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Purpose In advanced minimally invasive surgery the laparoscopic camera navigation (LCN) quality can influence the flow of the operation. This study aimed to investigate the applicability of a scoring system for LCN (SALAS score) in colorectal surgery and whether an adequate scoring can be achieved using a specified sequence of the operation. Methods The score was assessed by four blinded raters using synchronized video and voice recordings of 20 randomly selected laparoscopic colorectal surgeries (group A: assessment of the entire operation; group B: assessment of the 2nd and 3rd quartile). Experience in LCN was defined as at least 100 assistances in complex laparoscopic procedures. Results The surgical teams consisted of three residents, three fellows, and two attendings forming 15 different teams. The ratio between experienced and inexperienced camera assistants was balanced (n = 11 vs. n = 9). Regarding the total SALAS score, the four raters discriminated between experienced and inexperienced camera assistants, regardless of their group assignment (group A, p p Conclusion This study presents the first intraoperative, objective, and structured assessment of LCN in colorectal surgery. We could demonstrate that the SALAS score is a reliable tool for the assessment of LCN even when only the middle part (50%) of the procedure is analyzed. Construct validity was proven by discriminating between experienced and inexperienced camera assistants.

BackgroundEvidence suggests that environmental factors not only increase psychosis liability but also influence the prognosis and outcomes of psychotic disorders. We investigated temporal and cross-sectional associations of a weighted score of cumulative environmental liability for schizophrenia – the exposome score for schizophrenia (ES-SCZ) – with functioning in first-episode psychosis (FEP).MethodsData were derived from the baseline and 1-month assessments of the Athens FEP Research Study that enrolled 225 individuals with FEP. The Global Assessment of Functioning (GAF) and the Personal and Social Performance Scale (PSP) were used to measure social, occupational, and psychological functioning. The ES-SCZ was calculated based on the previously validated method.ResultsES-SCZ was associated with the total scores of GAF and PSP at baseline and 1-month assessments. These findings remained significant when accounting for several associated alternative explanatory variables, including other environmental factors (obstetric complications, migration, ethnic minority), clinical characteristics (duration of untreated psychosis, symptom severity, previous antipsychotic use), and family history of psychosis, demonstrating that the association between ES-SCZ and functioning is over and above other risk factors and cannot be explained by symptom severity alone. Functioning improved from baseline to 1-month assessment, but no significant ES-SCZ-by-time interaction was found on functioning, indicating that functioning changes were not contingent on ES-SCZ.ConclusionsOur findings suggest that rather than a predictor of functional improvement, ES-SCZ represents a stable severity indicator that captures poor functioning in early psychosis. Environmental risk loading for schizophrenia (ES-SCZ) can be beneficial for clinical characterization and incorporated into transdiagnostic staging models.

Background Psoriasis is a chronic immune-mediated inflammatory skin disease for which biologics are effective treatments. Dose reduction (DR) of the first generation biologics seems a promising way for more efficient use of expensive biologics. A substantial part of patients on tumor necrosis factor (TNF)-alfa inhibitors and ustekinumab could successfully lower their dose, after following a tightly controlled DR strategy. The objective of this study is to assess whether controlled DR of interleukin (IL)-17 and IL-23 inhibitors in psoriasis patients with low disease activity is non-inferior (NI) to usual care (UC). Methods This is an international, prospective, multicenter, pragmatic, randomized, non-inferiority trial. A total of 244 patients with stable low disease activity (Psoriasis Area and Severity Index (PASI) ≤ 5) for at least 6 months and using secukinumab, ixekizumab, brodalumab, guselkumab, risankizumab, or tildrakizumab in the standard dose, together with stable low disease activity, defined as a PASI ≤ 5 and Dermatology Life Quality Index (DLQI) ≤ 5 at the moment of inclusion, will be randomized 2:1 to DR or UC. In the DR group, dosing intervals will be prolonged stepwise to achieve 66% and 50% of the original dose. Disease activity is monitored every 3 months by PASI and DLQI. In case of disease flare (i.e., PASI and/or DLQI increase), treatment is adjusted to the previous effective dose. The primary outcome is the incidence proportion of persistent flares (PASI > 5 for ≥ 3 months), which will be compared between arms. Secondary outcomes include proportion of patients with successful DR, (course of) PASI and DLQI, serious adverse events (SAEs), health-related quality of life, costs, and pharmacokinetic profile. Outcomes of DR will be compared to UC. Discussion With this study, we aim to assess whether DR of IL-17 and IL-23 inhibiting biologics can be achieved for psoriasis patients with low disease activity, without losing disease control. Reducing the dose may lead to more efficient use of biologics. Trial registration ClinicalTrials.govNCT04340076. Registered on April 9 2020.

