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Understanding the drivers of net coral reef calcium carbonate production is increasingly important as ocean warming, acidification, and other anthropogenic stressors threaten the maintenance of coral reef structures and the services these ecosystems provide. Despite intense research effort on coral reef calcium carbonate production, the inclusion of a key reef forming/accreting calcifying group, the crustose coralline algae (CCA), remains challenging both from a theoretical and practical standpoint. While corals are typically the primary reef builders of today, ongoing declines in coral cover due to a range of environmental perturbations will likely increase the relative importance of CCA and other non-scleractinian calcifying taxa to coral reef carbonate production. Here, we demonstrate that CCA are important carbonate producers that, under certain conditions, can match or even exceed the contribution of corals to coral reef carbonate production. Despite their importance, CCA are often inaccurately recorded in benthic surveys or even entirely missing from coral reef carbonate budgets. We outline several recommendations to improve the inclusion of CCA into such carbonate budgets under the ongoing climate crisis.

OBJECTIVE To create a risk scoring system comprised of clinical and radiological characteristics that can predict the likelihood of antibiotic treatment failure of tubo-ovarian abscesses. The score should guide clinicians in identifying patients to whom early intervention should be offered instead of a prolonged trial of antibiotics. METHODS A multicenter, retrospective cohort study carried out between January 1, 2013 and September 30, 2019, identified consecutive patients with tubo-ovarian abscess. Using a chronological split, patients were allocated to two groups for the development and subsequent validation of the postulated scoring system. Univariate and bivariate analyses were performed to identify statistically significant variables for the failure of intravenous antibiotic treatment. RESULTS In total, 214 consecutive patients with tubo-ovarian abscesses were identified. Data from the first 150 patients were used for the development of the postulated scoring system; data from the subsequent 64 patients were used for validation. Statistically significant clinical features between those having successful and unsuccessful management were: temperature (median = 37.1℃ vs 38.2℃, P = 0.0001), C-reactive protein (151 mg/L vs 243 mg/L, P = 0.0001), and tubo-ovarian abscess diameter (6.0 cm vs 8.0 cm, P = 0.0001). These parameters were used to create a risk prediction score. A score of four or more was predictive of requiring surgical/radiological intervention of tubo-ovarian abscess (P

Ocean warming is increasing the incidence, scale, and severity of global-scale coral bleaching and mortality, culminating in the third global coral bleaching event that occurred during record marine heatwaves of 2014-2017. While local effects of these events have been widely reported, the global implications remain unknown. Analysis of 15,066 reef surveys during 2014-2017 revealed that 80% of surveyed reefs experienced significant coral bleaching and 35% experienced significant coral mortality. The global extent of significant coral bleaching and mortality was assessed by extrapolating results from reef surveys using comprehensive remote-sensing data of regional heat stress. This model predicted that 51% of the world’s coral reefs suffered significant bleaching and 15% significant mortality, surpassing damage from any prior global bleaching event. These observations demonstrate that global warming’s widespread damage to coral reefs is accelerating and underscores the threat anthropogenic climate change poses for the irreversible transformation of these essential ecosystems.

Forests play a key role in climate change mitigation, adaptation and delivery of a range of ecosystem services. There is increasing evidence for impacts of climate and other drivers on plant community change, and fragmented habitats are predicted to be much less resilient to negative impacts on biodiversity and other services. Within Europe, Scotland's native forests are highly fragmented and now cover 4% of the land after many centuries of degradation and loss, but little is known about how their species composition has changed. We recorded long-term vegetation change (from resurvey data) and examined the relationships with climate, pollutant deposition and grazing as key drivers of change, focusing on four forest types: pine, ash, acid- and base-rich oak-birch. All four forest types showed dynamic compositional change during 30–50 years between surveys, with increased species richness and decreased diversity. There was no evidence for homogenisation - the opposite was the case for all except pine (no change). Analyses indicate significant and varied climate, pollution and grazing impacts; NHy deposition showed the most frequent association with species compositional changes. Notable species changes include increases in pteridophytes and declines in forb cover, and a doubling in frequency and cover of Fagus sylvatica between surveys. Our findings suggest a possible extinction debt, with many more species declining than increasing between surveys. This trajectory of change and our other findings indicate a pressing need for mitigation management to reduce the risks of future species losses, with forest expansion planning explicitly considering spatial location in relation to existing native forest and those plant species identified as most at risk.

