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Mindfulness and mind wandering may both enhance the psychological outcomes of nature experiences. Both states are multi-faceted, with mindfulness involving specific components such as decentering, body awareness, and nonjudgment, and mind wandering involving intentional and spontaneous mind wandering. These facets may differentially predict psychological outcomes of nature experiences, however these associations have not been tested. In this study we examined facets of mindfulness and mind wandering in nature and tested their associations with outcomes of psychological restoration and nature connection. We also tested the effects of different environmental and personal circumstances on these engagement facets in nature. We conducted an experiment in which participants were instructed on how to engage with nature during a 20min outdoor experience and completed online surveys before and after the outdoor experience. Participants were allocated into one of four groups, each given different engagement instructions. Through an exploratory factor analysis, we found that the measure of state mindfulness assessed three facets – decentering, noticing and accepting the internal experience, and body awareness, and the measure of mind wandering assessed two facets – mindlessness, and pleasant mind wandering. Regression analyses revealed associations between these facets and outcomes of the nature experience: decentering, body awareness, and pleasant mind wandering were generally associated with positive outcomes, and mindlessness and noticing and accepting the internal experience were associated with poorer outcomes relating to negative affect and attention performance. Further analyses revealed environmental and personal contextual factors that influenced engagement during the nature experience. These results demonstrate the value of deconstructing mindfulness and mind wandering in nature to explore facets that have beneficial or adverse effects on psychological outcomes. We conclude with practical directions for nature-based engagement interventions that can target the beneficial components of these practices in different contexts.

There has been a dramatic rise in mental health difficulties during the coronavirus disease 2019 (COVID-19) pandemic. While young adults have the lowest risk of hospitalization and mortality due to COVID-19, they have been identified as being at highest risk of detrimental mental health outcomes during the pandemic, along with women, those with lower socioeconomic status and those with pre-existing mental health conditions. Somewhat of a crisis in mental health has emerged across the general population through the evolution of the pandemic. A national Canadian survey identified a quadrupling of those experiencing pervasive elevated anxiety symptoms early in the pandemic compared to pre-pandemic levels, and a doubling of those with pervasive elevated depressive symptoms. Independent of the pandemic, persons with inflammatory bowel disease (IBD) can face multiple challenges related to their disease, which can result in a significant psychosocial burden and psychologic distress. Anxiety and depression have been found to be more prevalent in persons with IBD. Many potential factors contribute to the increased psychologic distress and negative impacts on mental health of the COVID-19 pandemic on persons with IBD. These include the fears of contracting COVID-19 or infecting other people. Many believe that IBD or its treatments predispose them to an increased risk of COVID-19 or a worse outcome if acquired. Concerns about access to health care add to mental distress. People with IBD generally report lower quality of life (QOL) compared to community controls. Psychologic interventions, in addition to adequate disease control, have been shown to improve health-related QOL. Uncertainty is another factor associated with reduced health-related QOL. Most studies suggest that persons with IBD have suffered QOL impairment during the pandemic in comparison to the pre-pandemic period. Uncertainties brought on by the pandemic are important contributors for some of the reduction in QOL.

The risk of hospitalization and death from Coronavirus disease-19 (COVID-19) increases with age. The extreme elderly have been particularly vulnerable, with those above the age of 80 having a case-fatality rate as high as 15%. Aging of the immune system can lead to impaired inflammatory responses where eradication of an organism such as Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV2) is inadequate but is exaggerated in such a way as to enhance pneumonia and acute respiratory distress syndrome. Frailty and comorbidity are both more common in the elderly, and these can enhance the morbidity and mortality from COVID-19. Studies from Northern California and Italy suggest that elderly persons with inflammatory bowel disease (IBD) were more likely to acquire SARS-CoV-2 infection than youths with IBD. While the specific impact of age-related comorbidity is less well established among people with IBD who acquire COVID-19, data from the Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-IBD) database reported that having two or more chronic illnesses was independently associated with developing severe COVID-19 among people with IBD. Despite having exaggerated auto-inflammatory responses, people with IBD do not appear to have an overall increased risk of developing severe COVID-19 than the general population. However, whether seniors with IBD do worse once they acquire COVID-19 compared with seniors without IBD is not known. The advent of telehealth care has posed an information technology challenge for many seniors with and without IBD. Most persons with IBD have expressed satisfaction with virtual IBD health care (phone or video-based visits). While the elderly may have less robust immune responses to vaccinations, learning from experiences with other vaccination programs, especially influenza, have shown that vaccinating seniors decreases both morbidity and mortality and, in turn, healthcare resources.

The prevalence of inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, in Canada, is over 0.75% in 2021. Many individuals with IBD are immunocompromised. Consequently, the World Health Organization’s declaration of a global pandemic uniquely impacted those with IBD. Crohn’s and Colitis Canada (CCC) formed the COVID-19 and IBD Taskforce to provide evidence-based guidance during the pandemic to individuals with IBD and their families. The Taskforce met regularly through the course of the pandemic, synthesizing available information on the impact of COVID-19 on IBD. At first, the information was extrapolated from expert consensus guidelines, but eventually, recommendations were adapted for an international registry of worldwide cases of COVID-19 in people with IBD. The task force launched a knowledge translation initiative consisting of a webinar series and online resources to communicate information directly to the IBD community. Taskforce recommendations were posted to CCC’s website and included guidance such as risk stratification, management of immunosuppressant medications, physical distancing, and mental health. A weekly webinar series communicated critical information directly to the IBD community. During the pandemic, traffic to CCC’s website increased with 484,755 unique views of the COVID-19 webpages and 126,187 views of the 23 webinars, including their video clips. CCC’s COVID-19 and IBD Taskforce provided critical guidance to the IBD community as the pandemic emerged, the nation underwent a lockdown, the economy reopened, and the second wave ensued. By integrating public health guidance through the unique prism of a vulnerable population, CCC’s knowledge translation platform informed and protected the IBD community.

Inflammatory bowel disease (IBD) is a disease that results from dysregulation of the immune system and frequently requires medications that can affect the immune response to infections; therefore, it was imperative to quickly understand the risk of coronavirus disease 2019 (COVID-19) infection on persons living with IBD and how that risk may be increased by commonly used IBD medications. The IBD research community in Canada and beyond quickly established collaborative efforts to better understand the specific risk posed by COVID-19 on persons with IBD. We learned that IBD itself was not a risk factor for death or serious complications of COVID-19, and that most commonly used drug classes (with the notable exception of corticosteroids) do not increase the risk of COVID-19-related adverse outcomes. The risk factors for serious complications and death from COVID-19 appear to be similar to those identified in the wider population; those being advanced age, having pre-existing heart or lung disease, and smoking. We recommend that persons with IBD do not alter their course of therapy to avoid complications of COVID-19, though the indiscriminate use of corticosteroids should be avoided. Persons with IBD should follow the same public health recommendations as the general population to reduce their personal risk of acquiring COVID-19.

At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there were many unknowns: transmission vectors of the virus, appropriate intervention strategies and if being immunocompromised due to inflammatory bowel disease (IBD), for example, or medications put a person at increased risk for severe COVID-19. Imposing and relaxing of public health restrictions at different times and in different regions in Canada led to different epidemiologies of the virus in different provinces and territories. In order to understand the waxing and waning of waves of the COVID-19 pandemic, it is necessary to understand the effective reproductive number (Rt) and the countervailing forces that exert upward or downward pressure on the spread of the virus at a given point in time. As many regions in Canada deal with a third wave, the primary forces affecting the Rt of severe acute respiratory syndrome coronavirus 2 are variants of concern and the increasing vaccinations of Canadians leading to increased population-level immunity. Fortunately, for the IBD population, current research suggests that those with IBD are not at increased risk of contracting COVID-19, nor of having a more severe disease course when compared to the general population.

