Exercise training reduces the acute physiological severity of post-menopausal hot flushes.

A hot-flush is characterised by feelings of intense heat, profuse elevations in cutaneous vasodilation and sweating, and reduced brain blood flow. Exercise training reduces self-reported hot-flush severity, but underpinning physiological data are lacking. We hypothesised that exercise training attenuates the changes in cutaneous vasodilation, sweat rate and cerebral blood flow during a hot flush. In a preference trial, 18 symptomatic post-menopausal women underwent a passive heat stress to induce hot-flushes at baseline and follow-up. Fourteen participants opted for a 16-week moderate intensity supervised exercise intervention, while 7 participants opted for control. Sweat rate, cutaneous vasodilation, blood pressure, heart rate and middle cerebral artery velocity (MCAv) were measured during the hot-flushes. Data were binned into eight equal segments, each representing 12.5% of hot flush duration. Weekly self-reported frequency and severity of hot flushes were also recorded at baseline and follow-up. Following training, mean hot-flush sweat rate decreased by 0.04 mg·cm2 ·min-1 at the chest (95% CI: 0.02-0.06, P = 0.01) and by 0.03 mg·cm2 ·min-1 (0.02-0.05, P = 0.03) at the forearm, compared with negligible changes in control. Training also mediated reductions in cutaneous vasodilation by 9% (6-12) at the chest and by 7% (4-9) at forearm (P≤0.05). Training attenuated hot flush MCAv by 3.4 cm/s (0.7-5.1, P = 0.04) compared with negligible changes in control. Exercise training reduced the self-reported severity of hot-flush by 109 arbitrary units (80-121, P<0.001). These data indicate that exercise training leads to parallel reductions in hot-flush severity and within-flush changes in cutaneous vasodilation, sweating and cerebral blood flo

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

International consensus is needed on a core outcome set to advance the evidence of best practice in cancer prehabilitation services and research.

Prehabilitation aims to optimise patients’ physical and psychological status before treatment. The types of outcomes measured to assess the impact of prehabilitation interventions vary across clinical research and service evaluation, limiting the ability to compare between studies and services and to pool data. An international workshop involving academic and clinical experts in cancer prehabilitation was convened in May 2022 at Sheffield Hallam University’s Advanced Wellbeing Research Centre, England. The workshop substantiated calls for a core outcome set to advance knowledge and understanding of best practice in cancer prehabilitation and to develop national and international databases to assess outcomes at a population level

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Designing effective solutions to conservation planning problems

This chapter outlines an approach for ensuring the effectiveness of regional or local-scale conservation planning initiatives. The authors define 'conservation planning' as a collaborative, social learning-driven activity whose goal is to implement actions that ensure the persistence of nature by integrating the processes of spatial prioritisation and implementation strategy development to achieve effective conservation management. Many studies in the literature use 'conservation planning' to describe an activity termed as 'spatial conservation prioritisation' but do not include implementation strategies or stakeholder collaboration. Conservation planning comprises three broad activities: assessment, planning and management. Specifically defining the scope and differences between assessment, planning and management is essential for ensuring effective conservation action because some activities directly conserve nature whereas others do not. The chapter provides an operational model for conservation planning, highlighting the importance and context of problem orientation and problem formulation

Research data supporting “Recommendations to enhance breeding bird diversity in managed plantation forests determined using LiDAR”

This dataset contains habitat and bird diversity data collected in Thetford Forest. The data were derived from Breeding Bird Surveys, LiDAR structural information and management databases. Further details of the method and statistics are available in Tew et al “Recommendations to enhance breeding bird diversity in managed plantation forests determined using LiDAR” (Ecological Applications). Each row contains data for a management/age class group. Columns ‘Management type’, ‘Age class’ and ‘(Log) total area’ were derived from forest management databases. Columns ‘Horizontal heterogeneity, ‘Gap fraction’, ‘Top canopy height’, ‘Vertical heterogeneity’, ‘Shrub density’ and ‘Canopy density’ were derived from high-resolution remote sensing LiDAR data. ‘Horizontal heterogeneity’, ‘Gap fraction’ and ‘Top canopy height’ are summarised at four different resolutions: 0.5 m, 2 m, 5 m, 10 m. Bird diversity data were derived from bird surveys.NER

Recommendations to enhance breeding bird diversity in managed plantation forests determined using LiDAR.

Funder: Arcadia Fund; Id: http://dx.doi.org/10.13039/100012088Funder: University of Cambridge; Id: http://dx.doi.org/10.13039/501100000735Funder: Forestry EnglandWidespread afforestation is a crucial component of climate mitigation strategies worldwide. This presents a significant opportunity for biodiversity conservation if forests are appropriately managed. Within forests, structural and habitat diversity are known to be critical for biodiversity but pragmatic management recommendations are lacking. We make a comprehensive assessment of the effects of habitat variables on bird populations using data from over 4000 ha of forested landscape. We combine high-resolution remote sensing data with comprehensive management databases to classify habitat attributes and measure the response of six taxonomic and functional diversity metrics: species richness, Shannon diversity, functional richness, functional evenness, functional divergence, and functional dispersion. We use a novel approach that combines hierarchical partitioning analysis with linear models to determine the relative importance of different habitat variables for each bird diversity metric. The age class of forest stands was consistently the most important variable across all bird diversity metrics, outperforming other structural measures such as horizontal and vertical heterogeneity and canopy density. Shrub density and gap fraction were each significantly associated with one bird diversity metric. In contrast, variables describing within-stand structural heterogeneity (vertical and horizontal) were generally less important while tree species identity (e.g., conifer or broadleaved) was not significant for any bird diversity metric. Each of the six bird diversity metrics had different patterns of independent variable importance and significance, emphasizing the need to consider multiple diversity metrics in biodiversity assessments. Similarly, the optimal resolution for remote sensing metrics varied between structural variables and bird diversity metrics, suggesting that the use of remote sensing data in biodiversity studies could be greatly improved by first exploring different resolutions and data aggregations. Based on the results from this comprehensive study, we recommend that managers focus on creating habitat diversity at the between-, rather than exclusively within-stand scale, such as by creating a matrix of different age classes, to maximize bird diversity. This recommendation for forest managers is powerful yet pragmatic in its simplicity