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Abstract Background Severe mental ill health (SMI) includes schizophrenia, bipolar disorder and schizoaffective disorder and is associated with premature deaths when compared to people without SMI. Over 70% of those deaths are attributed to preventable health conditions, which have the potential to be positively affected by the adoption of healthy behaviours, such as physical activity. People with SMI are generally less active than those without and face unique barriers to being physically active. Physical activity interventions for those with SMI demonstrate promise, however, there are important questions remaining about the potential feasibility and acceptability of a physical activity intervention embedded within existing NHS pathways. Method This is a two-arm multi-site randomised controlled feasibility trial, assessing the feasibility and acceptability of a co-produced physical activity intervention for a full-scale trial across geographically dispersed NHS mental health trusts in England. Participants will be randomly allocated via block, 1:1 randomisation, into either the intervention arm or the usual care arm. The usual care arm will continue to receive usual care throughout the trial, whilst the intervention arm will receive usual care plus the offer of a weekly, 18-week, physical activity intervention comprising walking and indoor activity sessions and community taster sessions. Another main component of the intervention includes one-to-one support. The primary outcome is to investigate the feasibility and acceptability of the intervention and to scale it up to a full-scale trial, using a short proforma provided to all intervention participants at follow-up, qualitative interviews with approximately 15 intervention participants and 5 interventions delivery staff, and data on intervention uptake, attendance, and attrition. Usual care data will also include recruitment and follow-up retention. Secondary outcome measures include physical activity and sedentary behaviours, body mass index, depression, anxiety, health-related quality of life, healthcare resource use, and adverse events. Outcome measures will be taken at baseline, three, and six-months post randomisation. Discussion This study will determine if the physical activity intervention is feasible and acceptable to both participants receiving the intervention and NHS staff who deliver it. Results will inform the design of a larger randomised controlled trial assessing the clinical and cost effectiveness of the intervention. Trial registration ISRCTN: ISRCTN83877229. Registered on 09.09.2022.

Abstract The introduction of the signal crayfish Pacifastacus leniusculus to British rivers has led to ecological degradation and the decline of the native white‐clawed crayfish Austropotamobius pallipes. To manage and mitigate the impact of the signal crayfish, conservation agencies and government bodies employ multiple conservation strategies. These take the form of proactive native crayfish breeding and stocking programs and reactive invasive crayfish control programs. Here, we used eDNA to assess the populations of native and invasive crayfish species across 50 sites in 10 river catchments in Norfolk, United Kingdom (UK). The sites were chosen to enable assessment of the potential of eDNA to inform proactive and reactive crayfish conservation strategies. Three of the catchments sampled were selected to assess the success of recent A. pallipes reintroduction, whereas the remaining seven were selected to better understand the distribution of each species at the landscape scale. Combining results of eDNA‐based methods with net searches within an occupancy model enabled us to confidently determine the presence of P. leniusculus at eight sites, and A. pallipes at three sites, which was more than visual searches alone (five and two study sites, respectively). Neither eDNA nor net searches detected A. pallipes at sites where A. pallipes had been reintroduced. We recommend that practitioners using eDNA‐based surveys for management and conservation of crayfish should consider: (1) designing eDNA surveys with an emphasis on large spatial scales to comprehensively describe the distributions of native and invasive crayfish in a region of interest; (2) work with local conservation organizations and/or government bodies to inform the selection of study sites to generate results that are meaningful to real‐world conservation actions; and (3) use results from eDNA‐based crayfish surveys to target limited conservation resources to appropriate proactive and/or reactive conservation actions.

Abstract Climate change majorly impacts biodiversity in diverse regions across the world, including South Asia, a megadiverse area with heterogeneous climatic and vegetation regions. However, climate impacts on bats in this region are not well‐studied, and it is unclear whether climate effects will follow patterns predicted in other regions. We address this by assessing projected near‐future changes in climatically suitable areas for 110 bat species from South Asia. We used ensemble ecological niche modelling with four algorithms (random forests, artificial neural networks, multivariate adaptive regression splines and maximum entropy) to define climatically suitable areas under current conditions (1970–2000). We then extrapolated near future (2041–2060) suitable areas under four projected scenarios (combining two global climate models and two shared socioeconomic pathways, SSP2: middle‐of‐the‐road and SSP5: fossil‐fuelled development). Projected future changes in suitable areas varied across species, with most species predicted to retain most of the current area or lose small amounts. When shifts occurred due to projected climate change, new areas were generally northward of current suitable areas. Suitability hotspots, defined as regions suitable for >30% of species, were generally predicted to become smaller and more fragmented. Overall, climate change in the near future may not lead to dramatic shifts in the distribution of bat species in South Asia, but local hotspots of biodiversity may be lost. Our results offer insight into climate change effects in less studied areas and can inform conservation planning, motivating reappraisals of conservation priorities and strategies for bats in South Asia.

Knee osteoarthritis (OA) affects over 650 million patients worldwide. Total knee replacement is aimed at end-stage OA to relieve symptoms of pain, stiffness and reduced mobility. However, the role of imaging modalities in monitoring symptomatic disease progression remains unclear. This study aimed to compare machine learning (ML) models, with and without imaging features, in predicting the two-year Western Ontario and McMaster Universities Arthritis Index (WOMAC) score for knee OA patients. We included 2408 patients from the Osteoarthritis Initiative (OAI) database, with 629 patients from the Multicenter Osteoarthritis Study (MOST) database. The clinical dataset included 18 clinical features, while the imaging dataset contained an additional 10 imaging features. Minimal Clinically Important Difference (MCID) was set to 24, reflecting meaningful physical impairment. Clinical and imaging dataset models produced similar area under curve (AUC) scores, highlighting low differences in performance AUC < 0.025). For both clinical and imaging datasets, Gradient Boosting Machine (GBM) models performed the best in the external validation, with a clinically acceptable AUC of 0.734 (95% CI 0.687–0.781) and 0.747 (95% CI 0.701–0.792), respectively. The five features identified included educational background, family history of osteoarthritis, co-morbidities, use of osteoporosis medications and previous knee procedures. This is the first study to demonstrate that ML models achieve comparable performance with and without imaging features.

Background: The morbidity and mortality from AL amyloidosis has significantly improved with the development of novel treatments. Daratumumab is a highly effective treatment for AL amyloidosis, but end-stage kidney disease is a common complication of this condition. Kidney transplantation is the ideal form of renal replacement therapy but has historically been contraindicated in this group of patients. Methods: Given the improved survival and better treatments of both conditions, we argue that it is time to reconsider transplanting these patients. Results: We report our experience of transplanting four patients with AL amyloidosis who had achieved stable remission through treatment with daratumumab. Conclusions: We highlight the key challenges involved and discuss important clinical issues for patients receiving daratumumab, particularly the difficulties with interpreting the crossmatch in light of daratumumab and immunoglobulin therapy interference. We also discuss the complexities involved in balancing the risks of infection, relapse, rejection, and immunosuppression in such patients.

