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ABSTRACTConference realignment is the practice of universities moving from one athletic conference to another in hopes of increased media exposure and revenue. One aspect of conference realignment that does not garner as much attention is the travel demands that are placed upon the athletes. The purpose of the study was to understand how athletes perceive the effects of travel on their performance on the playing field and in the classroom. Football players from the Big Ten and Big 12 and hockey players from the WCHA and Hockey East conferences completed a qualitative questionnaire about their perceptions about the travel demands of their sport. Results indicated that most of the athletes felt the travel had a negative impact on their athletic performance, academics, and personal relationships. The findings could be useful for university and athletic administrators when deciding whether to change conferences for one that may require longer travel distances.

Background: Few studies have investigated associations between perceived social determinants of health (SDOH) and Alzheimer’s disease and related dementia (ADRD) biomarkers or between SDOH and resilience against ADRD.Objective: To examine associations between perceived and objective SDOH and ADRD-related outcomes.Methods: We used cross-sectional data on≥50-year-olds without dementia in the Healthy Brain Initiative (n = 162). Questionnaires captured trust in neighbors and indices of perceived neighborhood greenspace access, time spent in neighborhood greenspaces, and interpersonal discrimination. Residential addresses were linked to 2021 Area Deprivation Index scores. The Vulnerability Index (VI) is based on 12 dementia risk factors (e.g., age, race/ethnicity, diabetes) and Resilience Index (RI) is based on 6 protective factors (e.g., diet, mindfulness, physical activity). Cognitive measured included number symbol coding task and Montreal Cognitive Assessment. Biomarkers included Aβ42/40and pTau-217/npTau-217, hippocampal and white matter hyperintensity volume, lipoprotein A, and high-sensitivity c-reactive protein.Results: Perceived greater access to greenspaces (estimate = 2.83, 95% CI = 1.40–4.26) and greater time in neighborhood greenspaces were associated with greater RI scores (estimate = 2.30, 95% CI = 1.24–3.35). Reporting greater discrimination (estimate = 0.10, 95% CI = 0.04–0.16) and living in higher deprivation neighborhoods were associated with greater VI scores (estimate = 0.017, 95% CI = 0.003–0.032). Greater discrimination was associated with greater white matter hyperintensity volume (estimate = 0.27, 95% CI = 0.04–0.51).Conclusions: Perceived greenspace access and time spent in greenspaces were associated with resilience against ADRD, and interpersonal discrimination was associated with vulnerability to ADRD. Future work needs to validate perceived SDOH measures, examine associations in racially/ethnic diverse populations, and investigate longitudinal associations between SDOH and ADRD-related biomarkers.

Polar polymers such as poly(vinyl alcohol-co-ethylene) (EVOH) serve as excellent oxygen barriers in multilayered polymer films. However, their presence creates significant challenges for subsequent recycling. Melting and thermal degradation leave behind small domains of immiscible phases that render the final material less valuable. Here, we report a strategy to selectively remove OH groups from the EVOH polymer while preserving the polymer's hydrocarbon backbone. Pd supported on TiO2nanotubes exhibits excellent activity and selectivity for C–O bond scission and hydrogenation. This is evidenced in our study, which utilizes both the model compound 2,5-hexanediol (a small surrogate for polyols) and EVOH. The Lewis-acid sites generated on the TiO2surface, coupled with hydrogen dissociation on the metal particles and unique sites at the metal support interface, result in enhanced deoxygenation rates to generate saturated products at atmospheric pressure. The intimacy between Pd particles and their TiO2supports for EVOH conversion is also discussed.

Multi-layered plastic (MLP) films provide excellent properties for food packaging; however, because of the complicated chemistry of the hydrophobic substrates and tightly laminated hydrophilic layers, it is challenging to recycle the MLP films. The selective conversion of polar functional groups in hydrophilic layers with a minimal destruction of the carbon backbone of constituted polymers is considered a promising approach to improve the recyclability of MLP films. In this study, we combine computational and experimental studies to investigate the acid-catalyzed conversion of functional groups in polyalcohols, through which we report potential reaction pathways involved in the conversion of ethylene vinyl alcohol (EVOH), a common copolymer used in MLP films as an oxygen barrier. Using 2,4-pentanediol as a model compound, we show that its conversion proceeds primarily through the dehydration of a hydroxyl group viaeither a stepwise or a concerted mechanism to form an unsaturated alcohol that can be further converted into a conjugated diene or a saturated ketone; this secondary reaction determines the product selectivity. The rate determining intermediates and transition states are identified, and the activation barriers are calculated, in agreement with experimentally observed product selectivities. This study thus provides insights for the selective conversion of EVOH.