Globally, peatlands provide an important sink of carbon in their near natural state but potentially act as a source of gaseous and dissolved carbon emission if not in good condition. There is a pressing need to remotely identify peatland sites requiring improvement and to monitor progress following restoration. A medium resolution model was developed based on a training dataset of peatland habitat condition and environmental covariates, such as morphological features, against information derived from the Moderate Resolution Imaging Spectroradiometer (MODIS), covering Scotland (UK). The initial, unrestricted, model provided the probability of a site being in favourable condition. Receiver operator characteristics (ROC) curves for restricted training data, limited to those located on a peat soil map, resulted in an accuracy of 0.915. The kappa statistic was 0.8151, suggesting good model fit. The derived map of predicted peatland condition at the suggested 0.56 threshold was corroborated by data from other sources, including known restoration sites, areas under known non-peatland land cover and previous vegetation survey data mapped onto inferred condition categories. The resulting locations of the areas of peatland modelled to be in favourable ecological condition were largely confined to the North and West of the country, which not only coincides with prior land use intensity but with published predictions of future retraction of the bioclimatic space for peatlands. The model is limited by a lack of spatially appropriate ground observations, and a lack of verification of peat depth at training site locations, hence future efforts to remotely assess peatland condition will require more appropriate ground-based monitoring. If appropriate ground-based observations could be collected, using remote sensing could be considered a cost-efficient means to provide data on changes in peatland habitat condition.

Empirical critical loads are widely used to quantify and manage the ecological impacts of reactive nitrogen (N) deposition. Critical load values aim to identify a level of N deposition below which significant harmful effects do not occur according to present knowledge. Critical loads have been primarily based on experiments, but these are few in number and have well-known limitations, so there is a strong imperative to test and validate values with other forms of evidence. We assembled data on the spatial variability in vegetation communities in the United Kingdom and used Threshold Indicator Taxa Analyses (TITAN) to investigate linkages between species changes and modelled current and cumulative N deposition. Our analyses focused on five datasets: acid grasslands, alpine habitats, coastal fixed dunes, dune slacks and wet grasslands. In four of these habitats there was evidence for a significant decline in the cover of at least one species (a ‘species-loss change-point’) occurring below the critical load, and often at very low levels of N deposition. In all of the habitats there was evidence for clustering of many individual species-loss change-points, implying a community change-point analogous to an ecological threshold. Three of these community change-points occurred below the critical load and the remaining two overlapped with the critical load range. Studies using similar approaches are now increasingly common, with similar results. Across 19 similar analyses there has been evidence for plant species loss change-points below the critical load in 18 analyses, and community-level species loss change-points below the critical load in 13 analyses. None of these analyses has shown community change-points above the critical load. Field data increasingly suggest that many European critical loads are too high to confidently prevent loss of sensitive species.

Nitrogen (N) deposition poses a severe risk to global terrestrial ecosystems, and managing this threat is an important focus for air pollution science and policy. To understand and manage the impacts of N deposition, we need metrics which accurately reflect N deposition pressure on the environment, and are responsive to changes in both N deposition and its impacts over time. In the UK, the metric typically used is a measure of total N deposition over 1–3 years, despite evidence that N accumulates in many ecosystems and impacts from low-level exposure can take considerable time to develop. Improvements in N deposition modelling now allow the development of metrics which incorporate the long-term history of pollution, as well as current exposure. Here we test the potential of alternative N deposition metrics to explain vegetation compositional variability in British semi-natural habitats. We assembled 36 individual datasets representing 48,332 occurrence records in 5479 quadrats from 1683 sites, and used redundancy analyses to test the explanatory power of 33 alternative N metrics based on national pollutant deposition models. We find convincing evidence for N deposition impacts across datasets and habitats, even when accounting for other large-scale drivers of vegetation change. Metrics that incorporate long-term N deposition trajectories consistently explain greater compositional variance than 1–3 year N deposition. There is considerable variability in results across habitats and between similar metrics, but overall we propose that a thirty-year moving window of cumulative deposition is optimal to represent impacts on plant communities for application in science, policy and management. © 2019 Measures of nitrogen deposition which incorporate long-term pollution history explain more spatial variance in plant communities than those which do not. © 2019

