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Background: Previous studies have suggested differences in multiple sclerosis (MS) severity according to ethnicity. Methods: Data were obtained from the UK MS Register, a prospective longitudinal cohort study of persons with MS. We examined the association between self-reported ethnic background and age at onset, symptom of onset and a variety of participant-reported severity measures. We used adjusted multivariable linear regression models to explore the association between ethnicity and impact of MS, and Cox proportional hazards models to assess disability progression. Results: We analysed data from 17,314 people with MS, including participants from self-reported Black (n = 157) or South Asian (n = 230) ethnic backgrounds. Age at MS onset and diagnosis was lower in those of South Asian (median 30.0) and Black (median 33.0) ethnicity compared with White ethnicity (median 35.0). In participants with online MS severity measures available, we found no statistically significant evidence for an association between ethnic background and physical disability in MS in both cross-sectional and longitudinal analyses. Conclusion: We found no association between ethnic background and MS severity in a large, diverse UK cohort. These findings suggest that other factors, such as socioeconomic status and structural inequalities, may explain previous findings. [ABSTRACT FROM AUTHOR]

The impacts of climate change on marine organisms have been increasingly documented in laboratory and experimental studies. However, the use of different taxonomic groupings and the assessment of a range of processes make identifying overall trends challenging. Meta-analysis has been used to determine general trends, but coarse taxonomic granularity may mask phylogenetically specific responses. Bivalve molluscs are a data-rich clade of ecologically and economically important calcifying marine taxa that allow for the assessment of species-specific vulnerability across developmental stages. Drawing on the large body of available literature, we conduct a meta-analysis of 203 unique experimental set-ups in order to examine how bivalve growth responds to increased water temperature, acidity, deoxygenation, and changes in salinity in 10 climate change stressor combinations. This is the most complete examination of bivalve responses to date and shows that anthropogenic climate change will disproportionally affect particular families, suggesting taxonomic differentiation in climate change response. Specifically, Mytilidae, Ostreidae, and Pectinidae (67 % of experiments) respond with negative effect sizes for all individual stressors, whereas responses in Pinnidae, Tellinidae, and Veneridae are more complex. Our analysis shows that earlier studies reporting negative impacts on bivalves are driven by only three or four well-studied, commercially important families. Despite the taxonomic differentiation, almost all drivers and their combinations have significant negative effects on growth. The synergistic impacts of deoxygenation, acidification, and temperature result in the largest negative effect size. Infaunal taxa, including Tellinidae and Veneridae, appear more resistant to warming and oxygen reduction than epifaunal or motile taxa, but this difference between the two taxa is also based on a small number of data points. The current focus of experimental set-ups on commercially important taxa and families within a small geographic range creates gaps in the understanding of global impacts on these economically important foundation organisms. [ABSTRACT FROM AUTHOR]

Introduction: Prescribing guidance for disease-modifying treatment (DMT) in multiple sclerosis (MS) is centred on a clinical diagnosis of relapsing–remitting MS (RRMS). DMT prescription guidelines and monitoring vary across countries. Standardising the approach to diagnosis of disease course, for example, assigning RRMS or secondary progressive MS (SPMS) diagnoses, allows examination of the impact of health system characteristics on the stated clinical diagnosis and treatment access. Methods: We analysed registry data from six cohorts in five countries (Czech Republic, Denmark, Germany, Sweden and United Kingdom) on patients with an initial diagnosis of RRMS. We standardised our approach utilising a pre-existing algorithm (DecisionTree, DT) to determine patient diagnoses of RRMS or secondary progressive MS (SPMS). We identified five global drivers of DMT prescribing: Provision, Availability, Funding, Monitoring and Audit, data were analysed against these concepts using meta-analysis and univariate meta-regression. Results: In 64,235 patients, we found variations in DMT use between countries, with higher usage in RRMS and lower usage in SPMS, with correspondingly lower usage in the UK compared to other registers. Factors such as female gender (p = 0.041), increasing disability via Expanded Disability Status Scale (EDSS) score (p = 0.004), and the presence of monitoring (p = 0.029) in SPMS influenced the likelihood of receiving DMTs. Standardising the diagnosis revealed differences in reclassification rates from clinical RRMS to DT-SPMS, with Sweden having the lowest rate Sweden (Sweden 0.009, range: Denmark 0.103 – UK portal 0.311). Those with higher EDSS at index (p < 0.03) and female gender (p < 0.049) were more likely to be reclassified from RRMS to DT-SPMS. The study also explored the impact of diagnosis on DMT usage in clinical SPMS, finding that the prescribing environment and auditing practices affected access to treatment. Discussion: This highlights the importance of a healthcare system's approach to verifying the clinical label of MS course in facilitating appropriate prescribing, with some flexibility allowed in uncertain cases to ensure continued access to treatment. [ABSTRACT FROM AUTHOR]