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Background Patient and public involvement ( PPI) in research is growing internationally, but little is known about black and minority ethnic ( BME) involvement and the factors influencing their involvement in health and social care research. Objectives To characterize and critique the empirical literature on BME- PPI involvement in health and social care research. Search strategy Systematic searches of six electronic bibliographic databases were undertaken, utilizing both Me SH and free-text terms to identify international empirical literature published between 1990 and 2016. Inclusion criteria All study designs that report primary data that involved BME groups in health or social care research. Screening was conducted by two reviewers. Data extraction and synthesis Data extraction and quality appraisal were performed independently. Data extraction focused on the level(s) of PPI involvement and where PPI activity occurred in the research cycle. Studies were quality-assessed using the guidelines for measuring the quality and impact of user involvement in research. Data were analysed using a narrative approach. Main results Forty-five studies were included with the majority undertaken in the USA focusing on African Americans and indigenous populations. Involvement most commonly occurred during the research design phase and least in data analysis and interpretation. Conclusion This is the first systematic review investigating BME involvement in health and social care research internationally. While there is a widespread support for BME involvement, this is limited to particular phases of the research and particular ethnic subgroups. There is a need to understand factors that influence BME involvement in all parts of the research cycle. [ABSTRACT FROM AUTHOR]

Along urbanised coastlines, urban infrastructure is increasingly becoming the dominant habitat. These structures are often poor surrogates for natural habitats, and a diversity of eco-engineering approaches have been trialled to enhance their biodiversity, with varying success., We undertook a quantitative meta-analysis and qualitative review of 109 studies to compare the efficacy of common eco-engineering approaches (e.g. increasing texture, crevices, pits, holes, elevations and habitat-forming taxa) in enhancing the biodiversity of key functional groups of organisms, across a variety of habitat settings and spatial scales., All interventions, with one exception, increased the abundance or number of species of one or more of the functional groups considered. Nevertheless, the magnitude of effect varied markedly among groups and habitat settings. In the intertidal, interventions that provided moisture and shade had the greatest effect on the richness of sessile and mobile organisms, while water-retaining features had the greatest effect on the richness of fish. In contrast, in the subtidal, small-scale depressions which provide refuge to new recruits from predators and other environmental stressors such as waves, had higher abundances of sessile organisms while elevated structures had higher numbers and abundances of fish. The taxa that responded most positively to eco-engineering in the intertidal were those whose body size most closely matched the dimensions of the resulting intervention., Synthesis and applications. The efficacy of eco-engineering interventions varies among habitat settings and functional groups. This indicates the importance of developing site-specific approaches that match the target taxa and dominant stressors. Furthermore, because different types of intervention are effective at enhancing different groups of organisms, ideally a range of approaches should be applied simultaneously to maximise niche diversity. [ABSTRACT FROM AUTHOR]

Extensive development and construction in marine and coastal systems is driving a phenomenon known as “ocean sprawl”. Ocean sprawl removes or transforms marine habitats through the addition of artificial structures and some of the most significant impacts are occurring in sedimentary environments. Marine sediments have substantial social, ecological, and economic value, as they are rich in biodiversity, crucial to fisheries productivity, and major sites of nutrient transformation. Yet the impact of ocean sprawl on sedimentary environments has largely been ignored. Here we review current knowledge of the impacts to sedimentary ecosystems arising from artificial structures. Artificial structures alter the composition and abundance of a wide variety of sediment-dependent taxa, including microbes, invertebrates, and benthic-feeding fishes. The effects vary by structure design and configuration, as well as the physical, chemical, and biological characteristics of the environment in which structures are placed. The mechanisms driving effects from artificial structures include placement loss, habitat degradation, modification of sound and light conditions, hydrodynamic changes, organic enrichment and material fluxes, contamination, and altered biotic interactions. Most studies have inferred mechanism based on descriptive work, comparing biological and physical processes at various distances from structures. Further experimental studies are needed to identify the relative importance of multiple mechanisms and to demonstrate causal relationships. Additionally, past studies have focused on impacts at a relatively small scale, and independently of other development that is occurring. There is need to quantify large-scale and cumulative effects on sedimentary ecosystems as artificial structures proliferate. We highlight the importance for comprehensive monitoring using robust survey designs and outline research strategies needed to understand, value, and protect marine sedimentary ecosystems in the face of a rapidly changing environment. [ABSTRACT FROM AUTHOR]

The growing number of artificial structures in estuarine, coastal and marine environments is causing “ocean sprawl”. Artificial structures do not only modify marine and coastal ecosystems at the sites of their placement, but may also produce larger-scale impacts through their alteration of ecological connectivity - the movement of organisms, materials and energy between habitat units within seascapes. Despite the growing awareness of the capacity of ocean sprawl to influence ecological connectivity, we lack a comprehensive understanding of how artificial structures modify ecological connectivity in near- and off-shore environments, and when and where their effects on connectivity are greatest. We review the mechanisms by which ocean sprawl may modify ecological connectivity, including trophic connectivity associated with the flow of nutrients and resources. We also review demonstrated, inferred and likely ecological impacts of such changes to connectivity, at scales from genes to ecosystems, and potential strategies of management for mitigating these effects. Ocean sprawl may alter connectivity by: (1) creating barriers to the movement of some organisms and resources - by adding physical barriers or by modifying and fragmenting habitats; (2) introducing new structural material that acts as a conduit for the movement of other organisms or resources across the landscape; and (3) altering trophic connectivity. Changes to connectivity may, in turn, influence the genetic structure and size of populations, the distribution of species, and community structure and ecological functioning. Two main approaches to the assessment of ecological connectivity have been taken: (1) measurement of structural connectivity - the configuration of the landscape and habitat patches and their dynamics; and (2) measurement of functional connectivity - the response of organisms or particles to the landscape. Our review reveals the paucity of studies directly addressing the effects of artificial structures on ecological connectivity in the marine environment, particularly at large spatial and temporal scales. With the ongoing development of estuarine and marine environments, there is a pressing need for additional studies that quantify the effects of ocean sprawl on ecological connectivity. Understanding the mechanisms by which structures modify connectivity is essential if marine spatial planning and eco-engineering are to be effectively utilised to minimise impacts. [ABSTRACT FROM AUTHOR]

