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ObjectivesExtending palliative care services to those with long-term neurological conditions is a current aim of UK health policy. Lack of holistic guidelines for palliative and end-of-life care, and differing models of service provision, has resulted in heterogeneity in care access and quality. There is a need for evidence-based standards of care to audit Parkinson’s services and drive improvements.MethodsA two-stage Delphi process was used to achieve consensus on statements that define quality standards in palliative care for patients with Parkinson’s disease (PD). An expert panel was selected to comprise healthcare professionals, patients and carers based in the UK; this panel evaluated the statements via a Delphi survey. Quantitative and qualitative analysis of the results informed modifications between the Delphi rounds.ResultsA final set of 16 statements was produced, reflecting aspirational standards of palliative care in PD. These statements, split into four domains (‘Structures and processes of care’, ‘Preparing for the end of life’, ‘ Care in the last weeks of life’ and ‘Care in the last days of life’) underline the importance of joint working between generalist and specialist services, individualised care and early and regular advance care planning.ConclusionsThe Delphi process has established a set of standards which can be integrated within and guide services, helping to improve the quality and equality of care. Further work remains to establish the effectiveness of different models of service provision, including the implementation of keyworkers and telemedicine.

Biodiversity of terrestrial and marine ecosystems, including coral reefs, is dominated by small, often cryptic, invertebrate taxa that play important roles in ecosystem structure and functioning. While cryptofauna community structure is determined by strong small-scale microhabitat associations, the extent to which ecological and environmental factors shape these communities are largely unknown, as is the relative importance of particular microhabitats in supporting reef trophodynamics from the bottom up. The goal of this study was to address these knowledge gaps, provided coral reefs are increasingly exposed to multiple disturbances and environmental gradients that influence habitat complexity, condition and ecosystem functioning. We compared the density, biomass, size range, phylogenetic diversity and functional roles of motile cryptofauna in Palau, Western Micronesia, among four coral-derived microhabitats representing various states of degradation (live coral [Acropora and Pocillopora], dead coral and coral rubble) from reefs along a gradient of effluent exposure. In total, 122 families across ten phyla were identified, dominated by the Arthropoda (Crustacea) and Mollusca. Cryptofauna biomass was greatest in live Pocillopora, while coral rubble contained the greatest density and diversity. Size ranges were broader in live corals than both dead coral and rubble. From a bottom-up perspective, effluent exposure had mixed effects on cryptic communities including a decline in total biomass in rubble. From a top-down perspective, cryptofauna were generally unaffected by predator biomass. Our data show that, as coral reef ecosystems continue to decline in response to more frequent and severe disturbances, habitats other than live coral may become increasingly important in supporting coral reef biodiversity and food webs.

OBJECTIVE To analyze the impact of modern glucose-monitoring strategies on glycemic and patient-related outcomes in individuals with type 2 diabetes (T2D) and recent myocardial infarction (MI) and assess cost effectiveness. RESEARCH DESIGN AND METHODS LIBERATES was a multicenter two-arm randomized trial comparing self-monitoring of blood glucose (SMBG) with intermittently scanned continuous glucose monitoring (isCGM), also known as flash CGM, in individuals with T2D and recent MI, treated with insulin and/or a sulphonylurea before hospital admission. The primary outcome measure was time in range (TIR) (glucose 3.9–10 mmol/L/day) on days 76–90 post-randomization. Secondary and exploratory outcomes included time in hypoglycemia, hemoglobin A1c (HbA1c), clinical outcome, quality of life (QOL), and cost effectiveness. RESULTS Of 141 participants randomly assigned (median age 63 years; interquartile range 53, 70), 73% of whom were men, isCGM was associated with increased TIR by 17 min/day (95% credible interval −105 to +153 min/day), with 59% probability of benefit. Users of isCGM showed lower hypoglycemic exposure ( CONCLUSIONS Compared with SMBG, isCGM in T2D individuals with MI marginally increases TIR and significantly reduces hypoglycemic exposure while equally improving HbA1c, explaining its cost effectiveness. Studies are required to understand whether these glycemic differences translate into longer-term clinical benefit.

