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Objective: To develop performance metrics that objectively define a reference approach to a transurethral resection of bladder tumours (TURBT) procedure, seek consensus on the performance metrics from a group of international experts. Methods: The characterisation of a reference approach to a TURBT procedure was performed by identifying phases and explicitly defined procedure events (i.e., steps, errors, and critical errors). An international panel of experienced urologists (i.e., Delphi panel) was then assembled to scrutinise the metrics using a modified Delphi process. Based on the panel's feedback, the proposed metrics could be edited, supplemented, or deleted. A voting process was conducted to establish the consensus level on the metrics. Consensus was defined as the panel majority (i.e., >80%) agreeing that the metric definitions were accurate and acceptable. The number of metric units before and after the Delphi meeting were presented. Results: A core metrics group (i.e., characterisation group) deconstructed the TURBT procedure. The reference case was identified as an elective TURBT on a male patient, diagnosed after full diagnostic evaluation with three or fewer bladder tumours of ≤3 cm. The characterisation group identified six procedure phases, 60 procedure steps, 43 errors, and 40 critical errors. The metrics were presented to the Delphi panel which included 15 experts from six countries. After the Delphi, six procedure phases, 63 procedure steps, 47 errors, and 41 critical errors were identified. The Delphi panel achieved a 100% consensus. Conclusion: Performance metrics to characterise a reference approach to TURBT were developed and an international panel of experts reached 100% consensus on them. This consensus supports their face and content validity. The metrics can now be used for a proficiency‐based progression training curriculum for TURBT. [ABSTRACT FROM AUTHOR]

More than 7000 demosponge species have been described to date globally but <2% are known from the abyssal plains, which occupy some 50% of the Earth's surface. The demosponge fauna in the abyssal nodule fields at Clarion‐Clipperton Zone (CCZ) in the Pacific Ocean, a region being explored for potential deep‐sea mining, is a case in point. A total of 21 species belonging to 13 genera in nine families and seven orders were identified from the eastern region of the CCZ, of which most are new to science. They are small in size (<5 mm), with simple skeletons and poor spicule diversity. All ordinal representatives of Demospongiae were utilized to determine taxonomic position of the highly homoplasious tiny demosponges in our molecular phylogenetic analyses. Our results indicated Plenaster craigi, the most common and abundant species in the eastern CCZ, represents a new family, and possibly in a new order. Interestingly, P. craigi and members of the families Polymastiidae and Hamacanthidae, all filter‐feeding demosponge species, are far more abundant in nodule fields than the carnivorous sponges (Cladorhizidae) which were widely known to be the most dominant demosponge group in the abyssal depths. Lastly, it is highly likely that such tiny demosponges are present in other habitats. They might have been overlooked and/or ignored by sponge researchers in the past due to their tiny size and nondescript habitus. These demosponges could be distinct new species, not juveniles or indeterminates and warrant full taxonomic treatment. [ABSTRACT FROM AUTHOR]

ABSTRACT Forming therapeutic relationships is considered important within psychiatric and mental health nursing. One way of achieving this is through social interaction when engaging in joint activities. However, introducing and using nursing interventions based on joint activities in psychiatric inpatient care has proven challenging. Since staff motivation is important, researching the meaning of engaging in joint activities from the nursing professional's point of view can provide information that is relevant in this area. This study aims to illuminate the meaning of participating in joint activities with patients as narrated by nursing professionals in psychiatric inpatient care. Narrative interviews with 14 nursing professionals with experience from psychiatric inpatient care were conducted. Data were analysed using phenomenological hermeneutics and reported following the consolidated criteria for reporting qualitative research (COREQ) guidelines. Results illuminate that engaging in joint activities means being open to a process of learning. Four themes contributed to this understanding: Struggling with uncertainty, discovering aspects of the other, unfolding paths to self‐fulfilment and sharing personhood. Being open to a process of learning means being willing to face uncertainty when engaging in activities as well as being open to learning about oneself as well as the other. Through openness to this process of learning, a sharing of personhood can be achieved, where the nursing professional and the patient approach becoming two persons. Illuminating the meaning of joint activities from the nursing professionals' perspective may provide valuable insights related to introducing and using interventions focusing on joint activities. [ABSTRACT FROM AUTHOR]

Endometrial cancer (EC) is one of the most common female cancers and there is currently no routine screening strategy for early detection. An altered abundance of circulating microRNAs (miRNAs) and other RNA classes have the potential as early cancer biomarkers. We analyzed circulating RNA levels using small RNA sequencing, targeting RNAs in the size range of 17–47 nucleotides, in EC patients with samples collected prior to diagnosis compared to cancer‐free controls. The analysis included 316 cases with samples collected 1–11 years prior to EC diagnosis, and 316 matched controls, both from the Janus Serum Bank cohort in Norway. We identified differentially abundant (DA) miRNAs, isomiRs, and small nuclear RNAs between EC cases and controls. The top EC DA miRNAs were miR‐155‐5p, miR‐200b‐3p, miR‐589‐5p, miR‐151a‐5p, miR‐543, miR‐485‐5p, miR‐625‐p, and miR‐671‐3p. miR‐200b‐3p was previously reported to be among one of the top miRNAs with higher abundance in EC cases. We observed 47, 41, and 32 DA miRNAs for EC interacting with BMI, smoking status, and physical activity, respectively, including two miRNAs (miR‐223‐3p and miR‐29b‐3p) interacting with all three factors. The circulating RNAs are altered and show temporal dynamics prior to EC diagnosis. Notably, DA miRNAs for EC had the lowest q‐value 4.39–6.66 years before diagnosis. Enrichment analysis of miRNAs showed that signaling pathways Fc epsilon RI, prolactin, toll‐like receptor, and VEGF had the strongest associations. [ABSTRACT FROM AUTHOR]