Studies on the robustness of ecological communities suggest that the loss or reduction in abundance of individual species can lead to secondary and cascading extinctions. However, most such studies have been simulation-based analyses of the effect of primary extinction on food web structure., In a field experiment we tested the direct and indirect effects of reducing the abundance of a common species, focusing on the diverse and self-contained assemblage of arthropods associated with an abundant Brazilian shrub, Baccharis dracunculifolia D.C. ( Asteraceae)., Over a 5-month period we experimentally reduced the abundance of Baccharopelma dracunculifoliae ( Sternorrhyncha: Psyllidae), the commonest galling species associated with B. dracunculifolia, in 15 replicate plots paired with 15 control plots. We investigated direct effects of the manipulation on parasitoids attacking B. dracunculifoliae, as well as indirect effects (mediated via a third species or through the environment) on 10 other galler species and 50 associated parasitoid species., The experimental manipulation significantly increased parasitism on B. dracunculifoliae in the treatment plots, but did not significantly alter either the species richness or abundance of other galler species. Compared to control plots, food webs in manipulated plots had significantly lower values of weighted connectance, interaction evenness and robustness (measured as simulated tolerance to secondary extinction), even when B. dracunculifoliae was excluded from calculations., Parasitoid species were almost entirely specialized to individual galler species, so the observed effects of the manipulation on food web structure could not have propagated via the documented trophic links. Instead, they must have spread either through trophic links not included in the webs (e.g. shared predators) or non-trophically (e.g. through changes in habitat availability). Our results highlight that the inclusion of both trophic and non-trophic direct and indirect interactions is essential to understand the structure and dynamics of even apparently discrete ecological communities. [ABSTRACT FROM AUTHOR]

Summary Defining specific cellular and molecular mechanisms in most obesity-related diseases remains an important challenge. Here we report a serendipitous finding that consumption of a high-fat diet (HFD) greatly increased the occurrence of skin lesions in C57BL/6 mice. We demonstrated that HFD induced the accumulation of a specific type of CD11c + macrophages in skin preceding detectable lesions. These cells primed skin to induce IL-1β and IL-18 signaling, which further promoted the cytokines IFN-γ- and IL-17-mediated skin inflammation. Mechanistically, epidermal fatty acid binding protein (E-FABP) was significantly upregulated in skin of obese mice, which coupled lipid droplet formation and NLRP3 inflammasome activation. Deficiency of E-FABP in obese mice decreased recruitment of CD11c + macrophages in skin tissues, reduced production of IL-1β and IL-18, and consequently dampened activation of effector T cells. Furthermore, E-FABP-deficient mice are completely resistant to HFD-induced skin lesions. Collectively, E-FABP represents a molecular sensor triggering HFD-induced skin inflammation. [ABSTRACT FROM AUTHOR]

Voluntary and community organisations ( VCOs) have health benefits for those who attend and are viewed as having the potential to support long-term condition management. However, existing community-level understandings of participation do not explain the involvement with VCOs at an individual level, or the nature of support, which may elicit health benefits. Framing active participation as 'doing and experiencing', the aim of this qualitative study was to explore why people with long-term vascular conditions join VCOs, maintain their membership and what prevents participation. Twenty participants, self-diagnosed as having diabetes, chronic heart disease or chronic kidney disease, were purposefully sampled and recruited from a range of VCOs in the North West of England identified from a mapping of local organisations. In semi-structured interviews, we explored the nature of their participation. Analysis was thematic and iterative involving a continual reflection on the data. People gave various reasons for joining groups. These included health and well-being, the need for social contact and pursuing a particular hobby. Barriers to participation included temporal and spatial barriers and those associated with group dynamics. Members maintained their membership on the basis of an identity and sense of belonging to the group, developing close relationships within it and the availability of support and trust. Participants joined community groups often in response to a health-related event. Our findings demonstrate the ways in which the social contact associated with continued participation in VCOs is seen as helping with long-term condition management. Interventions designed at improving chronic illness management might usefully consider the role of VCOs. [ABSTRACT FROM AUTHOR]

Gradients in elevation are increasingly used to investigate how species respond to changes in local climatic conditions. Whilst many studies have shown elevational patterns in species richness and turnover, little is known about how food web structure is affected by elevation., Contrasting responses of predator and prey species to elevation may lead to changes in food web structure. We investigated how the quantitative structure of a herbivore-parasitoid food web changes with elevation in an Australian subtropical rain forest., On four occasions, spread over 1 year, we hand-collected leaf miners at twelve sites, along three elevational gradients (between 493 m and 1159 m a.s.l). A total of 5030 insects, including 603 parasitoids, were reared, and summary food webs were created for each site. We also carried out a replicated manipulative experiment by translocating an abundant leaf-mining weevil Platynotocis sp., which largely escaped parasitism at high elevations (≥900 m a.s.l.), to lower, warmer elevations, to test if it would experience higher parasitism pressure., We found strong evidence that the environmental change that occurs with increasing elevation affects food web structure. Quantitative measures of generality, vulnerability and interaction evenness decreased significantly with increasing elevation (and decreasing temperature), whilst elevation did not have a significant effect on connectance. Mined plant composition also had a significant effect on generality and vulnerability, but not on interaction evenness. Several relatively abundant species of leaf miner appeared to escape parasitism at higher elevations, but contrary to our prediction, Platynotocis sp. did not experience greater levels of parasitism when translocated to lower elevations., Our study indicates that leaf-mining herbivores and their parasitoids respond differently to environmental conditions imposed by elevation, thus producing structural changes in their food webs. Increasing temperatures and changes in vegetation communities that are likely to result from climate change may have a restructuring effect on host-parasitoid food webs. Our translocation experiment, however, indicated that leaf miners currently escaping parasitism at high elevations may not automatically experience higher parasitism under warmer conditions and future changes in food web structure may depend on the ability of parasitoids to adapt to novel hosts. [ABSTRACT FROM AUTHOR]

