Tropical forest disturbance is a key driver of global biodiversity decline. On continents, the effects of logging are greatest on endemic species, presumably because disturbance is more likely to ...cover narrower distributions (the “cookie cutter” model). Islands hold disproportionate biodiversity, and are subject to accelerating biotic homogenization, where specialist endemics are lost while generalists persist. We tested responses of tropical island mammals to logging at multiple spatial scales, using a long‐term experimental test in a Pacific archipelago. The most widely distributed ecological generalists did not decline after logging, and we detected no overall changes in relative abundance or species diversity. However, endemics with small ranges did decline in response to logging. The least mobile and most range‐restricted species declined even at the smallest spatial scale, supporting the cookie cutter model for sedentary species, and suggesting that habitat change due to selective logging is contributing to biotic homogenization on islands.
Tropical forest disturbance is a key driver of global biodiversity decline. Islands support a disproportionate amount of global biodiversity, and are subject to high rates of extinction. We tested responses of tropical island mammals to logging in a Pacific archipelago over a 23 year period. We show that only the most range‐restricted endemics have declined, supporting previous suggestions that these species are most vulnerable to extinction.
Aims
Prevention of foot ulcers in persons with diabetes is important to help reduce the substantial burden on both individual and health resources. A comprehensive analysis of reported interventions ...is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review and meta‐analysis is to assess the effectiveness of interventions to prevent foot ulcers in persons with diabetes who are at risk thereof.
Materials and Methods
We searched the available scientific literature in PubMed, EMBASE, CINAHL, Cochrane databases and trial registries for original research studies on preventative interventions. Both controlled and non‐controlled studies were eligible for selection. Two independent reviewers assessed risk of bias of controlled studies and extracted data. A meta‐analysis (using Mantel‐Haenszel's statistical method and random effect models) was done when >1 RCT was available that met our criteria. Evidence statements, including the certainty of evidence, were formulated according to GRADE.
Results
From the 19,349 records screened, 40 controlled studies (of which 33 were Randomised Controlled Trials RCTs) and 103 non‐controlled studies were included. We found moderate certainty evidence that temperature monitoring (5 RCTs; risk ratio RR: 0.51; 95% CI: 0.31–0.84) and pressure‐optimised therapeutic footwear or insoles (2 RCTs; RR: 0.62; 95% CI: 0.26–1.47) likely reduce the risk of plantar foot ulcer recurrence in people with diabetes at high risk. Further, we found low certainty evidence that structured education (5 RCTs; RR: 0.66; 95% CI: 0.37–1.19), therapeutic footwear (3 RCTs; RR: 0.53; 95% CI: 0.24–1.17), flexor tenotomy (1 RCT, 7 non‐controlled studies, no meta‐analysis), and integrated care (3 RCTs; RR: 0.78; 95% CI: 0.58–1.06) may reduce the risk of foot ulceration in people with diabetes at risk for foot ulceration.
Conclusions
Various interventions for persons with diabetes at risk for foot ulceration with evidence of effectiveness are available, including temperature monitoring (pressure‐optimised) therapeutic footwear, structured education, flexor tenotomy, and integrated foot care. With hardly any new intervention studies published in recent years, more effort to produce high‐quality RCTs is urgently needed to further improve the evidence base. This is especially relevant for educational and psychological interventions, for integrated care approaches for persons at high risk of ulceration, and for interventions specifically targeting persons at low‐to‐moderate risk of ulceration.
