Refining Vascular Care Through Science Without Losing the Art

The science of medicine involves the incorporation of data from evidence-based medicine (collecting, analyzing, conducting clinical trials), medical knowledge (learned patterns of health and disease), diagnostic testing (objective evidence), treatment protocols (guidelines based on scientific evidence and/or expert consensus), and pharmacology (prescribing safely and effectively). The art of medicine involves clinical judgment (learn to interpret clinical signs, symptoms, and histories often relying on intuition and gut feelings), bedside manner (understanding patient needs), customization of care (artistic touch to meet each person's unique circumstances including values, preferences, and social determinants of health), complex decision-making (decision-making based on experience or expertise when confronted with limited or conflicting data), and managing uncertainty (making decisions keeping "doors open" when faced with limited objective confirmation). The delivery of healthcare is not "either science or art" but rather "both science and art" proposition. So, how do we wrestle with this potential paradox?

Unclear relationships between mean survival rate and its environmental variance in vertebrates

Current environmental changes may increase temporal variability of life history traits of species thus affecting their long-term population growth rate and extinction risk. If there is a general relationship between environmental variances (EVs) and mean annual survival rates of species, that relationship could be used as a guideline for analyses of population growth and extinction risk for populations, where data on EVs are missing. For this purpose, we present a comprehensive compilation of 252 EV estimates from 89 species belonging to five vertebrate taxa (birds, mammals, reptiles, amphibians and fish) covering mean annual survival rates from 0.01 to 0.98. Since variances of survival rates are constrained by their means, particularly for low and high mean survival rates, we assessed whether any observed relationship persisted after applying two types of commonly used variance stabilizing transformations: relativized EVs (observed/mathematical maximum) and logit-scaled EVs. With raw EVs at the arithmetic scale, mean-variance relationships of annual survival rates were hump-shaped with small EVs at low and high mean survival rates and higher (and widely variable) EVs at intermediate mean survival rates. When mean annual survival rates were related to relativized EVs the hump-shaped pattern was less distinct than for raw EVs. When transforming EVs to logit scale the relationship between mean annual survival rates and EVs largely disappeared. The within-species juvenile-adult slopes were mainly positive at low (<0.5) and negative at high (>0.5) mean survival rates for raw and relativized variances while these patterns disappeared when EVs were logit transformed. Uncertainties in how to interpret the results of relativized and logit-scaled EVs, and the observed high variation in EV's for similar mean annual survival rates illustrates that extrapolations of observed EVs and tests of life history drivers of survival-EV relationships need to also acknowledge the large variation in these parameters.

The prevalence of rodent-borne zoonotic pathogens in the South Gobi desert region of Mongolia

The alpine ecosystems and communities of central Asia are currently undergoing large-scale ecological and socio-ecological changes likely to affect wildlife-livestock-human disease interactions and zoonosis transmission risk. However, relatively little is known about the prevalence of pathogens in this region. Between 2012 and 2015 we screened 142 rodents in Mongolia's Gobi desert for exposure to important zoonotic and livestock pathogens. Rodent seroprevalence to Leptospira spp. was >1/3 of tested animals, Toxoplasma gondii and Coxiella burnetii approximately 1/8 animals, and the hantaviruses being between 1/20 (Puumala-like hantavirus) and <1/100 (Seoul-like hantavirus). Gerbils trapped inside local dwellings were one of the species seropositive to Puumala-like hantavirus, suggesting a potential zoonotic transmission pathway. Seventeen genera of zoonotic bacteria were also detected in the faeces and ticks collected from these rodents, with one tick testing positive to Yersinia. Our study helps provide baseline patterns of disease prevalence needed to infer potential transmission between source and target populations in this region, and to help shift the focus of epidemiological research towards understanding disease transmission among species and proactive disease mitigation strategies within a broader One Health framework.

Shorter TB treatment regimens should be safer as well

Most ongoing and planned TB therapeutic trials are focused on shortening the duration of treatment while giving less consideration to other aspects of TB care that are important to people with TB. Here we argue that other variables besides duration of TB treatment should also be considered when developing new TB treatment regimens, including drug toxicity, time spent in monitoring and overall quality of life while on therapy. We examine the specific use of linezolid in treatment-shortening trials for drug-susceptible TB and propose additional endpoints that should be prioritised in TB treatment studies.

Affordance-based practice: An ecological-enactive approach to chronic musculoskeletal pain management

BACKGROUND

The biomedical understanding of chronic musculoskeletal pain endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. Although the biopsychosocial approach is an important advancement, it has a limited theoretical foundation. As such, it tends to be misinterpreted in manners that lead to artificial boundaries between the biological, psychological, and social, with fragmented and polarized clinical applications.