Abstract Animal size, a trait sensitive to spatial and temporal variables, is a key element in ecological and evolutionary dynamics. In the context of climate change, there is evidence that some bat species are increasing their body size via phenotypic responses to higher temperatures at maternity roosts. To test the generality of this response, we conducted a >20‐year study examining body size changes in 15 bat species in Italy, analysing data from 4393 individual bats captured since 1995. In addition to examining the temporal effect, we considered the potential influence of sexual dimorphism and, where relevant, included latitude and altitude as potential drivers of body size change. Contrary to initial predictions of a widespread increase in size, our findings challenge this assumption, revealing a nuanced interplay of factors contributing to the complexity of bat body size dynamics. Specifically, only three species (Myotis daubentonii, Nyctalus leisleri, and Pipistrellus pygmaeus) out of the 15 exhibited a discernible increase in body size over the studied period, prompting a reassessment of bats as reliable indicators of climate change based on alterations in body size. Our investigation into influencing factors highlighted the significance of temperature‐related variables, with latitude and altitude emerging as crucial drivers. In some cases, this mirrored patterns consistent with Bergmann's rule, revealing larger bats recorded at progressively higher latitudes (Plecotus auritus, Myotis mystacinus, and Miniopterus schreibersii) or altitudes (Pipistrellus kuhlii). We also observed a clear sexual dimorphism effect in most species, with females consistently larger than males. The observed increase in size over time in three species suggests the occurrence of phenotypic plasticity, raising questions about potential long‐term selective pressures on larger individuals. The unresolved question of whether temperature‐related changes in body size reflect microevolutionary processes or phenotypic plastic responses adds further complexity to our understanding of body size patterns in bats over time and space.

Abstract Purpose Refixation of acute anterior cruciate ligament (ACL) tears represents an increasingly popular treatment option. Systematic evaluations of various suture technique parameters are still pending. We therefore aimed to evaluate the mechanical pull‐out outcomes of various suture methods for optimization of ACL refixation. Methods Sixty fresh knees from mature domestic pigs were dissected and the femoral attachment of the ACL was peeled off. The 60 knees were divided in 10 groups and sutured as follows: (A) one suture (1, 2, 4 and 6 passes), (B) two sutures (2, 4 and 6 passes each; sutures knotted together as a loop) and (C) two sutures (2, 4 and 6 passes each, sutures knotted separately). The pull‐out test was conducted using a validated electrodynamic testing machine. First occurrence of failure, maximum pull‐out load and stiffness were measured. Suture failure was defined as pull‐out of the ACL. Results Two‐point fixation, using two sutures, with at least two passes, showed the most favourable biomechanical stability. The maximum pull‐out load was significantly higher with two sutures (529.5 N) used compared to one (310.4 N), p

Aims: The metabolic equivalent of task (MET) score examines patient performance in relation to energy expenditure before and after knee arthroplasty. This study assesses its use in a knee arthroplasty population in comparison with the widely used Oxford Knee Score (OKS) and EuroQol five-dimension index (EQ-5D), which are reported to be limited by ceiling effects. Methods: A total of 116 patients with OKS, EQ-5D, and MET scores before, and at least six months following, unilateral primary knee arthroplasty were identified from a database. Procedures were performed by a single surgeon between 2014 and 2019 consecutively. Scores were analyzed for normality, skewness, kurtosis, and the presence of ceiling/floor effects. Concurrent validity between the MET score, OKS, and EQ-5D was assessed using Spearman’s rank. Results: Postoperatively the OKS and EQ-5D demonstrated negative skews in distribution, with high kurtosis at six months and one year. The OKS demonstrated a ceiling effect at one year (15.7%) postoperatively. The EQ-5D demonstrated a ceiling effect at six months (30.2%) and one year (39.8%) postoperatively. The MET score did not demonstrate a skewed distribution or ceiling effect either at six months or one year postoperatively. Weak-moderate correlations were noted between the MET score and conventional scores at six months and one year postoperatively. Conclusion: In contrast to the OKS and EQ-5D, the MET score was normally distributed postoperatively with no ceiling effect. It is worth consideration as an arthroplasty outcome measure, particularly for patients with high expectations. Cite this article: Bone Jt Open 2023;4(3):129–137.

Abstract Background Traumatic musculoskeletal injuries are a common presentation to emergency care, the first-line investigation often being plain radiography. The interpretation of this imaging frequently falls to less experienced clinicians despite well-established challenges in reporting. This study presents novel data of clinicians’ confidence in interpreting trauma radiographs, their perception of AI in healthcare, and their support for the development of systems applied to skeletal radiography. Methods A novel questionnaire was distributed through a network of collaborators to clinicians across the Southeast of England. Over a three-month period, responses were compiled into a database before undergoing statistical review. Results The responses of 297 participants were included. The mean self-assessed knowledge of AI in healthcare was 3.68 out of ten, with significantly higher knowledge reported by the most senior doctors (Specialty Trainee/Specialty Registrar or above = 4.88). 13.8% of participants reported an awareness of AI in their clinical practice. Overall, participants indicated substantial favourability towards AI in healthcare (7.87) and in AI applied to skeletal radiography (7.75). There was a preference for a hypothetical system indicating positive findings rather than ruling as negative (7.26 vs 6.20). Conclusions This study identifies clear support, amongst a cross section of student and qualified doctors, for both the general use of AI technology in healthcare and in its application to skeletal radiography for trauma. The development of systems to address this demand appear well founded and popular. The engagement of a small but reticent minority should be sought, along with improving the wider education of doctors on AI.

Solar energy is an important renewable energy source. However, the ecological effects of solar farms are largely unknown. Behavioral experiments proved previously that smooth surfaces, such as solar panels act as sensory traps for bats and insects, increasing collision risk, and suggesting that solar farms may affect local ecosystems in a complex way. As the orientation of bats is impeded around smooth surfaces, the exploitation of solar farms as foraging habitats by bats needs research. We surveyed the activity of bats at solar farms and in the neighboring habitats (forests, grasslands, arable fields, settlements and watersides) to evaluate the effects of solar farms on the occurrence and activity of bats and on the composition of bat communities. We conducted bioacoustic surveys at 190 sites in 15 areas of Hungary and recorded nearly 30 000 bat echolocation call sequences. We detected patterns of overall bat activity similar to those in other open habitats such as arable land and grassland indicating that some bat species can exploit this anthropogenic environment. Bat species detected at solar farms also frequently occur in arable land and settlements (Hypsugo savii, Nyctalus noctula and Pipistrellus kuhlii), suggesting that bats adapted to anthropogenic environments exploit solar farms. However, some species of major conservation concern (e.g. Myotis spp. and Barbastella barbastellus) were detected less frequently on solar farms than in other habitats raising implications for mitigation procedures.

Abstract Background UK Children generally fail to meet physical activity (PA) recommendations. Whole school approaches (WSA) have the potential to impact large numbers of children due to their ubiquitous nature for school wide implementation, however there is limited knowledge regarding primary school PA WSA implementation in the UK. This study aimed to investigate the acceptability and feasibility of a PA WSA in the UK. Methods Semi structured interviews explored research aims with participants. A qualitative description approach was adopted and data were analysed using thematic analysis to draw codes and themes from the data. Results Thirteen primary school senior leadership team (SLT) and Physical Education (PE) leads were interviewed. A PA WSA was found acceptable by all participants. Implementation, however, was questioned when other significant mechanisms were not in place. A PA WSA aided prioritisation and planning of PA provision, providing a holistic overview of all key areas of PE, school-sport and PA (PESSPA). Due to the high acceptability but dependent feasibility of a PA WSA, it is recommended that PA WSAs align with whole-school health policy and improvement plans to advance implementation. Future research, however, is needed to explore how this method is best implemented as additional interventions may also be required to promote the prioritisation of the PA agenda due to the importance of SLT backing for implementation being paramount, as results highlight. Conclusions PA WSAs aid awareness, understanding and planning of school wide PESSPA provision, however their implementation in complex. Having SLT support and an appropriately resourced PE lead maximised the impact and utility of a PA WSA.