David Leiman,1,2 Maurice Jové,3 Gail Rosen Spahn,4 Pamela Palmer4 1HD Research, Houston, TX, USA; 2University of Texas at Houston, Department of Surgery, Houston, TX, USA; 3Atlanta Bone and Joint Specialists, Atlanta, GA, USA; 4Medical Affairs, AcelRx Pharmaceuticals, Inc, Redwood City, CA, USACorrespondence: David Leiman Email leimanmd@gmail.comObjective: This analysis reports the healthcare professional global assessment (HPGA) and patient global assessment (PGA) scores and the adverse event (AE) profile by age, body mass index (BMI), sex, and race from the three Phase III registration studies for sufentanil sublingual tablet (SST) 30 mcg.Methods: Global assessments and treatment-related AEs were analyzed from patients treated with SST 30 mcg for moderate-to-severe acute pain following surgery or in the emergency department (ED). Pooled data were analyzed across patient demographic subgroups.Results: A total of 283 patients were included in the HPGA/PGA analyses. The majority underwent abdominal surgery, with the remaining patients undergoing orthopedic or “other” types of surgery. Overall, SST 30 mcg was highly rated by both healthcare professionals and patients across the demographic subgroups. A total of 323 patients were included in the safety evaluation. The majority of patients did not experience any SST-related AEs; however, those that did experienced common opioid-related side effects such as nausea, headache, dizziness, and vomiting. No patients experienced unexpected AEs or required the use of naloxone.Conclusion: SST 30 mcg was highly rated and well tolerated across demographic subgroups with the majority of patients not experiencing any adverse event related to SST 30 mcg. These findings support the use of sublingual sufentanil in all adult patients, regardless of age, BMI, sex, or race for the treatment of moderate-to-severe acute pain.Keywords: acute pain, demography, global assessment, sublingual administration, sufentanil, surgery

European Community's Seventh Framework Program, European Commission [HEALTH-F2-2009-241909]; Scientific and Technological Research Council of Turkey, 2219 International Postdoctoral Research Fellowship Program; Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (SAM16PE07CP1, PI16/02012, and PI19/024)..., Erzin, G., Pries, L.-K., van Os, J., Fusar-Poli, L., Delespaul, P., Kenis, G., Luykx, J.J., Lin, B.D., Richards, A.L., Akdede, B., Binbay, T., Altınyazar, V., Yalınçetin, B., Gümüş-Akay, G., Cihan, B., Soygür, H., Ulaş, H., Cankurtaran, E.Ş., Kaymak, S.U., Mihaljevic, M.M., Andric-Petrovic, S., Mirjanic, T., Bernardo, M., Mezquida, G., Amoretti, S., Bobes, J., Saiz, P.A., García-Portilla, M.P., Sanjuan, J., Aguilar, E.J., Santos, J.L., Jiménez-López, E., Arrojo, M., Carracedo, A., López, G., González-Peñas, J., Parellada, M., Maric, N.P., Atbaşoğlu, C., Ucok, A., Alptekin, K., Saka, M.C., Arango, C., O'Donovan, M.C., Rutten, B.P.F., Guloksuz, S., Genetic Risk and Outcome of Psychosis (GROUP) investigators

Ecosystem services assessments have the potential to support negotiating the complex trade-offs between conservation goals and other economic, political and social agendas across administrative borders, spatial and temporal scales. While earlier studies showed the global importance of tropical areas in supplying ecosystem services, the specific contribution of mountain areas has not been investigated in details. The degradation of mountain ecosystems driven by climate, demographic and economic changes is however increasingly threatening essential ecosystem services supply to people living in- and outside mountains. In this study, we present an assessment of eight ecosystem services in mountains across the world using high resolution earth observation datasets for 2000 and 2010. We link the ecosystem services supply data with an expert survey dataset to assess ecosystem services demand. We show that most mountain ranges show large patches of decreasing ecosystem services in areas characterized by high population pressure. By comparing ecosystem services supply of and demand for ecosystem services, we highlight the growing scarcity of highly demanded ecosystem services, in particular water, food and forage in mountain areas of Global South. Population growth in mountain regions and surrounding lowlands accentuate this trend and call for urgent solutions to sustainably manage ecosystems in mountain areas., Ecosystem Services, 46, ISSN:2212-0416

Background Current strategies for cardiovascular disease (CVD) risk assessment focus on 10‐year or longer timeframes. Shorter‐term CVD risk is also clinically relevant, particularly for high‐risk occupations, but is under‐investigated. Methods and Results We pooled data from participants in the ARIC (Atherosclerosis Risk in Communities study), MESA (Multi‐Ethnic Study of Atherosclerosis), and DHS (Dallas Heart Study), free from CVD at baseline (N=16 581). Measurements included N‐terminal pro‐B‐type natriuretic peptide (>100 pg/mL prospectively defined as abnormal); high‐sensitivity cardiac troponin T (abnormal >5 ng/L); high‐sensitivity C‐reactive protein (abnormal >3 mg/L); left ventricular hypertrophy by ECG (abnormal if present); carotid intima‐media thickness, and plaque (abnormal >75th percentile for age and sex or presence of plaque); and coronary artery calcium (abnormal >10 Agatston U). Each abnormal test result except left ventricular hypertrophy by ECG was independently associated with increased 3‐year risk of global CVD (myocardial infarction, stroke, coronary revascularization, incident heart failure, or atrial fibrillation), even after adjustment for traditional CVD risk factors and the other test results. When a simple integer score counting the number of abnormal tests was used, 3‐year multivariable‐adjusted global CVD risk was increased among participants with integer scores of 1, 2, 3, and 4, by ≈2‐, 3‐, 4.5‐ and 8‐fold, respectively, when compared with those with a score of 0. Qualitatively similar results were obtained for atherosclerotic CVD (fatal or non‐fatal myocardial infarction or stroke). Conclusions A strategy incorporating multiple biomarkers and atherosclerosis imaging improved assessment of 3‐year global and atherosclerotic CVD risk compared with a standard approach using traditional risk factors.

