Recent geospatial dynamics of Terceira (Azores, Portugal) and the theoretical implications for the biogeography of active volcanic islands

Ongoing work shows that species richness patterns on volcanic oceanic islands are shaped by surface area changes driven by longer time scale (>1 ka) geological processes and natural sea level fluctuations. A key question is: what are the rates and magnitudes of the forces driving spatial changes on volcanic oceanic islands which in turn affect evolutionary and biogeographic processes? We quantified the rates of surface-area changes of a whole island resulting from both volcanogenic flows and sea level change over the last glacial-interglacial (GI) cycle (120 ka) for the volcanically active island of Terceira, (Azores, Macaronesia, Portugal). Volcanogenic activity led to incidental but long-lasting surface area expansions by the formation of a new volcanic cone and lava-deltas, whereas sea level changes led to both contractions and expansions of area. The total surface area of Terceira decreased by as much as 24% per time step due to changing sea levels and increased by 37% per time step due to volcanism per time step of 10 ka. However, while sea levels nearly continuously changed the total surface area, volcanic activity only impacted total surface area during two time steps over the past 120 ka. The surface area of the coastal and lowland region (here defined as area <300 m) was affected by sea level change (average change of 11% / 10 ka for 120–0 ka) and intra-volcanic change (average change of 17% / 10 ka for 120–0 ka). We discuss the biogeographic implications of the quantified dynamics, and we argue that surface area change is mainly driven by volcanic processes in the early stages of the island’s life cycle, while during the later stages, area change becomes increasingly affected by sea level dynamics. Both environmental processes may therefore affect biota differently during the life cycle of volcanic oceanic islands.S.J.N. received funding from the Portuguese National Funds, through Fundação para a Ciência e a Tecnologia (FCT), within the project UID/BIA/00329/2013 and the Research Fellowship PD/BD/114380/2016. S.P.A. acknowledges his research contract (IF/00465/2015) funded by the Portuguese Science Foundation (FCT). C.S.M. is benefiting from a PhD grant M3.1.a/F/100/2015 from FRCT/Açores 2020 by Fundo Regional para a Ciência e Tecnologia (FRCT). Financial support to R.A. was received from the Laboratory of Excellence ‘TULIP’ (PIA-10-LABX-41). This work was supported by FEDER funds through the Operational Programme for Competitiveness Factors – COMPETE and by National Funds through FCT under the UID/BIA/50027/2013, POCI-01-0145-FEDER-006821 and under DRCT-M1.1.a/005/Funcionamento-C-/2016 (CIBIO-A) project from FRCT. This work was also supported by FEDER funds (in 85%) and by funds of the Regional Government of the Azores (15%) through Programa Operacional Açores 2020, in the scope of the project “AZORESBIOPORTAL – PORBIOTA”: ACORES‑01‑0145-FEDER-000072.info:eu-repo/semantics/publishedVersio

Efficacy of serology driven “test and treat strategy” for eradication of H. pylori in patients with rheumatic disease in the Netherlands

The treatment of choice of H. pylori infections is a 7-day triple-therapy with a proton pump inhibitor (PPI) plus amoxicillin and either clarithromycin or metronidazole, depending on local antibiotic resistance rates. The data on efficacy of eradication therapy in a group of rheumatology patients on long-term NSAID therapy are reported here. This study was part of a nationwide, multicenter RCT that took place in 2000–2002 in the Netherlands. Patients who tested positive for H. pylori IgG antibodies were included and randomly assigned to either eradication PPI-triple therapy or placebo. After completion, follow-up at 3 months was done by endoscopy and biopsies were sent for culture and histology. In the eradication group 13% (20/152, 95% CI 9–20%) and in the placebo group 79% (123/155, 95% CI 72–85%) of the patients were H. pylori positive by histology or culture. H. pylori was successfully eradicated in 91% of the patients who were fully compliant to therapy, compared to 50% of those who were not (difference of 41%; 95% CI 18–63%). Resistance percentages found in isolates of the placebo group were: 4% to clarithromycin, 19% to metronidazole, 1% to amoxicillin and 2% to tetracycline

Perceptions of involvement in advance care planning and emotional functioning in patients with advanced cancer

