Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group

Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8–55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients' outcomes

A neo-institutional perspective on ethical decision-making

Drawing on neo-institutional theory, this study aims to discern the poorly understood ethical challenges confronted by senior executives in Indian multinational corporations and identify the strategies that they utilize to overcome them. We conducted in-depth interviews with 40 senior executives in Indian multinational corporations to illustrate these challenges and strategies. By embedding our research in contextually relevant characteristics that embody the Indian environment, we identify several institutional- and managerial-level challenges faced by executives. The institutional-level challenges are interpreted as regulative, normative and cognitive shortcomings. We recommend a concerted effort at the institutional and managerial levels by identifying relevant strategies for ethical decision-making. Moreover, we proffer a multi-level model of ethical decision-making and discuss our theoretical contributions and practical implications

Building knowledge in urban agriculture: the challenges of local food production in Sao Paulo and Melbourne

Urban environments face multiple burdens and significant challenges related to food safety and sustainable agriculture. Urban agriculture remains fragmented and incipient in many cities worldwide. In their efforts to ensure sustainable urban food systems and provide public access to affordable and quality food, city governments must identify and pursue emerging opportunities. This study analyzed how São Paulo and Melbourne are working to overcome the related challenges

Predicting biodiversity richness in rapidly changing landscapes: Climate, low human pressure or protection as salvation?

Rates of biodiversity loss in Southeast Asia are among the highest in the world, and the Indo-Burma and South-Central China Biodiversity Hotspots rank among the world’s most threatened. Developing robust multi-species conservation models is critical for stemming biodiversity loss both here and globally. We used a large and geographically extensive remote-camera survey and multi-scale, multivariate optimization species distribution modelling to investigate the factors driving biodiversity across these two adjoining biodiversity hotspots. Four major findings emerged from the work. (i) We identified clear spatial patterns of species richness, with two main biodiverse centres in the Thai-Malay Peninsula and in the mountainous region of Southwest China. (ii) Carnivores in particular, and large ungulates to a lesser degree, were the strongest indicators of species richness. (iii) Climate had the largest effect on biodiversity, followed by protected status and human footprint. (iv) Gap analysis between the biodiversity model and the current system of protected areas revealed that the majority of areas supporting the highest predicted biodiversity are not protected. Our results highlighted several key locations that should be prioritized for expanding the protected area network to maximize conservation effectiveness. We demonstrated the importance of switching from single-species to multi-species approaches to highlight areas of high priority for biodiversity conservation. In addition, since these areas mostly occur over multiple countries, we also advocate for a paradigmatic focus on transboundary conservation planning

Multi-scale habitat modelling identifies spatial conservation priorities for mainland clouded leopards (Neofelis nebulosa)

Diversity and Distributions Published by John Wiley & Sons Ltd. Aim: Deforestation is rapidly altering Southeast Asian landscapes, resulting in some of the highest rates of habitat loss worldwide. Among the many species facing declines in this region, clouded leopards rank notably for their ambassadorial potential and capacity to act as powerful levers for broader forest conservation programmes. Thus, identifying core habitat and conservation opportunities are critical for curbing further Neofelis declines and extending umbrella protection for diverse forest biota similarly threatened by widespread habitat loss. Furthermore, a recent comprehensive habitat assessment of Sunda clouded leopards (N. diardi) highlights the lack of such information for the mainland species (N. nebulosa) and facilitates a comparative assessment. Location: Southeast Asia. Methods: Species–habitat relationships are scale-dependent, yet <5% of all recent habitat modelling papers apply robust approaches to optimize multivariate scale relationships. Using one of the largest camera trap datasets ever collected, we developed scale-optimized species distribution models for two con-generic carnivores, and quantitatively compared their habitat niches. Results: We identified core habitat, connectivity corridors, and ranked remaining habitat patches for conservation prioritization. Closed-canopy forest was the strongest predictor, with ~25% lower Neofelis detections when forest cover declined from 100 to 65%. A strong, positive association with increasing precipitation suggests ongoing climate change as a growing threat along drier edges of the species’ range. While deforestation and land use conversion were deleterious for both species, N. nebulosa was uniquely associated with shrublands and grasslands. We identified 800 km2 as a minimum patch size for supporting clouded leopard conservation. Main conclusions: We illustrate the utility of multi-scale modelling for identifying key habitat requirements, optimal scales of use and critical targets for guiding conservation prioritization. Curbing deforestation and development within remaining core habitat and dispersal corridors, particularly in Myanmar, Laos and Malaysia, is critical for supporting evolutionary potential of clouded leopards and conservation of associated forest biodiversity

Multi-scale habitat modelling identifies spatial conservation priorities for mainland clouded leopards (Neofelis nebulosa)

Diversity and Distributions Published by John Wiley &amp; Sons Ltd. Aim: Deforestation is rapidly altering Southeast Asian landscapes, resulting in some of the highest rates of habitat loss worldwide. Among the many species facing declines in this region, clouded leopards rank notably for their ambassadorial potential and capacity to act as powerful levers for broader forest conservation programmes. Thus, identifying core habitat and conservation opportunities are critical for curbing further Neofelis declines and extending umbrella protection for diverse forest biota similarly threatened by widespread habitat loss. Furthermore, a recent comprehensive habitat assessment of Sunda clouded leopards (N. diardi) highlights the lack of such information for the mainland species (N. nebulosa) and facilitates a comparative assessment. Location: Southeast Asia. Methods: Species–habitat relationships are scale-dependent, yet &lt;5% of all recent habitat modelling papers apply robust approaches to optimize multivariate scale relationships. Using one of the largest camera trap datasets ever collected, we developed scale-optimized species distribution models for two con-generic carnivores, and quantitatively compared their habitat niches. Results: We identified core habitat, connectivity corridors, and ranked remaining habitat patches for conservation prioritization. Closed-canopy forest was the strongest predictor, with ~25% lower Neofelis detections when forest cover declined from 100 to 65%. A strong, positive association with increasing precipitation suggests ongoing climate change as a growing threat along drier edges of the species’ range. While deforestation and land use conversion were deleterious for both species, N. nebulosa was uniquely associated with shrublands and grasslands. We identified 800 km2 as a minimum patch size for supporting clouded leopard conservation. Main conclusions: We illustrate the utility of multi-scale modelling for identifying key habitat requirements, optimal scales of use and critical targets for guiding conservation prioritization. Curbing deforestation and development within remaining core habitat and dispersal corridors, particularly in Myanmar, Laos and Malaysia, is critical for supporting evolutionary potential of clouded leopards and conservation of associated forest biodiversity