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Maize is the most important crop grown in South Africa, but yields can be severely reduced by extreme high summer average temperatures and low precipitation, potentially adversely affecting both domestic consumption and regional food security exports. To help understand and manage climate risks to food security in Southern Africa it is essential to quantify the present-day likelihood and magnitude of climate extremes in South Africa's maize-growing region and explore the potential for unprecedented climate conditions which would likely result in record low maize yields. We analyse a large ensemble of initialised climate model simulations, which provides almost 100 times as many plausible present-day summers as the equivalent observational dataset. We quantify the risk of unprecedented climate extremes affecting maize production in South Africa and examine the role of the El Niño-Southern Oscillation. We find that the South African maize region is at risk of experiencing record-breaking hot, cold, dry or wet events under current climatic conditions. We find that the annual chance of unprecedented high temperatures in South Africa is approximately 4%, increasing to 62% during very strong El Niño years. We also find that the chance of exceeding the present day seasonal high temperature record has increased across the 1979–2018 period, being five times more likely now than it was in 1980. These extreme events could result in a record-breaking number of days above the optimum, or even the maximum, temperature for maize production, and lead to more severe floods or droughts. Under climate change scenarios, the magnitude and frequency of climate extremes is projected to increase meaning that the unprecedented extremes studied here could become commonplace in the future. This suggests that significant investment is needed to develop adaptations that manage the climate-related risks to food systems now and build resilience to the projected impacts of climate change.

Climate change will put millions more people in Africa at risk of food and nutrition insecurity by 2050. Integrated assessments of food systems tend to be limited by either heavy reliance on models or a lack of information on food and nutrition security. Accordingly, we developed a novel integrated assessment framework that combines models with in-country knowledge and expert academic judgement to explore climate-smart and nutrition-secure food system futures: the integrated Future Estimator for Emissions and Diets (iFEED). Here, we describe iFEED and present its application in Malawi, South Africa, Tanzania and Zambia. The iFEED process begins with a participatory scenario workshop. In-country stakeholders identify two key drivers of food system change, and from these, four possible scenarios are defined. These scenarios provide the underlying narratives of change to the food system. Integrated modeling of climate change, food production and greenhouse gas emissions is then used to explore nutrition security and climate-smart agriculture outcomes for each scenario. Model results are summarized using calibrated statements—quantitative statements of model outcomes and our confidence in them. These include statements about the way in which different trade futures interact with climate change and domestic production in determining nutrition security at the national level. To understand what the model results mean for food systems, the calibrated statements are expanded upon using implication statements. The implications rely on input from a wide range of academic experts—including agro-ecologists and social scientists. A series of workshops are used to incorporate in-country expertise, identifying any gaps in knowledge and summarizing information for country-level recommendations. iFEED stakeholder champions help throughout by providing in-country expertise and disseminating knowledge to policy makers. iFEED has numerous novel aspects that can be used and developed in future work. It provides information to support evidence-based decisions for a climate-smart and nutrition-secure future. In particular, iFEED: (i) employs novel and inclusive reporting of model results and associated in-country food system activities, with comprehensive reporting of uncertainty; (ii) includes climate change mitigation alongside adaptation measures; and (iii) quantifies future population-level nutrition security, as opposed to simply assessing future production and food security implications.

BACKGROUND: High-flow vascular stains (HFVS) are lesions that have the appearance of capillary malformations/port wine stains but are associated with increased arterial flow. OBJECTIVE: To identify features of HFVS that differentiate them from typical "slow-flow" port wine stains. METHODS: Retrospective multicenter cohort study of HFVS evaluated across 7 centers was conducted. HFVS were characterized by clinical features (warmth, thrill, rapid capillary refill), radiologic findings (fast flow), or mutations associated with capillary malformation-arteriovenous malformation syndrome. Investigators reviewed photographs. RESULTS: The study reviewed 70 patients with HFVS (47 multifocal and 23 solitary). Most were flat (77%), warm to the touch (60%), and red or pink-red in color (35%), with heterogeneous color saturation (73%) and well-defined borders (71%). Regional soft tissue swelling/overgrowth was common (47%). Head and neck location was most common (38%). Among 34 HFVS with photographic review over time, all demonstrated changes in appearance. LIMITATIONS: Retrospective design, recall bias, lack of standardized time points or visual analog scale, and image variability. CONCLUSION: Heterogeneity of stain color saturation, warmth to touch, peripheral pallor, and overgrowth/soft tissue swelling help distinguish HFVS from port wine stains. Darkening of color and increased border demarcation may develop over time. These findings raise suspicion for HFVS and provide an indication to assess for extracutaneous involvement.