OBJECTIVE

We present an ecological-enactive approach to complement the biopsychosocial model. In this approach, the disabling aspect of chronic pain is characterized as an embodied, embedded, and enactive process of experiencing a closed-off field of affordances (i.e., shutting down of action possibilities). Pain is considered as a multi-dimensional, multicausal, and dynamic process, not locatable in any of the biopsychosocial component domains. Based on a person-centered reasoning approach and a dispositional view of causation, we present tools to reason about complex clinical problems in face of uncertainty and the absence of 'root causes' for pain. Interventions to open up the field of affordances include building ability and confidence, encouraging movement variability, carefully controlling contextual factors, and changing perceptions through action according to each patient's self-identified goals. A clinical case illustrates how reasoning based on an ecological-enactive approach leads to an expanded, multi-pronged, affordance-based intervention.

CONCLUSIONS

The ecological-enactive perspective can provide an overarching conceptual and practical framework for clinical practice, guiding and constraining clinicians to choose, combine, and integrate tools that are consistent with each other and with a true biopsychosocial approach.

CycLing and EducATion (CLEAT): protocol for a single centre randomised controlled trial of a cycling and education intervention versus standard physiotherapy care for the treatment of hip osteoarthritis

BACKGROUND

Osteoarthritis (OA) is a chronic degenerative joint disorder for which there is no known cure. Non-surgical management for people with mild-to-moderate hip OA focuses mainly on alleviating pain and maximising function via the National Institute for Health and Care Excellence (NICE) recommended combination of education and advice, exercise, and, where appropriate, weight loss. The CHAIN (Cycling against Hip pAIN) intervention is a group cycling and education intervention conceived as a way of implementing the NICE guidance.

METHODS

CycLing and EducATion (CLEAT) is a pragmatic, two parallel arm, randomised controlled trial comparing CHAIN with standard physiotherapy care for the treatment of mild-to-moderate hip OA. We will recruit 256 participants referred to the local NHS physiotherapy department over a 24-month recruitment period. Participants diagnosed with hip OA according to NICE guidance and meeting the criteria for GP exercise referral will be eligible to participate. Primary outcome is the difference in Hip Disability and Osteoarthritis Outcome Score (HOOS) function, daily living subscale between those receiving CHAIN and standard physiotherapy care. Secondary outcomes include performance-based functional measures (40 m walking, 30s chair stand and stair climb tests), ability for patient to self-care (patient activation measure) and self-reported health-related resource use including primary and secondary care contacts. The primary economic endpoint is the number of quality adjusted life years (QALYs) at 24 weeks follow-up. The study is funded by the National Institute for Health Research, Research for Patient Benefit PB-PG-0816-20033.

DISCUSSION

The literature identifies a lack of high-quality trials which inform on the content and design of education and exercise in the treatment of patients with hip OA and explore cost-effectiveness. CLEAT is a pragmatic trial which seeks to build further evidence of the clinical benefits of the CHAIN intervention compared to standard physiotherapy care within a randomised, controlled trial setting, and examine its cost-effectiveness.

TRIAL REGISTRATION NUMBER

ISRCTN19778222. Protocol v4.1, 24th October 2022.

Birds differentially prioritize visual and olfactory foraging cues depending on habitat of origin and sex

Animals interpret their environment by combining information from multiple senses. The relative usefulness of different senses may vary between species, habitats and sexes; yet, how multimodal stimuli are integrated and prioritized is unknown for most taxa. We experimentally assessed foraging preferences of great tits (Parus major) to test whether urban and forest individuals prioritize visual and olfactory cues differently during foraging. We trained 13 wild-caught birds to associate multimodal (colour + odour) cues with a food reward and assessed their foraging preferences in a cue-separation test. In this, the birds could choose between the multimodal training cue and its olfactory or visual components. Our results suggest that the birds did not perceive multimodal cues in an integrated way, as their response was not stronger than for unimodal cue components. Urban birds preferred olfactory cues, while forest birds preferred visual cues. Nevertheless, female birds preferred the multimodal cue, while males foraged more randomly with respect to which cue was present. These findings contribute to our understanding of the relative roles of vision and olfaction in bird foraging behaviour. Future work should focus on how habitat- and sex-specific sensory prioritization modifies bird foraging behaviour and foraging success in the context of urban adaptations across populations.

