Plain Language Summary Research Articles

Dapagliflozin or saxagliptin in pediatric type 2 diabetes: a plain language summary

Plain Language Summary What is this plain language summary about? The T2NOW study was a clinical trial which tested the use of two different blood sugar-reducing drugs (dapagliflozin or saxagliptin) in young people aged between 10 and 17 years with type 2 diabetes. Each drug was compared with a placebo to see to what extent the treatment can control blood sugar levels, and to observe any side effects. Type 2 diabetes is a chronic condition affecting how the body processes sugar, resulting in high levels of sugar in the blood. Over time, high blood sugar levels can cause damage to certain parts of the body such as the cardiovascular system, the kidneys, nerves, and eyes, often resulting in serious health problems. Once considered a disease of middle-age or older-age, it is becoming more common in younger people, in part because of an increase in childhood obesity. This is concerning, as when diabetes starts at a young age it can progress quickly and lead to these serious health problems earlier in life. Improvements in diet and exercise are important elements for everyone with type 2 diabetes. However, there are currently very few other treatments available for children and adolescents. What are the key takeaways? When compared to a group of participants receiving placebo in the study, participants receiving dapagliflozin had significantly improved blood sugar control but participants receiving saxagliptin did not. Both the dapagliflozin and saxagliptin treatments were generally well tolerated by participants, with similar proportions in each group experiencing side effects. Only one participant in each group stopped treatment because of side effects. Similar proportions of participants in all groups–including the placebo group–had hypoglycemia, suggesting that neither dapagliflozin nor saxagliptin affected the likelihood of experiencing this important side effect. What are the main conclusions reported by the researchers? The T2NOW study showed that dapagliflozin could be an addition to treatment options for young people with type 2 diabetes as it helped to control blood sugar levels and did not raise any safety concerns. In contrast, although there were no safety concerns related to use of saxagliptin, it did not significantly help to control blood sugar levels in this study. This is an abstract of the Plain Language Summary of Publication article. View the full Plain Language Summary PDF of this article to read the full-text Link to original article here

Response to amoxicillin and perampanel in infantile Alexander disease.

Type I Alexander disease (AxD) presents with paroxysmal neurodegeneration, refractory epilepsy, and encephalopathy in the first years of life and is associated with a poor prognosis. Although there is no treatment, mild symptomatic improvement has been reported in one case of adult Alexander treated with ceftriaxone, given its interaction with the mutant glial fibrillary acid protein (GFAP) responsible for the disease's pathogenesis. We describe a patient presenting with irritability starting at 2 months of age, initially attributed to gastroesophageal reflux. A ventriculoperitoneal shunt was placed at 3 months of age due to hydrocephalus secondary to aqueduct stenosis detected through an MRI scan, but the irritability persisted. At 5 months, a new brain MRI was performed due to irritability worsening, onset of abnormal ocular movements and seizures. In addition genetic testing was performed. AxD was diagnosed due to the mutation c.716G>A (p.Arg239His) in GFAP. Since irritability had worsened and had not responded to levomepromazine, treatment with amoxicillin (80 mg/kg/day) was attempted to modulate glutamate levels. The patient showed a striking improvement of irritability in 48 h that persisted over the next months. The patient had frequent daily seizures which did not respond to valproate, clonazepam, or phenobarbital. Perampanel, a postsynaptic AMPA receptor antagonist, was added to phenobarbital and he was seizure free for more than 3 months. Drugs modulating glutamate levels in the central nervous system, including β-lactam antibiotics and perampanel, may have an important role in the symptomatic treatment of AxD and other neurodegenerative diseases where glutamatergic excitotoxicity is a pathogenic determinant. PLAIN LANGUAGE SUMMARY: Alexander disease is a rare and serious condition that affects the brain, often leading to neurodegeneration (brain damage), seizures, and other problems in early childhood. The disease is caused by a mutation in a gene called GFAP. There is no cure, and current treatments mainly focus on relieving symptoms. This article discusses the case of a baby who showed signs of irritability and seizures from a young age. The baby was diagnosed with Alexander disease after brain scans and genetic testing. Despite treatment with various drugs, the baby continued to experience seizures and irritability. The doctors decided to try amoxicillin, a common antibiotic, because of its potential to help control the disease by affecting a brain chemical called glutamate. Surprisingly, the baby's irritability improved within 2 days of starting amoxicillin, and the improvement lasted for several months. However, the seizures persisted until another medication, perampanel, was added. This combination controlled the baby's seizures for over 3 months. Unfortunately, the baby passed away at 13 months due to complications from the disease. However, doctors believe that drugs like amoxicillin and perampanel could be promising treatments for managing symptoms of Alexander disease and other similar brain conditions in the future, especially where excess glutamate plays a role in the damage. This case suggests that these treatments may help control irritability and seizures, offering hope for better management of this challenging disease.

