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We report long‐term follow‐up of a patient who underwent a tailored laparoscopic procedure for symptomatic cholelithiasis, massive splenomegaly, and a planned pregnancy. There were no complications, and the patient remained symptom‐free at the 5‐year follow‐up. We supplemented our case report with national surgical data demonstrating the safety of laparoscopic splenectomy. Laparoscopic splenectomy is a safe and effective approach for patients with immune thrombocytopenic purpura, even those with massive splenomegaly. We highlight the benefits of tailoring the surgical approach to address the patient's surgical needs.

Background Living in a cold home and being fuel poor can contribute to adverse physical and mental health. Energy efficiency interventions are considered the simplest ways of tackling fuel poverty and preventing associated negative health, wellbeing, and socio-economic consequences. The overall aim of the current study was to provide a greater understanding of the impact of a locally administered programme, which funded the installation of major heating/insulation measures in areas of high fuel poverty, on the health and wellbeing of beneficiaries of the programme. Methods A mixed-methods approach to explore the health and wellbeing impacts of a fuel poverty programme in East Sussex that took place between October 2016 and March 2018. Beneficiaries completed the Warwick-Edinburgh Mental Wellbeing Scale before and after any heating/insulation work had been completed in their home. Beneficiaries were also asked to retrospectively rate their health pre- and post-installation. Interviews with 23 beneficiaries of the programme were conducted to explore in-depth the impact of the programme on people’s health and wellbeing and the wider social determinants of health. Results A major heating/insulation measure was installed in 149 homes. The majority of measures installed were boilers (57.7%) and new central heating systems (32.2%). Self-rated health and wellbeing were significantly higher post-installation. Interviewees described clear examples of the positive impacts on physical health and wellbeing such as fewer chest infections, reduced pain, feeling less anxious and depressed, and generally feeling happier and more relaxed. Interviews also highlighted broader areas of impact such as reduced social isolation and increased use of domestic space. Many of the beneficiaries also reported a reduction in their energy bills since their new heating systems had been installed. Conclusions The findings from the evaluation suggest that the installation of major heating or insulation measures such as new boilers have substantial benefits for the health and wellbeing of beneficiaries. The findings also suggest that the programme had a positive impact on wider determinants of health including reduction in stress and isolation that are likely to be part of the pathways between fuel poverty interventions and mental and physical health outcomes.

Most patients with irritable bowel syndrome (IBS) are managed in primary care. When first-line therapies for IBS are ineffective, the UK National Institute for Health and Care Excellence guideline suggests considering low- dose tricyclic antidepressants as second-line treatment, but their effectiveness in primary care is unknown, and they are infrequently prescribed in this setting. This randomised, double-blind, placebo-controlled trial (Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment [ATLANTIS]) was conducted at 55 general practices in England. Eligible participants were aged 18 years or older, with Rome IV IBS of any subtype, and ongoing symptoms (IBS Severity Scoring System [IBS-SSS] score ≥75 points) despite dietary changes and first-line therapies, a normal full blood count and C-reactive protein, negative coeliac serology, and no evidence of suicidal ideation. Participants were randomly assigned (1:1) to low-dose oral amitriptyline (10 mg once daily) or placebo for 6 months, with dose titration over 3 weeks (up to 30 mg once daily), according to symptoms and tolerability. Participants, their general practitioners, investigators, and the analysis team were all masked to allocation throughout the trial. The primary outcome was the IBS-SSS score at 6 months. Effectiveness analyses were according to intention-to-treat; safety analyses were on all participants who took at least one dose of the trial medication. This trial is registered with the ISRCTN Registry (ISRCTN48075063) and is closed to new participants. Between Oct 18, 2019, and April 11, 2022, 463 participants (mean age 48·5 years [SD 16·1], 315 [68%] female to 148 [32%] male) were randomly allocated to receive low-dose amitriptyline (232) or placebo (231). Intention-to-treat analysis of the primary outcome showed a significant difference in favour of low-dose amitriptyline in IBS-SSS score between groups at 6 months (–27·0, 95% CI –46·9 to –7·10; p=0·0079). 46 (20%) participants discontinued low-dose amitriptyline (30 [13%] due to adverse events), and 59 (26%) discontinued placebo (20 [9%] due to adverse events) before 6 months. There were five serious adverse reactions (two in the amitriptyline group and three in the placebo group), and five serious adverse events unrelated to trial medication. To our knowledge, this is the largest trial of a tricyclic antidepressant in IBS ever conducted. Titrated low-dose amitriptyline was superior to placebo as a second-line treatment for IBS in primary care across multiple outcomes, and was safe and well tolerated. General practitioners should offer low-dose amitriptyline to patients with IBS whose symptoms do not improve with first-line therapies, with appropriate support to guide patient-led dose titration, such as the self-titration document developed for this trial. National Institute for Health and Care Research Health Technology Assessment Programme (grant reference 16/162/01).