Objectives Knee osteoarthritis is a major cause of physical disability and reduced quality of life, with end-stage disease often treated by total knee replacement (TKR). We set out to develop and externally validate a machine learning model capable of predicting the need for a TKR in 2 and 5 years time using routinely collected health data.Design A prospective study using datasets Osteoarthritis Initiative (OAI) and the Multicentre Osteoarthritis Study (MOST). OAI data were used to train the models while MOST data formed the external test set. The data were preprocessed using feature selection to curate 45 candidate features including demographics, medical history, imaging assessments, history of intervention and outcome.Setting The study was conducted using two multicentre USA-based datasets of participants with or at high risk of knee OA.Participants The study excluded participants with at least one existing TKR. OAI dataset included participants aged 45–79 years of which 3234 were used for training and 809 for internal testing, while MOST involved participants aged 50–79 and 2248 were used for external testing.Main outcome measures The primary outcome of this study was prediction of TKR onset at 2 and 5 years. Performance was evaluated using area under the curve (AUC) and F1-score and key predictors identified.Results For the best performing model (gradient boosting machine), the AUC at 2 years was 0.913 (95% CI 0.876 to 0.951), and at 5 years 0.873 (95% CI 0.839 to 0.907). Radiographic-derived features, questionnaire-based assessments alongside the patient’s educational attainment were key predictors for these models.Conclusions Our approach suggests that routinely collected patient data are sufficient to drive a predictive model with a clinically acceptable level of accuracy (AUC>0.7) and is the first such tool to be externally validated. This level of accuracy is higher than previously published models utilising MRI data, which is not routinely collected.

Abstract Background There is a lack of of cross-sectional research that has investigated muscle morphology, function, and functional capability in all age-bands of healthy adults. The primary aim of this study was to evaluate age-related differences in indices of vastus lateralis (VL) muscle morphology, function and functional capability in a sample of healthy males and females aged 18-70yrs. Secondary aims were to evaluate relationships between age and VL muscle morphology and function and functional capability. Methods B mode Ultrasonography and Tensiomyography were used to measure VL muscle thickness, pennation angle, fascicle length, and contractile properties in 274 healthy adults aged 18-70yrs. Measurements of grip strength and functional capability (1-min chair rise test) were also taken. Data analysis included descriptive statistics, correlations, one-way ANOVAs, and multiple regressions. Results Negative correlations were found between age and muscle thickness (rs = -.56), pennation angle (rs = -.50), fascicle length (rs = -.30), maximal displacement (rs = -.24), grip strength (rs = -.27) and the 1-min chair rise test (rs = -.32). Positive correlations were observed between age and the echo intensity of the muscle (rs = .40) and total contraction time (rs = .20). Differences in the indices of muscle health were noticeable between the 18–29 age band and the 50–59 and 60–70 age bands (p

Abstract Aquatic invasive species, such as the signal crayfish (Pacifastacus leniusculus), present a major threat to freshwater ecosystems. However, these species can be challenging to detect in recently invaded habitats. Environmental DNA (eDNA)–based methods are highly sensitive and capable of detecting just a few copies of target DNA from non‐invasively collected samples. Therefore, they have considerable potential for broad‐scale use in mapping and monitoring the spread of invasive species. In this study, we aimed to increase our understanding of the current distribution of signal crayfish in a headwater stream system in the United Kingdom (tributaries of the River Wharfe, Addingham, Yorkshire). Environmental DNA sampling, assessment of water chemistry variables, and conventional crayfish hand‐searching were conducted across 19 study sites in five tributary streams. Using hand‐searching, we detected signal crayfish at 26% of the sites (5/19 study sites). However, using eDNA‐based methods, occupancy increased to 47% of study sites (9/19). Our sampling revealed previously unknown sites of crayfish occupancy, and using eDNA‐based methods, we were able to define the geographical extent of the invasion front in each headwater stream sampled. This study highlights that eDNA‐based methods are well‐suited for detecting newly established signal crayfish populations in recently invaded habitats, even when the invasive species is at low abundance and, therefore, might otherwise be under‐represented or undetected using conventional survey methods. Our study provides further evidence that headwater stream ecosystems are particularly vulnerable to signal crayfish invasion. However, their geomorphological features may make methods used to reduce or prevent invasive crayfish dispersal more effective than in other freshwater ecosystems.

The feeding behaviour of the sanguivorous common vampire bat (Desmodus rotundus) facilitates the transmission of pathogens that can impact both human and animal health. To formulate effective strategies in controlling the spread of diseases, there is a need to obtain information on which animals they feed on. One DNA-based approach, shotgun sequencing, can be used to obtain such information. Even though it is costly, shotgun sequencing can be used to simultaneously retrieve prey and vampire bat mitochondrial DNA for population studies within one round of sequencing. However, due to the challenges of analysing shotgun sequenced metagenomic data such as false negatives/positives and typically low proportion of reads mapped to diet items, shotgun sequencing has not been used for the identification of prey from common vampire bat blood meals. To overcome these challenges and generate longer mitochondrial contigs which could be useful for prey population studies, we shotgun sequenced common vampire bat blood meal samples (n = 8) and utilised a two-step metagenomic approach based on combining existing bioinformatic workflows (alignment and mtDNA contig assembly) to identify prey. After validating our results from detections made through metabarcoding, we accurately identified the common vampire bats’ prey in six out of eight samples without any false positives. We also generated prey mitochondrial contig lengths between 138 bp to 3231 bp (median = 770 bp, Q1 = 262 bp, Q3 = 1766 bp). This opens the potential to conduct phylogenetic and phylogeographic monitoring of elusive prey species in future studies, through the analyses of blood meal metagenomic data.

Introduction: All the research investigating the cardiopulmonary capacity in climbers is focused on predictors for climbing performance. The effects of climbing on the cardiovascular system in adolescents climbing at an elite level (national team) have not been evaluated.Material and methods: Retrospective analysis of the cardiopulmonary exercise test (CPET) performed on a cycle ergometer during the annual medical examination of the entire German Junior National climbing team on one occasion and for a selected subgroup on two occasions spaced two years apart. The data from the subgroup was compared to an age- and gender-matched control of Nordic skiers from the German Junior National Nordic skiing team. Results: 47 climbers (20 girls, 27 boys) were examined once. The VO2peak achieved by the athletes was 41.3 mL kg−1 min−1 (boys) and 39.8 mL kg−1 min−1 (girls). 8 boys and 6 girls were tested twice over a period of 27.5 months. The parameters of the exercise test measured on both occasions were significantly lower than those of the 8 male and 6 female Nordic skiers. There was no change with respect to any variables (e.g. VO2peak, peak work load, peak heart rate, peak lactate or O2 pulse) over the examined period. Conclusions: The elite climbers investigated in this study showed comparable VO2peak values to athletes from team and combat sports. The Nordic skiers to which they were compared showed significantly higher values consistant with the fact that this is an endurance sport. Even though the cardiopulmonary measurements of the Nordic skiers still improved after two years of training, no adaptations could be observed in the elite climbers.

