An estimated 85% of individuals with spina bifida (SB) survive into adulthood, warranting SB-specific transition to adult healthcare guidelines to address the diverse and complex medical, adaptive, and social needs particular to this condition. Latex allergy constitutes one important health concern for this population that requires ongoing and life-long evidence-based management. This article discusses management of latex allergy according to the SB Latex Allergy Healthcare Guidelines from the 2018 Spina Bifida Association’s Fourth Edition of the Guidelines for the Care of People with Spina Bifida, reviews current care models in which such latex allergy guidelines can be implemented, and explores further relevant research topics in SB care relative to latex allergy.
Context High density deer populations can cause ecological damage, yet their distribution and impacts are poorly known across much of Australia. As a result, land managers rely on anecdotal reports to make decisions about management and control measures. Aims We aimed to model habitat suitability for deer in the South Coast of New South Wales (NSW), Australia, to be used as a baseline for future management and identify which threatened ecological communities (TECs) in the region are at greatest current risk of being occupied by deer. Methods We compiled 678 presence-only records of wild deer from online databases, observations made by National Parks and Wildlife Service field staff and field-based surveys. We combined these observations with eight environmental variables to model and map habitat suitability for deer across our study area using maximum entropy. Three spatial models of habitat suitability across our study area were produced: one for all deer species; and two species-specific models for fallow and sambar deer. Key results Our models indicate that suitable habitat for deer exists throughout much of the South Coast of NSW. Of the TECs examined, Coastal Saltmarsh, Themeda Grassland, and Swamp Sclerophyll Forest had the highest proportion of area likely to be extremely suitable for deer and thus should be prioritised for protection within our study area. Conclusions Further systematic field-based surveys are needed to improve the quality of models in this region. Implications We recommend that areas having high habitat suitability but are not yet occupied by deer be identified as sites where deer occupancy could be prevented.
Globally, high‐density populations of feral deer have been associated with a range of negative ecological consequences. Within Australia, limited quantitative research has assessed the impacts of deer, particularly in threatened ecological communities (TECs). Our study aimed to quantify the impact of feral deer on the herbivory of a range of woody plant species, non‐woody growth forms and TECs; and assess whether feral deer increase herbivory in TECs above background rates caused by native herbivores. We surveyed 356 transects across 89 sites representing eight TECs and collected herbivory data for woody and non‐woody plants. At each site, we recorded the presence or absence of deer sign and abundance of macropod pellets to account for variations in herbivory between groups of sympatric species. Generalised linear mixed models were developed to predict: (i) proportion of individual plants browsed (or grazed); and (ii) average browsing (or grazing) intensity for woody plant species and non‐woody plants. Controlling for macropod abundance, we found the average grazing intensity and proportion of non‐woody plants grazed was higher when deer were present compared to absent. Specifically, grazing pressure on rushes, cycads, sedges and grasses was significantly higher where deer were present. In contrast, we did not observe a significant impact of deer on woody plant species. The presence of deer resulted in higher grazing intensity in coastal saltmarsh, freshwater wetland, littoral rainforest and bangalay sand forest TECs. Although the deer population across our study region generally appears to be at low density compared to neighbouring regions, their presence is resulting in grazing pressure above that caused by native herbivores for a range of non‐woody plants. Our results contribute to a growing body of research about the ecological impacts of feral deer in Australia and can be used as a baseline for ongoing regional monitoring of deer impacts in TECs.
Autologous and implant-based breast reconstruction continues to evolve as new technology and mastectomy techniques become available. Robotic-assisted breast reconstruction represents a growing field within plastic surgery, with the potential to improve aesthetic and functional outcomes, as well as patient satisfaction. This article provides a review of indications, techniques, and outcome data supporting the use of robotic assistance in both implant-based and autologous breast reconstruction from surgeons around the world.
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