Background Implementation of long-term condition management interventions rests on the notion of whole systems re-design, where incorporating wider elements of health care systems are integral to embedding effective and integrated solutions. However, most self-management support (SMS) evaluations still focus on particular elements or outcomes of a sub-system. A randomised controlled trial of a SMS intervention (WISE-Whole System Informing Selfmanagement Engagement) implemented in primary care showed no effect on patient-level outcomes. This paper reports on a parallel process evaluation to ascertain influences affecting WISE implementation at patient, clinical and organisational levels. Normalisation Process Theory (NPT) provided a sensitising background and analytical framework. Methods A multi-method approach using surveys and interviews with organisational stakeholders, practice staff and trial participants about impact of training and use of tools developed for WISE. Analysis was sensitised by NPT (coherence, cognitive participation, collective action and reflective monitoring). The aim was to identify what worked and what did not work for who and in what context. Results Interviews with organisation stakeholders emphasised top-down initiation of WISE by managers who supported innovation in self-management. Staff from 31 practices indicated engagement with training but patchy adoption of WISE tools; SMS was neither prioritised by practices nor fitted with a biomedically focussed ethos, so little effort was invested in WISE techniques. Interviews with 24 patients indicated no awareness of any changes following the training of practice staff; furthermore, they did not view primary care as an appropriate place for SMS. Conclusion The results contribute to understanding why SMS is not routinely adopted and implemented in primary care. WISE was not embedded because of the perceived lack of relevance and fit to the ethos and existing work. Enacting SMS within primary care practice was not viewed as a legitimate activity or a professional priority. There was failure to, in principle, engage with and identify patients' support needs. Policy presumptions concerning SMS appear to be misplaced. Implementation of SMS within the health service does not currently account for patient circumstances. Primary care priorities and support for SMS could be enhanced if they link to patients' broader systems of implementation networks and resources. [ABSTRACT FROM AUTHOR]

Background: An implementation gap exists between policy aspirations for provision and the delivery of self-management support in primary care. An evidence based training and support package using a whole systems approach implemented as part of a randomised controlled trial was delivered to general practice staff. The trial found no effect of the intervention on patient outcomes. This paper explores why self-management support failed to become part of normal practice. We focussed on implementation of tools which capture two key aspects of self-management support - education (guidebooks for patients) and forming collaborative partnerships (a shared decision-making tool). Objectives: To evaluate the implementation and embedding of self-management support in a United Kingdom primary care setting. Design: Qualitative semi-structured interviews with primary care professionals. Settings: 12 General Practices in the Northwest of England located within a deprived inner city area. Participants: Practices were approached 3-6 months after undergoing training in a selfmanagement support approach. A pragmatic sample of 37 members of staff - General Practitioners, nurses, and practice support staff from 12 practices agreed to take part. The analysis is based on interviews with 11 practice nurses and one assistant practitioner; all were female with between 2 and 21 years' experience of working in general practice. Methods: A qualitative design involving face-to-face, semi-structured interviews audio- recorded and transcribed. Normalisation Process Theory framework allowed a systematic evaluation of the factors influencing the work required to implement the tools. Findings: The guidebooks were embedded in daily practice but the shared decision- making tools were not. Guidebooks were considered to enhance patient-centredness and were minimally disruptive. Practice nurses were reluctant to engage with behaviour change discussions. Self-management support was not formulated as a practice priority and there was minimal support for this activity within the practice: it was not auditable; [ABSTRACT FROM AUTHOR]

• Local people's voices need to be included in research and planning processes using inclusive and innovative methods. • We used participatory photography to capture local perspectives on resources, changes and adaptations in Papua New Guinea. • Results show that villagers are facing rapid social-ecological changes, including growing populations, more cash crop diseases and land shortages. • People have adapted by shifting to well yielding crop species, setting up small businesses and aiming to get an education. • Results can be used in future research and planning processes in Papua New Guinea. There is a need to include local people's voices in research and planning processes to better understand what they see as opportunities and challenges for their future. This is necessary because of the intrinsic importance of public participation, and because it can help produce more useful and implementable adaptation plans. We apply participatory photography in a Papua New Guinean smallholder farming community to explore local perspectives on resource management, drivers of change and adaptive strategies. Twenty-four farmers of different clans, genders and ages took photos of items important to their livelihoods, focusing separately on the past, present and future. We discussed the photos and their meanings in individual and group interviews, encouraging farmers to lead the conversations. Results show that farmers are shifting from relying mainly on natural capitals to using financial, social and physical capitals, and that this causes changes in people's well-being. Villagers see cash crop diseases, land shortages and lack of training as their main challenges. So far, people have adapted to changes by shifting to crop species that still yield well, and setting up small businesses and projects to have additional sources of income. Farmers see education as key to their future as it would allow for better land management and diversification of livelihoods. The participatory photography process provided triangulation of scientific studies, gave insights into farmers' perceptions, and highlighted adaptive strategies and the complexities of realising them. Overall, the results can be used in future research and planning processes in Papua New Guinea. [ABSTRACT FROM AUTHOR]