Purpose: Advance Care Planning (ACP) is positively associated with the quality of care, but its impact on emotional functioning is ambiguous. This study investigated the association between perceptions of ACP involvement and emotional functioning in patients with advanced cancer. Methods: This study analyzed baseline data of 1,001 patients of the eQuiPe study, a prospective, longitudinal, multicenter, observational study on quality of care and quality of life in patients with advanced cancer in the Netherlands. Patients with metastatic solid cancer were asked to participate between November 2017 and January 2020. Patients’ perceptions of ACP involvement were measured by three self-administered statements. Emotional functioning was measured by the EORTC-QLQ-C30. A linear multivariable regression analysis was performed while taking gender, age, migrant background, education, marital status, and symptom burden into account. Results: The majority of patients (87%) reported that they were as much involved as they wanted to be in decisions about their future medical treatment and care. Most patients felt that their relatives (81%) and physicians (75%) were familiar with their preferences for future medical treatment and care. A positive association was found between patients’ perceptions of ACP involvement and their emotional functioning (b=0.162, p<0.001, 95%CI[0.095;0.229]) while controlling for relevant confounders. Conclusions: Perceptions of involvement in ACP are positively associated with emotional functioning in patients with advanced cancer. Future studies are needed to further investigate the effect of ACP on emotional functioning. Trial registration number: NTR6584 Date of registration: 30 June 2017 Implications for Cancer Survivors: Patients’ emotional functioning might improve from routine discussions regarding goals of future care. Therefore, integration of ACP into palliative might be promising

Above- and below-ground vertebrate herbivory may each favour a different subordinate species in an aquatic plant community

At least two distinct trade-offs are thought to facilitate higher diversity in productive plant communities under herbivory. Higher investment in defence and enhanced colonization potential may both correlate with decreased competitive ability in plants. Herbivory may thus promote coexistence of plant species exhibiting divergent life history strategies. How different seasonally tied herbivore assemblages simultaneously affect plant community composition and diversity is, however, largely unknown. Two contrasting types of herbivory can be distinguished in the aquatic vegetation of the shallow lake Lauwersmeer. In summer, predominantly above-ground tissues are eaten, whereas in winter, waterfowl forage on below-ground plant propagules. In a 4-year exclosure study we experimentally separated above-ground herbivory by waterfowl and large fish in summer from below-ground herbivory by Bewick’s swans in winter. We measured the individual and combined effects of both herbivory periods on the composition of the three-species aquatic plant community. Herbivory effect sizes varied considerably from year to year. In 2 years herbivore exclusion in summer reinforced dominance of Potamogeton pectinatus with a concomitant decrease in Potamogeton pusillus, whereas no strong, unequivocal effect was observed in the other 2 years. Winter exclusion, on the other hand, had a negative effect on Zannichellia palustris, but the effect size differed considerably between years. We suggest that the colonization ability of Z. palustris may have enabled this species to be more abundant after reduction of P. pectinatus tuber densities by swans. Evenness decreased due to herbivore exclusion in summer. We conclude that seasonally tied above- and below-ground herbivory may each stimulate different components of a macrophyte community as they each favoured a different subordinate plant species

Preventing disease through opportunistic, rapid engagement by primary care teams using behaviour change counselling (PRE-EMPT): protocol for a general practice-based cluster randomised trial

BACKGROUND: Smoking, excessive alcohol consumption, lack of exercise and an unhealthy diet are the key modifiable factors contributing to premature morbidity and mortality in the developed world. Brief interventions in health care consultations can be effective in changing single health behaviours. General Practice holds considerable potential for primary prevention through modifying patients' multiple risk behaviours, but feasible, acceptable and effective interventions are poorly developed, and uptake by practitioners is low. Through a process of theoretical development, modeling and exploratory trials, we have developed an intervention called Behaviour Change Counselling (BCC) derived from Motivational Interviewing (MI). This paper describes the protocol for an evaluation of a training intervention (the Talking Lifestyles Programme) which will enable practitioners to routinely use BCC during consultations for the above four risk behaviours. METHODS/DESIGN: This cluster randomised controlled efficacy trial (RCT) will evaluate the outcomes and costs of this training intervention for General Practitioners (GPs) and nurses. Training methods will include: a practice-based seminar, online self-directed learning, and reflecting on video recorded and simulated consultations. The intervention will be evaluated in 29 practices in Wales, UK; two clinicians will take part (one GP and one nurse) from each practice. In intervention practices both clinicians will receive training. The aim is to recruit 2000 patients into the study with an expected 30% drop out. The primary outcome will be the proportion of patients making changes in one or more of the four behaviours at three months. Results will be compared for patients seeing clinicians trained in BCC with patients seeing non-BCC trained clinicians. Economic and process evaluations will also be conducted. DISCUSSION: Opportunistic engagement by health professionals potentially represents a cost effective medical intervention. This study integrates an existing, innovative intervention method with an innovative training model to enable clinicians to routinely use BCC, providing them with new tools to encourage and support people to make healthier choices. This trial will evaluate effectiveness in primary care and determine costs of the intervention