Plain language summary of the pivotal study of calcium hydroxylapatite with lidocaine for improvement of jawline contour

Summary What is this article about? A study (ClinicalTrials.gov identifier: NCT03583359) that tested whether an injectable filler treatment called calcium hydroxylapatite with lidocaine, or CaHA (+), could improve the shape of the jawline.How was the study in this summary conducted? Loss of jawline shape is a change to jawline appearance, like sagging or deflating, that occurs as people get older. A total of 123 participants received CaHA (+) injections on day 1 of the study (immediate treatment). Fifty-seven participants did not receive CaHA (+) until week 12 (delayed treatment). Jawline shape at week 12 was rated on a five-point scale (0 = no loss of shape or volume; 4 = extreme loss). Researchers also looked at participants’ satisfaction and self-reported improvement, ratings of how old participants thought they looked, and side effects.What were the results of the study? In the immediate treatment group, 76% of participants had improvement in jawline shape at week 12 (compared with 9% of participants in the delayed treatment group), which typically lasted approximately 8 months, and 94% self-reported improvement in jawline appearance. The participants were more satisfied with their jawlines and reported looking approximately 3 years younger at week 12 compared with before treatment. Regardless of sex or skin tone, side effects were categorized as mostly mild or moderate reactions, like lumps or bruising, at the site where CaHA (+) was injected.What do the results of this study mean? The results showed that CaHA (+) injections improved jawline shape in most participants and caused only mild or moderate side effects regardless of sex or skin tone, suggesting that CaHA (+) is safe and works well for diverse groups of patients.Who should read this article? This summary is for patients and others interested in learning about how CaHA (+) works, its safety, and its ability to improve jawline shape.Who sponsored this study? The study was sponsored by Merz North America, Inc.

Reduced predation and energy flux in soil food webs by introduced tree species: Bottom‐up control of multitrophic biodiversity across size compartments

Abstract The introduction of non‐native tree species has become a global concern and may disrupt native communities and related ecosystem functions. Soil food webs regulate organic matter decomposition and nutrient cycling in forests with their feeding activities, but evaluating consequences of the introduction of tree species on soil invertebrates is challenging due to the complex trophic structure and wide range in body size of soil invertebrates. Here, we employed an energetic food web approach and estimated the energy flux in soil food webs using a four‐node model including soil meso‐ and macrofauna decomposers and predators. We examined pure and mixed stands of native European beech (Fagus sylvatica), introduced Douglas fir (Pseudotsuga menziesii) and native range‐expanding Norway spruce (Picea abies) across site conditions. Compared to native forests, introduced tree species reduced total fresh mass of macrofauna predators by 92% at sandy sites but not that of decomposers, suggesting trophic downgrading in soil food webs by Douglas fir. The energy flux in mixed forests was intermediate between respective monocultures, suggesting that tree mixtures mitigate potential negative impacts of introduced tree species on food web functioning. Across size classes, soil macrofauna responded more sensitively to changes in environmental conditions than soil mesofauna. Additionally, total energy flux positively correlated with species richness, pointing to the significance of soil biodiversity for trophic functionality. The energy flux through mesofauna outweighed that through macrofauna when considering energy loss to predators, highlighting the importance of mesofauna for decomposition processes in forest soil food webs. Overall, the study emphasizes the critical role of tree species composition, site conditions and soil biodiversity in driving energy flux through soil food webs and maintaining forest ecosystem functions. Read the free Plain Language Summary for this article on the Journal blog.

Plant phenology predicts the stability of primary production in three ecosystems of the northern Chihuahuan Desert

Abstract The temporal stability of plant productivity affects species' access to resources, exposure to stressors and strength of interactions with other species in the community, including support to the food web. The magnitude of temporal stability depends on how a species allocates resources among tissues and across phenological stages, such as vegetative growth versus reproduction. Understanding how plant phenological traits correlate with the long‐term stability of plant biomass is particularly important in highly variable ecosystems, such as drylands. We evaluated whether phenological traits predict the temporal stability of plant species productivity by correlating 18 years of monthly phenology observations with biannual estimates of above‐ground plant biomass for 98 plant species from semi‐arid drylands. We then paired these phenological traits with potential climate drivers to identify abiotic contexts that favour specific phenological strategies among plant species. Phenological traits predicted the stability of plant species above‐ground biomass. Plant species with longer vegetative phenophases not only had more stable biomass production over time but also failed to fruit in a greater proportion of years, indicating a growth–reproduction trade‐off. Earlier leaf‐out dates, longer fruiting duration and longer time lags between leaf and fruit production also predicted greater temporal stability. Species with stability‐promoting traits began greening in drier conditions than their unstable counterparts and experienced unexpectedly greater exposure to climate stress, indicated by the wider range of temperatures and precipitation experienced during biologically active periods. Our results suggest that bet‐hedging strategies that spread resource acquisition and reproduction over long time periods help to stabilize plant species productivity in variable environments, such as drylands. Read the free Plain Language Summary for this article on the Journal blog.

