Community scientists produce open data for understanding insects and climate change.

Insect species are responding to human-caused global changes, sparking an urgent need for more conservation and management. Recent publications indicate the speed and scale of these changes to be both fast and large, impacting ecosystem function and human health. Community scientists are contributing vast amounts of data on insect occurrence and abundance to publicly available biodiversity platforms. These data are then used by ecologists to estimate insect diversity and distributions and forecast species' responses to the stressors of the Anthropocene. Yet, challenges remain with taxonomy, species identification, and sampling, some of which can be improved by new tools and approaches. Here we review the open, global community science programs providing the majority of publicly available insect data. We explore the advantages, challenges, and next steps with these large-scale community science ventures, emphasizing the importance of collaboration between professionals and community scientists to jointly address the conservation of insects.

Intravenous antibiotics in preterm infants have a negative effect upon microbiome development throughout preterm life.

BACKGROUND: Intestinal dysbiosis is implicated in the origins of necrotising enterocolitis and late-onset sepsis in preterm babies. However, the effect of modulators of bacterial growth (e.g. antibiotics) upon the developing microbiome is not well-characterised. In this prospectively-recruited, retrospectively-classified, case-control study, high-throughput 16S rRNA gene sequencing was combined with contemporaneous clinical data collection, to assess the within-subject relationship between antibiotic administration and microbiome development, in comparison to preterm infants with minimal antibiotic exposure. RESULTS: During courses of antibiotics, diversity progression fell in comparison to that seen outside periods of antibiotic use (-0.71units/week vs. + 0.63units/week, p < 0.01); Enterobacteriaceae relative abundance progression conversely rose (+ 10.6%/week vs. -8.9%/week, p < 0.01). After antibiotic cessation, diversity progression remained suppressed (+ 0.2units/week, p = 0.02). CONCLUSIONS: Antibiotic use has an acute and longer-lasting impact on the developing preterm intestinal microbiome. This has clinical implications with regard to the contribution of antibiotic use to evolving dysbiosis, and affects the interpretation of existing microbiome studies where this effect modulator is rarely accounted for.

Perinatal inflammation influences but does not arrest rapid immune development in preterm babies.

Infection and infection-related complications are important causes of death and morbidity following preterm birth. Despite this risk, there is limited understanding of the development of the immune system in those born prematurely, and of how this development is influenced by perinatal factors. Here we prospectively and longitudinally follow a cohort of babies born before 32 weeks of gestation. We demonstrate that preterm babies, including those born extremely prematurely (<28 weeks), are capable of rapidly acquiring some adult levels of immune functionality, in which immune maturation occurs independently of the developing heterogeneous microbiome. By contrast, we observe a reduced percentage of CXCL8-producing T cells, but comparable levels of TNF-producing T cells, from babies exposed to in utero or postnatal infection, which precedes an unstable post-natal clinical course. These data show that rapid immune development is possible in preterm babies, but distinct identifiable differences in functionality may predict subsequent infection mediated outcomes.

The impact of age on major orthopaedic trauma: an analysis of the United Kingdom Trauma Audit Research Network database.

AIMS: To compare the early management and mortality of older patients sustaining major orthopaedic trauma with that of a younger population with similar injuries. PATIENTS AND METHODS: The Trauma Audit Research Network database was reviewed to identify eligible patients admitted between April 2012 and June 2015. Distribution and severity of injury, interventions, comorbidity, critical care episodes and mortality were recorded. The population was divided into young (64 years or younger) and older (65 years and older) patients. RESULTS: Of 142 765 adults sustaining major trauma, 72 942 (51.09 %) had long bone or pelvic fractures and 45.81% of these were > 65 years old. Road traffic collision was the most common mechanism in the young (40.4%) and, in older people, fall from standing height (80.4%) predominated. The 30 day mortality in older patients with fractures is greater (6.8% versus 2.5%), although critical care episodes are more common in the young (18.2% versus 9.7%). Older people are less likely to be admitted to critical care beds and are often managed in isolation by surgeons. Orthopaedic surgery is the most common admitting and operating specialty and, in older people, fracture surgery accounted for 82.1% of procedures. CONCLUSION: Orthopaedic trauma in older people is associated with mortality that is significantly greater than for similar fractures in the young. As with the hip fracture population, major trauma in the elderly is a growing concern which highlights the need for a review of admission pathways and shared orthogeriatric care models. Cite this article: Bone Joint J 2017;99-B:1677-80.