Sarcasm is a common form of social language but one that can be challenging for children to understand. We investigated whether training can enhance children's ability to understand sarcasm. Participants were 111 five- to six- year-olds, assigned to either the training or control condition. In both conditions, children were first shown a series of puppet shows. Each puppet show ended with a sarcastic or literal remark. After each show children were asked about speaker belief, intent, and humour. Children's responses were used to estimate their pretraining sarcasm understanding. In the training condition, children were taught what sarcasm was and what cues to look for as they interacted with the researcher over a set of stories where characters made either sarcastic or literal remarks. In the control condition children read a nonsarcastic storybook with the researcher. Children's understanding of sarcasm was then reassessed using another series of puppet shows. For children who were not already proficient in sarcasm understanding, training was associated with more accurate speaker belief and intent responses and more accurate sarcasm detection. Training was not related to children's speaker humour responses. Thus, the findings of the present study provide evidence that aspects of children's sarcasm understanding can be enhanced through training. The training paradigm could be developed further to test its effectiveness in other populations who struggle with sarcasm understanding, and to help refine theories of irony development. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Biodiversity conservation and mental health and wellbeing are of increasing global concern, with growing relevance to planning and policy. A growing body of literature exploring the relationships between biodiversity and mental health and wellbeing—based on early research conducted largely from social science perspectives—suggests that particular qualities within natural environments confer particular benefits. Results so far have been inconclusive and inconsistent, contributing to an incohesive body of evidence. While past reviews have focused on reporting variations in results, the present study builds on early reviews by exploring variations from the perspective of author disciplines and the use of different guiding theories, and variables used to measure biodiversity, mental health and wellbeing. This aims to address a research gap in understanding whether research in this topic has become more interdisciplinary or has employed more consistent study designs, which were highlighted as priorities in past reviews, but the progress of which has not yet been explored in depth. We found that research connecting biodiversity and mental health and wellbeing has become only marginally more interdisciplinary in recent years, and there is still a large inconsistency in the use of guiding theories, variables and overall study designs. The variation in disciplinary perspectives and methods reflects a growing interest in this field and the variety of ways researchers are trying to understand and test the complex relationships between biodiversity and mental health and wellbeing. Our study shows that there are unique perspectives that different disciplines can contribute to this body of research and continuing to increase collaboration between disciplines with the use of consistent mixed methods approaches in future may contribute to a more cohesive body of evidence. We provide a framework to conceptualize recommendations for future research, highlighting the importance of interdisciplinary collaboration at multiple scales, and importantly focusing on more specific, mechanistic studies to inform decision-making that provides co-benefits for biodiversity and mental health and wellbeing.

Background Transition in care is defined as the “purposeful and planned movement of adolescents and young adults with a chronic medical condition from pediatric to adult-oriented healthcare systems/care providers.” Currently, there are no Level 1 evidence-based interventions to improve the care of transitioning adolescents and young adults (AYAs) with inflammatory bowel disease (IBD). The development of a transition program using a biopsychosocial approach will improve the standards for healthcare delivery to transitioning IBD patients. This is a protocol for a structured randomized controlled trial (RCT) to assess the clinical and implementation effectiveness of a multimodal intervention focused on improving patient function, transition readiness and outcomes among AYA patients with IBD being cared for at pediatric centers in Canada. Methods This multi-center RCT is a type 1 hybrid effectiveness-implementation trial to evaluate effectiveness of the intervention and how it can be implemented more widely after the trial. We will include patients aged 16.0–17.5 years. The intervention program consists of 4 core components: (1) individualized assessment, (2) transition navigator, (3) virtual patient skills-building with a focus on building resilience, self-management and self-efficacy, and (4) a virtual structured education program. The control group will undergo standard-of-care defined by each participating center. The primary outcome will be the IBD Disability Index, a validated measure to assess patient functioning. Secondary outcomes include transition readiness and success, anxiety and depression scales, and health service utilization rates. Additionally, we will measure implementation outcomes and related barriers and facilitators for the intervention program. Discussion The type 1 hybrid effectiveness-implementation design will allow for the development of a feasible, sustainable, and acceptable final intervention model. The intervention will consist of modules that can be accessed in an online, virtual platform. The implementation will allow centralization of interventions and funding in order to minimize the impact on local clinical practice or hospital resources. The authors anticipate that the main study limitation will relate to study subjects not completely adhering to every component of the intervention, which will be evaluated and addressed using the implementation science approach. Trial registration NCT05221281. Registry: ClinicalTrials.gov. Date of registration: February 2, 2022. https://clinicaltrials.gov/ct2/show/NCT05221281.

Fungi from the genus Epichloë form systemic endobiotic infections of cool season grasses, producing a range of host-protective natural products in return for access to nutrients. These infections are asymptomatic during vegetative host growth, with associations between asexual Epichloë spp. and their hosts considered mutualistic. However, the sexual cycle of Epichloë spp. involves virulent growth, characterized by the envelopment and sterilization of a developing host inflorescence by a dense sheath of mycelia known as a stroma. Microscopic analysis of stromata revealed a dramatic increase in hyphal propagation and host degradation compared with asymptomatic tissues. RNAseq was used to identify differentially expressed genes in asymptomatic vs stromatized tissues from 3 diverse Epichloë–host associations. Comparative analysis identified a core set of 135 differentially expressed genes that exhibited conserved transcriptional changes across all 3 associations. The core differentially expressed genes more strongly expressed during virulent growth encode proteins associated with host suppression, digestion, adaptation to the external environment, a biosynthetic gene cluster, and 5 transcription factors that may regulate Epichloë stroma formation. An additional 5 transcription factor encoding differentially expressed genes were suppressed during virulent growth, suggesting they regulate mutualistic processes. Expression of biosynthetic gene clusters for natural products that suppress herbivory was universally suppressed during virulent growth, and additional biosynthetic gene clusters that may encode production of novel host-protective natural products were identified. A comparative analysis of 26 Epichloë genomes found a general decrease in core differentially expressed gene conservation among asexual species, and a specific decrease in conservation for the biosynthetic gene cluster expressed during virulent growth and an unusual uncharacterized gene.

The Nobbs Suzuki Praxis (NSP) is a uniquely Australian adaptation of the Suzuki Method of Actor Training (SMAT) by John Nobbs, alongside co-director of Ozfrank Theatre, Jacqui Carroll. Nobbs and Ca...

PURPOSE To characterize the breadth of challenges that people with IBD experience in the workplace and identify supports and accommodations that can help sustain employment. MATERIALS AND METHODS A scoping review was conducted using the Arksey and O'Malley framework. Electronic databases (MEDLINE, PsycINFO, CINAHL, EMBASE) and grey literature websites identified English-language studies published from inception through to June 2020. Studies where details were insufficient to extract the study purpose, sample, methods, and findings were deemed of poorer quality and excluded. RESULTS Eighteen studies met selection criteria. Studies discussed common workplace challenges, including career planning, work performance, managing physical and cognitive symptoms, social impacts at work, and challenges related to the physical work environment and commuting. The range of workplace supports identified by studies was classified into five categories: flexibility, changes to the physical work environment, social support, self-management strategies, and extended health benefits. CONCLUSIONS IBD research typically has been descriptive and focused on broad characterizations of workplace challenges and supports. Future work needs to examine causal pathways and assess the efficacy of workplace supports, as well as conduct subgroup analyses and develop resources to facilitate communication and accommodation planning between workers living with IBD and their employers.Implications for RehabilitationRehabilitation professionals can play an important role in supporting people working with inflammatory bowel disease (IBD) by identifying accommodations and ways to make work environments more supportive.Providing rehabilitation support to people with IBD goes beyond symptom management and needs to consider the broader social, policy, and environmental challenges of employment.

