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  1. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos)
    Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al.
    J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):41-54.
    PMID: 29032636 DOI: 10.1002/jhbp.515
    The Tokyo Guidelines 2013 (TG13) for acute cholangitis and cholecystitis were globally disseminated and various clinical studies about the management of acute cholecystitis were reported by many researchers and clinicians from all over the world. The 1st edition of the Tokyo Guidelines 2007 (TG07) was revised in 2013. According to that revision, the TG13 diagnostic criteria of acute cholecystitis provided better specificity and higher diagnostic accuracy. Thorough our literature search about diagnostic criteria for acute cholecystitis, new and strong evidence that had been released from 2013 to 2017 was not found with serious and important issues about using TG13 diagnostic criteria of acute cholecystitis. On the other hand, the TG13 severity grading for acute cholecystitis has been validated in numerous studies. As a result of these reviews, the TG13 severity grading for acute cholecystitis was significantly associated with parameters including 30-day overall mortality, length of hospital stay, conversion rates to open surgery, and medical costs. In terms of severity assessment, breakthrough and intensive literature for revising severity grading was not reported. Consequently, TG13 diagnostic criteria and severity grading were judged from numerous validation studies as useful indicators in clinical practice and adopted as TG18/TG13 diagnostic criteria and severity grading of acute cholecystitis without any modification. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
    Matched MeSH terms: Biliary Tract Surgical Procedures/methods; Magnetic Resonance Imaging/methods; Tomography, X-Ray Computed/methods; Ultrasonography, Doppler, Color/methods; Multimodal Imaging/methods*
  2. Fulltext Low-dose intrapleural alteplase (without deoxyribonuclease) in complicated parapneumonic effusion: case series and literature reviews
    Lai C, Mohammad N, Hassan TM, Abdul Hamid MF
    BMJ Case Rep, 2017 Sep 11;2017.
    PMID: 28893806 DOI: 10.1136/bcr-2017-221239
    This case series reviews two cases of elderly patients who presented with fever, cough and shortness of breath. Clinical examinations and initial chest radiographs confirmed unilateral pleural effusion. Thoracenteses were consistent with exudative pleural effusion. We commenced intravenous antibiotics treating for parapneumonic effusions. The first case showed persistent effusion despite drainage, and the second case had a little aspirate from pleural tapping. Subsequent ultrasound of the thorax showed multiloculated effusions. We made the decisions for intrapleural fibrinolytic therapy using low-dose alteplase 2.5 mg each time, in view of the elderly patient as sacrosanct for risk of bleeding. Furthermore, DNase was not used, as it is not yet available in our setting. Both of our patients had good clinical and radiological outcomes, without the need for surgical interventions.
    Matched MeSH terms: Thoracentesis/methods*; Drainage/methods; Radiography/methods; Tomography, X-Ray Computed/methods; Ultrasonography/methods
  3. Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy
    Strong AT, Sharma G, Nor Hanipah Z, Tu C, Brethauer SA, Schauer PR, et al.
    Surg Obes Relat Dis, 2018 05;14(5):700-706.
    PMID: 29496441 DOI: 10.1016/j.soard.2017.12.021
    BACKGROUND: Warfarin dosing after bariatric surgery may be influenced by alterations in gastrointestinal pH, transit time, absorptive surface area, gut microbiota, food intake, and adipose tissue.

    OBJECTIVES: The aim of this study was to describe trends in warfarin dosing after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

    SETTING: Single academic center.

    METHODS: All patients chronically on warfarin anticoagulation before RYGB or SG were retrospectively identified. Indications for anticoagulation, history of bleeding or thrombotic events, perioperative complications, and warfarin dosing were collected.

    RESULTS: Fifty-three patients (RYGB n = 31, SG n = 22) on chronic warfarin therapy were identified (56.6% female, mean 54.4 ± 11.7 yr of age). Of this cohort, 34.0% had prior venous thromboembolic events, 43.4% had atrial fibrillation, and 5.7% had mechanical cardiac valves. Preoperatively, the average daily dose of warfarin was similar in the RYGB group (8.3 ± 4.1 mg) and SG group (6.9 ± 2.8 mg). One month after surgery, mean daily dose of warfarin was reduced 24.1% in the RYGB group (P

    Matched MeSH terms: Gastrectomy/methods; Laparoscopy/methods*; Preoperative Care/methods; Gastric Bypass/methods; Bariatric Surgery/methods*
  4. Fulltext Diagnostic tools in childhood malaria
    Amir A, Cheong FW, De Silva JR, Lau YL
    Parasit Vectors, 2018 01 23;11(1):53.
