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Understanding the cooling service provided by vegetation in cities is important to inform urban policy and planning. However, the performance of decision-support tools estimating heat mitigation for urban greening strategies has not been evaluated systematically. Here, we further develop a calibration algorithm and evaluate the performance of the urban cooling model developed within the open-source InVEST (Integrated Valuation of Ecosystem Services and Tradeoffs) software. The urban cooling model estimates air temperature reduction due to vegetation based on four predictors, shade, evapotranspiration, albedo, and building density, and was designed for data-rich and data-scarce situations. We apply the calibration algorithm and evaluate the model in two case studies (Paris, France, and Minneapolis–St Paul, USA) by examining the spatial correlation between InVEST predictions and reference temperature data at a 1 km horizontal resolution. In both case studies, model performance was high for nighttime air temperatures, which are an important indicator of human wellbeing. After calibration, we found medium performance for surface temperatures during daytime but low performance for daytime air temperatures in both case studies, which may be due to model and data limitations. We illustrate the model adequacy for urban planning by testing its ability to simulate a green infrastructure scenario in the Paris case study. The predicted air temperature change compared well to that of an alternative physics-based model (r2=0.55 and r2=0.85 for daytime and nighttime air temperatures, respectively). Finally, we discuss opportunities and challenges for the use of such parsimonious decision-support tools, highlighting their importance to mainstream ecosystem services information for urban planning.

Abstract Background Frontal fibrosing alopecia (FFA) is a form of inflammatory and cicatricial alopecia, presenting concomitantly with rarefaction of eyebrows and body hair. However, the involvement of body hair in FFA is still poorly investigated. Objectives To compare the dermoscopy findings of axillary hairs in a group of women with FFA with a group of women without FFA. Methods An observational case‐control study was carried out on the dermoscopic findings of the axillary hair in this group of patients with FFA compared to a group of women without FFA, matched by age groups and skin phototypes. Results Thirty women with a clinical and histopathological diagnosis of FFA were included in the study. Dermoscopy of the axilla in patients with FFA revealed the presence of axillary hair in 93.3% and all patients had hairless follicular openings. More than one wire per follicular ostium was observed in 70% of the patients and variability in the diameter of the hairs in 83.3% of the cases. Regarding dermoscopic inflammatory signs, a peripillary brownish halo was present in 83.3% of patients, peripillary scaling in 56.7%, diffuse scaling in 63.3% and pigmented network of the epidermis in 73.3% of the cases. When comparing the dermoscopic findings of the axilla of cases with controls, the chance of occurrence of brownish peripillary halos between cases was higher than double the chance of occurrence of these halos among controls (OR = 2.7; 95% CI: 1.1−7.6; p = 0.029). The rest of variables were not statistically associated with the FFA. Conclusions Dermoscopy of the axilla in patients with FFA revealed that brownish peripillary halos may be a diagnostic clue for FFA in the axillary region. The dermoscopy findings found in the present study allow characterizing the axillary involvement of patients with FFA and recognize the dermoscopic differences with other dermatoses involving this location.

Abstract Historical resurveys represent a unique opportunity to analyze vegetation dynamics over longer timescales than is typically achievable. Leveraging the oldest historical dataset of vegetation change in the Bavarian Alps, Germany, we address how environmental conditions, vegetation composition, and functional diversity in the calcareous grasslands of the Schachen region have changed across different elevational ranges over an 83‐year timeframe. We document changes in regional average temperature and precipitation. We use indicator values (IV) for species' ecological preferences and their palatability to grazers to infer local conditions (temperature, soil moisture/fertility, and grazing regime). We further estimate changes in temporal beta‐diversity and functional trait community composition between historical (1936) and contemporary (2019) surveys in two elevational (subalpine and alpine) belts. Both subalpine and alpine sites became drier; subalpine sites also became warmer with more palatable plants. Species occurrence and abundance in the Schachen region has not changed substantially over time despite changing macroclimate and local environmental conditions under anthropogenic change. Yet these grasslands have experienced several “invisible” changes in functional composition over the past 80 years. As the Schachen has become drier, species with traits related to drought tolerance and animal‐based dispersal have increased in dominance. Specifically, in alpine sites, community‐weighted means revealed that with low fecundity, higher potential for endo‐ and epizoochory (seed dispersal via animal gut and fur, respectively), higher foliar frost tolerance, and deeper dormancy increased in dominance. Similar trends were found for increasing dominance of low fecundity, epizoochorous species in subalpine sites. Vegetation data from resurveying historical plots in combination with changes in local conditions, classic biodiversity indices, and functional trait indices can provide more holistic insights into changes in the environment and potential impacts of those environmental changes on long‐term plant community and functional diversity.

