Potentially malignant disorders revisited-The lichenoid lesion/proliferative verrucous leukoplakia conundrum

Background: Clinically identifiable potentially malignant disorders (PMD) precede oral squamous cell carcinoma development. Oral lichenoid lesions (OLL) and proliferative verrucous leukoplakia (PVL) are specific precursor lesions believed to exhibit both treatment resistance and a high risk of malignant transformation (MT). Methods: A retrospective review of 590 PMD patients treated in Northern England by CO2 laser surgery between 1996 and 2014 was carried out. Lesions exhibiting lichenoid or proliferative verrucous features were identified from the patient database and their clinicopathological features and outcome post-treatment determined at the study census date of 31 December 2014. Results: One hundred and 98 patients were identified as follows: 118 OLL and 80 PVL, most frequently leukoplakia at ventrolateral tongue and floor of mouth sites, equally distributed between males and females. Most exhibited dysplasia on incision biopsy (72% OLL; 85% PVL) and were treated by laser excision rather than ablation (88.1% OLL; 86.25% PVL). OLL were more common in younger patients (OLL 57.1 year; PVL 62.25 years; P =.008) and more likely than PVL to present as erythroleukoplakia (OLL 15.3%; PVL 2.5%; P =.003). Whilst no significant difference was seen between OLL and PVL achieving disease-free status (69.5% and 65%, respectively; P =.55), this was less than the overall PMD cohort (74.2%). MT was identified in 2 OLL (1.7%) and 2 PVL (2.5%) during follow-up. Conclusion: One-third of PMD cases showed features of OLL or PVL, probably representing a disease presentation continuum. Post-treatment disease-free status was less common in OLL and PVL, although MT was infrequent

Bioturbator-stimulated loss of seagrass sediment carbon stocks

© 2018 Association for the Sciences of Limnology and Oceanography Seagrass ecosystems are highly productive, and are sites of significant carbon sequestration. Sediment-held carbon stocks can be many thousands of years old, and persist largely due to sediment anoxia and because microbial activity is decreasing with depth. However, the carbon sequestered in seagrass ecosystems may be susceptible to remineralization via the activity of bioturbating fauna. Microbial priming is a process whereby remineralization of sediment carbon (recalcitrant organic matter) is stimulated by disturbance, i.e., burial of a labile source of organic matter (seagrass). We investigated the hypothesis that bioturbation could mediate remineralization of sediment carbon stocks through burial of seagrass leaf detritus. We carried out a 2-month laboratory study to compare the remineralization (measured as CO 2 release) of buried seagrass leaves (Zostera muelleri) to the total rate of sediment organic matter remineralization in sediment with and without the common Australian bioturbating shrimp Trypaea australiensis (Decapoda: Axiidea). In control sediment containing seagrass but no bioturbators, we observed a negative microbial priming effect, whereby seagrass remineralization was favored over sediment remineralization (and thus preserving sediment stocks). Bioturbation treatments led to a two- to five-fold increase in total CO 2 release compared to controls. The estimated bioturbator-stimulated microbial priming effect was equivalent to 15% of the total daily sediment-derived CO 2 releases. We propose that these results indicate that bioturbation is a potential mechanism that converts these sediments from carbon sinks to sources through stimulation of priming-enhanced sediment carbon remineralization. We further hypothesized that significant changes to seagrass faunal communities may influence seagrass sediment carbon stocks

Realistic Expectations with Brain Computer Interfaces

PurposeThis paper describes the research underpinning the development and evaluation of a brain computer interface (BCI) system designed to be suitable for domestic use by people with acquired brain injury in order to facilitate control of their home environment. The purpose of the research is to develop a robust and user‐friendly BCI system which was customisable in terms of user ability, preferences and functionality. Specifically the human interface was designed to provide consistent visual metaphors in usage, while applications change, for example, from environmental control to entertainment and communications.Design/methodology/approachThe research took a user centred design approach involving representative end‐users throughout the design and evaluation process. A qualitative study adopting user interviews alongside interactive workshops highlighted the issues that needed to be addressed in the development of a user interface for such a system. User validation then underpinned prototype development.FindingsThe findings of the research indicate that while there are still significant challenges in translating working BCI systems from the research laboratories to the homes of individuals with acquired brain injuries, participants are keen to be involved in the deign and development of such systems. In its current stage of development BCI is multi‐facetted and uses complex software, which poses a significant usability challenge. This work also found that the performance of the BCI paradigm chosen was considerably better for those users with no disability than for those with acquired brain injury. Further work is required to identify how and whether this performance gap can be addressed.Research limitations/implicationsThe research had significant challenges in terms of managing the complexity of the hardware and software set‐up and transferring the working systems to be tested by participants in their home. Furthermore, the authors believe that the development of assistive technologies for the disabled user requires a significant additional level of personalisation and intensive support to the level normally required for non‐disabled users. Coupled with the inherent complexity of BCI, this leads to technology that does not easily offer a solution to both disabled and non‐disabled users.Originality/valueThe research contributes additional findings relating to the usability of BCI systems. The value of the work is to highlight the practical issues involved in translating such systems to participants where the acquired brain injury can impact on the ability of the participant to use the BCI system.</jats:sec

