Journals
2026 EN
Powers Jennifer S. · PowersTiffin Finnegan · Choksi Pooja
+10 more
ABSTRACT Many studies on the ecology of tropical trees occur in protected areas such as national parks. But we know little of the composition and structure of trees in areas outside protected forests, such as urban areas or along roads. Our goal was to contrast trees in three different land‐use types that represent an unmanaged or rural to urban gradient in Guanacaste, Costa Rica: forests inside conservation areas, fencerows, and urban parks. We hypothesized that: (1) trees in fencerows and urban parks have larger mean diameters, lower densities, and less plot‐level canopy cover and basal area; (2) tree diversity does not vary along rural to urban gradients, but trees in urban parks have comparatively more non‐native species and fewer native species. We measured and identified trees ≥ 7 cm diameter in replicated plots. Consistent with expectations, tree density and canopy cover were higher in conservation areas compared to fencerows or urban parks. However, basal area was lower in fencerows compared to both other land uses. Parks were dominated by large diameter trees, while conservation areas had smaller stems. When comparing land uses from the perspectives of biodiversity and provisioning ecosystem services such as edible fruit and shade, trees inside forests in conservation areas and outside forests in urban parks in Guanacaste provide complementary benefits to people and are not substitutable. We conclude that understanding trees both inside and outside of forests provides a broader context for studies situated in protected areas and an informative comparison for studies in urban areas.
Journals
2026 EN
Sogbossi Emmanuel Seg · Gbaglo Murielle · Dahoueto Wilfried
+2 more
ABSTRACT Background In low‐ and middle‐income countries, physiotherapy is often the only available rehabilitative care, making the quality of physiotherapy care particularly important. However, how well physiotherapy practice in managing children with cerebral palsy (CP) is supported by evidence‐based guidelines remains unclear. This study aims to describe the current practice of physiotherapists in managing children with CP in Benin, a French‐speaking country in Sub‐Saharan Africa. Methods This study used a cross‐sectional online survey, addressed to physiotherapists working in Benin. Results A total of 91 physiotherapists participated in the study, 52 of whom worked with children with CP. One‐third of the children with CP treated were under 2 years old. Physiotherapy sessions were delivered twice or thrice weekly and lasted 30–45 min. Most of the physiotherapists working with children with CP (63.5%) received no certified paediatric neurorehabilitation training. About 54% rarely or never used a standardized outcome measure, and 36.5% used such measures occasionally. CP‐specific common classification systems were mostly unused and unknown. The most common intervention modalities were handling techniques (muscle stretching, joint mobilization and Bobath therapy [for movement normalization]), but functional exercises (milestones) were also commonly used. About 58% felt confident in the management of children with CP, and the need for training on modern approaches was stressed. Conclusion The management of children with CP in Benin does not meet the standards of evidence‐based practice. The results of this study will help develop strategies to improve the physiotherapy quality of care provided to children with CP in Benin and beyond.
Journals
2026 EN
Smith Lucy · Daley David · Cortese Samuele
+1 more
ABSTRACT Background This study aims to explore for the first time the knowledge, understanding and management of sleep problems in children with ADHD among clinicians who specialise in sleep and ADHD. The aim was to inform the development of digital sleep awareness training for clinicians. Method Fifteen clinicians who work with children with ADHD and sleep difficulties in the United Kingdom participated in semistructured qualitative interviews. Data were analysed using a reflexive thematic analysis approach to generate and guide the content of digital sleep awareness training. Results Four core themes were developed: ‘It's a Problem’ highlighted the extent to which children with ADHD were reported to struggle with sleep difficulties and the impact this has on the child and family. Clinicians also discussed the difficulty they had in finding evidence‐based information they could share with caregivers. With little to no formal training, most of the advice they gave came from ‘learning on the job’. When discussing ADHD specific sleep difficulties and disorders, clinicians reflected on their own ‘insight into limitations of knowledge’. ‘Learning for practice’ highlighted the divergence in the methods of learning preferred by clinicians, despite convergence of learning content needed. Conclusions Sleep problems in children with ADHD are common, and clinicians often struggle to support these due to lack of formal training. There is a need for accessible, authoritative training for UK practitioners who work with children with ADHD.