    PMID: 29361963 DOI: 10.1186/s13071-018-2617-y
    Every year, millions of people are burdened with malaria. An estimated 429,000 casualties were reported in 2015, with the majority made up of children under five years old. Early and accurate diagnosis of malaria is of paramount importance to ensure appropriate administration of treatment. This minimizes the risk of parasite resistance development, reduces drug wastage and unnecessary adverse reaction to antimalarial drugs. Malaria diagnostic tools have expanded beyond the conventional microscopic examination of Giemsa-stained blood films. Contemporary and innovative techniques have emerged, mainly the rapid diagnostic tests (RDT) and other molecular diagnostic methods such as PCR, qPCR and loop-mediated isothermal amplification (LAMP). Even microscopic diagnosis has gone through a paradigm shift with the development of new techniques such as the quantitative buffy coat (QBC) method and the Partec rapid malaria test. This review explores the different diagnostic tools available for childhood malaria, each with their characteristic strengths and limitations. These tools play an important role in making an accurate malaria diagnosis to ensure that the use of anti-malaria are rationalized and that presumptive diagnosis would only be a thing of the past.
    Matched MeSH terms: Diagnostic Tests, Routine/methods*; Microscopy/methods; Nucleic Acid Amplification Techniques/methods; Molecular Diagnostic Techniques/methods*; Real-Time Polymerase Chain Reaction/methods
  5. Transient Expression of Green Fluorescent Protein in Integrase-Defective Lentiviral Vector-Transduced 293T Cell Line
    Nordin F, Hamid ZA, Chan L, Farzaneh F, Hamid MK
    Methods Mol Biol, 2016;1448:159-73.
    PMID: 27317180 DOI: 10.1007/978-1-4939-3753-0_12
    Non-integrating lentiviral vectors or also known as integrase-defective lentiviral (IDLV) hold a great promise for gene therapy application. They retain high transduction efficiency for efficient gene transfer in various cell types both in vitro and in vivo. IDLV is produced via a combined mutations introduced on the HIV-based lentiviral to disable their integration potency. Therefore, IDLV is considered safer than the wild-type integrase-proficient lentiviral vector as they could avoid the potential insertional mutagenesis associated with the nonspecific integration of transgene into target cell genome afforded by the wild-type vectors.Here we describe the system of IDLV which is produced through mutation in the integrase enzymes at the position of D64 located within the catalytic core domain. The efficiency of the IDLV in expressing the enhanced green fluorescent protein (GFP) reporter gene in transduced human monocyte (U937) cell lines was investigated. Expression of the transgene was driven by the spleen focus-forming virus (SFFV) LTRs. Transduction efficiency was studied using both the IDLV (ID-SFFV-GFP) and their wild-type counterparts (integrase-proficient SFFV-GFP). GFP expression was analyzed by fluorescence microscope and FACS analysis.Based on the results, the number of the GFP-positive cells in ID-SFFV-GFP-transduced U937 cells decreased rapidly over time. The percentage of GFP-positive cells decreased from ~50 % to almost 0, up to 10 days post-transduction. In wild-type SFFV-GFP-transduced cells, GFP expression is remained consistently at about 100 %. These data confirmed that the transgene expression in the ID-SFFV-GFP-transduced cells is transient in dividing cells. The lack of an origin of replication due to mutation of integrase enzymes in the ID-SFFV-GFP virus vector has caused the progressive loss of the GFP expression in dividing cells.Integrase-defective lentivirus will be a suitable choice for safer clinical applications. It preserves the advantages of the wild-type lentiviral vectors but with the benefit of transgene expression without stable integration into host genome, therefore reducing the potential risk of insertional mutagenesis.
    Matched MeSH terms: Transduction, Genetic/methods*
  6. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus
    Fock KM, Talley N, Goh KL, Sugano K, Katelaris P, Holtmann G, et al.
    Gut, 2016 Sep;65(9):1402-15.
    PMID: 27261337 DOI: 10.1136/gutjnl-2016-311715
    OBJECTIVE: Since the publication of the Asia-Pacific consensus on gastro-oesophageal reflux disease in 2008, there has been further scientific advancement in this field. This updated consensus focuses on proton pump inhibitor-refractory reflux disease and Barrett's oesophagus.

