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Objective International guidelines recommend that preterm infants should be supported to maintain their serum electrolytes within "normal" ranges. In term babies, cord blood values differed in pathological pregnancies from healthy ones. Study Design We examined cord blood sodium, chloride, potassium, glucose, and creatinine to derive maturity-related reference intervals. We examined associations with gestational age, delivery mode, singleton versus multiple, and prenatal maternal adverse conditions. We compared preterm cord values to term, and to adult reference ranges. Results There were 591 infants, 537 preterm and 54 term. Preterm cord glucose levels were steady (3.7 ± 1.1 mmol/L), while sodium, chloride, and creatinine increased over GA by 0.17, 0.14 mmol/L/week, and 1.07 µmol/L/week, respectively (p < 0.003). Average preterm cord potassium and chloride were higher than the term (p < 0.05). Compared with adult reference intervals, cord preterm reference intervals were higher for chloride (100–111 vs. 98–106 mmol/L), lower for creatinine (29–84 vs. 62–115 µmol/L), and more variable for potassium (2.7–7.9 vs. 3.5–5.0 mmol/L) and sodium (130–141 vs. 136–145 mmol/L). Cesarean section was associated with higher potassium and lower glucose, multiple births with higher chloride and creatinine and lower glucose, and SGA with lower glucose. Conclusion Cord blood values varied across the GA range with increases in sodium, chloride, and creatinine, while glucose remained steady. Average preterm reference values were higher than term values for potassium and chloride. Preterm reference values differed from published adults' reference values. The changes across GA and by delivery mode, SGA, and being a multiple, which may have direct implications for neonatal care and fluid management. Key Points Cord blood electrolyte, creatinine, and glucose values vary across neonatal gestational age. Average preterm cord values of potassium and chloride were higher than term values. Cord reference values differ by delivery mode, growth, and multiple impacting neonatal care decisions. [ABSTRACT FROM AUTHOR]

Background: Isotretinoin, indicated for severe acne, is a potent teratogen and therefore contraindicated in pregnancy. Thus, the pregnancy prevention program (PPP) for isotretinoin has been introduced. Objectives: The aim of this study was to assess the concomitant use of isotretinoin and effective contraception and the rate of potential isotretinoin-exposed pregnancies in females of childbearing age in 2017–2020 in Estonia. In addition, we aimed to evaluate whether compliance with the PPP has improved compared with the previous study conducted in Estonia covering the period of 2012–2016. Methods: This retrospective, nationwide study using prescription and healthcare claims data included 2575 females aged 15–45 years who started using isotretinoin between 2017 and 2020. Results: For 64.7% of females of childbearing age, no concurrent use of an effective contraceptive was detected while using isotretinoin. A moderately higher contraceptive coverage (35.3%) was observed compared with the previous study (29.7%) (p < 0.001). Complete contraception coverage was highest in females aged 30–39 years with an adjusted OR of 12.8 (p < 0.001) compared with the age group 15–19 years and 2.47 (p < 0.001) compared with the age group 20–29 years. 17 pregnancies coincided with the isotretinoin treatment-related period. The risk for potential isotretinoin-exposed pregnancy was 6.6 (95% CI 3.9–10.5) per 1000 treated females of childbearing age over the 4-year observation period. The risk for potential isotretinoin-exposed pregnancies per 1000 treated females was 1.0 in females aged 15–19 years, 11.6 in females aged 20–29 years, 8.8 in females aged 30–39 years, and 7.4 in females aged 40–45 years (p = 0.009). Conclusion: A slight improvement in complete contraceptive coverage during isotretinoin use has not resulted in a decrease in the risk of isotretinoin-exposed pregnancies. The contraceptive usage and risk for pregnancy vary greatly across age groups, suggesting the need for a more targeted approach to improve the effectiveness of the PPP. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the current clinical practices, adherence to clinical guidelines, efficacy, and reported side effects associated with Isotretinoin treatment in Palestine. Methods: A descriptive cross-sectional online questionnaire-based study using social media platforms (eg, Facebook and Telegram) was conducted among Birzeit University students in April 2023. This study included participants aged ≥ 18 years with a history of isotretinoin treatment; subjects with incomplete data were excluded. Statistical significance was set at P < 0.05. SPSS version 27 was used for data analysis. Results: A total of 548 participants were included in the study, the majority of most of whom were female (96%). The most predominant side effects were cracked, dry lips and xeroderma (96.2%). Moreover, 12% of participants had depression. Most respondents were educated about medication side effects and only 39.1% were counseled about blood donation. Of the 59 sexually active women, only 4 (6.8%) were asked for a recent pregnancy test. A total of 60.2% of dermatologists adhered to the American Academy of Dermatology (AAD) guidelines, and 48.7% ordered the required laboratory tests before initiating isotretinoin treatment. Only 1.7% of pharmacists followed the FDA-suggested protocols for dispensing isotretinoin to childbearing females. Conclusion: Adherence to isotretinoin safety prescribing protocols to provide patient education, monitoring, and ordering of laboratories to ensure patient safety can be improved by adapting policies and protocols in pharmacy and medical practice in Palestine to monitor and enforce adherence when prescribing, dispensing, or taking high-risk medications. [ABSTRACT FROM AUTHOR]

Valproic acid (VPA) is a very effective anticonvulsant and mood stabilizer with relatively few side effects. Being an epigenetic modulator, it undergoes clinical trials for the treatment of advanced prostatic and breast cancer. However, in pregnancy, it seems to be the most teratogenic antiepileptic drug. Among the proven effects are congenital malformations in about 10%. The more common congenital malformations are neural tube defects, cardiac anomalies, urogenital malformations including hypospadias, skeletal malformations and orofacial clefts. These effects are dose related; daily doses below 600 mg have a limited teratogenic potential. VPA, when added to other anti-seizure medications, increases the malformations rate. It induces malformations even when taken for indications other than epilepsy, adding to the data that epilepsy is not responsible for the teratogenic effects. VPA increases the rate of neurodevelopmental problems causing reduced cognitive abilities and language impairment. It also increases the prevalence of specific neurodevelopmental syndromes like autism (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). High doses of folic acid administered prior to and during pregnancy might alleviate some of the teratogenic effect of VPA and other AEDs. Several teratogenic mechanisms are proposed for VPA, but the most important mechanisms seem to be its effects on the metabolism of folate, SAMe and histones, thus affecting DNA methylation. VPA crosses the human placenta and was found at higher concentrations in fetal blood. Its concentrations in milk are low, therefore nursing is permitted. Animal studies generally recapitulate human data. [ABSTRACT FROM AUTHOR]

Insufficient polyamine intake could play a role in the induction of sensitization to dietary allergens. This proposal is based essentially on investigations made in sucking rats and in children. In sucking rats it has been established that oral administration of spermine can induce all the modifications occurring in the digestive tract at weaning. In the intestine events occur in two phases. The early event consists of desquamation of the epithelium resulting from an activation of apoptosis. The late event appears to involve an hormonal cascade in which adrenocorticotropic hormone, cytokines, bombesin and corticosterone are included. Observations in human subjects show that: (1) the spermine and spermidine concentrations are generally lower in infant formulas than in human breast milk. Mothers seem consistently to have relatively high or relatively low concentrations of spermine and spermidine in their milk. These individual variations may be due to diet, lifestyle or genetic background; (2) the probability of developing allergy can reach 80 % if the mean spermine concentration in the milk is lower than 2 nmol/ml milk. It is approximately 0 % if the mean spermine concentration is higher than 13 nmol/ml milk; (3) preliminary results show that the intestinal permeability to macromolecules differs in premature babies when they are fed on breast milk compared with infant formulas (J Senterre, J Rigo, G Forget, G Dandrifosse and N Romain, unpublished results). This difference does not seem to be present when powdered milk is supplemented with polyamines at the concentration found in breast milk; (4) spermine increases proliferation and differentiation of lymphocytes isolated from the tonsils of children. [ABSTRACT FROM PUBLISHER]