The minor allele (A) of the rs373863828 variant (p.Arg457Gln) in CREBRF is restricted to indigenous peoples of the Pacific islands (including New Zealand Māori and peoples of Polynesia), with a frequency of up to 25% in these populations. This allele associates with a large increase in body mass index (BMI) but with significantly lower risk of type-2 diabetes (T2D). It remains unclear whether the increased BMI is driven by increased adiposity or by increased lean mass.We undertook body composition analysis using DXA in 189 young men of Māori and Pacific descent living in Aotearoa New Zealand. Further investigation was carried out in two orthologous Arg458Gln knockin mouse models on FVB/NJ and C57BL/6j backgrounds.The rs373863828 A allele was associated with lower fat mass when adjusted for BMI (p0.05) and was associated with significantly lower circulating levels of the muscle inhibitory hormone myostatin (p0.05). Supporting the human data, significant reductions in adipose tissue mass were observed in the knockin mice. This was more significant in older mice in both backgrounds and appeared to be the result of reduced age-associated increases in fat mass. The older male knockin mice on C57BL/6j background also had increased grip strength (p0.01) and lower levels of myostatin (p0.05).Overall, these results prove that the rs373863828 A-allele is associated with a reduction of myostatin levels which likely contribute to an age-dependent lowering of fat mass, at least in males.

Persons with inflammatory bowel disease (IBD) make up more than 0.75% of the Canadian population in 2021. Early in the COVID-19 pandemic, individuals with IBD, particularly those on immunosuppressive therapies, were concerned that their health status may place them at higher risk of contracting COVID-19 or experiencing more severe disease course if infected with SARS-CoV-2. In response, Crohn’s and Colitis Canada developed the COVID-19 and IBD Taskforce in March 2020 to rapidly synthesize the evolving knowledge of COVID-19 as relevant to Canadians with IBD. The Taskforce communicated expert information directly to the Canadian IBD community through online tools and a webinar series. In order to understand the full impact of COVID-19 on the IBD community, Crohn’s and Colitis Canada commissioned a policy report that was informed through a systematic literature review and synthesized across working groups along the following domains: Epidemiology, Children and Expectant Mothers with IBD, Seniors with IBD, Mental Health, Risk Factors and Medications, Vaccines, and Healthcare Delivery during the Pandemic and the Future Model of IBD Care. This report from Canadian physicians, researchers, and IBD community representatives highlights the physical, mental, and health systems impact of COVID-19 on the entire spectrum of the IBD community, including children, adolescents, adults, seniors, and pregnant people with IBD. This executive summary provides an overview of the crucial information from each of the chapters of the policy report, supplemented with additional information made available through Crohn’s and Colitis Canada’s webinar-based knowledge translation platform.

Recent studies have identified key genes that control the symbiotic interaction between Epichloe festucae and Lolium perenne. Here we report on the identification of specific E. festucae genes that control host infection. Deletion of setB, which encodes a homolog of the H3K36 histone methyltransferase Set2/KMT3, reduced histone H3K36 trimethylation and led to severe defects in colony growth and hyphal development. The E. festucae ΔclrD mutant, which lacks the gene encoding the homolog of the H3K9 methyltransferase KMT1, displays similar developmental defects. Both mutants are completely defective in their ability to infect L. perenne. Alleles that complement the culture and plant phenotypes of both mutants also complement the histone methylation defects. Co-inoculation of either ΔsetB or ΔclrD with the wild-type strain enables these mutants to colonize the host. However, successful colonization by the mutants resulted in death or stunting of the host plant. Transcriptome analysis at the early infection stage identified four fungal candidate genes, three of which encode small-secreted proteins, that are differentially regulated in these mutants compared to wild-type. Deletion of crbA, which encodes a putative carbohydrate binding protein, resulted in significantly reduced host infection rates by E. festucae. This article is protected by copyright. All rights reserved.

Parenting has been robustly associated with offspring psychosocial development, and these effects are likely reflected in brain development. However, the claim that parenting influences offspring brain development in humans, as measured by structural and functional Magnetic Resonance Imaging (MRI), is subject to numerous methodological limitations. To interpret the state of the parenting and brain development literature, we review these limitations. Four limitations are common. First, most literature has been cross-sectional. Where longitudinal, studies rarely included multiple assessments of brain structure or function, precluding measurement of actual brain development. Second, parenting has largely been measured via selfor parent-report, as opposed to observational assessment. Third, there has been a focus on extreme forms of developmental adversity which do not necessarily lie on a continuum with normative parenting. Fourth, although not a limitation per se, studies have generally focused on negative as opposed to positive parenting behaviours. While not all studies are subject to all these limitations, the study of parenting in relation to offspring brain development is in its infancy.

Recent studies have identified key genes in Epichloë festucae that control the symbiotic interaction of this filamentous fungus with its grass host. Here we report on the identification of specific fungal genes that determine its ability to infect and colonize the host. Deletion of setB, which encodes a homolog of the H3K36 histone methyltransferase Set2/KMT3, specifically reduced histone H3K36 trimethylation and led to severe defects in colony growth and hyphal development. The E. festucae ΔclrD mutant, which lacks the gene encoding the homolog of the H3K9 methyltransferase KMT1, displays similar developmental defects. Both mutants are completely defective in their ability to infect the host grass, and mutational studies of key residues in the catalytic SET domains from these proteins show that these phenotypes are dependent on the methyltransferase activities of SetB and ClrD. A comparison of the differences in the host transcriptome between seedlings inoculated with wild-type versus mutants suggests that the inability of these mutants to infect the host was not due to an aberrant host defense response. Co-inoculation of either ΔsetB or ΔclrD with the wild-type strain enables these mutants to colonize the host. However, successful colonization by the mutants resulted in death or stunting of the host plant. Transcriptome analysis at the early infection stage identified four fungal candidate genes, three of which encode small-secreted proteins, that are differentially regulated in these mutants compared to wild-type. Deletion of crbA, which encodes a putative carbohydrate binding protein, resulted in significantly reduced host infection rates by E. festucae.Author SummaryThe filamentous fungus Epichloë festucae is an endophyte that forms highly regulated symbiotic interactions with the perennial ryegrass. Proper maintenance of such interactions is known to involve several signalling pathways, but much less is understood about the infection capability of this fungus in the host. In this study, we uncovered two epigenetic marks and their respective histone methyltransferases that are required for E. festucae to infect perennial ryegrass. Null mutants of the histone H3 lysine 9 and lysine 36 methyltransferases are completely defective in colonizing the host intercellular space, and these defects are dependent on the methyltransferase activities of these enzymes. Importantly, we observed no evidence for increased host defense response to these mutants that can account for their non-infection. Rather, these infection defects can be rescued by the wild-type strain in co-inoculation experiments, suggesting that failure of the mutants to infect is due to altered expression of genes encoding infection factors that are under the control of the above epigenetic marks that can be supplied by the wild-type strain. Among genes differentially expressed in the mutants at the early infection stage is a putative small-secreted protein with a carbohydrate binding function, which deletion in E. festucae severely reduced infection efficiency.

Sarcasm is a common form of social language but one that can be challenging for children to understand. We investigated whether training can enhance children’s ability to understand sarcasm. Participants were 111 five- to six- year-olds, assigned to either the training or control condition. In both conditions, children were first shown a series of puppet shows. Each puppet show ended with a sarcastic or literal remark. After each show children were asked about speaker belief, intent, and humour. Children’s responses were used to estimate their pre-training sarcasm understanding. In the training condition, children were taught what sarcasm was and what cues to look for as they interacted with the researcher over a set of stories where characters made either sarcastic or literal remarks. In the control condition children read a non-sarcastic storybook with the researcher. Children’s understanding of sarcasm was then re-assessed using another series of puppet shows. For children who were not already proficient in sarcasm understanding, training was associated with more accurate speaker belief and intent responses and more accurate sarcasm detection. Training was not related to children’s speaker humour responses. Thus, the findings of the present study provide evidence that aspects of children’s sarcasm understanding can be enhanced through training. The training paradigm could be developed further to test its effectiveness in other populations who struggle with sarcasm understanding, and to help refine theories of irony development.