    METHODS: A steering committee identified three areas to address: (1) burden of disease and diagnosis of reflux disease; (2) proton pump inhibitor-refractory reflux disease; (3) Barrett's oesophagus. Three working groups formulated draft statements with supporting evidence. Discussions were done via email before a final face-to-face discussion. We used a Delphi consensus process, with a 70% agreement threshold, using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria to categorise the quality of evidence and strength of recommendations.

    RESULTS: A total of 32 statements were proposed and 31 were accepted by consensus. A rise in the prevalence rates of gastro-oesophageal reflux disease in Asia was noted, with the majority being non-erosive reflux disease. Overweight and obesity contributed to the rise. Proton pump inhibitor-refractory reflux disease was recognised to be common. A distinction was made between refractory symptoms and refractory reflux disease, with clarification of the roles of endoscopy and functional testing summarised in two algorithms. The definition of Barrett's oesophagus was revised such that a minimum length of 1 cm was required and the presence of intestinal metaplasia no longer necessary. We recommended the use of standardised endoscopic reporting and advocated endoscopic therapy for confirmed dysplasia and early cancer.

    CONCLUSIONS: These guidelines standardise the management of patients with refractory gastro-oesophageal reflux disease and Barrett's oesophagus in the Asia-Pacific region.

    Matched MeSH terms: Endoscopy, Digestive System/methods*
  7. Temporal and spatial changes in persistent organic pollutants in Vietnamese coastal waters detected from plastic resin pellets
    Le DQ, Takada H, Yamashita R, Mizukawa K, Hosoda J, Tuyet DA
    Mar Pollut Bull, 2016 Aug 15;109(1):320-324.
    PMID: 27262498 DOI: 10.1016/j.marpolbul.2016.05.063
    Plastic resin pellets collected at Minh Chau island and Ba Lat estuary between 2007 and 2014 in Vietnam were analyzed for dichloro-diphenyl-trichloroethanes (DDTs), polychlorinated biphenyls (PCBs) and hexachlorocyclohexanes (HCHs). The study was carried out as part of the International Pellet Watch program for monitoring the global distribution of persistent organic pollutants (POPs). Higher levels of DDTs compared to PCBs indicated agricultural inputs rather than industrial discharges in the region. Most POP concentrations on both beaches decreased over the period, with the exception of HCH isomers. Though the concentration of DDTs showed a drastic decline on both beaches between 2007/2008 and 2014, DDTs accounted for 60-80% of total DDTs, suggesting that there is still a fresh input of these chemicals in the region. This study strongly recommends further investigations to track temporal and spatial patterns of POP levels in the marine environment using plastic resin pellets.
    Matched MeSH terms: Environmental Monitoring/methods*
  8. Fulltext The Development of a Strategic Prioritisation Method for Green Supply Chain Initiatives
    Masoumik SM, Abdul-Rashid SH, Olugu EU
    PLoS One, 2015;10(11):e0143115.
    PMID: 26618353 DOI: 10.1371/journal.pone.0143115
    To maintain a competitive position, companies are increasingly required to integrate their proactive environmental strategies into their business strategies. The shift from reactive and compliance-based to proactive and strategic environmental management has driven companies to consider the strategic factors while identifying the areas in which they should focus their green initiatives. In previous studies little attention was given to providing the managers with a basis from which they could strategically prioritise these green initiatives across their companies' supply chains. Considering this lacuna in the literature, we present a decision-making method for prioritising green supply chain initiatives aligned with the preferred green strategies alternatives for the manufacturing companies. To develop this method, the study considered a position between determinism and the voluntarism orientation of environmental management involving both external pressures and internal competitive drivers and key resources as decision factors. This decision-making method was developed using the analytic network process (ANP) technique. The elements of the decision model were derived from the literature. The causal relationships among the multiple decision variables were validated based on the results of structural equation modelling (SEM) using a dataset collected from a survey of the ISO 14001-certified manufacturers in Malaysia. A portion of the relative weights required for computation in ANP was also calculated using the SEM results. A case study is presented to demonstrate the applicability of the method.
