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Community-based conservation can support livelihoods and biodiversity, while reinforcing local and Indigenous values, cultures, and institutions. Its delivery can help address cross-cutting global challenges, such as climate change, conservation, poverty, and food security. Therefore, understanding trends in community-based conservation is pertinent to setting and implementing global goals. We undertook a horizon scan to prioritize 15 emerging threats and opportunities expected to impact the future effectiveness of community-based conservation. Topics relate to global biodiversity policy; human rights; shifting human geography; inclusion, diversity, equity, and access; conservation finance and income; and economic reforms. Our findings offer guidance on strengthening community-based conservation to achieve global environmental and development goals.

Background & Objective: Preoperative anxiety among children may at times be very cumbersome for the anesthesiologist, as an anxious child cannot be expected to be very cooperative. Anxiety may interfere into vascular excess and smooth induction of anesthesia. This study was conducted to assess the efficacy of ‘pediatric anesthesia comic information’ leaflet in reducing preoperative anxiety and to obtain parents feedback on its utility. Methodology: It was a prospective single blinded randomized controlled trial among 150 children, aged 6-12 y, undergoing elective surgery in a tertiary-care hospital. Test group (Group T) was given a comic leaflet along with oral information while control group (Group C) received only oral information. Preoperative anxiety was measured using Modified Yale Preoperative Anxiety Scale (m-YPAS) at three time intervals along with feedback from parents on the comic’s utility. Data was analyzed using SPSS version 21.0 with Chi-square, independent t and Mann Whitney tests applied to interpret the results. Results: Pre-operative anxiety on the day prior to surgery (T1) was 25.75 ± 5.52 and 26.61 ± 7.77 compared to baseline (T0) score of 25.8 ± 6.1 and 26.6 ± 8.0 in group T and C respectively. The mean scores in the holding area (T2) was 38.87 ± 14.20 and 41.35 ± 16.40 in Group T and C respectively. The p value of change in the preoperative anxiety scores T0-T1 was 0.2, and T0-T2 was 0.24 with no significant decrease in preoperative anxiety in intervention compared to the control group (p > 0.05). Conclusion: Our results show that comic leaflet, given pre-operatively in addition to standard oral information had no additional effect on reducing anxiety in children undergoing surgery. However, the parents of the study subjects found the comic leaflet to be informative and it needs to be explored further in future research. Key words: Anesthesia; Preoperative anxiety; Pediatrics; Surgery; Comic leaflet Citation: Kulkarni MM, Pradeep S, Rao M, Kulkarni MM. A randomized controlled trial to study the effect of a pediatric anesthesia comic information leaflet on preoperative anxiety in children. Anaesth. pain intensive care 2021;26(1):75-80. DOI: 10.35975/apic.v26i1.1771 Received: June 27, 2021, Reviewed: September 28, 2021, Accepted: November 17, 2021

BACKGROUND Pre-operative anxiety is common in children and its relief is an important concern for the anaesthesiologist. Oral midazolam has good sedative and anxiolytic properties. Dexmedetomidine, an alpha-2 agonist, produces sedation like natural sleep, in addition to having analgesic, anxiolytic and anaesthetic-sparing properties, making it a near ideal sedative. Alleviating this anxiety using minimally invasive and painless routes for sedative drugs is of paramount importance. The purpose of this study was to compare the sedation, child-parent separation, and mask acceptance between sublingual atomised dexmedetomidine and oral midazolam, along with the haemodynamic changes associated with these drugs. METHODS This prospective, double-blind, randomised control trial was conducted in a tertiary hospital setting. Using computer-generated randomisation, sixty paediatric patients were divided into one of two groups. Group - D received sublingual dexmedetomidine 1.5 µg/kg using a mucosal atomisation device, and Group - M, oral midazolam 0.5 mg/kg, 45 minutes before anaesthetic induction. Sedation status, child-parent separation, mask acceptance scores, haemodynamics and oxygen saturation were measured at baseline and every 15 minutes till induction. Quantitative data were compared with student’s t-test and repeated measures analysis of variance (ANOVA), and qualitative data using chi-square test. RESULTS Demographic data were comparable between the two groups. Children in Group - D were significantly more sedated (P < 0.0001), with lower heart rate at 30 and 45 minutes (P = 0.003, < 0.0001 respectively) than Group - M. However, mask acceptance score was significantly better (P = 0.007) in Group - M. Child-parent separation score was comparable. CONCLUSIONS Atomised sublingual dexmedetomidine produced significantly greater sedation and low-normal heart rate, but poorer mask acceptance than with oral midazolam. Child-parent separation was comparable. We conclude that sublingual atomised dexmedetomidine 1.5 µg/kg, is not a suitable alternative to oral midazolam 0.5 mg/kg for paediatric premedication. KEY WORDS Anaesthesia, Dexmedetomidine, Midazolam, Anti-Anxiety Agents, Premedication, Paediatric