This article studies how linguist Leo van Lier's ecological AAA-model (van Lier 1996), consisting of the three principles of awareness, autonomy, and authenticity, can be used to analyze teacher-student interactions in the classroom. Additionally, the model's application in developing teaching methods is illustrated. The research question addressed is: How can the AAA-model, as a tool for developing, carrying out, and analyzing teaching, help create learning-promoting action opportunities for multilingual students? An interaction between a teacher and her student during a Danish lesson in a 7th grade at a primary school ('Folkeskole'), where the majority are plurilingual students, is analyzed. The analysis, based on Mayring (2015), is structured as a deductive qualitative content analysis. Using the ecological AAA-model as the theoretical foundation, a learning situation is illustrated where neither the teacher nor the student achieves the desired outcome. The teacher aims to promote autonomy and authenticity for the student but ends up acting counterproductively, causing the student to do "double work" and become increasingly insecure and dependent throughout the interaction. The importance of considering all three principles simultaneously to promote learning and create meaningfulness, choices, and transparency in relation to academic and pedagogical goals is clarified based on the model.

BackgroundDespite the extensive use of antibiotics and the growing challenge of antimicrobial resistance, there has been a lack of substantial initiatives aimed at diminishing the prevalence of infections in nursing homes and enhancing the detection of urinary tract infections (UTIs). ObjectiveThis study aims to systematize and enhance efforts to prevent health care–associated infections, mainly UTIs and reduce antibiotic inappropriateness by implementing a multifaceted intervention targeting health care professionals in nursing homes. MethodsA before-and-after intervention study carried out in a minimum of 10 nursing homes in each of the 8 European participating countries (Denmark, Greece, Hungary, Lithuania, Poland, Slovakia, Slovenia, and Spain). A team of 4 professionals consisting of nurses, doctors, health care assistants, or health care helpers are actively involved in each nursing home. Over the initial 3-month period, professionals in each nursing home are registering information on UTIs as well as infection and prevention control measures by means of the Audit Project Odense method. The audit will be repeated after implementing a multifaceted intervention. The intervention will consist of feedback and discussion of the results from the first registration, training on the implementation of infection and prevention control techniques provided by experts, appropriateness of the diagnostic approach and antibiotic prescribing for UTIs, and provision of information materials on infection control and antimicrobial stewardship targeted to staff, residents, and relatives. We will compare the pre- and postintervention audit results using chi-square test for prescription appropriateness and Student t test for implemented hygiene elements. ResultsA total of 109 nursing homes have participated in the pilot study and the first registration audit. The results of the first audit registration are expected to be published in autumn of 2024. The final results will be published by the end of 2025. ConclusionsThis is a European Union–funded project aimed at contributing to the battle against antimicrobial resistance through improvement of the quality of management of common infections based on evidence-based interventions tailored to the nursing home setting and a diverse range of professionals. We expect the intervention to result in a significant increase in the number of hygiene activities implemented by health care providers and residents. Additionally, we anticipate a marked reduction in the number of inappropriately managed UTIs, as well as a substantial decrease in the overall incidence of infections following the intervention. International Registered Report Identifier (IRRID)DERR1-10.2196/60099

Paige is a robot programmed by society. Why else would she be ranking the bodies of the other moms at tot swim? Once upon a time she read Beowulf in [...]