    Matched MeSH terms: Conservation of Natural Resources/methods*
  9. Photocatalytic activity and reusability of ZnO layer synthesised by electrolysis, hydrogen peroxide and heat treatment
    Akhmal Saadon S, Sathishkumar P, Mohd Yusoff AR, Hakim Wirzal MD, Rahmalan MT, Nur H
    Environ Technol, 2016 Aug;37(15):1875-82.
    PMID: 26732538 DOI: 10.1080/09593330.2015.1135989
    In this study, the zinc oxide (ZnO) layer was synthesised on the surface of Zn plates by three different techniques, i.e. electrolysis, hydrogen peroxide and heat treatment. The synthesised ZnO layers were characterised using scanning electron microscopy, X-ray diffraction, UV-visible diffuse reflectance and photoluminescence spectroscopy. The photocatalytic activity of the ZnO layer was further assessed against methylene blue (MB) degradation under UV irradiation. The photocatalytic degradation of MB was achieved up to 84%, 79% and 65% within 1 h for ZnO layers synthesised by electrolysis, heat and hydrogen peroxide treatment, respectively. The reusability results show that electrolysis and heat-treated ZnO layers have considerable photocatalytic stability. Furthermore, the results confirmed that the photocatalytic efficiency of ZnO was directly associated with the thickness and enlarged surface area of the layer. Finally, this study proved that the ZnO layers synthesised by electrolysis and heat treatment had shown better operational stability and reusability.
    Matched MeSH terms: Electrolysis/methods*
  10. Fulltext Preparing patients for travel to high altitude: advice on travel health and chemoprophylaxis
    Flaherty GT, Kennedy KM
    Br J Gen Pract, 2016 Jan;66(642):e62-4.
    PMID: 26719484 DOI: 10.3399/bjgp16X683377
    Matched MeSH terms: Chemoprevention/methods*
  11. Fulltext Content Analysis of Food and Beverages Advertisements Targeting Children and Adults on Television in Sri Lanka
    Prathapan S, Wijewardena K, Low WY
    Asia Pac J Public Health, 2016 Jan;28(1 Suppl):86S-92S.
    PMID: 26658325 DOI: 10.1177/1010539515620481
    Food marketing is one of the main factors in the increase in childhood obesity. The objective is to compare the strategies used for promotion of food and beverages advertisements on Sri Lankan television for children and adults.
    Matched MeSH terms: Advertising as Topic/methods
  12. Differentiating multiple-system atrophy from Parkinson's disease
    Ramli N, Nair SR, Ramli NM, Lim SY
    Clin Radiol, 2015 May;70(5):555-64.
    PMID: 25752581 DOI: 10.1016/j.crad.2015.01.005
    The purpose of this review is to illustrate the differentiating features of multiple-system atrophy from Parkinson's disease at MRI. The various MRI sequences helpful in the differentiation will be discussed, including newer methods, such as diffusion tensor imaging, MR spectroscopy, and nuclear imaging.
    Matched MeSH terms: Magnetic Resonance Imaging/methods*
  13. Fulltext Using VigiBase to Identify Substandard Medicines: Detection Capacity and Key Prerequisites
    Juhlin K, Karimi G, Andér M, Camilli S, Dheda M, Har TS, et al.
    Drug Saf, 2015 Apr;38(4):373-82.
    PMID: 25687792 DOI: 10.1007/s40264-015-0271-2
    Substandard medicines, whether the result of intentional manipulation or lack of compliance with good manufacturing practice (GMP) or good distribution practice (GDP), pose a significant potential threat to patient safety. Spontaneous adverse drug reaction reporting systems can contribute to identification of quality problems that cause unwanted and/or harmful effects, and to identification of clusters of lack of efficacy. In 2011, the Uppsala Monitoring Centre (UMC) constructed a novel algorithm to identify reporting patterns suggestive of substandard medicines in spontaneous reporting, and applied it to VigiBase(®), the World Health Organization's global individual case safety report database. The algorithm identified some historical clusters related to substandard products, which were later able to be confirmed in the literature or by contact with national centres (NCs). As relevant and detailed information is often lacking in the VigiBase reports but might be available at the reporting NC, further evaluation of the algorithm was undertaken with involvement from NCs.
    Matched MeSH terms: Product Surveillance, Postmarketing/methods*
  14. A review of: application of synthetic scaffold in tissue engineering heart valves
    Fallahiarezoudar E, Ahmadipourroudposht M, Idris A, Mohd Yusof N
    Mater Sci Eng C Mater Biol Appl, 2015 Mar;48:556-65.