DNA methylation profiles from 26 bat species accurately predicts chronological age, while longevity-related methylation patterns across the genome suggest that bat longevity results from augmented immune response and cancer suppression.

Abstract Light trapping is an important tool for monitoring insect populations. This is especially true for biting Diptera, where light traps play a crucial role in disease surveillance by tracking the presence and abundance of vector species. Physiological and behavioural data have been instrumental in identifying factors that influence dipteran phototaxis and have spurred the development of more effective light traps. However, the development of less attractive domestic lights has received comparatively little interest but could be important for reducing interactions between humans and vector insects, with consequences for reducing disease transmission. Here, we discuss how dipteran eyes respond to light and the factors influencing positive phototaxis, and conclude by identifying key areas for further research. In addition, we include a synthesis of attractive and unattractive wavelengths for a number of vector species. A more comprehensive understanding of how Diptera perceive and respond to light would allow for more efficient vector sampling as well as potentially limiting the risk posed by domestic lighting.

Background There are ongoing concerns worldwide about prescribing benzodiazepines and Z-drugs (BZDs) due to the risks associated with these medicines. Despite guidance to limit their prescribing, in Scotland, the sustained level of prescribing over the last decade suggests chronic prescribing of BZDs. Although prescribing decisions is a complex process that is influenced by patient-related factors, little is known about the characteristics of those who are on chronic BZDs prescriptions, including childhood and adulthood characteristics. Therefore, this study aims to describe the trend of BZDs prescriptions over seven years and to characterise those who were on chronic/recurrent BZDs prescriptions. Methods This is a prospective longitudinal cohort study using data linkage technique, in which a birth cohort was linked to the Prescribing Information System, the Scottish Morbidity Database. Simple descriptive analysis was used to describe the incidence trends. To characterise individuals with chronic/recurrent prescriptions, multivariable Poisson regression models were constructed using a stepwise regression, the calculated risk ratios were reported with a 95% confidence interval. Findings The incidence of BZDs prescription declined from 3.4% [3.0-3.7] in 2010 to 2.0% [1.7%-2.3%] in 2015. While, within those receiving any prescriptions, the incidence of chronic/recurrent prescriptions was relatively constant around 7%. The study showed that those who had a history of behavioural disturbance in childhood were at increased risk of chronic/recurrent BZDs prescriptions compared with those who had not (risk ratio: 1.18 [95%CI: 1.03-1.35]). Similarly, those who had an IQ score < 100 were also more likely to be on chronic/recurrent BZDs prescriptions than those >100 (1.09 [0.99-1.21]). Chronic/recurrent BZDs prescriptions were more common among individuals in receipt of psychotropic prescriptions (1.77 [1.55-2.02]) or who had been hospitalised with depression/schizophrenia (1.28 [1.13-1.46]). Multimorbidity was also important: a dose-risk relationship was evident, such that, compared to participants reporting no morbidity, those reporting one, or five or more morbidities, experienced a 116% and 451% increase in risk (2.16 [1.47-3.18] and 5.51 [3.98-7.62], respectively). Finally, those who had taken early retirement (1.65 [1.36-1.99]) and those looking after family (1.35 [1.11-1.65]) were more likely to receive chronic/recurrent BZDs, compared to employed individuals. Conclusions Chronic/recurrent BZDs prescriptions are common. Careful interpretation for the decline in incidence as this is a close cohort where incidence might be diluted after a long follow-up. The need for these drugs might be an indication of an impaired coping system. Childhood is a sensitive age period for individuals’ development. And behavioural disturbance and/or lower IQ score might be a manifestation of a disadvantaged childhood which, in turn, might affect individuals’ ability to cope with life in adulthood. Also, the accumulation of trajectory events such as impact physical and mental health or lacking socioeconomic opportunity could impact individuals’ ability to cope, although, for factors in adulthood, one must be wary of reverse causation.

The current case study focused on a crucial match in the qualification for the Norwegian Premier League (Eliteserien). In the match, the participants of the study experienced a radical change in performance toward the end of the second half, from being behind by several goals to scoring 3 goals in 6 min and winning the qualifying game. The purpose of this study was therefore to examine the perceptions and reflections of players and coaches (sporting director) on what occurred within their own team and within the opposing team. The momentum shift in the opposition team can be described as a collective collapse. In the study, the theoretical collective collapse process model was used as a guide for the design of the interview questions where five semi-structured interviews were conducted with participants involved in the match (players, coach, and sporting director). The participants watched excerpt clips from the match to recall the main events, which they subsequently reflected on. The results highlighted the importance of the “before-game” aspects (i.e., pressure, first game result), the “during-the-game” behavior (i.e., goals scored, playing with a low degree of risk) and the cognitive (i.e., feelings of pressure, despair) and emotional reactions (i.e., frustration, joy) to the match unfolding. In addition, social contagion processes were evident in both teams relating to emotion and behavior. Overall, the data from this study investigated the general structure of the process model of collective sport team collapse and found support for the notion of a temporal cascade of causes for a team collapse. Future research is encouraged to examine this model, to provide guidance to teams, coaches, and sport psychologists in order to make recommendations for dealing with collective collapse in sport teams.

Abstract Background Up to one third of patients on renal replacement programmes have an unknown cause of kidney disease, and the diagnosis may only be established following renal transplantation when the disease recurs or if new extra-renal symptoms develop. Case presentation We present two patients who presented with progressive chronic kidney disease of unknown cause. Both patients underwent successful renal transplantation but subsequently developed multisystem abnormalities, and were ultimately diagnosed with mitochondrial cytopathy 10–15 years following transplantation. Conclusions Mitochondrial cytopathies are rare inborn errors of metabolism that should be considered in adults with renal impairment, especially in those with a family history of kidney or other multisystem disease. The widespread availability of genetic testing provides the potential for earlier diagnoses, thereby enhancing management decisions, anticipation of complications, avoidance of mitotoxic drugs, and informed prognosis prediction.

Objectives The beliefs of laypeople and medical professionals often diverge with regards to disease, and technology has had a positive impact on how research is conducted. Surprisingly, given the expanding worldwide funding and research into Artificial Intelligence (AI) applications in healthcare, there is a paucity of research exploring the public patient perspective on this technology. Our study sets out to address this knowledge gap, by applying the Nominal Group Technique (NGT) to explore patient public views on AI. Methods A Nominal Group Technique (NGT) was used involving four study groups with seven participants in each group. This started with a silent generation of ideas regarding the benefits and concerns of AI in Healthcare. Then a group discussion and round-robin process were conducted until no new ideas were generated. Participants ranked their top five benefits and top five concerns regarding the use of AI in healthcare. A final group consensus was reached. Results Twenty-Eight participants were recruited with the mean age of 47 years. The top five benefits were: Faster health services, Greater accuracy in management, AI systems available 24/7, reducing workforce burden, and equality in healthcare decision making. The top five concerns were: Data cybersecurity, bias and quality of AI data, less human interaction, algorithm errors and responsibility, and limitation in technology. Conclusion This is the first formal qualitative study exploring patient public views on the use of AI in healthcare, and highlights that there is a clear understanding of the potential benefits delivered by this technology. Greater patient public group involvement, and a strong regulatory framework is recommended.