Intrauterine growth restriction (IUGR) together with preterm birth could be harmful to bone health. The aim of the study was to examine bone status in IUGR versus non-IUGR preterms and to analyze the nutritional management best correlated with its improvement. Newborns < 34 weeks of gestational age (wGA), 75 IUGR and 75 non-IUGR, admitted to the Neonatal Intensive Care Unit of the University Hospital of Padova were enrolled and monitored from birth until 36 wGA through anthropometry (weight, length, head circumference, lower limb length (LLL)), biochemistry, bone quantitative ultrasound assessment of bone status (metacarpus bone transmission time, mc-BTT, us) and nutritional intakes monitoring during parenteral nutrition. IUGR compared to non-IUGR showed lower mean mc-BTT (0.45 vs. 0.51, p = 0.0005) and plasmatic phosphate (1.45 vs. 1.79, p < 0.001) at birth. Mc-BTT at 36 wGA, though equal between groups, correlated in IUGR newborns with basal phosphate, mean total energy of the first week and month (positively) and days to reach full enteral feeding (negatively). Lower i.v. vitamin D intake, LLL and prolonged total parenteral nutrition predicted worse mc-BTT at 36 wGA in the enrolled infants. These results suggest that preterms and in particular IUGR newborns need special nutritional care to promote bone development. [ABSTRACT FROM AUTHOR]

Postnatal muscle growth is impaired in low birth weight (L) neonatal pigs. Leucine supplementation has been established as a dietary intervention to enhance muscle growth in growing animals. The aim of this study was to investigate the efficacy of supplementing L neonatal pig formulas with branched-chain amino acids (B) to enhance the rate of protein accretion. Twenty-four 3-day old pigs were divided into two groups low (L) and normal birth weight (N) based on weight at birth. Pigs were assigned to a control (C) or 1% branched-chain amino acids (B) formulas, and fed at 250 mL·kg body weight −1·d−1 for 28 d. Body weight of pigs in the L group was less than those in the N group (P < 0.01). However, fractional body weight was greater for L pigs compared with their N siblings from day 24 to 28 of feeding regardless of formula (P < 0.01). In addition, feed efficiency (P < 0.0001) and efficiently of protein accretion (P < 0.0001) were greater for L than N pigs regardless of supplementation. Pigs fed the B formula had greater plasma leucine, isoleucine, and valine concentrations compared with those fed the C formula (P < 0.05). Longissimus dorsi Sestrin2 protein expression was less for pigs in the L group compared with those in the N group (P < 0.01), but did not result in a corresponding increase in translation initiation signaling. Longissimus dorsi mRNA expression of BCAT2 was less for LB pigs compared with those in the LC group, and was intermediate for NC and NB pigs (P < 0.05). Hepatic mRNA expression of BCKDHA was greater for pigs in the L compared with those in the N groups (P < 0.05). However, plasma branched-chain keto-acid concentration was reduced for C compared with those in the B group (P < 0.05). These data suggest that branched-chain amino acid supplementation does not improve lean tissue accretion of low and normal birth weight pigs, despite a reduction in Sestrin2 expression in skeletal muscle of low birth weight pigs. The modest improvement in fractional growth rate of low birth weight pigs compared with their normal birth weight siblings was likely due to a more efficient dietary protein utilization. [ABSTRACT FROM AUTHOR]

Background: In March 2018, the European pregnancy prevention programme for oral retinoids was updated as part of risk minimisation measures (RMM), emphasising their contraindication in pregnant women. Objective: To measure the impact of the 2018 revision of the RMMs in Europe by assessing the utilisation patterns of isotretinoin, alitretinoin and acitretin, contraceptive measures, pregnancy testing, discontinuation, and pregnancy occurrence concomitantly with a retinoid prescription. Methods: An interrupted time series (ITS) analysis to compare level and trend changes after the risk minimisation measures implementation was conducted on a cohort of females of childbearing age (12-55 years of age) from January 2010 to December 2020, derived from six electronic health data sources in four countries: Denmark, Netherlands, Spain, and Italy. Monthly utilisation figures (incidence rates [IR], prevalence rates [PR] and proportions) of oral retinoids were calculated, as well as discontinuation rates, contraception coverage, pregnancy testing, and rates of exposed pregnancies to oral retinoids, before and after the 2018 RMMs. Results: From 10,714,182 females of child-bearing age, 88,992 used an oral retinoid at any point during the study period (mean age 18.9-22.2 years old). We found non-significant level and trend changes in incidence or prevalence of retinoid use in females of child-bearing age after the 2018 RMMs. The reason of discontinuation was unknown in >95% of cases. Contraception use showed a significant increase trend in Spain; for other databases this information was limited. Pregnancy testing was hardly recorded thus was not possible to model ITS analyses. After the 2018 RMM, rates of pregnancy occurrence during retinoid use, and start of a retinoid during a pregnancy varied from 0.0 to 0.4, and from 0.2 to 0.8, respectively. Conclusion: This study shows a limited impact of the 2018 RMMs on oral retinoids utilisation patterns among females of child-bearing age in four European countries. Pregnancies still occur during retinoid use, and oral retinoids are still prescribed to pregnant women. Contraception and pregnancy testing information was limited in most databases. Regulators, policymakers, prescribers, and researchers must rethink implementation strategies to avoid any pregnancy becoming temporarily related to retinoid use. [ABSTRACT FROM AUTHOR]

Background: Despite the French pregnancy prevention program (PPP), a considerable number of pregnancies are potentially exposed to oral isotretinoin. New measures were taken by the French Medicines Agency, including the restriction of initial isotretinoin prescriptions to dermatology specialists in May 2015 and a new information campaign on teratogenicity in January 2019., Objectives: The aims were to: describe, between 2014 and 2021, compliance with PPP recommendations: isotretinoin use as a second-line treatment, first prescription by a dermatology specialist, monthly prescription renewal and pregnancy testing (PT); assess the effect of the 2015 and 2019 measures on PT compliance; and identify the determinants of PT noncompliance., Methods: A retrospective cohort study was conducted among women aged 11-50 years initiating isotretinoin between 2014 and 2021 using the French Health Data System. PT compliance corresponded to pregnancy test completion and specific delays between prescription and dispensation. Time series analyses were performed to evaluate the effect of the 2015 and 2019 measures on PT compliance, and log-binomial and Poisson multivariate regression models were used to identify the determinants of PT noncompliance., Results: Isotretinoin was prescribed as a second-line treatment in 64% of initiations, mainly by dermatology specialists (92%). A new monthly prescription was observed in 98% of dispensations. PT compliance reached 61%, 72% and 25% at initiation, renewals and end of treatment, respectively. The 2015 measure was associated with better PT compliance at initiation and renewals. The 2019 measure had no significant effect on PT compliance at the initiation or end of treatment but was associated with a decrease in PT compliance at renewals. Age, low socioeconomic level, initiation by a nondermatology specialist and during summer were associated with PT noncompliance., Conclusions: Understanding factors associated with PT noncompliance could help to target specific subpopulations of women treated with isotretinoin., (© 2024 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