Abstract Tumor-infiltrating lymphocytes (TILs) have been associated with outcomes in HER2-positive breast cancer patients treated with neoadjuvant chemotherapy and trastuzumab. However, it remains unclear if TILs could be a prognostic and/or predictive biomarker in the context of dual HER2-targeting treatment. In this study, we evaluated the association between TILs and pathological response (pCR) and invasive-disease free survival (IDFS) in 389 patients with stage II-III HER2 positive breast cancer who received neoadjuvant anthracycline-containing or anthracycline-free chemotherapy combined with trastuzumab and pertuzumab in the TRAIN-2 trial. Although no significant association was seen between TILs and pCR, patients with TIL scores ≥60% demonstrated an excellent 3-year IDFS of 100% (95% CI 100–100), regardless of hormone receptor status, nodal stage and attainment of pCR. Additionally, in patients with hormone receptor positive disease, TILs as a continuous variable showed a trend to a positive association with pCR (adjusted Odds Ratio per 10% increase in TILs 1.15, 95% CI 0.99–1.34, p = 0.070) and IDFS (adjusted Hazard Ratio per 10% increase in TILs 0.71, 95% CI 0.50–1.01, p = 0.058). We found no interactions between TILs and anthracycline treatment. Our results suggest that high TIL scores might be able to identify stage II-III HER2-positive breast cancer patients with a favorable prognosis.

This paper explores the dynamics of family law’s transformation over the past 50 years as the result of interactions of two autonomous systems: the law and the family. The interesting feature in the change of family is its democratisation. Equality, consent, freedom of partners, participative governance have become ideals of the Western family. Law is a motor of this family transformation through its own internal transformation on two points: the transformation of legal reasoning, based on human rights; the use of mediation in judiciary conflict resolution. This U turn can be explained by the new mechanisms of social order in modern differenciated societies. Following Anne Rawls’ reading of Durkheim’s insights, the article argues for the centrality of “constitutive practices” in modern societies. Legal framework can no longer derive and perform social order through moral rituals. Modern law must fit the procedural morality (instead of a moral consensus) of family interactions in order to be able to solve conflicts. This explanation of the success of mediation in family law is also the key to understand the constitutionalisation of family law via the use of principles (instead of rules) in legal reasoning. Intercultural conflicts arise inside families as well as inside societies. New flexible family law becomes a factor of pluralization of family forms. On this basis, transnationalization of family law can develop, even if state sovereignty remains a powerful brake of this evolution. Este artículo explora la dinámica de transformación del derecho de familia en los últimos 50 años como resultado de las interacciones de dos sistemas autónomos: el derecho y la familia. La característica interesante del cambio de la familia es su democratización. La igualdad, el consentimiento, la libertad de las parejas y el gobierno participativo se han convertido en ideales de la familia occidental. El derecho es un motor de esta transformación familiar a través de su propia transformación interna en dos puntos: la transformación del razonamiento jurídico, basado en los derechos humanos; el uso de la mediación en la resolución de conflictos judiciales. Este vuelco, a su vez, se explica por los nuevos mecanismos de orden social en las modernas sociedades diferenciadas. Siguiendo la lectura de Anne Rawls de las ideas de Durkheim, el artículo defiende la centralidad de las “prácticas constitutivas” en las sociedades modernas. El marco jurídico ya no puede derivar y realizar el orden social a través de rituales morales. El derecho moderno debe adaptarse a la moralidad procedimental (en lugar de a un consenso moral) de las interacciones familiares para poder resolver los conflictos. Esta explicación del éxito de la mediación en el derecho de familia es también la clave para entender la constitucionalización del derecho de familia mediante el uso de principios (en lugar de normas) en el razonamiento jurídico. Los conflictos interculturales surgen tanto en el seno de las familias como de las sociedades. El nuevo derecho de familia flexible se convierte en un factor de pluralización de las formas de familia. Sobre esta base, puede desarrollarse la transnacionalización del derecho de familia, aunque la soberanía estatal siga siendo un poderoso freno de esta evolución.