Genetic assessment of an embryo via preimplantation genetic testing (PGT) represents an important reproductive option for couples wanting to try and improve success rates from in vitro fertilisation (IVF) cycles, as well as reduce their risk of having a child born with a genetic condition. Currently, biopsy of the developing embryo prior to transfer allows genetic assessment of an embryo for either chromosome copy number (aneuploidy [PGT-A] or segmental rearrangement [PGT-SR]) or to avoid the transmission of a single gene condition (monogenic conditions [PGT-M]). However, this technology is invasive and commands considerable resources. Non-invasive PGT (niPGT) ofers a potential alternate mode of embryonic analysis. Whilst the utility of niPGT-A has been recently explored, there has been limited consideration of niPGT-M as an option for couples at risk of passing on a single gene or chromosomal condition. This review examines the historical and current clinical context of preimplantation embryonic analysis for monogenic conditions, in addition to important considerations surrounding the origin and analysis of cell-free deoxyribose nucleic acid (cfDNA), whether it is sourced via blastocentesis or spent embryonic culture medium (SCM). Future capabilities of this testing modality will almost certainly be enhanced by integration of whole genome sequencing into everyday practice. In addition, the increased utilisation of reproductive carrier screening as part of standard reproductive healthcare will likely result in the identification of a larger high-risk population. As a result, stratification of limited and highly specialised reproductive genetic resources will be required. Prospective parents should continue to be made aware of the limitations of this technology, with prenatal confirmatory testing remaining an essential part of antenatal care in these patients. However, niPGT-M poses an important alternate testing modality for high-risk couples, particularly in the setting of embryos that cannot be biopsied for traditional PGT-M and as demand for this treatment continues to grow. Refereed/Peer-reviewed

Background: Extending specialist palliative care to people with Parkinson's disease (PD) has been a priority over the past two decades. Despite improvements in advance care planning and early integration of palliative services, little is known about the dying phase of PD. Aims: To systematically review and synthesise the literature describing the occurrence and management of symptoms in the terminal phase of PD. Methods: Searches of MEDLINE, Embase, CINAHL, PsycInfo and Web of Science from 1990 to 2020 were conducted. Thematic synthesis of qualitative articles and narrative synthesis of quantitative articles were integrated to produce the final analysis. Findings: 285 articles were reviewed and 18 met the inclusion criteria. Professionals found recognition of the terminal phase challenging, and palliative care services are underused. Difficulties include titration of dopaminergic medication, leading to premature termination, or incorrect dosing, of medication. Conclusion: More research is needed to capture the terminal phase of PD, in both the hospital and community setting, in order to increase the evidence base for symptom management.

Background Uncertainty in patients' COVID-19 status contributes to treatment delays, nosocomial transmission, and operational pressures in hospitals. However, the typical turnaround time for laboratory PCR remains 12–24 h and lateral flow devices (LFDs) have limited sensitivity. Previously, we have shown that artificial intelligence-driven triage (CURIAL-1.0) can provide rapid COVID-19 screening using clinical data routinely available within 1 h of arrival to hospital. Here, we aimed to improve the time from arrival to the emergency department to the availability of a result, do external and prospective validation, and deploy a novel laboratory-free screening tool in a UK emergency department. Methods We optimised our previous model, removing less informative predictors to improve generalisability and speed, developing the CURIAL-Lab model with vital signs and readily available blood tests (full blood count [FBC]; urea, creatinine, and electrolytes; liver function tests; and C-reactive protein) and the CURIAL-Rapide model with vital signs and FBC alone. Models were validated externally for emergency admissions to University Hospitals Birmingham, Bedfordshire Hospitals, and Portsmouth Hospitals University National Health Service (NHS) trusts, and prospectively at Oxford University Hospitals, by comparison with PCR testing. Next, we compared model performance directly against LFDs and evaluated a combined pathway that triaged patients who had either a positive CURIAL model result or a positive LFD to a COVID-19-suspected clinical area. Lastly, we deployed CURIAL-Rapide alongside an approved point-of-care FBC analyser to provide laboratory-free COVID-19 screening at the John Radcliffe Hospital (Oxford, UK). Our primary improvement outcome was time-to-result, and our performance measures were sensitivity, specificity, positive and negative predictive values, and area under receiver operating characteristic curve (AUROC). Findings 72 223 patients met eligibility criteria across the four validating hospital groups, in a total validation period spanning Dec 1, 2019, to March 31, 2021. CURIAL-Lab and CURIAL-Rapide performed consistently across trusts (AUROC range 0·858–0·881, 95% CI 0·838–0·912, for CURIAL-Lab and 0·836–0·854, 0·814–0·889, for CURIAL-Rapide), achieving highest sensitivity at Portsmouth Hospitals (84·1%, Wilson's 95% CI 82·5–85·7, for CURIAL-Lab and 83·5%, 81·8–85·1, for CURIAL-Rapide) at specificities of 71·3% (70·9–71·8) for CURIAL-Lab and 63·6% (63·1–64·1) for CURIAL-Rapide. When combined with LFDs, model predictions improved triage sensitivity from 56·9% (51·7–62·0) for LFDs alone to 85·6% with CURIAL-Lab (81·6–88·9; AUROC 0·925) and 88·2% with CURIAL-Rapide (84·4–91·1; AUROC 0·919), thereby reducing missed COVID-19 cases by 65% with CURIAL-Lab and 72% with CURIAL-Rapide. For the prospective deployment of CURIAL-Rapide, 520 patients were enrolled for point-of-care FBC analysis between Feb 18 and May 10, 2021, of whom 436 received confirmatory PCR testing and ten (2·3%) tested positive. Median time from arrival to a CURIAL-Rapide result was 45 min (IQR 32–64), 16 min (26·3%) sooner than with LFDs (61 min, 37–99; log-rank p Interpretation Our findings show the generalisability, performance, and real-world operational benefits of artificial intelligence-driven screening for COVID-19 over standard-of-care in emergency departments. CURIAL-Rapide provided rapid, laboratory-free screening when used with near-patient FBC analysis, and was able to reduce the number of patients who tested negative for COVID-19 but were triaged to COVID-19-suspected areas.