The need for high quality evidence is recognized for optimizing practices of parenteral nutrition (PN). The purpose of the present systematic review is to update the available evidence and investigate the effect of standardized PN (SPN) vs. individualized PN (IPN) on protein intake, immediate morbidities, growth, and long-term outcome in preterm infants. A literature search was performed on articles published in the period from 1/2015 to 11/2022 in PubMed and Cochrane database for trials on parenteral nutrition in preterm infants. Three new studies were identified. All new identified trials were nonrandomized observational trials using historical controls. SPN may increase weight and occipital frontal circumference gain and lower the value of maximum weight loss. More recent trials suggest that SPN may easily increase early protein intake. SPN may reduce the sepsis incidence, but overall, no significant effect was found. There was no significant effect of standardization of PN on mortality or stage ≥2 necrotizing enterocolite (NEC) incidence. In conclusion SPN may improve growth through higher nutrient (especially protein) intake and has no effect on sepsis, NEC, mortality, or days of PN. [ABSTRACT FROM AUTHOR]

Purpose: In 2018, following an EU‐wide safety review, a revised pregnancy prevention programme (PPP) was introduced for isotretinoin (Roaccutane®). This study aimed to examine awareness, knowledge, and experience implementing the revised isotretinoin PPP in clinical practice across three healthcare professional (HCP) groups in Ireland. Methods: A cross‐sectional study using anonymous online surveys among general practitioners (GPs), community pharmacists, and specialist consultants was undertaken. Descriptive analyses are presented. Results: Across all HCP groups there was high (≥87%) awareness that oral isotretinoin is contraindicated in women of childbearing potential (WCBP) unless the conditions of the PPP are fulfilled, but varying awareness among GPs (54.9%) and community pharmacists (45.9%) that exposure during pregnancy can cause both severe fetal malformations and spontaneous abortions. Implementation of the PPP in clinical practice varied across HCP groups. When initiating isotretinoin in WCBP, 66.7% of specialists and 40.8% of GPs indicated they had considered alternative treatment options, and 71.4% of specialists and 31.6% of GPs reported they first requested a pregnancy test. There was limited provision of the patient reminder card to WCBP, where 26.1% of community pharmacists provide this at each dispensing, while 47.6% of specialists and 11.8% of GPs ensured WCBP had a copy of the card when initiating treatment. Across all HCP groups, there was high (≥81.6%) awareness of the need for urgent consultation and immediate cessation of isotretinoin in the event of an unplanned or suspected pregnancy. Conclusions: Reinforcement of the provision and utilisation of the isotretinoin patient reminder card may be required, and further targeted education on specific elements of the PPP should be considered for GPs and community pharmacists. [ABSTRACT FROM AUTHOR]

The Belgian Superior Health Council (SHC) preferentially recommended the 20-valent pneumococcal conjugate vaccine (PCV20) for adults aged ≥65 years, immunocompromised patients, and patients aged ≥50 years suffering from conditions that increase their risk for pneumococcal infections. The objective of this paper is to present the cost-utility of PCV20 compared to no vaccination and the alternative sequence of PCV15 followed by the 23-valent pneumococcal polysaccharide vaccine (PPV23) in this population. The analysis employed a static Markov model capturing lifetime risk of pneumococcal infections, associated disutility, mortality, and costs from different healthcare payer perspectives. Results indicated use of PCV20 among Belgian older and at-risk adults is highly cost-effective compared to no vaccination, with an incremental cost per quality-adjusted life-year (QALY) of €4,164. Compared to the sequential regimen (PCV15+PPV23), PCV20 vaccination is a cost-saving strategy. Subgroup analysis indicated PCV20 vaccination of at-risk adults aged 65–84 years would also be cost-saving from the national healthcare perspective. Based on current knowledge, this analysis suggests that access to PCV20 should be proposed in all adults recommended for vaccination by the SHC as PCV20 prevents additional hospitalizations and deaths caused by pneumococcal infection at an affordable cost. Pneumococcal infections cause a high burden on infected patients and society. Vaccination of patients at risk of severe infection has been recommended for decades, but uptake of pneumococcal vaccines in adults has historically been low in Belgium, where patients have borne the vaccine costs and the recommended vaccination schedule required the sequential administration of two vaccines. A single PCV20 dose is recommended as the preferred vaccine for adults at risk due to age or other factors in Belgium as it is expected to provide lasting protection against more types of disease-causing pneumococcal bacteria as well as being simpler to administer than alternatives requiring multiple injections. Uptake is expected to improve with the recent reimbursement of the new PCV20 vaccine, though reimbursement covers only a portion of the recommended population. This paper presents a detailed analysis of the PCV20 cost-effectiveness in all adults at increased risk of severe pneumococcal disease, including immunocompromised adults younger than 65 years. Our analysis captures and compares the lifetime risk of pneumococcal disease and associated healthcare costs in an unvaccinated cohort, a cohort vaccinated with the alternative recommendation of PCV15 and PPV23 vaccines and a cohort vaccinated with PCV20. This cost-effectiveness analysis indicates that use of PCV20 will help decrease the number of pneumococcal disease cases, hospitalizations, and premature deaths at an affordable healthcare cost: PCV20 is a cost-effective option compared to no vaccination and a cost-saving option compared to the sequential regimen PCV15 followed by PPV23 in the Belgian adult population recommended for pneumococcal vaccination. [ABSTRACT FROM AUTHOR]

Epiphytic communities offer an original framework to disentangle the contributions of environmental filters, biotic interactions and dispersal limitations to community structure at fine spatial scales. We determine here whether variations in light, microclimatic conditions and host tree size affect the variation in species composition and phylogenetic structure of epiphytic bryophyte communities, and hence, assess the contribution of environmental filtering, phylogenetic constraints and competition to community assembly.A canopy crane giving access to 1.1 ha of tropical rainforest in Yunnan (China) was employed to record hourly light and microclimatic conditions from 54 dataloggers and epiphytic bryophyte communities from 408 plots. Generalized Dissimilarity Modelling was implemented to analyse the relationship between taxonomic and phylogenetic turnover among epiphytic communities, host‐tree characteristics and microclimatic variation.Within‐tree vertical turnover of bryophyte communities was significantly about 30% higher than horizontal turnover among‐trees. Thus, the sharp vertical variations in microclimatic conditions from tree base to canopy are more important than differences in age, reflecting the likelihood of colonization, area, and habitat conditions between young and old trees, in shaping the composition of epiphytic bryophyte communities.Our models, to which microclimatic factors contributed most (83–98%), accounted for 33% and 18% of the variation in vertical turnover in mosses and liverworts, respectively. Phylogenetic turnover shifted from significantly negative or non‐significant within communities to significantly positive among communities, and was slightly, but significantly, correlated with microclimatic variation. These patterns highlight the crucial role of microclimates in determining the composition and phylogenetic structure of epiphytic communities.Synthesis. The mostly non‐significant phylogenetic turnover observed within communities does not support the idea that competition plays an important role in epiphytic bryophytes. Instead, microclimatic variation is the main driver of community composition and phylogenetic structure, evidencing the role of phylogenetic niche conservatism in community assembly. [ABSTRACT FROM AUTHOR]