Question Generation (QG) aims to automate the task of composing questions for a passage with a set of chosen answers found within the passage. In recent years, the introduction of neural generation models has resulted in substantial improvements of automatically generated questions in terms of quality, especially compared to traditional approaches that employ manually crafted heuristics. However, current QG evaluation metrics solely rely on the comparison between the generated questions and references, ignoring the passages or answers. Meanwhile, these metrics are generally criticized because of their low agreement with human judgement. We therefore propose a new reference-free evaluation metric called QAScore, which is capable of providing a better mechanism for evaluating QG systems. QAScore evaluates a question by computing the cross entropy according to the probability that the language model can correctly generate the masked words in the answer to that question. Compared to existing metrics such as BLEU and BERTScore, QAScore can obtain a stronger correlation with human judgement according to our human evaluation experiment, meaning that applying QAScore in the QG task benefits to a higher level of evaluation accuracy.

Aim To estimate the incidence of injury in adult elite women’s football and to characterise the nature and anatomical location of injuries.Design Systematic review and meta-analysis.Data sources Combinations of the key terms were entered into the following electronic databases (PubMed, SPORTDiscus, Science Direct and Discover) from inception to May 2021.Eligibility criteria for selecting studies (1) Used a prospective cohort design; (2) captured data on elite adult women players; (3) reported injury incidence by anatomical site; (4) captured data of at least one season or national team tournament; (5) included a definition of injury; and (6) written in English.Results The search identified 1378 records. Twelve studies published between 1991 and 2018 were included in our review and sampled 129 teams. In domestic club football, injury incidence rate was estimated to be 5.7/1000 hours (total), 19.5/1000 hours (match) and 3.1/1000 hours (training). In tournament, football match incidence was estimated to be 55.7/1000 hours. The knee (22.8%; 368/1822) was the most common site of injury in domestic club football. The ankle (23.7%, 105/443) was the most common site of injury in tournament football. Ligament sprains were the most common type of injury (27.8%), followed by muscle strains (19.1%). Severn studies (58%) had a high risk of bias associated with exposure definition and measurement and considerable heterogeneity exists between the included studies (I2=49.7%–95%).Summary/conclusion Ligament sprains occur more frequently in adult elite women football players. We advise caution in interpretating point estimates of the incidence of injury due to high statistical heterogeneity. Standardising injury reporting and the accurate recording of match and training exposure will overcome such limitations.PROSPERO registration number CRD42019130407.su

Abstract Background Flying foxes (Chiroptera: Pteropodidae) are large bats that often roost in the sun, hence solar-powered GPS/GSM devices can track their movements over extended periods. The endemic Mauritian flying fox (Pteropus niger) has recently been subjected to large-scale culling because of perceived damage to commercial fruit, and a consequent reduction in numbers of > 50% since 2015 resulted in its IUCN Red List Status being up-listed to Endangered. Determining its movements will be important for management and conservation, for understanding potential responses to environmental change, and for understanding population admixture. Methods Twelve bats were tagged with solar-powered GPS/GSM devices in 2014–2016. Tags remained active for up to almost a year (maximum 359 days: average 139 days (males) and 93 days (females)), providing some of the longest-term data on the movement ecology of bats yet obtained. Eight bats were probably hunted illegally, highlighting the scale of unauthorised persecution. Results Males travelled on average 9 km each night, females 6 km. The nightly distance covered by adults of both sexes was higher in winter than in summer, though the opposite pattern occurred for immature males. These differences are probably related to seasonal changes in fruit availability (adults) and to dispersal by immature males. The maximum distance covered during one night was > 92 km. Home ranges of males averaged 74,633 ha, females 31,072 ha. Core foraging areas averaged 2222 ha for males, 1364 ha for females. Fifty roosts were identified, mainly in forest fragments. As the bats disperse seeds of native plants that form forest canopies, conservation of the bats will potentially maintain and enhance native forest cover, in turn providing roosting sites for the bats. Conclusions Solar-powered GSM tagging provides unprecedented potential for understanding the movement ecology of flying foxes. Mauritian flying foxes often move between the few remnant native forest fragments, which remain important for their conservation, and have potentially important roles in seed dispersal. Their nomadic movement fits with their panmictic genetic structure. Although their ability for long distance movements, sometimes over short timescales, permits rapid responses to local threats and environmental change, being restricted to Mauritius renders the bats extremely vulnerable to intense culling.

Background and Objectives: Characterising the features of methodologies, clinical attributes and intervention protocols, of studies is valuable to advise directions for research and practice. This article reports the findings of a secondary analysis of the features from studies screened as part of a large systematic review of TENS (the meta-TENS study). Materials and Methods: A descriptive analysis was performed on information associated with methodology, sample populations and intervention protocols from 381 randomised controlled trials (24,532 participants) evaluating TENS delivered at a strong comfortable intensity at the painful site in adults with pain, irrespective of diagnosis. Results: Studies were conducted in 43 countries commonly using parallel group design (n = 334) and one comparator group (n = 231). Mean ± standard deviation (SD) study sample size (64.05 ± 58.29 participants) and TENS group size (27.67 ± 21.90 participants) were small, with only 13 of 381 studies having 100 participants or more in the TENS group. Most TENS interventions were ‘high frequency’ (>10 pps, n = 276) and using 100 Hz (109/353 reports that stated a pulse frequency value). Of 476 comparator groups, 54.2% were active treatments (i.e., analgesic medication(s), exercise, manual therapies and electrophysical agents). Of 202 placebo comparator groups, 155 used a TENS device that did not deliver currents. At least 216 of 383 study groups were able to access other treatments whilst receiving TENS. Only 136 out of 381 reports included a statement about adverse events. Conclusions: Clinical studies on TENS are dominated by small parallel group evaluations of high frequency TENS that are often contaminated by concurrent treatment(s). Study reports tended focus on physiological and clinical implications rather than the veracity of methodology and findings. Previously published criteria for designing and reporting TENS studies were neglected and this should be corrected in future research using insights gleaned from this analysis.

A multiwavelength study of galaxies is important to understand their formation and evolution. Only in the recent past, thanks to the Atacama Large (Sub) Millimeter Array (ALMA), were we able to study the far-infrared (IR) properties of galaxies at high redshifts. In this article, we summarize recent research highlights and their significance to our understanding of early galaxy evolution from the ALPINE survey, a large program with ALMA to observe the dust continuum and 158μm C+ emission of normal star-forming galaxies at z= 4–6. Combined with ancillary data at UV through near-IR wavelengths, ALPINE provides the currently largest multiwavelength sample of post-reionization galaxies and has advanced our understanding of (i) the demographics of C+ emission; (ii) the relation of star formation and C+ emission; (iii) the gas content; (iv) outflows and enrichment of the intergalactic medium; and (v) the kinematics, emergence of disks, and merger rates in galaxies at z>4. ALPINE builds the basis for more detailed measurements with the next generation of telescopes, and places itself as an important post-reionization baseline sample to allow a continuous study of galaxies over 13 billion years of cosmic time.