The indirect cost of illness represents the portion of human capital that is foregone due to lost productivity of patients and their caregivers and out-of-pocket healthcare expenses borne directly by patients. Indirect costs among persons with inflammatory bowel diseases (IBD) may be substantial because disease onset occurs during the teens and 20s for most persons and is lifelong. Thus, most persons with IBD are affected during periods of study or employment. The literature on indirect health-related costs among persons with IBD is limited, particularly with regard to Canadian studies. The greatest burden of indirect costs in this population relates to absenteeism and presenteeism among working individuals and premature retirement. However, costs related to reduced professional development and personal achievement due to illness—as well as caregiver costs—are largely unknown. After being extrapolated from multiple sources, the total indirect health-related cost of IBD in Canada in 2018 is estimated to be $1.29 billion Canadian dollars. Notably, this may be a significant underestimate because costs relating to presenteeism, reduced achievement and caregiver burden could not be estimated and are excluded from this calculation. Highlights Indirect costs account for a major portion of total healthcare costs among persons with inflammatory bowel disease (IBD) and are higher than indirect costs among persons without IBD. Persons with IBD are more likely to require time off work (absenteeism) and have reduced productivity at work (presenteeism) due to illness as compared with persons without IBD. Premature retirement and long-term disability are major factors contributing to indirect costs among IBD patients. A substantial proportion of individuals with IBD pay out-of-pocket for complementary and alternative medicines. After being extrapolated from multiple sources, the total annual indirect cost of IBD in Canada is estimated to be $1.29 billion CAD in 2018, or $4781 CAD per person with IBD. Key Summary Points The total indirect economic burden of IBD in Canada is estimated to be $1.29 billion CAD in 2018, or roughly $4781 CAD per person with IBD. This estimate comprises lost wages related to sick days and disability, premature retirement and premature death, and out-of-pocket costs. Losses from presenteeism, reduced professional development and caregiver burden are not included due to insufficient data on the cost impact of these factors. In a meta-analysis of studies between 1994 and 2014, the annual indirect cost of absenteeism for IBD patients ranged from $515.67 USD (USA) to $14,727 USD (Germany) per patient per annum (pooled estimate $7189 USD), after adjusting for purchasing power disparity. A large US survey found that, on average, IBD patients incurred an extra 4.8 days off of work and $783 USD in excess lost wages annually compared with persons without IBD. A study based on US private insurance claims found that ulcerative colitis patients cost an additional $2164 per person per annum relating to disability days and medically related absenteeism. A prospective study from an IBD centre reported weekly indirect health-related costs of $1133 for IBD patients with active disease, $370.13 for IBD patients in remission, and $191.23 for persons without IBD relating to both presenteeism and absenteeism. In a survey of 744 IBD patients from Manitoba, reduced workplace productivity during the previous 14 days was reported in 37% of individuals, including a reduction of one to two days by 18% of patients, thre to nine days by 16% of patients, and on most days by 3% of patients. The estimated average lifetime lost wages due to premature retirement is $1,044,498 CAD per person with Crohn’s disease and $994,760 CAD per person with ulcerative colitis. Aggregated over all IBD retirees, this equates to roughly $629 million CAD in permanent lost wages annually due to premature retirement. The lifetime indirect cost associated with premature death among IBD patients is estimated to be $746,070 CAD per decedent, or roughly $33.6 million aggregated across all IBD decedents of working age. In a US study of caregivers of children, the average unadjusted annual work loss was 214 hours for caregivers of Crohn’s disease patients and 170 hours for caregivers of children without IBD, translating to an additional $1122 in lost productivity for caregivers of persons with Crohn's disease. Canadian studies have reported complementary and alternative medicines (CAMs) use in 56% to 74% of people with IBD. A US national survey study estimated annual per-person out of pocket costs of $1603 USD for Crohn’s disease patients and $1263 USD for ulcerative colitis patients, which were substantially higher than in persons without IBD. Gaps in Knowledge and Future Directions Canadian-specific data on indirect health-related costs of IBD is sparse across all domains of indirect costs. In particular, the rates of absenteeism, presenteeism and premature retirement among IBD patients living in Canada require further study to gauge more accurately the indirect health-related costs of IBD in Canada. Indirect costs relating to decreased professional development, caregiver burden and out-of-pocket purchases among IBD patients are largely unknown and require further study. Indirect costs incurred by Canadian children with IBD and their families or caregivers are largely unknown.

Approximately one in every 160 seniors live with IBD. Due to the fact that IBD has no known cure, and thus patients diagnosed at younger ages will carry their disease with them into their senior years, the number of senior IBD patients is rising significantly in Canada. Seniors with IBD present unique challenges for care. Patients with IBD will experience greater comorbid conditions resulting from their advancing age and longer disease duration. Risks associated with IBD-related surgeries and complications from other illnesses associated with age and their medications further complicate treatment options and may lead to higher healthcare utilization. Healthcare providers need to be prepared to work in multidisciplinary teams with other specialists in order to address the complexity and comorbidities of seniors with IBD. Highlights 1. Approximately one out of every 160 individuals over the age of 65 in Canada is living with IBD. 2. The rising prevalence of IBD in seniors results from new diagnoses and advancing age of previously diagnosed patients with IBD. 3. Patients with IBD will experience greater comorbid conditions resulting from their advancing age and longer disease duration. 4. As the IBD population ages, the proportion of seniors with IBD will increase in gastroenterology clinics. 5. The care of seniors with IBD brings unique challenges with respect to therapeutic decision-making. Key Summary Points 1. Approximately 0.6% of seniors in Canada live with IBD. 2. In Ontario, the prevalence of IBD among seniors increased by 5.2% per year, which outpaced the 3.9% per year rise observed in nonseniors. 3. Approximately 15% of IBD patients are newly diagnosed after the age of 65 years. 4. The incidence of IBD in seniors ranged from 16.5 to 18.9 per 100,000 in Canada. 5. In Ontario, the diagnosis of ulcerative colitis in seniors was double that of Crohn’s disease. 6. Clinical presentation of seniors with Crohn’s disease is unique with a higher likelihood to present with isolated colonic disease without fistulizing disease or extra-intestinal manifestations as compared with those diagnosed at a younger age. 7. Seniors with IBD are less likely to have outpatient visits relating to their IBD as compared with younger patients with IBD. 8. Among individuals diagnosed over the age of 65, the 10-year risk of intestinal surgery was 7% to 19% for ulcerative colitis and 31% for Crohn’s disease. 9. Seniors who undergo intestinal resections for their IBD have significantly higher postoperative complications and mortality as compared with younger IBD patients undergoing surgery. 10. The use of anti-TNF agents in seniors is lower for Crohn’s disease (4.0%) and ulcerative colitis (2.3%) as compared with younger individuals with IBD. However, the rate of use of biologics is increasing over time. 11. Therapeutic decision-making in seniors with IBD is challenging due to their comorbid conditions. 12. Seniors who use thiopurines have a higher risk of lymphoma (5.4 per 1000 person-years) as compared with IBD patients younger than 50 (0.37 per 1000 person-years) exposed to thiopurines. 13. Newer gut-selective α4β7 integrin inhibitors may be a safer choice for seniors due to potentially lower risk of infection and cancer. 14. Due to multiple comorbidities, seniors with IBD may struggle with polypharmacy that can lead to drug interactions and reduced medication adherence. 15. Persons between 65 and 79 of age with IBD on average cost the healthcare system $5298 per year, which is higher than age-matched controls. Gaps in Knowledge and Future Directions 1. Administrative healthcare databases are more likely to misclassify senior patients with IBD. Future research is necessary to improve the identification of senior patients with IBD in databases. 2. Gastroenterologists will need to contend with an older IBD population with greater comorbidities. Research focusing on defining the burden of comorbidities in senior IBD patients is needed for healthcare resource utilization planning. 3. The use of anti-TNF in senior patients is lower than in younger individuals with IBD. Future research should evaluate trends in using biologics in the senior population with the advent of newer biologics such as integrin and other cellular adhesion molecule inhibitors. 4. Polypharmacy is a challenge for senior IBD patients. Future research should focus on interventions to simplify drug regimens and administration for senior patients. 5. Senior individuals with IBD cost the healthcare system more than age-matched controls. However, research is necessary to establish the IBD-attributable cost to the healthcare system and the indirect cost to society.