Background Impairments in psychosocial functioning have been demonstrated in 30–60% of adults with bipolar disorder (BD). However, the majority of studies investigating the effect of comorbid mental health disorders and age at onset outcomes in BD have focused on traditional outcome measures such as mood symptoms, mortality and treatment response. Therefore, this project aimed to investigate the impact of comorbid mental health disorders and age at onset on longitudinal psychosocial outcome in participants with BD. Method Mixed effects modelling was conducted using data from the Stanley Foundation Bipolar Network. Baseline factors were entered into a model, with Global Assessment of Functioning (GAF) score as the longitudinal outcome measure. Relative model fits were calculated using Akaike’s Information Criterion. Results No individual comorbidities predicted lower GAF scores, however an interaction effect was demonstrated between attention deficit hyperactivity disorder (ADHD) and any anxiety disorder (t = 2.180, p = 0.030). Participants with BD I vs BD II (t = 2.023, p = 0.044) and those in the lowest vs. highest income class (t = 2.266, p = 0.024) predicted lower GAF scores. Age at onset (t = 1.672, p = 0.095) did not significantly predict GAF scores. Conclusions This is the first study to demonstrate the negative psychosocial effects of comorbid anxiety disorders and ADHD in BD. This study adds to the growing database suggesting that comorbid mental health disorders are a significant factor hindering psychosocial recovery.

ObjectiveThe purpose of this systematic review was to critically appraise and synthesise the psychometric properties of Global Rating of Change (GROC) scales for assessment of patients with neck pain.DesignSystematic review.Data sourcesA search was performed in four databases (MEDLINE, EMBASE, CINAHL, SCOPUS) until February 2019.Data extraction and synthesisEligible articles were appraised using Consensus-based Standards for the selection of health Measurement Instruments checklist and the Quality Appraisal for Clinical Measurement Research Reports Evaluation Form.ResultsThe search obtained 16 eligible studies and included in total 1533 patients with neck pain. Test–retest reliability of global perceived effect (GPE) was very high (intraclass correlation coefficient=0.80 to 0.92) for patients with whiplash. Pooled data of Pearson’s r indicated that GROC scores were moderately correlated with neck disability change scores (0.53, 95% CI: 0.47 to 0.59). Pooled data of Spearman’s correlations indicated that GROC scores were moderately correlated with neck disability change scores (0.56, 95% CI: 0.41 to 0.68).ConclusionsThis study found excellent quality evidence of very good-to-excellent test–retest reliability of GPE for patients with whiplash-associated disorders. Evidence from very good-to-excellent quality studies found that GROC scores are moderately correlated to an external criterion patient-reported outcome measure evaluated pre-post treatment in patients with neck pain. No studies were found that addressed the optimal form of GROC scales for patients with neck disorders or compared the GROC to other options for single-item global assessment.PROSPERO registration numberCRD42018117874.

BackgroundIn a large and comprehensively assessed sample of patients with bipolar disorder type I (BDI), we investigated the prevalence of psychotic features and their relationship with life course, demographic, clinical, and cognitive characteristics. We hypothesized that groups of psychotic symptoms (Schneiderian, mood incongruent, thought disorder, delusions, and hallucinations) have distinct relations to risk factors.MethodsIn a cross-sectional study of 1342 BDI patients, comprehensive demographical and clinical characteristics were assessed using the Structured Clinical Interview for DSM-IV (SCID-I) interview. In addition, levels of childhood maltreatment and intelligence quotient (IQ) were assessed. The relationships between these characteristics and psychotic symptoms were analyzed using multiple general linear models.ResultsA lifetime history of psychotic symptoms was present in 73.8% of BDI patients and included delusions in 68.9% of patients and hallucinations in 42.6%. Patients with psychotic symptoms showed a significant younger age of disease onset (β = −0.09, t = −3.38, p = 0.001) and a higher number of hospitalizations for manic episodes (F11 338 = 56.53, p < 0.001). Total IQ was comparable between groups. Patients with hallucinations had significant higher levels of childhood maltreatment (β = 0.09, t = 3.04, p = 0.002).ConclusionsIn this large cohort of BDI patients, the vast majority of patients had experienced psychotic symptoms. Psychotic symptoms in BDI were associated with an earlier disease onset and more frequent hospitalizations particularly for manic episodes. The study emphasizes the strength of the relation between childhood maltreatment and hallucinations but did not identify distinct subgroups based on psychotic features and instead reported of a large heterogeneity of psychotic symptoms in BD.

