Exploring the role of nature-based typologies and stewardship schemes in enhancing urban green spaces: Citizen perceptions of landscape design scenarios and ecosystem services.

This research investigates the UK citizens' perceptions of the ecosystem services (ES) created using a range of Nature-Based Solutions (NBS) in urban green spaces (UGS). The longevity of the ES derived from UGS is dependent on the effective on-going maintenance of urban landscapes, therefore this paper also gathers data on direct UGS participation specifically through the lens of civic stewardship to assess the impact of such schemes upon ES. NBS typologies were created and used, in the mixed methods study, to gauge perceptions of and preferences for alternative urban landscape design. The UGS survey collected data from 345 respondents on ES and the NBS typologies. Twelve semi-structured interviews provide qualitative data on NBS typology preferences, perceptions, and understanding of ES as well as motivations behind civic engagement in UGS in the UK. Stewardship programmes were found to increase community resilience by providing additional ES. The results showed a preference for integrating complex, multifunctional UGS into the fabric of urban centres to ensure accessibility and to maximise engagement. More complex NBS typologies were perceived to provide additional ES when compared with traditional monoculture mown grass and shrub amenity planting. Mixed native planting and Tiny Forest NBS typologies were perceived as providing more provisioning, cultural, regulating, and supporting ES. Considering both UK citizens' perceptions of the ES gained from alternative NBS and stewardship schemes in UGS represents a holistic approach that can improve the design and management of NBS in cities. This study is the first to explore both concepts in the UK and suggests a holistic UGS approach to address urban challenges, including those related to Climate Change.

Perinucleolar Compartment (PNC) Prevalence as an Independent Prognostic Factor in Pediatric Ewing Sarcoma: A Multi-Institutional Study.

The perinucleolar compartment (PNC) is a small nuclear body that plays important role in tumorigenesis. PNC prevalence correlates with poor prognosis and cancer metastasis. Its expression in pediatric Ewing sarcoma (EWS) has not previously been documented. In this study, we analyzed 40 EWS tumor cases from Caucasian and Hispanic patients for PNC prevalence by immunohistochemical detection of polypyrimidine tract binding protein and correlated the prevalence with dysregulated microRNA profiles. EWS cases showed staining ranging from 0 to 100%, which were categorized as diffuse (≥77%, n = 9, high PNC) or not diffuse (<77%, n = 31) for low PNC. High PNC prevalence was significantly higher in Hispanic patients from the US (n = 6, p = 0.017) and in patients who relapsed with metastatic disease (n = 4; p = 0.011). High PNC was associated with significantly shorter disease-free survival and early recurrence compared to those with low PNC. Using NanoString digital profiling, high PNC tumors revealed upregulation of eight and downregulation of 18 microRNAs. Of these, miR-320d and miR-29c-3p had the most significant differential expression in tumors with high PNC. In conclusion, this is the first study that demonstrates the presence of PNC in EWS, reflecting its utility as a predictive biomarker associated with tumor metastasis, specific microRNA profile, Hispanic ethnic origin, and poor prognosis.

Travel attitudes or behaviours: Which one changes when they conflict?

In recent years, there has been a resurgence of interest in the 'disagreement' or dissonance between travel attitudes and behaviours. This has shown that when people experience travel-related dissonance they are less satisfied with their travel experience. However, what remains unclear is whether people experiencing dissonance are more likely to change their travel attitude or their behaviour, so that they are more closely aligned. Moreover, it is unclear whether and how life events, such as having a child, interact with creating or reducing travel-related dissonance. Using data from a large and well-designed longitudinal study, this paper addresses these two gaps in the literature on travel-related cognitive dissonance through an exploratory study. The findings suggest that dissonant travellers are more likely to change their segment membership than consonant travellers. Furthermore, in line with the theory of cognitive dissonance, people may adjust either their attitudes or behaviours to achieve a state of consonance. This suggests that policymakers should not only focus on subtle nudges aimed at changing attitudes (and subsequently behaviours) in desirable directions but also on implementing policies aimed at directly influencing behaviours, assuming that attitudes will follow.

Preoperative Considerations for the Frail Patient.