The technological evolution and widespread availability of wearables and handheld ECG devices capable of screening for atrial fibrillation (AF), and their promotion directly to consumers, has focused attention of health care professionals and patient organizations on consumer-led AF screening. In this Frontiers review, members of the AF-SCREEN International Collaboration provide a critical appraisal of this rapidly evolving field to increase awareness of the complexities and uncertainties surrounding consumer-led AF screening. Although there are numerous commercially available devices directly marketed to consumers for AF monitoring and identification of unrecognized AF, health care professional–led randomized controlled studies using multiple ECG recordings or continuous ECG monitoring to detect AF have failed to demonstrate a significant reduction in stroke. Although it remains uncertain if consumer-led AF screening reduces stroke, it could increase early diagnosis of AF and facilitate an integrated approach, including appropriate anticoagulation, rate or rhythm management, and risk factor modification to reduce complications. Companies marketing AF screening devices should report the accuracy and performance of their products in high- and low-risk populations and avoid claims about clinical outcomes unless improvement is demonstrated in randomized clinical trials. Generally, the diagnostic yield of AF screening increases with the number, duration, and temporal dispersion of screening sessions, but the prognostic importance may be less than for AF detected by single–time point screening, which is largely permanent, persistent, or high-burden paroxysmal AF. Consumer-initiated ECG recordings suggesting possible AF always require confirmation by a health care professional experienced in ECG reading, whereas suspicion of AF on the basis of photoplethysmography must be confirmed with an ECG. Consumer-led AF screening is unlikely to be cost-effective for stroke prevention in the predominantly young, early adopters of this technology. Studies in older people at higher stroke risk are required to demonstrate both effectiveness and cost-effectiveness. The direct interaction between companies and consumers creates new regulatory gaps in relation to data privacy and the registration of consumer apps and devices. Although several barriers for optimal use of consumer-led screening exist, results of large, ongoing trials, powered to detect clinical outcomes, are required before health care professionals should support widespread adoption of consumer-led AF screening.

Patient authorship is a new topic in medical publishing, with the number of patient‐authored publications growing rapidly.Publication stakeholders (e.g., editors, publishers, funders, researchers) should be aware of the legitimacy of patient authorship.Practical actions can be taken by different publication stakeholders to encourage and support patient authorship—ethically and effectively.Patient authorship can contribute to enhancing diversity, equity, and inclusion in medical publishing.Research on patient authorship could be strengthened with consensus on publication tagging practices (e.g., affiliation terms) and the use of artificial intelligence.A plain language summary of this article and the GRIPP2 form for reporting patient involvement are available as supplementary information.

Specimens of an extremely long, heteropolar nitzschioid diatom from mud scraped from mangrove pneumorrhizae on two Micronesian islands were identified as a new species of Gomphotheca.This genus contains two other, rarely seen species, only one of which has been observed with SEM. Our SEM images showed that G. marciaen. sp. is structurally similar to G. sinensis, with very long, heteropolar, cuneate cells with a central keel and internal costate fibulae, and thick, chambered copulae with contrasting external and internal pore patterns. However, the raphe path of G. marciaelacks a central break, conopea are present along each side of the keel, the fibula height is different, pseudosepta are present at both poles, while valve cross section and stria density also differ. We also report the presence of single-walled pleurae.