Inflammatory bowel disease (IBD) has a substantial impact on quality of life. It causes considerable personal, emotional and social burdens. The impact of IBD on quality of life cannot readily be quantified as a cost; however, the impact places a significant burden on the patient and caregivers. Numerous studies have shown that health-related quality of life is impaired in patients living with IBD as compared with the general population. While disease activity and severity is an important driver of physical and mental health–related quality of life, patients may experience psychological distress even during clinical remission. Reduced quality of life can impact persons living with IBD as they pursue employment, family planning and personal milestones. Further, the impact of IBD extends to the patient influencing the quality of lives of those around them, including their caregivers. Improving quality of life requires a multidisciplinary approach that includes screening for and managing psychological distress. Adaptive coping mechanisms help manage illness perceptions and reduce psychosocial distress. Highlights Health-related quality of life (HRQOL) is an important measure of the global impact of IBD on a person’s physical, mental and emotional well-being. Persons living with IBD have significantly lower HRQOL compared with that of the general population. Inflammatory bowel disease often affects individuals as they pursue employment, family building and personal milestones. Inflammatory bowel disease affects the quality of life (QOL) of those afflicted and their caregivers. Access to multidisciplinary, collaborative, chronic disease models of care improves the HRQOL of people living with IBD. Key Summary Points Inflammatory bowel disease impairs HRQOL by inhibiting need fulfillment (i.e., self-esteem, relationships, nutrition, hygiene and security) and causing psychological distress. Inflammatory bowel disease impairs interpersonal relationships, life activities, social participation and mental well-being. Patient symptoms like diarrhea and abdominal pain reduce HRQOL. While disease severity is an important driver of physical and mental HRQOL, patients experience psychological distress even during clinical remission. Psychological distress impairs work productivity and disrupts social activities and relationships. Patients with IBD experience emotional distress relating to factors such as loss of bowel control, impairment of body image, fear of sexual inadequacy, social isolation, fear of dependency, concern about not reaching one’s full potential and fear of stigmatization. Families with children with IBD have impaired QOL as a collective—for example, parental stress from medical factors and child’s perceived stress. Patients’ perception of their illness affects their ability to adjust to a diagnosis of IBD. Adaptive coping mechanisms help manage illness perceptions and reduce psychosocial distress. Biologics are associated with improvement in long-term HRQOL in people with IBD. Patients with IBD should have access to multidisciplinary care, including mental health practitioners, to screen for and manage psychological distress. Gaps in Knowledge and Future Directions Patients with IBD experience emotional distress that reduces HRQOL. Clinical tools are necessary to identify the key factors causing psychological distress in patients with IBD. HRQOL is reduced in individuals with IBD and their families. Studies should evaluate the cumulative burden of IBD on HRQOL in patients with IBD and their caregivers. Patient self-perception of their IBD influences their HRQOL. Clinical studies of interventions that improve adaptive coping are needed to reduce psychosocial distress. Multidisciplinary care including a psychologist to screen for and manage psychosocial risk and psychological distress should be evaluated in IBD clinics.

Accumulating evidence indicates that time spent in natural environments promotes creativity, but few researchers have considered how this occurs. We evaluate two candidate mechanisms, attention restoration and mind wandering. We compare the accounts in terms of attentional focus, brain network activation, cognitive effects, and the temporal progression of these processes across the stages of creativity. Based on this analysis, we propose that (1) gentle shifts between externally oriented soft fascination and internally oriented mind wandering can occur during nature experience; (2) this provides the basis for mutually reinforcing pathways that enhance attention control following nature experience; and (3) mind wandering might support additional benefits for creativity, including flexibility and new associations of ideas. We propose research to test the proposed pathways, including the conditions under which environments influence creativity, the ebb and flow of attention orientation during environmental experience, and the links between attentional focus, brain network activation and creativity.

Research indicates that heightened individual engagement in nature can improve psychological benefits of nature experiences, yet the current literature lacks robust consideration for how this occurs. Constrained nature experiences – such as busy, noisy urban environments – may undermine individual capacities to engage with nature, prompting the question of how engagement functions across different nature experiences. To address this gap, we draw on mindfulness as a framework to examine the pathways in which engagement in nature supports psychological restoration and connection with nature. We appraise existing literature and identify three key mechanisms underpinning mindful engagement in nature: perceptual sensitivity, decentering, and non-reactivity. This new framework provides a basis to examine mindful engagement in constrained nature experiences, where we find that the self-regulatory mechanisms of mindful engagement have a more direct role in supporting outcomes.

Most studies on psychological restoration and favorite places have addressed restoration in green or blue outdoor settings whereas the interest around built and indoor settings has been scarce. In this study, we analyzed restorative experiences in favorite indoor and outdoor urban places using a top-down approach by including psycho-environmental variables (nature and urban orientedness, place bonding) and personality traits (Big Five). A sample of 945 university students and staff recruited in 5 western countries (Finland, Spain, The Netherlands, UK and Australia) answered an online questionnaire. In the linear regression models, perceived restorative potential, place attachment and place identification were the strongest predictors of subjective restoration. Personality traits did not play a significant role in restorative experiences. This work extends restoration research by considering the role of indoor, as well as outdoor environments and highlights the role of certain top-down characteristics in restorative experiences.

In addition to membrane-bound organelles, eukaryotic cells feature various membraneless compartments, including the centrosome, the nucleolus and various granules. Many of these compartments form through liquid–liquid phase separation, and the principles, mechanisms and regulation of their assembly as well as their cellular functions are now beginning to emerge. Biomolecular condensates are micron-scale compartments in eukaryotic cells that lack surrounding membranes but function to concentrate proteins and nucleic acids. These condensates are involved in diverse processes, including RNA metabolism, ribosome biogenesis, the DNA damage response and signal transduction. Recent studies have shown that liquid–liquid phase separation driven by multivalent macromolecular interactions is an important organizing principle for biomolecular condensates. With this physical framework, it is now possible to explain how the assembly, composition, physical properties and biochemical and cellular functions of these important structures are regulated.

Australian cities have been slow to implement green roofs. This is because there are many potential barriers to their widely acceptance as a nature based solution that can make cities more liveable and help them adapt to, and mitigate, climate change. Due to significant differences in rainfall, temperature, available substrates and suitable vegetation relying on northern hemisphere research and experience is problematic as many of the environmental and economic benefits of green roofs are location specific. This paper aims to 1. Synthesise a decade of Australian green roof research that has sought to overcome these barriers, 2. Assess the current status of the Australian green roof industry and remaining knowledge gaps, and 3. Provide a roadmap for future progress developed in multidisciplinary industry workshops. Many of these insights will be applicable to areas with similar seasonally hot and dry climates or emerging green roof markets. We identified that significant progress has been made in addressing the barriers to green roofs in Australia. Research has focused on developing green roofs for local conditions and quantifying their benefits. Substrate research has investigated the suitability of locally available materials with a focus on how water retention additives and organic waste materials can increase plant available water and therefore survival. By taking a plant physiology approach Australian researchers have gained a strong functional understanding of suitable green roof plants and the benefits they provide, considerably expanding the available palette beyond the succulents commonly used internationally. Research has quantified green roofs’ stormwater retention and building insulation and energy benefits and provided evidence that they benefit well-being and performance, important for employee productivity.