Capacity development is critical to long-term conservation success, yet we lack a robust and rigorous understanding of how well its effects are being evaluated. A comprehensive summary of who is monitoring and evaluating capacity development interventions, what is being evaluated and how, would help in the development of evidence-based guidance to inform design and implementation decisions for future capacity development interventions and evaluations of their effectiveness. We built an evidence map by reviewing peer-reviewed and grey literature published since 2000, to identify case studies evaluating capacity development interventions in biodiversity conservation and natural resource management. We used inductive and deductive approaches to develop a coding strategy for studies that met our criteria, extracting data on the type of capacity development intervention, evaluation methods, data and analysis types, categories of outputs and outcomes assessed, and whether the study had a clear causal model and/or used a systems approach. We found that almost all studies assessed multiple outcome types: most frequent was change in knowledge, followed by behaviour, then attitude. Few studies evaluated conservation outcomes. Less than half included an explicit causal model linking interventions to expected outcomes. Half of the studies considered external factors that could influence the efficacy of the capacity development intervention, and few used an explicit systems approach. We used framework synthesis to situate our evidence map within the broader literature on capacity development evaluation. Our evidence map (including a visual heat map) highlights areas of low and high representation in investment in research on the evaluation of capacity development.

Purpose: This study aimed to evaluate the feasibility and repeatability of [18F]-fluorothymidine positron emission tomography (FLT-PET) and its utility as a proliferative imaging marker to evaluate response in patients with advanced pancreatic adenocarcinoma (PDAC) receiving gemcitabine-based chemotherapy. Methods: PDAC patients due to commence gemcitabine-based chemotherapy underwent FLT-PET over 60 minutes, before (baseline) and after 28 days of chemotherapy. Repeatability was assessed by a second FLT-PET scan within 7 days of baseline scan and before starting chemotherapy. Scans were assessed by two independent physician’s to determine inter-reporter concordance. FLT-PET uptake over 45-60 minutes was estimated as maximum and mean standardised uptake values (SUVmax and SUVmean). Exploratory analysis of tissue biomarkers was performed from archival tissue samples. Results: All 18 of the 21 patients consented who were imaged had primary tumour in-situ and 83% had metastases with 60% in liver. 17 patients received gemcitabine-based treatment. Thirty-five FLT-PET scans were acquired (89% evaluable) and 26 lesions delineated (17 primary tumours, 9 liver metastases). At baseline, liver metastases showed higher uptake compared with primary tumour with mean (SD) SUVmax [7.2 (1.1) vs 4.5 (1.3); p < 0.001] and SUVmean [4.7 (0.6) vs 2.1 (0.6); p < 0.001)]. There was good intra-patient repeatability and inter-reporter concordance with mean (SD) test-retest difference and inter-reporter Lin’s concordance coefficient being 4.9% (17.6) and 0.703 for SUVmax and -5.4% (SD 9.8) and 0.710 for SUVmean, respectively. FLT uptake between baseline and post-treatment scans were variable and did not predict for benefit from gemcitabine. However, gemcitabine-capecitabine combination therapy resulted in a higher FLT uptake compared to gemcitabine alone, although this did not translate to clinical benefit. No relationship was observed between tissue markers and FLT in half subjects imaged whose tissue was available. Conclusions FLT-PET is a feasible and reproducible imaging technique in patients with PDAC to evaluate proliferation-targeting therapy, using a simplified imaging protocol in well-designed clinical trials.