Repeatability of radiographic assessments for feline hip dysplasia suggest consensus scores in radiology are more uncertain than commonly assumed

Variation in the diagnostic interpretation of radiographs is a well-recognised problem in human and veterinary medicine. One common solution is to create a 'consensus' score based on a majority or unanimous decision from multiple observers. While consensus approaches are generally assumed to improve diagnostic repeatability, the extent to which consensus scores are themselves repeatable has rarely been examined. Here we use repeated assessments by three radiologists of 196 hip radiographs from 98 cats within a health-screening programme to examine intra-observer, inter-observer, majority-consensus and unanimous-consensus repeatability scores for feline hip dysplasia. In line with other studies, intra-observer and inter-observer repeatability was moderate (63-71%), and related to the reference assessment and time taken to reach a decision. Consensus scores did show reduced variation between assessments compared to individuals, but consensus repeatability was far from perfect. Only 75% of majority consensus scores were in agreement between assessments, and based on Bayesian multinomial modelling we estimate that unanimous consensus scores can have repeatabilities as low as 83%. These results clearly show that consensus scores in radiology can have large uncertainties, and that future studies in both human and veterinary medicine need to include consensus-uncertainty estimates if we are to properly interpret radiological diagnoses and the extent to which consensus scores improve diagnostic accuracy.

Nesting habitat suitability and breeding of Asian woollyneck (Ciconia episcopus) in Nepal

Asian woollyneck (Ciconia episcopus) is a large wading bird species whose conservation status has been recently down-listed, despite a lack of concrete information on its nesting ecology and breeding success. In this study, we report its breeding success and nest habitat suitability in Nepal from 39 nesting sites (2016–2020). Simal (Bombax ceiba) (n = 21), followed by sal tree(Shorea robusta) (n = 6), and rani-salla (Pinus roxburghii) (n = 4) were the most common tree with mean height of the nesting tree, nest height, and tree diameter being 30 ± 5.8 m (± SD), 25.20 ± 5.75 m, and 1.03 ± 0.35 m, respectively. Nesting and fledging success were recorded from 31 nesting attempts at 19 of these sites, with an estimated nesting success probability of 0.81 ± 0.07 and a mean fledging success of 1.94 ± 0.25 chicks per nest. MaxEnt modelling identified a total potential suitable nesting habitat area of 9.64% (14,228 km²) of the area in Nepal, with this located within 72 districts, mostly in the west. The modelling parameters suggest that slope, land use, and precipitation during the driest months were important determinants of nesting habitat suitability. We recommend that priority be given to conserving taller trees (especially simal) close to settlements and croplands of Nepal. Also, that future surveys should consider examining the districts highlighted by our model as being the most likely candidates for containing woollyneck nesting habitat, especially those (such as Dang District) where woollyneck nests have not been previously reported.

Viral infection changes the expression of personality traits in an insect species reared for consumption

Disease-induced personality change results from endogenous and adaptive host responses or parasitic manipulation. Within animal husbandry systems understanding the connection between behaviour and disease is important for health monitoring and for designing systems considerate to animal welfare. However, understanding these relationships within insect mass-rearing systems is still in its infancy. We used a simple repeated behavioural-emergence test to examine parasite-induced differences in group personality traits in the house cricket Acheta domesticus, by comparing the behaviours of 37 individuals infected with the Acheta domesticus densovirus (AdDV) and 50 virus-free individuals. AdDV-infected animals had a much lower emergence probability, longer times until emergence, and did not change their behaviour with experience compared to the virus-free animals. AdDV-infected animals also had lower variation in their probability of emergence within the population, most likely related to animals displaying a relatively uniform sickness response. These infected animals also had higher variation in their response to experimental trial experience; this greater variation resulted from a difference between males and females. Infected females responded to experience in a similar way as virus-free animals, while AdDV-infected males showed a response to experience in the opposite direction: i.e., while all other groups reduced emergence time with experience, infected males always increased their mean emergence time as trials progressed. Our results are important not only in the context of animal personality research, but also with regards to creating husbandry systems and disease monitoring within the insects-as-food industry that are considerate to both production traits and animal welfare.

Increasing risks for emerging infectious diseases within a rapidly changing High Asia

The cold and arid mountains and plateaus of High Asia, inhabited by a relatively sparse human population, a high density of livestock, and wildlife such as the iconic snow leopard Panthera uncia, are usually considered low risk for disease outbreaks. However, based on current knowledge about drivers of disease emergence, we show that High Asia is rapidly developing conditions that favor increased emergence of infectious diseases and zoonoses. This is because of the existing prevalence of potentially serious pathogens in the system; intensifying environmental degradation; rapid changes in local ecological, socio-ecological, and socio-economic factors; and global risk intensifiers such as climate change and globalization. To better understand and manage the risks posed by diseases to humans, livestock, and wildlife, there is an urgent need for establishing a disease surveillance system and improving human and animal health care. Public health must be integrated with conservation programs, more ecologically sustainable development efforts and long-term disease surveillance.

Unleashing the full power of LHCb to probe stealth new physics

In this paper, we describe the potential of the LHCb experiment to detect stealth physics. This refers to dynamics beyond the standard model that would elude searches that focus on energetic objects or precision measurements of known processes. Stealth signatures include long-lived particles and light resonances that are produced very rarely or together with overwhelming backgrounds. We will discuss why LHCb is equipped to discover this kind of physics at the Large Hadron Collider and provide examples of well-motivated theoretical models that can be probed with great detail at the experiment.