Spider waste enhances soil nutrient content, soil respiration, and plant growth

Abstract Predators can alter the movement of nutrients through ecosystems by depositing waste products following predation. Whilst the benefits of predator waste for large predators (e.g. bears) or dense accumulations of predators (e.g. seabirds on islands) seem clear, less is known about whether smaller, solitary predators can have measurable effects on local ecosystem processes. In separate experiments with web‐building and wandering spiders, we tested if the presence of predators affected soil nutrient content, soil respiration, soil microbial communities, and plant growth. In the first experiment with black widow spiders, total nitrogen and nitrate were not affected by spider presence, but ammonia and phosphorus were higher from soil under the edge of the spider web than soil away from the spider. Soil respiration and plant growth were both higher in soil collected from under the spider retreat compared with soil collected away from the spider web. In a second experiment with wolf spiders, we tested for interactions between spiders and soil microbial communities. There were positive effects of wolf spider presence on all soil nutrients and there were interactions between spiders and soil type (i.e. field‐collected versus autoclaved) for total carbon, total nitrogen, nitrate, and pH. Spider presence and soil type also affected soil respiration and spider presence had a large effect on the composition of the microbial community of the soil. There were also positive effects of wolf spider presence on plant biomass and plant height, with a significant interaction between spiders and soil type for plant height. Overall, our results show that two spiders with different life histories (i.e. web‐building and wandering) both have significant positive effects on plant growth through the deposition of their waste products. These effects may occur through the direct deposition of nutrients and changes in soil microbial communities. Although, further work is needed to resolve these interactions. Read the free Plain Language Summary for this article on the Journal blog.

Protected areas shape the distribution of tourism across rural Europe

Abstract Protected areas (PAs) have expanded rapidly in recent decades to help mitigate the ongoing biodiversity crisis but are under increasing human pressures that jeopardize their conservation effectiveness. Tourism in PAs may galvanize efforts towards biodiversity conservation, but it can also be a major source of threats, leading to multiple adverse social and ecological impacts. Considering the recent Kunming‐Montreal Global Biodiversity Framework, which aims to protect at least 30% of terrestrial ecosystems by 2030, understanding and assessing how and which PAs shape the spatial distribution of tourism is of great importance to biodiversity management and policy. In this study, we used a geospatial data set that describes the location and capacity of tourism accommodation in 81,185 local administrative units (LAUs) covering over 28 countries across rural Europe. After estimating the number of nights spent per LAU, we modelled the influence of PAs on the distribution of tourism throughout Europe while controlling for other social, economic and environmental covariates, but also for spatial autocorrelation. We reveal a positive link between highly protected PAs and the number of nights spent by tourists in LAUs. The attractiveness of these PAs for tourists may pose a conservation paradox, that is, highly protected PAs, which aim to safeguard nature tend to attract a disproportionate number of tourists, which may lead to nature degradation. Read the free Plain Language Summary for this article on the Journal blog.

Collaborative and side-by-side artmaking: reducing social isolation in refugee youth group art therapy

ABSTRACT Background Research on social isolation in refugee youth is important because it affects their sense of belonging, mental health and wellbeing; integration and acculturation into a new country; education; and future employment opportunities. There is limited art therapy research in Australia in this area, leaving a compelling gap in understanding the effectiveness of collaborative and side-by-side artmaking in group art therapy to connect refugee youth with their peers. Aims This study aimed to explore whether collaborative and side-by-side artmaking in group art therapy would connect youth more effectively; alleviate their social isolation from trauma, displacement and re-settlement experiences; provide a safe environment and platform to express themselves; and improve their mental health and wellbeing. Methods The triangular mixed-methods approach used standardised scales and semi-structured interviews to gather information from youth, teachers and art therapists. Mixed-method data analysis was applied using the Reliable Change Index, line graphs, descriptive statistics, and thematic analysis. Results Refugee youths’ self-esteem and confidence seemed to increase through collaborative and side-by-side artmaking. Results highlighted the importance of social connection, self-esteem, confidence and a sense of safety for making positive connections during artmaking. Conclusions Findings indicate potential benefits of pportunities for refugee youth to connect with their peers in the school environment and of group art therapy. Implications for practice and future research Opportunities could be achieved through collaborative and side-by-side artmaking in group art therapy. A larger study, longer programme and mixed populations in the school setting are recommended for future research. Plain-language summary The research aimed to examine if there was an effect of a six-week art therapy programme on social isolation for five 14–15-year-old female refugee youth. This research is important because social isolation affects youth’s mental health and wellbeing. Through creating art individually and next to each other (side-by-side artmaking), and creating artworks together (collaborative artmaking), the programme aimed to reduce social isolation and increase connections between youth during the sessions and in the school environment. The research was conducted in an early intervention creative therapies service onsite at a Queensland English-language transition secondary school. The service is provided by accredited art therapists and uses creative methods to support culturally diverse refugee youth in resettling, learning and recovering from trauma and stress. During the research, youth participants engaged in art activities, such as drawing and painting, while listening to music. Interventions were designed to establish group bonds, build self-esteem and resilience, and empower youth in a safe and supportive environment. Art therapists and teachers observed youth during the research period, completed standardised scales before and after the programme and participated in semi-structured interviews. The youth participants also completed standardised scales and were interviewed before and after the programme. The results showed that after the six-week programme, youths’ wellbeing and connections to each other increased. Three central themes were identified: (1) social connection is important within the school environment; (2) self-esteem and confidence are related to connecting to others and social isolation; and (3) there is a sense of safety in artmaking individually and collaboratively with peers. The study found that the art therapy programme positively affected youth mental health and wellbeing. This suggests the programme effectively reduced participants’ social isolation, potentially offering positive opportunities to connect other youth at risk of social isolation.