Frailty is a common geriatric syndrome, the relevance of which is becoming increasingly apparent in the clinical setting. It is often accompanied by varying degrees of sarcopenia and/or osteoporosis, leading to a decline in physical function, decreased levels of physical activity, and overall poorer health outcomes in older adults. Identifying this cohort of patients before stressor events such as spinal surgery can prove paramount to improving the postoperative outcomes of these patients. This review provides a pertinent descriptive analysis to aid identification of frailty in a clinical setting, in addition to outlining methods of preoperative intervention that may improve postoperative outcomes.

The diagnostic and prognostic value of artificial intelligence and artificial neural networks in spinal surgery : a narrative review.

In recent years, machine learning (ML) and artificial neural networks (ANNs), a particular subset of ML, have been adopted by various areas of healthcare. A number of diagnostic and prognostic algorithms have been designed and implemented across a range of orthopaedic sub-specialties to date, with many positive results. However, the methodology of many of these studies is flawed, and few compare the use of ML with the current approach in clinical practice. Spinal surgery has advanced rapidly over the past three decades, particularly in the areas of implant technology, advanced surgical techniques, biologics, and enhanced recovery protocols. It is therefore regarded an innovative field. Inevitably, spinal surgeons will wish to incorporate ML into their practice should models prove effective in diagnostic or prognostic terms. The purpose of this article is to review published studies that describe the application of neural networks to spinal surgery and which actively compare ANN models to contemporary clinical standards allowing evaluation of their efficacy, accuracy, and relatability. It also explores some of the limitations of the technology, which act to constrain the widespread adoption of neural networks for diagnostic and prognostic use in spinal care. Finally, it describes the necessary considerations should institutions wish to incorporate ANNs into their practices. In doing so, the aim of this review is to provide a practical approach for spinal surgeons to understand the relevant aspects of neural networks. Cite this article: Bone Joint J 2021;103-B(9):1442-1448.

Exploring 12-Year trends in childhood obesity prevalence for the Republic of Ireland - a national study using survey data from 2002 and 2014.

Background: The prevalence of overweight and obesity among children may have reached a plateau in some developed countries, including Ireland. The aim of this study was to examine 12-year trends in the prevalence of overweight and obesity among primary-school-aged children in the Republic of Ireland between 2002 and 2014. Methods: Two large-scale oral health cross-sectional surveys of primary-school-aged children aged 4-13 years were conducted 12 years apart in 2002 (n=14,055; response rate=68%) and 2014 (n=5,223; response rate=67%). Both surveys included standardised and calibrated height and weight measures. Ownership of a means-tested medical card determined economic status. Standard International Obesity Task Force criteria were applied to determine the prevalence of overweight and obesity. Results: The overall prevalence of overweight/obesity among 4-13-year-olds significantly decreased from 26% (95% CI: 25.1%-26.5%) in 2002 to 24% (95% CI: 22.4%-24.7%) in 2014. Among boys and girls aged 4-13 years, the significant decrease was from 23% (95% CI: 22.1%-24.1%) to 20% (95% CI: 18.9%-22.0 and 28% (95% CI: 27.4%-29.5%) to 27% (95% CI: 25.0%-28.4%), respectively. Among 5-year-old children, the overall prevalence of overweight and obesity significantly decreased from 25% (95% CI: 23.7%-26.2%) to 22% (95% CI: 19.9%-23.4%). In 2002, the estimated prevalence of overweight/obesity was similar in children with and without medical cards, whereas in 2014, overall prevalence was higher in those with medical cards.  Conclusions: Results suggest a fall in the prevalence of overweight/obesity between 2002 and 2014, and may suggest a favourable cohort effect. Despite this fall, the overall prevalence remains high and socioeconomic disparities have increased.

Pushed back, pulled forward: Exploring the impact of COVID-19 on young adults' life plans and future mobility.

