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Ocean acidification and warming will alter phytoplankton biomass and composition, yet despite numerous studies, there are few consistent responses on which to base predictions. To determine the responses of chlorophyll-a and phytoplankton size and composition to predicted lower pH (−0.33 to −0.5) alone, and also combined with elevated temperature (+2.5–3.5 °C), two mesocosm experiments were carried out in austral spring and autumn in temperate New Zealand coastal waters. Lower pH alone had no effect on chlorophyll-a in either experiment and, as the treatment pH was lower than the pH minimum recorded in a parallel four-year time series, this lack of response in chlorophyll-a was not attributable to prior in situ exposure. Conversely, chlorophyll-a increased under lower pH and warming in both experiments, with the large (>20 µm) phytoplankton size fraction showing opposing responses under nutrient deplete and replete conditions. Diatom biomass also increased in both treatments when nutrient availability was maintained, with a dominant pennate species Cylindrotheca clostridium emerging. The results highlight the value of contextual time series for experimental interpretation, and also the importance of assessing warming and acidification together using regionally representative nutrient concentrations, for prediction of coastal phytoplankton response to climate change.

IT HAS love, hate, violence and prejudice -- something for everyone. West Side Story was based on Romeo and Juliet, so spot the similarities, but it promises to captivate with its powerful themes weaved into what is essentially a love story. Set in the 1950s in New York, it deals with multiculturalism. An energetic and talented cast of some 40 performers will bring the story to life for four weeks. Members of the Ignatians Musical Society, they will be directed by Simone de Haas and music director Harmony Lentz. The lead role of Maria is played by Siobhan Kranz while Steven Moore takes on the role of Tony. Kranz, 18, has been singing and acting since she was 12. Moore, 26, is director of music at St Paul's Anglican Parish, Ipswich. In 2003 he was appointed musical director of the Blackstone-Ipswich Cambrian Choir which this year was champion choir at the 2006 state Eisteddfod. Coolibah Country. Today and tomorrow. Workshops 9.30am to 4.30pm. $45. Creative Arts Centre, Vindex St, Winton. Info: 4657 1620. THIS movable feast of dance starts at Kulgan Park and ends at the Parade Ground at QUT Creative Industries Precinct at Kelvin Grove. It consists of four teams of 30 internationally renowned and emerging artists from Australia, Britain, Japan and Korea who have developed the works. The teams encompass dance, original music, visual and sonic media, live and virtual digital performance and interactive technology. The performances are in and around the architecture at QUT's Creative Industries Precinct, with projections on to the precinct's indoor and outdoor screens.

Background The need for better methods for evaluation in health research has been widely recognised. The ‘complexity turn’ has drawn attention to the limitations of relying on causal inference from randomised controlled trials alone for understanding whether, and under which conditions, interventions in complex systems improve health services or the public health, and what mechanisms might link interventions and outcomes. We argue that case study research—currently denigrated as poor evidence—is an under-utilised resource for not only providing evidence about context and transferability, but also for helping strengthen causal inferences when pathways between intervention and effects are likely to be non-linear. Main body Case study research, as an overall approach, is based on in-depth explorations of complex phenomena in their natural, or real-life, settings. Empirical case studies typically enable dynamic understanding of complex challenges and provide evidence about causal mechanisms and the necessary and sufficient conditions (contexts) for intervention implementation and effects. This is essential evidence not just for researchers concerned about internal and external validity, but also research users in policy and practice who need to know what the likely effects of complex programmes or interventions will be in their settings. The health sciences have much to learn from scholarship on case study methodology in the social sciences. However, there are multiple challenges in fully exploiting the potential learning from case study research. First are misconceptions that case study research can only provide exploratory or descriptive evidence. Second, there is little consensus about what a case study is, and considerable diversity in how empirical case studies are conducted and reported. Finally, as case study researchers typically (and appropriately) focus on thick description (that captures contextual detail), it can be challenging to identify the key messages related to intervention evaluation from case study reports. Conclusion Whilst the diversity of published case studies in health services and public health research is rich and productive, we recommend further clarity and specific methodological guidance for those reporting case study research for evaluation audiences.