In this introduction, the authors present the ambition that guided the composition of this edition devoted to family law. They first highlight the interest in addressing the intersection between the process of democratisation and the process of transnationalisation of families. These two processes are refracted in family law. They find their origin in the same refusal of a substantial moral definition of the “good family”. However, all normative perspective is not abandoned. A new normative and effective relationship is established between interactions and institutions. The new regulation of the family gives an important place to interactions and their immanent normativity. Legal principles (human rights, procedural standards) give expression to this mutation. Institutions are no longer given before the interaction, but rather constitute instruments for repairing the interactional order. This trend in the evolution of the law is particularly visible in the two cases treated in the issue: homosexual marriage and international child abduction. The close analysis of these two situations, however, suggests the persistence of obstacles to these transformations, due to the persistence of the principle of national sovereignty. En esta introducción, los autores presentan la ambición que guió la composición de esta edición dedicada al derecho de familia. En primer lugar, destacan el interés por abordar la intersección entre el proceso de democratización a y el proceso de transnacionalización de las familias. Estos dos procesos se refractan en el derecho de familia. Encuentran su origen en el mismo rechazo de una definición moral sustancial de la “buena familia”. Sin embargo, no se abandona toda perspectiva normativa. Se establece una nueva relación entre interacciones e instituciones. La nueva regulación de la familia da un lugar importante a las interacciones y a su normatividad inmanente. Los principios jurídicos (derechos humanos, normas procesales) reemplazan las reglas que definen la “buena familia”. Las instituciones ya no se dan antes de la interacción, sino que constituyen instrumentos para reparar el orden interaccional. Esta tendencia en la evolución del derecho es particularmente visible en los dos casos tratados en el número: el matrimonio homosexual y la sustracción internacional de menores. El análisis cuidadoso de estas dos situaciones, sin embargo, sugiere la persistencia de obstáculos a estas transformaciones, debido a la persistencia del principio de soberanía nacional.

Chronic watery diarrhea is a frequent symptom. In approximately 10% of the patients, a diagnosis of microscopic colitis (MC) is established. The diagnosis relies on specific, but sometimes subtle, histopathological findings. As the histology of normal intestinal mucosa vary, discriminating subtle features of MC from normal tissue can be challenging and therefore auxiliary stainings are increasingly used. The aim of this study was to determine the variance in number of intraepithelial lymphocytes (IELs) and presence of a subepithelial band in normal ileum and colonic mucosa, according to different stains and digital assessment. Sixty-one patients without diarrhea referred to screening colonoscopy due to a positive feacal blood test and presenting with endoscopically normal mucosa were included. Basic histological features, number of IELs, and thickness of a subepithelial band was manually evaluated and a deep learning-based algorithm was developed to digitally determine the number of IELs in each of the two compartments; surface epithelium and cryptal epithelium, and the density of lymphocytes in the lamina propria compartment. The number of IELs was significantly higher on CD3-stained slides compared with slides stained with Hematoxylin-and-Eosin (HE) (p

IntroductionFLASH radiotherapy (RT) has emerged as a promising modality, demonstrating both a normal tissue sparing effect and anticancer efficacy. We have previously reported on the safety and efficacy of single fraction FLASH RT in the treatment of oral tumors in canine cancer patients, showing tumor response but also a risk of radiation-induced severe late adverse effects (osteoradionecrosis) for doses ≥35 Gy. Accordingly, the objective in this study was to investigate if single fraction high dose FLASH RT is safe for treating non-oral tumors.MethodsPrivately-owned dogs with superficial tumors or microscopic residual disease were included. Treatment was generally delivered as a single fraction of 15-35 Gy 10 MeV electron FLASH RT, although two dogs were re-irradiated at a later timepoint. Follow-up visits were conducted up to 12 months post-treatment to evaluate treatment efficiency and adverse effects.ResultsFourteen dogs with 16 tumors were included, of which nine tumors were treated for gross disease whilst seven tumors were treated post-surgery for microscopic residual disease. Four treatment sites treated with 35 Gy had ulceration post irradiation, which was graded as severe adverse effect. Only mild adverse effects were observed for the remaining treatment sites. None of the patients with microscopic disease experienced recurrence (0/7), and all patients with macroscopic disease showed either a complete (5/9) or a partial response (4/9). Five dogs were euthanized due to clinical disease progression.DiscussionOur study demonstrates that single fraction high dose FLASH RT is generally safe, with few severe adverse effects, particularly in areas less susceptible to radiation-induced damage. In addition, our study indicates that FLASH has anti-tumor efficacy in a clinical setting. No osteoradionecrosis was observed in this study, although other types of high-grade adverse effects including ulcer-formations were observed for the highest delivered dose (35 Gy). Overall, we conclude that osteoradionecrosis following single fraction, high dose FLASH does not appear to be a general problem for non-oral tumor locations. Also, as has been shown previously for oral tumors, 30 Gy appeared to be the maximum safe dose to deliver with single fraction FLASH RT.