The COVID-19 pandemic has caused unprecedented disruption to how people live, work and travel. There has been a recent outburst of research on the short-term impacts that the pandemic has had on travel behaviour. However, the long-term impact of the pandemic on travel behaviour is still uncertain and difficult to predict. In particular, young adults are facing some of the most significant disruptions from the pandemic; these disruptions are likely to have long-term impacts on their lives. This study aims to unpack the direct and indirect effects that COVID-19 may have on the travel behaviour of young adults. It does this through in-depth interviews with 26 young adults living in Melbourne and Victoria, Australia. Interviews suggest that while the pandemic has had significant impacts on the short-term travel behaviour of all young adults, the long-term impacts are more complex and mediated by how they are moving through key life milestones. Many respondents are relatively unimpacted by the pandemic. Others have faced a significant disruption to their lives. Those who had planned to live or work overseas have found their life plans 'accelerated', which may also accelerate their dependence on the car. In contrast, those who have lost work are facing a significant delay to their life plans. We propose a framework for how COVID-19 may directly and indirectly impact travel behaviour in the short- and long-term. The strongest impacts on mobility, through changes to life stage transitions, are indirect and unevenly spread across the population of young adults.

Application of 2016 WHO classification in the diagnosis of paediatric high-grade MYC-negative mature B-cell lymphoma with Burkitt-like morphological features.

AIMS: Historically, there has been no consensus on the diagnostic classification of high-grade B-cell lymphoma (HGBCL) with morphological features of Burkitt lymphoma (BL) but no MYC gene rearrangement (MYC-negative). The 2016 WHO classification of tumours of haematopoietic and lymphoid tissues has shed some light on this field with the modification of the grey-zone lymphoma with features intermediate between BL and diffuse large B-cell lymphoma, and the creation of several new entities. The aim of this study was to investigate how the revised WHO classification affects our practice in diagnosing these lymphomas in children. METHODS: We retrospectively reviewed cases of mature HGBCL diagnosed at our hospital between 2015 and 2018. RESULTS: Among 14 mature HGBCL cases with BL morphological features, 11 showed MYC rearrangement consistent with BL and 3 were MYC-negative. Two MYC-negative cases showed regions of 11q gain and loss by microarray consistent with Burkitt-like lymphoma with 11q aberration (BLL-11q). The third MYC-negative case showed diffuse and strong MUM1 expression, translocation involving 6p25 by chromosome analysis and IRF4 rearrangement by fluorescence in situ hybridisation analysis consistent with large B-cell lymphoma with IRF4 rearrangement (LBL-IRF4). All patients were treated according to applicable chemotherapeutic protocols and achieved remission. CONCLUSIONS: BLL-11q and LBL-IRF4, two newly defined entities, should be considered in paediatric MYC-negative mature HGBCL cases. Accurate diagnosis needs careful histopathological examination and proper cytogenetic testing. Since they have unique cytogenetic features, specific treatments for them may emerge in the future. Therefore, accurate diagnosis based on the 2016 WHO classification is clinically significant.

Neuroblastoma in Adolescents and Children Older than 10 Years: Unusual Clinicopathologic and Biologic Features.

Neuroblastoma (NB) in children older than 10 years is rare. We reviewed our archives for patients with NB aged 10 to 18 years and summarized their clinicopathologic/genetic records. Of 96 patients, 4 patients were identified in this age group. Four tumors were abdominal; 1 patient had 2 tumors at diagnosis, one of which was presacral. Tumor sizes ranged from 3 to 20 cm. All tumors were high risk at clinical stages 3 and 4, with metastasis to bone marrow and other areas. Four tumors were poorly differentiated with unfavorable histology and one patient with bilateral adrenal disease had an intermixed ganglioneuroblastoma on one side. Another tumor exhibited pheochromocytoma-like morphology. MYCN amplification was present in bone marrow metastasis in one case. Complex chromosomal gains and 19p deletions were common. Exome sequencing revealed ALK variants in 2 cases and previously unreported MAGI2, RUNX1, and MLL mutations. All patients received standard chemotherapy and 2 patients received ALK-targeted trial therapy. Three patients died of disease, ranging 18 to 23 months after diagnosis. One patient has active disease and is receiving trial therapy. In conclusion, NB in children older than 10 years may exhibit unusual clinicopathologic and genetic features with large tumors, bilateral adrenal disease, rare morphologic features, complex DNA microarray findings and novel mutations. Patients often have grim prognoses despite genomic profiling-guided targeted therapy.