Objective  Although thiazide diuretics are commonly used in the neonatal intensive care unit (NICU), the risk of thiazide-induced hyponatremia in infants has not been well documented. The primary objective of this study was to determine the frequency and severity of hyponatremia in neonates and infants receiving enteral chlorothiazide. Secondary objectives included identifying: (1) percent change in serum sodium from before chlorothiazide initiation to nadir, (2) time to reach nadir serum sodium concentration, and (3) percentage of patients on chlorothiazide receiving sodium supplementation. Study Design  This was a retrospective cohort study of NICU patients admitted between July 1, 2014, and July 31, 2019, who received ≥1 dose of enteral chlorothiazide. Mild, moderate, and severe hyponatremia were defined as serum sodium of 130 to 134 mEq/L, 120 to 129 mEq/L, and less than 120 mEq/L, respectively. Data including serum electrolytes, chlorothiazide dosing, and sodium supplementation were collected for the first 2 weeks of therapy. Descriptive and inferential statistics were performed in SAS software, Version 9.4. Results  One hundred and seven patients, receiving 127 chlorothiazide courses, were included. The median gestational age at birth and postmenstrual age at initiation were 26.0 and 35.9 weeks, respectively. The overall frequency of hyponatremia was 35.4% (45/127 courses). Mild, moderate, and severe hyponatremia were reported in 27 (21.3%), 16 (12.6%), and 2 (1.6%) courses. The median percent decrease in serum sodium from baseline to nadir was 2.9%, and the median time to nadir sodium was 5 days. Enteral sodium supplements were administered in 52 (40.9%) courses. Sixteen courses (12.6%) were discontinued within the first 14 days of therapy due to hyponatremia. Conclusion  Hyponatremia occurred in over 35% of courses of enteral chlorothiazide in neonates and infants. Given the high frequency of hyponatremia, serum sodium should be monitored closely in infants receiving chlorothiazide. Providers should consider early initiation of sodium supplements if warranted. Key Points One-third of infants on chlorothiazide develop hyponatremia. Nadir serum sodium typically occurs within 5 days. Monitor sodium closely after chlorothiazide initiation. [ABSTRACT FROM AUTHOR]

Vitamin D is a critical regulator of calcium and bone homeostasis. While vitamin D has multiple effects on bone and calcium metabolism, the regulation of intestinal calcium (Ca) absorption efficiency is a critical function for vitamin D. This is necessary for optimal bone mineralization during growth, the protection of bone in adults, and the prevention of osteoporosis. Intestinal Ca absorption is regulated by 1,25 dihydroxyvitamin D (1,25(OH)2 D), a hormone that activates gene transcription following binding to the intestinal vitamin D receptor (VDR). When dietary Ca intake is low, Ca absorption follows a vitamin-D-regulated, saturable pathway, but when dietary Ca intake is high, Ca absorption is predominately through a paracellular diffusion pathway. Deletion of genes that mediate vitamin D action (i.e., VDR) or production (CYP27B1) eliminates basal Ca absorption and prevents the adaptation of mice to low-Ca diets. Various physiologic or disease states modify vitamin-D-regulated intestinal absorption of Ca (enhanced during late pregnancy, reduced due to menopause and aging). [ABSTRACT FROM AUTHOR]

Background: Despite being the first-line treatment for severe or moderate acne, isotretinoin has several serious side effects that necessitate the evaluation of patients' knowledge about isotretinoin side effects and its proper use.Objective: The current study aim was to explore information needs about isotretinoin by evaluating patients' knowledge about the appropriate use of isotretinoin and its associated side effects.Methods: In addition to the sociodemographic variables, a validated online questionnaire was adopted from the literature to evaluate patients' knowledge about isotretinoin use and its potential side effects. Independent t-test and one-way analysis of variance (ANOVA) test were implemented to find the correlation between the study variables and the knowledge score.Results: The most recognized side effect of isotretinoin therapy was dryness (98.1%). The study patients showed good knowledge about isotretinoin use with a mean knowledge score of 8.1 (SD = 0.7). However, more than half of them (61.0%) mistakenly thought that isotretinoin therapy should be taken continuously for more than 6 months without stop, and some of them did not know that isotretinoin is recommended to be taken with fatty meal (24%) and sunblock (24.6%). Female gender (8.2 (SD = 0.8)) and using isotretinoin for more than 6 months (8.3 (SD = 1.2)) were significantly associated with a higher knowledge score of isotretinoin use (p=0.01), when compared with male patients (7.8 (SD = 0.7)) and less than 6-month use of isotretinoin (7.7 (SD = 0.7)).Conclusions: The lack of patients' information about the potential side effects, duration of therapy, and some instructions on isotretinoin use, such as taking the medication with fatty meal and sunblock, shed the light on the necessity to prepare leaflets, educational brochures, and educational posts via social media in order to improve patients' knowledge about isotretinoin therapy and its optimal use. [ABSTRACT FROM AUTHOR]

Summary: Background: Anthropometry‐based equations are commonly used to estimate infant body composition. However, existing equations were designed for newborns or adolescents. We aimed to (a) derive new prediction equations in infancy against air‐displacement plethysmography (ADP‐PEA Pod) as the criterion, (b) validate the newly developed equations in an independent infant cohort and (c) compare them with published equations (Slaughter‐1988, Aris‐2013, Catalano‐1995). Methods: Cambridge Baby Growth Study (CBGS), UK, had anthropometry data at 6 weeks (N = 55) and 3 months (N = 64), including skinfold thicknesses (SFT) at four sites (triceps, subscapular, quadriceps and flank) and ADP‐derived total body fat mass (FM) and fat‐free mass (FFM). Prediction equations for FM and FFM were developed in CBGS using linear regression models and were validated in Sophia Pluto cohort, the Netherlands, (N = 571 and N = 447 aged 3 and 6 months, respectively) using Bland–Altman analyses to assess bias and 95% limits of agreement (LOA). Results: CBGS equations consisted of sex, age, weight, length and SFT from three sites and explained 65% of the variance in FM and 79% in FFM. In Sophia Pluto, these equations showed smaller mean bias than the three published equations in estimating FM: mean bias (LOA) 0.008 (−0.489, 0.505) kg at 3 months and 0.084 (−0.545, 0.713) kg at 6 months. Mean bias in estimating FFM was 0.099 (−0.394, 0.592) kg at 3 months and −0.021 (−0.663, 0.621) kg at 6 months. Conclusions: CBGS prediction equations for infant FM and FFM showed better validity in an independent cohort at ages 3 and 6 months than existing equations. [ABSTRACT FROM AUTHOR]