Critical infrastructure networks, including water, power, communication, and transportation, among others, are necessary to society’s functionality. In recent years, the threat of different types of disruptions to such infrastructure networks has become an increasingly important problem to address. Due to existing interdependencies, damage to a small area of one of the networks could have far-reaching effects on the ability to meet demand across the entire system. Common disruption scenarios include, among others, intentional malevolent attacks, natural disasters, and random failures. Similar works have focused on only one type of scenario, but combining a variety of disruptions may lead to more realistic results. Additionally, the concept of social vulnerability, which describes an area’s ability to prepare for and respond to a disruption, must be included. This should promote not only the protection of the most at-risk components but also ensure that socially vulnerable communities are given adequate resources. This work provides a decision making framework to determine the allocation of defensive resources that accounts for all these factors. Accordingly, we propose a multi-objective mathematical model with the objectives of: (i) minimizing the vulnerability of a system of interdependent infrastructure networks, and (ii) minimizing the total cost of the resource allocation strategy. Moreover, to account for uncertainty in the proposed model, this paper incorporates a means to address robustness in finding the most adaptable network protection plan to reduce the vulnerability of the system of interdependent networks to a variety of disruption scenarios. The proposed work is illustrated with an application to social vulnerability and interdependent power, gas, and water networks in Shelby County, Tennessee.

Scanning electron microscope observations of remnants of Grunow’s Honduras Sargassum sample showed specimens corresponding to Navarro’s species Florella portoricensis and F. pascuensis. Grunow described his specimens as Striatella lindigiana and S. intermedia. There are greater discrepancies between Grunow’s specimens and his descriptions than between his Striatella specimens and our Florella materials. These materials include Navarro’s description of types and authenticated material for F. portoricensis and F. pascuensis as well as observations of the latter species from the Marshall Islands. The problem is resolved by transferring Striatella lindigiana and S. intermedia to Florella, as the new combinations Florella lindigiana and F. intermedia.

Psychoanalysts do not usually focus on culture or cultural differences when they seek to explain or understand the behavior of individuals or couples in treatment. In this paper, I explore the way in which Nicoletta Skoufalos faced a cultural dilemma, finding herself “othering” the Jewish couple who were her patients. Her feelings were in contradistinction to her humanitarian values, which created anxiety. Skoufalos tried to assuage her anxiety by finding many points of similarity between her and the couple; however, the reasons why she needed to “other” were not interrogated or addressed because she lacked a theoretical framework about culture and its influence on subjectivity to help her frame her clinical dilemma. I suggest that there is an urgent need for psychoanalysts to theorize about the ways in which social and political experiences influence the individual’s subjectivity, and to address the question of how we can learn to have direct discussions with our patients about cultural differences and how they affect treatment.

In recent years the taxonomy of Hasleahas been in flux. We describe several Hasleataxa from Guam, including four new species, in light of these recent findings. Four delicate, fusiform Hasleaspecies are described from a variety of benthic habitats on coral reefs. These species, H. fusiformiscomb. nov. and H. alexanderi, H. apoloniaeand H. guahanensisspp. nov. are distinguished by stria density, foramen (‘areola’) shape, and cell size from each other and from similar taxa. A key to all these taxa is provided. In addition, an arcuate species is described as Haslea arculatasp. nov. The presence of a bilayered wall is shown for all these taxa. We compare the morphology of specimens reported as H. howeanafrom Guam with Navicula tsukamotoi, recently described from Okinawa, and with ‘Naviculacf. howeana’ from Puerto Rico. We provide the first account of the complex cingulum of N. tsukamotoi. We conclude that our specimens match N. tsukamotoiand that H. howeanashould be returned to Navicula, but we leave open the question of conspecificity.

ABSTRACTRecent events such as the US presidential campaign have polarised public opinion, particularly in terms of support for ‘populist’ political figures, e.g. Donald Trump, and the seemingly non-egalitarian ideologies that they promote. One might anticipate that disempowered social groups, such as women or sexual minorities, would reject ‘rightwing populism’, as it rarely appears to advocate their interests or facilitate their empowerment. Yet the existence of movements like ‘Gays for Trump’ and ‘#WomenWhoVoteTrump’ indicate more complex patterns of support. How might we understand this from gender and sexualities perspectives? This paper presents the proceedings of a round table discussion. Our contributors, members of a crossinstitutional social psychological Gender and Sexualities Research Group, each presented a brief five-minute interpretation of the phenomenon. They did so from gender and/or sexualities perspectives, drawing upon different social psychological theory. A chaired debate followed. Key themes from the round table are identified which are potentially helpful in understanding the phenomenon. The broader implications of these themes for practice and theory are considered in terms of the concept of ‘safe identities’.

