The eocene flora of Svalbard and its climatic significance

Fossil plant remains are preserved within the deposits of the Eocene Aspelintoppen Formation on Svalbard. These sediments form the youngest continental deposits of early Paleogene age. The Aspelintoppen Formation sediments represent crevasse splay, backswamp and ephemeral lake deposits that represent a broad lowland floodplain that was subject to frequent flooding. The forests grew at a palaeolatitude of 75°N. New collections (1032 specimens) ofthe Aspelintoppen Formation flora are dominated by angiosperms including the Fagaceae? (Ushia olafsenii), Betulaceae (Corylites and Craspedodromophyllum), Hamamelidaceae (Platimelis pterospermoides), Platanaceae (Platimeliphyllum and Platanus), Ulmaceae (Ulmites ulmifolius), Trochodendraceae (Zizyphoides flabella), Cercidiphyllaceae Trochodendroides), Juglandaceae (Juglans laurifolia) and Hippocastinaceae (Aesculus longipedunculus). In addition, conifer fossils include Metasequoia shoots and cones, as well as Thuja shoots. Fern fronds of Osmunda and Coniopteris are present, along with the horsetail Equisetum. The Aspelintoppen Formation vegetation grew locally on the floodplain with angiosperms dominating the riparian environment and a mixed angiosperm Metasequoia-dominated flora in the backswamp environment, with Equisetum and ferns occupying the margins of ephemeral lakes and post-disturbance environments. The Aspelintoppen Formation flora is similar in composition and ecology to other early Paleogene Arctic floras from the Canadian Arctic, Greenland, Alaska and north-east Russia, showing that Polar Broadleaved Deciduous Forests were a dominant part of the Arctic environment. Palaeoclimate estimates were derived from the 22 angiosperm morphotypes using both physiognomic and nearest living relative methods. CLAMP results are considered to be the most reliable and indicate that the Eocene climate of Svalbard was temperate with a mean annual temperature of 11.6°C, a warm month mean of 18.rC and a cold month mean of 4.5°C. Precipitation estimates indicate high levels of precipitation with growing season precipitation estimates from 320 to 1531mm, and a strong wet or dry seasonal signal with 356 to 656mm precipitation for the three wettest months and 112 to 247mm for the three driest months. These estimates support sedimentary evidence that Eocene Arctic environments were seasonally warm and wet

Concealment, communication and stigma: The perspectives of HIV-positive immigrant Black African men and their partners living in the United Kingdom

This study explored the perspectives of Black men, originally from East Africa, living in the United Kingdom and their families on what it means to live with diagnosed HIV. This article reports on concealment of HIV-positive status as a strategy adopted by the affected participants to manage the flow of information about their HIV-positive status. Analysis of the data, collected using in-depth interviews involving 23 participants, found widespread selective concealment of HIV-positive status. However, a few respondents had ‘come out’ publicly about their condition. HIV prevention initiatives should recognise concealment as a vital strategy in managing communication about one’s HIV-positive status

The space from heart disease intervention for people with cardiovascular disease and distress: a mixed-methods study

BACKGROUND: Poor self-management of symptoms and psychological distress leads to worse outcomes and excess health service use in cardiovascular disease (CVD). Online-delivered therapy is effective, but generic interventions lack relevance for people with specific long-term conditions, such as cardiovascular disease. OBJECTIVE: To develop a comprehensive online CVD-specific intervention to improve both self-management and well-being, and to test acceptability and feasibility. METHODS: Informed by the Medical Research Council (MRC) guidance for the development of complex interventions, we adapted an existing evidence-based generic intervention for depression and anxiety for people with CVD. Content was informed by a literature review of existing resources and trial evidence, and the findings of a focus group study. Think-aloud usability testing was conducted to identify improvements to design and content. Acceptability and feasibility were tested in a cross-sectional study. RESULTS: Focus group participants (n=10) agreed that no existing resource met all their needs. Improvements such as "collapse and expand" features were added based on findings that participants' information needs varied, and specific information, such as detecting heart attacks and when to seek help, was added. Think-aloud testing (n=2) led to changes in font size and design changes around navigation. All participants of the cross-sectional study (10/10, 100%) were able to access and use the intervention. Reported satisfaction was good, although the intervention was perceived to lack relevance for people without comorbid psychological distress. CONCLUSIONS: We have developed an evidence-based, theory-informed, user-led online intervention for improving self-management and well-being in CVD. The use of multiple evaluation tests informed improvements to content and usability. Preliminary acceptability and feasibility has been demonstrated. The Space from Heart Disease intervention is now ready to be tested for effectiveness. This work has also identified that people with CVD symptoms and comorbid distress would be the most appropriate sample for a future randomized controlled trial to evaluate its effectiveness

Internet-delivered self-management support for improving coronary heart disease and self-management–related outcomes: a systematic review

Introduction: Coronary heart disease (CHD) is associated with significant morbidity and mortality, including mental health comorbidity, which is associated with poor outcomes. Self-management is key, but there is limited access to self-management support. Internet-delivered interventions may increase access. Objective: The aim of this study was to conduct a systematic review to (1) determine the effectiveness of Internet-delivered CHD self-management support for improving CHD, mood, and self-management related outcomes and (2) identify and describe essential components for effectiveness. Method: Randomized controlled trials that met prespecified eligibility criteria were identified using a systematic search of 3 healthcare databases (Medline, PsychINFO, and Embase). Results: Seven trials, which included 1321 CHD patients, were eligible for inclusion. There was considerable heterogeneity between studies in terms of the intervention content, outcomes measured, and study quality. All 7 of the studies reported significant positive between-group effects, in particular for lifestyle-related outcomes. Personalization of interventions and provision of support to promote engagement may be associated with improved outcomes, although more data are required to confirm this. The theoretical basis of interventions was poorly developed though evidence-based behavior change interventions were used. Conclusion: More well-designed randomized controlled trials are needed. These should also explore how interventions work and how to improve participant retention and satisfaction and examine the role of personalization and support within interventions

Evaluation of awake prone positioning effectiveness in moderate to severe COVID-19

Evidence mainly from high income countries suggests that lying in the prone position may be beneficial in patients with COVID-19 even if they are not receiving invasive ventilation. Studies indicate that increased duration of prone position may be associated with improved outcomes, but achieving this requires additional staff time and resources. Our study aims to support prolonged (≥ 8hours/day) awake prone positioning in patients with moderate to severe COVID-19 disease in Vietnam. We use a specialist team to support prone positioning of patients and wearable devices to assist monitoring vital signs and prone position and an electronic data registry to capture routine clinical data

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Parenting a child living with a visible difference

Children and young people living with visible differences can experience problems with self esteem, body image and anxiety. Parents of children with visible differences may experience associated heightened stress and distress. Such problems appear to be present irrespective of the nature, aetiology, or significance of the visible difference. Existing qualitative research in this area has predominantly been condition-specific and integration of the literature is now needed to elucidate cross-condition parental experiences. Systematic searching identified eight UK studies, from which thematic synthesis identified two overarching cross-condition themes. Upon learning of their child’s visible difference, parents embark on a process of 3 adjustment which is influenced by internal processes, social experiences, and various ‘interruptions’, resulting in differing levels of acceptance. Parents equip themselves with knowledge and employ strategies to enhance their child’s wellbeing and manage social challenges. Holistic familial assessments are required to identify need and provide appropriate intervention. Furthermore, greater representation and provision of information for professionals and the public could create more compassionate and accepting systems. Finally, cross-cultural and further cross-condition research is required to further inform intervention provisio