This exploratory study used participatory methods to identify, characterize, and rank climate-sensitive health priorities in Nunatsiavut, Labrador, Canada.n = 11). In addition, three PhotoVoice workshops were held with Rigolet community members (n = 11), where participants took photos of areas, items, or concepts that expressed how climate change is impacting their health. The workshop groups shared their photographs, discussed the stories and messages behind them, and then grouped photos into re-occurring themes. Two community surveys were administered in Rigolet to capture data on observed climatic and environmental changes in the area, and perceived impacts on health, wellbeing, and lifestyles (n = 187).A mixed method study design was used and involved collecting both qualitative and quantitative data at regional, community, and individual levels. In-depth interviews with regional health representatives were conducted throughout Nunatsiavut (Climate-sensitive health pathways were described in terms of inter-relationships between environmental and social determinants of Inuit health. The climate-sensitive health priorities for the region included food security, water security, mental health and wellbeing, new hazards and safety concerns, and health services and delivery.The results highlight several climate-sensitive health priorities that are specific to the Nunatsiavut region, and suggest approaching health research and adaptation planning from an EcoHealth perspective. Changes in climate and the resultant environmental alterations continue to be documented globally –3. The cexposure to climate-related health risks, sensitivity to these risks, and adaptive capacity to address, plan for, or manage them”  develop a baseline understanding of the climate-sensitive health outcomes currently affecting Labrador Inuit; (2) identify climate-sensitive health issues that are anticipated to affect Labrador Inuit in the future; and (3) prioritize climate-sensitive health issues to inform future research and adaptation strategy and policy development in the Nunatsiavut region.2 land claim settlement area (from north to south): Nain, Hopedale, Postville, Makkovik, and Rigolet. All five communities are remote and only accessible by a commercial year-round plane service and a seasonal ferry service. To access cabins, traditional lands, and hunting grounds outside of the communities, residents travel by snowmobile over snow and ice in winter months, and over water in small personal boats in the summer months. Labrador Inuit continue to rely on the local ecosystem for livelihoods, cultural continuity, and wellbeing, and depend on hunting and gathering of caribou, seals, ducks, geese, eggs, fish, and berries for partial subsistence  Inuit way of life and our way of thinking is all intertwined and interconnected [to the environment]. So, something as significant as changes in the temperature, and in snow and rain and that kind of thing, it’s all going to have a ripple effect.Health and wellbeing were described by participants as inextricably “interlinked” to “the land” (the environment). Interview and PV participants described the Inuit relationship to the land as “powerful,” “amazing,” “a need,” “a tradition,” “not an option,” “expected,” “a given,” “sheer want and internal desire,” “perfect,” “a sense of being,” and that “nothing can replace it.” Participants described that the land is “intertwined and interconnected” to various determinants of Inuit health. This understanding of health reflects the Inuit ecocentric concept of self, in which “the individual is in constant transaction with the physical environment” and “gives a central role to connections among individuals and to place in the health and well-being of the person” ; BPS survey: 65/110, (59.1 %)). Government interviewees and PV participants discussed the “huge implications” for these climatic and weather changes, including reduced snow and ice acting as additional barriers to accessing the land to visit cabins and to hunt, fish, trap, and harvest food—activities which are extremely important in Nunatsiavut and across the North and have documented positive influence on mental well-being . As one This finding is supported by previous research in Nunatsiavut , 9, 11, Participants believed that these relationships and interconnections between the land and health increased the region’s sensitivity to climate change impacts on health. Participants emphasized the importance of interactions between and among the environment and culture, environmental hazards, food security, water security, productivity, mental wellness, social cohesion, Western and Indigenous education and knowledge, housing, and healthcare services Government interviewees and PV participants reported that these changes were resulting in people “jeopardizing their lives going out on unstable elements,” “people going through the ice,” “family members that was off [on the land] and didn’t come back,” “issues with accidents,” “people being in danger,” and “that there have been near misses already.” Consequently, “safety,” “security on the land,” and “accidental death through changes in ice conditions and weather conditions” were identified as important climate-sensitive health priorities for the Nunatsiavut region. While research on unintentional injury and trauma on the land is limited in the North , previouLast year we had no blueberries. And I mean blueberries are almost a staple. They're so good for you and they're so high in the antioxidants. There were none. And there is none because it got really hot in the spring and the berry, the bushes fried up. But to have no blueberries, it's unheard of. You know, to have that happen [long pause].Interviewees explained that country food  provided “good supplements,” had high “nutritional value,” and was “high in