Otospermophilus beecheyi (Richardson, 1829), the California ground squirrel (formerly, Beechey ground squirrel), is dorsally brown with silver spotting. This facultatively social and ecologically flexible species occurs at a range of elevations, has a wide dietary niche, and is common in California grasslands and oak woodlands. Although listed as “Least Concern,” it has a tenuous relationship with humans. It contributes to crop and infrastructure damage and is associated with the spread of zoonoses, including plague. Nonetheless, it is an important prey species for mammalian, reptilian, and avian predators and an ecosystem engineer that constructs burrows that benefit commensals. Ongoing study of its behavioral ecology continues to advance our understanding of mammalian antipredator behavior, disease transmission, behavioral plasticity, and social evolution.

Green or vegetated roofs are increasingly built in cities to provide multiple environmental and social benefits and are an emerging horticultural industry in Australia. Since 2008, researchers at the University of Melbourne s Burnley Campus have undertaken transdiciplinary research developing and evaluating green roofs for southern Australian conditions which are characterised by hot, dry summers. We have quantified plant performance through experiments on roofs and in controlled environments, using both Australian native and exotic species, to identify plant physiological and morphological traits that will improve green roof performance. We have developed lightweight mineral substrates based on scoria, bottom-ash from coal fired power stations and crushed roof tiles and evaluated water retention additives to improve water holding capacity and plant survival. Hydrology studies have found that 10-cm deep green roofs with scoria substrate can reduce stormwater runoff in Melbourne by 43-88%, depending on season and plant species. We found that a 12.5-cm deep green roof reduces building energy use by 38% in summer. Environmental psychology research demonstrates that people prefer green roofs with flowering meadow like vegetation and that viewing this type of green roof improves concentration and improves work performance. Our results have been embraced by the Australian green roof industry, resulting in construction of green roofs with our best performing substrates and plants and the development of science-based guidelines for future green roof projects.

Green spaces are believed to enhance the well-being of residents in urban areas. While there is research exploring the emotional benefits of green spaces, most early works are based on user surveys and case studies, which are typically small in scale, intrusive, time-intensive and costly. In contrast to earlier works, we utilize a non-intrusive methodology to understand green space effects at large-scale and in greater detail, via digital traces left by Twitter users. Using this methodology, we perform an empirical study on the effects of green spaces on user sentiments, emotions and activities in Melbourne, Australia and our main findings are: (i) tweets in green spaces contain more positive and less negative emotions compared to those in urban areas; (ii) emotions in tweets vary seasonally; (iii) there are interesting changes in sentiments based on the hour, day and month that a tweet was posted; (iv) negative sentiments are typically associated with large transport infrastructures such as train interchanges, major road junctions and railway tracks; and (v) each green space is often associated with a specific type of activity and/or event, which can be a useful information for Online recommender systems. The novelty of our study is the combination of psychological theory, alongside data collection and analysis techniques on a large-scale Twitter dataset, which builds upon traditional methods in urban research and provides important implications for urban planning authorities.

The evidence for restorative effects of contact with nature is vast. Drawing from two well-known theories in Environmental Psychology, Stress reduction theory and Attention restoration theory, restoration can be seen as a sequential, interactive process that begins with physiological relaxation and results in affective and attention restoration and broader life reflection. This interaction between a person and their environment may be facilitated by actively engaging with the environment but this has been understudied. We examined engagement with the environment by asking participants to complete psychological, restoration theory-driven tasks designed to enhance physiological, affective and attention restoration, while walking on nature trails. We conducted two experimental field studies (conceptual replications) in Finland in a coniferous forest (Study 1; n = 128) and an urban park (Study 2; n = 121). The participants walked at their own pace for 4-6 km with or without psychological tasks. Those in the task conditions completed either theory-based restoration-enhancement tasks or alternative tasks that we expected to be less restorative (Study 1: the same tasks in the reverse order; Study 2: awareness-enhancement tasks). The participants completed self-reports on valence, activation, and restoration, and the Sustained Attention to Response Task, before, and after, the walk. We compared the change between measurements using regression models grouped by study conditions, with age, recent stress, difficulties with wayfinding, start time, and navigation method (Study 2 only) as covariates. Valence and self-reported restoration improved after the walk, but there was no additional benefit from the psychological tasks. In both studies, sustained attention consistently improved following different versions of the restoration-enhancement tasks and, to some extent, after a walk without the tasks. Participants who were more stressed experienced greater improvements in valence and self-reported restoration (Study 1) and sustained attention (Study 2). The results support both Stress reduction theory and Attention restoration theory, and imply that some forms of active engagement with the environment can aid sustained attention but not affective restoration. Future research efforts are needed to replicate these findings and to assess any potential long-term or multiplicative effects of engagement-based tasks, or other strategies that could enhance positive engagement with the environment.

Background Health research in Canada is funded by government, health charities, foundations and industry. We investigated levels of IBD research funding and the scientific impact of this research in Canada between 2013 and 2017. Methods An analysis of global and Canadian funding in IBD research was conducted using the Canadian Institutes of Health Research (CIHR) Funded Research Database and UberResearch’s Dimensions platform. Examples of priority-driven and investigator-initiated IBD research in Canada are provided. Bibliometric analysis was used to assess the quality of IBD research output in Canada. Results Total funding for IBD research Canada between 2013 and 2017 was over $119 million Canadian dollars (CAD), with CIHR, the largest funder, contributing almost $66 million CAD, and Crohn’s and Colitis Canada, investing more than $32 million CAD. This ranks Canada fourth internationally. A comparative analysis indicates that publications by Canadian IBD researchers have a greater impact than other Canadian and international comparators. When productivity and impact in IBD research are combined, Canada is among the top three in the world. Conclusions Investment in IBD research in Canada has resulted in the development of a strong collaborative group of researchers producing impactful, world-class research. On all measures of academic productivity and influence, Canada ranks in the top two or three internationally. The challenges ahead are to continue to fund innovative IBD research and grow the next generation of IBD researchers while moving research findings into changes in health policy and practice in order to benefit affected patients and their families—and ultimately, to find the cause(s) and identify the cure(s).

Canada has among the highest rates of IBD in the world, and the number of people living with these disorders is growing rapidly. This has placed a high burden on the health care system and on the Canadian economy—a burden that is only expected to grow in the future. It is important to understand IBD and its impact on Canadian society in order to appropriately plan for health care expenditures, reduce the burden on patients and their families, and improve the quality of life for those afflicted with IBD. In Canada, there is a lack of public awareness of the impact of Crohn’s disease and ulcerative colitis. Raising awareness is crucial to reducing the social stigma that is common with these diseases and to help individuals maximize their overall quality of life. A better public understanding of IBD can also help to raise and direct funds for research, which could lead to improved treatments and, ultimately, to a cure. This report from Canadian clinicians and researchers to Crohn’s and Colitis Canada makes recommendations aimed at the public, policy-makers, scientific funding agencies, charitable foundations and patients regarding future directions for advocacy efforts and areas to emphasize for research spending. The report also identifies gaps in knowledge in the fields of clinical, health systems and epidemiological research.

