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Introduction: Native bee communities of temperate forests are conventionally sampled from the understory, yet there is growing evidence that bee assemblages in forest canopies are distinct from those in the understory. Therefore, conventional approaches to quantify forest bee-habitat relationships may not comprehensively characterize forest bee communities. Methods: To examine this, we sampled bees 1--26 m from ground level at 5-m increments at 47 locations in forests located in western Massachusetts, USA. We evaluated bee abundance and species richness responses to a suite of environmental factors measured in the understory with linear and segmented regression comparing four bee sampling strategies: (1) understory sampling only, (2) understory and midstory, (3) understory and canopy, and (4) all strata combined. Results: We found that not sampling higher strata underestimated bee abundance and species richness, and linear models had less ability to explain the data when bees of higher strata were included. Among strategies, responses analyzed linearly differed in magnitude due to overall differences in abundance and species richness, but segmented regressions showed relationships with understory characteristics that also differed in slope, which would alter interpretation. Discussion: Collectively, our findings highlight the value of including vertically stratified sampling strategies throughout the flight season to fully characterize native bee and other pollinator communities of forests. [ABSTRACT FROM AUTHOR]

Background: Despite the clear benefits of physical activity in healthy ageing, engagement in regular physical activity among community-dwelling older adults remains low, with common barriers including exertional discomfort, concerns with falling, and access difficulties. The recent rise of the use of technology and the internet among older adults presents an opportunity to engage with older people online to promote increased physical activity. This study aims to determine the feasibility and acceptability of training volunteers to deliver online group exercises for older adults attending community social clubs. Methods: This was a pre-post mixed-methods study. Older adults aged ≥ 65 years attending community social clubs who provided written consent and were not actively participating in exercise classes took part in the feasibility study. Older adults, volunteers, and staff were interviewed to determine the acceptability of the intervention. The intervention was a once weekly volunteer-led online group seated strength exercises using resistance bands. The duration of the intervention was 6 months. The primary outcome measures were the feasibility of the intervention (determined by the number of volunteers recruited, trained, and retained, participant recruitment and intervention adherence) and its acceptability to key stakeholders. Secondary outcome measures included physical activity levels (Community Health Model Activities Programme for Seniors (CHAMPS) questionnaire), modified Barthel Index, Health-related quality of life (EQ-5D-5L), frailty (PRISMA-7) and sarcopenia (SARC-F), at baseline and 6 months. Results: Nineteen volunteers were recruited, 15 (78.9%) completed training and 9 (47.3%) were retained after 1 year (mean age 68 years). Thirty older adults (mean age 77 years, 27 female) participated, attending 54% (IQR 37–67) of exercise sessions. Participants had no significant changes in secondary outcome measures, with a trend towards improvement in physical activity levels (physical activity in minutes per week at baseline was 1770 min, and 1909 min at six months, p = 0.13). Twenty volunteers, older adults, and staff were interviewed and found the intervention acceptable. The seated exercises were perceived as safe, manageable, and enjoyable. Conclusions: Trained volunteers can safely deliver online group exercise for community-dwelling older adults which was acceptable to older adults, volunteers, and club staff. Trials registration: NCT04672200. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a 46-year-old woman who presented with corneal nerve thickening (CNT), a characteristic feature of multiple endocrine neoplasia (MEN) type 2B. However, genetic testing revealed that she had a new lineage of MEN2A, which is typically associated with medullary thyroid carcinoma (MTC), phaeochromocytoma, and primary hyperparathyroidism. The article highlights that while CNT is commonly associated with MEN2B, it can also be present in MEN2A, emphasizing the importance of considering both syndromes when CNT is detected. The study also discusses the intrafamilial variation in the presence and degree of CNT in families with MEN2A. [Extracted from the article]

Climate change and land-use change are leading drivers of biodiversity decline, affecting demographic parameters that are important for population persistence. For example, scientists have speculated for decades that climate change may skew adult sex ratios in taxa that express temperature-dependent sex determination (TSD), but limited evidence exists that this phenomenon is occurring in natural settings. For species that are vulnerable to anthropogenic land-use practices, differential mortality among sexes may also skew sex ratios. We sampled the spotted turtle (Clemmys guttata), a freshwater species with TSD, across a large portion of its geographic range (Florida to Maine), to assess the environmental factors influencing adult sex ratios. We present evidence that suggests recent climate change has potentially skewed the adult sex ratio of spotted turtles, with samples following a pattern of increased proportions of females concomitant with warming trends, but only within the warmer areas sampled. At intermediate temperatures, there was no relationship with climate, while in the cooler areas we found the opposite pattern, with samples becoming more male biased with increasing temperatures. These patterns might be explained in part by variation in relative adaptive capacity via phenotypic plasticity in nest site selection. Our findings also suggest that spotted turtles have a context-dependent and multi-scale relationship with land use. We observed a negative relationship between male proportion and the amount of crop cover (within 300 m) when wetlands were less spatially aggregated. However, when wetlands were aggregated, sex ratios remained consistent. This pattern may reflect sex-specific patterns in movement that render males more vulnerable to mortality from agricultural machinery and other threats. Our findings highlight the complexity of species' responses to both climate change and land use, and emphasize the role that landscape structure can play in shaping wildlife population demographics. [ABSTRACT FROM AUTHOR]

Our understanding of how bees (Apoidea) use temperate forests is largely limited to sampling the understory and forest floor. Studies over the last decade have demonstrated that bee communities are vertically stratified within forests, yet the ecology of bee assemblages immediately above the canopy, the canopy‐aerosphere interface, remains unexplored. We sampled and compared bee communities above the canopy of a temperate forest to the understory (1 m), midstory (10 m), and canopy (20 m) on the campus of the University of Massachusetts, in Amherst, Massachusetts, United States from April to August, 2021. Overall, we found that assemblages above the canopy had more bees than in the understory, were distinct in composition from all other strata, and included the greatest proportion of unique species. Bee abundance and species richness were highest in the understory throughout the spring (April and May) and decreased as the season progressed, while bee abundance and species richness at higher strata increased into the summer months. We also found that bees with preferences to nest in moist and rotting wood were largely restricted to canopy and midstory strata. We conclude that bee assemblages occupying the space above the forest canopy are abundant and diverse, and their unique composition suggests that this canopy‐aerosphere interface plays an additional role in the bee community of temperate forests. Alternatively, our findings question how forest bee communities should be defined while highlighting the need for research on fundamental processes governing species stratification in and above the canopy. [ABSTRACT FROM AUTHOR]