Question Dwarf shrub moorland dominated by ericaceous plants is a distinctive, internationally important feature of northwest Europe, with its stronghold in Scotland. There have been major declines in its condition and extent. How has moorland composition changed within Scotland over the past ca. 35 yr and what is the role of climate change, pollution and grazing in driving these changes? Location Five hundred and forty locations across Scotland, UK. Methods We used a long-term resurvey approach to assess change across Scottish moorlands. We relocated plots sampled ca. 35 yr previously in alpine heath, dry heath, wet heath and bog, and recorded vegetation species composition. We assessed change in species group richness and cover and mean Ellenberg values between surveys, using paired t-tests. We used CCA with variation partitioning and regression analysis to analyse the vegetation data with spatial data sets on climate, pollution and grazing, to assess the role of each driver in driving vegetation changes. Results Significant diversity and compositional changes between surveys were found for all habitat types, particularly alpine heath. Significant associations were found with climate (many variables), pollution (N and S) and herbivore number (primarily deer). Species richness generally increased, but several specialist species declined in cover, especially those associated with higher altitude habitats (e.g. Arctostaphylos uva-ursi, Salix herbacea and alpine lichens). Many of the most successful species are ubiquitous, e.g. the widespread grazing- and pollution-tolerant graminoids Anthoxanthum odoratum, Juncus squarrosus, Festuca rubra and Nardus stricta and the generalist mosses Rhytidiadelphus squarrosus and Hylocomium splendens. Conclusions Diversity and composition of moorlands in Scotland have changed significantly over the ca. 35-yr period studied; the drivers of these changes are complex, with climate, pollution and grazing playing variable roles across habitats. The reduction in specialist species, homogenization of alpine heaths and declines in forb and lichen cover all represent negative changes in the biodiversity value of Scottish moorlands.

Whilst a number of studies have examined the effects of biodiversity conservation on the delivery of ecosystems, they have been often limited by the scope of the ecosystem services (ES) assessed and often suffer from confounding spatial issues. This paper examines the impacts of nature conservation (designation) on the delivery of a full suite of ES across nine case-studies in the UK, using expert opinion. The case-studies covered a range of habitats and explore the delivery of ES from a ‘protected site’ and a comparable ‘non-protected’ site. By conducting pair-wise comparisons between comparable sites our study is one of the first to attempt to mitigate confounding cause and effect factors in relation to spatial context in correlative studies. Protected sites delivered higher levels of ecosystem services than nonprotected sites, with the main differences being in the cultural and regulating ecosystem services. Against expectations, there was no consistent negative impact of protection on provisioning services across the case-studies. Whilst the analysis demonstrated general patterns and differences in ecosystem delivery between protected and non-protected sites, the individual responses in each case-study highlights the importance of the social, biophysical, economic and temporal context of individual protected areas and the associated management.