Integrin signaling potentiates transforming growth factor-beta 1 (TGF-ß1) dependent down-regulation of E-Cadherin expression - Important implications for epithelial to mesenchymal transition (EMT) in renal cell carcinoma.

Signal transduction through the transforming growth factor-beta 1 (TGF-ß1) pathway affects epithelial to mesenchymal transition (EMT), partly by modulation of E-Cadherin expression. The concurrent impact of extracellular matrix driven regulation of integrin signaling on EMT has not been well characterized. We assessed the cumulative effect and molecular mechanisms of TGF-ß1 and integrin signal transduction on E-Cadherin in a renal cell cancer (RCC) model. Stimulation of RCC cells with TGF-ß1 demonstrated a three-fold increased expression of integrin αv. A ligand of integrin αv-ß3, (cyclopentapeptide containing Arginyl-Glycyl-Aspartic acid motif, RGD), was used to mimic integrin signaling. Treatment of cells with RGD and TGF-ß1 demonstrated significantly greater E-cadherin depletion than either ligand alone. This cooperative action on E-Cadherin expression is regulated by transcription factor Snai1 and is followed on a cellular level by increased cellular mobility as evidenced in a wound healing assay. Subsequent silencing of potential downstream mediators of the cumulative action of RGD and TGF-ß1 was carried out by small interfering RNA transfection and confirmed by Western blotting and/or RT-PCR. SiRNA mediated silencing of FAK and PINCH1 independently abrogated the cumulative effect of RGD and TGF-ß1 on E-Cadherin expression. We have identified a novel mechanism through which extracellular matrix event transduction by integrins further augments TGF-ß1 related effects on EMT. Molecular machinery involved in the integrin αv-TGF-ß1 interplay may represent a therapeutic target in RCC.

5 year retrospective follow-up of new cases of Charcot neuroarthropathy-A single centre experience.

BACKGROUND: Few data describe the natural history of Charcot neuroarthropathy treated with a total contact plaster cast (TCC). METHODS: A 5 year retrospective analysis of 50 patients presenting with an acute CN, Assessing time to clinical resolution into appropriate footwear and assessing if initial immobilisation device influenced resolution time. RESULTS: During the study period 42 patients (84%) of patients went into remission, 2 died during their treatment, 4 had major amputations, in 2 patients treatment was ongoing. 36 patients were treated with combination offloading devices, 6 were treated with one modality only. Median time to resolution for patients initially treated with a TCC was not significantly shorter than for those treated with a removable below knee boot. 34.9% required re-casting due to clinical deterioration in the removable device. CONCLUSIONS: More precise measures of resolution of CN are needed to assess the impact of initial treatment modality on time to resolution.

The effects of shared decision making in the conservative management of stable ankle fractures.

INTRODUCTION: The majority of ankle fractures seen in clinic are stable, will not displace and do not require plaster casting to achieve union in a good position. Nevertheless, many patients with stable ankle fractures are advised that they need a cast. In this study we counseled patients regarding the different options for conservative management of their stable ankle fracture. We then encouraged them to make an informed decision on which method of treatment they would like to pursue. MATERIALS AND METHODS: We analyzed eight years of a single consultant's fracture clinic. 163 patients were offered a choice of: a weight bearing below knee cast; a functional ankle brace; or a regime of rest, ice, compression bandage and elevation ("RICE" regime). All patients were advised to mobilize on the injured ankle as their pain allowed. RESULTS: 163 patients were suitable for all 3 treatment options. 82% (133/163) chose an ankle brace, 15% (25/163) opted for a RICE regime and 3% (5/163) chose a below knee cast. Of these only one returned to clinic complaining of increased pain, however after further discussion the patient opted to continue with his RICE regime as planned. DISCUSSION: A conservative approach to these injuries is now common practice; however there is a wide variation in what type of conservative management is given. Recent studies suggest orthopedic surgeons are still treating the majority of these injuries with a weight-bearing cast despite risks of stiffness, skin damage and thromboembolism. This study showed when the patient is given opportunity to make an informed choice the vast majority opt not to have a cast. The study suggests management of these injuries should be decided via a two-way conversation between patient and practitioner. CONCLUSIONS: Using a shared decision making approach to these injuries is a useful method of providing patients with the most suitable treatment for their personal treatment goals.