The association of hormonal contraception with increased risk of inflammatory bowel disease (IBD) observed in females suggests involvement of ovarian hormones, such as estradiol, and the estrogen receptors in the progression of intestinal inflammation. Here, we investigated the effects of prophylactic SERM2 and estradiol supplementation in dextran sulfate sodium‐induced colitis using mice with intact ovaries and ovariectomized (OVX) female mice. We found that graded colitis score was threefold reduced in the OVX mice, compared to mice with intact ovaries. Estradiol supplementation, however, aggravated the colitis in OVX mice, increasing the colitis score to a similar level than what was observed in the intact mice. Further, we observed that immune infiltration and gene expression of inflammatory interleukins Il1b, Il6, and Il17a were up to 200‐fold increased in estradiol supplemented OVX colitis mice, while a mild but consistent decrease was observed by SERM2 treatment in intact animals. Additionally, cyclo‐oxygenase 2 induction was increased in the colon of colitis mice, in correlation with increased serum estradiol levels. Measured antagonist properties of SERM2, together with the other results presented here, indicates an exaggerating role of ERα signaling in colitis. Our results contribute to the knowledge of ovarian hormone effects in colitis and encourage further research on the potential use of ER antagonists in the colon, in order to alleviate inflammation. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to retrospectively assess cardiac autonomic activity in children with LQTS, considering genotype, symptoms, sex, age, and beta‐blocker therapy (BB) and compare it to healthy controls. Methods: Heart rate variability (HRV), using power spectrum analysis, was analyzed in 575 Holter recordings from 116 children with LQTS and in 69 healthy children. The data were categorized into four age‐groups and four heart rate (HR) ranges. Results: In LQT1 and LQT2, increasing HR corresponded to significantly lower low (LF) and high frequency (HF) compared to controls. Total power (PTOT) was lower in all LQT1 age‐groups compared to controls at HR 120–140 bpm (1–15 years: p <.01; 15–18 years: p =.03). At HR 80–100, LQT1 patients aged 1–10 years had lower HF than LQT2 patients (1–5 years: p =.05; 5–10 years: p =.02), and LQT2 patients aged 15–18 years had lower HF than LQT1 patients (p <.01). Symptomatic patients aged 10–15 years had lower PTOT at HR 100–120 bpm than asymptomatic patients (p =.04). LQT1 girls aged 10–15 and 15–18 years had a lower PTOT (10–15 years: p =.04; 15–18 years: p =.02) than boys. Conclusion: This study shows a correlation between HR and changes in HRV parameters. At higher HRs, LQTS patients generally had lower HRV values than controls, suggesting an abnormal autonomic response. These results may strengthen the link between physical activity and arrhythmias in LQTS. [ABSTRACT FROM AUTHOR]

In their simulation study, Garcia‐Costoya et al. (2023) conclude that evolutionary constraints might aid populations facing climate change. However, we are concerned that this conclusion is largely a consequence of the simulated temperature variation being too small, and, most importantly, that uneven limitations to standing variation disadvantage unconstrained populations. [ABSTRACT FROM AUTHOR]

The pharmaceutical industry is plagued with long, costly development and high risk. Therefore, a company's effective management and optimisation of a portfolio of projects is critical for success. Project metrics such as the probability of success enable modelling of a company's pipeline accounting for the high uncertainty inherent within the industry. Making portfolio decisions inherently involves managing risk, and statisticians are ideally positioned to champion not only the derivation of metrics for individual projects, but also advocate decision‐making at a broader portfolio level. This article aims to examine the existing different portfolio decision‐making approaches and to suggest opportunities for statisticians to add value in terms of introducing probabilistic thinking, quantitative decision‐making, and increasingly advanced methodologies. [ABSTRACT FROM AUTHOR]

Persistent organic pollutants (POPs) pose a risk in aquatic environments. In sediment, this risk is frequently evaluated using total or organic carbon‐normalized concentrations. However, complex physicochemical sediment characteristics affect POP bioavailability in sediment, making its prediction a challenging task. This task can be addressed using chemical activity, which describes a compound's environmentally effective concentration and can generally be approximated by the degree of saturation for each POP in its matrix. We present a proof of concept to load artificial sediments with POPs to reach a target chemical activity. This approach is envisioned to make laboratory ecotoxicological bioassays more reproducible and reduce the impact of sediment characteristics on the risk assessment. The approach uses a constantly replenished, saturated, aqueous POP solution to equilibrate the organic carbon fraction (e.g., peat) of an artificial sediment, which can be further adjusted to target chemical activities by mixing with clean peat. We demonstrate the applicability of this approach using four polycyclic aromatic hydrocarbons (acenaphthene, fluorene, phenanthrene, and fluoranthene). Within 5 to 17 weeks, the peat slurry reached a chemical equilibrium with the saturated loading solution. We used two different peat batches (subsamples from the same source) to evaluate the approach. Variations in loading kinetics and eventual equilibrium concentrations were evident between the batches, which highlights the impact of even minor disparities in organic carbon properties within two samples of peat originating from the same source. This finding underlines the importance of moving away from sediment risk assessments based on total concentrations. The value of the chemical activity‐based loading approach lies in its ability to anticipate similar environmental impacts, even with varying contaminant concentrations. Environ Toxicol Chem 2024;43:279–287. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. [ABSTRACT FROM AUTHOR]

Introduction: Mental disorders, such as depression and anxiety with interlinked suicidality, are the leading cause of health‐related disability among young men. Knowledge of the interaction between emotional, bodily, social and gendered mental health processes in young men is limited and therefore needed. Aim: This study aimed to explore young men's lived embodied experiences of mental disorders and suicidality, and to conceptualise these by integrating affective–emotional, physiological, social and gendered processes. Methods: Semistructured individual interviews were conducted with 13 young men who had sought professional help for mental disorders and suicidality. Grounded theory (GT) was used with a social constructivist perspective. Results: The results comprise one core category—Living (dys)regulated and alienated young masculinity—with related categories "battling with the emotional body," "suffering in social silence" and "balancing embodied darkness and distress." The GT illustrates how young men navigate and manage their embodied and emotional suffering in a context of "regulative" masculine and social norms alongside insufficient social support. Conclusion: Our results suggest that young men's lived embodied experiences of mental disorders and suicidality can be understood as a dynamic process of internal and external "(dys)regulation and alienation." The generated GT provides a broad tentative explanation model, contributing to theory development, and serves as a basis for gender‐sensitive interventions—in both psychotherapy and physiotherapy—integrating body, mind and the social context. [ABSTRACT FROM AUTHOR]