The ecology of the canopy–aerosphere interface within forested ecosystems remains underexplored largely due to the challenges of physically accessing this zone. Sky bridges, towers and other permanent structures are most commonly used to sample the forest canopy–aerosphere interface, but these methods are costly, challenging to replicate, and often alter and degrade the local environment during construction. Thus, there is a clear need for cost‐effective and replicable methods for accessing and passively sampling above the forest canopy.We designed and deployed an inexpensive and lightweight telescopic hanger composed of common materials to sample aerial invertebrates above the forest canopy. Deployment involved climbing into tree crowns and securing our hanger design to vertical branches. We sampled the invertebrate community above forest fragments on the campus of the University of Massachusetts Amherst, USA by suspending blue vane traps from hangers, which were extended to approximately 1 m above the highest terminal bud of the tree, continuously from April through August 2021. We also recorded the microclimate conditions above the canopy at each hanger, including temperature and light intensity.All hangers and traps remained in place and active throughout the study period. In May, we made minor repairs at two locations where the hangers were attached to the trees and, following an intense weather event in July, observed damage to one hanger that did not affect sampling effort. We include cost breakdowns of design components as well as detailed building instructions.This tool offers a durable and inexpensive solution for researchers to access and sample the forest canopy–aerosphere interface that has minimal impacts on the environment and is more easily replicated compared to previous methods. Assembly pitfalls and design alterations are discussed based on our experience with the installation and implementation of the tested design, as well as included prototypes. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is important for older people to maintain functional independence and healthy ageing. There is strong evidence to support the benefits of physical activity interventions on the health outcomes of older adults. Nonetheless, innovative approaches are needed to ensure that these interventions are practical and sustainable. Aim: This systematic review explores the effectiveness of volunteer-led PA interventions in improving health outcomes for community-dwelling older people. Methods: Five databases (MEDLINE, Embase, CINAHL, PEDro, Cochrane library) were systematically searched for studies using trained volunteers to deliver PA interventions for community-dwelling older people aged ≥ 65 years. Meta-analysis was not conducted due to included study heterogeneity. Results: Twelve papers describing eight studies (five papers reported different outcomes from the same study) were included in the review. All eight studies included strength and balance exercises and frequency of PA ranged from weekly to three times a week. Volunteer-led exercises led to improvements in functional status measured using the short physical performance battery, timed up and go test, Barthel Index, single leg stand, step touch test, chair stand test, and functional reach. Frailty status identified by grip strength measurement or the use of long-term care insurance improved with volunteer-led exercises. Interventions led to improvement in fear of falls and maintained or improved the quality of life. The impact on PA levels were mixed. Conclusion: Limited evidence suggests that volunteer-led PA interventions that include resistance exercise training, can improve outcomes of community-dwelling older adults including functional status, frailty status, and reduction in fear of falls. More high-quality RCTs are needed to investigate the effects of volunteer-led PA interventions among older people. [ABSTRACT FROM AUTHOR]

The absence of some species from small habitat patches has long posed a challenge for conservationists, yet the underlying mechanisms that cause this "area‐sensitivity" remain poorly understood. Capacity of a species to extend their activities into the surrounding matrix habitat represents one potential determinant of area‐sensitivity. Species may be able to occupy smaller patches if they can utilize matrix habitat beyond patch boundaries, whereas area‐sensitive species may be restricted to larger patches due to their inability to utilize the surrounding matrix. We investigated the potential role of matrix utilization in determining area‐sensitivity by mapping the movements of two shrubland‐obligate passerines with contrasting patch area requirements in shrub‐dominated forest openings ranging in area by nearly an order of magnitude. Our findings were consistent with our predictions; the less area‐sensitive chestnut‐sided warbler (Setophaga pensylvanica) exhibited greater use of matrix habitat than the highly area‐sensitive prairie warbler (S. discolor). Furthermore, chestnut‐sided warblers that occupied smaller openings used mature forest more than conspecifics in larger patches, yet forest use by prairie warblers was unrelated to opening size. Chestnut‐sided warblers foraged as frequently in mature forest as within shrubland, whereas prairie warblers foraged significantly more in openings compared to forest. The findings of this study suggest that the ability or inclination of a species to utilize surrounding matrix habitat explains at least some of the observed variation in area‐sensitivity in songbirds and potentially other taxa. [ABSTRACT FROM AUTHOR]

Objectives: Appetite loss is common in hospitalised older individuals but not routinely assessed. Poor appetite in hospital has previously been identified as predictive of greater mortality in the six months following discharge in a single study of female patients. The present study aimed to assess this association in a larger sample including both hospitalised men and women. Design: Longitudinal observational study with six month follow up. Setting: Acute hospital wards in a single large hospital in England. Participants: Older inpatients aged over 70 years. Measurements: Appetite was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ) during hospital stay. Deaths during six month follow-up period were recorded. Association between SNAQ score during hospital admission and death 6 months post-discharge was assessed using binary logistic regression in unadjusted and adjusted analysis. Results: 296 participants (43% female, mean age 83 years (SD 6.9)) were included in this study. Prevalence of poor appetite (SNAQ score <14) was 41%. In unadjusted analysis a SNAQ score of <14 was associated with a 2.47 increase in odds of mortality at six months (OR 2.47 (95% CI 1.27,4.82)). This association remained after adjusting for number of comorbidities (Charlson index), length of stay and gender (OR 2.62 (95% CI 1.30, 5.27)). In unadjusted continuous analysis, every one point decrease in SNAQ score led to a 1.20 fold increase in odds of mortality at six months (OR 1.20 (95% CI 1.06–1.36)). This association remained in adjusted analysis (OR 1.22 (95% CI 1.07–1.39)). Conclusion: Poor appetite is common in hospitalised older people. We have confirmed the association, previously reported in older women, between poor appetite during hospital stay and greater mortality at six months post-discharge but in a larger study including older men and women. Further research is needed to understand the mechanisms of poor appetite, which lead to increased mortality. [ABSTRACT FROM AUTHOR]

