Explore the vast range of titles available.

Many important areas identified for conservation priorities focus on areas of high species richness, however, it is unclear whether these areas change depending on what aspect of richness is considered (e.g. evolutionary distinctiveness, endemicity, or threatened species). Furthermore, little is known of the extent of spatial congruency between biodiversity measures in the marine realm. Here, we used the distribution maps of all known marine sharks, rays, and chimaeras (class Chondrichthyes) to examine the extent of spatial congruency across the hotspots of three measures of species richness: total number of species, evolutionarily distinct species, and endemic species. We assessed the spatial congruency between hotspots considering all species, as well as on the subset of the threatened species only. We consider three definitions of hotspot (2.5%, 5%, and 10% of cells with the highest numbers of species) and three levels of spatial resolution (1°, 4°, and 8° grid cells). Overall, we found low congruency among all three measures of species richness, with the threatened species comprising a smaller subset of the overall species patterns irrespective of hotspot definition. Areas of congruency at 1° and 5% richest cells contain over half (64%) of all sharks and rays and occurred off the coasts of: (1) Northern Mexico Gulf of California, (2) USA Gulf of Mexico, (3) Ecuador, (4) Uruguay and southern Brazil, (5) South Africa, southern Mozambique, and southern Namibia, (6) Japan, Taiwan, and parts of southern China, and (7) eastern and western Australia. Coarsening resolution increases congruency two-fold for all species but remains relatively low for threatened measures, and geographic locations of congruent areas also change. Finally, for pairwise comparisons of biodiversity measures, evolutionarily distinct species richness had the highest overlap with total species richness regardless of resolution or definition of hotspot. We suggest that focusing conservation attention solely on areas of high total species richness will not necessarily contribute efforts towards species that are most at risk, nor will it protect other important dimensions of species richness.

Here, we summarise the extinction risk of the sharks and rays endemic to coastal, shelf, and slope waters of the southwest Indian Ocean and adjacent waters (SWIO+, Namibia to Kenya, including SWIO islands). This region is a hotspot of endemic and evolutionarily distinct sharks and rays. Nearly one-fifth ( n = 13 of 70, 18.6%) of endemic sharks and rays are threatened, of these: one is Critically Endangered, five are Endangered, and seven are Vulnerable. A further seven (10.0%) are Near Threatened, 33 (47.1%) are Least Concern, and 17 (24.3%) are Data Deficient. While the primary threat is overfishing, there are the first signs that climate change is contributing to elevated extinction risk through habitat reduction and inshore distributional shifts. By backcasting their status, few endemic species were threatened in 1980, but this changed soon after the emergence of targeted shark and ray fisheries. South Africa has the highest national conservation responsibility, followed by Mozambique and Madagascar. Yet, while fisheries management and enforcement have improved in South Africa over recent decades, substantial improvements are urgently needed elsewhere. To avoid extinction and ensure robust populations of the region’s endemic sharks and rays and maintain ecosystem functionality, there is an urgent need for the strict protection of Critically Endangered and Endangered species and sustainable management of Vulnerable, Near Threatened, and Least Concern species, underpinned by species-level data collection and reduction of incidental catch.

Spatial data characteristics have the potential to influence various aspects of prioritising biodiversity areas for systematic conservation planning. There has been some exploration of the combined effects of size of planning units and level of classification of physical environments on the pattern and extent of priority areas. However, these data characteristics have yet to be explicitly investigated in terms of their interaction with different socioeconomic cost data during the spatial prioritisation process. We quantify the individual and interacting effects of three factors-planning-unit size, thematic resolution of reef classes, and spatial variability of socioeconomic costs-on spatial priorities for marine conservation, in typical marine planning exercises that use reef classification maps as a proxy for biodiversity. We assess these factors by creating 20 unique prioritisation scenarios involving combinations of different levels of each factor. Because output data from these scenarios are analogous to ecological data, we applied ecological statistics to determine spatial similarities between reserve designs. All three factors influenced prioritisations to different extents, with cost variability having the largest influence, followed by planning-unit size and thematic resolution of reef classes. The effect of thematic resolution on spatial design depended on the variability of cost data used. In terms of incidental representation of conservation objectives derived from finer-resolution data, scenarios prioritised with uniform cost outperformed those prioritised with variable cost. Following our analyses, we make recommendations to help maximise the spatial and cost efficiency and potential effectiveness of future marine conservation plans in similar planning scenarios. We recommend that planners: employ the smallest planning-unit size practical; invest in data at the highest possible resolution; and, when planning across regional extents with the intention of incidentally representing fine-resolution features, prioritise the whole region with uniform costs rather than using coarse-resolution data on variable costs.