Sediment core and water quality data, together with historical information on land use/land cover (LULC), were used to reconstruct changes in phosphorus (P) loading and cycling in Lake Wilcox, Ontario, Canada, since the early 1920s. After first being cleared for farming, the originally forested watershed subsequently underwent urbanization. The large increase in P loading accompanying agricultural intensification after World War II caused the eutrophication of the lake. However, improved soil conservation since the 1980s and urban stormwater management since the 1990s have brought watershed P loading and sediment accumulation down to levels comparable to the early 1900s. Yet, the lake continues to exhibit eutrophication‐like symptoms, especially the intensification of hypoxia in the hypolimnion. Post‐2000 water quality data indicate that the latter is not driven by external P loading from the watershed, but rather by rapid salinization that strengthens the lake's summer stratification and enhances internal P loading. Salinization is caused by the increasing application of deicing agents in the expanding urban area. Curbing salt inputs will therefore be essential to restore the lake. Overall, our results provide new insights into the shifts in lake biogeochemistry associated with LULC changes and the implementation of best management practices. The approaches and findings of our case study have broad applicability for the large number of freshwater ecosystems worldwide that are experiencing salinization. Plain Language Summary: The impacts of a century of land use changes on a receiving lake were analyzed, from the early land clearing for farming to the recent rapid urban growth. We focused on the loading of the nutrient element phosphorus (P) to the lake and the resulting changes in water quality and biological productivity. The lake experienced the highest P loading during the period of intensive farming following World War II, which stimulated algal growth and the depletion of dissolved oxygen in the lake's deeper part. Since the 1980s, soil conservation measures have helped in reducing P loading and reversing water quality deterioration. From the early 1990s till today, as the urban area expanded, the lake saw its P loading drop to its lowest level because of the retention of P in urban stormwater ponds. Nonetheless, the lake still suffers from low oxygen concentrations. This is explained by the rising application of road salt in the urban areas of the watershed. The saltier runoff makes it more difficult for the lake to mix and reduces the amount of oxygen in the deeper waters. Thus, controlling salt, rather than P, loading to the lake will be needed to restore the lake. Key Points: Sediment core data link historical changes in land use/land cover to lake phosphorus loading, trophic state, and bottom water oxygenationExternal phosphorus loading and sediment burial peaked during agricultural intensification and dropped with urbanization of the watershedAgricultural soil conservation practices and urban stormwater ponds are very effective at lowering watershed phosphorus exports [ABSTRACT FROM AUTHOR]

Objectives: To compare the safety and efficacy of oral apixaban with that of injectable enoxaparin after robot‐assisted radical cystectomy (RARC) for venous thromboembolism (VTE) thromboprophylaxis. Materials and Methods: We conducted a retrospective review of prospectively collected data for all RARC patients treated at our tertiary care centre between 2018 and 2022. The study included two groups: patients who were subject to a prospectively implemented protocol from October 2021 to the present, comprising a 21‐day postoperative course of apixaban 2.5 mg twice daily after discharge, and patients treated prior to October 2021 who received enoxaparin 40 mg daily. Baseline demographics and clinical characteristics, such as VTE (defined as deep vein thrombosis and pulmonary embolism), were analysed. The primary outcome was incidence of symptomatic VTE confirmed with definitive imaging within 90 days of RARC. Secondary outcomes included major bleeding, complications, readmission, and mortality within 30 days postoperatively. Descriptive statistics included baseline patient characteristics, operative information and complications. Differences in baseline characteristics and postoperative data were compared between groups. Multivariate logistic regression was used to determine associations between variables and the primary outcome. Results: A total of 124 patients received apixaban and 250 patients received enoxaparin prophylaxis. Ten patients (2.7%) experienced a VTE within 90 days postoperatively (two [1.6%] apixaban group vs eight [3.2%] enoxaparin group; P = 0.5). After patient stratification into European Association of Urology risk groups, no statistically significant difference in VTE rates was seen between groups in the apixaban (2.7% high‐ + intermediate‐risk group vs 1.1% low‐risk group; P = 0.5) and enoxaparin cohorts (4.3% high‐ + intermediate‐risk group vs 2.5% low‐risk group; P = 0.5). On multivariate logistic regression, no variables were associated with the development of the primary outcome. Conclusion: Prophylaxis with apixaban and enoxaparin showed no statistically significant differences in VTE rates among RARC patients. Apixaban appears to be safe and effective for VTE prophylaxis after RARC. [ABSTRACT FROM AUTHOR]

Large pharmaceutical companies maintain a portfolio of assets, some of which are projects under development while others are on the market and generating revenue. The budget allocated to R&D may not always be sufficient to fund all the available projects for development. Much attention has been paid to the selection of optimal subsets of available projects to fit within the available budget. In this paper, we argue the need for a forward‐looking approach to portfolio decision‐making. We develop a quantitative model that allows the portfolio management to evaluate the need for future inflow of new projects to achieve revenue at desired levels, often aspiring to a certain annual revenue growth. Optimisation methods are developed for the presented model, allowing an optimal choice of number, timing and type of projects to be added to the portfolio. The proposed methodology allows for a proactive approach to portfolio management, prioritisation, and optimisation. It provides a quantitatively based support for strategic decisions regarding the efforts needed to secure the future development pipeline and revenue stream of the company. [ABSTRACT FROM AUTHOR]

Photoperiod is a common cue for seasonal plasticity and phenology, but climate change can create cue–environment mismatches for organisms that rely on it. Evolution could potentially correct these mismatches, but phenology often depends on multiple plastic decisions made during different life stages and seasons that may evolve separately. For example, Pararge aegeria (Speckled wood butterfly) has photoperiod‐cued seasonal life history plasticity in two different life stages: larval development time and pupal diapause. We tested for climate change‐associated evolution of this plasticity by replicating common garden experiments conducted on two Swedish populations 30 years ago. We found evidence for evolutionary change in the contemporary larval reaction norm—although these changes differed between populations—but no evidence for evolution of the pupal reaction norm. This variation in evolution across life stages demonstrates the need to consider how climate change affects the whole life cycle to understand its impacts on phenology. [ABSTRACT FROM AUTHOR]

Specifically, 69.8%, 67.7%, and 69.0% of patients prescribed adjustable-dose BUD/FORM maintenance, fixed-dose BUD/FORM maintenance, and intermittent BUD/FORM, respectively, did not claim SABA during follow-up (Table 1). Adjustable-dose BUD/FORM maintenance: physician-indicated temporary titration of BUD/FORM maintenance therapy to a maximum daily dose in the event of deteriorating asthma control plus an as-needed SABA reliever. [Extracted from the article]