The ecology and function of rocky temperate mesophotic ecosystems (TMEs) remain poorly understood globally despite their widespread distribution. They typically occur at 20-150 m (the limit of photosynthesis), and on rocky substratum they support rich benthic communities and mobile fauna. We determined the distribution of rocky TMEs, their conservation status, and their most characteristic biological groups. Rocky TMEs were dominated by algae, turf-invertebrate matrices (50 m only), sponges, bryozoans, and cnidarians. The community composition of TMEs differed significantly from shallow (0-15 m) subtidal reefs. Data were geographically biased and variable, available only from the North and South Atlantic, Mediterranean, and Temperate Australasia. Degree of protection of rocky TMEs varied considerably across the world. The biggest threats to rocky TMEs were identified changes in temperature, sedimentation rates, nutrient concentrations, and certain fishing types. We propose a conservation framework to inform future rocky TME management and conservation, highlighting the need to recognize the importance of these biologically diverse and functionally important ecosystems.Resumen La ecología y la función de los ecosistemas mesofóticos templados (TME) rocosos todavía no están muy comprendidas a nivel mundial a pesar de su amplia distribución. Comúnmente se encuentran entre los 20 y los 150 metros (el límite de la fotosíntesis) sobre sustratos rocosos que mantienen comunidades bénticas diversas y fauna móvil. Determinamos la distribución, estado de conservación y grupos biológicos más característicos de los TME rocosos. Estos ecosistemas estuvieron dominados por algas, matrices de invertebrados de pastos marinos (solamente a50 m), esponjas marinas, briozoos y cnidarios. La composición comunitaria de los TME difirió significativamente de los arrecifes submareales someros (0-15 m). Los datos estuvieron sesgados geográficamente y fueron variables, pues sólo estaban disponibles para el Atlántico norte y sur, el Mediterráneo y la Australasia templada. El nivel de protección de los TME rocosos varió considerablemente en todo el mundo. Las principales amenazas que enfrenta este ecosistema son los cambios en la temperatura, las tasas de sedimentación, la concentración de nutrientes y ciertos tipos de pesca. Proponemos un encuadre de conservación para orientar a futuro la gestión y conservación de los TME, el cual destaque la necesidad de reconocer la importancia de estos ecosistemas biológicamente diversos y funcionalmente importantes.虽然温带中光层岩石生态系统分布广泛, 但全球范围内对其生态及功能的了解仍然很少。它们通常出现在 20-150 米 (光合作用的极限), 以岩石为底质, 支持着丰富的底栖生物群落和活动的动物群。本研究确定了温带中光层岩石生态系统的分布、保护状态及其最具特色的生物群。我们发现, 温带中光层岩石生态系统主要由藻类、泥炭-无脊椎动物基质 (仅50 米) 、海绵、苔藓虫和刺胞动物组成, 其群落组成与浅海 (0-15 米) 潮下层礁石有很大不同。数据存在地理上的变异且有偏差, 只有北大西洋、南大西洋、地中海和温带澳大利西亚的数据。世界各地对温带中光层岩石生态系统的保护程度存在很大差异。温带中光层岩石生态系统的最大威胁是温度、沉积速度, 及营养物浓度和某些捕捞方式的变化。本研究提出了一个保护框架, 可为未来温带中光层岩石生态系统管理和保护提供参考, 并强调应认识到这些具有高生物多样性及关键功能的生态系统的重要性。【翻译: 胡怡思; 审校: 聂永刚】.