antioxidants” and “rich” in “nutrients”, which is reflected in the nutritional content of these foods , 72. ParThe conditions were horrible. People didn’t get what they normally get for caribou and then you rely on store food junk, because what other option do you have when you live in a remote fly-in only community? And, the foods sources that you usually get to, you can’t reach. There is not enough snow, there is not enough ice. It’s alarming that we are just seeing the beginning of climate change… And if the weather is down [bad] for five weeks, how do you get in and out of your community to access services? How do you get food in there? I mean the stores had to actually, I mean their stock was down to bare bones because there was no way to get food in.Participants also described how some of the observed changes in climatic conditions were contributing to an increased reliance on retail food, which was described as “sugary,” “junk,” “garbage,” “high sodium, high sugar food.” The increased rainfall and increased intensity and duration of storms were perceived to result in more interruptions in retail food delivery to the remote communities in Nunatsiavut, further illustrating the sensitivity of the food system to climate. As one government interviewee explained,Many participants also linked food security to other factors, including income, mental health, education, changing cultural practices, and increasing costs of supplies (e.g. fuel) and maintaining equipment . As such, participants believed that climate factors were putting additional pressure on an already stressed food system.E. coli and Salmonella), which has been suggested in other Inuit communities  have a real sense of purpose when they’re there [on the land]. You know, in the past when they [Inuit] lived on the land, everybody had a role and everybody had a job to do and those kinds of things. I think people, when they're out on the land, they feel that sense of independence and interdependence… People completely change–it's like they have a different personality when they're out on the land and connected to that. And there’s a real spiritual quality about that as well.Many participants described “productivity” as an important contributor to health and wellbeing, which included paid employment  and unpaid activities . Productivity was often described in terms of being able to connect with the land in some regard, because it “provides you with a sense of capability and a sense of peace within yourself.” As one government interviewee explained,Horrible, horrible, horrible. So, that is my first thought [about climate change]… already look at what has happened with people losing that sense of identify and pride and people feel proud of bringing that fish home and that caribou home and they share it with people. So, losing the ability to provide that, and give that satisfaction from giving and sharing and feeding your family–it is going to continue to erode.The observed changes in climate were challenging participants’ ability to access the land, which they believed impacted peoples’ ability to feel productive in their family and community. In particular, government interviewees described that the practice of hunting and sharing food contributes to defining “self-worth” and productivity. As one interviewee described,A community member explained that land-based “activit[ies] and community and sharing and a sense of being able to be productive with yourself comes with or creates health” Fig. . ConsistThey [Inuit] get rejuvenated, they feel good when they are out of the land and when they are in nature, when they are [at] their cabin, when they are hunting or fishing, when this happens they feel good. So, that to me is healing–feeling good about yourself, being proud of what you are doing–feeding your family, being creative, being resilient.Government interviewees explained that, similar to other Indigenous communities, there were mental health and mental wellbeing concerns in Nunatsiavut rooted in the legacies of colonization. Interviewees also linked mental health to other factors, including lack of housing, culture, income distribution, and productivity. Government interviewees and PV participants, however, believed that regularly and safely accessing and connecting with the land was essential for mental wellness Fig. . One govI think the trauma of being forced to assimilate … will be felt further if climate change affects [land-based] activity so you don’t find that worth through [land-based] activity, through cultural traditions, that some of those [assimilation] effects will seem to be a bit stronger to you and then the southern dependency needs to be more so. And, so I think the emotional health of people through [land-based] activity and through [country] food and the ability to produce something through their activity will be negatively impacted if the climate change affects us severely … I think if you take away those [land-based] activities and people feel less capable, less able to provide, and less healthy about themselves then those [assimilation] impacts will either come more to the forefront and have to be dealt with, or they [assimilation impacts] may just be built upon.Similar to previous research , governmEvery conversation was around the ice was thin, it was unsafe to go, then they added some worry to that because people were still craving to get out on their skidoos on thin ice, with people going through the ice, and then there were family members that was off and didn’t come back. So, a lot of extra anxiety and disappointment, and unfulfilled needs…it [the weather] was definitely different than it was expected here normally.Moreover, experiencing stress and anxiety about safety and new hazards on the land as a result of the observed changes in climate was described by many government