Restoration of coastal wetlands has the potential to deliver both climate change mitigation, called blue carbon, and adaptation benefits to coastal communities, as well as supporting biodiversity and ...providing additional ecosystem services. Valuing carbon sequestration may incentivize restoration projects; however, it requires development of rigorous methods for quantifying blue carbon sequestered during coastal wetland restoration. We describe the development of a blue carbon accounting model (BlueCAM) used within the Tidal Restoration of Blue Carbon Ecosystems Methodology Determination 2022 of the Emissions Reduction Fund (ERF), which is Australia's voluntary carbon market scheme. The new BlueCAM uses Australian data to estimate abatement from carbon and greenhouse gas sources and sinks arising from coastal wetland restoration (via tidal restoration) and aligns with the Intergovernmental Panel for Climate Change guidelines for national greenhouse gas inventories. BlueCAM includes carbon sequestered in soils and biomass and avoided emissions from alternative land uses. A conservative modeled approach was used to provide estimates of abatement (as opposed to on‐ground measurements); and in doing so, this will reduce the costs associated with monitoring and verification for ERF projects and may increase participation in blue carbon projects by Australian landholders. BlueCAM encompasses multiple climate regions and plant communities and therefore may be useful to others outside Australia seeking to value blue carbon benefits from coastal wetland restoration.
Comparative phylogeography is recognized as a powerful tool to discern common patterns of connectivity across species, information that can be crucial in assisting the design of protected area ...networks.
Previously, qualitative analyses have been undertaken in New Zealand waters in order to find concordance in marine dispersal barriers. This study presents the first attempt to quantitatively measure the congruence in genetic divergence breaks among 21 New Zealand marine coastal invertebrates, while accounting for the effects of variable sampling scale, life history traits and marker type.
Previously recognized phylogeographic barriers to dispersal were found to be significant across species, such as the North–South Island differentiation and a northern genetic break at Cape Reinga. Low‐dispersal species exhibited additional locations of common significant divergence. Some of the differences in genetic barriers observed among species may be more related to the habitat type of the species (intertidal zone or subtidal) and the marker type used in the study (mitochondrial DNA or microsatellites), than to the dispersal traits of the species (high or low dispersal).
Despite some limitations, the approach implemented here has significant advantages and permits the use of data from a wide variety of studies. This study provides the first quantitative insight into community‐wide genetic barriers within New Zealand's coastal marine ecosystem and provides directions for future investigations of this type in other regions.
A baby with a widespread itchy rash Lavery, Michael J; Woodcock, Deborah; Simmons, Will ...
BMJ (Online),
10/2019, Letnik:
367
Journal Article
Recenzirano
Polymorphic eruption with erythematous papules, nodules, and plaques Older children and adult family members and friends also had a similar itchy rash but the distribution was slightly different and ...not on the soles of their feet. The rash may be atypical and have a polymorphic presentation—ie, with different types of skin lesions presenting in the same patient (eg, nodules, papules, vesicles, plaques), and won’t always be interdigital. ...details of The BMJ policy on financial interests is here: https://www.bmj.com/about-bmj/resources-authors/forms-policies-and-checklists/declaration-competing-interests Provenance and peer review: not commissioned; externally peer reviewed. 1 Burkhart CN, Burkhart CG, Morrell DS.
PURPOSE OF REVIEWThe purpose of this review is to summarize recent studies and emerging consensus guidelines regarding food allergy prevention in infants of the past 5 years.
RECENT FINDINGSPrior to ...2013, the general consensus regarding prevention of food allergy in infants was to recommend delayed introduction or complete avoidance of commonly allergenic foods, such as milk, egg and peanut. However, in the past 5 years, several landmark studies have been conducted, particularly with peanut. The results of these studies have led to a paradigm shift from recommending delayed introduction to early introduction and frequent feeding of highly allergenic foods such as peanut, with hopes of achieving primary and secondary prevention of food allergy in infants.
SUMMARYRecent clinical trials have demonstrated that early introduction and frequent feeding, rather than delayed introduction or complete avoidance, of commonly allergenic foods plays a critical role in preventing food allergy in infants. More studies are required to risk-stratify infants by personal and family atopic history to tailor guidelines for groups with inherently different risks. The universal acceptance of the guidelines and their application outcome are still to be determined.