Skills, attitudes and uptake of evidence-based practice: a cross-sectional study of chiropractors in the Swedish Chiropractic Association.

BackgroundEvidence-based practice (EBP) is integral to the delivery of high-quality health care. Chiropractic has been a licensed health profession in Sweden since 1989, but little is known of the uptake of EBP in this professional group. This study explored the self-reported skills, attitudes and uptake of EBP, and the enablers and barriers of EBP uptake, among licensed chiropractors in Sweden.MethodsLicensed chiropractors (n = 172) of the Swedish Chiropractic Association (Legitimerade Kiropraktorers Riksorganisation) were invited to participate in an anonymous online questionnaire, using the Evidence-Based Practice Attitude and Utilisation Survey (EBASE) in February 2019.ResultsFifty-six (33%) chiropractors completed the survey. Participants were predominantly male, aged 30-49 years, held a Master's degree, and had received their highest qualification and practiced chiropractic for over a decade. Chiropractors rated their EBP skill-level mostly in the moderate to moderate-high range. The majority of chiropractors reported positive attitudes towards EBP, with most agreeing or strongly agreeing that EBP is necessary in the practice of chiropractic, and that EBP assists in making decisions about patient care. Chiropractors reported an average level of engagement in EBP activities. All participants indicated professional literature and research findings were useful in their day-to-day chiropractic practice. The main perceived enabler of EBP uptake was internet access in the workplace, whereas the main barrier to EBP uptake was lack of clinical evidence in chiropractic.ConclusionsParticipating chiropractors of the Swedish Chiropractic Association were generally favourable of EBP, though only reported modest levels of EBP-related skills and engagement in EBP activities. Our findings suggest future studies investigating interventions focussed on improving chiropractors' skills and uptake of EBP are warranted

Can we manage coastal ecosystems to sequester more blue carbon?

© The Ecological Society of America To promote the sequestration of blue carbon, resource managers rely on best-management practices that have historically included protecting and restoring vegetated coastal habitats (seagrasses, tidal marshes, and mangroves), but are now beginning to incorporate catchment-level approaches. Drawing upon knowledge from a broad range of environmental variables that influence blue carbon sequestration, including warming, carbon dioxide levels, water depth, nutrients, runoff, bioturbation, physical disturbances, and tidal exchange, we discuss three potential management strategies that hold promise for optimizing coastal blue carbon sequestration: (1) reducing anthropogenic nutrient inputs, (2) reinstating top-down control of bioturbator populations, and (3) restoring hydrology. By means of case studies, we explore how these three strategies can minimize blue carbon losses and maximize gains. A key research priority is to more accurately quantify the impacts of these strategies on atmospheric greenhouse-gas emissions in different settings at landscape scales

Vascular changes in diabetic retinopathy-a longitudinal study in the Nile rat

Diabetic retinopathy is the most common microvascular complication of diabetes and is a major cause of blindness, but an understanding of the pathogenesis of the disease has been hampered by a lack of accurate animal models. Here, we explore the dynamics of retinal cellular changes in the Nile rat (Arvicanthis niloticus), a carbohydrate-sensitive model for type 2 diabetes. The early retinal changes in diabetic Nile rats included increased acellular capillaries and loss of pericytes that correlated linearly with the duration of diabetes. These vascular changes occurred in the presence of microglial infiltration but in the absence of retinal ganglion cell loss. After a prolonged duration of diabetes, the Nile rat also exhibits a spectrum of retinal lesions commonly seen in the human condition including vascular leakage, capillary non-perfusion, and neovascularization. Our longitudinal study documents a range and progression of retinal lesions in the diabetic Nile rat remarkably similar to those observed in human diabetic retinopathy, and suggests that this model will be valuable in identifying new therapeutic strategies