Previous literature reports inconsistent associations between obesity and mental health. The objective of this study was to determine the association between weight status and mental health service utilization in Ontario children and youth.A cross-sectional study of children 0 to 18 years, identified using primary care electronic medical records from the EMRPC database in Ontario, Canada was conducted. Height and weight data were extracted to calculate BMI and linked to administrative data on mental health related outpatient visits, emergency department visits, and hospitalizations. Multivariable logistic regression models were performed.A total of 50,565 children were included. Overall, 2.2% were underweight, 70.4% had a normal weight, 18.3% were overweight, 6.9% had obesity and 2.2% had severe obesity. 28.2% of all children had at least one mental health visit. Multivariable analyses showed children with overweight, obesity, and severe obesity were 1.11 (95% CI 1.05-1.17), 1.18 (95% CI 1.08-1.27) and 1.39 (95% CI 1.22-1.59) times more likely to have an outpatient mental health visit compared to children with normal weight.Increased weight status was associated with mental health related outpatient visits and emergency department visits. This study may inform policy makers' planning of mental health resources for children with obesity and severe obesity.La littérature antérieure rapporte des associations irrégulières entre obésité et santé mentale. L’objectif de la présente étude était de déterminer l’association entre le statut pondéral et l’utilisation des services de santé mentale chez les enfants et les adolescents de l’Ontario.Une étude transversale d’enfants de 0 à 18 ans qui utilisait des dossiers médicaux électroniques des soins primaires tirés de la base de donnés EMRPC de l’Ontario, Canada a été menée. Les données sur la taille et le poids ont été extraites pour calculer l’indice de masse corporelle (IMC) et couplées aux données administratives sur la santé mentale liées aux visites de patients ambulatoires, aux visites au service d’urgence, et aux hospitalisations. Des modèles de régression logistique multivariée ont été exécutés.Au total, 50 565 enfants ont été inclus. En général, 2,2 % avaient un poids insuffisant, 70,4 % avaient un poids normal, 18,3 % avaient un excès de poids, 6,9 % présentaient une obésité et 2,2 % avaient une grave obésité. Parmi tous les enfants, 28,2 % avaient au moins une visite de santé mentale. Les analyses multivariées ont indiqué que les enfants ayant un excès de poids, une obésité et une grave obésité étaient 1,11 fois (IC à 95 % 1,05 à 1,17), 1,18 fois (IC à 95 % 1,08 à 1,27) et 1,39 fois (IC à 95 % 1,22 à 1,59) plus susceptibles d’avoir une visite ambulatoire de santé mentale comparé aux enfants de poids normal.Le statut pondéral accru était associé à des visites ambulatoires pour des raisons de santé mentale et à des visites au service d’urgence. Cette étude peut éclairer les décideurs dans leur planification des ressources de santé mentale pour les enfants souffrant d’obésité et de grave obésité.

Due to high present-day temperatures and reliance on rainfed agriculture, sub-Saharan Africa is highly vulnerable to climate change. We use a comprehensive set of global (CMIP5) and regional (CORDEX-Africa) climate projections and a new convection-permitting pan-Africa simulation (and its parameterized counterpart) to examine changes in rainfall and temperature and the impact on crop suitability of maize, cassava and soybean in sub-Saharan Africa by 2100 (RCP8.5). This is the first time an explicit-convection simulation has been used to examine crop suitability in Africa. Increasing temperatures and declining rainfall led to large parts of sub-Saharan Africa becoming unsuitable for multiple staple crops, which may necessitate a transition to more heat and drought resistant crops to ensure food and nutrition security. Soybean was resilient to temperature increases, however maize and cassava were not, leading to declines in crop suitability. Inclusion of sensitivity to extreme temperatures led to larger declines in maize suitability than when this was excluded. The results were explored in detail for Tanzania, Malawi, Zambia and South Africa. In each country the range of projections included wetting and drying, but the majority of models projected rainfall declines leading to declines in crop suitability, except in Tanzania. Explicit-convection was associated with more high temperature extremes, but had little systematic impact on average temperature and total rainfall, and the resulting suitability analysis. Global model uncertainty, rather than convection parameterizations, still makes up the largest part of the uncertainty in future climate. Explicit-convection may have more impact if suitability included a more comprehensive treatment of extremes. This work highlights the key uncertainty from global climate projections for crop suitability projections, and the need for improved information on sensitivities of African crops to extremes, in order to give better predictions and make better use of the new generation of explicit-convection models.

Background: The proliferative phase of infantile hemangiomas (IHs) is usually complete by 9 months of life. Late growth beyond age 3 years is rarely reported. Objective: To describe the demographic and clinic characteristics of a cohort of patients with late growth of IH, defined as growth in a patient >3 years of age. Methods: A multicenter, retrospective cohort study. Results: In total, 59 patients, 85% of which were female, met the inclusion criteria. The mean first episode of late growth was 4.3 (range 3-8.5) years. Head and neck location (55/59; 93%) and presence of deep hemangioma (52/59; 88%) were common characteristics. Posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye abnormalities (PHACE) syndrome was noted in 20 of 38 (53%) children with segmental facial IH. Systemic therapy (corticosteroid or beta-blocker) was given during infancy in 58 of 59 (98%) and 24 of 59 (41%) received systemic therapy (beta-blockers) for late IH growth. Limitations: The retrospective nature and ascertainment by investigator recall are limitations of the study. Conclusion: Late IH growth can occur in children after 3 years of age. Risk factors include head and neck location, segmental morphology, and involvement of deep dermal/subcutaneous tissues.