Background: PDSAFE is an individually-tailored, physiotherapist-delivered, balance, strength and strategy training programme aimed at preventing falls among people with Parkinson's. We evaluated the cost-effectiveness of PDSAFE compared with usual care for people with Parkinson's at higher risk of falling, from a UK National Health Service and Personal Social Service perspective.Methods: Resource use and quality of life data (EQ-5D-3L) were collected from 238 participants randomised to the PDSAFE intervention and 236 participants randomised to control, at baseline, 3 months, 6 months (primary outcome), and 12 months. Adjusted cost and quality-adjusted life-years (QALYs) were estimated using generalised linear models and uncertainty estimated using a non-parametric bootstrap.Results: Over 6 months, the PDSAFE intervention was associated with an incremental cost of £925 (95% CI £428 to £1422) and a very small and statistically insignificant QALY gain of 0.008 (95% CI - 0.006 to 0.021). The resulting incremental cost-effectiveness ratio (ICER) was £120,659 per QALY and the probability of the intervention being cost-effective at a UK threshold of £30,000/QALY was less than 1%. The ICER varied substantially across subgroups although no subgroup had an ICER lower than the £30,000 threshold. The result was sensitive to the time horizon with the ICER reducing to £55,176 per QALY when adopting a 12-month time horizon and assuming a sustained treatment effect on QoL, nevertheless, the intervention was still not cost-effective according to the current UK threshold.Conclusions: Evidence from this trial suggests that the PDSAFE intervention is unlikely to be cost-effective at 6 months. The 12-month analysis suggested that the intervention became closer to being cost-effective if quality of life effects were sustained beyond the intervention period, however this would require confirmation. Further research, including qualitative studies, should be conducted to better understand the treatment effect of physiotherapy and its impact on quality of life in people with Parkinson's given existing mixed evidence on this topic.Trial Registration: ISRCTN48152791. Registered 17 April 2014. http://www.isrctn.com/ISRCTN48152791. [ABSTRACT FROM AUTHOR]

African swine fever (ASF) entered Georgia in 2007 and the EU in 2014. In the EU, the virus primarily spread in wild boar (Sus scrofa) in the period from 2014–2018. However, from the summer 2018, numerous domestic pig farms in Romania were affected by ASF. In contrast to the existing knowledge on ASF transmission routes, the understanding of risk factors and the importance of different transmission routes is still limited. In the period from May to September 2019, 655 Romanian pig farms were included in a matched case-control study investigating possible risk factors for ASF incursion in commercial and backyard pig farms. The results showed that close proximity to outbreaks in domestic farms was a risk factor in commercial as well as backyard farms. Furthermore, in backyard farms, herd size, wild boar abundance around the farm, number of domestic outbreaks within 2 km around farms, short distance to wild boar cases and visits of professionals working on farms were statistically significant risk factors. Additionally, growing crops around the farm, which could potentially attract wild boar, and feeding forage from ASF affected areas to the pigs were risk factors for ASF incursion in backyard farms. [ABSTRACT FROM AUTHOR]

Background: Reduced food intake is prevalent in people in residential and hospital care settings. Little is known about the use of finger foods (i.e. foods eaten without cutlery) with respect to increasing feeding independence and food intake. The Social Care Institute for Excellence (Malnutrition Task Force: State of the Nation, 2017) recommends the use of finger foods to enable mealtime independence and to prevent loss of dignity and embarrassment when eating in front of others. The aim of this review is to identify and evaluate the existing literature regarding the use and effectiveness of finger foods among adults in health and social care settings. Methods: An integrative review methodology was used. A systematic search of electronic databases for published empirical research was undertaken in October 2018. Following screening of titles and abstracts, the full texts of publications, which investigated outcomes associated with the provision of finger foods in adult care settings, were retrieved and assessed for inclusion. Two independent investigators conducted data extraction and quality assessment using Critical Appraisal Skills Programme checklists. Thematic analysis was used to summarise the findings. Results: Six studies met the inclusion criteria. Four themes were identified: Finger food menu implementation; Importance of a team approach; Effect on nutrition; and Influence on wellbeing. Study designs were poorly reported, with small sample sizes. Conclusions: There is some evidence that the provision of finger foods may positively affect patient outcomes in long‐term care settings. There is a paucity of research evaluating the use of a finger food menu in acute care settings, including economic evaluation. Future high quality trials are required. [ABSTRACT FROM AUTHOR]

We demonstrate that a high-resolution Ga focused ion beam can be used to introduce artificial domain structures in Pt(1.6 nm)/Co(0.5 nm)/Pt(3.5 nm) trilayer transport structures. We have used thin SiO2 overlayers to control the effective energy and dose of Ga ions at the Pt/Co interface. The extraordinary Hall effect (EHE) was used to characterize the magnetic properties of the patterned films. Using 30 keV Ga ions and SiO2 overlayer thicknesses in the range of 0–24 nm, we achieve complete control of the coercive field of our Pt/Co/Pt trilayer structures. The magnetization reversal mechanism for an artificial domain of size of 3×0.5 μm2 is investigated using EHE. [ABSTRACT FROM AUTHOR]