Background: The Clinical High Risk state for Psychosis (CHR-P) has become the cornerstone of modern preventive psychiatry. The next stage of clinical advancements rests on the ability to formulate a more accurate prognostic estimate at the individual subject level. Individual Participant Data Meta-Analyses (IPD-MA) are robust evidence synthesis methods that can also offer powerful approaches to the development and validation of personalized prognostic models. The aim of the study was to develop and validate an individualized, clinically based prognostic model for forecasting transition to psychosis from a CHR-P stage.Methods: A literature search was performed between January 30, 2016, and February 6, 2016, consulting PubMed, Psychinfo, Picarta, Embase, and ISI Web of Science, using search terms ("ultra high risk" OR "clinical high risk" OR "at risk mental state") AND [(conver* OR transition* OR onset OR emerg* OR develop*) AND psychosis] for both longitudinal and intervention CHR-P studies. Clinical knowledge was used to a priori select predictors: age, gender, CHR-P subgroup, the severity of attenuated positive psychotic symptoms, the severity of attenuated negative psychotic symptoms, and level of functioning at baseline. The model, thus, developed was validated with an extended form of internal validation.Results: Fifteen of the 43 studies identified agreed to share IPD, for a total sample size of 1,676. There was a high level of heterogeneity between the CHR-P studies with regard to inclusion criteria, type of assessment instruments, transition criteria, preventive treatment offered. The internally validated prognostic performance of the model was higher than chance but only moderate [Harrell's C-statistic 0.655, 95% confidence interval (CIs), 0.627-0.682]. Conclusion: This is the first IPD-MA conducted in the largest samples of CHR-P ever collected to date. An individualized prognostic model based on clinical predictors available in clinical routine was developed and internally validated, reaching only moderate prognostic performance. Although personalized risk prediction is of great value in the clinical practice, future developments are essential, including the refinement of the prognostic model and its external validation. However, because of the current high diagnostic, prognostic, and therapeutic heterogeneity of CHR-P studies, IPD-MAs in this population may have an limited intrinsic power to deliver robust prognostic models.

Currently, vitiligo lacks a validated Physician Global Assessment (PGA) for disease extent. This PGA can be used to stratify and interpret the numeric scores obtained by the Vitiligo Extent Score (VES). We investigated the interrater reliability of a 5-point PGA scale during an international vitiligo workshop. Vitiligo experts from five different continents rated photographs of non-segmental vitiligo patients with varying degrees of extent with the PGA score. Good interrater agreements (intraclass correlation coefficient >0.6) were observed between the raters overall and within each continent. All hypotheses to evaluate construct validity were confirmed. Median VES values per category were for limited 1.10 [IQR: 0.21–1.67], moderate 3.17 [IQR: 1.75–6.21], extensive 9.58 [IQR: 6.21–13.03] and very extensive 42.67 [IQR: 21.20–42.67]. Defined categories for vitiligo extent can be valuable for inclusion criteria and may impact future reimbursement criteria.

Introduction Our objectives were to assess patient-reported improvement after patch testing at the 2–3-month follow-up visit in patients referred for patch testing with relevant positive patch test reactions at the University of California, San Francisco. Methods Cross-sectional analyses of patients patch tested between 2013 and 2016 who returned for a follow-up visit approximately 2–3 months after patch testing. We examined positive patch test results considered of definite, probable or possible relevance to the patient’s eczematous eruptions. Patients reported improvement after patch testing as a percentage: 0–100%. Patients were categorized into four groups: (1) those that reported no improvement or worsened, (2) those that reported > 0% and ≤ 60% improvement, (3) those that reported > 60% but < 100% improvement and (4) those that reported 100% improvement. Secondary measures included the association of allergens, gender, age and location of the rash. Results The majority (81%) of patients seen at follow-up reported improvement after patch testing. Women reported more improvement than men with statistical significance. Notably, there does not appear to be a statistically significant relationship in patient-reported improvement and age, atopy, strength of a the patient’s positive reactions, number of positive reactions and follow-up time or with potential systemic contact allergens (i.e., balsam of Peru, nickel, chrome and cobalt). Conclusion We find the large percentage of patients that self-report global benefit from patch testing encouraging, as we believe this to be a powerful measure of disease and symptom activity, as well as quality of life. The gender differences we found contradict the previous literature.

