Understanding implementation and usefulness of electronic clinical decision support (eCDS) for melanoma in English primary care: a qualitative investigation.

BACKGROUND: Timely diagnosis of the serious skin cancer melanoma can improve patient outcomes. Clinical guidelines suggest that GPs use checklists, such as the 7-point checklist (7PCL), to assess pigmented lesions. In 2016, the 7PCL was disseminated by EMIS as an electronic clinical decision support (eCDS) tool. AIM: To understand GP and patient perspectives on the implementation and usefulness of the eCDS. DESIGN & SETTING: Semi-structured interviews with GPs and patients were undertaken. The interviews took place in four general practices in the south east of England following consultations using the eCDS for suspicious pigmented lesions. METHOD: Data were collected from semi-structured face-to-face interviews with GPs and from telephone interviews with patients. They were recorded and transcribed verbatim. The Consolidated Framework for Implementation Research (CFIR) underpinned the analysis using thematic approaches. RESULTS: A total of 14 interviews with GPs and 14 interviews with patients were undertaken. Most GPs reported that, as the eCDS was embedded in the medical record, it was useful, easy to use, time-efficient, and could facilitate patient-GP communication. They were less clear that it could meet policy or patient needs to improve early diagnosis, and some felt that it could lead to unnecessary referrals. Few felt that it had been sufficiently implemented at practice level. More felt confident with their own management of moles, and that the eCDS could be most useful for borderline decision-making. No patients were aware that the eCDS had been used during their consultation. CONCLUSION: Successful implementation of a new tool, such as eCDS for melanoma, requires GPs to perceive its value and understand how it can best be integrated into clinical practice. Disseminating a tool without such explanations is unlikely to promote its adoption into routine practice.NIH

Parents' expected barriers to psychosocial care for children with complex problems

Background and objective: Even though children with complex problems frequently need psychosocial care, two thirds does not receive treatment. Various barriers, particularly expectations of barriers, can hinder effective access of care. Our aim was to assess the practical barriers expected by parents, and the child, family and need factors associated with these expected barriers. Methods: We sent web-based questionnaires to parents of a random sample of children known to have or be at risk of having complex problems (response = 77%). We used backward regression analyses to examine which factors were associated with expected barriers for children using psychosocial care, or no care at all. Results: Seventy-three percent of all parents expected practical barriers. Parents of children using psychosocial care expected more barriers than when using no care at all. For children who used no care, parents of girls expected more barriers (regression coefficient 0.54; 95%—confidence interval 0.16, 0.92) as did families having less social support (−0.30; −0.50, −0.11). When children used psychosocial care, parents expected more barriers when their child was of school-age (0.38; 0.01, 0.75), of non-western origin (vs. native) (0.52; 0.17, 0.88), when parents were older (i.e., 36+ years) (−0.77; −1.12, −0.42), experienced more adverse life events (0.29; 0.13, 0.45) or had less social support (−0.17; −0.34, 0.00). Conclusion: Even when their child is already receiving treatment, parents continue to expect practical barriers to psychosocial care. Psychosocial care services and their gatekeepers should address these concerns. Access to psychosocial care can be improved by removing practical barriers, especially if children already receive psychosocial care, or when parents have a limited network or belong to an ethnic minority.</p

The chemical basis of mate recognition in two parasitoid wasp species of the genus Nasonia