Human societies face existential challenges on multiple fronts: climate change, biodiversity loss, altered biogeochemical flows, social unrest and injustices. Innovative solutions are needed to shift current trajectories towards a sustainable and just future. Futures thinking enables people to explore and articulate alternative futures and find pathways towards their desired futures. Indigenous people have the potential to make significant contributions to futures thinking because of their distinctive perspectives: the viewpoint of already living in a post-apocalyptic world in the context of colonisation, unique knowledges, worldviews, and perspectives on time, as well as significant contributions to safeguarding biological and cultural diversity. A body of literature is emerging where Indigenous peoples contribute to and lead futures thinking approaches; however, this literature is diffuse and highly diverse in its approaches and terminology. Thus, we take an innovation-seeking and systematic approach to (1) identify patterns and processes in futures thinking with, for, and by Indigenous people; (2) highlight innovative approaches; (3) bring together diverse and sector-specific terminology; and (4) foreground emerging strengths and weaknesses. We identified four framings of Indigenous futures thinking: Adaptation oriented, Participatory, Culturally grounded, and Indigenising. Factors contributing to innovation include strong involvement of Indigenous people in the research team, co-design, and authorship, using Indigenous methodologies, cultural protocols, and explicitly employing decolonisation and trauma-informed approaches. We spotlight the challenges of conducting an exhaustive literature review in an emerging field with inconsistent terminology (e.g., capturing regions where Indigeneity is contested). We also create a living glossary of terms to aid other researchers and communities in using and refining the suite of methods identified here, with the aim of stimulating further innovations in this field.

Aim: Regional-scale assessments are frequently conceived to guide the strategic application of conservation actions. Although changes to priority areas from initial assessments are inevitable, the transition from regional-scale assessment to implementing local actions is poorly understood. An outstanding question concerns the frequency with which regionally assessed priorities should be updated as actions are implemented. We address this gap by simulating the incremental implementation of local actions guided by regional conservation assessments, exploring how update frequency can influence aspects of translating regional assessments to local actions. Location: Fiji coral reefs. Methods: Our simulations were designed within the framework of systematic conservation planning, with implemented actions simulated based on conservation value in achieving objectives and feature rarity. Other decision rule-sets were put in place to simulate on-the-ground negotiations that are often necessary when transitioning from regional-scale conservation assessments to local actions. We use our simulations to evaluate how the frequency of updating regional priorities influences (1) total time taken to achieve objectives represented by numbers of planning units investigated, (2) total extent of final reserve systems and (3) spatial overlap between initial regional priorities and final implemented reserves. Results: Changes in the frequencies of updating did not influence the time taken to achieve conservation objectives, nor the total extent of final reserve systems. However, there was a significant difference in the number of times planning units were re-investigated for implementing actions within in scenarios that involved more frequent updates. Spatial overlap between initial regional priorities and final implemented reserves increased with decreases in update frequency. Main conclusions: We find two potential benefits to updating priorities more frequently: (1) faster achievement of objectives for high-priority features and (2) greater potential to capitalize on areas previously investigated. Our findings provide insights into trade-offs to consider regarding the frequency of updating regional assessments, which varies depending on the planning context.