The composition of local mammalian carnivore communities has far-reaching effects on terrestrial ecosystems worldwide. To better understand how carnivore communities are structured, we analysed camera trap data for 108 087 trap days across 12 countries spanning five continents. We estimate local probabilities of co-occurrence among 768 species pairs from the order Carnivora and evaluate how shared ecological traits correlate with probabilities of co-occurrence. Within individual study areas, species pairs co-occurred more frequently than expected at random. Co-occurrence probabilities were greatest for species pairs that shared ecological traits including similar body size, temporal activity pattern and diet. However, co-occurrence decreased as compared to other species pairs when the pair included a large-bodied carnivore. Our results suggest that a combination of shared traits and top-down regulation by large carnivores shape local carnivore communities globally. Fil: Davis, Courtney L.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; Argentina Fil: Rich, Lindsey N.. University of California at Berkeley; Estados Unidos Fil: Farris, Sach J.. Virginia Tech University; Estados Unidos. Appalachian State University; Estados Unidos Fil: Kelly, Marcela J.. Virginia Tech University; Estados Unidos Fil: Di Bitetti, Mario Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; Argentina Fil: Di Blanco, Yamil Edgardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; Argentina Fil: Albanesi, Sebastian Alejandro. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales e Instituto Miguel Lillo. Instituto de Ecología Regional; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Biodiversidad Neotropical. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales e Instituto Miguel Lillo. Instituto de Biodiversidad Neotropical. Instituto de Biodiversidad Neotropical; Argentina Fil: Farhadinia, Mohammad S.. University of Oxford; Reino Unido Fil: Gholikhani, Navid. Iranian Cheetah Society; Irán Fil: Hamel, Sandra. UiT The Arctic University of Norway; Noruega Fil: Harmsen, Bart J.. University of Belize; Belice Fil: Wultsch, Claudia. Virginia Tech University; Estados Unidos Fil: Kane, Mamadou D.. Senegalese National Parks Directorate; Senegal Fil: Martins, Quinton. UiT The Arctic University of Norway; Noruega. The Cape Leopard Trust, Cape Town; Sudáfrica Fil: Murphy, Asia J.. State University of Pennsylvania; Estados Unidos Fil: Steenweg, Robin. Grande Prairi; Canadá Fil: Sunarto, Sunarto. World Wildlife Fund; Indonesia Fil: Taktehrani, Atieh. Iranian Cheetah Society; Irán Fil: Thapa, Kanchan. Virginia Tech University; Estados Unidos. Conservation Science Unit; Nepal Fil: Tucker, Jody M.. Conservation Science Unit; Nepal Fil: Whittington, Jesse. Park Resource Conservation; Canadá Fil: Widodo, Febri A.. World Wildlife Fund; Indonesia Fil: Yoccoz, Nigel G.. UiT The Arctic University of Norway; Noruega Fil: Miller, David A.W.. State University of Pennsylvania; Estados Unidos

Background: The long-term course of symptoms in patients with mild-to-moderate depression is not well understood. A 12-month-follow-up analysis was performed on those participants from a randomized controlled 10-week trial (RCT, MIND-study), who had received either treatment with an antidepressant (sertraline) or a psychotherapeutic intervention (group cognitive-behavioral therapy (CBT)).Methods: The longitudinal interval follow-up evaluation (LIFE) was applied to 77 patients with mild-to moderate depression. The primary outcome was the number of weeks in the one-year follow-up period spent completely recovered from all depressive symptoms. Functional outcome was measured with the Global Assessment of Functioning (GAF) scale. Further outcomes were relapse and remission rates based on weekly psychiatric rating scales (PSR) and the number of weeks in the follow-up period during which patients had a depressive disorder or subthreshold symptoms of depression.Results: Patients with acute treatment (10 weeks) with SSRI and those with acute treatment with CBT (also 10 weeks) did not differ significantly concerning the number of weeks in the follow-up period in which they were completely recovered (primary outcome) (SSRI: 31.6 weeks (standard deviation (SD): 23.7), CBT: 27.8 weeks (SD: 24.3)). Sertraline was superior to CBT regarding GAF scores by trend (p = 0.06).Limitations: The generalizability of the findings is limited by the moderate sample size and missing values (LIFE).Conclusions: Sertraline and group CBT have similar anti-depressive effects in the long-term course of mild-tomoderate depression. Regarding long-term global functioning, sertraline seems to be slightly superior to CBT.

The quality of the urban environment, and of the residential environment in particular, is one of the main components of people's overall quality of life. Global satisfaction with people's own residential environment has both affective and cognitive components. On the one hand, people experience feelings with respect to their own houses/neighborhoods (ie, place attachment); on the other hand, they assess the degree of quality for each different feature of their own houses/neighborhoods (ie, residential quality). Knowing residential satisfaction, residential attachment, and residential quality with reference to the inhabitants of a specific place can help its design, management, and policy.