    PMID: 25579957 DOI: 10.1016/j.msec.2014.12.016
    The four heart valves represented in the mammalian hearts are responsible for maintaining unidirectional, non-hinder blood flow. The heart valve leaflets synchronically open and close approximately 4 million times a year and more than 3 billion times during the life. Valvular heart dysfunction is a significant cause of morbidity and mortality around the world. When one of the valves malfunctions, the medical choice is may be to replace the original valves with an artificial one. Currently, the mechanical and biological artificial valves are clinically used with some drawbacks. Tissue engineering heart valve concept represents a new technique to enhance the current model. In tissue engineering method, a three-dimensional scaffold is fabricated as the template for neo-tissue development. Appropriate cells are seeded to the matrix in vitro. Various approaches have been investigated either in scaffold biomaterials and fabrication techniques or cell source and cultivation methods. The available results of ongoing experiments indicate a promising future in this area (particularly in combination of bone marrow stem cells with synthetic scaffold), which can eliminate the need for lifelong anti-coagulation medication, durability and reoperation problems.
    Matched MeSH terms: Tissue Engineering/methods*
  15. A novel approach to life support training using "action-linked phrases"
    Hunt EA, Cruz-Eng H, Bradshaw JH, Hodge M, Bortner T, Mulvey CL, et al.
    Resuscitation, 2015 Jan;86:1-5.
    PMID: 25457379 DOI: 10.1016/j.resuscitation.2014.10.007
    Observations of cardiopulmonary arrests (CPAs) reveal concerning patterns when clinicians identify a problem, (e.g. loss of pulse) but do not immediately initiate appropriate therapy (e.g. compressions) resulting in delays in life saving therapy.
    Matched MeSH terms: Internship and Residency/methods
  16. Fulltext Subspace-based technique for speckle noise reduction in ultrasound images
    Yahya N, Kamel NS, Malik AS
    Biomed Eng Online, 2014;13(1):154.
    PMID: 25421914 DOI: 10.1186/1475-925X-13-154
    Ultrasound imaging is a very essential technique in medical diagnosis due to its being safe, economical and non-invasive nature. Despite its popularity, the US images, however, are corrupted with speckle noise, which reduces US images qualities, hampering image interpretation and processing stage. Hence, there are many efforts made by researches to formulate various despeckling methods for speckle reduction in US images.
    Matched MeSH terms: Image Enhancement/methods*
  17. Quantification of landfill methane using modified Intergovernmental Panel on Climate Change's waste model and error function analysis
    Govindan SS, Agamuthu P
    Waste Manag Res, 2014 Oct;32(10):1005-14.
    PMID: 25323145 DOI: 10.1177/0734242X14552551
    Waste management can be regarded as a cross-cutting environmental 'mega-issue'. Sound waste management practices support the provision of basic needs for general health, such as clean air, clean water and safe supply of food. In addition, climate change mitigation efforts can be achieved through reduction of greenhouse gas emissions from waste management operations, such as landfills. Landfills generate landfill gas, especially methane, as a result of anaerobic degradation of the degradable components of municipal solid waste. Evaluating the mode of generation and collection of landfill gas has posted a challenge over time. Scientifically, landfill gas generation rates are presently estimated using numerical models. In this study the Intergovernmental Panel on Climate Change's Waste Model is used to estimate the methane generated from a Malaysian sanitary landfill. Key parameters of the model, which are the decay rate and degradable organic carbon, are analysed in two different approaches; the bulk waste approach and waste composition approach. The model is later validated using error function analysis and optimum decay rate, and degradable organic carbon for both approaches were also obtained. The best fitting values for the bulk waste approach are a decay rate of 0.08 y(-1) and degradable organic carbon value of 0.12; and for the waste composition approach the decay rate was found to be 0.09 y(-1) and degradable organic carbon value of 0.08. From this validation exercise, the estimated error was reduced by 81% and 69% for the bulk waste and waste composition approach, respectively. In conclusion, this type of modelling could constitute a sensible starting point for landfills to introduce careful planning for efficient gas recovery in individual landfills.
    Matched MeSH terms: Environmental Monitoring/methods*
  18. Conceptual transitions in methods of skull-photo superimposition that impact the reliability of identification: a review
    Jayaprakash PT
    Forensic Sci Int, 2015 Jan;246:110-21.