Epilepsy in CHAD: Realities, constraints, and prospects.

Epilepsy is a significant public health problem. More than 50 million people worldwide live with epilepsy, and over three-quarters of them are in low- and middle-income countries. The situation in Chad regarding people with epilepsy is challenging to assess, starting from the shortage of scientific data, the inadequacy of technical facilities, the lack of human resources, and the inadequacy of government action. The Ministry of Health and Chadian Society of Neurology are looking forward to prioritizing epilepsy as well as improving the living conditions of persons with this disease. The epilepsy treatment issue is also problematic. Most of the patients are either off treatment or under-medicated. Few antiseizure medications (ASMs) are available, notably carbamazepine, phenobarbital, and valproic acid. Epilepsy remains little-known and does not seem to be a priority for decision-makers. We describe the current situation in Chad, to improve the conditions under which epilepsy is treated. PLAIN LANGUAGE SUMMARY: Epilepsies is a chronic brain problem that is common in poorer settings. The daily lives of people with epilepsy are chaotic in Chad. The challenges are numerous, particularly those related to health infrastructures, due to the lack of adequate diagnostic means and the lack of neurologists. The cultural and language challenges, especially since epilepsy is still considered the devil's disease and the name differs according to the dialects. Stigmatization is also frequent and is often responsible for school dropout, refusal, or dismissal from work. Care and prevention are daily challenges that require government action. Social coverage is insufficient and almost absent in rural areas. It is urgent to prioritize epilepsy in future action plans and also to increase awareness of the conditions to overcome these challenges.

Nitrogen deposition and heathland management cause multi‐element stoichiometric mismatches, reducing insect fitness

Abstract Increased nitrogen and acidifying deposition negatively affect biogeochemical cycles and nutrient stoichiometry, particularly in oligotrophic habitats. In heathlands, management aims to mitigate effects of deposition by topsoil removal (sod‐cutting) or by liming to increase soil pH. However, these management efforts may further exacerbate macro‐ and micronutrient stoichiometric mismatch, with cascading effects on heathland insects. Here, we investigate the physiological mechanisms by which deposition and management affect insects, focusing on nutrient uptake and excretion. We combined a phosphorus (P) addition and liming experiment in previously sod‐cut heathland with laboratory‐rearing experiments using the field cricket (Gryllus campestris L., 1) as a model species. We hypothesized that P addition would benefit cricket performance by reducing food N:P ratio. Conversely, we hypothesized that liming would reduce performance by decreasing food Mn:Mg and/or Fe:Mg ratios. Elemental uptake efficiency, consumption and reproduction, as well as cricket field density, were significantly higher under increased P availability, confirming insect P limitation in the field. Liming decreased food Mn:Mg ratio and reduced reproductive success, eliminating any beneficial effects of P addition. Moreover, cricket stoichiometry better explained growth rates than the amount of food consumed. The best model highlighted cricket N and Mn content, with increasing N content negatively influencing growth, while the opposite was true for Mn. We found no support for liming‐induced Fe limitation. We propose that both P and Mn limit crickets independently. Specifically, P limitation affects growth via reduced ribosomal content, and Mn limitation impacts growth by limiting arginase activity and hence restricting the recycling of amino acids. Our study shows that restoration management can fail to restore habitat quality for insects and may even amplify mismatches in macro and micronutrient stoichiometry. To address this, the addition of not only P but also Mn may be required as follow‐up management, but reducing N‐emission remains imperative as this removes the need for disruptive management interventions. Read the free Plain Language Summary for this article on the Journal blog.