Several hundred species are hunted for wild meat in the tropics, supporting the diets, customs, and livelihoods of millions of people. However, unsustainable hunting is one of the most urgent threats to wildlife and ecosystems worldwide and has serious ramifications for people whose subsistence and income are tied to wild meat. Over the past 18 years, although research efforts have increased, scientific knowledge has largely not translated into action. One major barrier to progress has been insufficient monitoring and evaluation, meaning that the effectiveness of interventions cannot be ascertained. Emerging issues include the difficulty of designing regulatory frameworks that disentangle the different purposes of hunting, the large scale of urban consumption, and the implications of wild meat consumption for human health. To address these intractable challenges, wepropose eight new recommendations for research and action for sustainable wild meat use, which would support the achievement of the United Nations Sustainable Development Goals., This article is primarily an output of the WILDMEAT Project and was funded by the United States Fish and Wildlife Service (AFR1732 Grant F17AP00421 Supplement 0001) and the United States Agency for International Development (USAID) (D.J.I., K.A., L.C., F.N.T., D.M.I.). This project also benefitted from funding from the UK Research and Innovation’s Global Challenges Research Fund (UKRI GCRF) Trade, Development and the Environment Hub project (project number ES/S008160/1) (E.J.M.G., C.S., L.C.). A.B.-L. is supported by a Juan de la Cierva Incorporación grant (IJCI-2017-31419) from the Spanish Ministry of Science, Innovation and Universities. H.R.E.B. is supported by the Brazilian National Council for Scientific and Technological Development (grant numbers 201475/2017-0 and 441435/2017-3). T.Q.M. is supported by the Wildlife Conservation Society Graduate Scholarship Program (Christensen Conservation Leaders Scholarship), the Wildlife Conservation Network Scholarship Program (Sidney Byers Scholarship), and the British Federation of Women Graduates (Funds for Women Graduates). R.N., J.E.F., L.C., and N.V.V. were funded by USAID as part of the Bushmeat Research Initiative of the CGIAR research program on Forests, Trees and Agroforestry. G.C. and J.M.R. are supported by Research England. C.D.G. acknowledges that he is an unpaid science advisory board member at Oceana. K.A. acknowledges that her husband is Minister of Water, Forests, Seas and Environment in Gabon and is responsible for policies concerning hunting management.

Analysing the drivers of deforestation and forest degradation in conservation landscapes can provide crucial information for conservation management. While rates of forest loss can be measured through remote sensing, on the ground information is needed to confirm the commodities and actors behind deforestation. We administered a questionnaire to Wildlife Conservation Society’s landscape managers to assess the deforestation drivers in 28 tropical conservation landscapes. Commercial and subsistence agriculture were the main drivers of deforestation, followed by settlement expansion and infrastructure development. Rice, rubber, cassava and maize were the crops most frequently cited as drivers of deforestation in these emblematic conservation landscapes. Landscape managers expected deforestation trends to continue at similar or greater magnitude in the future, calling for urgent measures to mitigate these trends. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13280-020-01325-9) contains supplementary material, which is available to authorized users.

Background and Aims: Preoperative laboratory testing is done to detect abnormalities in the body not detected by clinical examination. Often a battery of tests is advocated as a routine for patients scheduled for low or intermediate risk surgery. This prospective observational study was aimed to assess agreement of the current practice of preoperative laboratory investigations with the National Institute of Clinical Excellence (NICE) guidelines, and the impact of investigations on patient care and costs. Material and Methods: The study was conducted at a tertiary referral center on 385 patients aged 18-70 years of either gender, posted for elective general surgical, gynaecological or otolaryngological surgery. Sixteen investigations were examined: hemogram, blood urea, serum creatinine, serum electrolytes, coagulation profile, urinalysis, thyroid function tests, electrocardiogram, echocardiogram, chest x-ray, pulmonary function tests, blood sugar, glycosylated hemoglobin, liver function tests, treadmill test and coronary angiogram. The history and physical examination were reviewed to examine for indication for these laboratory investigations. These were compared with NICE guidelines. Impact of these investigations on anesthetic decision-making was noted. Results: There was almost no agreement of the current practice with the NICE guidelines. The total cost of all tests obtained was Rs 5,48,755. Total additional cost of unindicated tests was Rs 5,10,730 (93%). Average amount spent on additional investigations per patient was Rs 1326.57. Conclusion: Most investigations are overprescribed and have minimal agreement with NICE guidelines. None of the tests had any impact on clinical care. Nearly a million rupees is incurred per year in one referral hospital alone, when NICE guidelines are not followed.