Magnetic Resonance Imaging (MRI) is increasingly a fundamental component of the diagnostic pathway across a range of conditions. Historically, the presence of a cardiac implantable electronic device (CIED) has been a contraindication for MRI, however, development of MR Conditionaldevices that can be scanned under strict protocols has facilitated the provision of MRI for patients. Additionally, there is growing safety data to support MR scanning in patients with CIEDs that do not have MR safety labelling or with MR ConditionalCIEDs where certain conditions are not met, where the clinical justification is robust. This means that almost all patients with cardiac devices should now have the same access to MRI scanning in the National Health Service as the general population. Provision of MRI to patients with CIED, however, remains limited in the UK, with only half of units accepting scan requests even for patients with MR ConditionalCIEDs. Service delivery requires specialist equipment and robust protocols to ensure patient safety and facilitate workflows, meanwhile demanding collaboration between healthcare professionals across many disciplines. This document provides consensus recommendations from across the relevant stakeholder professional bodies and patient groups to encourage provision of safe MRI for patients with CIEDs.

ABSTRACTBackground:Severe peri-device leaks after left atrial appendage (LAA) occlusion requires continuation of life-long oral anticoagulation. However, the majority of patients referred for LAA occlusion are not suitable for anticoagulation. Data on the incidence, characteristics, and management of peri-device leak after LAA occlusion are scarce.Methods:We assessed the incidence of peri-device leak, its characteristics, and their management outcomes in 200 consecutive patients who underwent LAA occlusion between April 2016 and August 2018.Results:Severe persistent peri-device flow was present in 9/200 patients (4.5%) at 45 days. Baseline clinical characteristics were comparable between patients with or without severe leaks. However, patients with severe leaks had larger LAA diameter (24.5 ± 4.3 vs. 19.8 ± 3.7 mm, p< 0.001), and more sub-optimal deployments (100% vs. 26.7%, p< 0.001). Sub-optimal deployment parameters included: non-coaxial deployment, preferential single lobe deployment, incomplete coverage of a proximal side lobe, and shallow implantation. Among patients with severe leaks, 7 (78%) underwent percutaneous closure. Percutaneous closure with the Amplatzer Vascular Plug-II device had a 100% success rate and no short-term complications.Conclusions:Severe peri-device leak is present in ~5% of patients following LAA occlusion. Certain anatomical and procedural factors might contribute to the occurrence of peri-device leak. Severe leaks can be effectively closed with percutaneous techniques.

Digital health interventions present an important opportunity to improve health care for people with psychosis or bipolar disorder, but despite their potential, integrating and implementing them into clinical settings has been difficult worldwide. This Review aims to identify factors affecting implementation of digital health interventions for people affected by psychosis or bipolar disorder. We searched seven databases and synthesised data from 26 studies using the Consolidated Framework for Implementation Research. Attitudes and beliefs about interventions were crucial factors for both staff and service users, with negative attitudes and scepticism resulting in a lack of motivation to engage with interventions or complete them. The complexity of the interventions was a barrier for people with psychiatric symptoms, low premorbid intelligence quotient, or minimal information technology skills. The accessibility and adaptability of interventions were key facilitators, but insufficient resources, finances, and staff time were barriers to implementation. Interventions need to be user friendly and adaptable to the needs and capabilities of people with psychosis or bipolar disorder, and the staff who support their implementation. Service users and staff should cofacilitate the process of developing and implementing the interventions.

Reflex anoxic seizures (RAS) present with a transient loss of consciousness and are triggered by an unexpected stimuli. These are paroxysmal, short-lived episodes of pronounced bradycardia or transient asystole; the episodes are self-limiting, lasting between 15 seconds and 1 minute. RAS are an important differential diagnosis of transient loss of consciousness but they are commonly misdiagnosed as epileptic events. An accurate and focused history is key to the diagnosis. They are mostly managed by performing an ECG to rule out other causes of arrhythmia, with subsequent explanation of the condition and reassurance given to parents. Nurses play an important role in eliciting the history and providing support to parents following the diagnosis. This article addresses the epidemiology and pathophysiology of RAS, with suggestions for management. An illustrative case study is included to highlight some of the challenges that health professionals working in different clinical set-ups are likely to come across while managing a child with RAS.