interviewees and community members. Interview and PV participants described being “frustrated,” “dissatisfied,” “distressed,” and “unsettled,” and expressed feelings of “worry,” “anxiety,” “disappointment,” and “sadness” about the climatic variability observed in the previous year; a sentiment which is supported by previous research , 57. SimIn the BPS survey, the odds of reporting feeling angry, scared, and frustrated by changes in the environment were higher for women compared to men Table . Past reMy mom and I, God rest her soul, used to have our absolute best times berry picking… we talked about things we've never talked about before because it's very relaxed, beautiful day, and you’re out. Then you got your picnic lunch, and you're just picking berries and you're chattin’, she might be over there and I'm over there and everything was sa.., it’s safe, it’s a safe place to, even air things that are never talked about, is when you're out berry picking. It's wonderful. And you're walking and you’re bending and, it's just good for your soul, it’s good for everything.Similar to other Inuit communities , particiI think that community health is based on cohesiveness, and the cohesiveness doesn’t have to be physical. It doesn’t mean that you visit all the time, which is great as well. It doesn’t mean that you have to be seeing people all the time. But, it usually means there’s some camaraderie in [land-based] activity… there’s a cohesiveness that needs to continue, and if that cohesiveness is usually on a common denominator of outdoor-based activities, cultural based activities, it’s sort of somewhat fragmented [because of climate change]. The cohesiveness that now bonds the community could be jeopardized because what else are you bonding on?Participants explained that observed changes either already have, or had the potential to impact their ability to access the land and develop and reinforce these relationships, which has important health implications Fig. , Table 2Participants identified two types of education in Nunatsiavut: (1) formal institutionalized training and (2) informal or traditional ways of learning. Challenges facing both types of education were described, but changes and challenges to traditional ways of learning were more often the focus of discussion Fig. . GovernmParticipants reported that, similar to other Inuit regions , 96, “hoParticipants were also concerned about damage to infrastructure from erosion, shifting grounds, and damage from heavy storms. Participants worried that in the future these changes might result in further damage to infrastructure and housing that was already in need of repair and further worsen over-crowding and mould problems; a concern shared in other Inuit communities .While it was not discussed by community members, all government interviewees described several challenges in healthcare provision in the north: “health care delivery for rural and remote areas is often very complex and very difficult.” These challenges are similar to those reported in many Indigenous communities in Canada  , 101, reThere is not as much snow as we normally get, and it definitely had an effect–but being able to get staff into the community–or staff in the community can’t get out of the community, patients can’t get to the hospital for their appointment if they need to do that. People that came out for appointments can’t get back into the community–so it is huge–it is huge and those [travel interruptions] were not normal. You know, 11, 12 days at a time when the planes can’t get into the community is not normal for here.Government interviewees linked several aspects of healthcare provision to weather conditions. As one healthcare worker explained, “there’s no doubt about it that weather [is important], it’s a key factor in everything we do every hour of the day.” Interviewees most commonly identified transportation as a climate-sensitive challenge in healthcare provision. Similar to most remote Inuit communities , communiYou have these freak periods of heavy snow that knock down the radio tower that knock down the telecommunications, so then people were literally back in the old days… but that is how climate change can affect so many layers of remote living. Right from using your ATM card to being able to fly out because someone is having a heart attack. It’s all related.Government workers also explained how climatic variability was impacting the ability to plan and implement health programming. Several examples were provided to illustrate how unusual weather was “interrupting plans”, causing “major disruptions” for healthcare programming that had “huge implications” and “huge effects on planning”, especially for land-based programs . Participants also reported that increasing extreme weather conditions lead to communication outages along the coast,As such, climate-related adaptation planning in public and primary health programming, policies, procedures, and regulations was identified by participants as important moving forward, which is supported in the literature .After participants described and discussed climate-health relationships, interviewees were then asked to identify and rank what they perceived to be the most important climate-sensitive health impacts in the present and in the near-future. Government employees and PV participants identified the following as the top climate-sensitive health priorities in the Nunatsiavut region: food security, water safety and security, mental and wellbeing, new hazards and safety concerns on the land, and health services and delivery Fig. . ParticiSeveral limitations of this study should be noted. First, caution should be used in extrapolating these results beyond Nunatsiavut, since the impacts of changing climatic conditions are often unequally distributed and differentially experienced at