Journals
2026 EN
Shifti Desalegn Markos · Pitt Erin · Versteegh Lesley
+7 more
ABSTRACT Allergic diseases and asthma are significant public health concerns in Australia and globally. However, comprehensive data on the burden among Aboriginal and Torres Strait Islander people are scarce. This scoping review aimed to systematically map existing evidence on the burden and risk factors of allergic diseases and asthma among Aboriginal and Torres Strait Islander people. MEDLINE, Scopus, Embase and Web of Science Core Collection were systematically searched through March 2024. We included studies that reported allergic diseases and asthma among Aboriginal and Torres Strait Islander people. Study characteristics and outcome data were tabulated and evidence was synthesised narratively. Fifty‐four studies involving an estimated 176,792 Aboriginal and Torres Strait Islander people were included. These studies reported on asthma ( n = 48), eczema ( n = 10), allergic rhinitis ( n = 6), atopy ( n = 3), mixed allergies (combining food, drug and other undefined allergies) ( n = 2), and anaphylaxis ( n = 1). No studies solely investigating food allergies were found. The majority of studies were from Western Australia (WA, n = 15) and the Northern Territory (NT, n = 14). Estimates of allergy prevalence varied widely between studies, with eczema ranging from 2.0% to 44.4%, allergic rhinitis from 0.2% to 37.3%, and atopy from 1.7% to 36.4%. Asthma prevalence ranged from 2.0% to 50.5%. Risk factors for asthma included exposure to smoke and lower socioeconomic status, while a family history of allergy was associated with an increased risk of allergic rhinitis. In conclusion, Aboriginal and Torres Strait Islander people face a potentially significant burden of allergic diseases and asthma, yet they remain underrepresented in research. Culturally responsive studies are needed to address this substantial evidence gap.
Journals
2026 EN
Dogra Prerna · Šambula Lana · Saini Jasmine
+18 more
ABSTRACT Objective Data on bone health in patients with mild autonomous cortisol secretion (MACS) are limited and heterogenous. We sought to assess the prevalence of osteoporosis and symptomatic fragility fractures in patients with adrenal adenomas and hypercortisolism, and explore associations with the degree of cortisol excess and frailty. Design This multicenter cross ‐sectional study involved prospective enrollment of adults with nonfunctioning adrenal adenomas (NFA), MACS, Cushing syndrome (CS) and referent subjects without adrenal disorders during the study period (January 2019–September 2022). All participants completed a bone health questionnaire at enrollment and had dual‐energy X ‐ray absorptiometry bone mineral density assessment within 12‐months. Final analyses were adjusted for age, sex, body mass index, smoking status, alcohol use. Results Participants included 117 with NFA (median age 62 years, 80% women), 191 with MACS (median age 63 years, 74% women), 62 with CS (median age 50 years, 92% women), and 101 referent subjects (median age 59 years, 47% women). Both patients with CS (OR: 3.0, 95% CI: 1.1–8.3) and MACS (OR: 2.2, 95% CI: 1.9–4.9) had a higher prevalence of osteoporosis when compared to referents. Among patients with MACS, only those with post 1‐mg dexamethasone suppression test (post‐1mg‐DST) cortisol > 83 nmol/L had a higher prevalence of osteoporosis when compared to referents (OR: 3.2, 95% CI: 1.4–7.5) and NFA (OR: 2.2, 95% CI: 1.1–4.4). For clinical fragility fractures, only patients with CS showed an increased prevalence when compared to referents (OR: 6.1, 95% CI: 1.7–26.4) and NFA (OR: 3.8, 95% CI: 1.3–11.2). Prevalence of clinical fragility fractures was similar to referents in patients with MACS (OR: 1.8, 95% CI: 0.6–6.9) and NFA (OR: 1.5, 95% CI: 0.4–6.1), and was not associated with post‐1mg‐DST cortisol or frailty in the MACS and NFA groups. Conclusion Patients with CS, and those with MACS and post‐1mg‐DST cortisol > 83 nmol/L, exhibited a higher burden of osteoporosis. However, only CS was associated with an elevated risk of symptomatic fragility fractures.