Although government promoted public health, social media and media campaigns have communicated nutrition information, the Australian population remains chronic under-consumers of fruit and vegetables and overconsumers of ultra-processed foods. This scoping review aimed to determine how social media influencers (SMI) communicate nutrition information and the factors that influence the popularity of messages. Identified factors could inform how governments may utilise social media to impact positively on food choices.Nine databases were searched in the past 5 years (2016-2021). After relevant sources were identified, entire texts of the grey literature and the "Results" sections of the academic literature were coded. Using Microsoft Word, each key feature of the relevant text was highlighted, and the relevant code was recorded. Inductive coding was utilised where codes were created based on the text itself. These codes were then sorted iteratively into relevant themes and subthemes.Eleven studies were included. From these sources, five themes were identified. These were, (i) promoting dietary change, (ii) certain modes/styles of content delivery, (iii) an attractive individual, (iv) language features and (v) appearing connected to the audience.SMI are selective in their content and communication techniques to ensure their nutrition messages are popular with social media users. These methods exhibited by SMI could inform strategies to build trust in government messages about food and nutrition.

The Tasman and Golden Bays (TBGB) are a semi-enclosed embayment system in New Zealand that supports numerous commercial and recreational activities. We present three ecosystem models of the TBGB ecosystem with varying levels of complexity, aimed at contributing as tools to aid in understanding this ecosystem and its responses to anthropogenic and natural pressures. We describe the process of data compilation through to model validation and analyse the importance of knowledge gaps with respect to model dynamics and results. We compare responses in all three models to historical fishing, and analyse similarities and differences in the dynamics of the three models. We assessed the most complex of the models against initialisation uncertainty and sensitivity to oceanographic variability and found it most sensitive to the latter. We recommend that scenarios relating to ecosystem dynamics of the TBGB ecosystem include sensitivities, especially oceanographic uncertainty, and compare responses across all three models where it is possible to do so.

Refuge availability and fishing alter predator-prey interactions on coral reefs, but our understanding of how they interact to drive food web dynamics, community structure and vulnerability of different trophic groups is unclear. Here, we apply a size-based ecosystem model of coral reefs, parameterized with empirical measures of structural complexity, to predict fish biomass, productivity and community structure in reef ecosystems under a broad range of refuge availability and fishing regimes. In unfished ecosystems, the expected positive correlation between reef structural complexity and biomass emerges, but a non-linear effect of predation refuges is observed for the productivity of predatory fish. Reefs with intermediate complexity have the highest predator productivity, but when refuge availability is high and prey are less available, predator growth rates decrease, with significant implications for fisheries. Specifically, as fishing intensity increases, predators in habitats with high refuge availability exhibit vulnerability to over-exploitation, resulting in communities dominated by herbivores. Our study reveals mechanisms for threshold dynamics in predators living in complex habitats and elucidates how predators can be food-limited when most of their prey are able to hide. We also highlight the importance of nutrient recycling via the detrital pathway, to support high predator biomasses on coral reefs.

In response to multiple stressors, coral reef health has declined in recent decades, with reefs exhibiting reduced living coral and structural complexity, and a concomitant rise in the dominance of algal resources. Reef degradation alters food availability and reduces the diversity and density of refuges for prey. These changes affect predator-prey interactions and can have cascading impacts on food webs and fisheries productivity. We use a size-based ecosystem model of coral reefs that incorporates the influence of structural complexity, benthic primary production and detrital recycling to explore how predator-prey interactions and fisheries productivity respond to a gradient of reef degradation. We show that fisheries productivity overall may be robust to initial stages of reef degradation because the benefits of increased resources outweigh the costs of moderate refuge decline. However, the assemblage composition and size structure of reef fish will differ on degraded reefs, with herbivores and invertivores contributing relatively more to productivity. More significant losses of refuges associated with the erosion of structural complexity correspond to fisheries productivity losses of at least 35% compared to healthy reefs. Synthesis and applications. Our model provides fisheries managers with quantitative predictions about how fisheries productivity may change in response to the ongoing degradation of coral reefs. We predict an initial increase in productivity at intermediate reef degradation, followed by a drastic decline when structural complexity is lost. We also capture subtle changes to potential catch composition and fish size, including increases in smaller herbivorous and invertivorous fish from degraded reefs, which will undoubtedly impact fisheries value. On the one hand, our results reassure for continued productivity in the short term, but on the other, we warn against complacency. Management must change to capture any potential benefits to fisheries, and long-term sustainability still depends on the maintenance of complex coral reef habitats.