Aim: The mechanisms underlying the maintenance of biodiversity remain to be elucidated. Taxonomic diversity alone remains an unresolved issue, especially in terms of the mechanisms of species co‐existence. We hypothesized that phylogenetic information could help to elucidate the mechanism of community assembly and the services and functions of ecosystems. The aim of this study was to explore the mechanisms driving floral diversity in subtropical forests and evaluate the relative effects of these mechanisms on diversity variation, by combining taxonomic and phylogenetic information. Location: We examined 35 1‐ha tree stem‐mapped plots across eight national nature reserves in Guangxi Zhuang Autonomous Region, China. Taxon: Trees. Methods: We quantified the taxonomic and phylogenetic β‐diversity between each pair of plots using the (abundance‐based) Rao's quadratic entropy and the (incidence‐based) Sørensen dissimilarity indices. Using a null model approach, we compared the observed β‐diversity with the expected diversity at random and calculated the standard effect size of the observed β‐diversity deviation. Furthermore, we used distance‐based redundancy analysis (dbRDA) to partition the variations in taxonomic and phylogenetic observed β‐diversity and β‐deviation into four parts to assess the environmental and spatial effects. Results: The taxonomic β‐deviation was related to and higher than the phylogenetic β‐deviation (r =.74). This indicated that the species turnover between pairwise plots was mainly the turnover of closely related species. Higher taxonomic and phylogenetic β‐deviation were mainly concentrated in the pairwise karst and nonkarst forest plots, indicating that the species in karst forests and nonkarst forests were predominantly from distantly related clades. A large proportions of the variation in taxonomic and phylogenetic β‐deviation were explained by the joint effect of environmental and spatial variables, while the contribution of environmental variables was greater than that of spatial variables, probably owing to the influence of the sampling scale dependence, integrality of sampling size and species pool, and the unique climatic and geomorphic characteristics. Main conclusions: Our study highlights the importance of phylogeny in biodiversity research. The incorporation of taxonomic and phylogenetic information provides a perspective to explore potential underlying mechanisms that have shaped species assemblages and phylogenetic patterns in biodiversity hotspots. [ABSTRACT FROM AUTHOR]

The interest and demand for healthy and less processed foods for human consumption have been mirrored in the pet industry, with an explosion of alternative diets available. Several nontraditional feeding methodologies including raw meat-based diets (RMBDs) are believed by many dog owners to be superior to traditional extruded commercial dog foods. Despite the strong opinions, limited data are available comparing objective health measures among healthy dogs fed using different methods of diet preparation. Therefore, we compared health markers in client-owned dogs fed an RMBD to markers in dogs fed a high-quality extruded kibble. We hypothesized that healthy adult dogs fed RMBD would show differences in biochemical and hematological parameters and improved clinical health scores (e.g. dental, external ear canal, and integument scores) compared with dogs fed a kibble diet. A cross-sectional observational study was performed comparing hematology, serum biochemistry, urinalysis management history, and clinical health scores in healthy client-owned dogs reported as fed RMBD (n = 28) or kibble (n = 27) for >1 yr. Dental, external ear canal, and integument health scores were assigned by a single veterinary evaluator blinded to feed group, using a scale where 0 was normal and 3 was most severely affected. Spearman correlation coefficient (r s) was calculated to assess the strength and direction of the relationship of biochemical outcomes with age and body condition score (BCS), while analysis of variance was used to determine if biochemical analytes differed by breed or gender. Biochemical data were analyzed using multiple linear regression models, adjusting for the covariates gender, breed, age, and BCS. A composite clinical health score, (CCS) = 9 − (dental score + otitis score + integument score), was compared between feeding groups using Mann–Whitney test. Serum alkaline phosphatase activity (P < 0.001) and globulin concentration (P < 0.001) were lower, while lymphocyte count (P < 0.05) was higher in dogs fed RMBD. No differences were found in urinalysis between diet groups. Dogs fed RMBD showed a slight improvement in CCS compared with kibble-fed dogs (CCS: P = 0.03). Owner management significantly differed with a greater likelihood of management interventions including dietary supplements and sporting activities in the RMBD group. Further work is needed to specifically determine the impact of diet processing and nutrient content on canine health. [ABSTRACT FROM AUTHOR]

Species' evolutionary histories shape their present‐day ecologies, but the integration of phylogenetic approaches in ecology has had a contentious history. The field of ecophylogenetics promised to reveal the process of community assembly from simple indices of phylogenetic pairwise distances – communities shaped by environmental filtering were composed of closely related species, whereas communities shaped by competition were composed of less closely related species. However, the mapping of ecology onto phylogeny proved to be not so straightforward, and the field remains mired in controversy. Nonetheless, ecophylogenetic methods provided important advances across ecology. For example the phylogenetic distances between species is a strong predictor of pest and pathogen sharing, and can thus inform models of species invasion, coexistence and the disease dilution/amplification effect of biodiversity. The phylogenetic structure of communities may also provide information on niche space occupancy, helping interpret patterns of facilitation, succession and ecosystem functioning – with relevance for conservation and restoration – and the dynamics among species within foodwebs and metacommunities. I suggest leveraging advances in our understanding of the process of evolution on phylogenetic trees would allow the field to progress further, while maintaining the essence of the original vision that proved so seductive. [ABSTRACT FROM AUTHOR]

Acne vulgaris ranks among the most common dermatologic conditions encountered during adolescence up to adulthood. For moderate to severe cases of acne, isotretinoin is indicated as it is considered the most efficacious medication against acne. However, isotretinoin use is known to have its side effects and most importantly is the drug's teratogenic potential. As a response, programs such as the Retinoid Pregnancy Prevention Program (PPP), System to Manage Accutane-Related Teratogenicity (SMART), and iPLEDGE were put into action as attempts to promote awareness on isotretinoin's teratogenicity and reduce the incidence of exposed pregnancies. Such programs are lacking in Saudi Arabia. This study aimed, therefore, to evaluate the awareness of women of childbearing age in Makkah Province, Saudi Arabia, with regards to the side effects of the medication, specifically its teratogenicity. This study also intended to assess the compliance of both doctors and patients with the recommendations and precautions associated with isotretinoin. A cross-sectional study was conducted on 766 women participants using a previously validated questionnaire. Results showed that majority of the respondents (91%) are generally aware of the side effects of isotretinoin use, particularly its teratogenicity. However, lapses have been identified with regards to the compliance of both the treating physician and the patient. Three-fourths of sexually active women did not use any form of contraception while being on isotretinoin treatment. Two-thirds of the study participants responded that they were not issued approval forms indicating their understanding of the side effects of isotretinoin and the importance of compliance to the treating physician's instructions; 11.5% claimed that their doctors did not perform any blood tests; and 67.7% claimed that no pregnancy test was performed at any time during the treatment. These findings strongly suggest a need for improvement when it comes to compliance of both doctors and patients. It is recommended that doctor-patient communication be more comprehensive and more efforts should be made to follow international guidelines in that regard. [ABSTRACT FROM AUTHOR]

Aims: (a) To determine the contribution of current macro‐environmental factors in explaining the phylogenetic structure of European forest vegetation, (b) to map and describe spatial patterns in their phylogenetic structure and (c) to examine which lineages are the most important contributors to phylogenetic clustering and whether their contribution varies across forest types and regions. Location: Europe. Taxon: Angiosperms. Methods: We analysed the phylogenetic structure of 61,816 georeferenced forest vegetation plots across Europe considering alternative metrics either sensitive to basal (ancient evolutionary dynamics) or terminal (recent dynamics) branching in the phylogeny. We used boosted regression trees to model metrics of the phylogenetic structure as a function of current macro‐environmental factors. We also identified clades encompassing significantly more taxa than under random expectation in phylogenetically clustered plots. Results: Phylogenetic clustering was driven by climatic stress and instability and was strong in the areas glaciated during the Pleistocene, likely reflecting limited postglacial migration, and to a lower extent in areas of northern‐central Europe and in summer‐dry Mediterranean regions. Phylogenetic overdispersion was frequent in the hemiboreal zone in Russia, in some areas around the Mediterranean Basin, and along the Atlantic seaboard of the Iberian Peninsula. The families Ericaceae, Poaceae and Fagaceae were overrepresented in clustered plots in different regions of Europe. Main conclusions: We provide the first maps and analyses on the phylogenetic structure of European forest vegetation at the plot level. Our results highlight the role of environmental filtering, postglacial dispersal limitation and spatial transitions between major biomes in determining the distribution of plant lineages in Europe. [ABSTRACT FROM AUTHOR]