Purpose The Gleason scoring system has been the traditional basis for studies on the assessment and treatment of prostate cancer. Recent reports of long-term prostate cancer outcomes stratified by ...Gleason score based on the 2005 ISUP (International Society of Urological Pathology) update suggest that important aspects of the biology of prostate cancer correlate with commonly available histopathological information. In this review we present a conceptual framework for the possible existence of distinct but interrelated developmental pathways in the context of the Gleason score in considering various biological and clinical aspects of prostate cancer. This may be useful in characterizing prostate cancer as an indolent condition in some and an aggressive disease in others, in decision making for treatment, and in the interpretation of the biological course and treatment outcomes. Materials and Methods A comprehensive review of clinical, pathological and investigational biological literature on this topic was conducted. In addition, the biological behavior of prostate cancer as interpreted from this survey was compared to that of other solid neoplasms in developing a schema for characterizing the pathogenesis of various forms of the disease. Results The Gleason scoring system has been found to have fundamental value in predicting the behavior of prostate cancer and assessing outcomes of its treatment. Increasingly, the proportion of Gleason pattern 4 in a prostatectomy specimen is being recognized as a critical factor in predicting the rates of biochemical recurrence and prostate cancer specific mortality. Under the current Gleason classification, a Gleason 3 + 3 = 6 cancer carries a minimal long-term risk of progression or mortality. Risk of biochemical recurrence and prostate cancer specific mortality increases with increasing proportions of the Gleason 4 component in the prostatectomy specimen, from 3 + 3 = 6 with tertiary 4 (ie less than 5% of a 4 component) to 3 + 4 = 7, 4 + 3 = 7 and 4 + 4 = 8. Assuming that the Gleason 4 component increases in volume more rapidly with time than well differentiated components, it can be inferred that a smaller proportion of Gleason 4 could mean that the cancer has been identified at an earlier phase in the natural history of the disease. This could explain the improved prognosis on the basis of length and lead time biases, and conceivably on the basis of a decreased likelihood of cancer cells having metastasized. Correspondingly, increasing amounts of Gleason 4 cancer in a prostate specimen might be explained in 2 ways, as the preferential growth of a single clone of Gleason 4 cells, possibly with intraprostatic spread, or the evolution of Gleason 3 cancer cells to become Gleason 4. These hypotheses have been examined by genetic analysis of metastatic deposits and by comparisons of multiple foci of cancer within individual prostates. The clinical significance of these concepts in regard to disease status at diagnosis, treatment selection, outcomes of treatment, and implications for future research on the basis of clinical and molecular observations are the basis of the developmental schemata we propose. Conclusions Given the relatively benign nature of homogeneous, low volume Gleason 3 tumors, and the progressive risk of biochemical recurrence and prostate cancer specific mortality with increasing quantities of Gleason 4 components, we propose that Gleason 4 (and 5) cancers constitute cancer diatheses distinct from that of Gleason 3 cancer. This distinction may contribute to the understanding of the prognosis intrinsic to these biological behavioral patterns, and help guide the translation of findings at molecular and histological levels to a more precise selection of treatments.
There are several applications of electrical stimulation described in medical literature to accelerate wound healing and improve cutaneous perfusion. This is a simple technique that could be ...incorporated as an adjunctive therapy in plastic surgery. The objective of this review was to evaluate the results of randomized clinical trials that use electrical stimulation for wound healing.
We identified 21 randomized clinical trials that used electrical stimulation for wound healing. We did not include five studies with treatment groups with less than eight subjects.
Electrical stimulation was associated with faster wound area reduction or a higher proportion of wounds that healed in 14 out of 16 wound randomized clinical trials. The type of electrical stimulation, waveform, and duration of therapy vary in the literature.
Electrical stimulation has been shown to accelerate wound healing and increase cutaneous perfusion in human studies. Electrical stimulation is an adjunctive therapy that is underutilized in plastic surgery and could improve flap and graft survival, accelerate postoperative recovery, and decrease necrosis following foot reconstruction.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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