A controlled trial comparing the impact of guided forest bathing or a mindful urban walk on heart rate, blood pressure, and mood in young Thai adults

Abstract In Thailand, cardiovascular disease and mental health cause a large health and economic burden, with 10% of Thai adults and 32% of adolescents reporting depression. Forest bathing (FB) (mindful nature walking) is growing in popularity globally as a preventative health intervention. Most FB research compares FB with a non‐active control of unguided urban walking, finding improved health and well‐being in FB but not the urban condition. This controlled trial offers a unique and robust comparison of guided FB with an active control of guided mindful urban walking. This is also the first study testing the acceptability and effectiveness of guided FB in Thailand. In a crossover design, heart rate, heart rate variability, blood pressure, and mood in 30 participants were compared before and after 1 h of guided FB and a guided mindful urban walk. MANOVA and t‐test analyses revealed that heart rate and blood pressure reduced in both conditions, but more in the mindful urban condition. Whilst negative mood was reduced in the FB condition but increased in the mindful urban condition. The study offers evidence for the promising health and well‐being benefits of both guided FB and mindful urban walking. Poor mental health and health inequalities are of increasing global concern, hence further research into the effectiveness of alleviating these difficulties through inexpensive interventions such as guided FB and mindful walking are encouraged. The study also offers the first data indicating that FB was acceptable and effective in a Thai population. Read the free Plain Language Summary for this article on the Journal blog.

Mycorrhizal specialization toward each distinct Oliveonia fungus in two closely related photosynthetic Dactylostalix orchids

Abstract Although rhizoctonias from Ceratobasidiaceae, Tulasnellaceae and Serendipitaceae are typical orchid mycobionts, orchid mycorrhizal fungi exhibit vast taxonomic and ecological diversity. This diversity stems from the high specificity of orchid mycorrhizal associations and the remarkable diversity of over 28,000 orchid species. The subtribe Calypsoinae is particularly notable for its diverse mycorrhizal partnerships, including rhizoctonias, ectomycorrhizal and saprotrophic non‐rhizoctonia fungi. However, the mycobionts within certain Calypsoinae lineages, such as the genus Dactylostalix, remain understudied. This study explores the physiological ecology of two photosynthetic Calypsoinae species, Dactylostalix ringens and Dactylostalix uniflora, to gain insight into potentially novel associations and their ecological implications. We analysed the mycorrhizal communities of both Dactylostalix species using high‐throughput ITS metabarcoding of root samples collected from multiple locations. Additionally, we measured the natural abundances of 13C and 15N isotopes in the leaves of the two Dactylostalix species and their co‐occurring autotrophic reference plants, as well as in fungal pelotons isolated from D. ringens, to assess the potential for partial mycoheterotrophy. Our findings revealed that D. ringens and D. uniflora form specialized mycorrhizal associations predominantly with distinct lineages of Oliveonia (Oliveoniaceae, Auriculariales), even in sympatric populations. Stable isotope analysis showed that both Dactylostalix species exhibited conflicting isotopic signals: elevated δ15N values, supporting partial mycoheterotrophy, but lower δ13C values compared to autotrophic plants, suggesting autotrophy. Peloton samples from D. ringens displayed only modest 13C enrichment relative to autotrophic references. These conflicting isotopic signals make it difficult to precisely determine whether both Dactylostalix species are autotrophic or partially mycoheterotrophic. Intriguingly, the 13C and 15N signatures of Dactylostalix species and their pelotons resemble those of many rhizoctonia‐associated orchids. This isotopic evidence implies a niche overlap with endophytic tendencies between rhizoctonias and Oliveonia, suggesting that potential endophytic traits may have facilitated the recruitment of Oliveonia as novel mycorrhizal partners. Furthermore, the mycorrhizal segregation between D. ringens and D. uniflora likely promotes their sympatric coexistence and may contribute to reproductive isolation through ecological specialization. Read the free Plain Language Summary for this article on the Journal blog.

Seed dispersal mechanisms modulate Janzen‐Connell effects in Mediterranean forests through antagonists and mutualists

Abstract Antagonist and mutualist organisms mediate the long‐standing, classical Janzen‐Connell effects and yet they are rarely investigated, especially when they share plant species hosts. Here, we propose that plant species create an “antagonists‐ and mutualist‐scape” which, coupled with seed dispersal mechanisms, will govern the relative survival rates of juveniles within the landscape and influence their later life stages. We combined data on fully stem mapped plots of woody plant species in two Mediterranean forests (Mixed Forest of Segura [MFS] and Mixed Forest of Jaen [MFJ]) with data on the associated communities of leaf epiphytic fungi, leaf pathogens, sap‐sucking insects and chewer insects hosted by each woody plant species. This allowed us to indirectly test the Janzen‐Connell hypothesis by investigating the placement of plant species with contrasting seed dispersal mechanisms (fleshy fruited vs. dry‐fruited plant) within the antagonists‐ and mutualist‐scapes. More specifically, we determined the degree of host‐specificity of plant‐associated organisms and defined the antagonist‐ or mutualist‐scapes for focal plants as the mean number of antagonist‐ or mutualist species the focal plant shares with its (sapling or adult) plant neighbours, respectively. We then applied multivariate spatial point pattern analysis to test whether saplings and adults of the focal species tended to be located in favourable sites of the antagonist‐scapes (i.e. were neighboured by fewer antagonist species than expected) or were distributed independently of the antagonist‐scapes. A substantial proportion of organisms was associated with more than one plant species, with organisms at MFJ being more “host‐specific” than organisms at MFS. Our spatial analyses revealed spatial patterns that differed strongly between fleshy‐fruited and dry‐fruited species and were, in most cases, consistent with our expectations. For example, saplings of dry‐fruited species were placed in favourable sites in the saplings antagonist‐scapes, whereas saplings of fleshy‐fruited species were independently placed with respect to the saplings antagonist‐scapes. Our results show how the placement of plant species within the antagonist‐scapes changes during the ontogeny, and how this is influenced by Janzen‐Connell effects and the seed dispersal mechanisms. We provide a new approach and indications about the importance of generalist antagonists and mutualists as drivers of the spatial assembly of plant communities. Read the free Plain Language Summary for this article on the Journal blog.

