. Therefore, the aim of the prevalence study of the DeliA project (Delirium in Nursing Homes) is to assess the prevalence of delirium and its associated factors in 750 nursing home residents.Methods and analysis Trained registered nurses from each participating nursing home will collect the data in a multicentre cross-sectional study. The inclusion criteria for residents are valid informed consent, age ≥65 years and sufficient language skills. The exclusion criteria are aphasia, coma, deafness or end-of-life status. The 4 ‘A’s Test will be used as the primary measurement. Delirium motor subtypes will be determined using the Delirium Motor Subtype Scale. Covariables for associated factors, including functional impairments, pain, cognitive status and nutritional status, are assessed through standardised measurements. Moreover, data such as prescribed drugs or medical diagnosis, hearing impairment or falls will be assessed from the nursing records. Furthermore, the Drug Burden Index will be calculated, and associated factors will be determined using a logistic regression model. The period for data collection in participating nursing homes is planned for 2 consecutive weeks in April 2024.Ethics and dissemination This study was approved by the Ethics Committee of Witten/Herdecke University (no. 82/2023). Findings will be published in peer-reviewed journals and presented at conferences.Registration https://osf.io/xkfvh/ (DOI 10.17605/OSF.IO/XKFVH).

Background Foot drop is a challenging condition that significantly impacts the affected patient's mobility and quality of life. Tendon transfer has emerged as a viable treatment option. We hereby present data of the tendon transfer procedures in patients with foot drop in our department. Besides a detailed description of our surgical technique, we also compare our results with those reported in the literature.

Background Obstructive sleep apnoea increases risk of respiratory depression with administration of sedatives, narcotics or anxiolytics. To reduce adverse events during hospital admission, we implemented STOP-BANG screening to prompt respiratory monitoring for inpatients receiving these medications. This study reports on protocol development, implementation and an initial analysis over 5 years to evaluate implementation success and outcomes.Intervention The STOP-BANG measure was embedded in the nurse navigator at admission. If the score was ≥3 and sedatives, narcotics and/or anxiolytics were ordered, the provider was prompted to monitor patients with continuous pulse oximetry and/or capnography.Methods We assessed the impact of the intervention using a retrospective pre–post design. Preprotocol data from all adult inpatients over a 2.5-year period, and postprotocol data from all adult inpatients from over a 5-year period, were extracted from the electronic health record. Outcomes included use of monitoring; adverse events during hospitalisation were included to evaluate the effects of the intervention: mortality, rate of rapid response team events, reversal and/or rescue, intensive care unit admission and orders for positive airway pressure equipment.Results The combined preprotocol and postprotocol sample included 254 121 patients. After protocol implementation, overall mortality for patients receiving sedatives, narcotics or anxiolytics decreased slightly from 2.1% to 1.9% (p

This thematic issue explores the global fact-checking field, focusing on its organizations, practices, and institutional dynamics. Over the past decade, fact-checking has expanded to over 400 organizations, with approximately half operating in the Global South. Fact-checkers have built a solid institutional framework featuring annual conferences, regulatory bodies, and partnerships with big techs and public organizations. Even with this cohesion, the fact-checking movement remains deeply heterogeneous. Organizations range from small local outlets to global media giants, operating within varied media and political systems. These differences shape how fact-checkers define their mission and approach misinformation, and offer a valuable lens for journalism and political communication studies to analyze evolving media systems and digitalization effects worldwide. Given such diversity, our issue addresses the need for research to observe regional and comparative perspectives on fact-checking alongside studies of broader global trends. Recent scholarship has focused on how fact-checkers adapt to diverse environments, particularly in Africa, Asia, and Latin America, and how the field is evolving. It also examines fact-checkers’ relationships with platform companies, policymakers, and transnational institutions combating misinformation. Contributions employing diverse methodologies, from case studies to large-scale content analyses, are included, with a particular emphasis on understanding organizational and contextual specificities in this crucial area of media and political communication.

Small-scale fisheries provide seafood for billions of people and are one of the largest employers in many coastal communities. Those households engaged in these fisheries who maintain diverse income sources are generally thought to be better prepared to cope with social or ecological perturbations such as the crises presented by the COVID-19 pandemic. One outcome of the COVID-19 crisis was the collapse of international tourism after many nations instituted strict border controls to slow the virus’s spread, severely impacting coastal communities that depend on tourism-related employment. This research assessed the effects of COVID-19-induced collapse of tourism on small-scale coral reef fishers and households in Moorea, French Polynesia. Ninety-five households were surveyed about their livelihoods, fishing, demographics, and income-generating occupations before and after the lockdown. Shifts in fish biomass were evaluated using time series data collected through underwater visual surveys, and roadside fish vendors were surveyed to assess fish sales. Results showed that after tourism employment evaporated more Moorea households began fishing to boost their incomes and food security. However, the increase in fishing pressure showed no appreciable decline in the biomass of fishable species. The households responsible for the increased fishing activities were those who were working in the tourism economy prior to the pandemic and subsequently lost their jobs. Households that combined fishing with construction or other stable sectors showed greater abilities to cope, while those combining fishing with tourism were heavily impacted. Importantly, results showed that those households devoted solely to fishing managed the crisis adeptly due to their superior fishing skills and ecological knowledge. This pattern suggests that not all forms of household livelihood diversification confer equal advantages and that resource-dependent households are not necessarily intrinsically less resilient. More generally, it is argued that we should be cautious when promoting livelihood diversification as a blanket solution to decrease household vulnerability, and that ecological knowledge diversity is underappreciated.