Low-frequency mowing has been proposed to be an effective strategy for the restoration and management of boreal fens after abandonment of traditional haymaking. This study investigates how mowing affects long-term vegetation change in both oceanic and continental boreal rich-fen vegetation. This will allow evaluation of the effectiveness of mowing as a management and restoration tool in this ecosystem in the face of climate change. At two nature reserves in Central Norway (Tågdalen, 63° 03’ N, 9° 05 E, oceanic climate and Sølendet, 62° 40’ N, 11° 50’ E, continental climate), we used permanent plot data from the two sites to compare plant species composition from the late 1960s to the early 1980s with that recorded in 2012–2015 in abandoned and mown fens. Changes in species composition and frequency were analysed by multivariate and univariate methods in relation to environmental variables and modelled climate and groundwater data. Mowing resulted in a decline in shrub and Molinia caerulea cover at the continental and oceanic sites respectively, and the total cover of specialist fen species had increased to a significantly greater extent in the mown plots than the unmown at the continental site. However, mowing did not have an effect on the cover of specialist bryophyte species, and some specialist species declined regardless of mowing treatment. Temperature sums had increased at both sites, but precipitation had not changed significantly. Mowing was shown to be the most important determinant of plant community composition at both sites, with local environmental conditions being of secondary importance. In conclusion, the abandonment of traditional management practices results in the loss of characteristic fen species. In order to encourage the restoration of typical rich-fen vegetation, particularly in oceanic areas, additional management measures, such as more intensive mowing, may be required. Copyright: © 2019 Ross et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Introduction Emergent information technologies offer museum professionals new ways of bringing information about their collections directly to their audiences. There is a strong ethos within museums to widen public access to collections via the ever-growing digital provision of collections data. Over the past decade, the number of online museum collections, and the number of online visitors using those collections, has increased significantly. These changes have posed challenges for museum professionals and academics alike, seeking to understand how digital museum resources feature in the information seeking practices of their online visitors. There are now vast amounts of digital museum resources available to support scholarship. These resources are changing the ways researchers work, offering convenient quick access to a wide selection of materials, particularly with regard to cultural heritage content. However, finding information in museums, as well as libraries and archives (memory institutions), is not an easy task. Collections database information systems can be overwhelming and daunting to many users. Designing intuitive systems that meet researchers’ needs requires a thorough understanding of the information-seeking behaviour of collection database users. A proper understanding of how museum visitors use digital museum resources is critical for the success of museums in the information age. As museums cope with the challenges of ‘being digital’ (Hamma, 2004), meeting the information needs of online visitors has become an important part of the museum's role (Marty, 2004) and it is now critical for researchers and museum professionals to explore the use of museum digital resources, in-house and online (Booth, 1999; Sarraf, 1999). The British Museum has a commitment to expanding virtual and physical access to its collections, utilizing different mediums to open up the museum collections to a wider, more diverse audience. In October 2007, it launched an online version of its collections database, British Museum Collection Database Online (COL2). By the end of 2009, nearly two million records from the museum collections had been made available to the public worldwide. Despite recent technical advances in collections access and interpretation, very little is known about whether and how this material is used, or if it makes possible new kinds of engagement with museum objects.

Background: Liverwort heath is considered in Scotland to be one of the vegetation types most vulnerable to environmental change, yet detailed insights into its dynamics are lacking.Aims: To assess the nature and extent of plant compositional changes in liverwort heath over 50 years and relate this to environmental change drivers.Methods: Vegetation plots previously recorded 20 and 50 years ago were re-surveyed to assess changes in species composition, plot-level species richness and between-plot variability, using several β-diversity indices and partitioning. The environmental indicator values of the species that showed most change were used to identify the environmental drivers of change.Results: Liverwort heath in north-west Scotland has undergone compositional changes over 50 years, becoming more heterogeneous, and losing some of its distinct character. Dwarf shrubs and specialist liverworts have decreased, while graminoids have increased. Partitioning of change in β diversity indicated that mainly cha...

Background: The effect of the anticipated climate change on the stability of vegetation and the factors underlying this stability are not well understood. Aims: Our objective was to quantify long-term vegetation changes in a range of habitats in northern Europe by exploring species co-occurrences and their links to diversity and productivity gradients. Methods: We re-sampled vegetation in 16 arctic, mountain and mire sites 20 to 90 years after the original inventories. A site-specific change in species assemblages (stability) was quantified using species co-occurrences. Using a randomisation test we tested whether the changes observed were significantly greater than those expected by chance. Relationships between patterns in vegetation stability and time between surveys, numbers of plots, or species diversity and proxies for productivity, were tested using regression analysis. Results: At most sites the changes in species co-occurrences of vascular plants and bryophytes were greater than those expected by...

Sheep grazing is an important part of agriculture in the North Atlantic region, defined here as the Faroe Islands, Greenland, Iceland, Norway and Scotland. This process has played a key role in shaping the landscape and biodiversity of the region, sometimes with major environmental consequences, and has also been instrumental in the development of its rural economy and culture. In this review, we present results of the first interdisciplinary study taking a long-term perspective on sheep management, resource economy and the ecological impacts of sheep grazing, showing that sustainability boundaries are most likely to be exceeded in fragile environments where financial support is linked to the number of sheep produced. The sustainability of sheep grazing can be enhanced by a management regime that promotes grazing densities appropriate to the site and supported by area-based subsidy systems, thus minimizing environmental degradation, encouraging biodiversity and preserving the integrity of ecosystem processes.