Aim: We expand on community phylogenetic approaches to Darwin's Naturalization Conundrum by considering phylogenetic scale, comprised of phylogenetic grain and extent. We assess relatedness between invasive, non‐native and native plant species at multiple depths in the phylogeny (i.e. phylogenetic grain) and across multiple clades (i.e. phylogenetic extents) at regional and local spatial scales in the highly fragmented, critically imperilled pine rockland ecosystem. Location: Miami‐Dade County, Florida, USA. Methods: We used two metrics differing in phylogenetic grain to determine whether invasive or non‐native species were more closely related to native species in the regional pool and at 33 habitat fragments. At both spatial scales, we altered phylogenetic extent from all vascular plants to four smaller phylogenetic domains (Monilophyte, Gymnosperm, Monocotyledon and Dicotyledon) and assessed whether the interpretation of relatedness changed. Results: For the regional pool and at a broad phylogenetic grain, non‐native species were more closely related to the native community than invasive species were for all phylogenetic extents (i.e. support for Darwin's Naturalization Hypothesis, DNH), and at a fine phylogenetic grain for only two phylogenetic extents. At the local scale, there was limited support for DNH across all phylogenetic extents. In Monocotyledons, support for DNH was more prevalent at the fine phylogenetic grain, while Dicotyledons showed support for DNH at the broad phylogenetic grain. Main conclusions: In the pine rockland flora, we found either support for DNH or no difference in relatedness between non‐native‐to‐native and invasive‐to‐native species. However, patterns of relatedness varied across spatial and phylogenetic grain and, critically, this variability is highly dependent on the phylogenetic extent considered. By explicitly assessing the interactions between spatial scale and phylogenetic scale, we show that support for DNH was context dependent, and findings at smaller phylogenetic extents rarely agreed with findings at the larger phylogenic extent. [ABSTRACT FROM AUTHOR]

Background: Previously, we revealed sexually dimorphic mRNA expression and responsiveness to maternal dietary supplementation with n-3 long-chain polyunsaturated fatty acids (LCPUFA) in placentas from a defined INFAT study subpopulation. Here, we extended these analyses and explored the respective placental microRNA expression, putative microRNA-mRNA interactions, and downstream target processes as well as their associations with INFAT offspring body composition. Results: We performed explorative placental microRNA profiling, predicted microRNA-mRNA interactions by bioinformatics, validated placental target microRNAs and their putative targets by RT-qPCR and western blotting, and measured amino acid levels in maternal and offspring cord blood plasma and placenta. microRNA, mRNA, protein, and amino acid levels were associated with each other and with offspring body composition from birth to 5 years of age. Forty-six differentially regulated microRNAs were found. Validations identified differential expression for microRNA-99a (miR-99a) and its predicted target genes mTOR, SLC7A5, encoding L-type amino acid transporter 1 (LAT1), and SLC6A6, encoding taurine transporter (TauT), and their prevailing significant sexually dimorphic regulation. Target mRNA levels were mostly higher in placentas from control male than from female offspring, whereas respective n-3 LCPUFA responsive target upregulation was predominantly found in female placentas, explaining the rather balanced expression levels between the sexes present only in the intervention group. LAT1 and TauT substrates tryptophan and taurine, respectively, were significantly altered in both maternal plasma at 32 weeks' gestation and cord plasma following intervention, but not in the placenta. Several significant associations were observed for miR-99a, mTOR mRNA, SLC7A5 mRNA, and taurine and tryptophan in maternal and cord plasma with offspring body composition at birth, 1 year, 3 and 5 years of age. Conclusions: Our data suggest that the analyzed targets may be part of a sexually dimorphic molecular regulatory network in the placenta, possibly modulating gene expression per se and/or counteracting n-3 LCPUFA responsive changes, and thereby stabilizing respective placental and fetal amino acid levels. Our data propose placental miR-99, SLC7A5 mRNA, and taurine and tryptophan levels in maternal and fetal plasma as potentially predictive biomarkers for offspring body composition. [ABSTRACT FROM AUTHOR]

Ant communities are extremely diverse and provide a wide variety of ecological functions in tropical forests. Here, we investigated the abiotic factors driving ant composition turnover across an elevational gradient at Mont Itoupé, French Guiana. Mont Itoupé is an isolated mountain whose top is covered by cloud forests, a biogeographical rarity that is likely to be threatened according to climate change scenarios in the region. We examined the influence of six soil, climatic, and LiDAR‐derived vegetation structural variables on leaf litter ant assembly (267 species) across nine 0.12‐ha plots disposed at three elevations (ca. 400, 600, and 800m asl). We tested (a) whether species cooccurring within a same plot or a same elevation were more similar in terms of taxonomic, functional, and phylogenetic composition, than species from different plots/elevations, and (b) which environmental variables significantly explained compositional turnover among plots. We found that the distribution of species and traits of ant communities along the elevational gradient was significantly explained by a turnover of environmental conditions, particularly in soil phosphorus and sand content, canopy height, and mean annual relative humidity of soil. Our results shed light on the role exerted by environmental filtering in shaping ant community assembly in tropical forests. Identifying the environmental determinants of ant species distribution along tropical elevational gradients could help predicting the future impacts of global warming on biodiversity organization in vulnerable environments such as cloud forests. [ABSTRACT FROM AUTHOR]

Aim: To systematically identify studies of implementing risk management measures when prescribing teratogenic medicines for women of childbearing age and studies reporting risk perceptions of teratogenic medications. Methods: MEDLINE, CINAHL, Scopus, EMBASE, and International Pharmaceutical Abstracts were searched. Studies were included in the risk management section if they reported any of the following risk management measures: teratogenic counseling, contraceptive counseling, pregnancy testing before starting treatment, pregnancy testing during treatment, use of contraception before starting treatment, and use of contraception during treatment. Studies were included in the perceptions section if they reported perceived teratogenic risk as numerical value. Results: Fifty‐five studies were included in the risk management section and seven studies were included in the perceptions sections. Prevalence of risk management measures varied as follows: teratogenic counseling (9.5%–99.3%), contraceptive counseling (6.1%–98%), pregnancy testing before starting treatment (0%–95.1%), pregnancy testing during treatment (12.7%–100%), contraception use before starting treatment (15.7%–94%), and contraception use during treatment (1.7%–100%). A proper estimation of the teratogenic risk was reported for thalidomide (by general practitioners and obstetric/gynecologists), for etretinate (by pregnant women), and for misoprostol (by pregnant and nonpregnant women). An under‐estimation was reported for warfarin and retinoids (by general practitioners and obstetric/gynecologists). And over‐estimation was reported for thalidomide, valproate, lithium, isotretinoin, phenytoin, warfarin and etretinate by different populations. Conclusion: Considerable variation in the implementation of risk management measures when prescribing teratogenic medicines to women of childbearing age is reported in the literature. A common tendency to over‐estimate the risk of teratogenic medications was evident. [ABSTRACT FROM AUTHOR]