Oomycete infections in farmed fish are one of the most significant disease issues in salmonid aquaculture worldwide. In the present study, Saprolegnia spp. in different farmed fish species in Finland were identified, and the molecular epidemiology of especially Saprolegnia parasitica was examined. We analysed tissue samples from suspected oomycete‐infected salmonids of different life stages from a number of fish farms, as well as three wild salmonids. From collected oomycete isolates, the ITS1, 5.8S and ITS2 genomic regions were amplified, analysed phylogenetically and compared with corresponding sequences deposited in GenBank. Of the sequenced isolates, 91% were identified as S. parasitica. Isolates of yolk sac fry were identified as different Saprolegnia spp. Among the isolates from rainbow trout eggs Saprolegnia diclina dominated. In order to determine potential dominating clones among the S. parasitica, isolates were analysed using Multi Locus Sequence Typing (MLST). The results showed that one main clone contained the majority of the isolates. The MLST analysis showed four main sequence types (ST1–ST4) and 13 unique STs. This suggests that the Saprolegnia infections in farmed fish in Finland are not caused by different strains originating in the farm environment. Instead, one main clone of S. parasitica is present in Finnish fish farms. [ABSTRACT FROM AUTHOR]

Objective: To provide the first clinical validation of the European Association of Urology Robotic Urology Section (ERUS) curriculum for training in robot‐assisted radical cystectomy with intracorporeal urinary diversion (iRARC). Patients and Methods: The ERUS proposed a structured curriculum, divided into 11 steps, to train novice surgeons and help overcome the steep learning curve associated with iRARC. In this study, one trainee completed the curriculum under the mentorship of an expert. Twenty‐one patients were operated on by the trainee following the proposed iRARC curriculum [(t)iRARC group] and were compared with 42 patients treated with the standard of care by the mentor [(m)iRARC group]. To evaluate curriculum safety, peri‐operative outcomes, surgical margins and complications were assessed. Propensity‐score matching (1:2) was used to identify comparable (t)iRARC and (m)iRARC cases. Matched variables included age, body mass index, neoadjuvant therapy, American Society of Anesthesiologists score and cT stage. Mann–Whitney and chi‐squared tests were used to compare peri‐ and postoperative outcomes between the two cohorts. To evaluate curriculum efficacy, steps attempted and completed by the trainee were assessed and studied as a function of growing surgical experience of the trainee. Results: The trainee progressed in proficiency‐based training through steps of increasing difficulty. No differences in estimated blood loss, positive soft tissue margins, number of resected lymph nodes, overall and high‐grade complications, or 90‐day readmissions between the (t)iRARC and (m)iRARC groups were observed (all P > 0.05). However, operating time was significantly longer in the (t)iRARC group (P = 0.01). Of the 209 available steps, the trainee attempted 168 (80%) and successfully performed 125 (60%). Increasing experience was associated with more steps being successfully performed (P < 0.001). Conclusions: The proposed ERUS curriculum assists naïve surgeons during the learning curve for iRARC and should be encouraged in order to guarantee optimal outcomes during the learning phase of this procedure. [ABSTRACT FROM AUTHOR]

Aim: The abyssal Clarion‐Clipperton Zone (CCZ), Pacific Ocean, is an area of commercial importance owing to the growing interest in mining high‐grade polymetallic nodules at the seafloor for battery metals. Research into the spatial patterns of faunal diversity, composition, and population connectivity is needed to better understand the ecological impacts of potential resource extraction. Here, a DNA taxonomy approach is used to investigate regional‐scale patterns of taxonomic and phylogenetic alpha and beta diversity, and genetic connectivity, of the dominant macrofaunal group (annelids) across a 6 million km2 region of the abyssal seafloor. Location: The abyssal seafloor (3932–5055 m depth) of the Clarion‐Clipperton Zone, equatorial Pacific Ocean. Methods: We used a combination of new and published barcode data to study 1866 polychaete specimens using molecular species delimitation. Both phylogenetic and taxonomic alpha and beta diversity metrics were used to analyse spatial patterns of biodiversity. Connectivity analyses were based on haplotype distributions for a subset of the studied taxa. Results: DNA taxonomy identified 291–314 polychaete species from the COI and 16S datasets respectively. Taxonomic and phylogenetic beta diversity between sites were relatively high and mostly explained by lineage turnover. Over half of pairwise comparisons were more phylogenetically distinct than expected based on their taxonomic diversity. Connectivity analyses in abundant, broadly distributed taxa suggest an absence of genetic structuring driven by geographical location. Main Conclusions: Species diversity in abyssal Pacific polychaetes is high relative to other deep‐sea regions. Results suggest that environmental filtering, where the environment selects against certain species, may play a significant role in regulating spatial patterns of biodiversity in the CCZ. A core group of widespread species have diverse haplotypes but are well connected over broad distances. Our data suggest that the high environmental and faunal heterogeneity of the CCZ should be considered in future policy decisions. [ABSTRACT FROM AUTHOR]

Empirical studies have shown a positive relationship between migration and fecundity, suggesting a 'migration syndrome' that also includes delayed reproduction and an extended reproductive lifespan. At the same time, life history theory predicts that the cost of migration should result in lower fecundity because both traits draw from a common resource.We test whether migration is associated with higher fecundity and delayed reproduction in five closely related butterfly species in the Nymphalini tribe. Two of these are migratory, Vanessa cardui and Vanessa atalanta, and three are non‐migratory, Aglais urticae, Aglais io, and Polygonia c‐album, which appears in a diapausing and a non‐diapausing generation.Laboratory experiment of this study demonstrated a higher lifetime fecundity in the non‐migratory species A. urticae and A. io, compared with the migratory species. When reproductive output was measured in terms of egg mass over adult female mass, also the non‐migratory species P. c‐album had a higher reproductive investment than the two migratory species, and the non‐diapausing generation had a higher reproductive output than the diapausing generation. All species but P. c‐album delayed reproduction until 5–7 days after eclosion/emergence.These results indicate that a migratory lifestyle carries a reproductive cost and suggests that the migratory habit has not resulted in selection for higher fecundity. However, the migratory species are highly fecund in a wider phylogenetic perspective, which leads to the conclusion that rather than selection having selected for high fecundity and delayed reproduction, these traits may be prerequisites for evolving a migratory lifestyle. [ABSTRACT FROM AUTHOR]