Over the past two decades (2000–2020), volcano infrasound (acoustic waves with frequencies less than 20 Hz propagating in the atmosphere) has evolved from an area of academic research to a useful monitoring tool. As a result, infrasound is routinely used by volcano observatories around the world to detect, locate, and characterize volcanic activity. It is particularly useful in confirming subaerial activity and monitoring remote eruptions, and it has shown promise in forecasting paroxysmal activity at open-vent systems. Fundamental research on volcano infrasound is providing substantial new insights on eruption dynamics and volcanic processes and will continue to do so over the next decade. The increased availability of infrasound sensors will expand observations of varied eruption styles, and the associated increase in data volume will make machine learning workflows more feasible. More sophisticated modeling will be applied to examine infrasound source and propagation effects from local to global distances, leading to improved infrasound-derived estimates of eruption properties. Future work will use infrasound to detect, locate, and characterize moving flows, such as pyroclastic density currents, lahars, rockfalls, lava flows, and avalanches. Infrasound observations will be further integrated with other data streams, such as seismic, ground- and satellite-based thermal and visual imagery, geodetic, lightning, and gas data. The volcano infrasound community should continue efforts to make data and codes accessible and to improve diversity, equity, and inclusion in the field. In summary, the next decade of volcano infrasound research will continue to advance our understanding of complex volcano processes through increased data availability, sensor technologies, enhanced modeling capabilities, and novel data analysis methods that will improve hazard detection and mitigation.

Invasions of nonnative species have multiple implications, including modification of biogeochemical cycles, inhibition of natural regeneration of native species, and loss of ecosystem biodiversity and productivity. Japanese honeysuckle ( Lonicera japonica Thunb.) is a vigorous invader of the southern forestlands of the United States (U.S.). Our objectives were to document changes in the distribution of Japanese honeysuckle since the turn of the century, identify climatic variables correlated with its successful invasion, and project its potential future distribution under climate change. To accomplish this, we analyzed the most recent U.S. Forest Service field measurements of Japanese honeysuckle in the southern U.S. Our analysis indicated that the number of sampled plots invaded by Japanese honeysuckle from 2009 to 2017 increased by approximately 53% compared to plots sampled from 2000 to 2008, and the mean percent coverage of Japanese honeysuckle in sampled plots increased significantly. Results of boosted regression tree analysis indicated that probability of invasion was correlated with six climatic variables, including annual precipitation, annual mean temperature, max temperature of warmest month, mean diurnal range, temperature annual range, and isothermality. The states projected to be most at risk to invasion under the historical climate were Kentucky, Arkansas, Tennessee, North Carolina, Mississippi, Alabama, Georgia, and South Carolina. Future projections imply a northward shift of predominant species presence, with the most likely affected states being Kentucky, Virginia, Tennessee, North Carolina, Alabama, and Georgia. Our model provides important insights into the management of Japanese honeysuckle in the southern forestlands of the U.S. By identifying current and potential future high-risk and low-risk areas, our results can aid forest managers in developing long term monitoring and control strategies for effectively slowing Japanese honeysuckle range expansion and mitigating its effects.

Bacillus anthracis, the causative agent of anthrax in humans, livestock, and wildlife, exists in a community with hundreds of other species of bacteria in the environment. Work on the genetics of these communities has shown that B. anthracis shares a high percentage of chromosomal genes with both B. thuringiensis and B. cereus, and that phenotypic differences among these bacteria can result from extra-chromosomal DNA in the form of plasmids. We developed a simple hypothetical individual-based model to simulate the likelihood of detecting plasmids with genes encoding anthrax toxins within bacterial communities composed of B. anthracis, B. thuringiensis, and B. cereus, and the surrounding matrix of extra-cellular polymeric substances. Simulation results suggest the horizontal transfer of plasmids with genes encoding anthrax toxins among Bacillus species persisting outside the host could function as a proximate factor triggering anthrax outbreaks.