Effective conservation planning needs to consider the threats of cropland expansion to biodiversity. We used Myanmar as a case study to devise a modeling framework to identify which Key Biodiversity Areas (KBAs) are most vulnerable to cropland expansion in a context of increasingly resolved armed conflict. We studied 13 major crops with the potential to expand into KBAs. We used mixed-effects models and an agricultural versus forest rent framework to model current land use and conversion of forests to cropland for each crop. We found that the current cropland distribution is explained by higher agricultural value, lower transportation costs and lower elevation. We also found that protected areas and socio-political instability are effective in slowing down deforestation with conflicts in Myanmar damaging farmland and displacing farmers elsewhere. Under plausible economic development and socio-political stability scenarios, the models forecast 48.5% of land to be converted. We identified export crops such as maize, and pigeon pea as key deforestation drivers. This cropland expansion would pose a major threat to Myanmar’s freshwater KBAs. We highlight the importance of considering rapid land-use transitions in the tropics to devise robust conservation plans.

The shark and ray (Elasmobranchii) trade is a commercially valuable industry that has negative consequences for wild populations. An estimated 100 million sharks are caught each year to supply the demand for cultural cuisines, traditions and practices, including shark fin soup and Traditional Chinese Medicine. Despite the establishment of frameworks and regulations by international trade and conservation bodies as well as national legislations, elasmobranch populations continue to decline. While their conservation becomes an ever more pressing concern, a major obstacle that hampers regulation is the mislabelling and/or misidentification of dried products or carcasses that have had fins removed. Here we use DNA barcoding to identify the species of origin for a variety of shark and ray products readily available to consumers in Singapore, a major importer of these goods. We amplified a fragment of the cytochrome c oxidase subunit I gene from shark fin, cartilage and meat, as well as ray gill plates and meat for DNA sequencing. Our analysis of 207 DNA barcodes yielded 28 positively identified elasmobranch species, eight of which are listed under Appendix II of the Convention on International Trade in Endangered Species of Wild Fauna and Flora, and 12 are listed as Endangered or Vulnerable by the International Union for the Conservation of Nature. This information will be useful to regulatory bodies in controlling trade and establishing new or revisiting previous conservation status listings.

A hundred research priorities of critical importance to protected area management were identified by a targeted survey of conservation professionals; half researchers and half practitioners. Respondents were selected to represent a range of disciplines, every continent except Antarctica and roughly equal numbers of men and women. The results analysed thematically and grouped as potential research topics as by both practitioners and researchers. Priority research gaps reveal a high interest to demonstrate the role of protected areas within a broader discussion about sustainable futures and if and how protected areas can address a range of conservation and socio-economic challenges effectively. The paper lists the hundred priorities structured under broad headings of management, ecology, governance and social (including political and economic issues) and helps contribute to setting future research agendas.

Unsustainable trade in wildlife products both legally and illegally is a leading cause of population declines and increased extinction risk in commercially valuable species. However due to the clandestine nature of illegal trade and paucity of overarching studies of legal trade our understanding on international trade networks is patchy. We develop a gravity–underreporting modelling framework to analyse and compare: (i) data on the legal trade in mammalian, avian and reptilian products from recorded by The Convention on the International Trade in Endangered Species of Wild Fauna and Flora (CITES) and (ii) to data on the seizures of illegal products entering the USA between 2004 and 2013. We find substantial differences in the factors driving legal trade for the 3 taxonomic groups considered, indicating different drivers for different product markets. Illegal imports for all groups were associated with increasing exporter GDP. We found higher probabilities of underreporting for avian and reptile products, and in general central Africa, central Asia, Eastern Europe and Pacific Island states showed higher underreporting than other regions, indicating the existence of complex trade networks and the potential for the laundering of illegal products through legal markets. Our results show the important regional and economic trends driving wildlife trade. Our new modelling framework can also help illuminate previously unseen aspects of illegal and legal wildlife trade, which can help with the implementation of interventions to curb the impact of trade on wild populations.

Political and economic transitions have had substantial impacts on forest conservation. Where transitions are underway or anticipated, historical precedent and methods for systematically assessing future trends should be used to anticipate likely threats to forest conservation and design appropriate and prescient policy measures to counteract them. Myanmar is transitioning from an authoritarian, centralized state with a highly regulated economy to a more decentralized and economically liberal democracy and is working to end a long-running civil war. With these transitions in mind, we used a horizon-scanning approach to assess the 40 emerging issues most affecting Myanmar's forests, including internal conflict, land-tenure insecurity, large-scale agricultural development, demise of state timber enterprises, shortfalls in government revenue and capacity, and opening of new deforestation frontiers with new roads, mines, and hydroelectric dams. Averting these threats will require, for example, overhauling governance models, building capacity, improving infrastructure- and energy-project planning, and reforming land-tenure and environmental-protection laws. Although challenges to conservation in Myanmar are daunting, the political transition offers an opportunity for conservationists and researchers to help shape a future that enhances Myanmar's social, economic, and environmental potential while learning and applying lessons from other countries. Our approach and results are relevant to other countries undergoing similar transitions.