Direct health care costs of illness reflect the costs of medically necessary services and treatments paid for by public and private payers, including hospital-based care, outpatient physician consultations, prescription medications, diagnostic testing, complex continuing care, and home care. The costs of caring for persons with inflammatory bowel disease (IBD) have been rising well above inflation over the past fifteen years in Canada, largely due to the introduction and penetration of expensive biologic therapies. Changing paradigms of care toward frequent patient monitoring and achievement of stricter endpoints for disease control have also increased health services utilization and costs among IBD patients. While the frequency and costs of surgeries and hospitalizations have declined slightly in parallel with increased biologic use (due to better overall disease control), the direct medical costs of care for IBD patients are largely dominated by prescription drug costs. Introduction and penetration of biosimilar agents (at a markedly lower price point than the originator drugs) and increasing gastroenterologist involvement in the care of IBD patients may help to balance rising health care costs while improving health outcomes and quality of life for IBD patients. Ultimately, however, the predicted rise in the prevalence of IBD over the next decade, combined with increasing use of expensive biologic therapies, will likely dictate a continued rise in the direct costs of IBD patient care in Canada for years to come. In 2018, direct health care costs of IBD are estimated to be at least $1 billion Canadian dollars (CAD) and possibly higher than $2 billion CAD. Highlights 1. In Canada, the direct cost of caring for people living with IBD is estimated in 2018 to be close to $1.28 billion (roughly $4731 per person with IBD). 2. The costs of caring for people living with IBD are dominated by prescription drugs, followed by hospitalization costs. There has been a shift away from hospitalizations and toward pharmaceuticals as the predominant driver of direct health care costs in IBD patients, due to the introduction and widespread use of expensive biologic therapies. 3. The rates of hospitalizations and major abdominal surgeries have been declining in IBD patients in Canada over the past two decades, possibly due to penetration of biologic therapies and advances in patient management paradigms. 4. Inflammatory bowel disease patients cared for by gastroenterologists have better outcomes, including lower risks of surgery and hospitalization. Canadians who live in rural and underserviced areas are less likely to receive gastroenterologist care, potentially due to care preferences or poorer access, which may result in poorer long-term outcomes. 5. Introduction of biosimilar agents at a lower price point than originator biologic therapies, increased gastroenterologist care of IBD patients, and improvements in IBD care paradigms may balance overall treatment costs while improving health outcomes and quality of life for IBD patients. However, in the long-term, direct costs of care may continue to increase, dictated by a rising IBD prevalence and increasing use of biologic therapies. Key Summary Points 1. The costs of health care for patients with IBD are more than double those without IBD. 2. Prescription drug use accounts for 42% of total direct costs in IBD patients, and costs to treat IBD continue to rise due to increased use of existing biologic therapies and the introduction of several new biologic therapies in recent years. 3. In Manitoba, the mean health care utilization and medication costs for persons with IBD in the year before beginning anti-TNF therapy was $10,206 and increased to $44,786 in the first year of therapy. 4. Biosimilar agents to anti-TNF drugs are now entering the Canadian marketplace and may result in cost savings in patients using biologic agents to treat their IBD. 5. Timely gastroenterologist care has been associated with reduced risks of requiring surgery and emergency care among ambulatory IBD patients and a reduced risk of death among hospitalized patients with ulcerative colitis. 6. Inflammatory bowel disease care provided by gastroenterologists has increased over the past two decades. Even then, the average time from symptom onset to IBD diagnosis exceeds six months, and only one-third of IBD patients receive continuing care with a gastroenterologist during the first five years following diagnosis. 7. Senior (age ≥65), rural-dwelling, and non-immigrant IBD patients have less frequent gastroenterologist care than other groups. 8. About one in five adults with Crohn’s disease and one in eight adults with ulcerative colitis are hospitalized in Ontario every year. Hospitalizations are most common during the first year following IBD diagnosis. Children with IBD (age

The burden of extra-intestinal disease is high in patients with IBD, some of whom respond to or are prevented by treating the bowel inflammation, whereas others require specific treatment because they are independent of the underlying bowel inflammation. Among the most common extra-intestinal manifestations are other chronic immune-mediated diseases such as erythema nodosum, ankylosing spondylitis and primary sclerosing cholangitis. Patients with IBD are at higher risk of complications in other organ systems such as osteoporosis, venous thromboembolism and cardiovascular disease. In addition, patients with IBD have a higher risk of cancer, including colon cancer. Mental health comorbidity is important and common in IBD though not always recognized and managed. Consequently, patients and care providers need to be vigilant in the surveillance of extra-intestinal manifestations and complications of IBD. Highlights The burden of extra-intestinal disease is high in patients with IBD.Immune-mediated inflammatory diseases (IMIDs) commonly coexist with patients with IBD and the activity of IMIDs can be either dependent or independent of bowel inflammation.Patients with IBD can be diagnosed with coexisting diseases that affect every organ, including bones, blood, heart, liver, and others.Patients with IBD are at increased risk of cancer, including colon cancer, caused by their bowel inflammation, cholangiocarcinoma due to primary sclerosing cholangitis, and rarely lymphoma related to immunosuppressive medications.The best way to prevent or reduce the burden of many of the extra-intestinal disease is to treat the inflammation of IBD, however some extra-intestinal inflammatory diseases run courses that are independent of the intestinal disease activity. Key Summary Points Patients with IBD are often burdened with extra-intestinal manifestations, some of which respond to or are prevented by treating the bowel inflammation whereas others require specific treatment because they are independent of the underlying bowel inflammation.Other immune-mediated inflammatory diseases (IMIDs) can coexist with IBD.Some IMIDs run an independent course from the bowel inflammation of IBD, such as ankylosing spondylitis, iritis, and primary sclerosing cholangitis.Immune-mediated inflammatory diseases that often have courses that match the bowel inflammation of IBD include erythema nodosum and peripheral arthritis.Immune-mediated inflammatory diseases such as multiple sclerosis and psoriasis have been associated with IBD. However, these conditions may also emerge as complications of therapy for IBD.Patients with IBD are at risk for venous thromboembolic disease, which occurs at a rate of one per 200 person-years.Venous thromboembolic disease can be reduced by treating patients admitted to hospital with an IBD diagnosis with venous thromboembolism prophylaxis.Arterial vascular disease is also increased in IBD patients, including both coronary artery disease and cerebrovascular disease.Osteoporosis is more prevalent in IBD patients and translates to a 40% increased risk of fracture. While corticosteroids increase the risk of osteoporosis, patients with IBD can also develop metabolic bone disease independent of corticosteroid use.Persons with IBD are more likely to be infected with Clostridium difficile than community controls and often without prior antibiotic exposure.Mental health comorbidity is important in IBD. Depression may antedate a diagnosis of IBD by several years and increase post-diagnosis. High stress can exacerbate symptoms in IBD but does not necessarily increase bowel inflammation.Fatigue is a common symptom in IBD and is not always explained by depression, active inflammatory disease or other apparent factors.The risk of colorectal cancer is increased twofold in Crohn’s colitis and in ulcerative colitis and 10-fold in persons with primary sclerosing cholangitis with colitis.Primary sclerosing cholangitis runs a course independent of IBD and can progress to cirrhosis, liver transplantation or death. Patients with IBD and primary sclerosing cholangitis are at higher risk of cholangiocarcinoma, which is often fatal.The risk of lymphoma may be increased in older males with Crohn’s disease and in patients using thiopurines or anti-TNF therapy.The risk for intensive care unit admission is nearly twofold higher for patients with IBD and higher in Crohn’s disease than in ulcerative colitis. Risk factors for intensive care unit admission from the year before admission included cumulative corticosteroid use and IBD-related surgery. Gaps in Knowledge and Future Directions Patients with IBD are often burdened with extra-intestinal disease. Future research should determine the collective frequency and added costs of living with extra-intestinal disease.Immune-mediated inflammatory diseases are commonly codiagnosed with IBD. Future research should focus on the pathogenesis connecting coexisting IMIDs with IBD.Care pathways that support the investigation and mitigation of extra-intestinal disease are needed. For example, when and how ambulatory patients with IBD should receive prophylaxis against venous thromboembolic disease is unknown.With an aging IBD population, the burden of extra-intestinal disease should be studied in the context of comorbidities of advancing age.Increasing mental health screening and access to mental health care should be a goal of IBD management.