Background Recent initiatives to target the personal, social and clinical needs of people with long-term health conditions have had limited impact within primary care. Evidence of the importance of social networks to support people with long-term conditions points to the need for self-management approaches which align personal circumstances with valued activities. The Patient-Led Assessment for Network Support (PLANS) intervention is a needs-led assessment for patients to prioritise their health and social needs and provide access to local community services and activities. Exploring the work and practices of patients and telephone workers are important for understanding and evaluating the workability and implementation of new interventions. Methods Qualitative methods (interviews, focus group, observations) were used to explore the experience of PLANS from the perspectives of participants and the telephone support workers who delivered it (as part of an RCT) and the reasons why the intervention worked or not. Normalisation Process Theory (NPT) was used as a sensitising tool to evaluate: the relevance of PLANS to patients (coherence); the processes of engagement (cognitive participation); the work done for PLANS to happen (collective action); the perceived benefits and costs of PLANS (reflexive monitoring). 20 patients in the intervention arm of a clinical trial were interviewed and their telephone support calls were recorded and a focus group with 3 telephone support workers was conducted. Results Analysis of the interviews, support calls and focus group identified three themes in relation to the delivery and experience of PLANS. These are: formulation of 'health' in the context of everyday life; trajectories and tipping points: disrupting everyday routines; precarious trust in networks. The relevance of these themes are considered using NPT constructs in terms of the work that is entailed in engaging with PLANS, taking action, and who is implicated this process. Conclusions PLANS gives scope to align long-term condition management to everyday life priorities and valued aspects of life. This approach can improve engagement with health-relevant practices by situating them within everyday contexts. This has potential to increase utilisation of local resources with potential cost-saving benefits for the NHS. [ABSTRACT FROM AUTHOR]

Purpose: Adolescents and young adults (AYAs) aged 15-39 at diagnosis have very low cancer clinical trial accrual rates. To date, no studies have examined attitudes toward clinical trial participation in this age range to determine if certain individuals are less likely to enroll if offered participation. The current study assessed attitudes toward participation using the Cancer Treatment Subscale of the Attitudes toward Cancer Trials Scales. Methods: Data were collected from a sample of leukemia and lymphoma survivors ( n=99) and a healthy college student sample ( n=397). Following a principal components analysis, two subscales-Personal Barriers/Safety and Personal Benefits-were retained for analysis. Results: In the cancer survivor group, only 14 (13.3%) reported being offered participation in a cancer clinical trial, and only 8 of those 14 (7.6% of survivors) participated. Responses from leukemia and lymphoma survivors revealed no significant relationships between age, gender, race/ethnicity, clinical trial participation, insurance status, or social class with Personal Benefits or Personal Barriers/Safety. Healthy college females had more negative Personal Barriers/Safety attitudes compared to males after adjusting for race/ethnicity and social class ( p=0.01), but no associations were present when examining Personal Benefits as an outcome. Conclusion: This preliminary investigation suggests that drivers of attitudes toward clinical trial participation in AYAs are not well understood and may impact cancer trial participation. Future work should focus on defining attitudes toward cancer clinical trials in the AYA population and developing interventions to increase awareness, knowledge, and positive attitudes toward participating in cancer research. [ABSTRACT FROM AUTHOR]

Objective To combine insights from service users with long-term conditions ( LTCs) to assist the development of a community referral intervention designed to promote engagement and improve access to health-relevant resources. Background Social deprivation and reduced access to resources have been causally linked with social isolation and the ability to manage LTCs. Participation in meaningful activity has been associated with positive health benefits, and strategies to promote access to community activities have shown some potential to improve outcomes for people with LTCs. This suggests the need to develop an engagement and referral intervention in partnership with service users and community groups as part of mainstream self-care support. Method A series of focus groups and interviews with members of community groups in Greater Manchester designed as an iterative and collaborative approach to elicit the role of personal and community networks that support long-term condition management ( LTCM) to develop a community referral tool. Results Participants reported a broad range of resources relevant to LTCM that often went beyond the usual concerns associated with self-care. This helped to inform a tool ( PLANS) to tailor access to types of community-based resources which can support LTCM. Conclusions Understanding the everyday challenges of living with a LTC highlighted the importance of connecting and engaging with localized support for people. In response to this, we developed an intervention ( PLANS) which tailors access to local resources based on personal preferences, needs and acceptability to encourage service users to engage with sustainable health choices. [ABSTRACT FROM AUTHOR]

Coastal areas are especially vulnerable to habitat loss, sea-level rise, and other climate change effects. Oyster-dominated eco-engineered reefs have been promoted as integral components of engineered habitats enhancing coastal resilience through provision of numerous ecological, morphological, and socio-economic services. However, the assessed 'success' of these eco-engineered oyster reefs remains variable across projects and locations, with their general efficacy in promoting coastal resilience, along with related services, often mixed at best. Understanding factors influencing the success of these eco-engineered habitats as valuable coastal management tools could greatly inform related future efforts. Here, we review past studies incorporating reef-building oysters for coastal resilience and enhanced ecosystem services. Our aims are to better understand their utility and limitations, along with critical knowledge gaps to better advance future applicability. Success depends largely on site selection, informed by physical, chemical and biological factors, and adjacent habitats and bottom types. Better understanding of oyster metapopulation dynamics, tolerance and adaptation to changing conditions, and interactions with adjacent habitats will help to better identify suitable locations, and design more effective eco-engineered reefs. These eco-engineered reefs provide a useful tool to assist in developing coastal resilience in the face of climate change and sea level rise. • Oyster-dominated reefs have been promoted as integral components of engineered habitats for reducing coastal vulnerability. • Oyster reefs can be a useful tool in our toolkit for achieving ecological, morphological and socio-economic benefits. • Understanding the factors influencing the success of these eco-engineered habitats could greatly inform related future efforts. • Oyster reefs can support coastal resilience in the face of climate change and related rising sea-levels [ABSTRACT FROM AUTHOR]

Summary: Species-rich tropical communities are expected to be more specialized than their temperate counterparts [1–3]. Several studies have reported increasing biotic specialization toward the tropics [4–7], whereas others have not found latitudinal trends once accounting for sampling bias [8, 9] or differences in plant diversity [10, 11]. Thus, the direction of the latitudinal specialization gradient remains contentious. With an unprecedented global data set, we investigated how biotic specialization between plants and animal pollinators or seed dispersers is associated with latitude, past and contemporary climate, and plant diversity. We show that in contrast to expectation, biotic specialization of mutualistic networks is significantly lower at tropical than at temperate latitudes. Specialization was more closely related to contemporary climate than to past climate stability, suggesting that current conditions have a stronger effect on biotic specialization than historical community stability. Biotic specialization decreased with increasing local and regional plant diversity. This suggests that high specialization of mutualistic interactions is a response of pollinators and seed dispersers to low plant diversity. This could explain why the latitudinal specialization gradient is reversed relative to the latitudinal diversity gradient. Low mutualistic network specialization in the tropics suggests higher tolerance against extinctions in tropical than in temperate communities. [ABSTRACT FROM AUTHOR]