To recognize one's mate is essential for all sexually reproducing animals. In insects, mate recognition is often based on chemical cues such as hydrocarbons which are distributed over the insect's cuticle. In the parasitoid wasp genus Nasonia (Hymenoptera: Pteromalidae), interspecific mating possibly occurs in microsympatry between Nasonia vitripennis Walker and Nasonia giraulti Darling despite post-zygotic isolation mechanisms preventing hybridization. Males of N. vitripennis are known to equally court con- and heterospecific females, which they recognize by means of cuticular hydrocarbons. A recent study surprisingly showed that this might not be the case in N. giraulti, leaving open how males of this species achieve the recognition of mating partners. In this study, we investigated chemical mate recognition in N. giraulti in more detail and compared observed behaviors with behaviors of N. vitripennis by conducting experiments with both species concurrently and under the same experimental conditions. We disentangled the role of female-derived non-polar cuticular lipids – i.e., cuticular hydrocarbons – and more polar cuticular lipids in the ability of males to recognize con- and heterospecific females. In addition, we tested whether females of the two species discriminate similarly between con- and heterospecific males. We demonstrate that, in contrast to N. vitripennis, males of N. giraulti prefer live conspecific females over heterospecific ones. Furthermore, in contrast to N. vitripennis, mate recognition in N. giraulti males is not based on cuticular hydrocarbons, but rather involves other chemical messengers, presumably more polar cuticular lipids. In both species, discrimination against heterospecific males decreases with female age

Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology.

BACKGROUND: Melanoma accounts for 90% of skin cancer mortality and typically presents in primary care, where it can be challenging to distinguish from benign lesions. Dermoscopy is a tool for skin visualization that is routinely used for melanoma diagnosis in secondary care. However, the role of dermoscopy in primary care remains unclear. OBJECTIVES: To determine views on, and use of, dermoscopy by dermatology-interested general practitioners (GPs). METHODS: An online questionnaire was emailed to the UK Primary Care Dermatology Society members in February 2018, and responses collected over the following 4 weeks. RESULTS: A total of 205 responses were analysed. Most respondents were GPs (94%), aged over 50 (53%), had a postgraduate dermatological qualification (67%) and used dermoscopy regularly when reviewing pigmented skin lesions (97%). Dermoscopy use was commoner amongst GPs who had worked longer in primary care and had experience of secondary care dermatology. Most had undertaken training in dermoscopy (91%), although one-fifth (20%) had not updated their training in over 5 years. Most of those who had received only 1 day of face-to-face training reported feeling confident using a dermatoscope. Few respondents (11%) reported access to teledermatology or teledermoscopy for urgent or routine referrals. CONCLUSIONS: UK GPs with a special interest in dermatology are routinely using dermoscopy in the primary care setting. More research is needed to establish optimal approaches to training and updating GP dermoscopy skills. When dermoscopy has been shown to be safe, effective, acceptable and cost-effective in this setting, more GPs may also be able to gain and maintain the skills to implement dermoscopy into routine primary care. Technological advances, including incorporation of artificial intelligence (AI) and algorithms to guide GPs, could also contribute to widening use of dermoscopy among GPs

Recognising Colorectal Cancer in Primary Care

This study was supported by the CanTest Collaborative (funded by Cancer Research UK C8640/A23385). No funding or sponsorship was received for the publication of this article.Peer reviewedPublisher PD

Seasonal morphotypes of <i>Drosophila suzukii</i> differ in key life-history traits during and after a prolonged period of cold exposure

Seasonal polyphenism in Drosophila suzukii manifests itself in two discrete adult morphotypes, the “winter morph” (WM) and the “summer morph” (SM). These morphotypes are known to differ in thermal stress tolerance, and they co-occur during parts of the year. In this study, we aimed to estimate morph-specific survival and fecundity in laboratory settings simulating field conditions. We specifically analyzed how WM and SM D. suzukii differed in mortality and reproduction during and after a period of cold exposure resembling winter and spring conditions in temperate climates. The median lifespan of D. suzukii varied around 5 months for the WM flies and around 7 months for the SM flies. WM flies showed higher survival during the cold-exposure period compared with SM flies, and especially SM males suffered high mortality under these conditions. In contrast, SM flies had lower mortality rates than WM flies under spring-like conditions. Intriguingly, reproductive status (virgin or mated) did not impact the fly survival, either during the cold exposure or during spring-like conditions. Even though the reproductive potential of WM flies was greatly reduced compared with SM flies, both WM and SM females that had mated before the cold exposure were able to continuously produce viable offspring for 5 months under spring-like conditions. Finally, the fertility of the overwintered WM males was almost zero, while the surviving SM males did not suffer reduced fertility. Combined with other studies on D. suzukii monitoring and overwintering behavior, these results suggest that overwintered flies of both morphotypes could live long enough to infest the first commercial crops of the season. The high mortality of SM males and the low fertility of WM males after prolonged cold exposure also highlight the necessity for females to store sperm over winter to be able to start reproducing early in the following spring.</p