An evaluation of prenatal ultrasound screening for CTEV: accuracy data from a single NHS University Teaching Hospital.

Congenital Talipes Equinovarus (CTEV) is one of the most common congenital limb deformities. We reviewed the records of infants who had received treatment for structural CTEV between 1 January 2007 and 30 November 2012. This was cross-referenced with the prenatal scans of mothers over a corresponding period of time. We investigated the sensitivity, specificity, and positive and negative predictive values of the fetal anomaly scan for the detection of CTEV and explored whether the publication of Fetal Anomaly Screening Programme guidelines in 2010 affected the rate of detection. During the study period there were 95 532 prenatal scans and 34 373 live births at our hospital. A total of 37 fetuses with findings suggestive of CTEV were included in the study, of whom 30 were found to have structural CTEV at birth. The sensitivity of screening for CTEV was 71.4% and the positive predictive value was 81.1%. The negative predictive value and specificity were more than 99.5%. There was no significant difference between the rates of detection before and after publication of the guidelines (p = 0.5). We conclude that a prenatal fetal anomaly ultrasound screening diagnosis of CTEV has a good positive predictive value enabling prenatal counselling. The change in screening guidance has not affected the proportion of missed cases. This information will aid counselling parents about the effectiveness and accuracy of prenatal ultrasound in diagnosing CTEV.

Prognostic and therapeutic relevance of FLIP and procaspase-8 overexpression in non-small cell lung cancer.

Non-small cell lung carcinoma remains by far the leading cause of cancer-related deaths worldwide. Overexpression of FLIP, which blocks the extrinsic apoptotic pathway by inhibiting caspase-8 activation, has been identified in various cancers. We investigated FLIP and procaspase-8 expression in NSCLC and the effect of HDAC inhibitors on FLIP expression, activation of caspase-8 and drug resistance in NSCLC and normal lung cell line models. Immunohistochemical analysis of cytoplasmic and nuclear FLIP and procaspase-8 protein expression was carried out using a novel digital pathology approach. Both FLIP and procaspase-8 were found to be significantly overexpressed in tumours, and importantly, high cytoplasmic expression of FLIP significantly correlated with shorter overall survival. Treatment with HDAC inhibitors targeting HDAC1-3 downregulated FLIP expression predominantly via post-transcriptional mechanisms, and this resulted in death receptor- and caspase-8-dependent apoptosis in NSCLC cells, but not normal lung cells. In addition, HDAC inhibitors synergized with TRAIL and cisplatin in NSCLC cells in a FLIP- and caspase-8-dependent manner. Thus, FLIP and procaspase-8 are overexpressed in NSCLC, and high cytoplasmic FLIP expression is indicative of poor prognosis. Targeting high FLIP expression using HDAC1-3 selective inhibitors such as entinostat to exploit high procaspase-8 expression in NSCLC has promising therapeutic potential, particularly when used in combination with TRAIL receptor-targeted agents.

An antibiotic formulary for a tertiary care foot clinic: admission avoidance using intramuscular antibiotics for borderline foot infections in people with diabetes.