Questions Is there evidence for biotic homogenization of upland vegetation? Do the magnitude and nature of floristic and compositional change vary between vegetation types? What can be inferred about the drivers responsible for the observed changes? Location Upland heath, mire and grassland communities of the northwest Highlands of Scotland, UK. Methods We re-survey plots first described in a phytosociological study of 1956–1958 to assess the changes in plant species composition over the last 50 yr in five major upland vegetation types. Using a combination of multivariate analysis, dissimilarity measures, diversity metrics and published data on species attributes; we quantify, characterize and link potential drivers of environmental change with the observed changes in species composition. Results Grassland and heath vegetation declined in species richness and variation in community composition, while mires showed little change. Previously distinct vegetation types became more similar in composition, characterized by the increased dominance of generalist upland graminoids and reduced dwarf-shrub, forb and lichen cover, although novel assemblages were not apparent. Species with an oceanic distribution increased at the expense of those with an arctic-montane distribution. Temperature, precipitation and acidity were found to be potentially important in explaining changes in species composition: species that had undergone the greatest increases had a preference for warmer, drier and more acidic conditions. Conclusions The vegetation of the northwest Scottish Highlands has undergone marked biotic homogenization over the last 50 yr, manifested through a loss of various aspects of diversity at the local, community and landscape scales. The magnitude of change varies between vegetation types, although the nature of change shows many similar characteristics. Analyses of species attributes suggest these changes are driven by climate warming and acidification, although over-grazing may also be important. This study highlights the importance of the link between the loss of plant diversity and homogenization at multiple scales, and demonstrates that boreal heath communities are particularly at risk from these processes.

Background: Re-visitation studies are often based on phytosociological survey data where the precise location of the original plots is unknown. Attempts to evaluate the error associated with relocation uncertainty are rare, yet this is important in interpreting the results with any degree of confidence. Aims: Using a 50-year re-visitation study of upland vegetation in the Scottish Highlands, we aim to assess the potential for, and implications of, uncertainty in relocating plots. Methods: At nine sites, three to five replicate plots were surveyed within a stand of vegetation relocated to the nearest 100 m using the original plot location data. Results: The compositional difference (measured by the Bray–Curtis distance) between the original plot and new replicate plots was greater than that among the replicate plots, both for the combined data and individual vegetation types. Temporal species turnover was greatest in the lower cover-abundance categories (< 5%). Conclusions: We demonstrate that if temporal ...

We report the case of a woman with uterus didelphys who spontaneously conceived two singleton pregnancies, one in each uterus, and was delivered in both instances of a healthy breech infant at term by elective caesarean section.

We characterized the pharmacological properties of P2 receptors expressed in G292 osteoblastic cells by studying the responses or changes in intracellular Ca(2+) level to P2 receptor agonists, antagonists and modulators. ATP induced robust responses in a concentration-dependent manner with EC(50) of 0.5+/-0.07 microM. While alpha,beta-methylene-ATP (alphabetameATP) and 2',3'-O-(4-benzoylbenzoyl)-ATP (BzATP) were ineffective, ADP mimicked the action of ATP with EC(50) of 0.7+/-0.2 microM. UTP and UDP also evoked responses with EC(50) of 2.0+/-0.4 microM and 0.5+/-0.1 microM respectively, but their responses were much smaller, resulting in an order of the response magnitude: ATP~ADP>>UTP~UDP. The responses evoked by ATP and ADP were blocked by pyridoxal-5'-phosphate-6-azophenyl-2,4,-disulfonate (PPADS) with IC(50) of 3.0+/-0.05 microM and 5.0+/-0.4 microM respectively, but not by suramin up to 30 microM. ATP-evoked responses were insensitive to inhibition by trinitrophenyl-ATP (TNP-ATP) and brilliant blue G. ADP-evoked responses were significantly inhibited by 2'-deoxy-N(6)-methyladenosine-3',5'-biphosphate (MRS2179) and 2-chloro-N(6)-methyl-(N)-methanocarba-2'-deoxyadenosine-3',5'-bisphosphate (MRS2279) with IC(50) of 48+/-1.9 microM and 7.7+/-0.9 microM respectively. Taken together, these results provide strong evidence for functional expression of ATP-sensitive P2Y receptors and particularly P2Y(1)-like receptor in G292 cells.