What about the negatives? An integrated framework for revealing diverse values of nature and its conservation

Abstract Taking into account the perspectives of local stakeholders is essential for just and effective biodiversity conservation. Plural valuation, making visible the diverse values people hold in relation to nature, has emerged as a key approach towards better inclusion of stakeholders' perspectives. So far, plural valuation has mainly focused on positive values, leaving equally important negative values underexposed. To address this, a concrete proposal has been presented to also consider ‘disvalues’. However, accessible frameworks to help practitioners apply this concept are arguably still lacking. To address this gap, we here propose the ‘Integrated Nature Futures Framework’ (I‐NFF), where ‘integrated’ indicates joint consideration of positive and negative values. The I‐NFF draws on the popular Nature Futures Framework (NFF) to develop disvalue thinking in a more accessible form. The I‐NFF considers three perspectives (‘nature’, ‘society’ and ‘culture’), based on which something can be placed on a spectrum from positive (‘for nature’, ‘for society’ and ‘as culture’) to negative (‘against nature’, ‘against society’ and ‘in conflict with culture’), and can be represented as two mirrored triangles. Using empirical data, we illustrate various purposes for which the I‐NFF can be used: to inventory nature‐related topics ‘at play’ in a given context, to depict how people frame their overall relationship with nature or to depict how people frame specific issues. This demonstrates how the I‐NFF helps reveal value pluralism and trade‐offs, capture the reciprocity of human–nature relationships and identify where perspectives differ and share common ground. We close by discussing how the I‐NFF can enhance the inclusion of stakeholder voices in biodiversity conservation, which is indispensable for a more nature‐ and people‐positive future. Read the free Plain Language Summary for this article on the Journal blog.

The complexity of compliance—Diverse responses to octopus fishery closures in Zanzibar

Abstract Marine protected areas like periodic closures are increasingly used to improve both fisheries management and biodiversity conservation, and often secondarily, human well‐being. Yet rule breaking, whether formal regulations, or community‐agreed norms, continues to negate expected management and conservation outcomes, remaining a major challenge. Although compliance scholarship today is expanding beyond non‐economic explanations of (non)‐compliance behaviour, approaches and theory used fail to show the diversity of perceptions and dispositions that can underpin motivations. A deepening engagement with behavioural sciences like sociology, psychology or behavioural economics is increasingly recognized as key in tackling compliance issues in marine protected areas. In this paper, we contribute to such a strand of compliance scholarship by presenting the responses and positions to (non‐) compliance, rules/regulations and authorities of different people, for example, fishers, traders and others involved in an area‐based fishery management intervention in Zanzibar, Tanzania. We take a qualitative approach aligning with an interpretive research ethic to carry out story circles, photo‐elicitation tasks and focus groups at three sites enacting periodic octopus closures. Theory drawn from sociology, anthropology and cognitive sciences was used to interpret how participants justified were motivated by or dispositioned towards rules, rule makers and rule breakers. Generally, the area‐management intervention was supported by participants, signalling the potential for future compliance most commonly based on the recognition of a degraded marine ecosystem in need of protection. However, the diverse and dynamic responses by different livelihood groups (i.e. traders and fishers) indicated on which basis and through which logics compliance behaviour was condoned or legitimated. This type of insight can help managers gauge or anticipate the potential for non‐compliance in participatory approaches that can impact the health of marine ecosystems. Recommendations include providing discussion spaces for conservation participants' (not just fishermen or fishery organizations) own meanings to be understood and not assumed. Meanings which create and shape relations, actions and concepts in marine protected area processes and thus directly impact the uptake and sustainability of conservation interventions. Read the free Plain Language Summary for this article on the Journal blog.