Background Loneliness and social isolation are health risk factors that are comparable to obesity and cigarette smoking, with those experiencing it having a 26% greater likelihood of mortality. There are two at risk population groups: young adults (18–25 years) and oldest old (70 years). Through a combination of questionnaires, user-stories and discussions with experts, we learnt that this research applied to Cambridge: Cambridge medical students expressed feelings of loneliness and isolation during medical student placements, where they could be allocated in small groups (often 2 or 3 individuals) to remote areas of Cambridgeshire. Care homes residents reported a feeling of lack of social integration with those outside of their care homes. Aims Our aim was to create an intervention that: Tackled loneliness in students and elderly residents in Cambridge. Established social integration across different generations. Intervention Following a stakeholder engagement and workshop with: medical student representatives, Cambridge university executive board and Cambridge local council care home lead; a pilot pen-pal scheme was launched between care home residents and Cambridge medical students. Measurement of impact and improvement Impact will be measured following a year of letter-writing to assess: A change in score of feeling of loneliness. Understanding another generation. Provisional feedback has been positive, with all 10 pairs in the pilot recommending the scheme to a friend or family, and reporting that they have had ‘interesting and enjoyable conversations’. Conclusion Pen-to-paper is a unique and engaging way to tackle the complex problem of social isolation and loneliness in two at high-risk groups. The intervention has been well received by both groups and we are extending the intervention to residents in warden controlled/sheltered accommodation.

Library exhibition practices vary significantly between institutions, depending on expertise, resources and goals of the individual library. The University Libraries at Virginia Tech have supported and developed two exhibition programmes within the past 6 years, both with a focus on showcasing products and processes from classes around campus rather than library materials and artefacts. While such work is unique, it can provide valuable experiences both for the contributors and for the creators of these exhibitions, as well as those who see and interact with them. In this article, we discuss the history and origins of these programmes, the Course Exhibit Initiative and the Active Learning Curation Program, how they work and the outcomes they strive to achieve. We discuss the workflows that we take to showcase the work of our contributors and demonstrate how these programmes share some outcomes with exhibit programmes based in special collections but have their own unique challenges and opportunities. Finally, we make the case that the output of these two exhibit programmes provides a new experience of serendipity in libraries.

Background Hospice care is often perceived as being associated with stereotypical patients: white, middle-class, young and with cancer. Aim To review the literature concerning who is/is not referred for hospice care, with a focus on diagnosis, age, gender, marital status, ethnicity, geography and socio-economic status. Design of study Systematic literature review and narrative synthesis. Methods Searches of Medline, PsycINFO, CINAHL, Web of Science, Assia and Embase databases from January 1987 to December 2017 were conducted, with further citation, reference and hand searches. Studies of adult patients living in the UK/Australia/New Zealand and Canada and receiving a range of hospice care (inpatient, outpatient, day hospice, hospice at home, community specialist (Macmillan) nursing) were included. Case studies, opinion pieces and systematic reviews were excluded. Of 28 433 articles reviewed, 152 met the inclusion criteria. Extracted data were analysed using NVivo with a narrative synthesis of emergent themes. Results Since 1987, there has been extensive research demonstrating inequalities in hospice care provision. There is some evidence that some inequalities are reducing, particularly for those with non-malignant diseases. Nonetheless, there are still important groups with less access to hospice care, including the oldest old, ethnic minorities and those living in areas of high socioeconomic deprivation. Gender and marital status have little effect on hospice care provision. The literature concerning hospice care provision for the LGBTQ community and those living with HIV/AIDs is very limited. Conclusion Prognostic uncertainty and fragmentation of care remain barriers to receipt of hospice care for those with non-malignant disease. The oldest-old, the socio-economically deprived and those from ethnic minorities continue to receive less hospice care. There is a persisting challenge to the hospice movement to provide equitable access to all.