Metabolic bone disease (MBD) is an important cause of morbidity in premature, very low birth weight (VLBW) and sick infants and, if left undiagnosed, may lead to structural deformities and spontaneous fractures. MBD is defined as impaired bone mineralization in a neonate with lower than expected bone mineral levels in either a fetus or a neonate of comparable gestational age and/or weight, coupled with biochemical abnormalities with or without accompanying radiological manifestations. MBD has been reported to occur in 16% to 40% of extremely low birth weight neonates and presents by 6-16 weeks after birth. Insufficient calcium and phosphorous stores during the phase of accelerated growth predispose to MBD in neonates along with the use of some medications such as caffeine or steroids, prolonged parenteral nutrition and chronic immobilization. Enhanced physical activity in preterm infants facilitates bone mineralization and weight gain. Biochemical abnormalities tend to worsen significantly, as the severity of disease progresses. These abnormalities may include hypocalcemia, hypophosphatemia, hyperphosphatasia and secondary hyperparathyroidism. In addition, urinary phosphate wasting and hypovitaminosis D can be additional complications. Conversely, biochemical abnormalities may not be accompanied by rachitic changes. Newer diagnostic modalities include non-invasive bone densitometry by quantitative ultrasound over the mid-tibial shaft. The management of MBD includes adequate calcium, phosphorous and vitamin D supplementation, along with optimum nutrition and physical activity. Similarly, preventive strategies for MBD should target nutritional enhancement in combination with enhanced physical activity. MBD usually results in preventable morbidity in preterm and VLBW neonates. Treatment consists of optimum nutritional supplementation and enhanced physical activity. [ABSTRACT FROM AUTHOR]

Aim: The tropical niche conservatism (TNC) hypothesis is one of the most prominent evolutionary hypotheses that has been supported as an explanation for the diversity gradients of several animal taxa, mainly vertebrates. However, the validity of TNC for less‐known taxa such as disease vectors is not clear. Here, we test predictions of TNC in driving the geographical co‐occurrence among triatomine species, vector insects of Chagas disease. We aim to infer the relative effects of ecological and evolutionary processes in determining triatomine species richness at broad spatial scales. Location: America. Taxon: Triatominae (Hemiptera: Reduviidae). Methods: We gathered distributional, phylogenetic and climatic information for 63 triatomine species. We apply the phylogenetic field (PF) framework based on the phylogenetic structure of species co‐occurrences, considering their climatic preferences. We defined PFs of species by estimating the phylogenetic structure of species co‐occurrence within a focal species' range. Likewise, climatic conditions within focal species' ranges were defined as their preferred climates. We applied a spatial‐phylogenetic statistical framework to evaluate geographical variation of species' co‐occurrence and tested the significance of PFs based on biogeographically informed null models. Results: Phylogenetic fields of 17 out of 59 triatomine species showed a trend from overdispersed to clustered, coincident with tropical to subtropical–temperate climate. Triatomines co‐occur with more closely related species in temperate areas and more distantly related species in tropical areas. Temperature seasonality was inversely related to the phylogenetic structure of co‐occurrence within species ranges. Main conclusions: Geographical co‐occurrence among triatomine species revealed a tropical to subtropical–temperate gradient from overdispersed to clustered PFs and a correspondence between the type of climate in which these species are found and their PFs. Phylogenetic structure within triatomine ranges is explained by their evolutionary history. Our study provides a methodological framework to evaluate the New World triatomine geographical co‐occurrence patterns under a phylogenetic perspective and our results make an important contribution to the understanding of the broad‐scale biodiversity patterns in Triatominae. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the pharmacist's assessment of patient eligibility for safe use of isotretinoin and the quality of pharmacist's counseling. Patients and Methods: A covert simulated patient (SP) methodology was used in which a trained female researcher, who was 25 years old, played the patient's role through this cross-sectional study by visiting community pharmacies and requesting isotretinoin capsules through a controlled prescription. A data form was used to collect the information following each pharmacy visit by asking about medical/family history and providing comprehensive counseling about the most common adverse effects, proper use instructions, and the importance of adherence to medication. The pharmacists, who did not initiate counseling, were prompted by the SP. Results: The pharmacists in 400 pharmacies who agreed to participate were visited by the SP. Only 7 (2%) pharmacists provided a complete assessment of patient eligibility for using isotretinoin with comprehensive counseling. Most of the pharmacists (84%) provided incomplete assessment as indicated by the overall score. Only 11 (3%) pharmacists asked the six crucial questions for the assessment of patient eligibility. On prompting, only 6 (2%) pharmacists provided complete counseling about the expected adverse effects. The most frequently provided adverse effect was dry skin, specifically dry lips (71.8%). A minority of 108 (27%) pharmacists provided education about the importance of using contraception during isotretinoin therapy. A complete level of counseling was provided by 125 (31.3%) pharmacists regarding the lab tests that the SP needs to undergo during therapy. Female pharmacists were more likely to provide counseling about the pregnancy test (mean=134, p=0.001). Conclusion: Suboptimal level of the patient's assessment was revealed with poor educational counseling by the community pharmacists. New strategies are needed to improve pharmaceutical care services in the UAE. [ABSTRACT FROM AUTHOR]

Questions: In vast areas of Central African forests, the upper canopy is presently dominated by light‐demanding tree species. Here, we confront three hypotheses to explain this dominance: (a) these species have expanded their distribution because of widespread past slash‐and‐burn activities, as suggested by important charcoal amounts recorded in the soils of the region; (b) their abundance is rather explained by soil properties, as this guild establishes preferentially on favourable physico‐chemical conditions for rapid growth; (c) soil properties have been substantially influenced by past human disturbances and those two effects cannot be disentangled. Location: Pallisco‐CIFM logging concession, southeastern Cameroon (300,000 ha). Methods: We quantified soil charcoal abundance and measured ten soil variables at the basis of 60 target trees that belonged to a list of three long‐living pioneer light‐demanding (LLP) and four shade‐bearer (SB) species. We identified all stems with a diameter at breast height (DBH) ≥ 20 cm within a distance of 15 m around each target tree. Species were characterised by their wood‐specific gravity (WSG), which reflected their light requirement. Multiple regression models were used to quantify and test the relative effects of charcoal abundance and soil variables on the mean WSG of the 60 tree communities, as well as the abundance of three guilds: LLP, SB, and non‐pioneer light demanders (NPLD). Results: The mean WSG was the only response variable significantly explained by soil variables and charcoal abundance combined. It was significantly negatively associated with soil calcium and Mg content and with charcoal abundance, with soil and charcoal influencing the mean WSG independently. Conclusion: Our study provides evidence that past human disturbances and soil fertility have independently promoted the establishment of light‐demanding species in western Central African forests, thereby shedding light on tree community assembly rules in these ecosystems which remain considerably understudied compared to the tropical forests of other continents. [ABSTRACT FROM AUTHOR]

Introduction: Risk minimization programs are interventions mandated by regulatory agencies to ensure that benefits of pharmaceutical products outweigh risks. Many regulatory agencies require programs be evaluated for effectiveness; however, the quality of evidence has limited the ability to definitively determine if programs improve drug safety.Objective: The aim of this systematic review was to assess and describe the current status of reporting on the effectiveness of pharmaceutical risk management programs.Methods: Peer-reviewed articles published between January 2012 and December 2018 were selected from three online databases (MEDLINE, PubMed, Embase). Eligible studies reported on effectiveness evaluations of mandated risk minimization measures (beyond labeling) and were written in English. Two reviewers independently examined 2744 titles of articles and 52 full articles were included. Forty-eight sources of gray literature from conference abstract presentations and publicly available regulatory documents were also included.Results: Key opportunities for improvement in reporting included the provision of information regarding (1) selection, design, and testing of risk minimization measures, (2) implementation of programs, (3) process and outcome metrics, including the extent to which programs reached the intended audience, were integrated into the target healthcare settings, or were sustained over time, and (4) burden of the program on the healthcare system and implications for patient access.Conclusions: Gaps in reporting of risk minimization program evaluation studies were identified. Addressing gaps will help build the evidence base regarding risk minimization initiatives, as well as ensure that programs are maximally effective and minimally burdensome on the healthcare system, and do not unduly interfere with patient access to the medicine. [ABSTRACT FROM AUTHOR]