Genomics of sex allocation in the parasitoid wasp Nasonia vitripennis

This research was funded by the Netherlands Genomics Initiative (Zenith 93511041) and the by the Natural Environment Research Council (NE/J024481/1).Background Whilst adaptive facultative sex allocation has been widely studied at the phenotypic level across a broad range of organisms, we still know remarkably little about its genetic architecture. Here, we explore the genome-wide basis of sex ratio variation in the parasitoid wasp Nasonia vitripennis, perhaps the best studied organism in terms of sex allocation, and well known for its response to local mate competition. Results We performed a genome-wide association study (GWAS) for single foundress sex ratios using iso-female lines derived from the recently developed outbred N. vitripennis laboratory strain HVRx. The iso-female lines capture a sample of the genetic variation in HVRx and we present them as the first iteration of the Nasonia vitripennis Genome Reference Panel (NVGRP 1.0). This panel provides an assessment of the standing genetic variation for sex ratio in the study population. Using the NVGRP, we discovered a cluster of 18 linked SNPs, encompassing 9 annotated loci associated with sex ratio variation. Furthermore, we found evidence that sex ratio has a shared genetic basis with clutch size on three different chromosomes. Conclusions Our approach provides a thorough description of the quantitative genetic basis of sex ratio variation in Nasonia at the genome level and reveals a number of inter-related candidate loci underlying sex allocation regulation.Publisher PDFPeer reviewe

THE FIRST VATICAN COUNCIL IN THE ZAGREB PRESS

U članku se donose informacije o pripremama i radu Prvoga vatikanskog koncila kako ih je prenosio zagrebački tisak. Istražuje se pisanje triju zagrebačkih tiskovina: Narodnih novina, Agramer Zeitunga i Zagrebačkoga katoličkog lista. Na osnovi vijesti iz navedenih izvora izlaže se početak, djelovanje i rad Prvoga vatikanskog koncila sve od njegova sazivanja 29. lipnja 1869. pa do prekida 1. rujna 1870., nakon čega je uslijedila okupacija Rima, što je učinila Kraljevina Italija, i prekid postojanja Papinske Države. Posebna pozornost posvećuje se koncilskom zasjedanjima na kojima je najaktualnija bila tema o papinoj nepogrešivosti. Na kraju rada u zaključnim razmatranjima donosi se analiza pisanja zagrebačkog tiska, iščitava se njihov stav o radu Koncila i proglašenoj dogmi, uočava se važnost tiska i javnosti u odnosu na zasjedanje Koncila. Opća konstatacija je da zagrebačke tiskovine nisu blagonaklono gledale na proglašenje dogme o papinoj nepogrešivosti, već su slijedile politiku vlastite države i stavove većine domaćeg episkopata.This article reveals information about preparations and work of the First Vatican Council as it was reported in the contemporary Zagreb press. Authors investigate writings in three newspapers from Zagreb: Narodne novine [National newspapers], Agramer Zeintug [Zagreb Newspapers] and Zagrebački katolički list [Zagreb Catholic Newspapers]. On the basis of the articles and information published in these newspapers, authors reconstruct opening and work of the First Vatican Council from its convocation (29th June 1869) until its downtime on 1st September 1870, which was followed by Italian occupation of Rome and abolishment of the Papal state. Authors give special attention to the Council’s sessions in which the most important topic was thesis about the papal impeccability. In the conclusion authors deliver an analysis of the texts published in the Zagreb press concerning the Council, in which they reveal press’ attitude and opinions about the work of the Council and the decreed dogma. Finally, authors have deduced that the press was quite important in making of the public opinion about the Council. Namely, it is quite clear that Zagreb press did not welcome decree of dogma on the papal impeccability, and in this manner press followed state policy and views of the majority of the local episcopacy