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Rapa Nui, an isolated island in the Southeast Pacific, was settled by the Polynesians most likely around 1200AD and was discovered by the Europeans in 1722 AD. While the Polynesians presumably found a profuse palm woodland on Rapa Nui, the Europeans faced a landscape dominated by grassland. Scientists have examined potential anthropogenic, biological and climatic induced vegetation changes on Rapa Nui. Here, we analyse observational climate data for the last decades and climate model results for the period 800-1750AD to explore the potential for a climatic-induced vegetation change. A direct influence of the ENSO phenomenon on the climatic parameters of Rapa Nui could not be found in the model simulations. Furthermore, strong climatic trends from a warm Medieval Period to a Little Ice Age or rapid climatic fluctuations due to large volcanic eruptions were not verifiable for the Rapa Nui region, although they are detectable in the simulations for many regions world wide. Hence, we tentatively conclude that largescale climate changes in the oceanic region around Rapa Nui might be too small to explain strong vegetation changes on the island over the last millennium. [ABSTRACT FROM AUTHOR]

The psychological characteristics and the hair problems of 58 females with androgenetic alopecia were compared with a group of women with non-apparent dermatological diseases, and with a group of men with androgenetic alopecia. The women with androgenetic alopecia had higher scores for self-sufficiency and social inadequacy compared to women with non-visible dermatological complaints, and they scored higher for inadequacy, rigidity and general psychological maladjustment than the men and had lower scores for injuredness self-evaluation and self-esteem. The women with androgenetic alopecia had more psychosocial problems, which they attributed to the hair loss, than the other groups. [ABSTRACT FROM AUTHOR]

The article focuses on a case of allergic contact dermatitis caused due to pyridine in Karl Fischer reagent. A 36-year-old laboratory technician developed eczema on fingertips and interdigital spaces of both hands after working for 6 months in a chemical laboratory. In spite of strict avoidance of allergens, there was still gradual worsening of her hand dermatitis. She was therefore tested with various occupational contactants. The only positive reaction was observed with Karl Fischer reagent containing pyridine mix. Pyridine itself was most probably responsible for the allergic reactions.

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

Aim: Differences in the gaze behaviour of experts and novices are described in aviation and surgery. This study sought to describe the gaze behaviour of clinicians from different training backgrounds during a simulated paediatric emergency., Methods: Clinicians from four clinical areas undertook a simulated emergency. Participants wore SMI (SensoMotoric Instruments) eye tracking glasses. We measured the fixation count and dwell time on predefined areas of interest and the time taken to key clinical interventions., Results: Paediatric intensive care unit (PICU) consultants performed best and focused longer on the chest and airway. Paediatric consultants and trainees spent longer looking at the defibrillator and algorithm (51 180 ms and 50 551 ms, respectively) than the PICU and paediatric emergency medicine consultants., Conclusions: This study is the first to describe differences in the gaze behaviour between experts and novices in a resuscitation. They mirror those described in aviation and surgery. Further research is needed to evaluate the potential use of eye tracking as an educational tool., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Decompressive hemicraniectomy (DHC) after space-occupying strokes among patients older than 60 years has been shown to reduce mortality rates but at the cost of severe disability. There is an ongoing debate about what could be considered an acceptable outcome for these patients. Data about retrospective consent to the procedure after lengthy time periods are lacking., Methods: This study included 79 consecutive patients who underwent DHC during a 7.75-year period. Surviving patients were assessed for functional and psychological outcome, quality of life (QoL) and retrospective consent for the procedure. Patients younger than 60 years were compared with older patients., Results: Of our 79 patients, 44 were younger than 60 years (median 50 years, interquartile range (IQR) 19-59 years) and 35 were older (median 68 years, interquartile range 60-87 years). The 30-day mortality rate was higher for the older group, but the difference was not statistically significant. Functional outcome was significantly better in the younger group: 31% of the patients in this group vs. 10% in the older group had a modified Rankin Scale score of 0-3 (p = 0.046). The mean National Institutes of Health Stroke Scale score was 17 ± 14 for the younger group and 29 ± 15 for the older group (p = 0.002). On the 36-Item Short Form Health Survey, with the exception of the item 'General health', the older group reported higher values for all items, with statistically significant differences between the 2 groups on the items 'Role limitation emotional' (p = 0.0007) and 'Vitality' (p = 0.02). In the younger group, 29% of patients retrospectively declined consent for DHC opposed to 0% of patients in the older group (p = 0.07)., Conclusions: Despite impaired functional outcome after DHC, indicators of QoL and retrospective consent are higher for patients older than 60 years over the long term. This finding should be taken into account by those who counsel patients and caregivers with regard to this serious procedure., (© 2015 S. Karger AG, Basel.)

Background: Organizational processes affect the duration of mechanical ventilation in adult and pediatric intensive care units, but surprisingly little is known about role responsibilities for mechanical ventilation and weaning and related contextual factors that may influence timely liberation from mechanical ventilation., Objective: To determine the professional group and seniority of clinicians responsible for key decisions regarding ventilation and weaning; use of ventilation protocols and automated closed loop systems; and provision of education on mechanical ventilation., Methods: Mailed survey to nurse managers of pediatric intensive care units in the United Kingdom., Results: Response rate was 61%. In most units, nurse managers reported that physicians and nurses usually collaborated in making decisions about initializing (63%) and adjusting (94%) ventilator settings and for determining weaning readiness (88%), weaning method (59%), extubation readiness (82%), and weaning failure (100%). Protocols for mechanical ventilation were available in 35% of units, some specific to weaning (18%) and others for noninvasive ventilation (35%). Automated closed loop systems were used in 18% of units. Competency training was required before nurses could adjust ventilator settings in 35% of responding units; in the remaining units, settings were adjusted by nurses who had no specific competency training., Conclusions: Key decisions were mainly collaborative, but nurses were limited in their ability to adjust ventilator settings independently. This limitation may be due to a lack of standardized competency programs and the infrequent use of non-physician-led weaning protocols and automated systems. These findings indicate some ways of improving processes to avoid delays in ventilator weaning.