Climatic warming and land use change are likely to facilitate range expansions in invasive plant species, although the ability to predict such changes requires a better mechanistic understanding of the biological limits of populations. The introduced weed Oxalis pes-caprae, a significant pest of cultivation in many Mediterranean-type ecosystems, presents a suitable case study. The species distribution in the Mediterranean Basin closely follows that of olive cultivation, limited to below 600 m; yet its potential to colonise vulnerable areas at higher elevations has yet to be adequately assessed. To investigate the possibility, plant performance was assessed by experimentally sowing O. pes-caprae bulbils along an altitudinal gradient in the Lefka Ori mountains, Crete. The survivorship and bulbil biomass of the resulting plants all declined significantly with elevation, irrespective of soil type, initial bulbil size or seasonal variation. Whilst plants survived vegetatively up to 1400 m, seasonal bulbil productivity, likely to be critical to population viability, exceeded that of the sown bulbil biomass only below 750 m. These data indicate that the current elevation of O. pes-caprae is close to, but not at, its current climatic limit, and that low propagule pressure and scarcity of suitable habitat probably also act to limit the altitudinal distribution. Plant performance was correlated strongly with the duration of spring snow cover. Despite a 2 °C difference in mean spring temperatures in the 2 years of study, the predicted elevational change was only 37 m higher in the milder conditions. Overall, our results suggest that while O. pes-caprae performance is strongly linked to climate and is currently close to its climatic limit on Crete, there is limited scope for further spread unless land use and/or propagule pressure change at higher elevations. For this species, these elements are likely to be more significant drivers of invasion risk than the predicted changes of future climates.

1. Single species can have a disproportionate effect on ecosystem function and diversity, yet our understanding of the importance of single species in driving terrestrial ecosystems during succession remains poor. 2. Utilizing a long-term experiment, where birch was planted on heather moorland 20 years ago, the cascading effects of a single tree species (Betula pubescens) on ecosystem characteristics (plant species richness, soil chemistry, soil fauna and decomposition rates) were tested. 3. Under the birch, plant species richness decreased and the vegetation composition changed, with lower cover of grasses and Vaccinium myrtillus. The depth of the soil organic horizon, its moisture content and percentage carbon were all smaller under the birch than under the heather. Concentrations of available phosphorus and mineralizable-N were significantly greater in the soil under birch than under the heather plots. Decomposition was faster in the birch than in the heather plots. The abundance and species richness of collembola and oribatid, mesostigmatid and prostigmatid mites were all significantly greater under the birch than under the heather. 4. The durability of the engineering effects of the birch was studied in a second experiment. Plots were established in first generation birch woodland that had developed on Calluna-dominanted moorland. The plots were cleared of birch and planted with heather. After 20 years soil chemical properties, microarthropod communities and decomposition rates were not significantly different between plots with and without the birch. However, the mass of the soil O-horizon was significantly greater in the felled birch plots than in the control birch plots, providing the first indication of a change towards soil properties more typical of a Calluna moorland. Thus for most of the birch engineering effects measured here their durability in the absence of the engineering species is at least 20 years. 5. This work has provided experimental evidence that birch acts as a top-down engineer, driving cascading effects on both above- and below-ground communities, soil chemical and physical properties and ecosystem processes. The work also shows that the role of birch in driving changes in the ecosystem is durable 20 years after the removal of the birch.

Drug use during pregnancy is common and the developing foetus may be exposed to a range of environmental toxins that have long-term consequences for neurodevelopment. We conducted a systematic review of the literature to explore the results of longitudinal cohort studies that have examined this question. Out of 2,977 abstracts identified, 7 previous systematic reviews and 95 original articles met further selection criteria. These mostly addressed the neurodevelopmental effects of exposure to lead, polychlorinated biphenyls, mercury, cocaine, alcohol, marijuana, cigarettes and antidepressants. Radiation, opiates, steroids, amphetamines and caffeine have received much less attention. Findings are difficult to interpret because risk factors tend to cluster together and interact. However, some findings are consistent. Lead and PCB's have a general effect on brain development, whilst marijuana and alcohol appear to have long-term effects specifically on attentional skills. The effects of alcohol increase with maternal age and binge drinking is more important than average intake. The effects of cocaine diminish with age and are largely mediated through psychosocial factors, whilst the relation between smoking and later delinquency is largely mediated by genetically inherited factors. Exposure to toxins during pregnancy may constitute an important but relatively unacknowledged cause of child psychiatric morbidity.