Objectives: To prospectively analyse robotically administered transperitoneal transversus abdominis plane (robot‐assisted transversus abdominis plane [RTAP]) compared with both ultrasonography‐guided transversus abdominis plane (UTAP) and local anaesthesia (LA) with regard to pain control and narcotic use in patients undergoing robot‐assisted prostatectomy (RARP) or robot‐assisted partial nephrectomy (RAPN). Subjects/Patients and Methods: Patients undergoing RARP or RAPN were randomized in a single‐blind 2:2:1 fashion to RTAP:UTAP:LA, with the study powered to evaluate superiority of UTAP to LA and non‐inferiority of RTAP to UTAP. We compared time to deliver the block, operating room time, postoperative pain scores using the visual analogue scale, and intra‐operative and postoperative analgesia consumption. Results: A total of 143 patients were randomized and received treatment. There was no significant difference in patient baseline characteristics. UTAP did not demonstrate superiority to LA in terms of pain control. RTAP and LA were faster to administer than UTAP (time to perform block 2.5 vs 2.5 vs 6.25 min; P < 0.001). There was no difference in postoperative narcotic, acetaminophen, ketorolac or ondansetron requirements among the three groups (P > 0.05). The study was terminated early due to the unexpected efficacy of LA. Conclusion: This study showed that UTAP and RTAP do not provide superior pain control to LA. The efficiency, effectiveness, and ease of administration of LA make it an excellent option for first‐line therapy for postoperative analgesia. [ABSTRACT FROM AUTHOR]

Background: In adults and adolescents with asthma, use of ≥3 short‐acting β2‐agonist (SABA) canisters/year is associated with increased exacerbation risk. Whether this association is present in younger children remains unknown. In this SABA use IN Asthma (SABINA) Junior study, we assessed the association of SABA collection with exacerbation risk in the general Swedish pediatric asthma population. Methods: This population‐based cohort study utilized linked data from the Swedish national healthcare registries involving patients with asthma (<18 years) treated in secondary care between 2006–2015. Exacerbation risk, by baseline SABA collection (0–2 vs. ≥3 canisters, further examined as ordinal/continuous variable) and stratified on comorbid atopic disease (allergic rhinitis, dermatitis and eczema, and food/other allergies), was assessed for 1‐year follow‐up using negative binomial regression. Results: Of 219,561 patients assessed, 45.4%, 31.7%, and 26.5% of patients aged 0–5, 6–11, and 12–17 years, respectively, collected ≥3 SABA canisters during the baseline year (high use). Collection of ≥3 SABA canisters (vs. 0–2) was associated with increased exacerbation risk during follow‐up (incidence rate ratios [95% confidence interval]: 1.35 [1.29–1.42], 1.22 [1.15–1.29], and 1.26 [1.19–1.34] for 0–5‐, 6–11‐, and 12–17‐year‐olds, respectively); the association persisted with SABA as a continuous variable and was stronger among patients without atopic diseases (32%–44% increased risk versus. 14%–21% for those with atopic disease across groups). Conclusions: High SABA use was associated with increased asthma exacerbation risk in children, particularly in those without comorbid atopic diseases, emphasizing the need for asthma medication reviews and reformative initiatives by caregivers and healthcare providers on SABA use. [ABSTRACT FROM AUTHOR]

Flavobacteria are among the most important pathogens in freshwater salmonid aquaculture worldwide. Due to concerns regarding development of antibiotic resistance, phage therapy has been proposed as a solution to decrease pathogen load. However, application of phages is challenged by the development of phage resistance, and knowledge of the mechanisms and implications of phage resistance is therefore required. To study this, 27 phage‐resistant isolates of F. psychrophilum were genome sequenced and characterized to identify genetic modifications and evaluate changes in phenotypic traits, including virulence against rainbow trout. Phage‐resistant isolates showed reduction or loss of gliding motility, proteolytic activity, and adhesion to surfaces, and most isolates were completely non‐virulent against rainbow trout fry. Genomic analysis revealed that most phage‐resistant isolates had mutations in genes associated with gliding motility and virulence. Reversal of these mutations in a sub‐set of isolates led to regained motility, proteolytic activity, virulence and phage susceptibility. Although costly, the fast generation of phage resistance driven by single, reversible mutations likely represents a flexible and efficient phage defence mechanism in F. psychrophilum. The results further suggest that phage administration in aquaculture systems to prevent F. psychrophilum outbreaks selects for non‐virulent phage‐resistant phenotypes. [ABSTRACT FROM AUTHOR]

Aim: To describe newly graduated registered nurses' (NGRNs') experiences of encountering stress in emergency departments (EDs) during the COVID‐19 pandemic. Design: A qualitative descriptive study. Methods: Data from 14 in‐depth interviews with NGRNs working in an ED for 3‐36 months after graduation was analysed by the means of qualitative content analysis as described by Graneheim and Lundman. Interviews were conducted from March to November 2020 covering the first two waves of the pandemic. Results: Data revealed three categories and nine subcategories comprised in the theme Battling extraordinary situations and conflicting emotions. Empowered by acknowledging themselves as important caregivers during the pandemic NGRNs struggle against limitations and exert themselves beyond their known limit. External stressors due to work overload in combination with understaffing force NGRNs into the role of the experienced nurse prematurely and internal stressors derives from part taking in less qualitative care. [ABSTRACT FROM AUTHOR]

Climate change allows species to expand polewards, but non‐changing environmental features may limit expansions. Daylength is unaffected by climate and drives life cycle timing in many animals and plants. Because daylength varies over latitudes, poleward‐expanding populations must adapt to new daylength conditions. We studied local adaptation to daylength in the butterfly Lasiommata megera, which is expanding northwards along several routes in Europe. Using common garden laboratory experiments with controlled daylengths, we compared diapause induction between populations from the southern‐Swedish core range and recently established marginal populations from two independent expansion fronts in Sweden. Caterpillars from the northern populations entered diapause in clearly longer daylengths than those from southern populations, with the exception of caterpillars from one geographically isolated population. The northern populations have repeatedly and rapidly adapted to their local daylengths, indicating that the common use of daylength as seasonal cue need not strongly limit climate‐induced insect range expansions. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the impact of neoadjuvant chemotherapy on survival and recurrence patterns in muscle‐invasive bladder cancer after robot‐assisted radical cystectomy. Materials and methods: The International Robotic Cystectomy Consortium database was reviewed to identify patients who underwent robot‐assisted radical cystectomy for muscle‐invasive bladder cancer between 2002 and 2019. Survival outcomes, response rates, and recurrence patterns were compared between patients who received neoadjuvant chemotherapy and those who did not. Survival distributions were estimated using Kaplan–Meier analyses and compared using the log‐rank test. Results: A total of 1370 patients with muscle‐invasive bladder cancer were identified, of whom 353 (26%) received neoadjuvant chemotherapy. After a median follow‐up of 27 months, neoadjuvant chemotherapy recipients had higher 3‐year overall survival (74% vs 57%; log‐rank P < 0.01), 3‐year cancer‐specific survival (83% vs 73%; log‐rank P = 0.03), and 3‐year relapse‐free survival (64% vs 48%; log‐rank P < 0.01). Neoadjuvant chemotherapy was a predictor of higher overall survival, cancer‐specific survival, and relapse‐free survival in univariate but not multivariate analysis. Pathological downstaging (46% vs 23%; P < 0.01), complete responses (24% vs 8%; P < 0.01), and margin negativity (95% vs 91%; P < 0.01) at robot‐assisted radical cystectomy were more common in the neoadjuvant chemotherapy group. Neoadjuvant chemotherapy recipients had lower distant (15% vs 22%; P < 0.01) but similar locoregional (12% vs 13%; P = 0.93) recurrence rates. Conclusions: In this analysis from a large international database, patients with muscle‐invasive bladder cancer who received neoadjuvant chemotherapy before robot‐assisted radical cystectomy had higher rates of survival, pathological downstaging, and margin‐negative resections. They also experienced fewer distant recurrences. [ABSTRACT FROM AUTHOR]