Background: Although a high fraction of inspired oxygen (FIO2) could reduce surgical site infection, there is concern it could increase postoperative pulmonary complications, including hypoxemia. Intraoperative positive end-expiratory pressure can improve postoperative pulmonary function. A practical measure of postoperative pulmonary function and the degree of hypoxemia is supplemental oxygen requirement. We performed a double-blind randomized 2 × 2 factorial study on the effects of intraoperative FIO2 0.3 versus more than 0.9 with and without positive end-expiratory pressure on the primary outcome of postoperative supplemental oxygen requirements in patients undergoing lower risk surgery. Methods: After Institutional Review Board approval and consent, 100 subjects were randomized using computer-generated lists into four treatment groups (intraoperative FIO2 0.3 vs. more than 0.9, with and without 3-5 cm H2O positive end-expiratory pressure). Thirty minutes and 24 h after extubation, supplemental oxygen was discontinued. Arterial oxygen saturation by pulse oximetry was recorded 15 min later. If oxygen saturation decreased to less than 90%, supplemental oxygen was added incrementally to maintain saturation more than 90%. Results: Nearly all subjects required supplemental oxygen in the postanesthesia care unit. Nonparametric Wilcoxon rank sum test demonstrated no statistically significant difference between groups in supplemental oxygen requirements at 45 min and 24 h after tracheal extubation (P = 0.56 and 0.98, respectively). Conclusions: Use of intraoperative FIO2 more than 0.9 was not associated with increased oxygen requirement, suggesting it does not induce postoperative hypoxemia beyond anesthetic induction and surgery. Therefore, it may be reasonable to use high inspired oxygen in surgical patients with relatively normal pulmonary function. [ABSTRACT FROM AUTHOR]

Background: Kruppel-like factor KLF4 is a transcription factor critical for the establishment of the barrier function of the skin. Its function in stem cell biology has been recently recognized. Previous studies have revealed that hair follicle stem cells contribute to cutaneous wound healing. However, expression of KLF4 in hair follicle stem cells and the importance of such expression in cutaneous wound healing have not been investigated. Methodology/Principal Findings: Quantitative real time polymerase chain reaction (RT-PCR) analysis showed higher KLF4 expression in hair follicle stem cell-enriched mouse skin keratinocytes than that in control keratinocytes. We generated KLF4 promoter-driven enhanced green fluorescence protein (KLF4/EGFP) transgenic mice and tamoxifen-inducible KLF4 knockout mice by crossing KLF4 promoter-driven Cre recombinase fused with tamoxifen-inducible estrogen receptor (KLF4/ CreERTM) transgenic mice with KLF4(flox) mice. KLF4/EGFP cells purified from dorsal skin keratinocytes of KLF4/EGFP transgenic mice were co-localized with 5-bromo-2'-deoxyuridine (BrdU)-label retaining cells by flow cytometric analysis and immunohistochemistry. Lineage tracing was performed in the context of cutaneous wound healing, using KLF4/CreERTM and Rosa26RLacZ double transgenic mice, to examine the involvement of KLF4 in wound healing. We found that KLF4 expressing cells were likely derived from bulge stem cells. In addition, KLF4 expressing multipotent cells migrated to the wound and contributed to the wound healing. After knocking out KLF4 by tamoxifen induction of KLF4/CreERTM and KLF4(flox) double transgenic mice, we found that the population of bulge stem cell-enriched population was decreased, which was accompanied by significantly delayed cutaneous wound healing. Consistently, KLF4 knockdown by KLF4-specific small hairpin RNA in human A431 epidermoid carcinoma cells decreased the stem cell population and was accompanied by compromised cell migration. Conclusions/Significance: KLF4 expression in mouse hair bulge stem cells plays an important role in cutaneous wound healing. These findings may enable future development of KLF4-based therapeutic strategies aimed at accelerating cutaneous wound closure. [ABSTRACT FROM AUTHOR]

Adolescent and young adult cancer survivors face unique challenges not systematically addressed by cancer clinicians. Four focus groups and two individual interviews were conducted with 19 survivors to profile experiences and identify key concerns for future interventions. The resultant themes reflect cancer care continuum challenges (such as delays in diagnosis, problems with adherence), psychosocial concerns (such as infertility and reproductive concerns, changing social relationships, financial burden), and the paradox of being diagnosed with cancer as a young adult. Future intervention development for adolescent and young adult survivors should involve patient voices at each stage of the research process. [ABSTRACT FROM AUTHOR]

Adolescent and young adult cancer survivors face unique challenges not systematically addressed by cancer clinicians. Four focus groups and two individual interviews were conducted with 19 survivors to profile experiences and identify key concerns for future interventions. The resultant themes reflect cancer care continuum challenges (such as delays in diagnosis, problems with adherence), psychosocial concerns (such as infertility and reproductive concerns, changing social relationships, financial burden), and the paradox of being diagnosed with cancer as a young adult. Future intervention development for adolescent and young adult survivors should involve patient voices at each stage of the research process. [ABSTRACT FROM PUBLISHER]

