How to write a Critically Appraised Topic: evidence to underpin routine clinical practice

Critically appraised topics (CATs) are essential tools for busy clinicians who wish to ensure that their daily clinical practice is underpinned by evidence-based medicine. CATs are short summaries of the most up-to-date, high-quality available evidence that is found using thorough structured methods. They can be used to answer specific, patient-orientated questions that arise recurrently in real-life practice. This article provides readers with a detailed guide to performing their own CATs. It is split into four main sections reflecting the four main steps involved in performing a CAT: formulation of a focused question, a search for the most relevant and highest-quality evidence, critical appraisal of the evidence and application of the results back to the patient scenario. As well as helping to improve patient care on an individual basis by answering specific clinical questions that arise, CATs can help spread and share knowledge with colleagues on an international level through publication in the evidence-based dermatology section of the British Journal of Dermatolog

Hypothalamic-pituitary-adrenal axis and autonomic nervous system reactivity in children prenatally exposed to maternal depression:A systematic review of prospective studies

Depression is a common condition affecting up to 20% of all pregnant women, and is associated with subsequent developmental and behavioral problems in children, such as conduct disorder and ADHD. One proposed mechanism underlying these associations is modification of the fetal hypothalamic pituitary adrenal (HPA)-axis and the autonomic nervous system (ANS), resulting in altered responses to stress. This review examined the evidence regarding altered HPA-axis and ANS reactivity in children prenatally exposed to high maternal depressive symptoms. A systematic search was conducted in the electronic databases MEDLINE, EMBASE and PsycINFO, for studies published till 25 July 2017. A total of 13 studies comprising 2271 mother-infant dyads were included. None of the studies were suitable for meta-analysis. Risk of bias assessment showed low risk for four studies. Only three studies described an independent association between exposure to high maternal prenatal depressive symptoms and altered stress reactivity in children. There is limited evidence of an independent association between prenatal exposure to maternal depression and altered HPA or ANS reactivity in children

Green beach vegetation dynamics explained by embryo dune development

Sandy coastlines are dynamic environments with potential for biodiverse habitats, such as green beaches. Green beach vegetation can develop on nutrient-poor beaches landward from embryo dunes. It is characterised by low-dynamic coastal wetland habitat such as salt marshes and dune slacks. It has been hypothesised that the establishment of green beach vegetation is facilitated by the shelter provided by embryo dunes, however evidence is lacking. We explored the importance of geomorphology and soil conditions on the species richness and turnover of green beach vegetation over a time period of 10 years. We recorded 107 plots along 11 transects over a gradient from beach to dune on the island of Schiermonnikoog, the Netherlands. We characterised transect geomorphology at transect level and soil conditions and vegetation at plot level in 2006 and 2016. We found that the green beach vegetation was highly dynamic, total plant cover increased by 62% within 10 years. In 2006 beach width was an important factor in explaining species richness, with the highest number of species occurring on narrow beaches with a large volume of embryo dunes. In 2016, species richness was positively associated with the build-up of organic matter. Overall species richness declined relative to 2006 and was accompanied by an increase in elevation due to sand burial and the expansion of embryo dune volume. Our data suggests that geomorphology influenced the vegetation indirectly by affecting sand burial rate. Plant species richness declined less at sheltered conditions where sand burial was limited, allowing the build-up of organic matter. This indicates a time-dependent relationship between the development of embryo dunes and plant species richness: embryo dunes can be a source of shelter, thus increasing species richness, but can compete for space over time, lowering species richness again. Our results are relevant for engineering and management of biodiverse sandy shores

Managing hedgerows for nocturnal wildlife:Do bats and their insect prey benefit from targeted agri-environment schemes?

1. Mitigating the detrimental impacts of intensive farming on biodiversity requires the implementation of cost-effective conservation actions. Targeted agri-environment-schemes (AESs) to enhance populations of threatened species inhabiting farmland have been proposed for this purpose, yet their effectiveness for nocturnal wildlife remains unknown. 2. We assessed whether hedgerow management prescribed by targeted AESs to improve habitat conditions for the greater horseshoe bat (Rhinolophus ferrumequinum) in England may positively influence the species, the entire bat assemblage and the insect prey of bats. We specifically investigated the responses of bats (occurrence, activity, and species richness) and insects (biomass, abundance, and diversity) to time since last trimming (from 1 up to 10 years). We explored the mechanisms underlying the effects of AES via changes in trimming regime on bats. Moreover, we investigated the effects of landscape context on bats as we expected that highly mobile species would benefit further from landscape-scale management. 3. Bat species richness significantly increased with time since last trimming. Three bat taxa of major conservation concern in Western Europe substantially benefited from the targeted prescription, namely R. ferrumequinum, R. hipposideros and Plecotus spp. Insect-family richness and dipteran abundance were also significantly greater at hedgerows that were untrimmed for at least three years. The activity of more common bat species (i.e. pipistrelle bats) was not influenced by time since last trimming. 4. Changes in trimming regime strongly affected hedgerow height which directly and indirectly (by increasing prey abundance) influenced bat occurrence, activity and species richness along hedgerows. 5. The activity of highly mobile bat species was mainly associated with a range of landscape attributes. The amount of semi-natural grassland within 0.5 km of the sampling sites positively influenced R. ferrumequinum while the presence of urban areas negatively affected light-sensitive bat species. 6. Synthesis and applications. The implementation of targeted agri-environment-schemes can include effective measures to enhance bats and their insect prey in farmland. Although we highlight the success of current prescriptions on hedgerow management, we suggest that their effectiveness can easily be optimized by encouraging farmers to keep hedgerows untrimmed for longer periods (>3 up to 10 years). We also highlight that a multi-scale management approach is required to successfully promote bats in farmland

Effect of dual actuating strip guidance systems in a continuous steel annealing line

In the past, Royal Hoogovens, a main primary steel and aluminum manufacturer in the Netherlands, used pre-shaped rolls and sophisticated tension tables to guarantee good strip tracking for all strip geometry's in both their Continuous Annealing lines. However: with an increasing product mix (wider range of geometrical dimensions: widths between 800 - 1200 mm and thickness' between. 0.15 - 0.30 mm) in combination with high annealing temperatures of approximately 1000 K, these methods were not sufficient anymore. The steel strips became too vulnerable for wrinkles. To prevent wrinkles and tracking problems, Hoogovens Packaging Steel improved the flexibility of a processing line by partly substituting the pre-shaped rolls by flat rolls and new steering rolls. Before this process was started, a lot of time was spent, developing a suitable new steering roll type. This steering roll, it is called the DUal Actuating strip guidance System (DUAS), has a minimal influence on the strip tension distribution, basically consists of a flat roll and two hydraulic actuators mounted on a small frame and fits in an existing installations without large modifications. In December '95 the first system was placed in the furnace of one of the Hoogovens annealing lines and in November '96 another two