individual, family, and regional scales. Rather, the goal of this study was to characterize climate-sensitive health priorities for Nunatsiavut, and pilot a participatory process of characterizing climate-related health priorities that could be used in other regions. Second, while data collection in Rigolet provided a community perspective to the research and contextualized the insights provided by regional stakeholders, we acknowledge that the climatic change observations and priorities likely vary for each Nunatsiavut community. While participants described changes in weather observed over their lifetime, most examples that participants provided to illustrate the impacts of these climatic changes were from their immediate experiences in the last 5–10 years. Thus, further research is required to differentiate the impacts of long-term climatic change from year-to-year climatic variability. Finally, these types of assessment are intended to be an ongoing assessment and action process, not a single assessment of risks and interventions conducted at one point in time . As suchThis study used a participatory approach to identify and describe the climate-sensitive health priorities in Nunatsiavut, Labrador, Canada. Participants described the environment as being inextricably linked to several determinants of Inuit health, which increases sensitivity to climatic change related impacts on health. This view coincides with EcoHealth concepts, which posits that human health and wellbeing is a function of complex social and ecological interactions . EcoHealImportantly, these priorities were identified through a participatory process that engaged health professionals, government decision makers, and community members. This process underpinned the local and cultural relevance and accuracy of the climate-sensitive health priorities identified, and places the priorities within an appropriate societal, cultural, environmental, political, and economic context for the Nunatsiavut region. Furthermore, engaging local stakeholders in the priority identification process is commonly recommended in climate change policy literature as it enhances policy uptake and applicability, increases legitimacy of priority areas, enables integration of Inuit knowledge, increases community representation in decision-making, and increases local capacity to respond to climate-related stressors –105, 115In summary, this study provided baseline understanding of the climate-sensitive health issues affecting Labrador Inuit, which included the following as top health priorities: food security, water security, mental health and wellbeing, new hazards and safety concerns, and health services and delivery. These climate-sensitive health issues were experienced through complex inter-relationships between environmental and social determinants of Inuit health. This work, in turn, has guided the development of a 5-year research program focusing on Indigenous health and climate change, including research focusing in greater depth on these priority areas in Rigolet. Several climate-sensitive health outcomes have been identified at national or global scales, and many of the climate-sensitive health priorities described in our study are not only Northern issues , 76, 117


Every important hospital should have on its resident staff of surgeons at least one who is well and able to deal with any emergency that may arise”. [“ arise”. William S. Halsted (1852–1922)With 2015 at a close, it is now a solid 111 years that have passed since Halstead voiced his opinion in his 1904 address , and elsFirst, and regrettably, emergency cases are still a neglected field in most countries, despite acknowledged high mortality numbers and increasing documentation of care issues –10. The Second, as follows from the above, fight over resources and operating rooms needs a better organized approach to the patient presenting with an emergency condition in need of care . Highly http://www.uemssurg.org/divisions/emergency-surgery/ebsq/how-to-apply). Successful candidates will achieve the title of Fellow of European Board of Surgery – Emergency surgery (FEBS/EmSurg). This is a step forward in standardizing curriculum and criteria across Europe.Third, it appears that the development of a “new” specialty is what is done to address the need for focused attention to emergency surgical conditions, as general surgery as we know it is vanishing. In Norway, it appears that a new specialty structure and remodelling of training will dismiss “general surgery” as a defined specialty overall, and incorporate trauma and acute surgery into the current specialty of gastrointestinal surgery. While this may be a logical step from the current training situation and a reasonable logic in terms of disease burden and exposure to conditions, it will require a restructured training approach in many aspects, including time, focused areas of training, procedures and hospital volume and population coverage. However, the exact form and content is yet to be chiselled and currently only a rough template appears in view. Notably, The European Union of Medical Specialists (UEMS) is now launching opportunity for Fellowship examinations in Emergency surgery starting April 2016   or perfoThus, there are new and exciting opportunities ahead for those interested to get involved in a highly challenging, diverse, yet rewarding area of medicine and surgery. Indeed, the whole concept of emergency surgery and trauma may be on of the most clinically interesting and academically rewarding areas in surgery for both the near and distant future. The bid is out, no go bite at it. Let us make Emergency general surgery 2.0 the service under which we all would want to receive care ourselves, be it as a severely injured or as an elderly with an acute surgical condition. Let us make Emergency surgery 2.0 work!