Factors influencing the global distribution of the endangered Egyptian vulture

Vultures are ecologically important primarily because of their scavenging role in cleaning carcasses of the environment. Because of anthropogenic impacts, the Egyptian vulture (Neophron percnopterus) has suffered catastrophic declines in parts of its range and, thus, information about its global distribution and factors influencing its occurrence within this range are essential for its conservation. To this end, we estimated the global distribution of Egyptian vulture and variables related to this distribution. We used occurrence points (n = 4740) from online data sources and literature, environmental variables related to these sites and Maximum Entropy software to model the distribution of this species and its relationship to environmental variables during the entire year, breeding and overwintering. Out of ~ 49 million km² study area, the Egyptian vulture had a predicted range of 6,599,508 km² distributed across three continents: Africa, Asia and Europe. The densest distribution was in Southern Europe, India and Northern Africa and a sparser distribution was around Mid and Western Africa, the Middle East and Afghanistan. Climate was related to the vulture’s most probable range: in particular medium temperature seasonality and low precipitation during the coldest yearly quarter were important variables regardless of the season of observations examined. Conservation of identified habitats and mitigation of anthropogenic impacts to conserve these vultures are recommended for immediate and long-term conservation of the Egyptian vulture globally.

Tree species identity and composition shape the epiphytic lichen community of structurally simple boreal forests over vast areas

Greatly simplified ecosystems are often neglected for biodiversity studies. However, these simplified systems dominate in many regions of the world, and a lack of understanding of what shapes species occurrence in these systems can have consequences for biodiversity and ecosystem services at a massive scale. In Fennoscandia, ~90% of the boreal forest (~21Mha) is structurally simplified with little knowledge of how forest structural elements shape the occurrence and diversity of for example epiphytic lichens in these managed forests. One form of structural simplification is the reduction of the number and frequency of different tree species. As many lichen species have host tree preferences, it is particularly likely that this simplification has a huge effect on the lichen community in managed forests. In a 40–70 years old boreal forest in Sweden, we therefore related the occurrence and richness of all observed epiphytic lichens to the host tree species and beta and gamma lichen diversity at the forest stand level to the stand’s tree species composition and stem diameter. Picea abies hosted the highest lichen richness followed by Pinus sylvestris, Quercus robur, Alnus glutinosa, Betula spp., and Populus tremula. However, P. tremula hosted twice as many uncommon species as any of the other tree species. Stand level beta and gamma diversity was twice as high on stands with four compared to one tree species, and was highest when either coniferous or deciduous trees made up 40–50% of the trees. The stem diameter was positively related to lichen richness at the tree and stand level, but negatively to beta diversity. For biodiversity, these findings imply that leaving a few trees of a different species during forest thinning is unlikely as effective as combining life-boat trees for endangered species with an even tree species mixture.

Adapted tolerance to virus infections in four geographically distinct Varroa destructor-resistant honeybee populations

The ectoparasitic mite, Varroa destructor, is unarguably the leading cause of honeybee (Apis mellifera) mortality worldwide through its role as a vector for lethal viruses, in particular, strains of the Deformed wing virus (DWV) and Acute bee paralysis virus (ABPV) complexes. Several honeybee populations across Europe have well-documented adaptations of mite-resistant traits but little is known about host adaptations towards the virus infections vectored by the mite. The aim of this study was to assess and compare the possible contribution of adapted virus tolerance and/or resistance to the enhanced survival of four well-documented mite-resistant honeybee populations from Norway, Sweden, The Netherlands and France, in relation to unselected mite-susceptible honeybees. Caged adult bees and laboratory reared larvae, from colonies of these four populations, were inoculated with DWV and ABPV in a series of feeding infection experiments, while control groups received virus-free food. Virus infections were monitored using RT-qPCR assays in individuals sampled over a time course. In both adults and larvae the DWV and ABPV infection dynamics were nearly identical in all groups, but all mite-resistant honeybee populations had significantly higher survival rates compared to the mite-susceptible honeybees. These results suggest that adapted virus tolerance is an important component of survival mechanisms.