Summary Sharks and rays are possibly the most threatened Class of marine fishes and their declines can be halted if protected areas are optimised to benefit these species. We identify spatial priorities for all 63 endemic sharks and rays in the marine biodiversity hotspot, the Western Indian Ocean (WIO). Collectively, while the WIO nations currently surpass the 10% Aichi ocean protection target, this amounts to a dismal protection of only 1.57% of each species’ distribution range. We show that the entire ranges of all endemics can be achieved by protecting 11% of EEZs of WIO nations, well within reach of the new 30% of oceans by 2030 target. Regional management bodies exist, which if taken advantage of to implement shark and ray management, provide opportunities to implement more efficient management across the region. We recommend key management actions to implement and explicit incentivisation of international cooperation in the post-2020 biodiversity framework. Science for Society The past decade has seen massive growth in the establishment of marine protected areas (MPAs), driven by the Aichi biodiversity target of protecting 10% of all ocean areas. This expansion of MPAs, however, has largely occurred in areas residual to extractive uses, often coinciding with less threatened areas of lower conservation value. This coming decade will see a further push to ensure 30% of the oceans are protected by 2030. It is important to understand how existing and future MPAs should be placed to benefit threatened biodiversity. Currently this is unclear for sharks and rays, comprising a species group that is the most evolutionarily distinct vertebrate radiation in the world and also one of the most threatened. We identify both regional and national conservation priorities for expanding marine protected areas to benefit all 63 endemic sharks and rays occurring in the Western Indian Ocean region. We find that the region has already exceeded the 10% ocean protection target, but this amounts to an average of only 1.57% protection of the distribution ranges of these species. We show that protecting the top 10% priority sites will conserve almost half of the geographic range of each species yet require only 1.16% of the total EEZ – a tiny fraction of the 30% by 2030 target. We also show that regional collaboration among all nations can result in more spatially efficient conservation priorities. We recommend that the post-2020 biodiversity framework needs to explicitly incentivise regional cooperation between nations to efficiently achieve urgent targets and maximise benefits to biodiversity. Competing Interest Statement The authors have declared no competing interest.

The process of understanding the rapid global decline of sawfishes (Pristidae) has revealed great concern for their relatives, the wedgefishes (Rhinidae) and giant guitarfishes (Glaucostegidae), not least because all three families are targeted for their high-value and internationally-traded white fins. The objective of this study was to assess the extinction risk of all 10 wedgefishes and 6 giant guitarfishes by applying the International Union for Conservation of Nature (IUCN) Red List Categories and Criteria, and to summarise their biogeography and habitat, life history, exploitation, use and trade, and population status. Wedgefishes and giant guitarfishes have overtaken sawfishes as the most imperilled marine fish families globally, with all but one of the 16 species facing an extremely high risk of extinction due to a combination of traits: limited biological productivity, presence in shallow waters overlapping with some of the most intense and increasing coastal fisheries in the world, and over-exploitation in target and bycatch fisheries driven by the need for animal protein and food security in coastal communities and trade in meat and high-value fins. Two species with very restricted ranges, the Clown Wedgefish (Rhynchobatus cooki) of the Indo-Malay Archipelago and the False Shark Ray (Rhynchorhina mauritaniensis) of Mauritania may be very close to extinction. Only the Eyebrow Wedgefish (Rhynchobatus palpebratus) is not assessed as Critically Endangered, due to it occurring primarily in Australia where fishing pressure is low, and some management measures are in place. Australia represents a lifeboat for the three wedgefish and one giant guitarfish species occurring there. To conserve populations and permit recovery, a suite of measures will be required which will need to include species protection, spatial management, bycatch mitigation, and harvest and international trade management, all of which will be dependent on effective enforcement. Footnotes * Revised Red List Indices; revised Rhynchobatus cooki status; revised Guinea management