Colonial management drives ecological change following the exclusion of Indigenous stewardship in a Stoney Iyethka montane grassland, Canadian Rocky Mountains

Abstract For millennia, Indigenous Peoples and their ecological stewardship have kept culturally important landscapes open, diverse and productive. Under colonization which suppresses stewardship activities, landscape vegetation patterns shift and areas previously stewarded by Indigenous Peoples are now undergoing successional change. As a case study, we document ecological change on the homelands of the Stoney Iyethka Nations in the Canadian Rocky Mountains, where landscapes have changed dramatically over the past century of colonial management. On the Stoney Iyethka traditional montane Egnuck Wida grasslands, we analysed vegetation change on both the landscape and plot level. Using oblique photographs taken in 1924 paired with 2021 satellite imagery, we compared past and present landscape vegetation cover and assessed drivers of succession. We also examined differences in vegetation class cover and plant community structure between surveys conducted in 1981, 1995 and 2020. Nearly half (47%) of the landscape surveyed showed seral progression in vegetation class, which was not explained by topography, geology or climate warming. Grassland area decreased four‐fold between 1924 and 2021. Grassland retention was strongly related to management zoning, with greater losses in the crown‐managed ecological reserve than on lands that remain under Stoney Iyethka stewardship. Vegetation plots surveyed reveal changes to plant community composition and shifts in dominant vegetation class. In plots previously composed primarily of forbs and graminoids, shrubs have become the dominant groundcover. Declines in historic vegetation include a loss of culturally important food, medicine and ceremonial plants to the Stoney Iyethka Nations. The most likely explanation for these results is the displacement of Indigenous Peoples and their stewardship from the landscape. We demonstrate that the past century of colonial environmental management has altered ecological processes maintained on this landscape for millennia by Indigenous Peoples. Read the free Plain Language Summary for this article on the Journal blog.

Prehabilitative/rehabilitative exercise, nutrition, and psychological support for bladder cancer: A scoping review of randomized clinical trials.

The study of prehabilitation and rehabilitation ([p]rehabilitation) to alleviate the sequelae of bladder cancer and its treatment has generated numerous opportunities to improve the quality of life of bladder cancer survivors. The authors conducted a scoping review of randomized clinical trials (RCTs) to identify knowledge gaps in and research directions for (p)rehabilitative support for those affected by bladder cancer. The authors systematically searched six databases and synthesized key findings from RCTs conducted from January 1, 2004, through March 15, 2022, that enrolled participants with bladder cancer, survivors, or caregivers in outpatient (p)rehabilitative programs (e.g., exercise, nutrition, or psychological support). Outcomes were characterized according to eight prespecified, clinically relevant categories. The search retrieved 10,968 records, 27 of which met the inclusion criteria, and 24 described unique RCTs with 2471 enrolled participants. Of 24 interventions, 17 (71%) yielded statistically significant results for the outcome of interest. Only one RCT included a cost-effectiveness analysis, and only two characterized the efficacy of interventions for caregivers. Of 11 RCTs involving psychological support, eight yielded statistically significant results, as did nine of 11 RCTs with physical exercise interventions, three of four RCTs with educational interventions, three of four RCTs with nutritional support interventions, one of two RCTs with pharmacologic medications, and zero of one RCT with physical therapy. The most promising interventions for inclusion in multimodal, personalized (p)rehabilitation programs included exercise, stress management training, cognitive training, smoking and alcohol cessation counseling, immunonutrition, stoma education, and penile rehabilitation. Further studies of the cost effectiveness and efficacy for caregivers of such interventions are needed. PLAIN LANGUAGE SUMMARY: In a scoping review of all randomized clinical trials involving prehabilitative or rehabilitative diet, exercise, and psychological support interventions for patients with bladder cancer, survivors, and their caregivers, 17 of 24 (71%) interventions yielded statistically significant improvements in the outcome of interest. Clinicians should consider implementing such interventions for those affected by bladder cancer.

Newer glucose-lowering drugs reduce the risk of late-onset seizure and epilepsy: A meta-analysis.

Newer glucose-lowering drugs (GLDs) protect against cerebrovascular, neurodegenerative, and neuroinflammatory pathologies. Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) comparing newer GLDs to placebo that assessed long-term cardiovascular and renal outcomes to analyze their potential to prevent late-onset seizures and epilepsy, separately and as a combined outcome. A comprehensive MEDLINE and CENTRAL databases search for DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitor RCTs, which reported adverse effects, including seizures and epilepsy on clinicaltrials.gov, yielded 413 studies. Of them, 27 studies with almost 200 000 patients (mean age 64.9 years, 65.6% males) were included. We calculated relative risk (RR) and odds ratio (OR) using the Mantel-Haenszel method and Peto's method. Patients taking newer GLDs had a 24% lower risk of late-onset seizures and epilepsy, combined, (RR: 0.76, 95% CI: 0.62-0.95) and 22% lower risk of late-onset seizures only (RR = 0.78; 95% CI = 0.60-1.00), compared to patients on placebo. This seizure and epilepsy prevention benefit was only noted among patients taking GLP-1 receptor agonists. Stroke incidence was comparable between newer GLDs and placebo group. GLP-1 receptor agonists like Semaglutide significantly reduce late-onset seizures and epilepsy, and their anti-epileptogenic potential in older adults needs further exploration. PLAIN LANGUAGE SUMMARY: Our analysis 27 clinical trials and nearly 200 000 patients evaluated the potential of newer glucose-lowering drugs (GLDs) to prevent late-onset seizures and epilepsy in older adults. The study found that newer GLDs, especially GLP-1 receptor agonists like Semaglutide, reduced the combined risk of seizures and epilepsy by 24% compared to placebo. These findings suggest that newer GLDs may offer prevention against the development of seizures and epilepsy in older adults. However, further research is needed to confirm their anti-epileptogenic effects.