Treatment Effect and Safety of Icatibant in Pediatric Patients with Hereditary Angioedema.

BACKGROUND: Clinical manifestations of hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE) usually begin in childhood, often intensifying during puberty. Currently there are insufficient efficacy/safety data for HAE therapies in children and adolescents due to the small number of pediatric patients enrolled in studies. OBJECTIVE: The objective of this phase 3 study was to evaluate the efficacy/safety of a single subcutaneous dose of icatibant (0.4 mg/kg; maximum 30 mg) in pediatric patients with C1-INH-HAE. METHODS: Patients aged 2 years to younger than 18 years were categorized as prepubertal (children) and pubertal/postpubertal (adolescents). The primary end point was time to onset of symptom relief-earliest time posttreatment to 20% or more improvement in composite symptom score. RESULTS: Thirty-two patients received icatibant (safety population: 11 children with attack, 10 adolescents without attack, and 11 adolescents with attack). The efficacy population consisted of 11 children and 11 adolescents with edematous attacks. Most attacks in the efficacy population (16 [72.7%]) were cutaneous, 5 (22.7%) were abdominal, and 1 (4.5%) was both cutaneous and abdominal; none was laryngeal. Overall, the median time to onset of symptom relief was 1.0 hour, the same for children and adolescents. Thirty-two treatment-emergent adverse events (all mild or moderate) occurred in 9 (28.1%) patients. Gastrointestinal symptoms were most common (9 events in 3 [9.4%] patients). Injection-site reactions affected most (90.6%) patients (particularly erythema and swelling), but almost all resolved by 6 hours postdose. Icatibant demonstrated a monophasic plasma concentration-time profile. Time to peak concentration was approximately 0.5 hours postdose. CONCLUSIONS: Symptom relief was rapid, and a single icatibant injection in pediatric patients with C1-INH-HAE was well tolerated (ClinicalTrials.gov identifier, NCT01386658).

Effects of semantic context on access to words of low imageability in deep-phonological dysphasia: a treatment case study.

BACKGROUND: Deep dysphasia is a relatively rare subcategory of aphasia, characterised by word repetition impairment and a profound auditory-verbal short-term memory (STM) limitation. Repetition of words is better than nonwords (lexicality effect) and better for high-image than low-image words (imageability effect). Another related language impairment profile is phonological dysphasia, which includes all of the characteristics of deep dysphasia except for the occurrence of semantic errors in single word repetition. The overlap in symptoms of deep and phonological dysphasia has led to the hypothesis that they share the same root cause, impaired maintenance of activated representation of words, but that they differ in severity of that impairment, with deep dysphasia being more severe. AIMS: We report a single-subject multiple baseline, multiple probe treatment study of a person who presented with a pattern of repetition that was consistent with the continuum of deep-phonological dysphasia: imageability and lexicality effects in repetition of single and multiple words and semantic errors in repetition of multiple-word utterances. The aim of this treatment study was to improve access to and repetition of low-imageability words by embedding them in modifier-noun phrases that enhanced their imageability. METHODS & PROCEDURES: The treatment involved repetition of abstract noun pairs. We created modifier-abstract noun phrases that increased the semantic and syntactic cohesiveness of the words in the pair. For example, the phrases "long distance" and "social exclusion" were developed to improve repetition of the abstract pair "distance-exclusion". The goal of this manipulation was to increase the probability of accessing lexical and semantic representations of abstract words in repetition by enriching their semantic -syntactic context. We predicted that this increase in accessibility would be maintained when the words were repeated as pairs, but without the contextual phrase. OUTCOMES & RESULTS: Treatment outcomes indicated that increasing the semantic and syntactic cohesiveness of low-imageability and low-frequency words later improved this participant's ability to repeat those words when presented in isolation. CONCLUSIONS: This treatment approach to improving access to abstract word pairs for repetition was successful for our participant with phonological dysphasia. The approach exemplifies the potential value in manipulating linguistic characteristics of stimuli in ways that improve access between phonological and lexical-semantic levels of representation. Additionally, this study demonstrates how principles of a cognitive model of word processing can be used to guide treatment of word processing impairments in aphasia.

Infantile Feeding Difficulties: It Is Not Always Reflux.