Trends in seabird breeding populations across the Great Barrier Reef

The Great Barrier Reef is an iconic ecosystem, known globally for its rich marine biodiversity that includes many thousands of tropical breeding seabirds. Despite indications of localized declines in some seabird species from as early as the mid-1990s, trends in seabird populations across the reef have never been quantified. With a long history of human impact and ongoing environmental change, seabirds are likely sentinels in this important ecosystem. Using 4 decades of monitoring data, we estimated site-specific trends for 9 seabird species from 32 islands and cays across the reef. Trends varied markedly among species and sites, but probable declines occurred at 45% of the 86 species-by-site combinations analyzed compared with increases at 14%. For 5 species, we combined site-specific trends into a multisite trend in scaled abundance, which revealed probable declines of Common Noddy (Anous stolidus), Sooty Tern (Onychoprion fuscatus), and Masked Booby (Sula dactylatra), but no long-term changes in the 2 most widely distributed species, Greater Crested Tern (Thalasseus bergii) and Brown Booby (Sula leucogaster). For Brown Booby, long-term stability largely resulted from increases at a single large colony on East Fairfax Island that offset declines at most other sites. Although growth of the Brown Booby population on East Fairfax points to the likely success of habitat restoration on the island, it also highlights a general vulnerability wherein large numbers of some species are concentrated at a small number of key sites. Identifying drivers of variation in population change across species and sites while ensuring long-term protection of key sites will be essential to securing the future of seabirds on the reef.

Virus Diversity and Loads in Crickets Reared for Feed: Implications for Husbandry

Insects generally have high reproductive rates leading to rapid population growth and high local densities; ideal conditions for disease epidemics. The parasites and diseases that naturally regulate wild insect populations can also impact when these insects are produced commercially, on farms. While insects produced for human or animal consumption are often reared under high density conditions, very little is known about the microbes associated with these insects, particularly those with pathogenic potential. In this study we used both target-free and targeted screening approaches to explore the virome of two cricket species commonly reared for feed and food, Acheta domesticus and Gryllus bimaculatus. The target-free screening of DNA and RNA from a single A. domesticus frass sample revealed that only 1% of the nucleic acid reads belonged to viruses, including known cricket, insect, bacterial and plant pathogens, as well as a diverse selection of novel viruses. The targeted screening revealed relatively high levels of Acheta domesticus densovirus, invertebrate iridovirus 6 and a novel iflavirus, as well as low levels of Acheta domesticus volvovirus, in insect and frass samples from several retailers. Our findings highlight the value of multiple screening approaches for a comprehensive and robust cricket disease monitoring and management strategy. This will become particularly relevant as-and-when cricket rearing facilities scale up and transform from producing insects for animal feed to producing insects for human consumption.

Navigating between the science and art of acute limb ischemia treatment

The diagnosis and treatment of acute limb ischemia (ALI) has long been a fierce adversary that has evolved over the last several decades with scientific advancements in endovascular therapy. History and physical examination remain the mainstay of diagnosis enhanced by detailed imaging to guide therapy. Many endovascular tools are available for prompt restoration of flow that compliment traditional surgical options. These devices incorporate the mechanical removal of thrombus and the chemical dissolution of thrombus . Medical decision-making for ALI patients must take into account the patient characteristics, anatomic variables, mechanism of ischemia, degree of ischemia, and operator skill to employ the right strategy for the right patient. This moving target challenges scientific study, making the therapeutic bedside decision making an artform. We present an overview of the field, supportive data, and a treatment algorithm that hopefully captures this delicate balance.

Patient Information Leaflets for Lumbar Spine Surgery: A Missed Opportunity

BACKGROUND

High-quality patient information is recommended to help reduce procedure-related anxiety and encourage patients to become active participants in their recovery. The objective of this study was to analyze the quality of patient information leaflets (PILs) given to National Health Service (NHS) patients ahead of lumbar spine surgery.

METHODS

The DISCERN tool was used to evaluate the quality of PILs, sourced from NHS websites.

RESULTS

Thirty-two PILs on lumbar surgery were included. Two (6%) leaflets were considered poor, 13 (41%) were marked as fair, 14 (44%) were of good quality, and 3 (9%) were scored as excellent. The total mean score was 55 (30-74), which corresponds to good quality. The lowest scoring questions were sources of information (Q4), balanced/unbiased content (Q6), and explanation of no treatment (Q12).

CONCLUSIONS

There is considerable variation in the quality of PILs provided ahead of lumbar spine surgery. The scope for improvement is clear, and as the move toward patient-centered, evidence-based care continues, it is important that hospital resources provide recommendations based upon evidence of clinical effectiveness.

Gene flow relates to evolutionary divergence among populations at the range margin

Background

Morphological differentiation between populations resulting from local adaptations to environmental conditions is likely to be more pronounced in populations with increasing genetic isolation. In a previous study a positive clinal variation in body size was observed in isolated Roesel’s bush-cricket, Metrioptera roeselii, populations, but were absent from populations within a continuous distribution at the same latitudinal range. This observational study inferred that there was a phenotypic effect of gene flow on climate-induced selection in this species.

Methods

To disentangle genetic versus environmental drivers of population differences in morphology, we measured the size of four different body traits in wild-caught individuals from the two most distinct latitudinally-matched pairs of populations occurring at about 60°N latitude in northern Europe, characterised by either restricted or continuous gene flow, and corresponding individuals raised under laboratory conditions.