Developing an optimal diet for rearing endangered white-clawed crayfish Austropotamobius pallipes is important for captive breeding success prior to wild release. Four ex situ, 40-day experiments assessed survival and growth of crayfish fed different treatment diets. Two experiments (A and B) were undertaken with hatchlings, to determine if live food was an essential dietary component during the first few weeks after hatching. The second set of experiments (C and D) were undertaken with juvenile (60-day-old) A. pallipes, to determine an optimal diet after the initial critical feeding stage. In experiment A, we fed hatchlings: i) live Artemia nauplii + plankton (Live + P); ii) decapsulated Artemia cysts + plankton (Cyst + P) or iii) decapsulated Artemia cysts + plankton encapsulated in agar gel (Gel + CP). Survival and growth was significantly greater with Live + P than with the other two diets. In experiment B we compared Live + P with commercially available feeds by feeding hatchlings: i) live Artemia nauplii + Australian pellet (Live + Aus); ii) live Artemia nauplii plus New Zealand pellet (Live + NZ); iii) live Artemia nauplii + plankton (Live + P); or (iv) practical Spanish crayfish pellet diet (Spain). Under these experimental conditions crayfish survival was significantly higher with Live + P diet than with Live + Aus or Spain. Growth was also significantly greater with Live + P than with the Live + NZ or Spanish treatment diets. In experiment C, 60-day-old juvenile A. pallipes were fed: i) defrosted plankton plus vegetables (Standard) or (ii) defrosted plankton plus vegetables encapsulated in agar gel (Gel + PV). Survival was not significantly different between the diets; however, growth was significantly greater with the Standard diet rather than Gel + PV. In experiment D, juveniles were fed four different diets: i) Australian pellet (Australia); ii) New Zealand pellet (New Zealand); iii) plankton and vegetables (Standard); or iv) practical Spanish diet (Spain). Survival was significantly lower in crayfish fed the New Zealand diet. Crayfish growth was significantly greater with the Standard diet of plankton and vegetables than all three pellet diets. Our results showed that live food is optimal for high survival and growth in A. pallipes hatchlings and a plankton, plus vegetable, diet produces higher growth in juveniles compared to pellet diets.

ObjectivesCompliant surfaces beneath a casualty diminish the quality of cardiopulmonary resuscitation (CPR) in clinical environments. To examine this issue in a sporting environment, we assessed chest compression quality and rescuer exertion upon compliant sports safety matting.MethodsTwenty-seven advanced life support providers volunteered (13 male/14 female; mass = 79.0 ± 12.5 kg; stature = 1.77 ± 0.09 m). Participants performed 5 × 2 min, randomized bouts of continuous chest compressions on a mannequin, upon five surfaces: solid floor; low-compliance matting; low-compliance matting with a backboard; high-compliance matting; high-compliance matting with a backboard. Measures included chest compression depth and rate, percentage of adequate compressions, and rescuer heart rate and perceived exertion.ResultsChest compression depth and rate were significantly lower upon high-compliance matting relative to other surfaces (pConclusionProviders of CPR should be alerted to the detrimental effects of compliant safety matting in a sporting environment and prepare to alter the targeted compression depth and rescuer rotation intervals accordingly.

The tequila bat (Leptonycteris yerbabuenae) has been the focus of intense research over the last 20 years. Its close relationship to economically important plants used in the production of tequila and mezcal has raised awareness of its importance as both a keystone mutualist and a mobile link between habitats. The study of its migratory habits has shed light on patterns of movement and routes that animals follow, and how these movements affect the genetic composition of its populations. Delimiting the boundaries of breeding populations is of great importance for conservation, however, determining these boundaries has been difficult for L. yerbabuenae. Understanding the demographic history of the species could provide additional insight into current differences of its migratory behaviour and reproductive asynchrony. Here, we report evidence of historical matrilineal structure by comparing partial sequences of mtDNA cytochrome b (bp 306) and Control Region (497 bp) and inferred patterns of differentiation across the distribution of L. yerbabuenae in Mexico. Our population-based statistical analysis suggests panmixia among colonies with low genetic differentiation between north-western and south-eastern colonies. Neutrality tests of the Control Region indicate the presence of two divergent mitochondrial lineages in the south-east and the north-west of Mexico. Our results corroborate recent population expansion events, possibly due to the influence of physical barriers to migration and historical population demography. We recognize one single population but two Conservation Units (CUs) based on differences in reproductive phenology, migratory behaviour and the evidence of two matrilineal lineages as found in this study. We recommend the use of large-scale genomic datasets to better delimit fine-scale population structure in the future.

Background Up to half of all musculoskeletal injuries are investigated with plain radiographs. However, high rates of image interpretation error mean that novel solutions such as artificial intelligence (AI) are being explored.Objectives To determine patient confidence in clinician-led radiograph interpretation, the perception of AI-assisted interpretation and management, and to identify factors which might influence these views.Methods A novel questionnaire was distributed to patients attending fracture clinic in a large inner-city teaching hospital. Categorical and Likert scale questions were used to assess participant demographics, daily electronics use, pain score and perceptions towards AI used to assist in interpretation of their radiographs, and guide management.Results 216 questionnaires were included (M=126, F=90). Significantly higher confidence in clinician rather than AI-assisted interpretation was observed (clinician=9.20, SD=1.27 vs AI=7.06, SD=2.13), 95.4% reported favouring clinician over AI-performed interpretation in the event of disagreement.Small positive correlations were observed between younger age/educational achievement and confidence in AI-assistance. Students demonstrated similarly increased confidence (8.43, SD 1.80), and were over-represented in the minority who indicated a preference for AI-assessment over their clinicians (50%).Conclusions Participant’s held the clinician’s assessment in the highest regard and expressed a clear preference for it over the hypothetical AI assessment. However, robust confidence scores for the role of AI-assistance in interpreting skeletal imaging suggest patients view the technology favourably.Findings indicate that younger, more educated patients are potentially more comfortable with a role for AI-assistance however further research is needed to overcome the small number of responses on which these observations are based.

The aim of this case series is to describe and evaluate our experience of continuous positive airway pressure (CPAP) to treat type 1 respiratory failure in patients with COVID-19. CPAP was delivered in negative pressure rooms in the newly repurposed infectious disease unit. We report a cohort of 24 patients with type 1 respiratory failure and COVID-19 admitted to the Royal Liverpool Hospital between 1 April and 30 April 2020. Overall, our results were positive; we were able to safely administer CPAP outside the walls of a critical care or high dependency unit environment and over half of patients (58%) avoided mechanical ventilation and a total of 19 out of 24 (79%) have survived and been discharged from our care.

Objective: CD3+CD8+CD28− cells are higher in Rheumatoid Arthritis (RA). The aim of this study was to assess CD3+CD8+CD28− cells in patients with early RA and assess the effects of cytomegalovirus (CMV) seropositivity.Method: In this prospective observation study, 50 RA patients were recruited from Cardiff University Hospital of Wales (UHW) rheumatology outpatient, 25 patients with early disease (disease duration 0–6 months) and 25 patients with established disease (>2 years). These were compared with 25 healthy controls. Clinical and serological markers of inflammation were noted, and peripheral blood mononuclear cells were analyzed using flow cytometry.Results: The percentage of the CD8+CD28− T cells was increased in RA patients and was associated with disease duration. The percentage of CD8+CD28− T cells was increased in CMV positive early and established RA grouped and early RA patients in comparison to CMV negative patients (p < 0.05). There is a weak but statistically significant correlation between the percentage of CD3+CD8+CD28− cells and CRP in CMV positive RA patients (r = 0.227, p < 0.05).Conclusion: The percentage of CD8+CD28− T cells is higher in RA patients and correlates with disease duration, highlighting a potential role early in the disease process. These cells were also higher in CMV positive early RA patients which may suggest a role of CMV in disease development.