The need to support learning and provide equal access to information does not stop when a health emergency arises. It becomes even more important, and as such, libraries of all types in the Commonwealth quickly responded to 2020’s emerging crisis by enhancing existing services and creating innovative new services, proving that once again, library staff are vital participants in providing for the well-being of patrons. This column explores how library workers and libraries in Virginia quickly adapted to restrictions imposed as the COVID-19 pandemic began to spread.

Coral reefs provide critical services to coastal communities, and these services rely on ecosystem functions threatened by stressors. By summarizing the threats to the functioning of reefs from fishing, climate change, and decreasing water quality, we highlight that these stressors have multiple, conflicting effects on functionally similar groups of species and their interactions, and that the overall effects are often uncertain because of a lack of data or variability among taxa. The direct effects of stressors on links among functional groups, such as predator-prey interactions, are particularly uncertain. Using qualitative modeling, we demonstrate that this uncertainty of stressor impacts on functional groups (whether they are positive, negative, or neutral) can have significant effects on models of ecosystem stability, and reducing uncertainty is vital for understanding changes to reef functioning. This review also provides guidance for future models of reef functioning, which should include interactions among functional groups and the cumulative effect of stressors.

Sharks are considered the apex predator of coral reefs, but the consequences of their global depletion are uncertain. Here we explore the ecological roles of sharks on coral reefs and, conversely, the importance of reefs for sharks. We find that most reef-associated shark species do not act as apex predators but instead function as mesopredators along with a diverse group of reef fish. While sharks perform important direct and indirect ecological roles, the evidence to support hypothesised shark-driven trophic cascades that benefit corals is weak and equivocal. Coral reefs provide some functional benefits to sharks, but sharks do not appear to favour healthier reef environments. Restoring populations of sharks is important and can yet deliver ecological surprise.

Structural complexity strongly influences biodiversity and ecosystem productivity. On coral reefs, structural complexity is typically measured using a single and small-scale metric (‘rugosity’) that represents multiple spatial attributes differentially exploited by species, thus limiting a complete understanding of how fish associate with reef structure. We used a novel approach to compare relationships between fishes and previously unavailable components of reef complexity, and contrasted the results against the traditional rugosity index. This study focused on damselfish to explore relationships between fishes and reef structure. Three territorial species, with contrasting trophic habits and expected use of the reef structure, were examined to infer the potential species-specific mechanisms associated with how complexity influences habitat selection. Three-dimensional reef reconstructions from photogrammetry quantified the following metrics of habitat quality: 1) visual exposure to predators and competitors, 2) density of predation refuges and 3) substrate-related food availability. These metrics explained the species distribution better than the traditional measure of rugosity, and each species responded to different complexity components. Given that a critical effect of reef degradation is loss of structure, adopting three-dimensional technologies potentially offers a new tool to both understand species-habitat association and help forecast how fishes will be affected by the flattening of reefs.

Under projections of global climate change and other stressors, significant changes in the ecology, structure and function of coral reefs are predicted. Current management strategies tend to look to the past to set goals, focusing on halting declines and restoring baseline conditions. Here, we explore a complementary approach to decision making that is based on the anticipation of future changes in ecosystem state, function and services. Reviewing the existing literature and utilizing a scenario planning approach, we explore how the structure of coral reef communities might change in the future in response to global climate change and overfishing. We incorporate uncertainties in our predictions by considering heterogeneity in reef types in relation to structural complexity and primary productivity. We examine 14 ecosystem services provided by reefs, and rate their sensitivity to a range of future scenarios and management options. Our predictions suggest that the efficacy of management is highly dependent on biophysical characteristics and reef state. Reserves are currently widely used and are predicted to remain effective for reefs with high structural complexity. However, when complexity is lost, maximizing service provision requires a broader portfolio of management approaches, including the provision of artificial complexity, coral restoration, fish aggregation devices and herbivore management. Increased use of such management tools will require capacity building and technique refinement and we therefore conclude that diversification of our management toolbox should be considered urgently to prepare for the challenges of managing reefs into the 21st century.

Dear EditorThis spring, a “list of practical procedures” in which junior doctors in the UK should be competent is published by the GMC. However, barriers to achieving competency are not addressed d...