Background: Patients with long-term conditions are increasingly the focus of quality improvement activities in health services to reduce the impact of these conditions on quality of life and to reduce the burden on care utilisation. There is significant interest in the potential for self-management support to improve health and reduce utilisation in these patient populations, but little consensus concerning the optimal model that would best provide such support. We describe the implementation and evaluation of self-management support through an evidence-based 'whole systems' model involving patient support, training for primary care teams, and service re-organisation, all integrated into routine delivery within primary care. Methods: The evaluation involves a large-scale, multi-site study of the implementation, effectiveness, and cost-effectiveness of this model of self-management support using a cluster randomised controlled trial in patients with three long-term conditions of diabetes, chronic obstructive pulmonary disease (COPD), and irritable bowel syndrome (IBS). The outcome measures include healthcare utilisation and quality of life. We describe the methods of the cluster randomised trial. Discussion: If the 'whole systems' model proves effective and cost-effective, it will provide decision-makers with a model for the delivery of self-management support for populations with long-term conditions that can be implemented widely to maximise 'reach' across the wider patient population. [ABSTRACT FROM AUTHOR]

Induction of ornithine decarboxylase (ODC), a key enzyme in polyamine biosynthesis, in ODC transgenic skin stimulates epidermal proliferation but not hyperplasia, activates underlying stromal cells and promotes skin tumorigenesis following a single subthreshold dose of a carcinogen. Because chronic wounds are a well-recognized risk factor for skin cancer, we investigated the response to a tissue remodeling event in normal skin that is abraded to remove only the epidermal layer in K6/ODC transgenic (follicular ODC expression) and in inducible ODCER transgenic mice (suprabasal ODC expression). When regenerative epidermal hyperplasia was resolved in normal littermates following abrasion, ODC transgenic mice exhibited progressive epidermal hyperplasia with formation of benign tumor growths and maintained an increased epidermal proliferation index and activation of translation-associated proteins at abrasion sites. The epidermal hyperplasia and tumor-like growth was accompanied by activation of underlying stromal cells and prolonged infiltration of inflammatory cells. Treatment with the anti-inflammatory agent dexamethasone did not reduce the high proliferative index in the regenerated epidermis but dramatically reduced the epidermal hyperplasia and prevented the wound-induced tumor growths in abraded ODCER skin. Treatment with α-difluoromethylornithine, a specific inhibitor of ODC activity, normalized the wound response in transgenic mice and decreased wound-induced inflammation if administered from the time of abrasion but not if initiated 4 days following abrasion. These results suggest a role for polyamines in prolonging wound-associated inflammation in addition to stimulating proliferation both of which are sufficient to sustain epidermal hyperplasia and benign tumor growth even in the absence of genetic damage. [ABSTRACT FROM AUTHOR]

The article informs about a study on the role of stem cells in chemical carcinogenesis. It is speculated that tumors may arise from stem cells especially in tissues with a high selfrenewing capacity, such as the haematopoietic system, gut and the skin. It is stated that the rapid progress in stem cell and cancer stem cell research will provide effective insights in carcinogenesis, resulting in considerable improvement in cancer treatments.

While many studies have demonstrated that organic farms support greater levels of biodiversity, it is not known whether this translates into better provision of ecosystem services. Here we use a food-web approach to analyse the community structure and function at the whole-farm scale. Quantitative food webs from 10 replicate pairs of organic and conventional farms showed that organic farms have significantly more species at three trophic levels (plant, herbivore and parasitoid) and significantly different network structure. Herbivores on organic farms were attacked by more parasitoid species on organic farms than on conventional farms. However, differences in network structure did not translate into differences in robustness to simulated species loss and we found no difference in percentage parasitism (natural pest control) across a variety of host species. Furthermore, a manipulative field experiment demonstrated that the higher species richness of parasitoids on the organic farms did not increase mortality of a novel herbivore used to bioassay ecosystem service. The explanation for these differences is likely to include inherent differences in management strategies and landscape structure between the two farming systems. [ABSTRACT FROM AUTHOR]

Swidden agriculture (a type of small-scale agriculture) is crucial to the livelihood and food security of millions of people in tropical regions. Social-ecological changes, including population growth and anti-swidden policies, are putting pressure on the existing swidden system to increase agricultural productivity in a sustainable way. Enhancing soil fertility is a promising option for increasing crop yields and extending lifetimes of agricultural fields, thereby reducing the demand to clear new land. However, there is limited information on how swidden farmers can best maintain soil fertility. Our aim was to investigate whether using locally available fertilisers can increase soil quality, crop yields and lifetimes of swidden fields. We established experimental gardens on the land of swidden farmers in the Lowlands of Papua New Guinea, where the majority of the population depends on swidden agriculture. Gardens were set up on two types of sites; five were established on new sites that had just been prepared for gardening by cutting and burning vegetation after a fallow period, whereas another five were prepared on garden sites that were just being fallowed. We applied three treatments; i) compost consisting of decaying banana peels, ii) chicken manure, and iii) NPK fertiliser to different plots within each garden; and tracked soil quality and yields of sweet potato over 12 months (three post-intervention cropping periods). We also conducted in-depth interviews with local farmers to understand their perspective on soil management. Few farmers typically used compost, chicken manure or NPK fertiliser. Many were keen to try these fertilisers, provided they had more information. The performance of treatments depended on the type of garden with chicken manure increasing tuber yields in fallowed gardens but not new gardens, and banana peel compost also increasing tuber yields in fallowed gardens although not significantly. NPK fertiliser was the best option because it was the only fertiliser that increased yields in both new and fallowed gardens, produced tubers of similar quality and taste to control plots and was financially profitable. Treatments affected yield through increasing available nitrogen and reducing soil moisture. We also found that farmers fallow their gardens despite adequate sweet potato yields, so whether using fertilisers can enhance the lifetime of fields will depend on additional factors such as labour input needed. Our work shows how swidden agriculture can potentially be adapted so that it continues to be a sustainable way of farming and living. [Display omitted] • Locally available fertilisers improved soil quality and enhanced the yields of swidden farmers. • Fertilisers improved yield through increasing available nitrogen and reducing soil moisture. • Treatment with NPK fertiliser produced the highest yields and good quality crops. • Farmers in Papua New Guinea showed great interest in applying fertilisers provided they had more information. • Soil management practices can help swidden farmers adapt to social-ecological changes. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses Comprehensive Microarray Transcriptome Profiling of CD34-Enriched Mouse Keratinocyte Stem Cells.