Introduction Uranium mining in the United States arose in the 1940s, peaked in the 1970s, and subsided in the late 1980s, with extensive activity concentrated in Navajo, Puebloan, and other [...], BACKGROUND: Uranium exposure remains an important environmental legacy and physiological health concern, with hundreds of abandoned uranium mines located in the Southwestern United States largely impacting underserved indigenous communities. The negative effects of heavy metals on barrier permeability and inhibition of intestinal epithelial healing have been described; however, transcriptomic changes within the intestinal epithelial cells and impacts on lineage differentiation are largely unknown. OBJECTIVES: Herein, we sought to determine the molecular and cellular changes that occur in the colon in response to uranium bearing dust (UBD) exposure. METHODS: Human colonoids from three biologically distinct donors were acutely exposed to UBD then digested for single cell RNA sequencing to define the molecular changes that occur to specific identities of colonic epithelial cells. Validation in colonoids was assessed using morphological and imaging techniques. RESULTS: Human colonoids acutely exposed to UBD exhibited disrupted proliferation and hyperplastic differentiation of the secretory lineage cell, enteroendocrine cells (EEC). Single-cell RNA sequencing also showed more EEC subtypes present in UBD-exposed colonoids. DISCUSSION: These findings highlight the significance of crypt-based proliferative cells and secretory cell differentiation using human colonoids to model major colonic responses to uranium-bearing particulate dust exposure. https://doi.org/10.1289/EHP13855

The aryl diester compound, 2-methyl-1,4-phenylene bis(3,5-dibromobenzoate), C21H12Br4O4, was synthesized by esterification of methyl hydroquinone with 3,5-dibromobenzoic acid. A crystalline sample was obtained by cooling a sample of the melt (m.p. = 502 K/DSC) to room temperature. The molecular structure consists of a central benzene ring with anti-3,5-dibromobenzoate groups symmetrically attached at the 1 and 4 positions and a methyl group attached at the 2 position of the central ring. In the crystal structure (space group P\overline{1}), molecules of the title aryl diester are located on inversion centers imposing disorder of the methyl group and H atom across the central benzene ring. The crystal structure is consolidated by a network of C—H...Br hydrogen bonds in addition to weaker and offset π–π interactions involving the central benzene rings as well as the rings of the attached 3,5-dibromobenzoate groups.

Managed retreat, a key strategy in climate change adaptation for areas with high hazard exposure, raises concerns due to its disruptive nature, vulnerability issues and overall risk in the new location. On-site upgrading or near-site resettlement is seen as more appropriate and effective compared to a relocation far from the former place of living. However, these conclusions often refer to only a very limited set of empirical case studies or do not sufficiently consider different context conditions and phases in resettlement. Against this background, this paper examines the conditions and factors contributing to community resilience of different resettlement projects in Metro Manila. In this urban agglomeration reside an estimated 500 000 informal households, with more than 100 000 occupying high-risk areas. In light of the already realized and anticipated climate change effects, this precarious living situation exposes families, already socio-economically vulnerable, to an increased risk of flooding. The response of the Philippine government to the vexing problem of informal dwellers has been large-scale resettlement from coasts, rivers and creeks to state-owned sites at urban fringes. However, only very few resettlement projects could be realized as in-city projects close to the original living space. The study employs a sequential mixed-method approach, integrating a large-scale quantitative household survey and focus group discussions (FGDs) for a robust comparison of resettlement types. Further, it reveals community-defined enabling factors for managed retreat as climate change adaptation strategy. Results indicate minor variations in well-being conditions between in-city and off-city resettlement, challenging the expected impact of a more urban setting on resilience. Instead, essential prerequisites for resettlement involve reduced hazard exposure, secure tenure and safety from crime. Beyond these essential conditions, social cohesion and institutional support systems emerge as significant influencers for the successful establishment of well-functioning new settlements. With this findings, the study contributes to the expanding body of literature on managed retreat, offering a comprehensive evaluation based on extensive datasets and providing entry points for the improvement of retreat as a climate change adaptation strategy.

As indústrias siderúrgicas brasileiras geram, em média, 145 mil toneladas por mês de areia descartada de fundição (ADF) ou resíduos de areia de fundição (RAF), como um subproduto do processo de fundição, impactando meio ambiente, sociedade, as próprias siderurgias e aterros sanitários. Porém, por ser considerado um resíduo não perigoso e muito semelhante aos agregados minerais, seu reuso na construção civil se mostra como uma interessante alternativa, evitando os impactos do descarte, além de beneficiar financeiramente as infraestruturas construídas. Nesse contexto, este artigo objetivou a dedução de uma rota metodológica para contabilizar a economia gerada pelo reuso de ADF/RAF e estimar, em termos de economia financeira e de bens ambientais, os benefícios gerados no Brasil e no município de João Pessoa, estado da Paraíba, como um estudo de caso. Dessa forma, uma equação foi obtida, abrangendo diversos aspectos da cadeia de produção e descarte de ADF/RAF, estimando economias da ordem de 500 milhões de USD anuais, além de redução de emissões de CO2 equivalente ao consumo de mais de 10 mil veículos por ano, pelo reuso da ADF/RAF produzida no Brasil.