Background. Gastric volvulus refers to a torsion of all or part of the stomach that may cause an obstruction of the foregut. The clinical symptoms of gastric volvulus range from asymptomatic to life-threatening and thus must be rapidly diagnosed. However, the presenting symptoms of gastric volvulus vary widely, which may cause diagnosis to be delayed or missed. Objective. Describe varying presentations of gastric volvulus (including a case report of a rare presentation), pathophysiology of the entity, and how to diagnose/treat the phenomenon. Design/Method. Article review and case presentation. Results. Our patient was taken to the operating room for a gastropexy and G-tube placement. During surgery, the stomach was redundant and large, but not currently torsed, consistent with intermittent organoaxial volvulus. There are several approaches to classifying gastric volvulus as well as different theories on how to treat the volvulus based on type and degree of rotation that this article aims to detail more thoroughly. Conclusion. There are a growing number of case reports describing gastric volvulus, which had historically been viewed as a rare finding. The presenting symptoms of gastric volvulus commonly mimic other, more benign newborn diagnoses, and thus can be difficult to diagnose. We present our patient as well as an article review of other cases to highlight the diverse presentations of gastric volvulus so this potentially devastating disease can be diagnosed quickly with prompt treatment initiation.

A simple protocol for assessing inter-trial and inter-examiner reliability for two noninvasive measures of limb muscle strength.

Noninvasive measures of limb muscle strength are quite useful in preclinical translational studies that use mouse models of muscle disease, peripheral nerve disease, and movement disorders. The present study uses a simple protocol for assessing both inter-trial and inter-examiner reliability for two noninvasive methods of assessing limb strength in dystrophic (mdx) and wild type mice. One method, termed the whole body tension (WBT) method or escape test, measures the total phasic pulling tension exerted by the fore- and hindlimbs while a mouse attempts to escape into a darkened tube. Another procedure, termed the four limb wire grid holding test, measures the minimal amount of sustained tension (physical impulse) exerted by the fore- and hindlimbs while the mouse hangs suspended in an upside-down position. A comparison of the two methods revealed significant inter-trial and inter-examiner correlations in each procedure, although the WBT procedure consistently produced higher correlations than the four limb wire grid holding test. Inter-trial reliability for each test was higher than inter-examiner reliability, indicating that each longitudinal series of tests is best performed by a single investigator. The holding test also did not consistently detect differences between wild type and mdx populations at ages greater than 4 months. These results demonstrate the utility of a simple protocol for assessing the reliability of noninvasive tests that measure limb strength, and should be useful in comparing different functional measures in a broad range of translational studies.

A new process for organizing assessments of social, economic, and environmental outcomes: case study of wildland fire management in the USA.

Ecological risk assessments typically are organized using the processes of planning (a discussion among managers, stakeholders, and analysts to clarify ecosystem management goals and assessment scope) and problem formulation (evaluation of existing information to generate hypotheses about adverse ecological effects, select assessment endpoints, and develop an analysis plan). These processes require modification to be applicable for integrated assessments that evaluate ecosystem management alternatives in terms of their ecological, economic, and social consequences.We present 8 questions that define the steps of a new process we term integrated problem formulation (IPF), and we illustrate the use of IPF through a retrospective case study comparing 2 recent phases of development of the Fire Program Analysis (FPA) system, a planning and budgeting system for the management of wildland fire throughout publicly managed lands in the United States. IPF extends traditional planning and problem formulation by including the explicit comparison of management alternatives, the valuation of ecological, economic and social endpoints, and the combination or integration of those endpoints. The phase 1, limited prototype FPA system used a set of assessment endpoints of common form (i.e., probabilities of given flame heights over acres of selected land-resource types), which were specified and assigned relative weights at the local level in relation to a uniform national standard. This approach was chosen to permit system-wide optimization of fire management budget allocations according to a cost-effectiveness criterion. Before full development, however, the agencies abandoned this approach in favor of a phase 2 system that examined locally specified (rather than system-optimized) allocation alternatives and was more permissive as to endpoint form. We demonstrate how the IPF process illuminates the nature, rationale, and consequences of these differences, and argue that its early use for the FPA system may have enabled a smoother development path.