Along elevational gradients, phylogenetic relatedness patterns constitute a considerable source of information and may shed light on ecological processes that structure communities. This study focuses on community phylogenetic structure of planthoppers, specifically the species‐rich and abundant Fulgoromorpha families (Hemiptera, Auchenorrhyncha), Cixiidae and Derbidae + Achilidae, along an elevational gradient on Mount Wilhelm (Papua New Guinea). In order to assess the factors driving planthoppers community composition, we recorded abundance data for planthoppers species at each elevation and we generated a molecular phylogeny of the local species, using Bayesian inference. We analyzed 168 individuals representing 59 local morphospecies. Using a fully resolved and well‐supported phylogeny, we then investigated the phylogenetic structure of the communities by performing a Spatial Analysis of Community Diversity. We show that Cixiidae are phylogenetically clustered along the elevational gradient, whereas Derbidae + Achilidae harbor a random structure, suggesting that local adaptation to elevation shapes community structure of Cixiidae, but not that of Derbidae + Achilidae. Our findings highlight the importance of phylogenies in the study of tropical elevational gradients. [ABSTRACT FROM AUTHOR]

Background: Different charts are used to assess premature growth. The Fenton chart, based on prenatal growth, has been used in the neonates' intensive care unit (NICU) of the Notre Dame des Secours University Hospital to assess premature newborns' development. Intergrowth21 is a new multidisciplinary, multiethnic growth chart better adapted to premature growth. Our objective was to compare both charts Fenton and Intergrowth21 in order to implement Intergrowth in our unit.Methods: We analyzed 318 files of premature babies born who were admitted to the NICU from 2010 till 2017. Anthropometric data (weight, height and head circumference) converted to percentiles was filled on both charts from birth till 1 month of age.Results: The results of the linear regression, taking the weight at birth as the dependent variable, showed that the Fenton scale (R2 = 0.391) would predict the weight at birth better than the Intergrowth 21 scale (R2 = 0.257). The same applies for height and cranial perimeter at birth when taken as dependent variables. When considering the weight and height at 2 weeks, the results showed that the Intergrowth 21 scale would predict those variables better than the Fenton scale, with higher R2 values higher in favor of the Intergrowth 21 scale for both weight (0.384 vs 0.311) and height (0.650 vs 0.585). At 4 weeks, the results showed that the Fenton scale would predict weight (R2 = 0.655 vs 0.631) and height (R2 = 0.710 vs 0.643) better than the Intergrowth 21 scale. The results obtained were adjusted over the newborns' sociodemographic and clinical factors.Conclusion: The results of our study are controversial where the Fenton growth charts are superior to Intergrowth 21 before 2 weeks of age and at 4 weeks, whereas Intergrowth 21 charts showed higher percentiles for weight and height than Fenton charts at 2 two weeks of age. Further studies following a different design, such as a clinical trial or a prospective study, taking multiple ethnicities into account and conducted in multiple centers should be considered to enroll a more representative sample of Lebanese children and be able to extrapolate our results to the national level. [ABSTRACT FROM AUTHOR]

Adaptations to exercise training are determined by the response of metabolic and molecular mechanisms that determine changes in proteins. The type, intensity, and duration of exercise, as well as nutrition, determine these responses. The importance of protein, in the form of intact proteins, hydrolysates, or free amino acids, for exercise adaptations is widely recognized. Exercise along with protein intake results in accumulation of proteins that influence training adaptations. The total amount of protein necessary to optimize adaptations is less important than the type of protein, timing of protein intake, and the other nutrients ingested concurrently with the protein. Acute metabolic studies offer an important tool to study the responses of protein balance to various exercise and nutritional interventions. Recent studies suggest that ingestion of free amino acids plus carbohydrates before exercise results in a superior anabolic response to exercise than if ingested after exercise. However, the difference between pie- and postexercise ingestion of intact proteins is not apparent. Thus, the anabolic response to exercise plus protein ingestion seems to be determined by the interaction of timing of nutrient intake in relation to exercise and the nutrients ingested. More research is necessary to delineate the optimal combination of nutrients and timing for various types of training adaptations. Protein and amino acid intake have long been deemed important for athletes and exercising individuals. Olympic athletes, from the legendary Milo to many in the 1936 Berlin games, reportedly consumed large amounts of protein. Modem athletes may consume slightly less than these historical figures, yet protein is deemed extremely important by most. Protein is important as a source of amino acids for recovery from exercise and repair of damaged tissues, as well as for adaptations to exercise training, such as muscle hypertrophy and mitochondrial biogenesis. [ABSTRACT FROM AUTHOR]

The concept of biological diversity, or biodiversity, is at the core of evolutionary and ecological studies. Many indices of biodiversity have been developed in the last four decades, with species being one of the central units of these indices. However, evolutionary and ecological studies need a precise description of species' characteristics to best quantify inter‐species diversity, as species are not equivalent and exchangeable. One of the first concepts characterizing species in biodiversity studies was abundance‐based rarity. Abundance‐based rarity was then complemented by trait‐ and phylo‐based rarity, called species' trait‐based and phylogenetic originalities, respectively. Originality, which is a property of an individual species, represents a species' contribution to the overall diversity of a reference set of species. Originality can also be defined as the rarity of a species' characteristics such as the state of a functional trait, which is often assumed to be represented by the position of the species on a phylogenetic tree. We review and compare various approaches for measuring originality, rarity and diversity and demonstrate that (i) even if attempts to bridge these concepts do exist, only a few ecological and evolutionary studies have tried to combine them all in the past two decades; (ii) phylo‐ and trait‐based diversity indices can be written as a function of species rarity and originality measures in several ways; and (iii) there is a need for the joint use of these three types of indices to understand community assembly processes and species' roles in ecosystem functioning in order to protect biodiversity efficiently. [ABSTRACT FROM AUTHOR]

We investigated spatial patterns of evolutionary relatedness and diversification rates to test hypotheses about the historical biogeographic processes underlying the radiation of Neotropical rats and mice (Sigmodontinae, ~400 species). A negative correlation between mean phylogenetic distance and diversification rates of rodent assemblages reveals a pattern of species co‐occurrence in which assemblages of closely related species are also the fastest diversifying ones. Subregions of the Neotropics occupied by distantly related species that are on average more slowly diversifying include Central America, northern South America, and the Atlantic forest. In southern South America, recent species turnover appears to have been higher. Ancestral locations for the main tribes of sigmodontines were also estimated, suggesting eastern South America and the Amazonian lowlands were colonized before some central Andean regions, even though the latter are now centers of species richness for these rodents. Moreover, a past connection between the tropical Andes and the Atlantic Forest is suggested by our results, highlighting a role for a hypothetical arc connecting the two biomes, which would have impacted many other groups of organisms. Whether rapid, recent speciation in some regions is related to Quaternary climatic fluctuations and the young age of sigmodontines (~12.7 Ma crown age) or instead to intrinsic traits of these rodents remains an open question. If the former is true, we hypothesize that contrasting trends will characterize older Neotropical clades. [ABSTRACT FROM AUTHOR]