Genetic subtypes of acute lymphoblastic leukaemia (ALL) are used to determine risk and treatment in children. 25% of precursor B-ALL cases are genetically unclassified and have intermediate prognosis. We aimed to use a genome-wide study to improve prognostic classification of ALL in children. We constructed a classifier based on gene expression in 190 children with newly diagnosed ALL (German Cooperative ALL [COALL] discovery cohort) by use of double-loop cross-validation and validated this in an independent cohort of 107 newly diagnosed patients (Dutch Childhood Oncology Group [DCOG] independent validation cohort). Hierarchical cluster analysis with classifying gene-probe sets revealed a new ALL subtype, the underlying genetic abnormalities of which were characterised by comparative genomic hybridisation-arrays and molecular cytogenetics. Our classifier predicted ALL subtype with a median accuracy of 90·0% (IQR 88·3–91·7) in the discovery cohort and correctly identified 94 of 107 patients (accuracy 87·9%) in the independent validation cohort. Without our classifier, 44 children in the COALL cohort and 33 children in the DCOG cohort would have been classified as B-other. However, hierarchical clustering showed that many of these genetically unclassified cases clustered with BCR–ABL1-positive cases: 30 (19%) of 154 children with precursor B-ALL in the COALL cohort and 14 (15%) of 92 children with precursor B-ALL in the DCOG cohort had this BCR–ABL1-like disease. In the COALL cohort, these patients had unfavourable outcome (5-year disease-free survival 59·5%, 95% CI 37·1–81·9) compared with patients with other precursor B-ALL (84·4%, 76·8–92·1%; p=0·012), a prognosis similar to that of patients with BCR–ABL1-positive ALL (51·9%, 23·1–80·6%). In the DCOG cohort, the prognosis of BCR–ABL1-like disease (57·1%, 31·2–83·1%) was worse than that of other precursor B-ALL (79·2%, 70·2–88·3%; p=0.026), and similar to that of BCR–ABL1-positive ALL (32·5%, 2·3–62·7%). 36 (82%) of the patients with BCR–ABL1-like disease had deletions in genes involved in B-cell development, including IKZF1, TCF3, EBF1, PAX5, and VPREB1; only nine (36%) of 25 patients with B-other ALL had deletions in these genes (p=0·0002). Compared with other precursor B-ALL cells, BCR–ABL1-like cells were 73 times more resistant to L-asparaginase (p=0·001) and 1·6 times more resistant to daunorubicin (p=0·017), but toxicity of prednisolone and vincristine did not differ. New treatment strategies are needed to improve outcome for this newly identified high-risk subtype of ALL. Dutch Cancer Society, Sophia Foundation for Medical Research, Paediatric Oncology Foundation Rotterdam, Centre of Medical Systems Biology of the Netherlands Genomics Initiative/Netherlands Organisation for Scientific Research, American National Institute of Health, American National Cancer Institute, and American Lebanese Syrian Associated Charities.

Introduction Standardized patients (SPs) are integral to training medical students in virtual consultation (VC) skills. A key aspect of their role is the ability to evaluate student performance and deliver meaningful feedback to enhance learning. This study aimed to design and validate a scoring rubric specifically for SPs to assess undergraduate medical students' performance during VC encounters. Methods This study adopted a seven-step approach to rubric development. The content and face validation of the rubric were conducted with the participation of relevant stakeholders. The reliability of the rubric was assessed by measuring the internal consistency and the inter-rater, intra-rater and test–retest correlation coefficient of the SPs evaluation scores of medical students’ performance in VC. Results A rubric comprising ten evaluation dimensions and a four-level scoring scale was developed. The item content validity index (I-CVI) exceeded 0.78, while the average content validity index (AVE-CVI) was 0.98. Face validity was assessed qualitatively which confirmed the rubric’s clarity and relevance. Five SPs participated in evaluating medical student's performance in VC encounters, each reviewing 35 videos. The rubric demonstrated strong internal consistency, with a Cronbach’s alpha of 0.82. Additionally, inter-rater, intra-rater, and test–retest correlation coefficients indicated a high level of reliability. Conclusion The newly developed SP assessment rubric of medical students’ VC skills has reached the desired level of psychometric property making it suitable for use in training and assessing VC competency. Future research is required to test its applicability to be used in an alternative form, for example as a guide for SPs to provide formative verbal feedback to medical students.

The Stroke Life Support Central Health Alliance, Registry & Technology Enabled caRe (SLS CHARTER) Programme addresses stroke patients’ rehabilitation needs through timely evaluation and intervention, but it has not been evaluated. This study evaluated the programme’s outcomes over 6 months. The primary outcome was Post Stroke Checklist (PSC) usage per SLS participant. For the final analysis, 206 SLS and 55 control participants from a public healthcare institution in Singapore were included. Secondary economic outcomes included healthcare utilisation and return to work (RTW). Multivariate analyses, adjusted for demographics and clinical factors, used gamma-log link and Poisson regression for healthcare utilisation, and logistic and Cox regression for RTW outcomes, to evaluate associations with intervention status. PSC usage increased from 50.5% 1-month post stroke to 86.9% 6-month post stroke; mean utilisation rose from 1.76 to 4.25. SLS participants reported longer lengths of stay (LOS) in certain rehabilitation institution and less day care visits. Additionally, there was varying RTW for different patient subgroups. Our findings suggest the SLS CHARTER Programme increases PSC usage, which is useful to guide future care coordination programmes. Identification of patients at risk of poorer RTW, for proactive occupational rehabilitation, may help to reduce the economic burden of stroke.