Journals
2026 EN
Sudnawa Khemika K. · Geltzeiler Alexa · Kanner Cara H.
+13 more
ABSTRACT Mitogen‐activated protein kinase 8‐interacting protein 3‐related neurodevelopmental disorder ( MAPK8IP3 ‐related NDD) results from heterozygous pathogenic or likely pathogenic variants in MAPK8IP3 . We report on 32 individuals (median age 7.5 years, range 1.3–22.0), all of whom had heterozygous pathogenic/likely pathogenic MAPK8IP3 variants, including missense (62.5%) and predicted loss‐of‐function (LOF) variants (34.4%). Common symptoms included cognitive impairment, hypotonia, motor difficulties, strabismus, microcephaly, and attention deficits. Corpus callosum thinning was reported in 62.1%. Nearly all individuals walked independently but demonstrated slower gait speed and a wider base of support compared to controls. The mean DAS‐II General Conceptual Ability score was 62.5 ± 26.5. EEG analysis suggested a trend toward lower power accentuated frequency compared to typically developing individuals. Missense variants were associated with more severe symptoms than LOF variants. This study provides valuable insights into the clinical characteristics, patient management, and preparation for future clinical trials.
Journals
2026 EN
Plumptre Andrew J. · Waliczky Zoltan · Baisero Daniele
+44 more
Abstract Key Biodiversity Areas (KBAs) are sites of significance for the global persistence of biodiversity. Based on the Global Standard for the Identification of Key Biodiversity Areas (KBA Standard), published in 2016, sites are currently being assessed for KBA designation in a growing number of countries across the world. For these assessments, the KBA criteria are applied to all species and ecosystems with available data. We reviewed the first comprehensive assessments of 11 countries and compared the KBA network before and after assessments. The mean (SD) number of KBAs per country increased by 69.6% (102.1), and the mean total extent of KBAs per country increased by 164.2% (150.7). More than half of the KBAs in 2024 had >50% of their area outside the 2019 KBAs, indicating a substantial increase in KBA extent (54.0% [18.8] of KBAs). The mean proportion of each KBA covered by protected or conserved areas decreased from 56.2% (20.2) to 44.5% (15.5), owing to the incorporation of unprotected sites in the KBA network. On average, 41.1% (14.0) of sites in each country (mean 44.5 [46.4] sites per country) and 47.2% (20.5) of new KBA area after the assessment were completely unprotected, indicating that many of the new sites were not recognized in national protected area networks as significant for biodiversity before the assessment. Making a comprehensive assessment of KBAs increased the combined coverage of protected and conserved area networks from 25.4% (10.6) to 32.0% (13.1) in each country and thus contributed to reducing biodiversity loss. Therefore, comprehensive assessments of KBAs led to a substantially increased number and extent of recognized sites of importance for biodiversity published in the World Database of KBAs. Where such assessments have not been made, many important areas for biodiversity may be overlooked. We therefore encourage other nations to update their KBA networks to inform efforts to meet the goals and targets of the Kunming–Montreal Global Biodiversity Framework.
Journals
2026 EN
Ridley Francesca A. · Sayer Catherine A. · Mair Louise
+15 more
Abstract Area of habitat (AOH) maps provide a high‐resolution representation of the habitat available in a species’ range and can support conservation policy and planning processes. However, until recently, there was insufficient knowledge on the distribution of inland wetlands and freshwater biodiversity to develop AOH mapping methods specifically tailored to inland wetlands. We used a combined empirical and thematic approach to translate inland wetland habitat classes in the International Union for Conservation of Nature (IUCN) Habitats Classification Scheme into spatially explicit wetland‐cover types derived from the Global Lakes and Wetlands Database 2 and the World Karst Aquifer Map. The AOH was subsequently estimated as the area in the mapped range that corresponded to each species’ habitat and elevation associations. We developed and tested the method with IUCN Red List assessment data, range maps, and point locality data for fishes, odonates, decapod crustaceans, and mollusks (22,876 species). The method performed well in comparison with similar methods already developed for terrestrial mammals, birds, amphibians, and reptiles. The mean map prevalence (proportion of area in a species’ range that was AOH) was 18–32% for each taxonomic group. Based on data on known localities of occurrence, 78–100% of species per taxonomic group had a higher classification accuracy than expected if AOH were distributed in the range at random. This represents an increased accuracy in the distribution of wetland species. Our study represents the first attempt to distinguish between inland wetland habitat subclasses and to include subterranean habitats in an AOH mapping method. Our method will facilitate the inclusion of previously underrepresented taxa in key conservation tools and analyses and is expected to increase the accuracy of AOH mapping for any species associated with inland wetlands.