    PMID: 25498986 DOI: 10.1016/j.forsciint.2014.10.043
    Establishing identification during skull-photo superimposition relies on correlating the salient morphological features of an unidentified skull with those of a face-image of a suspected dead individual using image overlay processes. Technical progression in the process of overlay has included the incorporation of video cameras, image-mixing devices and software that enables real-time vision-mixing. Conceptual transitions occur in the superimposition methods that involve 'life-size' images, that achieve orientation of the skull to the posture of the face in the photograph and that assess the extent of match. A recent report on the reliability of identification using the superimposition method adopted the currently prevalent methods and suggested an increased rate of failures when skulls were compared with related and unrelated face images. The reported reduction in the reliability of the superimposition method prompted a review of the transition in the concepts that are involved in skull-photo superimposition. The prevalent popular methods for visualizing the superimposed images at less than 'life-size', overlaying skull-face images by relying on the cranial and facial landmarks in the frontal plane when orienting the skull for matching and evaluating the match on a morphological basis by relying on mix-mode alone are the major departures in the methodology that may have reduced the identification reliability. The need to reassess the reliability of the method that incorporates the concepts which have been considered appropriate by the practitioners is stressed.
    Matched MeSH terms: Forensic Anthropology/methods
  19. Assessment of the factors contributing to the variations in microcystins biodegradability of the biofilms on a practical biological treatment facility
    Li J, Shimizu K, Akasako H, Lu Z, Akiyama S, Goto M, et al.
    Bioresour Technol, 2015 Jan;175:463-72.
    PMID: 25459856 DOI: 10.1016/j.biortech.2014.10.047
    This study revealed the biotic and abiotic parameters driving the variations in microcystins (MCs) biodegradability of a practical biological treatment facility (BTF). Results showed that similar trends of seasonal variation were seen for microcystin-LR (MCLR) biodegradability of biofilms on the BTF and indigenous MCLR-degrader population, where both peaks co-occurred in October, following the peaks of natural MCLR concentration and water temperature observed in August. The lag period might be required for accumulation of MCLR-degraders and MCLR-degrading enzyme activity. The MCLR-degrader population was correlated to temperature, MCLR and chlorophyll-a concentration in water where the biofilms submerged, indicating that these abiotic and biotic parameters exerted direct and/or indirect influences on seasonal variation in MCLR-biodegradability. In comparison, no effect of other co-existing MCs on biodegradation of one MC was observed. However, proliferation of MC-degraders along biodegradation processes positively responded to total amount of MCs, suggesting that multiple MCs contributed additively to MC-degrader proliferation.
    Matched MeSH terms: Water Purification/methods*
  20. Fulltext Spatially explicit trends in the global conservation status of vertebrates
    Rodrigues AS, Brooks TM, Butchart SH, Chanson J, Cox N, Hoffmann M, et al.
    PLoS One, 2014;9(11):e113934.
    PMID: 25426636 DOI: 10.1371/journal.pone.0113934
    The world's governments have committed to preventing the extinction of threatened species and improving their conservation status by 2020. However, biodiversity is not evenly distributed across space, and neither are the drivers of its decline, and so different regions face very different challenges. Here, we quantify the contribution of regions and countries towards recent global trends in vertebrate conservation status (as measured by the Red List Index), to guide action towards the 2020 target. We found that>50% of the global deterioration in the conservation status of birds, mammals and amphibians is concentrated in <1% of the surface area, 39/1098 ecoregions (4%) and eight/195 countries (4%) - Australia, China, Colombia, Ecuador, Indonesia, Malaysia, Mexico, and the United States. These countries hold a third of global diversity in these vertebrate groups, partially explaining why they concentrate most of the losses. Yet, other megadiverse countries - most notably Brazil (responsible for 10% of species but just 1% of deterioration), plus India and Madagascar - performed better in conserving their share of global vertebrate diversity. Very few countries, mostly island nations (e.g. Cook Islands, Fiji, Mauritius, Seychelles, and Tonga), have achieved net improvements. Per capita wealth does not explain these patterns, with two of the richest countries - United States and Australia - fairing conspicuously poorly. Different countries were affected by different combinations of threats. Reducing global rates of biodiversity loss will require investment in the regions and countries with the highest responsibility for the world's biodiversity, focusing on conserving those species and areas most in peril and on reducing the drivers with the highest impacts.
    Matched MeSH terms: Conservation of Natural Resources/methods*
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