Results

Individuals that originated from the genetically isolated populations were always bigger (femur, pronotum and genital appendages) when compared to individuals from latitudinally-matched areas characterised by continuous gene flow between populations. The magnitude of this effect was similar for wild-caught and laboratory-reared individuals. We found that previously observed size cline variation in both male and female crickets was likely to be the result of local genetic adaptation rather than phenotypic plasticity.

Conclusions

This strongly suggests that restricted gene flow is of major importance for frequencies of alleles that participate in climate-induced selection acting to favour larger phenotypes in isolated populations towards colder latitudes.

Why we should care about movements: Using spatially explicit integrated population models to assess habitat source-sink dynamics

Assessing the source–sink status of populations and habitats is of major importance for understanding population dynamics and for the management of natural populations. Sources produce a net surplus of individuals (per capita contribution to the metapopulation > 1) and will be the main contributors for self‐sustaining populations, whereas sinks produce a deficit (contribution < 1). However, making these types of assessments is generally hindered by the problem of separating mortality from permanent emigration, especially when survival probabilities as well as moved distances are habitat‐specific.

To address this long‐standing issue, we propose a spatial multi‐event integrated population model (IPM) that incorporates habitat‐specific dispersal distances of individuals. Using information about local movements, this IPM adjusts survival estimates for emigration outside the study area.

Analysing 24 years of data on a farmland passerine (the northern wheatear Oenanthe oenanthe), we assessed habitat‐specific contributions, and hence the source–sink status and temporal variation of two key breeding habitats, while accounting for habitat‐ and sex‐specific local dispersal distances of juveniles and adults. We then examined the sensitivity of the source–sink analysis by comparing results with and without accounting for these local movements.

Estimates of first‐year survival, and consequently habitat‐specific contributions, were higher when local movement data were included. The consequences from including movement data were sex specific, with contribution shifting from sink to likely source in one habitat for males, and previously noted habitat differences for females disappearing.

Assessing the source–sink status of habitats is extremely challenging. We show that our spatial IPM accounting for local movements can reduce biases in estimates of the contribution by different habitats, and thus reduce the overestimation of the occurrence of sink habitats. This approach allows combining all available data on demographic rates and movements, which will allow better assessment of source–sink dynamics and better informed conservation interventions.

Identification errors in camera-trap studies result in systematic population overestimation

Reliable assessments of animal abundance are key for successful conservation of endangered species. For elusive animals with individually-unique markings, camera-trap surveys are a benchmark standard for estimating local and global population abundance. Central to the reliability of resulting abundance estimates is the assumption that individuals are accurately identified from photographic captures. To quantify the risk of individual misidentification and its impact on population abundance estimates we performed an experiment under controlled conditions in which 16 captive snow leopards (Panthera uncia) were camera-trapped on 40 occasions and eight observers independently identified individuals and recaptures. Observers misclassified 12.5% of all capture occasions, resulting in systematically inflated population abundance estimates on average by one third (mean ± SD = 35 ± 21%). Our results show that identifying individually-unique individuals from camera-trap photos may not be as reliable as previously believed, implying that elusive and endangered species could be less abundant than current estimates indicate.

Demography, heritability and genetic correlation of feline hip dysplasia and response to selection in a health screening programme

Feline hip dysplasia (FHD) is a debilitating condition affecting the hip joints of millions of domestic cats worldwide. Despite this, little is known about FHD except that it is relatively common in the large breed Maine Coon. We used 20 years of data from 5038 pedigree-registered Maine Coon cats in a radiographic health screening programme for FHD to determine, for the first time, its heritability, genetic correlation to body mass and response to selection. FHD prevalence was 37.4%, with no sex predilection; however, FHD severity increased with age and body mass. Heritability of the radiographic categories used to classify FHD severity was 0.36 (95%CI: 0.30–0.43). The severity of FHD symptoms was also genetically correlated with body mass (0.285), suggesting that selection for a large body type in this breed concurrently selects for FHD. Support for this was found by following generational responses to selective breeding against FHD. Not only did selective breeding successfully reduce the severity of FHD symptoms in descendants, but these cats were also smaller than their ancestors (−33g per generation). This study highlights the value of breeding programmes against FHD and cautions against breed standards that actively encourage large bodied cats.