AIMS: To develop an antibiotic foot formulary for the empirical treatment of diabetes-related foot infections presenting to our service. Subsequently, to asses costs associated with the introduction of our protocol, in particular to assess the effect on admissions avoidance and any cost savings achieved. METHODS: We reviewed several existing antibiotic protocols. We analysed data on costs related to treatment and admission rates prior to and after the introduction of the protocol. RESULTS: We rationalized our antibiotic protocol and adapted the Infectious Disease Society of America guideline by introducing a category of 'moderate infection-borderline admission' to our classification. This enabled the administration of outpatient intramuscular antibiotics. After introducing the rationalized protocol, our average antibiotic prescribing costs for a 3-week course of treatment fell from £17.12 to £16.42. Over 22 months of follow-up, 26 episodes were eligible for treatment with intramuscular antibiotics. Over the same time period, 121 people were admitted directly from the foot clinic. The costs saved as a result of avoided or delayed admission for those 26 episodes was over £76 000. For 12 people who required subsequent admission, their length of hospital stay was significantly shorter than those admitted directly [9.25 days (range 2-25) vs. 16.11 (2-64), P = 0.045]. CONCLUSIONS: By modifying the Infectious Disease Society of America classification and adopting a protocol to administer outpatient oral and intramuscular antibiotics, we have led to substantial cost savings, shorter hospital admissions and also have developed a successful admissions avoidance strategy.

Modification of anodised aluminium surfaces using a picosecond fibre laser for printing applications.

The use of an ultrafast fibre laser at a wavelength of 1064 nm has allowed the surface modification of anodised aluminium plates coated with a 2 micron thick anodised layer for potential industrial applications. The micro- and nano-scale structuring of the anodised aluminium using picosecond pulses of approximately 25 ps duration at 200 kHz repetition rate was investigated. The interaction of the laser with the substrate created a hydrophilic surface, giving a contact angle of less than 10 degrees. On examination under a Scanning Electron Microscope (SEM), a morphology created due to laser induced spallation was observed. It has been found that these laser processed hydrophilic surfaces revert to a hydrophobic state with time. This has potential for application in the printing industry and offers reusability and sustainability of the process materials. This has been confirmed in initial trials.

Surface modification of anodised aluminium using a femtosecond laser.

Femtosecond laser pulses at 775 nm, combined with a scanning galvonometer system, have allowed the micro scale structuring of an aluminium plate coated with a 2 micron thick anodised aluminium layer for potential industrial applications. The micro-scale structuring of aluminium was investigated using ultrafast pulses of 180 fs duration at a repetition rate of 1 kHz. Under suitably optimised conditions, the interaction of the laser pulses with the substrate created a hydrophilic surface with a contact angle of less than 10 degrees. These surfaces revealed a 'lotus-leaf' like morphology when examined under a Scanning Electron Microscope (SEM). It has been found that these laser processed hydrophilic surfaces revert with time and they undergo this cycle of alternate hydrophilic/hydrophobic behaviour several times upon exposure to the laser pulses. Their potential application in the printing industries is strong due to their reusability and sustainability; initial trials on printing confirm this. This technology would offer extra advantages as a non-chemical process without the need for developer, thereby reducing the overall cost and time of printing.

Toxin producing Vibrio cholerae O75 outbreak, United States, March to April 2011.

The Florida Department of Health, Florida, United States, is investigating a Vibrio cholerae O75 outbreak. Ten cases with disease onsets from 23 March to 13 April 2011, presented with gastrointestinal symptoms of diarrhoea, nausea, vomiting, cramps, chills, and/or fever, after consuming raw or lightly cooked oysters harvested from Apalachicola Bay, Florida. Symptoms were milder than those during outbreaks of epidemic (serogroup O1 and O139) Vibrio cholerae; no case required rehydration treatment or hospitalisation.

Vibrio illness in Florida, 1998-2007.

This study characterized the current epidemiology of vibrio infections in Florida and examined cases reported from 1998 to 2007. Logistic regression was used to determine risk of death. There were 834 vibrio infections in 825 individuals (average annual incidence rate 4·8/1,000,000). Common Vibrio species reported were Vibrio vulnificus (33%), V. parahaemolyticus (29%), and V. alginolyticus (16%). Most exposures were attributed to wounds (42%), and the most common clinical syndromes were wound infections (45%) and gastroenteritis (42%). Almost half of individuals reported an underlying health condition. Risk of death was associated with any underlying condition and increased with the number of conditions (P<0·0001). In Florida, incidence of vibriosis associated with raw oyster consumption has decreased while incidence associated with wound infections has increased. Most prevention efforts to date have focused on oyster consumption. New educational messages focusing on the risk of vibriosis from wound infections should target high-risk populations.