Objective Bile acid diarrhoea is a common cause of chronic diarrhoea. Increased levels of potentially carcinogenic bile acids in faeces, theoretically, may increase the risk of colorectal cancer in particular, but the long-term disease course is unknown. We aimed to investigate the overall and site-specific cancer risk in bile acid diarrhoea.Design Adult patients with bile acid diarrhoea were identified using nationwide Danish registries from 2003 to 2020 by a diagnostic gold-standard 75-selenium tauroselcholic acid procedure followed within 6 months by sequestrant prescription. The risk of overall and site-specific cancers in cases with bile acid diarrhoea was compared with sex, age and comorbidity-adjusted matched controls. A competing risk model estimated cumulative incidence functions and cause-specific HRs.Results We identified 2260 patients with bile acid diarrhoea with a mean follow-up of 5.5 years (SD 4.2). The overall cancer risk was increased by an HR of 1.32 (95% CI 1.12 to 1.54). The risk of site-specific cancer was increased in 3 of 10 cancer groups: haematological, HR 2.41 (1.36 to 4.02); skin, HR 1.33 (1.01 to 1.71); and male genital cancers, HR 1.85 (1.11 to 2.92). No increased risk of colorectal cancer was detected in patients with bile acid diarrhoea, HR 0.73 (0.34 to 1.63).Conclusions Bile acid diarrhoea was associated with an increased overall risk of cancer, especially haematological cancers, but the risk of colorectal cancer was not increased. The lack of a diagnostic code for bile acid diarrhoea and potential residual confounding are limitations, and the findings should be replicated in other cohorts.

Field practice is pivotal in teacher education, serving both as a bridge connecting the theoretical and practical dimensions of the teaching profession in real-world schools, and as a place for acquiring the complex core skills of the profession in their own right. While prior work has mainly explored general teacher self-efficacy, or broad student-related concerns in field practice, there is surprisingly little knowledge of the specific teacher and teaching-related practices that might challenge student teachers during field practice. This study aims to address this gap by exploring the issue both from the student teacher and the field-practice teacher perspective. Utilizing focus groups and individual interviews with students and field-practice teachers, the study employs content analysis, and an innovative agreement circle to identify which practices students may doubt they can enact/engage in while in field practice. The findings highlight four main areas of concern stemming from both students and field practice teachers: adaptability in teaching; balancing subject knowledge with pedagogical competence; classroom leadership; and teaching independently. The study also uncovers discrepancies between student teachers, who are preoccupied with their teaching performance, and field-practice teachers, who also emphasize the importance of collaborative practices with, for example, parents. The study opens a new field of inquiry and is the first step towards a theory of practice self-efficacy in education. Future research could focus on creating measurement tools to evaluate student teacher efficacy in field practice within the four identified areas, thereby enabling identification of early challenges, assessment of field-practice effectiveness, and the provision of tailored field-practice preparation.

Background: In breast cancer survivors at risk for lymphedema, variation in lymphatic function and arm volume has been observed related to a bout of exercise, with potential for prediction of breast cancer-related arm lymphedema (BCRaL). This novel, exploratory study examined the acute lymphatic response to resistance exercise and later development of BCRaL in women at high risk for BCRaL. Methods: One year after participation in a cross-over trial evaluating the acute lymphatic response to upper-extremity resistance exercise (low-and heavy-load), participants were assessed for BCRaL (n ​= ​16). The response to exercise was assessed before and after (post, 24- and 72-hrs) each exercise bout as extracellular fluid (L-Dex; bioimpedance spectroscopy (BIS)), interarm volume % difference (IVD; Dual-energy x-ray absorptiometry (DXA)) and symptoms (Numeric rating scale, 0–10 (NRS)). BCRaL at follow-up was defined as presence of one objective indicator (L-Dex >10, change ≥+6.5, IVD >5%) plus one objective or subjective indicator (interarm symptom ≥1 or visual inspection). Descriptive statistics were used to compare the acute response between participants with and without BCRaL at follow-up. Results: No trends indicating a similar acute response to exercise was observed in participants who later developed BCRaL (n ​= ​5). There were no observable differences in acute lymphatic response between participants that developed BCRaL and those who did not, both at an individual and group level. Conclusions: Findings from this exploratory study showed no evidence to suggest that the acute response to resistance exercise can predict BCRaL development.