Factors influencing plasticity in the arrival-breeding interval in a migratory species reacting to climate change

Climate change is profoundly affecting the phenology of many species. In migratory birds, there is evidence for advances in their arrival time at the breeding ground and their timing of breeding, yet empirical studies examining the interdependence between arrival and breeding time are lacking. Hence, evidence is scarce regarding how breeding time may be adjusted via the arrival-breeding interval to help local populations adapt to local conditions or climate change. We used long-term data from an intensively monitored population of the northern wheatear (Oenanthe oenanthe) to examine the factors related to the length of 734 separate arrival-to-breeding events from 549 individual females. From 1993 to 2017, the mean arrival and egg-laying dates advanced by approximately the same amount (~5-6 days), with considerable between-individual variation in the arrival-breeding interval. The arrival-breeding interval was shorter for: (a) individuals that arrived later in the season compared to early-arriving birds, (b) for experienced females compared to first-year breeders, (c) as spring progressed, and (d) in later years compared to earlier ones. The influence of these factors was much larger for birds arriving earlier in the season compared to later arriving birds, with most effects on variation in the arrival-breeding interval being absent in late-arriving birds. Thus, in this population it appears that the timing of breeding is not constrained by arrival for early- to midarriving birds, but instead is dependent on local conditions after arrival. For late-arriving birds, however, the timing of breeding appears to be influenced by arrival constraints. Hence, impacts of climate change on arrival dates and local conditions are expected to vary for different parts of the population, with potential negative impacts associated with these factors likely to differ for early- versus late-arriving birds.

A Critical Analysis of the Exercise Prescription and Return to Activity Advice That Is Provided in Patient Information Leaflets Following Lumbar Spine Surgery

Background and objectives: Lumbar spine surgery may be considered if pharmacologic, rehabilitation and interventional approaches cannot provide sufficient recovery from low back-related pain. Postoperative physiotherapy treatment in England is often accompanied by patient information leaflets, which contain important rehabilitation advice. However, in order to be an effective instrument for patients, the information provided in these leaflets must be up to date and based on the best available evidence and clinical practice. This study aims to critically analyse the current postoperative aspects of rehabilitation (exercise prescription and return to normal activity) that are provided in patient information leaflets in England as part of an evaluation of current practice following lumbar spine surgery. Materials and Methods: Patient information leaflets from English National Health Service (NHS) hospitals performing lumbar spine surgery were sourced online. A content analysis was conducted to collect data on postoperative exercise prescription and return to normal activities. Results: Thirty-two patient information leaflets on lumbar surgery were sourced (fusion, n = 11; decompression, n = 15; all lumbar procedures, n = 6). Many of the exercises prescribed within the leaflets were not based on evidence of clinical best practice and lacked a relationship to functional activity. Return to normal activity advice was also wide ranging, with considerable variation in the recommendations and definitions provided. Conclusions: This study highlights a clear variation in the recommendations of exercise prescription, dosage and returning to normal activities following lumbar spine surgery. Future work should focus on providing a consistent and patient-centred approach to recovery.

An integrated management strategy to prevent outbreaks and eliminate infection pressure of American foulbrood disease in a commercial beekeeping operation

The bacterial disease American Foulbrood (AFB), caused by the Gram-positive bacterium Paenibacillus larvae, is considered the most contagious and destructive infectious disease affecting honeybees world-wide. The resilient nature of P. larvae bacterial spores presents a difficult problem for the control of AFB. Burning clinically symptomatic colonies is widely considered the only workable strategy to prevent further spread of the disease. Antibiotic use is banned in EU countries, and although used commonly in the U.S. and Canada, it only masks symptoms and does not prevent the further spread of the disease. Not surprisingly, there is an increased demand for chemical-free strategies to prevent and control of AFB. The aim of this study was to implement a management program with a long-term perspective to reduce infection pressure and eliminate AFB outbreaks. The study was conducted within a commercial beekeeping operation in central Sweden that has previously experienced reoccurring AFB outbreaks. For 5 years, P. larvae were cultured from adult bee samples taken in the fall. The following spring, any identified sub-clinically infected colonies were shaken onto new material and quarantined from the rest of the beekeeping operation. After the first year clinical symptoms were not again observed, and during the 5 years of the study the proportion of apiaries harbouring P. larvae spores decreased from 74% to 4%. A multinomial regression analysis also clearly demonstrated that the proportion of infected colonies with the highest levels of spore counts disproportionately declined so that by the end of the study the only remaining infected apiaries were in the lowest spore count category (the three higher spore count categories having been eradicated). These results demonstrate the importance of management practices on AFB disease epidemiology. Early detection of subclinical spore prevelance and quarantine management as presented here can provide an effective sustainable chemical-free preventive solution to reduce both the incidence of AFB outbreaks and continued transmission risk at a large-scale.

Approaching Ecological Sustainability in the Emerging Insects-as-Food Industry

The emerging insects-as-food industry is increasingly promoted as a sustainable alternative to other animal protein production systems. However, the exact nature of its environmental benefits are uncertain because of the overwhelming lack of knowledge concerning almost every aspect of production: from suitable species, their housing and feed requirements, and potential for accidental release. If ecological sustainability is to be a hallmark of mass insect rearing for consumption, ecologists need to engage in research related to sustainability criteria that are directly linked to key elements of the development of the industry. There is more to this subject than simply comparing feed-conversion ratios (FCRs) of insects to traditional livestock production, and we highlight areas where research needs to be immediately focused.