Journals
2026 EN
Eyre Hannah · Prince David K. · Abrahamson Sandra
+7 more
ABSTRACT Background Efforts to identify barriers and improve access to kidney transplantation in the United States are limited by a lack of population‐level data on early steps in the transplant evaluation process. Methods We used a rule‐based natural language processing (NLP) approach with clinical notes in the US Veterans Affairs Healthcare System (VA) electronic health record (EHR) and linkage with the United States Renal Data System registry to characterize sequential steps in the kidney transplant evaluation process. Adults with advanced kidney disease (estimated glomerular filtration rate ≤20 mL/min/1.73m 2 ) from 1/1/2012–12/31/2019 who were receiving care within the VA were followed through 12/31/2021. Results Among 45,174 cohort members, the median age was 71 (IQR 64, 80) years, and 97.2% were men. There was documentation of kidney transplant being mentioned as a treatment option for 46.3% of cohort members, 28.2% engaged in some type of evaluation for transplant, and 8.4% were referred to and 5.4% evaluated at a VA kidney transplant center. 6.9% of cohort members were added to the national deceased donor waitlist and 3.1% received a kidney transplant. Compared with events identified through EHR chart search and manual review by two clinicians, NLP identified events within 90 days with a precision of 0.82–0.94 and recall of 0.56–0.89. Conclusion These results illuminate the substantial proportion of patients who engage in early steps in the kidney transplant evaluation process. The work also demonstrates that NLP can accurately identify these key steps in the process as documented in patients’ EHRs.
Journals
2026 EN
Chen Daniel M. · Arunachalam Ambalavanan · Peigh Graham
+9 more
ABSTRACT Background Postoperative atrial arrhythmia (POAA) is common after lung transplant, but data on its implications and management are limited. This study assessed POAA incidence and timing, its association with mortality and rehospitalizations, and outcomes related to postoperative beta‐blocker use. Methods We retrospectively studied 233 adult lung transplant patients at Northwestern Memorial Hospital (2014–2024) without prior atrial arrhythmia. POAA, defined as atrial fibrillation or flutter, was confirmed by ECG or ambulatory monitoring. Multivariable logistic and Cox regression models evaluated predictors and outcomes, adjusting for covariates. Results POAA occurred in 69/233 patients (29.6%) and was associated with higher mortality (HR3.09, 95%CI [1.57–6.08]). Among these, 18/69 (26.1%) developed POAA after the index hospitalization at median 216 days post‐transplant, also associated with higher mortality (HR4.37, 95%CI [1.90–10.06]). Additionally, 10/69 (14.5%) required emergency visits or hospitalization specifically for arrhythmia management, and 66.6% underwent additional rhythm control (2.9% cardioversion, 46.4% anti‐arrhythmic drug, 17.4% both). Postoperative beta‐blocker use was associated with 73% less POAA (HR0.27, 95%CI [0.09–0.80]). Conclusion POAA was common and clinically significant after lung transplant, associated with substantially higher adjusted mortality even when occurring after index hospitalization. We report for the first time that POAA was frequently associated with emergency visits or rehospitalization for arrhythmia, highlighting its clinical burden well beyond the perioperative period. Postoperative beta‐blocker use was associated with markedly less POAA, a novel finding suggesting a potential prophylactic role. Overall, these findings challenge the traditional view of POAA as benign and highlight the need for tailored, evidence‐based guidelines in this high‐risk population.