A checklist of chiggers from Brazil, including new records (Acari: Trombidiformes: Trombiculidae and leeuwenhoekiidae)

A checklist of the family Trombiculidae and Leeuwenhoekiidae is presented, containing 63 species in 30 genera of chiggers from 80 different hosts and 146 localities in Brazil. The type locality and depository are provided, including new locality and host records for the country

The occurrence of ecto-parasitic Leptus sp. mites on Africanised honey bees

Honey bee-mite-pathogen associations have led to the widespread collapse of Apis mellifera colonies in various parts of the world. The global trade in bees continues to expose honey bees to new pests and pathogens. Here we highlight to the beekeeping community a potential new mite-pathogen association. In South America ecto-parasitic Leptus mite larvae have been recorded parasitising adult honey bees and these mites are known to transmit Spiroplasma bacteria the causative agent of 'Mays disease' in bees. Here we provide new data and review past studies on Leptus mites and discuss the potential risk to A. mellifera this mite may pose in the future

The use of adjustable gastric bands for management of severe and complex obesity

BACKGROUND: Obesity levels in the UK have reached a sustained high and ∼4% of the population would be candidates for bariatric surgery based upon current UK NICE guidelines, which has important implications for Clinical Commissioning Groups. SOURCES OF DATA: Summary data from Cochrane systematic reviews, randomized controlled trials (RCTs) and cohort studies. AREAS OF AGREEMENT: Currently, the only treatment that offers significant and durable weight loss for those with severe and complex obesity is surgery. Three operations account for 95% of all bariatric surgery in the UK, but the NHS offers surgery to only a small fraction of those who could benefit. Laparoscopic adjustable gastric banding (gastric banding) has potentially the lowest risk and up-front costs of the three procedures. AREAS OF CONTROVERSY: Reliable Level 1 evidence of the relative effectiveness of the operations is lacking. GROWING POINTS: As a point intervention, weight loss surgery together with the chronic disease management strategy for obesity can prevent significant future disease and mortality, and the NHS should embrace both. AREAS TIMELY FOR DEVELOPING RESEARCH: Better RCT evidence is needed including clinical effectiveness and economic analysis to answer the important question ‘which is the best of the three operations most frequently performed?’ This review considers the current evidence for gastric banding for the treatment of severe and complex obesity

Sampling Effort and Uncertainty in Leaf Litterfall Mass and Nutrient Flux in Northern Hardwood Forests

Designs for litterfall sampling can be improved by understanding the sources of uncertainty in litterfall mass and nutrient concentration. We compared the coefficient of variation of leaf litterfall mass and nutrient concentrations (nitrogen, phosphorus, calcium, magnesium, and potassium) at different spatial scales and across years for six northern hardwood species from 23 stands in the White Mountains of New Hampshire, USA. Stands with steeper slopes (P = 0.01), higher elevations (P = 0.05), and more westerly aspect (P = 0.002) had higher interannual variation in litter mass, probably due to a litter trap design that allowed litter to blow into traps in windy years. The spatial variation of nutrient concentrations varied more across stands than within stands for all elements (P \u3c 0.001). Phosphorus was the most spatially variable of all nutrients across stands (P \u3c 0.001). Litter nutrient concentrations varied less from year to year than litter mass, but the magnitude of difference depended on the element and tree species. We compared the relative importance of variation in mass vs. concentration to estimates of nutrient flux by simulating different sampling intensities of one while holding the other constant. In this dataset, interannual variability of leaf litter mass contributed more to uncertainty in litterfall flux calculations than interannual variation in nutrient concentrations. Optimal sampling schemes will depend on the elements of interest and local factors affecting spatial and temporal variability

Enabling recruitment success in bariatric surgical trials: pilot phase of the By-Band-Sleeve study

This is the final version. Available on open access from Springer Nature via the DOI in this recordData availability: The data (transcripts) that support the findings of this study are available on request from the corresponding author. The data are not publicly available because of them containing information that could compromise privacy/consent, but the authors will be able to consider specific requests on a case-by-case basis.BACKGROUND: Randomized controlled trials (RCTs) involving surgical procedures are challenging for recruitment and infrequent in the specialty of bariatrics. The pilot phase of the By-Band-Sleeve study (gastric bypass versus gastric band versus sleeve gastrectomy) provided the opportunity for an investigation of recruitment using a qualitative research integrated in trials (QuinteT) recruitment intervention (QRI). PATIENTS/METHODS: The QRI investigated recruitment in two centers in the pilot phase comparing bypass and banding, through the analysis of 12 in-depth staff interviews, 84 audio recordings of patient consultations, 19 non-participant observations of consultations and patient screening data. QRI findings were developed into a plan of action and fed back to centers to improve information provision and recruitment organization. RESULTS: Recruitment proved to be extremely difficult with only two patients recruited during the first 2 months. The pivotal issue in Center A was that an effective and established clinical service could not easily adapt to the needs of the RCT. There was little scope to present RCT details or ensure efficient eligibility assessment, and recruiters struggled to convey equipoise. Following presentation of QRI findings, recruitment in Center A increased from 9% in the first 2 months (2/22) to 40% (26/65) in the 4 months thereafter. Center B, commencing recruitment 3 months after Center A, learnt from the emerging issues in Center A and set up a special clinic for trial recruitment. The trial successfully completed pilot recruitment and progressed to the main phase across 11 centers. CONCLUSIONS: The QRI identified key issues that enabled the integration of the trial into the clinical setting. This contributed to successful recruitment in the By-Band-Sleeve trial-currently the largest in bariatric practice-and offers opportunities to optimize recruitment in other trials in bariatrics.National Institute for Health Research Health Technology Assessment ProgrammeMedical Research Council (MRC