Cultural ecosystem services (CES) reflect peoples’ physical and cognitive interactions with nature and are increasingly recognised for providing non-material benefits to human societies. Whereas coasts, seas, and oceans sustain a great proportion of the human population, CES provided by these ecosystems have remained largely unexplored. Therefore, our aims were (1) to analyse the state of research on marine and coastal CES, (2) to identify knowledge gaps, and (3) to pinpoint research priorities and the way forward. To accomplish these objectives, we did a systematic review of the scientific literature and synthesised a subset of 72 peer-reviewed publications. Results show that research on marine and coastal CES is scarce compared to other ecosystem service categories. It is primarily focused on local and regional sociocultural or economic assessments of coastal ecosystems from Western Europe and North America. Such research bias narrows the understanding of social-ecological interactions to a western cultural setting, undermining the role of other worldviews in the understanding of a wide range of interactions between cultural practices and ecosystems worldwide. Additionally, we have identified clusters of co-occurring drivers of change affecting marine and coastal habitats and their CES. Our systematic review highlights knowledge gaps in: (1) the lack of integrated valuation assessments; (2) linking the contribution of CES benefits to human wellbeing; (3) assessing more subjective and intangible CES classes; (4) identifying the role of open-ocean and deep-sea areas in providing CES; and (5) understanding the role of non-natural capital in the co-production of marine and coastal CES. Research priorities should be aimed at filling these knowledge gaps. Overcoming such challenges can result in increased appreciation of marine and coastal CES, and more balanced decision-supporting mechanisms that will ultimately contribute to more sustainable interactions between humans and marine ecosystems. Fil: Garcia Rodrigues, João. Universidad de Santiago de Compostela; España Fil: Conides, Alexis J.. Institute for Marine Biological Resources and Inland Waters; Grecia Fil: Rivero Rodriguez, Susana. Centro Tecnológico del Mar; España Fil: Raicevich, Saša. National Research Council ; Italia. Italian National Institute for Environmental Protection and Research; Italia Fil: Pita, Pablo. Universidad de Santiago de Compostela; España. International Campus of Excellence; España Fil: Kleisner, Kristin M.. Northeast Fisheries Science Center, National Oceanic and Atmospheric Administration; Estados Unidos Fil: Pita, Cristina. University of Aveiro; Portugal Fil: Lopes, Priscila F. M.. Federal University of Rio Grande do Norte; Brasil Fil: Alonso Roldán, Virginia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto Patagónico para el Estudio de los Ecosistemas Continentales; Argentina Fil: Ramos, Sandra S.. University of Porto; Portugal. University of Hull; Reino Unido Fil: Klaoudatos, Dimitris. Hellenic Centre for Marine Research, Institute for Marine Biological Resources and Inland Waters; Grecia Fil: Outeiro, Luís. Universidade de Santiago de Compostela; España Fil: Armstrong, Claire. University of Tromsø; Noruega Fil: Teneva, Lida. Center for Oceans, Conservation International; Estados Unidos Fil: Stefanski, Stephanie. Duke University; Estados Unidos Fil: Böhnke-Henrichs, Anne. Wageningen University; Países Bajos. Foundation for Sustainable Development; Países Bajos Fil: Kruse, Marion. Kiel University; Alemania Fil: Lillebø, Ana I.. University of Aveiro; Portugal Fil: Bennett, Elena M.. McGill University; Canadá Fil: Belgrano, Andrea. Swedish University of Agricultural Sciences; Suecia. Swedish Institute for the Marine Environment (SIME); Suecia Fil: Murillas, Arantza. Marine Research Division; España Fil: Sousa Pinto, Isabel. University of Porto; Portugal Fil: Burkhard, Benjamin. Leibniz Universität Hannover; Alemania. Leibniz Centre for Agricultural Landscape Research ZALF; Alemania Fil: Villasante, Sebastián. Universidade de Santiago de Compostela; España. International Campus of Excellence; España

Microfluidic assays are versatile tests which, using only small amounts of blood, enable high throughput analyses of platelet function in several minutes. In combination with fluorescence microscopy, these flow tests allow real-time visualisation of platelet activation with the possibility of examining combinatorial effects of wall shear rate, coagulation and modulation by endothelial cells. In particular, the ability to use blood and blood cells from healthy subjects or patients makes this technology promising, both for research and (pre)clinical diagnostic purposes. In the present review, we describe how microfluidic devices are used to assess the roles of platelets in thrombosis and haemostasis. We place emphasis on technical aspects and on experimental designs that make the concept of “blood-vessel-component-on-a-chip” an attractive, rapidly developing technology for the study of the complex biological processes of blood coagulability in the presence of flow.