Irreducible posterior subtalar dislocation with incarceration of a fracture of the anterior process of the calcaneum.

Subtalar dislocation is a significant injury characterised by late complications, including subtalar arthritis. We describe a rare case of irreducible posterior subtalar dislocation due to incarceration of a fracture of the anterior process of the calcaneum in the subtalar joint, and discuss appropriate management.

Preoperative staging of rectal cancer: pelvic MRI plus abdomen and pelvic CT. Does extrahepatic abdomen imaging matter? A case for routine thoracic CT.

OBJECTIVE: To assess the quality of preoperative magnetic resonance imaging (MRI) staging of rectal cancer, and the clinical significance of abdomen and pelvic computed tomogram (CT) scans in preoperative staging of rectal cancer in a district general hospital. We postulated that the 'metastatic yield' of extrahepatic abdominal imaging is poor, and rarely altered management of rectal cancer. METHODS: This is a retrospective study of preoperative MRI, CT scans and postoperative histology results of patients who had definitive surgery for rectal cancer at the Mid-Staffordshire General Hospitals NHS Trust over a 36-month period. Preoperative multiplanar pelvic MRI locoregional staging was compared with eventual histology. The incidence of and significance of abdomen and pelvic CT detected pathology (including metastasis) in the management of rectal cancers was also assessed. RESULTS: Preoperative pelvic MRI correctly predicted 'clear' Circumferential resection margins, in 28 of 29 patients who had primary surgery. This is comparable with many published studies. Significant CT detected pathology (including metastasis) on preoperative abdomen and pelvic CT scans was uncommon, and did not influence management of any rectal cancer patient in our study. DISCUSSION: Given that exclusive CT detected significant pathology caudal to the liver (extrahepatic abdomen) is rare, can full abdomen and pelvic CT scans be justified for preoperative staging of rectal cancers? - especially where chest X rays are employed for lung staging. Preoperative thoracic and upper abdomen CT scan may be a more productive use of resources. Full abdominal scans may be more appropriate for selection of rectal cancer patients with isolated liver metastasis for metastasectomy.

Suitability of two carbon dioxide-baited traps for mosquito surveillance in the United Kingdom.

Rapidly changing environments and an increase in human movement around the globe have contributed to a rise in new and emerging diseases, many of which are arthropod borne. The threat posed to the United Kingdom by such diseases is uncertain, and there is a real need to understand the distribution, seasonality and behaviour of potential vectors in the country. At present, there is no standard method for routine mosquito surveillance in the UK. Here we compared the catching efficiency of two carbon dioxide-baited traps, the CDC light trap and the MosquitoMagnet Pro trap, for collecting British mosquitoes. Two of each type of trap were operated at four sites in central and southern England from June to September, 2003. To determine whether trap height affected collections, three light traps were operated at 1, 2.5 and 5 m above the ground in one site in 2004. Both types of trap were efficient at catching mosquitoes, collecting 5414 mosquitoes of 16 species. MosquitoMagnet traps caught 2.7 times more mosquitoes than CDC light traps (P<0.001) and a wider range of species (16 species vs 11) than CDC light traps. Four to six times more female Culex pipiens s.l. were collected in light traps at 5 m (P<0.001) compared with traps at lower heights. MosquitoMagnet traps ran continuously for up to 8 weeks, whilst the battery of a CDC light trap had to be replaced every 24 hrs. Although MosquitoMagnets collected more specimens and a greater range of mosquito species, they were considerably more expensive, prone to breakdown and incurred higher running costs than the CDC light traps. MosquitoMagnets are useful tools for collecting mosquitoes during longitudinal surveys during the summer months, whilst CDC light traps are to be preferred for rapid assessments of the presence or absence of mosquitoes, particularly the important species Culex pipiens.