When making decisions regarding the investment and design for a Phase 3 programme in the development of a new drug, the results from preceding Phase 2 trials are an important source of information. However, only projects in which the Phase 2 results show promising treatment effects will typically be considered for a Phase 3 investment decision. This implies that, for those projects where Phase 3 is pursued, the underlying Phase 2 estimates are subject to selection bias. We will in this article investigate the nature of this selection bias based on a selection of distributions for the treatment effect. We illustrate some properties of Bayesian estimates, providing shrinkage of the Phase 2 estimate to counteract the selection bias. We further give some empirical guidance regarding the choice of prior distribution and comment on the consequences for decision‐making in investment and planning for Phase 3 programmes. [ABSTRACT FROM AUTHOR]

Management of patients with temporomandibular disorders (TMD) appears to be more challenging than for other dental conditions. This study aimed to explore the decision‐making process in TMD management, and thereby to conceptualize the decision‐making process in dentistry. Individual semi‐structured interviews were conducted during 2018 and 2019 with a purposive sample of 22 general dental practitioners from the Public Dental Healthcare Services and private practices in the Region of Västerbotten, Northern Sweden. The interviews were analysed using the Grounded Theory approach of Charmaz. Data analysis resulted in the core category 'Combining own competence and others' expectations in the desire to do the right thing'. The dentists showed interest in and a desire to apply professional knowledge, but also reflected on challenges and complexity in the decision‐making process for TMD. The challenges were primarily related to organisational factors and lack of self‐confidence. This identifies a need for re‐organisation of daily clinical management in dentistry, and a need for more postgraduate training to improve self‐confidence. The complexity of the decision‐making process for TMD makes the study findings applicable in other dental situations. [ABSTRACT FROM AUTHOR]

Pre-oxygenation using high-flow nasal oxygen can decrease the risk of desaturation during rapid sequence induction in patients undergoing emergency surgery. Previous studies were single-centre and often in limited settings. This randomised, international, multicentre trial compared high-flow nasal oxygen with standard facemask pre-oxygenation for rapid sequence induction in emergency surgery at all hours of the day and night. A total of 350 adult patients from six centres in Sweden and one in Switzerland undergoing emergency surgery where rapid sequence induction was required were included and randomly allocated to pre-oxygenation with 100% oxygen using high-flow nasal oxygen or a standard tight-fitting facemask. The primary outcome was the number of patients developing oxygen saturations <93% from the start of pre-oxygenation until 1 min after tracheal intubation. Data from 349 of 350 patients who entered the study were analysed (174 in the high-flow nasal oxygen group and 175 in the facemask group). No difference was detected in the number of patients desaturating <93%, five (2.9%) vs. six (3.4%) patients in the high-flow nasal oxygen and facemask group, respectively (p = 0.77). The risk of desaturation was not increased during on-call hours. No difference was seen in end-tidal carbon dioxide levels in the first breath after tracheal intubation or in the number of patients with signs of regurgitation between groups. These results confirm that high-flow nasal oxygen maintains adequate oxygen levels during pre-oxygenation for rapid sequence induction. [ABSTRACT FROM AUTHOR]

Paleolimnological reconstructions provide insights into hydrological variability of dynamic floodplain lakes. However, spatial and temporal integration of multiple reconstructions often remains underdeveloped because the efficacy of different paleolimnological measurements varies among lakes due to gradients in energy of floodwaters and sediment composition. Here, we use linear discriminant analysis to identify 10 significant elemental concentrations in sediment obtained from multiple sampling campaigns that distinguish among three end‐member allochthonous sources for lakes in the Peace‐Athabasca Delta (PAD; Canada): Athabasca River, Peace River, and local catchment runoff. Over 90% of sediment samples were correctly classified into original groups after cross‐validation due to the distinctiveness of the three end‐members, which permitted development of a robust Bayesian mixing model to discern the relative contributions of sediment from the three sources. We evaluate performance of the mixing model via application to sediment cores from two adjacent lakes in the Athabasca sector of the PAD and demonstrate its effectiveness to discriminate three known hydrological phases during the past 300 years. Notably, model results indicated that ~ 60% of the sediment originated from the Peace River during the largest ice‐jam flood event on record (1974), which was unrecognized by other methods. The approach provides a new, universal method that can be applied across the full range of sediment composition to quantify changes in source, frequency, and magnitude of sediment delivery by river floodwaters to lakes and is transferable to other dynamic floodplain landscapes where broad range of sediment composition challenges application of other approaches. [ABSTRACT FROM AUTHOR]

Summary: The fish pathogen Flavobacterium psychrophilum infects farmed salmonids worldwide, and application of bacteriophages has been suggested for controlling disease outbreaks in aquaculture. Successful application of phages requires detailed knowledge about the variability in phage susceptibility of the host communities. In this study, we analysed the genetic diversity of F. psychrophilum hosts and phages from the Baltic Sea area to identify genetic determinants of phage‐host interaction patterns. A host range analysis of 103 phages tested against 177 F. psychrophilum strains (18 231 phage–host interactions) identified nine phage clusters, infecting from 10% to 91% of the strain collection. The core genome‐based comparison of 35 F. psychrophilum isolates revealed an extremely low overall genomic diversity (>99.5% similarity). However, a small subset of 16 ORFs, including genes involved in the type IX secretion system (T9SS), gliding motility and hypothetical cell‐surface related proteins, exhibited a highly elevated genetic diversity. These specific genetic variations were linked to variability in phage infection patterns obtained from experimental studies, indicating that these genes are key determinants of phage susceptibility. These findings provide novel insights on the molecular mechanisms determining phage susceptibility in F. psychrophilum and emphasizes the importance of phages as drivers of core genomic diversity in this pathogen. [ABSTRACT FROM AUTHOR]