Where humans and wildlife co-exist, mitigation is often needed to alleviate potential conflicts and impacts. Deterrence methods can be used to reduce impacts of human structures or activities on wildlife, or to resolve conservation conflicts in areas where animals may be regarded as a nuisance or pose a health hazard. Here we test two methods (acoustic and radar) that have shown potential for deterring bats away from areas where they forage and/or roost. Using both infrared video and acoustic methods for counting bat passes, we show that ultrasonic speakers were effective as bat deterrents at foraging sites, but radar was not. Ultrasonic deterrents decreased overall bat activity (filmed on infrared cameras) by ~80% when deployed alone and in combination with radar. However, radar alone had no effect on bat activity when video or acoustic data were analysed using generalised linear mixed effect models. Feeding buzzes of all species were reduced by 79% and 69% in the ultrasound only treatment when compared to the control and radar treatments, but only the ultrasound treatment was significant in post-hoc tests. Species responded differently to the ultrasound treatments and we recorded a deterrent effect on both Pipistrellus pipistrellus (~40-80% reduction in activity) and P. pygmaeus (~30-60% reduction), but not on Myotis species. However, only the ultrasound and radar treatment was significant (when compared to control and radar) in post-hoc tests for P. pipistrellus. Deterrent treatment was marginally non-significant for P. pygmaeus, but the ultrasound only treatment was significant when compared to radar in post-hoc tests. We therefore suggest that acoustic, but not radar methods are explored further as deterrents for bats. The use of acoustic deterrence should always be assessed on a case-by-case basis, with a focus on bat conservation.

The bamboo bats belonging to the genus Tylonycteris are unique due to their morphology and ecology, and are known from few locations in South Asia. We collected voucher specimens of Tylonycteris malayana from North Andaman Island, which forms the basis of the first specimen-based record of this species from the Andaman & Nicobar Islands, and the second record from India. Our analyses based on morphometrics, craniodental measurements, bacular morphology and molecular phylogeny based on cytochrome c oxidase subunit I gene indicate that the insular population of T. malayana may have diversified in isolation to differ from the mainland forms, and could represent putative new subspecies, described herein. In light of the new findings, we discuss the importance of conducting detailed study on the specimens of the Lesser Bamboo Bat earlier reported from the Andaman & Nicobar Islands to ascertain their taxonomic status.

Background and Objectives: Uncertainty about the clinical efficacy of transcutaneous electric nerve stimulation (TENS) to alleviate pain spans half a century. There has been no attempt to synthesise the entire body of systematic review evidence. The aim of this comprehensive review was to critically appraise the characteristics and outcomes of systematic reviews evaluating the clinical efficacy of TENS for any type of acute and chronic pain in adults. Materials and Methods: We searched electronic databases for full reports of systematic reviews of studies, overviews of systematic reviews, and hybrid reviews that evaluated the efficacy of TENS for any type of clinical pain in adults. We screened reports against eligibility criteria and extracted data related to the characteristics and outcomes of the review, including effect size estimates. We conducted a descriptive analysis of extracted data. Results: We included 169 reviews consisting of eight overviews, seven hybrid reviews and 154 systematic reviews with 49 meta-analyses. A tally of authors’ conclusions found a tendency toward benefits from TENS in 69/169 reviews, no benefits in 13/169 reviews, and inconclusive evidence in 87/169 reviews. Only three meta-analyses pooled sufficient data to have confidence in the effect size estimate (i.e., pooled analysis of >500 events). Lower pain intensity was found during TENS compared with control for chronic musculoskeletal pain and labour pain, and lower analgesic consumption was found post-surgery during TENS. The appraisal revealed repeated shortcomings in RCTs that have hindered confident judgements about efficacy, resulting in stagnation of evidence. Conclusions: Our appraisal reveals examples of meta-analyses with ‘sufficient data’ demonstrating benefit. There were no examples of meta-analyses with ‘sufficient data’ demonstrating no benefit. Therefore, we recommend that TENS should be considered as a treatment option. The considerable quantity of reviews with ‘insufficient data’ and meaningless findings have clouded the issue of efficacy. We offer solutions to these issues going forward.

Abstract Background SCOPE 1 was the first UK based multi-centre trial involving radiotherapy of the oesophagus. A comprehensive radiotherapy trials quality assurance programme was launched with two main aims: 1. To assist centres, where needed, to adapt their radiotherapy techniques in order to achieve protocol compliance and thereby enable their participation in the trial. 2. To support the trial’s clinical outcomes by ensuring the consistent planning and delivery of radiotherapy across all participating centres. Methods A detailed information package was provided and centres were required to complete a benchmark case in which the delineated target volumes and organs at risk, dose distribution and completion of a plan assessment form were assessed prior to recruiting patients into the trial. Upon recruiting, the quality assurance (QA) programme continued to monitor the outlining and planning of radiotherapy treatments. Completion of a questionnaire was requested in order to gather information about each centre’s equipment and techniques relating to their trial participation and to assess the impact of the trial nationally on standard practice for radiotherapy of the oesophagus. During the trial, advice was available for individual planning issues, and was circulated amongst the SCOPE 1 community in response to common areas of concern using bulletins. Results 36 centres were supported through QA processes to enable their participation in SCOPE1. We discuss the issues which have arisen throughout this process and present details of the benchmark case solutions, centre questionnaires and on-trial protocol compliance. The range of submitted benchmark case GTV volumes was 29.8–67.8cm3; and PTV volumes 221.9–513.3 cm3. For the dose distributions associated with these volumes, the percentage volume of the lungs receiving 20Gy (V20Gy) ranged from 20.4 to 33.5%. Similarly, heart V40Gy ranged from 16.1 to 33.0%. Incidence of incorrect outlining of OAR volumes increased from 50% of centres at benchmark case, to 64% on trial. Sixty-five percent of centres, who returned the trial questionnaire, stated that their standard practice had changed as a result of their participation in the SCOPE1 trial. Conclusions The SCOPE 1 QA programme outcomes lend support to the trial’s clinical conclusions. The range of patient planning outcomes for the benchmark case indicated, at the outset of the trial, the significant degree of variation present in UK oesophageal radiotherapy planning outcomes, despite the presence of a protocol. This supports the case for increasingly detailed definition of practice by means of consensus protocols, training and peer review. The incidence of minor inconsistencies of technique highlights the potential for improved QA systems and the need for sufficient resource for this to be addressed within future trials. As indicated in questionnaire responses, the QA exercise as a whole has contributed to greater consistency of oesophageal radiotherapy in the UK via the adoption into standard practice of elements of the protocol. Trial registration The SCOPE1 trial is an International Standard Randomized Controlled Trial, ISRCTN47718479 .