The “Building Capacity for Conservation in Southeast Asia” symposium was held at the 2015 Association for Tropical Biology and Conservation, Asia-Pacific Chapter meeting. The range of programs discussed fell into three categories: career development, project-specific activities and outreach, and delivering conservation information to diverse audiences. Though different approaches were used, we identified practices and methods which increased the meaning, relevance, and applicability of the messages provided. We found that delivering successful conservation education requires understanding conservation's place in society, developing a feeling of community among students, providing students with financial support, practical teaching, and crafting culturally appropriate messages.

The status of elasmobranchs in Southeast Asia has been highlighted as a serious concern, yet there are limited data to assess stocks and develop appropriate management plans. Surveys of elasmobranchs at two fishery ports in Singapore were conducted between 2017 and 2020. These fishery ports receive fresh, whole imports of seafood from the region as well as seafood caught in Singapore waters. Data were collected on 13,817 rays, 2,480 sharks, and 1,297 wedgefishes and giant guitarfishes over 102 surveys. The majority of elasmobranchs were imported from Indonesia or Malaysia, and only a few individuals (six sharks and 278 rays) were reportedly caught within Singapore waters. In Singapore, elasmobranchs are predominantly used for their meat, and wedgefish snouts are also commonly used in collagen soup. The data collected highlights potential conservation concerns, particularly surrounding the large volumes of Maculabatis gerrardi and Maculabatis macrura rays (categorized as Vulnerable and Not Assessed by the IUCN) that are imported, and the high proportions of immature individuals of Carcharhinus sorrah and Carcharhinus sealei sharks. During this study, a single Rhynchobatus cooki was discovered – the first reported sighting in over 20 years.

BACKGROUND Triple-negative breast cancer (TNBC) lacks estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2)/neu receptors, and is aggressive and therapeutically challenging. Genetic ancestry testing is an emerging medical field. Mitochondrial DNA (mtDNA), which is distinct from nuclear DNA, is maternally inherited and allows for origin determination. Patients with TNBC tend to be younger and are more likely to be African American, making this an ideal disease for mtDNA exploration. To the authors' knowledge, the current study is the first to perform mtDNA for self-described African American, White, and Hispanic patients with TNBC to identify mtDNA patterns. METHODS Patients with TNBC who were at any stage of therapy/survivorship were included. Self-reported ethnicity was confirmed at the time of the prospective buccal swab. Haplogroup prediction was performed on sequencing of hypervariable region 1. Using sequence similarity scores and lineage databases, sequence patterns were determined. Data regarding presentation and treatment, tumor features, and outcomes was collected. RESULTS A total of 92 patients were included: 31 self-described African American, 31 White, and 30 Hispanic individuals. Hispanic patients were found to have the largest tumor size (4.5 cm; P = .01) and youngest age (41 years; P

Although deforestation and forest degradation have long been considered the most significant threats to tropical biodiversity, across Southeast Asia (Northeast India, Indochina, Sundaland, Philippines) substantial areas of natural habitat have few wild animals (>1 kg), bar a few hunting-tolerant species. To document hunting impacts on vertebrate populations regionally, we conducted an extensive literature review, including papers in local journals and reports of governmental and nongovernmental agencies. Evidence from multiple sites indicated animal populations declined precipitously across the region since approximately 1980, and many species are now extirpated from substantial portions of their former ranges. Hunting is by far the greatest immediate threat to the survival of most of the region's endangered vertebrates. Causes of recent overhunting include improved access to forests and markets, improved hunting technology, and escalating demand for wild meat, wildlife-derived medicinal products, and wild animals as pets. Although hunters often take common species, such as pigs or rats, for their own consumption, they take rarer species opportunistically and sell surplus meat and commercially valuable products. There is also widespread targeted hunting of high-value species. Consequently, as currently practiced, hunting cannot be considered sustainable anywhere in the region, and in most places enforcement of protected-area and protected-species legislation is weak. The international community's focus on cross-border trade fails to address overexploitation of wildlife because hunting and the sale of wild meat is largely a local issue and most of the harvest is consumed in villages, rural towns, and nearby cities. In addition to improved enforcement, efforts to engage hunters and manage wildlife populations through sustainable hunting practices are urgently needed. Unless there is a step change in efforts to reduce wildlife exploitation to sustainable levels, the region will likely lose most of its iconic species, and many others besides, within the next few years.