The convex transform order is one way to make precise comparison between the skewness of probability distributions on the real line. We establish a simple and complete characterization of when one Beta distribution is smaller than another according to the convex transform order. As an application, we derive monotonicity properties for the probability of Beta distributed random variables exceeding the mean or mode of their distribution. Moreover, we obtain a simple alternative proof of the mode‐median‐mean inequality for unimodal distributions that are skewed in a sense made precise by the convex transform order. This new proof also gives an analogous inequality for the anti‐mode of distributions that have a unique anti‐mode. Such inequalities for Beta distributions follow as special cases. Finally, some consequences for the values of distribution functions of binomial distributions near to their means are mentioned. [ABSTRACT FROM AUTHOR]

Objective: To develop and seek consensus from procedure experts on the metrics that best characterise a reference robot‐assisted radical prostatectomy (RARP) and determine if the metrics distinguished between the objectively assessed RARP performance of experienced and novice urologists, as identifying objective performance metrics for surgical training in robotic surgery is imperative for patient safety. Materials and methods: In Study 1, the metrics, i.e. 12 phases of the procedure, 81 steps, 245 errors and 110 critical errors for a reference RARP were developed and then presented to an international Delphi panel of 19 experienced urologists. In Study 2, 12 very experienced surgeons (VES) who had performed >500 RARPs and 12 novice urology surgeons performed a RARP, which was video recorded and assessed by two experienced urologists blinded as to subject and group. Percentage agreement between experienced urologists for the Delphi meeting and Mann–Whitney U‐ and Kruskal–Wallis tests were used for construct validation of the newly identified RARP metrics. Results: At the Delphi panel, consensus was reached on the appropriateness of the metrics for a reference RARP. In Study 2, the results showed that the VES performed ~4% more procedure steps and made 72% fewer procedure errors than the novices (P = 0.027). Phases VIIa and VIIb (i.e. neurovascular bundle dissection) best discriminated between the VES and novices. Limitations: VES whose performance was in the bottom half of their group demonstrated considerable error variability and made five‐times as many errors as the other half of the group (P = 0.006). Conclusions: The international Delphi panel reached high‐level consensus on the RARP metrics that reliably distinguished between the objectively scored procedure performance of VES and novices. Reliable and valid performance metrics of RARP are imperative for effective and quality assured surgical training. [ABSTRACT FROM AUTHOR]

Objective: Eating disorders commonly co‐occur with gastrointestinal problems. This case–control study aimed to (a) document the prevalence of disorders of gut‐brain interaction (DGBI) in eating disorders, (b) examine the specific impact of disordered eating behaviors on the risk of DGBI, and (c) explore the impact of current eating disorder psychopathology on DGBI. Method: We included 765 cases with eating disorders and 1,240 controls. DGBI were assessed via the ROME III questionnaire. Prevalences of DGBI were calculated across eating disorder diagnoses (anorexia nervosa, bulimia nervosa, and multiple eating disorders) and in controls. The association between disordered eating behaviors and DGBI was examined using logistic regression models. Lastly, we compared the total number of DGBI in individuals with high versus low current eating disorder symptoms. Results: A large majority (88.2–95.5%) of individuals with eating disorders reported at least one DGBI and 34.8–48.7% reported three or more DGBI. Of the DGBI categories, functional bowel disorders were the most commonly endorsed category, and of the individual DGBI, irritable bowel syndrome was the most frequently reported (43.9–58.8%). All investigated disordered eating behaviors showed a positive association with most DGBI categories. Finally, individuals reporting high current eating disorder symptoms reported higher mean number of DGBI (3.03–3.34) than those with low current symptoms (1.60–1.84). Discussion: The directionality and mechanisms underlying the nature of the relationship between gastrointestinal and eating disorder symptoms is worthy of further study and clinicians should adopt an integrated approach by attending to both gastrointestinal and eating disorder symptoms in their patients. [ABSTRACT FROM AUTHOR]

Aims: To describe lived experiences of spirituality from the perspective of people who have been subject to inpatient psychiatric care and to interpret these experiences from an understanding of health as dialectical. Methods: After approval from a regional ethical board, eleven participants were recruited from two organisations for people with mental health problems. Participants were asked to narrate about spiritual experiences and occasions where such experiences had come close. The transcribed interviews were analysed by means of a phenomenological hermeneutical approach. Findings: A structural analysis of the text resulted in three themes; perceiving the presence of something extra mundane, making sense of reality and struggling for acceptance. The comprehensive understanding highlights spiritual experiences as going beyond religion, even though religious experiences appear as part of it. These experiences can indeed be a resource contributing to experiences of hope, connectedness, meaning and coherence in life. However, they can also give rise to doubt, anxiety and feelings of loneliness and hopelessness. Rather than understanding spiritual experiences as being either 'good' or 'bad', we could approach spirituality as something that is always present in alternate and inter‐related forms. Metaphorically, this could be understood as a 'near‐life experience', summarising participants' experiences related to their struggle with issues related to suffering and health which are simultaneously present. Conclusions: If psychiatric nurses could approach this complexity and, without being judgemental, explore seemingly positive and negative experiences of spirituality as dialectically related to each other, rather than viewing them as either resources or problems, this could contribute to insiderness care and hopefully also support people who struggle with these experiences to seek help when needed. [ABSTRACT FROM AUTHOR]