The concept of citizen science (CS) is currently referred to by many actors inside and outside science and research. Several descriptions of this purportedly new approach of science are often heard in connection with large datasets and the possibilities of mobilizing crowds outside science to assists with observations and classifications. However, other accounts refer to CS as a way of democratizing science, aiding concerned communities in creating data to influence policy and as a way of promoting political decision processes involving environment and health.In this study we analyse two datasets  retrieved from the Web of Science (WoS) with the aim of giving a scientometric description of what the concept of CS entails. We account for its development over time, and what strands of research that has adopted CS and give an assessment of what scientific output has been achieved in CS-related projects. To attain this, scientometric methods have been combined with qualitative approaches to render more precise search terms.Results indicate that there are three main focal points of CS. The largest is composed of research on biology, conservation and ecology, and utilizes CS mainly as a methodology of collecting and classifying data. A second strand of research has emerged through geographic information research, where citizens participate in the collection of geographic data. Thirdly, there is a line of research relating to the social sciences and epidemiology, which studies and facilitates public participation in relation to environmental issues and health. In terms of scientific output, the largest body of articles are to be found in biology and conservation research. In absolute numbers, the amount of publications generated by CS is low (N = 1935), but over the past decade a new and very productive line of CS based on digital platforms has emerged for the collection and classification of data. During the past decade “citizen science” (CS) has engaged an increasing number of academic researchers. The lion’s share of these well-circulated accounts tell a very favourable story of the successful involvement of non-scientists in research –6, even However, there are numerous instances in which volunteer contributors have remained invisible. In a recent study by Cooper et al. , the autGiven the multiple descriptions of CS, the purpose of this article is to provide an insight into what CS is, with regards to the following questions:RQ 1.How has CS and related terms developed over time?RQ 2.What strands of research have adopted CS?RQ 3.Which CS projects have a scientific output?These questions will be answered with two datasets retrieved from the WoS Core Collection. One is based on a qualitative survey of relevant CS-related terminology combined with a set of recursive searches to find more and relevant search terms, and one is based on the names of individual citizen science projects, which have been retrieved from previous studies. This way, we create a dual approach for describing the phenomenon of CS. The paper then concludes with a discussion of the different strands of research that we have mapped out and a reflection upon the limitations of the scientometric method.Perhaps the most elusive problem in describing CS originates from the multiple meanings of the concept itself. On a qualitative level this is evident by observing how two distinct meanings have developed in the natural- and social sciences respectively since the early to mid-1990s.The most common conception of the meaning of CS, which in recent years has gained significant momentum in the natural sciences, originates in the type of research described by Bonney et al. who attest that “[i]n the past two decades, CLO’s [Cornell Laboratory of Ornithology] projects have engaged thousands of individuals in collecting and submitting data on bird observations” (p. 977). This practice, however, goes back at least to the 1960s and is sometimes even extended to include the National Audubon Society’s annual Christmas Bird Count, beginning in the year 1900, even if the name “citizen science” was not used until the 1990s . In thisCitizen Science: A Study of People, Expertise and Sustainable Development” where CS is defined as “/…/ a science which assists the needs and concerns of citizens /…/ a form of science developed and enacted by citizens themselves”[On the other hand we find a very influential notion originating in the social sciences, as expressed in the account of Irwin’s 1995 book “emselves”. This viemselves”. In pracThese two major understandings do not, however, exhaust all forms of CS that are of relevance for researchers interested in this phenomenon. There is also a plethora of concepts that have been coined to describe primarily local and activist-oriented forms of CS. These are more difficult to trace via scientometric methods because the results are not published in peer-reviewed literature. Instead the data from these studies are mainly used for direct interventions in policy-making and litigations. However, such interventions are often made visible by social scientists doing research on the phenomenon of CS. For example, there are cases of activist-oriented CS were data are scientifically validated and used for legal action against polluting industries ,16, GeogA qualitative review of search terms for describing CS has clear limitations, the most obvious one being that false negatives will appear if a term is unknown to the researcher when constructing the search string. While false positives can be easily omitted if they are not too numerous, false negatives are much harder to detect. To minimize this problem we have conducted triple recursive searches (3RS) as documented in Not exclusive to science. For example “crowdsourcing” and “public participation”.Overlapping with existing search terms. For example “PPGIS” and “participatory GIS”.Already included in the second dataset based on individual project names. For example “Ebird”.Do not designate active participation of volunteers. For example “ranger-based monitoring” and “volunteers in research” were excluded because in the former case research is conducted by professionals and in the latter case volunteers are merely objects of study, not actively participating in scientific work.On 2015-12-15 we performed three “snowball searches” to recursively include more search terms according to the above mentioned criteria. Thus we added “public engagement”, “participatory monitoring”, “participatory sensing”, “public participation in scientific research”, “locally based monitoring” and “volunteer based monitoring” to our original search string. This produced an additional 654 records, making the total N = 1935. As comparison, we used the same search string in the Scopus database, which returned 1954 records. Due to the complexity in comparing these two databases  we decided to only use the WoS results in the present study.Based on the qualitative survey combined with recursive searches, we retrieved 1935 articles from the Web of Science Core Collection using a search string composed of the terminology from the qualitative survey . The seaThe second dataset attempts a different approach for mapping CS. By scanning a number of review articles that included lists of CS projects as part of their analysis ,8,24,29 The concept and practice of citizen science is barely visible in the WoS in the mid 1990s. Only at the turn of the millennium there is a slow increase. However, around 2010 there is a significant increase in published articles .It is worth noting that the increasing visibility of CS since around 2010 coincides with several digital citizen science projects that use web-platforms for reaching a large crowd of contributors to scientific research, for example Galaxy Zoo, Ebird, FoldIT, Planet Hunters, Genographic Project et cetera (see RQ 3 below). The increase in publications for these projects is further described in the analysis of individual projects below. While the absolute numbers for CS-related publications are low, there is still reason to speak of an emerging trend in relative terms, as shown in Article keywords, as defined by authors, were used to draw a map of what types of research that have adopted CS. One method of visualizing the possible connections between various fields of research, or within a research network, utilizes word co-occurences  appearinThe keyword “citizen science” is the most common label of CS research. It overlaps frequently with the keywords “monitoring”, “climate change” and “invasive species”, which indicate a proximity with the biology strand of CS-based research. However, it also co-occurs with the notions of “public participation” and “public participation in scientific research”, concepts that belong more to a social science tradition. From geography we also find co-occurrences with keywords such as “crowdsourcing” and “openstreetmap”, which are not restricted to CS research.To visualize the keywords in The first and most frequent use of citizen science has been carried out under overlapping concepts, such as “community-based monitoring”, “volunteer monitoring” and “participatory monitoring” and is to be found in research on ecology, environmental science, geography and biodiversity conservation . ParticuFurthermore, the fields of Volunteered Geographic Information, and Neogeography are related to each other, especially through various technologies such as “Web 2.0” and “crowdsourcing”. The notions of crowdsourcing and data quality are shared with the cluster around conservation and monitoringLastly, concerning the third category of social scientific research on CS, it is imperative to note that most of these studies are conducted by researchers interested in studying the phenomenon of CS, rather than using CS as a method. The central notion here is “public engagement”, which co-occurs frequently with “nanotechnology”. Social scientists are here concerned with the various aspects of participation and democratic involvement and inclusion in science and technology policy, on different aspects of the proliferation of nanotechnology. Moreover, this field also shares the use of the keywords “climate change” and “public participation”. However, what is meant by these terms is not necessarily the same things. When natural scientists use the term public participation, they usually refer to collection of data with the assistance of volunteers, whereas social scientists instead refer to representative engagement of stakeholders in policy processes. These double meanings are sometimes conflated on a policy level and attached with high expectations for the future of CS .A number of keywords tie together these three categories. The notions of “crowdsourcing” and “data quality” are shared by the natural sciences and the geographic lines of research, while the notion of “public participation” and “climate change” connects the natural with the social sciences, in broad terms.In terms of publication patterns, an analysis based on bibliographic coupling  of sourcTo further describe CS, we conducted a search based on the names of individual CS projects.Out of 490 projects found, only 78 had a scientific output in terms of publications  and bioscience (Foldit) have emerged as fields of research that successfully employ the contributions of non-scientists. Citizen projects in the social sciences and the humanities are, however, absent from the results and not yet developed to a degree that matches those in biodiversity and conservation. This is also the case for medical research.http://www.ancientlives.org/) and Operation War Diary (http://www.operationwardiary.org/), which are part of the Zooniverse platform. These projects remain invisible in most scientometric analyses due to their publication patterns, which are often located outside the WoS. In medicine and health, large repositories of data already exist and a strong development of digital mobile technologies, sensors and platforms, spur the data avalanche further on. Currently, medical research has been considered to be less