Based on attention restoration theory we proposed that micro-breaks spent viewing a city scene with a flowering meadow green roof would boost sustained attention. Sustained attention is crucial in daily life and underlies successful cognitive functioning. We compared the effects of 40-s views of two different city scenes on 150 university students' sustained attention. Participants completed the task at baseline, were randomly assigned to view a flowering meadow green roof or a bare concrete roof, and completed the task again at post-treatment. Participants who briefly viewed the green roof made significantly lower omission errors, and showed more consistent responding to the task compared to participants who viewed the concrete roof. We argue that this reflects boosts to sub-cortical arousal and cortical attention control. Our results extend attention restoration theory by providing direct experimental evidence for the benefits of micro-breaks and for city green roofs.

Studying large, widely spread Twitter data has laid the foundation for many novel applications from predicting natural disasters and epidemics to understanding urban dynamics. Recent studies have focused on exploring people's emotional response to their urban environment, e.g., green spaces versus built up areas, through analysing the sentiment of tweets within that area. Since green spaces have the capacity to improve citizen's well-being, we developed a system that is capable of recommending green spaces to users. Our system is unique in the sense that the recommendations are tailored with regard to users' preferred activity as well as the degree of positive sentiments in each green space. We show that the incoming flow of tweets can be used to refine the recommendations over time. Furthermore, We implemented a web-based, user-friendly interface to solicit user inputs and display recommendation results.

Green spaces are believed to improve the well-being of users in urban areas. While there are urban research exploring the emotional benefits of green spaces, these works are based on user surveys and case studies, which are typically small in scale, intrusive, time-intensive and costly. In contrast to earlier works, we utilize a non-intrusive methodology to understand green space effects at large-scale and in greater detail, via digital traces left by Twitter users. Using this methodology, we perform an empirical study on the effects of green spaces on user sentiments and emotions in Melbourne, Australia and our main findings are: (i) tweets in green spaces evoke more positive and less negative emotions, compared to those in urban areas; (ii) each season affects various emotion types differently; (iii) there are interesting changes in sentiments based on the hour, day and month that a tweet was posted; and (iv) negative sentiments are typically associated with large transport infrastructures such as train interchanges, major road junctions and railway tracks. The novelty of our study is the combination of psychological theory, alongside data collection and analysis techniques on a large-scale Twitter dataset, which overcomes the limitations of traditional methods in urban research.

Living, or green roofs, are increasingly built in cities for their environmental benefits, however there is little evidence about how to maximise their aesthetic appeal. Because preferences for landscapes can be determined by vegetation characteristics we surveyed the preferences of 274 Australian office workers using 40 living roof images which systematically manipulated plant life-form, foliage colour, flowering, diversity and height. These preferences were compared to those for a bare concrete roof. The potential restorativeness of the most preferred living roof and the concrete roof were also assessed. Results showed that all living roofs were preferred over the concrete roof; however preferences differed according to vegetation characteristics. The most preferred and restorative living roof had taller, green, grassy and flowering vegetation, while lower-growing red succulent vegetation was least preferred. Participants preferred a productive landscape, with green foliage and flowering consistently preferred. Participants with a stronger connection to nature consistently assigned higher preferences to taller, compared to lower-growing, vegetation. Increasing diversity was associated with higher preferences overall, but decreasing preferences for highly preferred vegetation. This research makes an important contribution to understanding employee preferences in the unique context of urban living roof landscapes.

While a relatively small body of research links green roofs to psychological benefits such as aesthetic enjoyment and improved concentration, these outcomes are becoming important objectives in green roof design. Claims regarding benefits of green roofs are therefore often derived from research on psychological benefits of ground-level urban greenspaces. Compared with other urban landscapes, green roofs have limited space and accessibility, reducing the opportunity for physical exercise and the opportunity for larger masses of vegetation, particularly trees. Given these differences, there is a risk that the psychological benefits of green roofs are overstated or may only apply to a subset of green roof designs. Guidance for designing green roofs for psychological benefits may also be misleading if it fails to consider the unique green roof context. To address these challenges, we review research on psychological benefits of green roofs through a social-ecological lens on human-environment interactions. We consider how experiences of green roofs arise from an interaction between characteristics of the physical environment (including characteristics of green roof vegetation, wind patterns, and surrounding buildings), social climate (including social factors influencing access and use, and social norms for nature in cities), activities that can be undertaken on a green roof (such as exercise, socialisation, rest and relaxation), and individual resources and adaptation (for example, prior mood and opportunities to change environments to support individual needs). We explore how these factors interact with each other and with broader natural, built and socio-cultural systems that might encourage or inhibit opportunities to view, access, and enjoy green roofs. We conclude with recommendations regarding how green roofs can be designed to promote psychological benefits and identify future research needs.

Smith, Jennifer E., Long, Douglas J., Russell, Imani D., Newcomb, Kate Lee, Muñoz, Valeska D. (2016): Otospermophilus beecheyi (Rodentia: Sciuridae). Mammalian Species 48 (939): 91-108, DOI: 10.1093/mspecies/sew010, URL: http://dx.doi.org/10.1093/mspecies/sew010

Quantifying the clearance of extractables and leachables (E/L) throughout ultrafiltration/diafiltration (UFDF) operations allows for greater flexibility in the implementation of single-use technologies in steps upstream of the UFDF process. A proof-of-concept study was completed in which the clearance of 7 E/L from single-use technologies (trimethylsilanol, hexanoic acid, butyrolactone, t-butyl alcohol, caprolactam, acetonitrile, and benzyl alcohol) in four representative proteins were measured and monitored during the UFDF process using quantitative NMR. This study demonstrated that the defined E/L spiked into a variety of protein solutions can be cleared to1 ppm by 9 diavolumes from a maximum initial load concentration of 1,000 ppm. However, in some cases a rebound effect was observed in the recovered pool to1 ppm, which is explained in detail. The overall clearance trend observed for both buffer control and protein-containing solutions resembled the ideal clearance trend where no apparent interactions were observed between E/L with the protein, UFDF system, or with other defined E/L which may be present in the system. Additionally, the UFDF system is capable of clearing these potential E/L from single-use technologies below 1 ppm irrespective of initial concentrations in the load (1,000 or 100 ppm), independently from the type of protein. In general, mass recoveries were within ±15% of each spiked compound in protein solutions and their respective buffer controls, suggesting spiked E/L do not interact strongly with protein. By demonstrating the product independent clearance trends of the spiked E/L across UFDF, these results will contribute to the simplification of the E/L toxicology assessment and allow modular manufacturing approach for single-use technologies in biopharmaceutical manufacturing. © 2016 American Institute of Chemical Engineers Biotechnol. Prog., 32:718-724, 2016.

Based on the assertion that previous research may have inadvertently confounded two stereotypes, we considered the impact of benevolent sexism on rape victim blame in the context of independent manipulations of gender and the perceived genuineness (victim stereotypicality) of an acquaintance rape victim. We predicted that for blame, benevolent sexism may be independently positively associated with gender and victim counter-stereotypicality. Following pilot work, 120 Australian undergraduates read an acquaintance rape scenario. Results indicated that benevolent sexism was only positively associated with blame of the gender counter-stereotypical victim when that victim was also counter-stereotypical in terms of victim stereotypes. This result indicates a more moderate role than previously indicated for benevolent sexism in accounting for rape victim blame.