Aim: To test the hypothesis that delayed menarche is associated with an increased microvascular complication risk among women with Type 1 diabetes. Methods: We studied the female participants of an ongoing prospective study of childhood‐onset Type 1 diabetes diagnosed during the period 1950–1980. Of 325 women, we included data from 315 who had reached menarche by the study baseline (1986–1988) and who self‐reported their age at menarche. Both cross‐sectional and prospective analyses over the 25‐year follow‐up were used to assess the relationship of age at menarche with the prevalence, incidence and cumulative incidence of microvascular complications, comprising overt nephropathy, proliferative retinopathy and confirmed distal symmetric polyneuropathy. Results: In cross‐sectional analyses at baseline, the odds of overt nephropathy increased 1.24 times (P=0.02) with each annual increase in age at menarche, and 3.2 times (P=0.009) in those with delayed menarche compared with women with normal menarche onset, after adjustment. Similarly, the cumulative incidence of overt nephropathy increased 1.16 times (P=0.01) with each older year of menarche and women with delayed menarche were at twofold increased risk of overt nephropathy (hazard ratio 2.30, P=0.001) compared with women with normal menarche onset. However, age at menarche was not significantly associated with either proliferative retinopathy or confirmed distal symmetric polyneuropathy after adjusting for covariates. Conclusions: Age at menarche was significantly associated with the prevalence and cumulative incidence of overt nephropathy, but not with proliferative retinopathy or confirmed distal symmetric polyneuropathy in Type 1 diabetes. Women with delayed menarche may therefore be targeted for early screening and timely interventions to prevent the development of nephropathy. What's new?: Delayed menarche is a common finding in women with Type 1 diabetes, but its association with microvascular complications has not been extensively studied.In this prospective cohort of women with childhood‐onset Type 1 diabetes, age at menarche was significantly associated with both the prevalence and cumulative incidence of macroalbuminuria.Age at menarche was, however, not associated with proliferative retinopathy or confirmed distal symmetric polyneuropathy. [ABSTRACT FROM AUTHOR]

Introduction multiple conditions in later life (multi-morbidity) is a major challenge for health and care systems worldwide, is of particular relevance for older people, but has not (until recently) received high priority as a topic for research. We have identified the top 10 research priorities from the perspective of older people, their carers, and health and social care professionals using the methods of a James Lind Alliance Priority Setting Partnership. Methods in total, 354 participants (162 older people and carers, 192 health professionals) completed a survey and 15 older people and carers were interviewed to produce 96 'unanswered questions'. These were further refined by survey and interviews to a shortlist of 21 topics, and a mix of people aged 80+ living with three or more conditions, carers and health and social care providers to prioritised the top 10. Results the key priorities were about the prevention of social isolation, the promotion of independence and physical and emotional well-being. In addition to these broad topics, the process also identified detailed priorities including the role of exercise therapy, the importance of falls (particularly fear of falling), the recognition and management of frailty and Comprehensive Geriatric Assessment. Conclusion these topics provide a unique perspective on research priorities on multiple conditions in later life and complement existing UK and International recommendations about the optimisation of health and social care systems to deliver essential holistic models of care and the prevention and treatment of multiple co-existing conditions. [ABSTRACT FROM AUTHOR]

Background: Few studies have explored the activity levels of hospitalised older people and the intra-daily activity patterns in this group have not been described.Aims: To describe the quantity and daily pattern of physical activity among hospitalised older people using two accelerometers: the ankle-worn StepWatch Activity Monitor (SAM), and the wrist-worn GENEActiv.Methods: This cross-sectional observational study was conducted on the acute medical wards for older people in one UK hospital. Inclusion criteria: participants aged ≥ 70 years, and able to mobilise prior to admission. Participants wore both devices for up to seven consecutive days, or until hospital discharge, whichever was sooner. Intra-daily activity levels were analysed hourly over each 24 h period.Results: 38 participants (mean age 87.8 years, SD 4.8) had their activity levels measured using both devices. The SAM median daily step count was 600 (IQR 240-1427). Intra-daily activity analysis showed two peak periods of ambulatory activity between 9 am-11 am and 6 pm-7 pm. With physical activity defined as ≥ 12 milli-g (GENEActiv), the median time spent above this cut-off point was 4.2 h. 62% of this activity time was only sustained for 1-5 min. Acceptability of both devices was high overall, but the wrist-worn device (96%) was more acceptable to patients than the ankle-worn device (83%).Conclusion: Activity levels of these hospitalised older people were very low. Most physical activity was sustained over short periods. The intra-daily pattern of activity is an interesting finding which can help clinicians implement time-specific interventions to address the important issue of sedentary behaviour. [ABSTRACT FROM AUTHOR]

Appropriate preoperative blood typing and cross-matching is an important quality improvement target to minimise costs and rationalise the use of blood bank resources. This can be facilitated using a maximum surgical blood ordering schedule (MSBOS) for specific operations. It is recommended that individual hospitals develop a site-specific MSBOS based on institutional data, but this is challenging in non-tertiary centres without electronic databases. Our aim was to audit our perioperative blood transfusions to develop a site-specific MSBOS. A retrospective audit of blood transfusions in surgical patients in our regional referral hospital was conducted using five years' coded administrative data. Procedures with higher transfusion rates warranting preoperative testing (type and screen with or without subsequent cross-matching) were identified. There were about 15,000 eligible surgical procedures performed in our institution over the audit period. The need for preoperative testing was identified for only a few procedures, namely laparotomy, bowel resection, major amputation, joint arthroplasty, hip/femur fracture and humerus surgery, and procedures for obstetric complications. We observed a reduction in transfusion rates over time for total joint arthroplasty. The use of coding data represents an efficient method by which centres without electronic anaesthesia information management systems can conduct large-scale audits to develop a site-specific MSBOS. This would represent a significant improvement for hospitals that currently base preoperative testing recommendations on expert opinion alone. As many procedures in regional centres have very low transfusion rates, hospitals with a similar case mix to ours could consider selectively auditing higher-risk operations where local data is most likely to alter testing recommendations. [ABSTRACT FROM AUTHOR]

Abstract: The EUFORA fellowship programme ‘Livestock Health and Food Chain Risk Assessment’ was proposed by the Animal and Plant Health Agency (APHA), a British governmental institution responsible for safeguarding animal and plant health in the UK. The working programme, which was organised into four different modules, covered a wide range of aspects related to risk assessment including identification of emerging risks, risk prioritisation methods, scanning surveillance, food production exposure assessment and import risk assessment of animal and human infectious diseases. Over the course of the year, the Fellow had the opportunity to work for international projects with experts in these disciplines. This allowed for significant opportunities to ‘learn‐by‐doing’ the methods and the techniques that are employed to assess animal health and food safety risks. Moreover, he consolidated his knowledge by attending several training courses and academic lessons, submitting scientific papers to peer‐reviewed journals and conferences, giving presentations and using modelling software. [ABSTRACT FROM AUTHOR]