Resistance of aspirin during and after pregnancy: A longitudinal cohort study

Objectives: The objective of this study is to investigate possible changes in aspirin resistance during and after pregnancy over time. Study design: A longitudinal cohort study in obstetric high risk women with an indication for aspirin usage during pregnancy to prevent placenta mediated pregnancy complications. Main outcome measures: Aspirin resistance measured in the first, second and third trimester of pregnancy and at least three months postpartum by four complementary test: PFA-200, VerifyNow®, Chronolog light transmission aggregometry (Chronolog LTA) and serum thromboxane B2 (TxB2) level measurements. Correlation between the devices was investigated. Results: In total, 23 pregnant women participated in the present study. Aspirin resistance according to the PFA-200, VerifyNow®, Chronolog LTA and serum TxB2, was 30.4%, 17.4%, 26.1% and 23.8% respectively. Resistance by any device was 69.6%. Aspirin resistance measured by the VerifyNow®, Chronolog LTA, serum TxB2 and aspirin resistance by any device during pregnancy was demonstrated more frequently than aspirin resistance after pregnancy. Correlation between the different devices was weak. Conclusion: Aspirin resistance was found in a considerable part of the participants. Considerable variation between participants, within participants over time and between the different devices was found. Prevalence of aspirin resistance during pregnancy differs from after pregnancy. More research on aspirin resistance and clinical obstetric outcome is needed

Recent geospatial dynamics of Terceira (Azores, Portugal) and the theoretical implications for the biogeography of active volcanic islands

Ongoing work shows that species richness patterns on volcanic oceanic islands are shaped by surface area changes driven by longer time scale (&gt;1 ka) geological processes and natural sea level fluctuations. A key question is: what are the rates and magnitudes of the forces driving spatial changes on volcanic oceanic islands which in turn affect evolutionary and biogeographic processes? We quantified the rates of surface-area changes of a whole island resulting from both volcanogenic flows and sea level change over the last glacial-interglacial (GI) cycle (120 ka) for the volcanically active island of Terceira, (Azores, Macaronesia, Portugal). Volcanogenic activity led to incidental but long-lasting surface area expansions by the formation of a new volcanic cone and lava-deltas, whereas sea level changes led to both contractions and expansions of area. The total surface area of Terceira decreased by as much as 24% per time step due to changing sea levels and increased by 37% per time step due to volcanism per time step of 10 ka. However, while sea levels nearly continuously changed the total surface area, volcanic activity only impacted total surface area during two time steps over the past 120 ka. The surface area of the coastal and lowland region (here defined as area &lt;300 m) was affected by sea level change (average change of 11% / 10 ka for 120–0 ka) and intra-volcanic change (average change of 17% / 10 ka for 120–0 ka). We discuss the biogeographic implications of the quantified dynamics, and we argue that surface area change is mainly driven by volcanic processes in the early stages of the island’s life cycle, while during the later stages, area change becomes increasingly affected by sea level dynamics. Both environmental processes may therefore affect biota differently during the life cycle of volcanic oceanic islands

Performance of the Montreal classification for inflammatory bowel diseases

RESULTS: The inter-observer agreement was excellent for diagnosis (k = 0.96), perianal disease (k = 0.92) and disease location in CD (k = 0.82) and good for age of onset (k = 0.67), upper gastrointestinal disease (k = 0.62), disease behaviour in CD (k = 0.79) and disease extent in UC (k = 0.65). Disease severity in UC was scored poor (k = 0.23). The additional items resulted in a good inter-observer agreement for EIM (k = 0.68) and a moderate agreement for disease severity in CD (k = 0.44). Percentages of correct answers over all Montreal items give a good reflection of the inter-observer agreement (> 80%), except for disease severity (48%-74%). IBD-nurses were significantly worse in scoring upper gastrointestinal disease in CD compared to gastroenterologists (P = 0.008) and gastroenterologists in training (P = 0.040). Observers with less than 10 years of experience were significantly better at scoring UC severity than observers with 10-20 years (P = 0.003) and more than 20 years (P = 0.003) of experience with IBD patient care. Observers with 10-20 years of experience with IBD patient care were significantly better at scoring upper gastrointestinal disease in CD than observers with less than 10 years (P = 0.007) and more than 20 years (P = 0.007) of experience with IBD patient care. CONCLUSION: We found a good to excellent interobserver agreement for all Montreal items except for disease severity in UC (poor). AIM: To validate the Montreal classification system for Crohn's disease (CD) and ulcerative colitis (UC) within the Netherlands. METHODS: A selection of 20 de-identified medical records with an appropriate representation of the inflammatory bowel disease (IBD) sub phenotypes were scored by 30 observers with different professions (gastroenterologist specialist in IBD, gastroenterologist in training and IBD-nurses) and experience level with IBD patient care. Patients were classified according to the Montreal classification. In addition, participants were asked to score extra-intestinal manifestations (EIM) and disease severity in CD based on their clinical judgment. The inter-observer agreement was calculated by percentages of correct answers (answers identical to the "expert evaluation") and Fleiss-kappa (k ). Kappa cutoffs: 0.8 excellent