This article describes the use of emotion talk in the context of using a manualised approach to family therapy where the presenting problem is self-harm. Whilst we understand that there is an internal aspect to emotion, we also consider emotions to be socially purposeful, culturally constructed and interactional. We found that within the presenting families, negative emotions were often talked about as located within the young person. Through using 'emotion talk' (Fredman, 2004) in deconstructing and tracking emotions and exploring how emotions connected to family-of-origin and cultural contexts, we developed an interactional understanding of these emotions. This led to better emotional regulation within the family and offered alternative ways of relating. The article discusses the use of relational reflexivity, and using the therapist and team's emotions to enable the therapeutic process, encouraging reflexivity on the self of the therapist in relation to work with emotions.Emotions can be seen as both a reflection of feelings experienced by the individual and as a communication.An interactional understanding of emotions can be used therapeutically.Therapists should explore emotional displays and track the interactional patterns within the therapeutic system.Therapists should self-reflexive about ways of doing emotions and use this awareness in practice.青少年自残情境下的情感谈话：在家庭治疗中面对情绪情绪既可以被看作是自身感受的反映, 也可以被看作是一种沟通对情绪的互动式理解可以协助治疗治疗师应探索情绪的表现, 并追踪治疗系统之内的互动模式治疗师应对其处理情绪的方法和在实践中应用该方法的过程具有自我反省意识.

In our recent review of the ecological roles of sharks on coral reefs [1], we concluded that the evidence to support hypothesised shark-driven trophic cascades on coral reefs was weak and equivocal. In their response to our review, Ruppert et al. [2] assert that a major issue with our approach was that we primarily reviewed evidence from correlative observational studies to reach this conclusion. This is incorrect, because our conclusion is based upon multiple lines of evidence, including observational studies, food-web models, dietary and stable isotope analysis, trophic position, habitat use, and behavioural evidence [1].

Recovery of the Caribbean long-spined sea urchin Diadema antillarum from the pathogen-induced mass mortality event of 1983 has been slow and variable. Multiple studies indicate that post-mortality population densities are greatest in sheltered lagoon and back reef habitats, and that recovery is limited on forereefs where pre-mortality densities were also high (Miller R. J. et al., 2003; Van der Hal, 2005; Debrot and Nagelkerken, 2006; Steiner and Williams, 2006; Vermeij et al., 2010). We carried out detailed surveys of a recovering population of D. antillarum in Curacao to document an ongoing influence of habitat type on population density, and to explore what ecosystem characteristics might drive observed recovery patterns. We quantified D. antillarum population density, larval settlement rates, herbivorous fish biomass, algal turfs, macroalgae, and predatory fish biomass in sites with and without structural complexity on reefs in sheltered lagoon and backreef locations, and on the forereef, using an orthogonal survey design. D. antillarum densities were greatest in sheltered lagoon and backreef locations, with high structural complexity. However, densities were significantly lower than those reported prior to the mass mortality event. Larval settlement rates were greater in sheltered lagoon and backreef locations but did not fully account for observed patterns in urchin density. Sheltered lagoon and backreef habitats had more turf algae and fewer herbivorous fish than forereef habitats. Predator abundance was generally low and did not differ significantly among habitat types. In light of our results, we hypothesize that patterns of D. antillarum recovery in Curacao are consistent with dynamics expected in the presence of density-dependent habitat selection. More algal resources and fewer herbivorous fish provide a mechanism for increased fitness and habitat suitability in sheltered, lagoon, and backreef habitats. Forereefs, by contrast, offer reduced habitat suitability and, we hypothesize, will only be re-colonized once the carrying capacity of more favorable habitats is exceeded. We propose a number of testable predictions to explore this theory further, and advocate for including sheltered lagoon and backreef habitats in D. antillarum population surveys to monitor recovery, as well as protecting populations found in these habitats where necessary. We predict that when current populations return to pre-mortality densities, range expansion may allow for a return of D. antillarum to Caribbean forereefs.

SUMMARY The importance of the retinoblastoma tumor suppressor protein pRB in cell cycle control is well established. However, less is known about its role in differentiation during animal development. Here, we investigated the role of Rbf, the Drosophila pRB homolog, in adult skeletal muscles. We found that the depletion of Rbf severely reduced muscle growth and altered myofibrillogenesis but only minimally affected myoblast proliferation. We identified an Rbf-dependent transcriptional program in late muscle development that is distinct from the canonical role of Rbf in cell cycle control. Unexpectedly, Rbf acts as a transcriptional activator of the myogenic and metabolic genes in the growing muscles. The genomic regions bound by Rbf contained the binding sites of several factors that genetically interacted with Rbf by modulating Rbf-dependent phenotype. Thus, our results reveal a distinctive role for Rbf as a direct activator of the myogenic transcriptional program that drives late muscle differentiation., Graphical Abstract, In Brief Inactivation of the tumor suppressor RB, an obligatory step in most cancers, results in unrestrained cell cycle progression. Zappia et al. show that Rbf, the RB Drosophila ortholog, directly activates the metabolic program that accompanies muscle development. This work expands the understanding of the plethora of Rbf functions.