Abstract: Background: Undernutrition affects over 44% of hospitalised older people, who often dislike oral nutritional supplements (ONS). This review summarises the evidence for an alternative strategy, using energy and protein dense meals (via fortification) or snacks (supplementation) to increase the dietary energy and protein intake of older inpatients. Methods: A search was conducted through PubMed, EMBASE, CINAHL and the Cochrane database of systematic reviews (May 1996 to May 2016) that used fortification or supplementation to increase the energy or protein intake of patients (mean age ≥60 years) in hospitals or rehabilitation centres. Results: Ten articles (546 patients, mean age 60–83 years) were identified. Compared with usual nutritional care, six studies using either energy or protein based fortification and supplementation significantly increased intake of energy (250–450 kcal day−1) or protein (12–16 g day−1). Two studies enriched menus with both energy and protein, and significantly increased both energy (698 kcal day−1 and 21 kJ kg−1) and protein (16 g and 0.2 g kg−1) intake compared to usual care. ONS was similar to supplementation in one study but superior to fortification in another. Four studies reported good acceptability of enriched products and two studies that found they were cost‐effective. Conclusions: Compared with usual nutritional care, energy‐ and protein‐based fortification and supplementation could be employed as an effective, well‐tolerated and cost‐effective intervention to improve dietary intake amongst older inpatients. This strategy may be particularly useful for patients with cognitive impairment who struggle with ONS, and clinical trials are required to compare these approaches and establish their impact on functional outcomes. [ABSTRACT FROM AUTHOR]

We present the results of experimental investigations of magnetic switching and magnetotransport in a generation of magnetic devices containing artificially patterned domains. Our devices are realized by locally reducing the coercive field of a perpendicularly magnetized Pt(3.5 nm)/Co(0.5 nm)/Pt(1.6 nm) trilayer structure using a gallium focused ion beam. Artificial domain walls are created at the interfaces between dosed and undosed regions when an external magnetic field switches the former but not the latter. We have exploited this property to create stripelike domains with widths down to submicron length scales, separated by undosed regions. Using the extraordinary Hall effect to monitor the local magnetization we have investigated the reversal dynamics of these artificial domains by measuring major and minor hysteresis loops. The coercive field of regions irradiated with identical doses systematically increases as their size decreases. In the lower branch of minor loops, reversal is seen to occur via a few large Barkhausen events. Preliminary measurements of transport across domain walls reveal a positive domain-wall resistance, that does not change sign from 4.2 to 300 K. [ABSTRACT FROM AUTHOR]

An editorial is presented on anorexia of ageing and how using big data can offer helpful insights and new challenges to understand the problem. Topics include research interest in anorexia of ageing has increased over the last decade due to the importance of appetite loss in trajectories of healthy ageing and increased morbidity and mortality; and insights into the link between anorexia and poor health outcomes using ICD-10 codes to explore the link between anorexia and poor health outcomes.

Background: The assessment of physical activity levels of hospitalised older people requires accurate and reliable measures. Physical activities that older people in hospital commonly engage in include exercises and walking. Measurement of physical activity levels of older inpatients is essential to evaluate the impact of interventions to improve physical activity levels and to determine associations between physical activity in hospital and other health-related outcome measures. Objective: To determine which measures are used to measure physical activity of older people in hospital, and to describe their properties and applications. Method: A systematic review of four databases: Medline, Embase, CINAHL and AMED was conducted for papers published from 1996 to 2016. Inclusion criteria were participants aged ≥ 65 years and studies which included measures of physical activity in the acute medical inpatient setting. Studies which specifically assessed the activity levels of surgical patients or patients with neurological conditions such as stroke or brain injury were excluded. All study designs were included in the review. Results: 18 studies were included from 127 articles selected for full review. 15 studies used objective measures to measure the physical activity of older inpatients: 11 studies used accelerometers and four used direct systematic observations. Seven accelerometers were identified including the StepWatch Activity Monitor, activPAL, GENEActiv, Kenz Lifecorder EX, Actiwatch-L, Tractivity and AugmenTech Inc. Pittsburgh accelerometer. Three studies used a subjective measure (interviews with nurses and patients) to classify patients into low, intermediate and high mobility groups. The StepWatch Activity Monitor was reported to be most accurate at step-counting in patients with slow gait speed or altered gait. The activPAL was reported to be highly accurate at classifying postures. Conclusion: Physical activity levels of older inpatients can be measured using accelerometers. The accuracy of the accelerometers varies between devices and population-specific validation studies are needed to determine their suitability in measuring physical activity levels of hospitalised older people. Subjective measures are less accurate but can be a practical way of measuring physical activity in a larger group of patients. [ABSTRACT FROM AUTHOR]