In recent years, scholars have called for studies exploring how key concepts originating from the children's rights discourse are understood in local contexts. In Sweden, national policy advocates that a child perspective should guide social assistance (SA), a cash benefit constituting society's last safety net. The study analyses the child perspective as an idea (i.e. an ambiguous principle), which is translated (i.e. reformulated and interpreted) at the local level. The findings indicate multiple and partly inconsistent translations of a child perspective. The study argues that it is unclear what adopting a child perspective implies for children in families receiving SA. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the postoperative complication and mortality rate following laparoscopic radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) in octogenarians. Patients and Methods: We conducted a retrospective analysis comparing postoperative complication and mortality rates depending on age in a consecutive series of 1890 patients who underwent RARC with ICUD for bladder cancer between 2004 and 2018 in 10 European centres. Outcomes of patients aged <80 years and those aged ≥80 years were compared with regard to postoperative complications (Clavien–Dindo grading) and mortality rate. Cancer‐specific mortality (CSM) and other‐cause mortality (OCM) after surgery were calculated using the non‐parametric Aalen‐Johansen estimator. Results: A total of 1726 patients aged <80 years and 164 aged ≥80 years were included in the analysis. The 30‐ and 90‐day rate for high‐grade (Clavien–Dindo grades III–V) complications were 15% and 21% for patients aged <80 years compared to 11% and 13% for patients aged ≥80 years (P = 0.2 and P = 0.03), respectively. In a multivariable logistic regression analysis adjusting for pre‐ and postoperative variables, age ≥80 years was not an independent predictor of high‐grade complications (odds ratio 0.6, 95% confidence interval 0.3–1.1; P = 0.12). The non‐cancer‐related 90‐day mortality was 2.3% for patients aged ≥80 years and 1.8% for those aged <80 years, respectively (P = 0.7). The estimated 12‐month CSM and OCM rates for those aged <80 years were 8% and 3%, and for those aged ≥80 years, 15% and 8%, respectively (P = 0.009 and P < 0.001). Conclusions: The minimally invasive approach to RARC with ICUD for bladder cancer in well‐selected elderly patients (aged ≥80 years) achieved a tolerable high‐grade complication rate; the 90‐day postoperative mortality rate was driven by cancer progression and the non‐cancer‐related rate was equivalent to that of patients aged <80 years. However, an increased OCM rate in this elderly group after the first year should be taken into account. These results will support clinicians and patients when balancing cancer‐related vs treatment‐related risks and benefits. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate how surgeon heterogeneity – the variation in outcomes between individual surgeons – influences functional and oncological outcomes after robot‐assisted laparoscopic prostatectomy (RALP) and retropubic radical prostatectomy (RRP), and to assess whether surgeon heterogeneity affects the comparison between RALP and RRP. Patients and Methods: Laparoscopic Prostatectomy Robot Open (LAPPRO) is a prospective, controlled, non‐randomized trial performed at 14 Swedish centres with 68 operating surgeons. A total of 4003 men with localized prostate cancer were enrolled between 2008 and 2011. The endpoints were urinary incontinence, erectile dysfunction (ED) and recurrence at 24 months after surgery. Logistic regression models were built to evaluate surgeon heterogeneity and, secondarily, surgeon‐specific factors were added to the models to investigate their influence on heterogeneity and the comparison between RALP and RRP. Results: Among surgeons who performed at least 20 surgeries during the study period (n=25), we observed statistically significant heterogeneity for incontinence (P = 0.001), ED (P < 0.001) and rate of recurrent disease (P < 0.001). The significant heterogeneity remained when analysing only experienced surgeons with a stated experience of at least 250 radical prostatectomies (n=12). Among all participating surgeons (n=68), differences in surgeon volume explained 42% of the observed heterogeneity for incontinence (P = 0.003), 11% for ED (P = 0.03) and 19% for recurrence (P = 0.01). Taking surgeon volume into account when comparing RALP and RRP had a significant impact on the results. The effect was greatest for functional outcomes, and the additional adjustments for the surgeons' previous experience changed whether the difference between techniques was statistically significant or not. The surgeons' annual volume had the greatest effect on the recurrence rate. Conclusions: There was a large degree of heterogeneity among surgeons regarding both functional and oncological outcomes and this had a significant impact on the results when comparing RALP and RRP. Some of the observed heterogeneity was explained by differences in surgeon volume. Efforts to decrease heterogeneity are warranted and variation among surgeons must be accounted for when conducting comparative analyses between surgical techniques. [ABSTRACT FROM AUTHOR]

In a time with decreasing biodiversity, especially among insects, a detailed understanding about specific resource utilization strategies is crucial. The physiological and behavioural responses to host switches in phytophagous insects are poorly understood. Earlier studies indicate that a host plant switch might be associated with distinctive molecular and physiological responses in different lineages. Expanding the assessment of such associations across Lepidoptera will reveal if there are general patterns in adaptive responses, or if each switch event is more of a unique character. We investigated host plant preference, fitness consequences, effects on expression profiles and gut microbiome composition in two common wood white (Leptidea sinapis) populations with different host plant preferences from the extremes of the species distribution area (Sweden and Catalonia). Our results show that female Catalonian wood whites lack preference for either host plant (Lotus corniculatus or L. dorycnium), while Swedish females laid significantly more eggs on L. corniculatus. Individuals from both populations reared on L. dorycnium had longer developmental times and smaller body size as adults. This indicates that both environmental and genetic factors determine the choice to use a specific host plant. Gene expression analysis revealed a more pronounced response to host plant in the Catalonian compared to the Swedish population. In addition, host plant treatment resulted in a significant shift in microbiome community structure in the Catalonian population. Together, this suggests that population specific plasticity associated with local conditions underlies host plant utilisation in wood whites. [ABSTRACT FROM AUTHOR]

Introduction and Methods: A large number of behavioral studies show that retrieval practice is a powerful way of strengthening learning of new information. Repeated retrieval might support long‐term retention in a quantitative sense by inducing stronger episodic representations or in a qualitative sense by contributing to the formation of more gist‐like representations. Here we used fMRI to examine the brain bases related to the learning effects following retrieval practice and provide imaging support for both views by showing increased activation of anterior and posterior hippocampus regions during a delayed memory test. Results: Brain activity in the posterior hippocampus increased linearly as a function of number of successful retrievals during initial learning, whereas anterior hippocampus activity was restricted to items retrieved many but not few times during the learning phase. Conclusion: Taken together, these findings indicate that retrieval practice strengthens subsequent retention via "dual action" in the anterior and posterior hippocampus, possibly reflecting coding of individual experiences as well as integration and generalization across multiple experiences. Our findings are of educational significance by providing insight into the brain bases of a learning method of applied relevance. [ABSTRACT FROM AUTHOR]

In what has become quite a turbulent quasi‐market for residential care for children and youth, providers now compete for public contracts. To create visibility and attract customers, many providers use marketing activities to project the desired impression of themselves to maintain or strengthen their market position. In this article, we analyse how companies that provide residential care for children manage the impressions they project on their websites and in advertisements. The results reveal that residential care providers use a range of impression management strategies to enhance their organizational image and to respond to potentially damaging or threatening images. The information providers choose to disclose leaves customers—in this case, the social workers responsible for choosing and purchasing care on behalf of clients—with rather limited opportunities to evaluate the quality of care. This is a significant problem considering other, more reliable, sources of information are difficult to access. [ABSTRACT FROM AUTHOR]