Objectives: The aim of this study is to evaluate the effect of acupotomy in patients with degenerative lumbar spine stenosis. Methods: A total of 437 patients who had been diagnosed as having lumbar spine stenosis and who had been admitted to Daejeon Oriental hospital from June 1, 2008, to September 31, 2012, were included in this study. The patients underwent acupotomy once, twice or three times on the lumbar spine, according to their symptoms. Then, the patients were asked to complete the verbal numeric rating scale (VNRS) and the oswestry disability index (ODI) before and after acupotomy and underwent a global assessment. The resulting data were analyzed. Results: The gender ratio of the participants was 1:1.54, and the mean age was 65 ± 10.0 yr. The number of patients over the age of 65 yr was less than that of the patients under the age of 65 yr in the ratio of 1:1.3. The average disease period was 30.17 ± 56.63 months. The verbal numeric rating scale (VNRS) significantly decreased from 10 to an average of 7.10 ± 2.50 after one acupotomy, 6.30 ± 2.60 after two acupotomies, and 5.50 ± 2.50 after three acupotomies. The ODI was significantly decrease from 20.60 ± 8.70 to 17.80 ± 8.60 after once acupotomy, 17.10 ± 8.50 after two acupotomies, and 16.70 ± 8.60 after three acupotomies. High scores were also observed on the global assessment. Conclusion: These results provide evidence that acupotomy is effective to relieve pain and to improve quality of life in patients with degenerative lumbar spinal stenosis.

Objectives Patient-reported outcomes assessing multiple gastrointestinal symptoms are central to characterizing the therapeutic benefit of novel agents for irritable bowel syndrome (IBS). Common approaches that sum or average responses across different illness components must be unidimensional and have small unique variances to avoid aggregation bias and misinterpretation of clinical data. This study sought to evaluate the unidimensionality of the IBS Symptom Severity Scale (IBS-SSS) and to explore person-centered cluster analytic methods for characterizing multivariate-based patient profiles. Methods Ninety-eight Rome-diagnosed patients with IBS completed the IBS-SSS and a single, global item of symptom severity (UCLA Symptom Severity Scale) at pretreatment baseline of a clinical trial funded by the National Institutes of Health. k -means cluster analyses were performed on participants' symptom severity scores. Results The IBS-SSS was not unidimensional. Exploratory cluster analyses revealed four common symptom profiles across five items of the IBS-SSS. One cluster of patients (25%) had elevated scores on pain frequency and bowel dissatisfaction, with less elevated but still high scores on life interference and low pain severity ratings. A second cluster (19%) was characterized by intermediate scores on both pain dimensions but more elevated scores on bowel dissatisfaction. A third cluster (18%) had elevated scores across all IBS-SSS subcomponents. The fourth and the most common cluster (37%) had relatively low scores on all dimensions except bowel dissatisfaction and life interference due to IBS symptoms. Conclusions Patient-reported outcome end points and research on IBS more generally relying on multicomponent assessments of symptom severity should take into account the multidimensional structure of symptoms to avoid aggregation bias and to optimize the sensitivity of detecting treatment effects.

Aims.To study the systematic assessment of need for care and clinical parameters for use in treatment plans in patients diagnosed with severe mental illness.Methods.The Cumulative Needs for Care Monitor (CNCM) includes various validated instruments, such as the Camberwell Assessment of Need. A Markov-type cost-effectiveness model (health care perspective, 5-year time horizon) was used to compare CNCM with care as usual (CAU). Two studies were used to determine model parameters: a before–after study (n = 2155) and a matched-control study (n = 937).Results.The CNCM may lead to a gain in psychiatric functioning according to the models. CNCM patients remain in (outpatient) care, while CAU patients drop out more frequently. There is only a small difference in inpatient care. As a result, average costs per patient in the CNCM group are between €2809 (before–after model) and €5251 (matched-control model) higher. The iCER was between €45 127 and €57 839 per life year without psychiatric dysfunction gained.Conclusions.CNCM may be only cost-effective when willingness to pay for a life year without psychiatric dysfunction is higher than €45 000. However, this result is highly sensitive to the level of psychiatric dysfunctioning in patients who do not receive care.

Objective: To test Antarth, a polyherbal phytomedicine, for its efficacy and safety in patients with osteoarthritis (OA) and compared with placebo. Material and Methods: A total of 90 male or female adult patients who were diagnosed clinically and radiologically with OA were recruited in the study. Antarth or placebo was given 2 capsules b.i.d. for 3 months and the patients were assessed every month for its efficacy. Diclofenac sodium was allowed to be taken as rescue medication. Results: After 3 months of treatment, the reduction in severity of pain on Visual Analog Scale (VAS) was more in Antarth group compared to placebo but the difference between the two groups was not significant. However, pain during functioning of disabled joints while walking distance, squatting, sitting cross-legged and climbing steps were significantly reduced in Antarth group compared to placebo (P < 0.05). Reduction in consumption of rescue medication, diclofenac sodium, was more in Antarth than in placebo group. Conclusions: In Patients’ Global Assessment, patients treated with Antarth were more satisfied than the ones treated with placebo. Observations were similar in Physicians’ Global Assessment too. There were no adverse events in both the groups.