Background: Comprehensive Geriatric Assessment (CGA) is now the accepted gold standard for caring for frail older people in hospital. However, there is uncertainty about identifying and targeting suitable recipients and which patients benefit the most. Objectives: our objectives were to describe the key elements, principal measures of outcome and the characteristics of the main beneficiaries of inpatient CGA. Methods: we used the Joanna Briggs Institute umbrella review method. We searched for systematic reviews and metaanalyses describing CGA services for hospital inpatients in the Cochrane Database of Systematic Reviews, Database of Reviews of Effectiveness (DARE), MEDLINE and EMBASE and a range of other sources. Results: we screened 1,010 titles and evaluated 419 abstracts for eligibility, 143 full articles for relevance and included 24 in a final quality and relevance check. Thirteen reviews, reported in 15 papers, were selected for review. The most widely used definition of CGA was: 'a multidimensional, multidisciplinary process which identifies medical, social and functional needs, and the development of an integrated/co-ordinated care plan to meet those needs'. Key clinical outcomes included mortality, activities of daily living and dependency. The main beneficiaries were people ≥55 years in receipt of acute care. Frailty in CGA recipients and patient related outcomes were not usually reported. Conclusions: we confirm a widely used definition of CGA. Key outcomes are death, disability and institutionalisation. The main beneficiaries in hospital are older people with acute illness. The presence of frailty has not been widely examined as a determinant of CGA outcome. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate the thermal stability of 23 commercially-available endodontic obturation materials. Materials and methods: Specimens ( n = 10) were sealed in aluminum differential scanning calorimetry (DSC) crucibles and subjected to thermal scan series consisting of a 25 to 70 °C at 5 °C/min followed by a rapid increase to 230 °C, followed by a second scan from 25 to 70 °C at 5 °C/min. The first scan evaluated the materials as-received followed by a worse-case-scenario thermal challenge simulating temperatures involved with warm vertical condensation obturation techniques. The second thermal scan observed any phase changes from the high temperature challenge. This two-scan process was repeated twice to observe changes encountered by repeat high heat exposure during obturation. Mean thermal enthalpies were analyzed with Kruskal-Wallis and Games-Howell post-hoc test. ( p = 0.05). Results: Thermal behavior was material dependent. During the first thermal scan, materials typically demonstrated broad endothermic enthalpy curves suggesting either a gutta-percha phase mixture and/or an alpha crystalline phase. The first high-heat challenge produced definitive alpha/beta thermal phase signatures usually associated with gutta-percha. Changes in beta-phase enthalpies were noted with Therarmafil Plus and UltraFil Firmset while increase in alpha-phases was observed with GuttaCore, K3, Lexicon, and Schein Accessory Points. Conclusions: Commercial endodontic gutta-percha obturation materials displayed thermal characteristics that were material dependent. However, all demonstrated stability at temperatures in excess to that experienced during warm vertical condensation techniques. Clinical relevance: The gutta-percha obturation materials evaluated in this evaluation can be used successfully in warm vertical condensation techniques without fear of degradation. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is common in hospital inpatients and is associated with increased morbidity and mortality. Insufficient assistance at mealtimes can contribute to this and therefore trained volunteer mealtime assistants may be of benefit. Objectives: To identify and review the current evidence for the impact of trained volunteer mealtime assistants on dietary intake and satisfaction with mealtime care in adult hospital inpatients. Methods: A systematic search of Medline, Embase and CINAHL was conducted to identify relevant articles. Articles of any methodology were considered. Quality assessment and data extraction were carried out by two reviewers independently. Participants: Participants were inpatients in a hospital setting, including rehabilitation units. Participants in long term care facilities were excluded. Intervention: Articles that examined the effect of trained volunteer mealtime assistants on nutritional outcomes or satisfaction with mealtime care were included. Results: 5576 articles were identified, of which 14 were included in the review. Nine were small research studies and five were quality improvement initiatives. The quality of eight studies was moderate, with one study being of lower quality. Eight articles reported dietary intake and seven demonstrated an improvement, with protein intakes at volunteer mealtimes increasing by 4.3g-10.1g and energy intakes by 44-105kcal. Ten articles reported positive staff, patient and volunteer feedback. No adverse events were reported. Conclusion: There is evidence from small studies and improvement projects that trained volunteer mealtime assistants are safe and improve satisfaction with mealtime care in hospital inpatients, although evidence for an effect on dietary intake was less consistent. Larger studies with robust methodology are required to confirm this. [ABSTRACT FROM AUTHOR]

Objective: To determine the feasibility of a Dance Centre delivering a programme of mixed dances to people with Parkinson's and identify suitable outcomes for a future definitive trial. Design: A two-group randomized controlled feasibility trial. Methods: People with Parkinson's were randomized to a control or experimental group (ratio 15:35), alongside usual care. In addition, participants in the experimental group danced with a partner for one hour, twice-a-week for 10 weeks; professional dance teachers led the classes and field-notes were kept. Control-group participants were given dance class vouchers at the end of the study. Blinded assessments of balance, mobility and function were completed in the home. Qualitative interviews were conducted with a subsample to explore the acceptability of dance. Results: A total of 51 people with Parkinson's (25 male) with Hoehn and Yahr scores of 1-3 and mean age of 71 years (range 49-85 years), were recruited to the study. Dance partners were of similar age (mean 68, range 56-91 years). Feasibility findings focused on recruitment (target achieved); retention (five people dropped out of dancing); outcome measures (three measures were considered feasible, changes were recommended). Proposed sample size for a Phase III trial, based on the 6-minute walk test at six months was 220. Participants described dance as extremely enjoyable and the instructors were skilled in instilling confidence and motivation. The main organizational challenges for a future trial were transport and identifying suitable dance partners. Conclusion: We have demonstrated the feasibility of conducting the study through a Dance Centre and recommend a Phase III trial. [ABSTRACT FROM AUTHOR]

ABSTRACT Declines in populations of birds that breed in disturbance-dependent early-successional forest have largely been ascribed to habitat loss. Clearcutting is an efficient and effective means for creating early-successional vegetation; however, negative public perceptions of clearcutting and the small parcel size typical of private forested land in much of the eastern United States make this practice impractical in many situations. Group selection harvests, where groups of adjacent trees are removed from a mature forest matrix, may be more acceptable to the public and could provide habitat for shrubland birds. Although some shrubland bird species that occupy clearcuts are scarce or absent from smaller patches created by group selection, some of these smaller patches support shrubland species of conservation concern. The specific factors affecting shrubland bird occupancy of these smaller patches, such as habitat structure, patch area, and landscape context, are poorly understood. We sampled birds in forest openings ranging 0.02-1.29 ha to identify species-specific minimum-area habitat requirements and other factors affecting shrubland birds. We modeled bird occurrence in relation to microhabitat-, patch-, and landscape-level variables using occupancy models. The minimum-area requirements for black-and-white warblers ( Mniotilta varia), common yellowthroats ( Geothlypis trichas), chestnut-sided warblers ( Setophaga pensylvanica), eastern towhees ( Pipilo erythrophthalmus), and gray catbirds ( Dumetella carolinensis) were ≤0.23 ha, whereas indigo buntings ( Passerina cyanea) and prairie warblers ( S. discolor) required openings of 0.56 ha and 1.11 ha, respectively. Notably, prairie warblers were more likely to occur in openings closer to large patches of habitat such as powerline corridors, even if those openings were small in size. We concluded that, despite their inability to support the entire suite of shrubland species, small forest openings can provide habitat for several species of conservation concern if proper attention is given to promoting suitable microhabitat, patch, and landscape characteristics. © 2017 The Wildlife Society. [ABSTRACT FROM AUTHOR]