Objectives (1) To estimate the proportion of National Health Service (NHS) professionals who have come into contact with trafficked people and (2) to measure NHS professionals’ knowledge and confidence to respond to human trafficking.Design A cross-sectional survey.Setting Face-to-face mandatory child protection and/or vulnerable adults training sessions at 10 secondary healthcare provider organisations in England, and meetings of the UK College of Emergency Medicine.Participants 782/892 (84.4%) NHS professionals participated, including from emergency medicine, maternity, mental health, paediatrics and other clinical disciplines.Measures Self-completed questionnaire developed by an expert panel. Questionnaire asks about prior training and contact with potential victims of trafficking, perceived and actual human trafficking knowledge, confidence in responding to human trafficking, and interest in future human trafficking training.Results 13% participants reported previous contact with a patient they knew or suspected of having been trafficked; among maternity services professionals this was 20.4%. However, 86.8% (n=679) reported lacking knowledge of what questions to ask to identify potential victims and 78.3% (n=613) reported that they had insufficient training to assist trafficked people. 71% (n=556), 67.5% (n=528) and 53.4% (n=418) lacked confidence in making appropriate referrals for men, women and children, respectively, who had been trafficked. 95.3% (n=746) of respondents were unaware of the scale of human trafficking in the UK, and 76.5% (n=598) were unaware that calling the police could put patients in more danger. Psychometric analysis showed that subscales measuring perceived knowledge, actual knowledge and confidence to respond to human trafficking demonstrated good internal consistency (Cronbach's αs 0.93, 0.63 and 0.64, respectively) and internal correlations.Conclusions NHS professionals working in secondary care are in contact with potential victims of human trafficking, but lack knowledge and confidence in how to respond appropriately. Training is needed, particularly for maternity staff, on how to identify and respond to victims’ needs, including through making safe referrals

Background Reducing the worldwide mortality ratio by 75 per cent between 1990 and 2015 is a key Millennium Development Goal. Randomized controlled trials (RCTs) are the accepted ‘gold standard’ to assess the effectiveness of interventions but they are not always appropriate for practical, ethical or economic reasons in developing countries. This study examines the use of cluster randomized trials and quasi-experimental (nonrandomized) study designs to evaluate complex interventions implemented to reduce maternal mortality. Methods We systematically searched electronic databases including MEDLINE, EMBASE, CINAHL, BNI, ASSIA, IBSS, CSA and COCHRANE. English language publications between 1990 and 2003 were included. Studies that assessed the effects of complex interventions aimed at reducing maternal mortality in developing countries were included. Results Four cluster randomized trials and eleven quasiexperimental studies were identified. Two cluster randomized trials examined reduction in prenatal visits with no adverse effects on maternal mortality. Two trials assessed the effects of vitamin A supplementation. Both trials found a significant reduction in maternal mortality ratios after vitamin A supplementation. A decline in maternal deaths was reported in eight of the nonrandomized studies. Measuring maternal mortality was a frequent problem because of insufficient sample sizes and/or poor recording methods. Other limitations include lack of suitable comparison groups and difficulties assessing the effects of confounding factors in the quasi-experimental studies. Conclusions RCTs may not be appropriate to evaluate complex interventions in maternal mortality and cluster RCTs and quasi-experimental designs may be more suitable. However, further work is required to improve the robustness of such alternative study designs.

Emergent Internet of Things (IoT) based technologies offer the potential for new ways in engaging with places, spaces and objects. The use of mobile and tablet computing linked specifically to objects and memory, comment and narrative creation opens up a potentially game-changing methodology in user interaction above and beyond the traditional 'kiosk' type approach. In this position statement we detail the QRator project in the Grant Museum at University College London. The QRator project explores how handheld mobile devices and Internet enabled interactive digital labels can create new models for public engagement, personal meaning-making and the construction of narrative opportunities inside museum spaces. The project won the United Kingdom National Museum and Heritage Award for Innovation for exploring the cultural shift that is anticipated as society moves to a ubiquitous form of computing in which every device is 'on', and every device is connected in some way to the Internet.

First-year medical students at UCLA are introduced to the special health problems of the elderly by a process in which they interview symptomatic volunteers at both extended care and ambulatory care facilities. In addition, they interview healthy elderly volunteers to gain information on gerontology and lifespan development, with supplementation from selected readings, films, lectures and panels. This curricular model seems effective in reducing prejudice about the aged and in training future physicians to render humane competent care in the field of geriatrics.