Background There is a growing need for methods that acknowledge and successfully capture the dynamic interaction between context and implementation of complex interventions. Case study research has the potential to provide such understanding, enabling in-depth investigation of the particularities of phenomena. However, there is limited guidance on how and when to best use different case study research approaches when evaluating complex interventions. This study aimed to review and synthesise the literature on case study research across relevant disciplines, and determine relevance to the study of contextual influences on complex interventions in health systems and public health research. Methods Systematic meta-narrative review of the literature comprising (i) a scoping review of seminal texts ( n  = 60) on case study methodology and on context, complexity and interventions, (ii) detailed review of empirical literature on case study, context and complex interventions ( n  = 71), and (iii) identifying and reviewing ‘hybrid papers’ ( n  = 8) focused on the merits and challenges of case study in the evaluation of complex interventions. Results We identified four broad (and to some extent overlapping) research traditions, all using case study in a slightly different way and with different goals: 1) developing and testing complex interventions in healthcare; 2) analysing change in organisations; 3) undertaking realist evaluations; 4) studying complex change naturalistically. Each tradition conceptualised context differently—respectively as the backdrop to, or factors impacting on, the intervention; sets of interacting conditions and relationships; circumstances triggering intervention mechanisms; and socially structured practices. Overall, these traditions drew on a small number of case study methodologists and disciplines. Few studies problematised the nature and boundaries of ‘the case’ and ‘context’ or considered the implications of such conceptualisations for methods and knowledge production. Conclusions Case study research on complex interventions in healthcare draws on a number of different research traditions, each with different epistemological and methodological preferences. The approach used and consequences for knowledge produced often remains implicit. This has implications for how researchers, practitioners and decision makers understand, implement and evaluate complex interventions in different settings. Deeper engagement with case study research as a methodology is strongly recommended.

Background Guidance and reporting principles such as CONSORT (for randomised trials) and PRISMA (for systematic reviews) have greatly improved the reporting, discoverability, transparency and consistency of published research. We sought to develop similar guidance for case study evaluations undertaken to explore the influence of context on the processes and outcomes of complex interventions. Methods A range of experts were recruited to an online Delphi panel, sampling for maximum diversity in disciplines (e.g. public health, health services research, organisational studies), settings (e.g. country), and sectors (e.g. academic, policy, third sector). To inform panel deliberations, we prepared background materials based on: [a] a systematic meta-narrative review of empirical and methodological literatures on case study, context and complex interventions; [b] the collective experience of a network of health systems and public health researchers; and [c] the established RAMESES II standards (which cover one kind of case study). We developed a list of topics and issues based on these sources and encouraged panel members to provide free text comments. Their feedback informed development of a set of items in the form of questions for potential inclusion in the reporting principles. We circulated these by email, asking panel members to rank each potential item twice (for relevance and validity) on a 7-point Likert scale. This sequence was repeated twice. Results We recruited 51 panel members from 50 organisations across 12 countries, who brought experience of a range of case study research methods and applications. 26 completed all three Delphi rounds, reaching over 80% consensus on 16 items covering title, abstract, definitions of terms, philosophical assumptions, research question(s), rationale, how context and complexity relates to the intervention, ethical approval, empirical methods, findings, use of theory, generalisability and transferability, researcher perspective and influence, conclusions and recommendations, and funding and conflicts of interest. Conclusion The ‘Triple C’ ( C ase study, C ontext, C omplex interventions) reporting principles recognise that case studies are undertaken in different ways for different purposes and based on different philosophical assumptions. They are designed to be enabling rather than prescriptive, and to make case study evaluation reporting on context and complex health interventions more comprehensive, accessible and useable.

Global mobility has made global health a priority within nursing curricula and health care organizations. A collaborative online learning activity could promote international perspectives of health care delivery. Including a collaborative online international learning activity in continuing education for practicing nurses is a viable strategy that is consistent with the internationalization at home movement. Use of a qualitative descriptive evaluation approach when teaching prelicen-sure nursing students and educating practicing nurses provides effective international collaboration, promotes a global mindset, and provides an exemplar for professional development specialists to teach practicing nurses. [J Contin Educ Nurs. 2024;55(5):220–223.]