There is general consensus that claimants to the South China Sea (SCS) should set aside territorial disputes and cooperate to preserve the natural resources of the sea. These resources are vital to millions of fishermen and consumers but are severely overexploited. Failure to prevent further exploitation or replenish stocks will exacerbate tensions in the SCS as countries compete for dwindling resources. Understanding how and where to start cooperating is a topic of much debate, and few ideas have gained enough traction for implementation. This report suggests that agreements can be built from existing commonalities in national laws and policies concerning fisheries and the marine environment. Utilizing these commonalities could help to build confidence by showing that despite disputes, there are in fact similarities and areas of alignment. This would not only build confidence but may serve as a less contentious route toward cooperation, because countries are agreeing - at a regional level - on criteria they already agree on at a national level. This concept is explored by looking at the fisheries and marine environmental laws and policies of China, Philippines, Vietnam, Malaysia and Indonesia.

Southeast (SE) Asia holds high regional biodiversity and endemism levels but is also one of the world's most threatened regions. Local, regional and global threats could have severe consequences for the future survival of many species and the provision of ecosystem services. In the face of myriad pressing environmental problems, we carried out a research prioritisation exercise involving 64 experts whose research relates to conservation biology and sustainability in SE Asia. Experts proposed the most pressing research questions which, if answered, would advance the goals of biodiversity conservation and sustainable development in SE Asia. We received a total of 333 questions through three rounds of elicitation, ranked them (by votes) following a workshop and grouped them into themes. The top 100 questions depict SE Asia as a region where strong pressures on biodiversity interact in complex and poorly understood ways. They point to a lack of information about multiple facets of the environment, while exposing the many threats to biodiversity and human wellbeing. The themes that emerged indicate the need to evaluate specific drivers of biodiversity loss (wildlife harvesting, agricultural expansion, climate change, infrastructure development, pollution) and even to identify which species and habitats are most at risk. They also suggest the need to study the effectiveness of practice-based solutions (protected areas, ecological restoration), the human dimension (social interventions, organisational systems and processes and, the impacts of biodiversity loss and conservation interventions on people). Finally, they highlight gaps in fundamental knowledge of ecosystem function. These 100 questions should help prioritise and coordinate research, conservation, education and outreach activities and the distribution of scarce conservation resources in SE Asia. Accepted version The workshop was funded by a generous donation from Haiyi Holdings Pte Ltd. to the Department of Biological Sciences of the National University of Singapore.

Merkel-cell carcinoma is a rare form of aggressive cutaneous cancer that is associated with a poor prognosis. Despite significant advances, its pathogenesis is still poorly understood, and treatment remains controversial. Timely diagnosis and early management is essential in improving survival rate. We present a case of a 63-year-old patient with a rapidly growing upper limb Merkel-cell carcinoma. It was treated with wide-local excision and adjuvant radiotherapy.

Protected areas (PAs) are an essential tool for the conservation of biodiversity globally. Previous studies have focussed on the effectiveness of PAs and the design of optimal PA networks. However, not all PAs remain intact permanently; many PAs undergo downgrading, downsizing and/or degazettement (PADDD), a fact largely ignored until recently. The drivers of enacted PADDD events and the factors influencing its spatial occurrence are poorly understood, potentially undermining the efficacy of PAs and PA networks. Here we examine the spatial relationship between PADDD and economic, demographic and structural variables, using a 110-year data set of 342 enacted PADDD events across 44 countries in the tropics and subtropics. We find that the probability of an enacted PADDD event increases with the size of the PA and through a synergistic interaction between PA size and local population densities. Our results are robust to the under-reporting of enacted PADDD events that occur among smaller PAs and in regions with lower population density. We find an economic motive for PADDD events, given that the opportunity costs associated with larger PAs are higher, on average, than smaller PAs. Our findings suggest a need for conservation practitioners to better consider PA characteristics, as well as the social, economic and political context in which PAs are situated, to aid the creation of more efficient and sustainable PA networks. In particular, the dynamics of enacted PADDD events highlight the need to explicitly consider PA robustness as a core component of systematic conservation planning for PA networks.

Hamartoma of breast is one of a rare pathological lesion. Clinically, this is diagnosed out of exclusion, other reason for breast lump.