In this article, we discuss the emergence of new models for delivery of Comprehensive Geriatric Assessment (CGA) in the acute hospital setting. CGA is the core technology of Geriatric Medicine and for hospital inpatients it improves key outcomes such as survival, time spent at home and institutionalisation. Traditionally It is delivered by specialised multidisciplinary teams, often in dedicated wards, but in recent years has begun to be taken up and developed quite early in the admission process (at the 'front door'), across traditional ward boundaries and in specialty settings such as surgical and preoperative care, and oncology. We have scanned recent literature, including observational studies of service evaluations, and service descriptions presented as abstracts of conference presentations to provide an overview of an emerging landscape of innovation and development in CGA services for hospital inpatients. [ABSTRACT FROM AUTHOR]

Feldspars occur with a range of major element chemistry and mineral structure. When dating sediments using coarse-grained feldspars, samples are prepared using density separation to make a crude distinction between potassium-rich and potassium-poor feldspar grains and other minerals. When applying luminescence dating techniques to rocks, even such relatively crude physical separation of minerals is not possible where intact rock slices are used. However, for both sediment and rock dating of feldspars, use of imaging detectors such as Electron-Multiplying Charge Coupled Devices (EMCCD) presents the opportunity to spatially resolve different mineral grains, offering potential advantages over the more conventional photomultiplier tubes that are typically used. Furthermore, scanning micro X-ray Fluorescence (µXRF) devices offer the opportunity to resolve major element chemistry at a similar resolution (~20µm) to EMCCD data, revealing different feldspar types and enabling these to be linked to luminescence behaviour. Such an approach would allow us to assess whether some feldspar types are better suited to dating than others. This study explores spatially-resolved optical resetting, dose response and fading properties for IRSL and IRPL signals in a selection of chemically and structurally characterized museum specimens of alkali and plagioclase feldspar. These feldspars were prepared as ~300 µm thick slices, and exposure to a SOL- 2 solar simulator was used to test optical resetting of the various luminescence signals examined. Spatiallyresolved detection of each luminescence signal was achieved using sensitive EMCCD detectors on SIRIOL [1] and DASH [2] heads mounted on a TL/OSL DA20 Risø reader. Maps of major element distributions for each feldspar slice were produced with a Bruker M4 Tornado Plus µXRF spectrometer. EMCCD and µXRF data were processed and analyzed using various packages in the Fiji distribution of the ImageJ software [3]. Bulk mineral structure was characterized for the feldspar samples by X-ray Diffraction (XRD) on powdered sample using a PANalytical X'Pert PRO Materials Powder Diffractometer, and bulk chemistry by XRF on pressed pellets of sample and cellulose binder using a Rigaku Primus IV XRF spectrometer. Spatial variability was observed in the luminescence properties across the signals and feldspars investigated. Relationships between the behaviour of these luminescence properties and major element chemistry are explored. The benefits of high spatial resolution measurements, and different feldspar types, are discussed in terms of luminescence dating of rocks and sediments. [ABSTRACT FROM AUTHOR]

Aims: To develop financial models which offset additional costs associated with femtosecond laser (FL)-assisted cataract surgery (FLACS) against improvements in productivity and to determine important factors relating to its implementation into the National Health Service (NHS). Methods: FL platforms are expensive, in initial purchase and running costs. The additional costs associated with FL technology might be offset by an increase in surgical efficiency. Using a 'hub and spoke' model to provide high-volume cataract surgery, we designed a financial model, comparing FLACS against conventional phacoemulsification surgery (CPS). The model was populated with averaged financial data from 4 NHS foundation trusts and 4 commercial organisations manufacturing FL platforms. We tested our model with sensitivity and threshold analyses to allow for variations or uncertainties. Results: The averaged weekly workload for cataract surgery using our hub and spoke model required either 8 or 5.4 theatre sessions with CPS or FLACS, respectively. Despite reduced theatre utilisation, CPS (average £433/case) was still found to be 8.7% cheaper than FLACS (average £502/case). The greatest associated cost of FLACS was the patient interface (PI) (average £135/case). Sensitivity analyses demonstrated that FLACS could be less expensive than CPS, but only if increased efficiency, in terms of cataract procedures per theatre list, increased by over 100%, or if the cost of the PI was reduced by almost 70%. Conclusions: The financial viability of FLACS within the NHS is currently precluded by the cost of the PI and the lack of knowledge regarding any gains in operational efficiency. [ABSTRACT FROM AUTHOR]

Background Young people in residential or foster care experience multiple transitions around their 18th birthday without the long term and consistent support from their family of origin that most of their peers can expect. We report a mixed methods qualitative study of transitions across health and social care services for children leaving care, providing narratives of what young people described as positive, and what they and professionals think might be improved. Methods Data were collected in participatory meetings and individual interviews between young people and researchers ( n = 24) and individual interviews with practitioners ( n = 11). In addition to discussion and interview techniques, we used pictorial and other participatory methods. Interviews were coded by three members of the team and differences resolved with a fourth. Our analysis draws on thematic and framework approaches. Results Health was rarely at the top of any young person's agenda, although gaps in health care and exceptional care were both described. Housing, financial support and education took priority. Young people and professionals alike emphasized the importance of workers prepared to go the extra mile; of young people being able to contact professionals; and professionals being able to contact one another. Conclusions Policy and practice aspirations for care leavers recommend gradual change but transfer rather than transition continues to be described by care leavers. Our data support the need for transition as a long-term process, with children and young people having early opportunities to prepare for citizenship. [ABSTRACT FROM AUTHOR]

Objectives To quantitate the vestibulo-ocular reflex ( VOR) gain in patients with acute vestibular neuritis ( VN) and repeat this daily using a portable video head impulse test device to assess vestibular recovery in the acute stage of VN. Materials and methods We enrolled adults with symptoms and signs of VN presenting to the emergency department within 48 h of symptom onset. We recorded the eye movement response to rapid head impulses using the ICS Impulse™ video head impulse test device on each day of their hospital admission. Results There were eight patients (75% men, aged 35-85 years) who had marked variation in their initial vestibulo-ocular reflex gains. Three patients had vestibulo-ocular reflex gains in the normal range initially, despite having physical signs of VN. Two patients had initial contralesional gains below the normal range, associated with markedly reduced ipsilesional gains. Most patients' vestibulo-ocular reflex gains increased during admission, but four patients' ipsilesional gains remained in the abnormal range. Patients with lower vestibulo-ocular reflex gains were less likely to improve into the normal range. No patient with initially abnormal VOR gain recovered normal vestibulo-ocular reflex gain along with resolution of physical signs. Conclusion Early video head impulse testing in the emergency department and each day of admission is feasible and well tolerated. There is marked variation in VOR gain in patients with symptoms and signs of VN, and low initial VOR gains are a predictor for low VOR gains on subsequent days. Improvement in VOR gains was seen in most patients. [ABSTRACT FROM AUTHOR]