The discovery of long-lived epithelial stem cells in the bulge region of the hair follicle led to the hypothesis that epidermal renewal and epidermal repair after wounding both depend on these cells. To determine whether bulge cells are necessary for epidermal renewal, here we have ablated these cells by targeting them with a suicide gene encoding herpes simplex virus thymidine kinase (HSV-TK) using a Keratin 1–15 (Krt1-15) promoter. We show that ablation leads to complete loss of hair follicles but survival of the epidermis. Through fate-mapping experiments, we find that stem cells in the hair follicle bulge do not normally contribute cells to the epidermis which is organized into epidermal proliferative units, as previously predicted. After epidermal injury, however, cells from the bulge are recruited into the epidermis and migrate in a linear manner toward the center of the wound, ultimately forming a marked radial pattern. Notably, although the bulge-derived cells acquire an epidermal phenotype, most are eliminated from the epidermis over several weeks, indicating that bulge stem cells respond rapidly to epidermal wounding by generating short-lived 'transient amplifying' cells responsible for acute wound repair. Our findings have implications for both gene therapy and developing treatments for wounds because it will be necessary to consider epidermal and hair follicle stem cells as distinct populations. [ABSTRACT FROM AUTHOR]

Natural killer (NK) cells are crucial in the control of cytomegalovirus infections in mice and humans. Here we show that the viral UL141 gene product has an immunomodulatory function that is associated with low-passage strains of human cytomegalovirus. UL141 mediated efficient protection of cells against killing by a wide range of human NK cell populations, including interferon-a-stimulated bulk cultures, polyclonal NK cell lines and most NK cell clones tested. Evasion of NK cell killing was mediated by UL141 blocking surface expression of CD155, which was previously identified as a ligand for NK cell-activating receptors CD226 (DNAM-1) and CD96 (TACTILE). The breadth of the UL141-mediated effect indicates that CD155 has a key role in regulating NK cell function. [ABSTRACT FROM AUTHOR]

Mouse keratinocyte stem cells originate from the bulge of hair follicle, and, according to definition, possess a clonogenic activity in vitro. We have investigated seven inbred (C57BL/6, C3H, DBA/2, BALB/c, FVB) and outbred (SENCAR, CD-1) mouse strains and found that three genetically distinct subsets of mouse strains differ significantly in the frequency of clonogenic activity in vitro. The analysis of keratinocyte colonies in two reciprocal backcross [C57BL/6 × (BALB/c × C57BL/6); BALB/c × (BALB/c × C57BL/6)] and intercross [(BALB/c × C57BL/6)F2] of BALB/c and C57BL/6 mice allowed us to identify two subpopulations of clonogenic keratinocytes able to produce small (less than 2 mm2) and large (more than 2 mm2) colonies. We conducted linkage analysis and found that small colonies associated with mouse chromosomes 1, 6, 7, 8, and 9; but large colonies—with the chromosome 4. We defined locus on the chromosome 9 that associated with small colonies as keratinocyte stem cell locus 1 ( Ksc1), and locus on the mouse chromosome 4 associated with large colonies-keratinocyte stem cell locus 2 ( Ksc2). Ksc1 and loci on chromosomes 6 and 7 are close if not equal to loci associated with sensitivity to skin carcinogenesis. We conclude that two subpopulations of stem cells able to produce small and large colonies regulated by different genes and genes regulating small colonies might be responsible for sensitivity to skin carcinogenesis. [ABSTRACT FROM AUTHOR]

Cell adhesion and communication are interdependent aspects of cell behavior that are critical for morphogenesis and tissue architecture. In the skin, epidermal adhesion is mediated in part by specialized cell-cell junctions known as desmosomes, which are characterized by the presence of desmosomal cadherins, known as desmogleins and desmocollins. We identified a cadherin family member, desmoglein 4, which is expressed in the suprabasal epidermis and hair follicle. The essential role of desmoglein 4 in skin was established by identifying mutations in families with inherited hypotrichosis, as well as in the lanceolate hair mouse. We also show that DSG4 is an autoantigen in pemphigus vulgaris. Characterization of the phenotype of naturally occurring mutant mice revealed disruption of desmosomal adhesion and perturbations in keratinocyte behavior. We provide evidence that desmoglein 4 is a key mediator of keratinocyte cell adhesion in the hair follicle, where it coordinates the transition from proliferation to differentiation. [Copyright &y& Elsevier]

Presents evidence that despite otherwise similar cutaneous parameters, the number of keratinocyte colony is a genetically definable quantitative trait. Difference between the keratinocyte colony number from two backcross generation; Tendency for the colony number in the F2 generation to be intermediate between the two backcrosses.

Presents letters to the editor related to dermatology. Epithelialization of cells; Formation of hair follicle; Use of primary epidermal cells for the investigation.

Background: Implementation of long-term condition management interventions rests on the notion of whole systems re-design, where incorporating wider elements of health care systems are integral to embedding effective and integrated solutions. However, most self-management support (SMS) evaluations still focus on particular elements or outcomes of a sub-system. A randomised controlled trial of a SMS intervention (WISE-Whole System Informing Self-management Engagement) implemented in primary care showed no effect on patient-level outcomes. This paper reports on a parallel process evaluation to ascertain influences affecting WISE implementation at patient, clinical and organisational levels. Normalisation Process Theory (NPT) provided a sensitising background and analytical framework.Methods: A multi-method approach using surveys and interviews with organisational stakeholders, practice staff and trial participants about impact of training and use of tools developed for WISE. Analysis was sensitised by NPT (coherence, cognitive participation, collective action and reflective monitoring). The aim was to identify what worked and what did not work for who and in what context.Results: Interviews with organisation stakeholders emphasised top-down initiation of WISE by managers who supported innovation in self-management. Staff from 31 practices indicated engagement with training but patchy adoption of WISE tools; SMS was neither prioritised by practices nor fitted with a biomedically focussed ethos, so little effort was invested in WISE techniques. Interviews with 24 patients indicated no awareness of any changes following the training of practice staff; furthermore, they did not view primary care as an appropriate place for SMS.Conclusion: The results contribute to understanding why SMS is not routinely adopted and implemented in primary care. WISE was not embedded because of the perceived lack of relevance and fit to the ethos and existing work. Enacting SMS within primary care practice was not viewed as a legitimate activity or a professional priority. There was failure to, in principle, engage with and identify patients' support needs. Policy presumptions concerning SMS appear to be misplaced. Implementation of SMS within the health service does not currently account for patient circumstances. Primary care priorities and support for SMS could be enhanced if they link to patients' broader systems of implementation networks and resources. [ABSTRACT FROM AUTHOR]