Theropods are bipedal dinosaurs that appeared 230 million years ago and are still extant as birds. Their history is characterized by extreme variations in body mass, with gigantism evolving independently and on several occasions between many theropod groups. However, no study has shown whether all theropods evolved the same limb adaptations to high body mass or whether they had different morphologies. Here we studied the shape variation across 68 femora from 41 species of theropods using a 3D comparative approach, multivariate statistics, and phylogenetically informed analyses. We demonstrated that all the heaviest theropods evolved similar adaptations regardless of their phylogenetic affinities by enlarging muscular attachments and articular surfaces. We also highlighted that the lightest theropods evolved femoral adaptations to miniaturization, which occurred close to the bird lineage (Avialae). In addition, our results support a gradual evolution of known “avian” features, independent from body mass variations, which may relate to a more “avian” type of locomotion, where the knee drives hindlimb movement instead of the hip, like in earlier theropod relatives. The distinction between body mass variations and a more “avian” locomotion is represented by a decoupling in the mediodistal crest morphology, whose biomechanical nature should be studied to better understand the importance of its functional role in gigantism, miniaturization, and the evolution of a more “avian” type of locomotion. Theropods are obligate bipedal dinosaurs that appeared 230 Ma and are still extant as birds. Their history is characterized by extreme variations in body mass, with gigantism evolving convergently between many lineages. However, no quantification of hindlimb functional morphology has shown whether these body mass increases led to similar specializations between distinct lineages. Here we studied femoral shape variation across 41 species of theropods (n = 68 specimens) using a high-density 3D geometric morphometric approach. We demonstrated that the heaviest theropods evolved wider epiphyses and a more distally located fourth trochanter, as previously demonstrated in early archosaurs, along with an upturned femoral head and a mediodistal crest that extended proximally along the shaft. Phylogenetically informed analyses highlighted that these traits evolved convergently within six major theropod lineages, regardless of their maximum body mass. Conversely, the most gracile femora were distinct from the rest of the dataset, which we interpret as a femoral specialization to “miniaturization” evolving close to Avialae (bird lineage). Our results support a gradual evolution of known “avian” features, such as the fusion between lesser and greater trochanters and a reduction of the epiphyseal offset, independent from body mass variations, which may relate to a more “avian” type of locomotion (more knee than hip driven). The distinction between body mass variations and a more “avian” locomotion is represented by a decoupling in the mediodistal crest morphology, whose biomechanical nature should be studied to better understand the importance of its functional role in gigantism, miniaturization, and higher parasagittal abilities.

Healthcare professionals need clearer guidance on responding to racism in paediatric settings, argue Zeshan Qureshi and colleagues

We present coupled sulfur and oxygen isotope data from sulfur nodules and surrounding gypsum, as well as iron and manganese concentration data, from the Lisan Formation near the Dead Sea (Israel). The sulfur isotope composition in the nodules ranges between -9 and -11‰, 27 to 29‰ lighter than the surrounding gypsum, while the oxygen isotope composition of the gypsum is constant around 24‰. The constant sulfur isotope composition of the nodule is consistent with formation in an 'open system'. Iron concentrations in the gypsum increase toward the nodule, while manganese concentrations decrease, suggesting a redox boundary at the nodule-gypsum interface during aqueous phase diagenesis. We propose that sulfur nodules in the Lisan Formation are generated through bacterial sulfate reduction, which terminates at elemental sulfur. We speculate that the sulfate-saturated pore fluids, coupled with the low availability of an electron donor, terminates the trithionate pathway before the final two-electron reduction, producing thionites, which then disproportionate to form abundant elemental sulfur.

Human colonic neuromuscular functions decline among the elderly. The aim was to explore the involvement of senescence. A preliminary PCR study looked for age-dependent differences in expression of CDKN1A (encoding the senescence-related p21 protein) and CDKN2A (encoding p16 and p14) in human ascending and descending colon (without mucosa) from 39 (approximately 50: 50 male: female) adult (aged 27–60 years) and elderly donors (70–89 years). Other genes from different aging pathways (e.g., inflammation, oxidative stress, autophagy) and cell-types (e.g., neurons, neuron axonal transport) were also examined. Unlike CDKN1A, CDKN2A (using primers for p16 and p14 but not when using p14-specific primers) was upregulated in both regions of colon. Compared with the number of genes appearing to upregulate in association with temporal age, more genes positively associated with increased CDKN2A expression (respectively, 16 and five of 44 genes studied for ascending and descending colon). Confirmation of increased expression of CDKN2A was sought by immunostaining for p16 in the myenteric plexus of colon from 52 patients, using a semi-automated software protocol. The results showed increased staining not within the glial cells (S100 stained), but in the cytoplasm of myenteric nerve cell bodies (MAP2 stained, with identified nucleus) of ascending, but not descending colon of the elderly, and not in the cell nucleus of either region or age group (5,710 neurons analyzed: n = 12–14 for each group). It was concluded that increased p16 staining within the cytoplasm of myenteric nerve cell bodies of elderly ascending (but not descending) colon, suggests a region-dependent, post-mitotic cellular senescence-like activity, perhaps involved with aging of enteric neurons within the colon.