Background: The Health of the Nation Outcome Scales (HoNOS) is widely used to evaluate mental health care outcomes. For appropriate use and interpretation in routine clinical practice, further validation of the adapted version for older clients (HoNOS 65+) is needed.Objective: The aim of this study is to compare scoring profiles produced by different categories of professionals, assess the internal consistency of the sum score and proposed subscales, and concurrent validity of the total sum score of the Dutch version of HoNOS 65+.Methods: We used baseline data from fourteen mental health care organizations participating in the MEntal health care Monitor Older adults (MEMO), a nationwide routine outcome monitoring system. A total of 767 older clients, referred for gerontopsychiatric disorders, were administered HoNOS 65+ by non-academic (primarily nurses, n = 430) or academic professionals (psychologists/physicians, n = 337). Demo-graphics and full DSM-IV classification, including the Global Assessment of Functioning (GAF), were derived from the electronic medical dossier.Results: HoNOS 65+ seemed to discriminate between clients with and without a depressive disorder, adjustment disorder, anxiety disorder and psychotic disorder on the items expected. In clients suffering from a depressive or psychotic disorder, nurses/social workers and physicians/psychologists did not differ in scoring on all items of HoNOS 65+. In clients with an adjustment disorder or anxiety disorder, professions differed in rating on two items. Confirmatory Factor Analyses supported neither the factor structure of the original HoNOS nor the initially reported structure of HoNOS 65+ version. Cronbach's alpha of the total sum score was 0.60. Internal consistency of previously identified subscales was low. A new set of subscales could not be identified satisfactorily. A medium-sized correlation of the HoNOS 65+ sum score and the GAF was found (r=-.30, pConclusions: It is preferable to use individual HoNOS 65+ items, to evaluate care outcomes. The HoNOS 65+ items discriminate between clients with and without a particular diagnosis. Nonetheless, in some of the most prevalent gerontopsychiatric disorders rating differs between professionals with different educational backgrounds. (C) 2013 Elsevier Ltd. All rights reserved.

Polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins and dibenzo-p-furans (PCDD/Fs), organochlorine pesticides (OCPs), polybrominated diphenyl ethers (PBDEs), hexabromocyclododecane diastereomers (HBCDs), and perfluorinated compounds (PFCs) were analyzed in popular farmed fish such as salmon, trout, tilapia, and pangasius and in farmed shrimp. The samples originated from southeast Asia, Europe, and South America. Results show the following: (i) Carnivorous species contained higher contaminant concentrations than omnivorous species. (ii) Contaminant concentrations generally decreased per species in the following order of salmon > trout >> tilapia approximately equal to pangasius approximately equal to shrimp. (iii) Most contaminant concentrations decreased in the following order of PCBs approximately equal to dichloro-diphenyl-trichloroethanes (DDTs) >> hexachlorobenzene approximately equal to pentachlorobenzene approximately equal to dieldrin approximately equal to PBDEs approximately equal to alpha-HBCD approximately equal to perfluorooctane sulfonate (PFOS) >> World Health Organization toxic equivalents (WHO-TEQ) [PCDD/Fs and dioxin-like (dl)-PCBs]. (iv) Contaminant concentrations were very low (mostly

A number of recent food safety incidents have involved chemical substances, while various activities aim at the early identification of emerging chemical risks. This review considers recent cases of chemical and biochemical risks, as a basis for recommendations for awareness and prevention of similar risks at an early stage. These cases include examples of unapproved genetically modified food crops, intoxications with botanical products containing unintentionally admixed toxic herbs, residues of unapproved antibiotics and contaminants in farmed aquaculture species such as shrimp and salmon; and adverse effects of chemical and biological pesticides of natural origin. Besides case-specific recommendations for mitigation of future incidents of the same nature, general inferences and recommendations are made. It is recommended, for example, to establish databases for contaminants potentially present within products. Pro-active reconnaissance can facilitate the identification of products potentially contaminated with hazardous substances. In international trade, prevention and early identification of hazards are aided by management systems for product quality and safety, rigorous legislation, and inspections of consignments destined for export. Cooperation with the private sector and foreign authorities may be required to achieve these goals. While food and feed safety are viewed from the European perspective, the outcomes also apply to other regions.

Summarization: Extremes are rare and unexpected. This limits observations and constrains our knowledge on their predictability and behavior. Graphical tools are among the many methods developed to study extremes. A major weakness is that they rely on visual-inspection inferences which are subjective and make applications to large datasets time-consuming and impractical. Here, we advance a graphical method, the so-called Mean Excess Function (MEF), into an algorithmic procedure. MEF investigates the mean value of a variable over threshold, and thus, focuses on extremes. We formulate precise and easy-to-apply statistical tests, based on the MEF, to assess if observed data can be described by exponential or heavier tails. As a real-world example, we apply our method in 21,348 daily precipitation records from all over the globe. Results show that the exponential-tail hypothesis is rejected in 75.8% of the records indicating that heavy-tail distributions (alternative hypothesis) can better describe rainfall extremes. The spatial variation of the tail heaviness reveals that heavy tails prevail in regions of Australia and Eurasia, with a “hot spot” found in central Russia and Kazakhstan. We deem this study offers a new diagnostic tool in assessing the behavior of extremes, easy to apply in large databases, and for any variable of interest. Our results on precipitation extremes reinforce past findings and further highlight that exponential tails should be used with caution. Παρουσιάστηκε στο: Advances in Water Resources