Equivariant de Rham cohomology is extended to the infinite-dimensional setting of a loop subgroup acting on a loop group, using Hida supersymmetric Fock space for the Weil algebra and Malliavin test forms on the loop group. The Mathai–Quillen isomorphism (in the BRST formalism of Kalkman) is defined so that the equivalence of various models of the equivariant de Rham cohomology can be established.

The standard BRST procedure for canonical quantization of a system with symmetry generated by a closed constraint algebra is extended to the case where the algebra is partly open. The method is illustrated by a specific topological model.

Report Back provides news, views and reports from local government and the voluntary and community sectors. These reports are related, whenever possible, to the special theme of each issue of Benefits, but the most important consideration is their topicality and relevance to as wide an audience in these fields as possible. Benefits may commission pieces for particular themes but individual contributions are welcomed from those working in these areas and should be sent to the Editorial Office. These contributions might focus on either local government or the voluntary and community sectors, or on relationships between the two.

While positive interactions have been observed to influence patterns of recruitment and succession in marine and terrestrial plant communities, the role of facilitation in macroalgal phase shifts is relatively unknown. In December 2012, typhoon Bopha caused catastrophic losses of corals on the eastern reefs of Palau. Within weeks of the typhoon, an ephemeral bloom of monospecific macroalgae (Liagora sp.) was observed, reaching a peak of 38.6 % cover in February 2013. At this peak, we observed a proliferation of a second macroalgal species, Lobophora variegata. Lobophora was distributed non-randomly, with higher abundances occurring within the shelter of Liagora canopies than on exposed substrates. Bite rates of two common herbivorous fish (Chlorurus sordidus and Ctenochaetus striatus) were significantly higher outside canopies (2.5- and sixfold, respectively), and cage exclusion resulted in a significant increase in Lobophora cover. Experimental removal of Liagora canopies resulted in a 53.1 % decline in the surface area of Lobophora after 12 days, compared to a 51.7 % increase within canopies. Collectively, these results indicate that Liagora canopies act as ecological facilitators, providing a ‘nursery’ exclusion zone from the impact of herbivorous fish, allowing for the establishment of understory Lobophora. While the ephemeral Liagora bloom had disappeared entirely 9 months post-typhoon, the facilitated shift to Lobophora has persisted for over 18 months, dominating ~40 % of the reef substrate. While acute disturbance events such as typhoons have been suggested as a mechanism to reverse algal phase shifts, our results suggest that typhoons may also trigger, rather than just reverse, phase shifts.

SummaryCoral reefs face a diverse array of threats, from eutrophication and overfishing to climate change. As live corals are lost and their skeletons eroded, the structural complexity of reefs declines. This may have important consequences for the survival and growth of reef fish because complex habitats mediate predator-prey interactions [1, 2] and influence competition [3–5] through the provision of prey refugia. A positive correlation exists between structural complexity and reef fish abundance and diversity in both temperate and tropical ecosystems [6–10]. However, it is not clear how the diversity of available refugia interacts with individual predator-prey relationships to explain emergent properties at the community scale. Furthermore, we do not yet have the ability to predict how habitat loss might affect the productivity of whole reef communities and the fisheries they support. Using data from an unfished reserve in The Bahamas, we find that structural complexity is associated not only with increased fish biomass and abundance, but also with nonlinearities in the size spectra of fish, implying disproportionately high abundances of certain size classes. By developing a size spectrum food web model that links the vulnerability of prey to predation with the structural complexity of a reef, we show that these nonlinearities can be explained by size-structured prey refugia that reduce mortality rates and alter growth rates in different parts of the size spectrum. Fitting the model with data from a structurally complex habitat, we predict that a loss of complexity could cause more than a 3-fold reduction in fishery productivity.Video Abstract

A geometric theory of path integration on supermanifolds is developed, and used to establish a path‐integral formula for the super heat kernel exp(−D/2t−D/τ) of the Dirac operator D/ on a Riemannian manifold. The earlier part of the paper describes an extension of Wiener measure, Brownian motion, and stochastic calculus to include paths in spaces parametrized by anticommuting variables; these constructions are then combined with the geometrical data of a Riemannian manifold to construct stochastic differential equations whose solutions provide appropriate superpaths for the study of the Dirac operator.