Background: Recent initiatives to target the personal, social and clinical needs of people with long-term health conditions have had limited impact within primary care. Evidence of the importance of social networks to support people with long-term conditions points to the need for self-management approaches which align personal circumstances with valued activities. The Patient-Led Assessment for Network Support (PLANS) intervention is a needs-led assessment for patients to prioritise their health and social needs and provide access to local community services and activities. Exploring the work and practices of patients and telephone workers are important for understanding and evaluating the workability and implementation of new interventions.Methods: Qualitative methods (interviews, focus group, observations) were used to explore the experience of PLANS from the perspectives of participants and the telephone support workers who delivered it (as part of an RCT) and the reasons why the intervention worked or not. Normalisation Process Theory (NPT) was used as a sensitising tool to evaluate: the relevance of PLANS to patients (coherence); the processes of engagement (cognitive participation); the work done for PLANS to happen (collective action); the perceived benefits and costs of PLANS (reflexive monitoring). 20 patients in the intervention arm of a clinical trial were interviewed and their telephone support calls were recorded and a focus group with 3 telephone support workers was conducted.Results: Analysis of the interviews, support calls and focus group identified three themes in relation to the delivery and experience of PLANS. These are: formulation of 'health' in the context of everyday life; trajectories and tipping points: disrupting everyday routines; precarious trust in networks. The relevance of these themes are considered using NPT constructs in terms of the work that is entailed in engaging with PLANS, taking action, and who is implicated this process.Conclusions: PLANS gives scope to align long-term condition management to everyday life priorities and valued aspects of life. This approach can improve engagement with health-relevant practices by situating them within everyday contexts. This has potential to increase utilisation of local resources with potential cost-saving benefits for the NHS.Trial Registration: ISRCTN45433299. [ABSTRACT FROM AUTHOR]

Objective To combine insights from service users with long-term conditions ( LTCs) to assist the development of a community referral intervention designed to promote engagement and improve access to health-relevant resources. Background Social deprivation and reduced access to resources have been causally linked with social isolation and the ability to manage LTCs. Participation in meaningful activity has been associated with positive health benefits, and strategies to promote access to community activities have shown some potential to improve outcomes for people with LTCs. This suggests the need to develop an engagement and referral intervention in partnership with service users and community groups as part of mainstream self-care support. Method A series of focus groups and interviews with members of community groups in Greater Manchester designed as an iterative and collaborative approach to elicit the role of personal and community networks that support long-term condition management ( LTCM) to develop a community referral tool. Results Participants reported a broad range of resources relevant to LTCM that often went beyond the usual concerns associated with self-care. This helped to inform a tool ( PLANS) to tailor access to types of community-based resources which can support LTCM. Conclusions Understanding the everyday challenges of living with a LTC highlighted the importance of connecting and engaging with localized support for people. In response to this, we developed an intervention ( PLANS) which tailors access to local resources based on personal preferences, needs and acceptability to encourage service users to engage with sustainable health choices. [ABSTRACT FROM AUTHOR]

The mammalian skin is a complex dynamic organ composed of thin multilayered epidermis and a thick underlying connective tissue layer dermis. The epidermis undergoes continuous renewal throughout life. The stems cells uniquely express particular surface markers utilized for their identification, isolation and localization in specific niches in epidermis as well as hair follicles (HFs). The two stage skin carcinogenesis model involves stepwise accumulation of genetic alterations and ultimately leading to malignancy. Whereas early research on skin carcinogenesis focused on the molecular nature of carcinogens and tumor promoters, more recent studies have focused on the identification of the target cells and tumor promoting cells for both chemical and physical carcinogens and promoters. Recent studies support the hypothesis that keratinocyte stem cells are the targets in skin carcinogenesis. In this review, we discuss briefly the localization of stem cells in the epidermis and HFs, and review the possibility that skin papillomas and carcinomas are derived from stem cells, as well as from other cells in the cutaneous epithelium whose stem cell properties are not well known. [ABSTRACT FROM AUTHOR]

Background: Patients with long-term conditions are increasingly the focus of quality improvement activities in health services to reduce the impact of these conditions on quality of life and to reduce the burden on care utilisation. There is significant interest in the potential for self-management support to improve health and reduce utilisation in these patient populations, but little consensus concerning the optimal model that would best provide such support. We describe the implementation and evaluation of self-management support through an evidence-based 'whole systems' model involving patient support, training for primary care teams, and service re-organisation, all integrated into routine delivery within primary care.Methods: The evaluation involves a large-scale, multi-site study of the implementation, effectiveness, and cost-effectiveness of this model of self-management support using a cluster randomised controlled trial in patients with three long-term conditions of diabetes, chronic obstructive pulmonary disease (COPD), and irritable bowel syndrome (IBS). The outcome measures include healthcare utilisation and quality of life. We describe the methods of the cluster randomised trial.Discussion: If the 'whole systems' model proves effective and cost-effective, it will provide decision-makers with a model for the delivery of self-management support for populations with long-term conditions that can be implemented widely to maximise 'reach' across the wider patient population.Trial Registration Number: ISRCTN: ISRCTN90940049. [ABSTRACT FROM AUTHOR]