There is a growing body of public health research documenting how characteristics of neighborhoods are associated with differences in the health status of residents. However, little is known about how the spatial resolution of neighborhood observational data or community audits affects the identification of neighborhood differences in health. We developed a systematic neighborhood observation instrument for collecting data at very high spatial resolution (we observe each parcel independently) and used it to collect data in a low-income minority neighborhood in Dallas, TX. In addition, we collected data on the health status of individuals residing in this neighborhood. We then assessed the inter-rater reliability of the instrument and compared the costs and benefits of using data at this high spatial resolution. Our instrument provides a reliable and cost-effect method for collecting neighborhood observational data at high spatial resolution, which then allows researchers to explore the impact of varying geographic aggregations. Furthermore, these data facilitate a demonstration of the predictive accuracy of self-reported health status. We find that ordered logit models of health status using observational data at different spatial resolution produce different results. This implies a need to analyze the variation in correlative relationships at different geographic resolutions when there is no solid theoretical rational for choosing a particular resolution. We argue that neighborhood data at high spatial resolution greatly facilitates the evaluation of alternative geographic specifications in studies of neighborhood and health.

Global mobility has made global health a priority within nursing curricula and health care organizations. A collaborative online learning activity could promote international perspectives of health care delivery. Including a collaborative online international learning activity in continuing education for practicing nurses is a viable strategy that is consistent with the internationalization at home movement. Use of a qualitative descriptive evaluation approach when teaching prelicen-sure nursing students and educating practicing nurses provides effective international collaboration, promotes a global mindset, and provides an exemplar for professional development specialists to teach practicing nurses. [J Contin Educ Nurs. 2024;55(5):220–223.]

Background The optimal use of various therapeutic combinations for moderate/severe chronic obstructive pulmonary disease (COPD) is unclear. The GLISTEN trial compared the efficacy of two long-acting anti-muscarinic antagonists (LAMA), when combined with an inhaled corticosteroid (ICS) and a long-acting β2 agonist (LABA). Methods This randomised, blinded, placebo-controlled trial in moderate/severe COPD patients compared once-daily glycopyrronium (GLY) 50 µg, once-daily tiotropium (TIO) 18 µg or placebo (PLA), when combined with salmeterol/fluticasone propionate (SAL/FP) 50/500 µg twice daily. The primary objective was to determine the non-inferiority of GLY+SAL/FP versus TIO+SAL/FP on trough FEV1 after 12 weeks. An important secondary objective was whether addition of GLY to SAL/FP was better than SAL/FP alone. Results 773 patients (mean FEV1 57.2% predicted) were randomised; 84.9% completed the trial. At week 12, GLY+SAL/FP demonstrated non-inferiority to TIO+SAL/FP for trough FEV1: least square mean treatment difference (LSMdiff) −7 mL (SE 17.4) with a lower limit for non-inferiority of −60 mL. There was significant increase in week 12 trough FEV1 with GLY+SAL/FP versus PLA+SAL/FP (LSMdiff 101 mL, p<0.001). At 12 weeks, GLY+SAL/FP produced significant improvement in St George's Respiratory Questionnaire total score versus PLA+SAL/FP (LSMdiff −2.154, p=0.02). GLY+SAL/FP demonstrated significant rescue medication reduction versus PLA+SAL/FP (LSMdiff −0.72 puffs/day, p<0.001). Serious adverse events were similar for GLY+SAL/FP, TIO+SAL/FP and PLA+SAL/FP with an incidence of 5.8%, 8.5% and 5.8%, respectively. Conclusions GLY+SAL/FP showed comparable improvements in lung function, health status and rescue medication to TIO+SAL/FP. Importantly, addition of GLY to SAL/FP demonstrated significant improvements in lung function, health status and rescue medication compared to SAL/FP. Trial registration number NCT01513460.

Bohring–Opitz syndrome (BOS) is a rare congenital disorder of unknown etiology diagnosed on the basis of distinctive clinical features. We suggest diagnostic criteria for this condition, describe ten previously unreported patients, and update the natural history of four previously reported patients. This is the largest series reported to date, providing a unique opportunity to document the key clinical features and course through childhood. Investigations undertaken to try and elucidate the underlying pathogenesis of BOS using array comparative genomic hybridization and tandem mass spectrometry of cholesterol precursors did not show any pathogenic changes responsible.