A Core Outcome Set for the Benefits and Adverse Events of Bariatric and Metabolic Surgery:the BARIACT project

BackgroundBariatric and metabolic surgery is used as a treatment for patients with severe and complex obesity. However, there is a need to improve outcome selection and reporting in bariatric surgery trials. A Core Outcome Set (COS), an agreed minimum set of outcomes reported in all studies of a specific condition, may achieve this. Here, we present the development of a COS for BARIAtric and metabolic surgery Clinical Trials-the BARIACT Study.Methods and findingsOutcomes identified from systematic reviews and patient interviews informed a questionnaire survey. Patients and health professionals were surveyed three times and asked to rate the importance of each item on a 1-9 scale. Delphi methods provided anonymised feedback to participants. Items not meeting predefined criteria were discarded between rounds. Remaining items were discussed at consensus meetings, held separately with patients and professionals, where the COS was agreed. Data sources identified 2,990 outcomes, which were used to develop a 130-item questionnaire. Round 1 response rates were moderate but subsequently improved to above 75% for other rounds. After rounds 2 and 3, 81 and 14 items were discarded, respectively, leaving 35 items for discussion at consensus meetings. The final COS included nine items: "weight," "diabetes status," "cardiovascular risk," "overall quality of life (QOL)," "mortality," "technical complications of the specific operation," "any re-operation/re-intervention," "dysphagia/regurgitation," and "micronutrient status." The main limitation of this study was that it was based in the United Kingdom only.ConclusionsThe COS is recommended to be used as a minimum in all trials of bariatric and metabolic surgery. Adoption of the COS will improve data synthesis and the value of research data. Future work will establish methods for the measurement of the outcomes in the COS

Bariatric surgery provision in response to the COVID-19 pandemic: retrospective cohort study of a national registry

Background When surgery resumed following outbreak of the COVID-19 pandemic, guidelines recommended the prioritization of patients with greater obesity-related comorbidity and/or higher Body Mass Index (BMI). Objectives The aim of this study was to record the effect of the pandemic on total number, patient demographic and peri-operative outcomes of elective bariatric surgery in the United Kingdom. Setting and Method The United Kingdom National Bariatric Surgical Registry was used to identify patients that underwent elective bariatric surgery during the pandemic (one year from 1st April 2020). Characteristics of this group were compared with a pre-pandemic cohort. Primary outcomes were case volume, case-mix and provider. National Health Service (NHS) cases were analyzed for baseline health status and peri-operative outcomes. Chi-square, Fisher’s exact or Student’s t-test were used as appropriate. Results Total number of cases reduced to one third of pre-pandemic volume (8615 to 2930). Operating volume reduction varied, with thirty-six (45%) hospitals experiencing a 75-100% reduction. Cases performed in the NHS fell from 74% to 53% (p<0.0001). There was no change in baseline BMI (45.2 kg/m2 ± 8.3 from 45.5 kg/m2 ± 8.3; p=0.228) or prevalence of Type 2 Diabetes Mellitus (26% from 26%; p=0.999. Length of stay (median 2 days) and surgical complication rate (1.4% from 2.0%; RR 0.71 (95% CI 0.45 – 1.12); p=0.133) were unchanged. Conclusions In the context of a dramatic reduction in elective bariatric surgery due to the COVID-19 pandemic, patients with more severe comorbidity were not prioritized for surgery. These findings should inform preparation for future crises

Recommendations on the most suitable quality-of-life measurement instruments for bariatric and body contouring surgery:a systematic review

Objective: The objective of this study is to systematically assess the quality of existing patient-reported outcome measures developed and/or validated for Quality of Life measurement in bariatric surgery (BS) and body contouring surgery (BCS). Methods: We conducted a systematic literature search in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Database Systematic Reviews and CENTRAL identifying studies on measurement properties of BS and BCS Quality of Life instruments. For all eligible studies, we evaluated the methodological quality of the studies by using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and the quality of the measurement instruments by applying quality criteria. Four degrees of recommendation were assigned to validated instruments (A–D). Results: Out of 4,354 articles, a total of 26 articles describing 24 instruments were included. No instrument met all requirements (category A). Seven instruments have the potential to be recommended depending on further validation studies (category B). Of these seven, the BODY-Q has the strongest evidence for content validity in BS and BCS. Two instruments had poor quality in at least one required quality criterion (category C). Fifteen instruments were minimally validated (category D). Conclusion: The BODY-Q, developed for BS and BCS, possessed the strongest evidence for quality of measurement properties and has the potential to be recommended in future clinical trials