We describe a research‐based mentoring program for new full‐time faculty at a small residential college, which emphasizes the empowerment of the new faculty themselves to identify and obtain the resources they need for success. In our model, the mentor takes on a role of primarily providing accountability, easing the burden on mentors, thereby making for a more sustainable program. Our mixed methods assessment of the program suggests that, paradoxically, these lessened expectations foster closer personal relationships between mentor and protégé than might have occurred if that were a programmatic expectation.

Licmophoraspecies are common epiphytes, with new species being discovered in under-sampled areas, and a need for a larger morphological character set for all species. In the rich flora of Guam, there are several distinctive new species, four of which we describe here, with a reconsideration and expansion of their useful taxonomic characters. Licmophora attenuatan. sp. formed large colonies on long mucilage stalks; narrowly cuneate valves, 209–339 µm long, were notable for a large, possibly hollow, spine, and the head-pole rimoportulae set back along the sternum. Licmophora bulbosan. sp. was solitary or on short, branched mucilage stalks, with broadly cuneate valves, 95–122 µm long, with slightly inflated apices giving it a ‘turkey baster’ shape; valvocopulae bore a novel perforated silica ingrowth along the entire midrib, which we call a Tharngan strip. Licmophora curvatan. sp. attached by mucilage pads, the 87–170 µm long cells were distinctive by their curvature and 21–30 µm broad valves. Licmophora labianatisn. sp. was found in large colonies on long branched stalks, with 311–365 µm long valves that were distinctive for a delicate section mid-way along the valve where vimines were absent. Licmophoracells are heterovalvar and we define the ‘back’ frustule as the one with the basal rimoportula. Frustules are also heteropolar and thus have a left and right side. These terms do not correspond to epivalve/hypovalve and primary/secondary sides of valves and are useful for specifying locations of features. The Licmophoraepitheca (i.e., the mature half of the frustule) has a cingulum comprising five copulae (a valvocopula + four pleurae) that differ from each other and between species; we describe their morphology in detail. Copular striae were often denser than valvar striae. Midribs were positioned symmetrically along the midline of the band, or asymmetrically, closer to one margin. Advalvar and abvalvar copular striae consisted of single slits or a series of pores (rimate vs porate) and the type often changed along the band. Midribs on valvocopulae transitioned in distinctive ways from the abvalvar side at the cell apex to the advalvar side. The 2nd and 4th pleurae (closed at the apex of the frustule, like the valvocopula) were sometimes very similar to one another but in other species the 4th pleura was reduced to an apical cap with a very narrow band. The 1st and 3rd pleurae, closed at the base, were usually distinct from one another in the size and shape of the open tips. The expanded set of valve + copula characters will be useful in resolving the taxonomy of the majority of short, straight Licmophoraspecies, but studies of additional species are needed to narrow the list to the most useful copula characters.

Supplemental Digital Content is available in the text.Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.

Epiphytic diatoms on seaweeds and seagrasses were collected from tropical regions in the western Pacific Ocean (i.e., Siladen Island, Celebes Sea, Indonesia; Guam; Palau). Fifteen species of Diploneisare described in detail with light and scanning electron microscopy including six species new to science, D. cerebrum, D. claustra, D. craticula, D. crispa, D. rimosaand D. weissflogiopsis. Valve structure in Diploneisis particularly complicated, and two new distinctive structures are described for the first time: (1) central external raphe endings with flaps or rolled flaps and (2) internal globular papillae near the marginal ends of the virgae. In addition, we confirm that openings on the inner surface of the longitudinal canals are of taxonomic value. The structural complexities encountered in Diploneisrequire the study of a great many more taxa before a meaningful revision of the genus can be undertaken. Its diversity in warm waters is a rich resource for new Diploneistaxa to further our understanding of the genus.