Aim To evaluate whether objective data could be obtained regarding internal pressure conditions of a molar tooth with canals prepared but not filled exposed to reduced barometric pressures that could be experienced by aircrew. Methodology The root canals of five mandibular molars were prepared but not filled. Root apices were sealed with a resin-modified glass-ionomer liner and root surfaces sealed with a dental adhesive. The sealed root surfaces were then coated with a polyvinylsiloxane ( PVS) adhesive and the teeth inserted into cylinders of PVS impression material to the level of the cervical enamel junction. Barometric pressure transducers were placed in the pulp chambers with the endodontic access sealed with cotton and a provisional restoration. The specimens were then subjected to a manually controlled, atmospheric altitude challenge consisting of a slow ascent and descent to a simulated 25 000 feet above sea level followed by a rapid altitude climb and descent. The real-time difference between intracanal and simulated atmospheric pressures were recorded and correlated (Pearson's, P = 0.05). Results No tooth material fractured, and there was no failure of the provisional restorations. Barometric pressures inside the closed prepared molar canals and the ambient atmospheric pressure were found to correlate ( r2 = 0.97-0.99; P < 0.0001), but pressure equalization lags were observed. However, no differences greater than six pounds per square inch (310 torr) were noted. Conclusion This pilot study established a protocol that demonstrated that objective data regarding barometric pressures within the prepared canals of molars can be obtained at simulated altitude conditions. [ABSTRACT FROM AUTHOR]

Objectives: To understand lay views on infant size and growth and their implications for a British population.Methods: A systematic review of parental and other lay views about the meanings and importance of infant size and growth using Medline, PsycInfo, CINAHL, Sociological Abstracts, IBSS, ASSIA, British Nursing Index ChildData, Caredata, SIGLE, Dissertation Abstracts (US), Index to Theses. 19 studies, most of which reported the views of mothers, from the US, Canada, the UK and Finland were reviewed.Results: Notions of healthy size and growth were dominated by the concept of normality. Participants created norms by assessing and comparing size and growth against several reference points. When size or growth differed from these norms, explanations were sought for factors that would account for this difference. When no plausible explanation could be found, growth or size became a worry for parents.Conclusions: Parents consider the importance of contextual factors when judging what is appropriate or healthy growth. For public health advice to be effective, lay, as well as scientific, findings and values need to be considered. [ABSTRACT FROM AUTHOR]

Plants possess anti-herbivore defences that could be exploited for crop protection. The potential for deploying physical defence traits for more sustainable pest management (i.e. reduced pesticide application) has not been fully realised. Using a perennial crop (red raspberry, Rubus idaeus), we take the novel approach of quantifying within- and between-genotype variation in a resistance trait, leaf trichome density, to determine precisely the effect of trichomes on host plant preference and suitability for two shoot-feeding arthropods, the European large raspberry aphid ( Amphorophora idaei) and two-spotted spider mite ( Tetranychus urticae). Additionally, we tested whether this trait influenced searching behaviour of a generalist herbivore predator (lacewing larvae, Chrysoperla carnea). Although there was no consistent genotypic variation in R. idaeus suitability for T. urticae, our hypothesis that T. urticae would avoid high leaf trichome density was supported on certain genotypes. The deterrent effect was mainly on egg deposition rather than leaf selection by adults, with up to sixfold differences in leaf preference depending on the genotypes offered. By contrast, there was significant genotypic variation in R. idaeus suitability for A. idaei (10-fold variation in aphid abundance), but, contrary to our prediction, aphid preference and infestation levels were unrelated to leaf trichome density. Instead, A. idaei performed best on vigorous genotypes, indicating that plant tolerance traits contributed to R. idaeus suitability for aphids. Leaf trichomes had little effect on the behaviour of the beneficial control agent C. carnea larvae. We conclude that physical anti-herbivore defences, specifically leaf trichomes, could be deployed to deter particular arthropod pests. However, the mechanistic approach adopted here is necessary to avoid antagonistic effects on other pests or on natural enemies. [ABSTRACT FROM AUTHOR]

Objective: Painful peripheral neuropathy in people with type 2 diabetes is a disabling complication. We explored associations of this condition with socioeconomic deprivation. Research Design and Methods: The Townsend index of socioeconomic deprivation was examined in the pseudonymised GP records of 15388 (44.1 % female) individuals with type 2 diabetes in the Cheshire county of England, and related to prevalence of drug treated painful diabetic neuropathy. We also analysed prescription trends with respect to pharmacotherapy for neuropathy pain relief. Results: Treatment for neuropathic pain was initiated in 3 266 (21.2 %) of patients. Those on treatment were older [68.2 (95 % CI 67.8–68.7) vs. 66.6 (66.4–66.8) years] than those not on treatment. There was no difference in HbA1c (7 %, 55 mmol/mol). There were significant differences between the groups for the Townsend deprivation index, with a greater proportion (30.6 % vs. 22.8 % of patients with treated neuropathic pain) having a score of ≥ 1 (X2 = 83.9, p < 0.0001). Multivariate logistic regression analyses indicated that each unit increment in the Townsend index was associated with an 6 % increased odds of requiring neuropathic pain treatment [odds ratio (95 %CI) 1.06 (1.05-1.08), p < 0.0001] independent of 5 year age band, BMI, gender, systolic BP, eGFR, HbA1C and total cholesterol. Conclusions: In this study using pseudonymised clinical records, a higher level of socioeconomic deprivation seemingly may predispose to severe neuropathic pain in diabetes requiring pharmacological intervention. Targeted allocation of healthcare resources to this group may offer clinical benefits. [ABSTRACT FROM AUTHOR]