Disentangling olfactory and visual information used by field foraging birds

Foraging strategies of birds can influence trophic plant-insect networks with impacts on primary plant production. Recent experiments show that some forest insectivorous birds can use herbivore-induced plant volatiles (HIPVs) to locate herbivore-infested trees, but it is unclear how birds combine or prioritize visual and olfactory information when making foraging decisions. Here, we investigated attraction of ground-foraging birds to HIPVs and visible prey in short vegetation on farmland in a series of foraging choice experiments. Birds showed an initial preference for HIPVs when visual information was the same for all choice options (i.e., one experimental setup had all options with visible prey, another setup with hidden prey). However, if the alternatives within an experimental setup included visible prey (without HIPV) in competition with HIPV-only, then birds preferred the visual option over HIPVs. Our results show that olfactory cues can play an important role in birds' foraging choices when visual information contains little variation; however, visual cues are preferred when variation is present. This suggests certain aspects of bird foraging decisions in agricultural habitats are mediated by olfactory interaction mechanisms between birds and plants. We also found that birds from variety of dietary food guilds were attracted to HIPVs; hence, the ability of birds to use plant cues is probably more general than previously thought, and may influence the biological pest control potential of birds on farmland.

Quantifying the links between land use and population growth rate in a declining farmland bird

Land use is likely to be a key driver of population dynamics of species inhabiting anthropogenic landscapes, such as farmlands. Understanding the relationships between land use and variation in population growth rates is therefore critical for the management of many farmland species. Using 24 years of data of a declining farmland bird in an integrated population model, we examined how spatiotemporal variation in land use (defined as habitats with "Short" and "Tall" ground vegetation during the breeding season) and habitat-specific demographic parameters relates to variation in population growth taking into account individual movements between habitats. We also evaluated contributions to population growth using transient life table response experiments which gives information on contribution of past variation of parameters and real-time elasticities which suggests future scenarios to change growth rates. LTRE analyses revealed a clear contribution of Short habitats to the annual variation in population growth rate that was mostly due to fledgling recruitment, whereas there was no evidence for a contribution of Tall habitats. Only 18% of the variation in population growth was explained by the modeled local demography, the remaining variation being explained by apparent immigration (i.e., the residual variation). We discuss potential biological and methodological reasons for high contributions of apparent immigration in open populations. In line with LTRE analysis, real-time elasticity analysis revealed that demographic parameters linked to Short habitats had a stronger potential to influence population growth rate than those of Tall habitats. Most particularly, an increase of the proportion of Short sites occupied by Old breeders could have a distinct positive impact on population growth. High-quality Short habitats such as grazed pastures have been declining in southern Sweden. Converting low-quality to high-quality habitats could therefore change the present negative population trend of this, and other species with similar habitat requirements.

When significance becomes insignificant: Effect sizes and their uncertainties in Bayesian and frequentist frameworks as an alternative approach when analyzing ecotoxicological data

Bayesian methods and frequentist confidence intervals are proposed as an alternative approach in ecotoxicology, emphasizing effect sizes and associated (un)certainties to judge the biological relevance of effects instead of basing decisions on p values. These approaches show advantages over null hypothesis significance testing. In particular, Bayesian methods revealed more potential than frequentist counterparts, as the posterior distribution and its credible intervals can be directly interpreted as the probability of effect sizes. Environ Toxicol Chem 2018;37:1949-1955. © 2018 SETAC.

A novel clinical framework: The use of dispositions in clinical practice. A person centred approach

This paper explores a novel clinical framework that is underpinned by a specific philosophical perspective of causation and its utility in clinical practice. A dispositional theory of causation may overcome challenges that clinicians face in complex clinical presentations including those that are medically unexplained. Dispositionalism identifies causes not as regular events necessitating an effect but rather phenomena, which are highly complex, context-sensitive, and which tend toward an effect. Diagnostic uncertainty and causal explanation are significant challenges in terms of clinical reasoning, communication, and the overall therapeutic outcome. This novel framework aims to facilitate improved collaborative clinical reasoning, enhanced patient-practitioner interaction, and supported treatment planning. The paper uses a real case study of a patient with nonspecific spinal pain to demonstrate the clinical framework as used in clinical practice.

Constraining Quirky Tracks with Conventional Searches

Quirks are particles that are charged both under the standard model and under a new confining group. The quirk setup assumes there are no light flavors of the new confining group, so that while the theory is in a confining phase, the quirk-antiquirk distance can be macroscopic. In this Letter, we reinterpret existing collider limits, those from monojet and heavy stable charged particle searches, as limits on quirks. Additionally, we propose a new search in the magnetic-field-less CMS data for quirks and estimate the sensitivity. We focus on the region where the confinement scale is roughly between 1 and 100 eV and find mass constraints in the TeV range, depending on the quirk's quantum numbers.