BackgroundThe evidence base for digital interventions for physical and mental health, including severe and enduring mental health difficulties, is increasing. In a feasibility trial, web-based Enhanced Relapse Prevention (ERPonline) for bipolar disorder demonstrated high recruitment and retention rates. Relative to participants in the waitlist control group, those who received ERPonline showed increased monitoring for early warning signs of relapse and had developed more positive illness models.ObjectiveTo understand users’ motivations and barriers for taking part in an online/telephone-based trial, and for engagement with ERPonline.MethodsParticipants from the trial who had been allocated to receive ERPonline were purposively sampled to participate in telephone-based, in-depth qualitative interviews about their experiences. Interviews (n=19) were analysed using framework analysis to identify themes relevant to study aims.FindingsParticipants took part due to the convenient, flexible and rewarding aspects of the trial design, as well as a desire to improve the mental health of themselves and others. Barriers included extensive assessments, practical difficulties and mood. ERPonline was was generally considered to be accessible, relevant and straightforward, but there were individual preferences regarding design, content and who it was for. Several participants reported positive changes, but there was a sense that digital interventions should not replace routine care.ConclusionsThere are a number of barriers and facilitators to consider when evaluating and implementing digital interventions. Individual preferences and human contact were key factors for both trial design and engagement with an online intervention.Clinical implicationsDigital interventions should be co-produced, personalised, interactive and embedded as one component in a broader package of care.Trial registration numberISRCTN56908625; Post-results.

Although multistage thermal decomposition (fractionation) of biomass with catalytic upgrading is a promising strategy of achieving sustainable fuels production, the number of thermal decomposition stages, their conditions, and the optimal catalytic upgrading chemistries are not known. In this paper, we use conceptual process modeling to propose a general roadmap for the design of a biorefinery by employing these technologies. The overall process considered includes a biomass pretreatment system, a (multistage) thermal decomposition system in which the biomass in decomposed into various fractions, a fraction upgrading system, and a combustion system. We focus primarily on the design of the thermal decomposition and fraction upgrading systems. The goal of our work is to demonstrate the key trade‐offs between various process options and to identify important areas for improvement. In general, increasing the complexity of the fraction upgrading systems increases the ultimate yield of C6+products, though there are diminishing returns on the increase in product yield versus the complexity of the catalytic upgrading sequences. The choice of the number of thermal decomposition stages is not simple and requires careful consideration of the chemistries available to upgrade different components and the relative abundances of these different components. Therefore, the optimal design of the thermal decomposition and fraction upgrading systems cannot be done independently. Mapping it out: We use conceptual process modeling to propose a general roadmap for the design of a biorefinery by employing a multistage thermal decomposition system of biomass. The choice of the number of thermal decomposition stages and upgrading strategies requires careful consideration of the chemistries available to upgrade the different species in the thermal fractions.

Group psychoeducation is a low-cost National Institute for Health and Care Excellence-recommended treatment for bipolar disorder. However, the clinical effectiveness and acceptability of this intervention are unclear compared with unstructured peer support matched for delivery and aim of treatment, and for previous bipolar history. We aimed to assess the clinical effectiveness and acceptability of structured group psychoeducation versus optimised unstructured peer support for patients with remitted bipolar disorder.

While searching for specimens ofNavicula fusiformisGrunow in remnant materials of the diatoms fromSargassumcollected by A. Lindig and studied by A. Grunow, we discovered an undescribed species ofKoernerella, which we nameK. grunowiiin his honor. It is similar in length and stria density to the generitypeK. recticostata, but differs in its more slender and more tapered valve, wider margin around the basal pore field, and in the size and distribution of the areolae. The new species is also similar toPerideraion elongatum in possessing a circular basal pore field, but differs in the position of the apical rimoportula on the valve face (characteristic ofKoernerella) rather than on the mantle. This brings the number of species in a clade of Fragilariales containing Bleakeleya,KoernerellaandPerideraionto six but it is expected that additional taxa await discovery and description.

The Valsalva manoeuvre is an internationally recommended treatment for supraventricular tachycardia, but cardioversion is rare in practice (5–20%), necessitating the use of other treatments including adenosine, which patients often find unpleasant. We assessed whether a postural modification to the Valsalva manoeuvre could improve its effectiveness.