Abstract Background Physical inactivity is one of the leading causes of chronic disease in Canadian adults. With less than 50% of Canadian adults reaching the recommended amount of daily physical activity, there is an urgent need for effective programs targeting this risk factor. HealtheSteps™ is a healthy lifestyle prescription program, developed from an extensive research base to address risk factors for chronic disease such as physical inactivity, sedentary behaviour and poor eating habits. HealtheSteps™ participants are provided with in-person lifestyle coaching and access to eHealth technologies delivered in community-based primary care clinics and health care organizations. Method/Design To determine the effectiveness of Healthesteps™, we will conduct a 6-month pragmatic randomized controlled trial with integrated process and economic evaluations of HealtheSteps™ in 5 clinic settings in Southwestern Ontario. 110 participants will be individually randomized (1:1; stratified by site) to either the intervention (HealtheSteps™ program) or comparator (Wait-list control). There are 3 phases of the HealtheSteps™ program, lasting 6 months each. The active phase consists of bi-monthly in-person coaching with access to a full suite of eHealth technology supports. During the maintenance phase I, the in-person coaching will be removed, but participants will still have access to the full suite of eHealth technology supports. In the final stage, maintenance phase II, access to the full suite of eHealth technology supports is removed and participants only have access to publicly available resources and tools. Discussion This trial aims to determine the effectiveness of the program in increasing physical activity levels and improving other health behaviours and indicators, the acceptability of the HealtheSteps™ program, and the direct cost for each person participating in the program as well as the costs associated with delivering the program at the different community sites. These results will inform future optimization and scaling up of the program into additional community-based primary care sites. Trial registration NCT02413385 (Clinicaltrials.gov). Date Registered: April 6, 2015.

BACKGROUND:Human cytomegalovirus (HCMV) can be managed by monitoring HCMV DNA in the blood and giving valganciclovir when viral load exceeds a defined value. We hypothesised that such pre-emptive therapy should occur earlier than the standard 3000 genomes/ml (2520 IU/ml) when a seropositive donor transmitted virus to a seronegative recipient (D+R-) following solid organ transplantation (SOT). METHODS:Our local protocol was changed so that D+R- SOT patients commenced valganciclovir once the viral load exceeded 200 genomes/ml; 168 IU/ml (new protocol). The decision point remained at 3000 genomes/ml (old protocol) for the other two patient subgroups (D+R+, D-R+). Virological outcomes were assessed three years later, when 74 D+R- patients treated under the old protocol could be compared with 67 treated afterwards. The primary outcomes were changes in peak viral load, duration of viraemia and duration of treatment in the D+R- group. The secondary outcome was the proportion of D+R- patients who developed subsequent viraemia episodes. FINDINGS:In the D+R- patients, the median values of peak viral load (30,774 to 11,135 genomes/ml, p

The diversity of bats worldwide includes large numbers of cryptic species, partly because divergence in acoustic traits such as echolocation calls are under stronger selection than differences in visual appearance in these nocturnal mammals. Island faunas often contain disproportionate numbers of endemic species, and hence we might expect cryptic, endemic species to be discovered relatively frequently in bats inhabiting islands. Species are best defined when multiple lines of evidence supports their diagnosis. Here we use morphometric, acoustic, and molecular phylogenetic data to show that a horseshoe bat in the Andaman Islands is distinct in all three aspects, supporting its status as a distinct species. We recommend investigation into possible new and endemic bat species on islands by using integrated approaches that provide independent lines of evidence for taxonomic distinctiveness. We provide a formal redescription of the taxon newly raised to species level, Rhinolophus andamanensis Dobson, 1872.

PurposeSurgical education videos currently all use a single point of view (POV) with the trainee locked onto a fixed viewpoint, which may not deliver sufficient information for complex procedures. We developed a novel multiple POV video system and evaluated its training outcome compared with traditional single POV.MethodsWe filmed a hip resurfacing procedure performed by an expert attending using 8 cameras in theatre. 30 medical students were randomly and equally allocated to learn the procedure using the multiple POV (experiment group [EG]) versus single POV system (control group [CG]). Participants advanced a pin into the femoral head as demonstrated in the video. We measured the drilling trajectories and compared it with pre-operative plan to evaluate distance of the pin insertion and angular deviations. Two orthopedic attendings expertly evaluated the participants' performance using a modified global rating scale (GRS). There was a pre-video knowledge test that was repeated post-simulation alongside a Likert-scale questionnaire.ResultsThe angular deviation of the pin in EG was significantly less by 29% compared to CG (p = 0.037), with no significant difference in the entry point's distance between groups (p = 0.204). The GRS scores for EG were 3.5% higher than CG (p = 0.046). There was a 32% higher overall knowledge test score (pConclusionThe novel multiple POV provided significant objective and subjective advantages over single POV for acquisition of technical skills in hip surgery.

The Diadem Leaf-nosed Bat Hipposideros diadema (E. Geoffroy, 1813) is recorded for the first time from the Andaman Islands, India. A solitary female specimen was collected on October 13, 2015 from a limestone cave on Baratang Island. Cranial measurements and other morphological characters indicate that the specimen differs from the endemic subspecies, the Nicobar Diadem Leaf-nosed Bat Hipposideros diadema nicobarensis (Dobson, 1871), but compares favourably with the South-east Asian subspecies, Mason’s Diadem Leaf-nosed Bat Hipposideros diadema masoni (Dobson, 1872), in description, craniodental characters, and echolocation calls. This is the first record of Hipposideros diadema (E. Geoffroy, 1813) from Andaman Islands, and the subspecies Mason’s Diadem Leaf-nosed Bat Hipposideros diadema masoni (Dobson, 1872) from India.

Mountain biking is an increasingly popular outdoor activity on the extreme sport continuum. Extreme and high-risk sports have been investigated using a variety of motivational theories with sensation seeking a dominant theme; however, behavioral and motivational homogeneity within these types of populations should not be assumed. Recent studies have highlighted the therapeutic potential of extreme sports and similar outdoor activities. The aim of this study was to describe the characteristics of mountain biking participants, their engagement methods, and perceived benefits to mental health and well-being. This was a cross-sectional survey and participants were recruited via social media. An online questionnaire specific to the domain of mountain biking was developed. Analysis of the full sample (n = 1,484) and of three independent paired sub-samples was conducted using SPSS. The sub-samples compared the results of males and females; younger and older riders; and those who have recently engaged in downhill mountain biking and those who have not. The results have succeeded in identifying some disparities in mountain biker characteristics and engagement methods. The results suggest that some riders found pleasure in higher risk engagement. The study proposes various explanations for the disproportion of women in mountain biking. Irrespective of the confounding factors related to rider characteristics or engagement methods, mountain bikers reported copious benefits to mental health and well-being related to their engagement. There was a high reported usage of mountain biking as a coping strategy. As such, this study provides insights that could inform the development of outdoor activities as interventions for mental health.

Emerging lighting technologies provide opportunities for reducing carbon footprints, and for biodiversity conservation. In addition to installing light-emitting diode street lights, many local authorities are also dimming street lights. This might benefit light-averse bat species by creating dark refuges for these bats to forage and commute in human-dominated habitats. We conducted a field experiment to determine how light intensity affects the activity of the light-opportunistic Pipistrellus pipistrellus and light-averse bats in the genus Myotis. We used four lighting levels controlled under a central management system at existing street lights in a suburban environment (0, 25, 50 and 100% of the original output). Higher light intensities (50 and 100% of original output) increased the activity of light-opportunistic species but reduced the activity of light-averse bats. Compared to the unlit treatment, the 25% lighting level did not significantly affect either P. pipistrellus or Myotis spp. Our results suggest that it is possible to achieve a light intensity that provides both economic and ecological benefits by providing sufficient light for human requirements while not deterring light-averse bats.