Direct visualization of microwires in hybrid depth electrodes using high-resolution photon-counting CT.

Hybrid depth electrodes are increasingly being used for epilepsy monitoring and human neurophysiology research. Microwires extending from the tip of the Behnke-Fried (BF) electrode into (sub)cortical areas allow to isolate single neurons and perform microstimulation. Conventional CT or MRI visualize the entire microwire bundle as an artifact extending from the BF electrode tip with low resolution, without proper identification of individual microwires. We illustrate the first direct visualization method of individual microwires using high-resolution photon-counting CT (PCCT). Coregistration of the PCCT scan with a preoperative MRI can visualize individual wires directly in cortex, which is an advantage as it provides feedback on the accuracy of the implantation method and can guide future implantations. This PCCT technique allows for accurately depicting individual microwires which could be relevant for neuroscientific research through improved visualization and implantation of specific cortical and subcortical brain areas. PLAIN LANGUAGE SUMMARY: Researchers are using hybrid depth electrodes to study epilepsy and brain activity. These electrodes, called Behnke-Fried (BF) electrodes, have microwires at the tip that can record single neurons and stimulate brain areas. Regular CT or MRI scans do not show the individual microwires clearly. The authors use a new high-resolution photon-counting CT (PCCT) technique, which can show each individual microwire in the brain. By combining PCCT with MRI, the authors can precisely see where the microwires are located. This could improve future implantation surgeries and brain research.

Moderating Role of Self-Regulation Difficulties in the Momentary Associations Between Depressive Symptoms and Participation Poststroke.

Because depressive symptoms are momentarily associated with lower levels of participation poststroke, it is crucial to investigate what moderates such associations to identify a potential intervention target to reduce the momentary links between depressive symptoms and participation poststroke. Self-regulation seems to be a potential moderator of such associations. To investigate the extent to which difficulties in self-regulation moderate the momentary associations between depressive symptoms and participation poststroke. This study uses a real-time, repeated-measures design using smartphone-based ecological momentary assessment surveys five times a day for 10 days. We performed multilevel modeling to uncover the momentary associations among the study variables. Community. 39 people with stroke. We obtained real-time data for difficulties in self-regulation (total, cognitive, behavioral, and emotion regulation), depressive symptoms, and participation in daily activities (performance in daily activities and satisfaction with performing daily activities). We included 1,612 survey responses in the analysis. Higher depressive symptoms were momentarily associated with lower levels of performance (β = -0.05 to -0.07, p < .001) and satisfaction (β = -0.04 to -0.06, p < .05), regardless of adjusting for self-regulation variables and other covariates. Difficulties in total self-regulation (β = -0.01, p < .001) and emotion regulation (β = -0.02, p < .001) magnified the negative associations between depressive symptoms and satisfaction with performing daily activities. Using self-regulation and emotion regulation strategies may be a target for just-in-time intervention for reducing the momentary associations between depressive symptoms and satisfaction with performing daily activities poststroke. Plain-Language Summary: Depressive symptoms have immediate and real-time associations with lower levels of participation in daily activities in people with stroke. Self-regulation, including cognitive regulation (e.g., goal setting, planning strategies), behavioral regulation (e.g., controlling impulsive behaviors), and emotion regulation (e.g., managing negative feelings), may be an intervention target for reducing the immediate associations between depressive symptoms and lower levels of participation poststroke. Thus, we investigated whether difficulties in self-regulation variables magnify the negative real-time associations between depressive symptoms and participation poststroke. To obtain real-time data on difficulties in self-regulation variables, depressive symptoms, and participation (i.e., performance and satisfaction), we asked 39 community-dwelling people with stroke to answer smartphone surveys. The results showed that difficulties in total self-regulation and emotion regulation magnified the negative associations between depressive symptoms and satisfaction with performing daily activities. Our findings suggest that self-regulation and emotion regulation strategies may be a target for real-time intervention for reducing the momentary associations between depressive symptoms and satisfaction with performing daily activities poststroke.