adequate for CS due to ethical concerns and patient security, but there are notable exceptions such as Cell Slider (http://cellslider.net) and Malaria Spot . Moreover, in the social sciences there has been a long tradition of engaging closely with citizens as objects of study, especially in survey-oriented research. However, this cannot be considered to count as instances of CS, since there is no active participation or contribution from the citizens as research subjects. Recent calls for developing the social sciences in a CS direction have been proposed, for example Citizen Social Science  but have not yet made a scientometric footprint and is thus not detectable in our data.As our findings reveal, CS and adjacent notions have been used by different fields of research, even though the social sciences, medicine and the humanities are still areas in our data where CS is not utilized to any larger extent, in comparison with the natural sciences and geography. As a general observation, it is foremost in the biological sciences where CS has been adopted as a method with the purpose of collecting observations in the field. The reasons for this has been described as managing problems of time , space  and largIt is a fair speculation that the development of CS will spread to new fields of research in the future, as digital technologies will make large repositories of data possible. Although large data sets pose serious challenges for science, they also promise discoveries if and when resources for their analysis are available. Often the resources necessary include not only equipment, but also expensive human labor, especially if scientists are to be free to perform more demanding conceptual work than routine tasks. Enlisting the help of volunteers is an attractive way for science to expand the workforce needed to work with large data sets. A future challenge here will be to provide a standardized format for sharing meta-data between CS-projects, which will make both sharing of data and evaluation of data quality more accessible. Data quantity, spanning large spatial and time frames can also ensure that even messy data might be reconciled statisticallyAs Finally, many CS-projects do not have scientific output as their primary goal. As While the concept of CS has gained unprecedented presence in scientific literature during the past decade, the practice itself is much older. Previously, volunteer contributors have not been made visible in scientific articles to a wide extent. However, especially with the introduction of digital platforms, this has changed.The main field of study employing CS is to be found in biology, ecology and conservation research. Moreover, the social sciences and geography have increasingly started to invite volunteer contributors to research.In quantitative terms, the largest scientific output is to be found in the fields of ornithology, astronomy, meteorology and microbiology. However, most CS projects fall outside the scope of scientometric evaluation, since scientific output is not a main goal.S1 Appendix(XLSX)Click here for additional data file.S2 Appendix(XLSX)Click here for additional data file.


We support our argument with empirical observations from patterning along the major body axis of the fruit fly embryo. We use this example to highlight the limitations of the standard information-theoretic characterization of biological signalling, which are frequently de-emphasized, and illustrate how they can be resolved.Information theory is gaining popularity as a tool to characterize performance of biological systems. However, information is commonly quantified without reference to whether or how a system could extract and use it; as a result, information-theoretic quantities are easily misinterpreted. Here, we take the example of pattern-forming developmental systems which are commonly structured as cascades of sequential gene expression steps. Such a multi-tiered structure appears to constitute sub-optimal use of the positional information provided by the input morphogen because noise is added at each tier. However, one must distinguish between the total information in a morphogen and information that can be usefully extracted and interpreted by downstream elements. We demonstrate that quantifying the information that is  Although it may not have become the ‘general calculus for biology’, as predicted by Johnson in his 1970 review –5.κB . To build intuition, we will assume the noise of input σ0, and uncorrelated between cells1 : σi is a Gaussian random variable of variance a). Cells respond to morphogen access, amplify and average.Consider a one-dimensional array of cells ance σ02 a. Cells gout be a gene product whose expression is controlled by gout under the control of a promoter that is responsive to τ. In our model, we express the amount of gout produced during this time by a cell as τ (‘access’), and F is some deterministic input–output function (‘amplify’); for simplicity, we first consider F to be pure linear amplification with coefficient λ, denoted Fλ. The ‘access’ operation (a noisy estimate of the input) is the key element of our framework. Specifically, we writeτ and comes at the price of corrupting the signal with extra noise of magnitude η0.Let t noise’  is the oT is the time available for patterning, the system can effectively perform T/τ access operations. In addition, the production of soluble factors that can be shared between cells gives rise to spatial averaging  as a function of η0, treating it as a variable parameter: the decay of Iη0acc[c⋆] with η0 characterizes the tolerance to added noise of the information encoded in a morphogen (or set of morphogens) c⋆. Applied to gene expression data from the early Drosophila segmentation gene network, this analysis will show how our simple model explains the use of multi-tier gradient interpretation in a real system  in N=8 single embryos. We determine the expression noise of each gene by comparing levels in a given nucleus with those of its immediate dorsal and ventral neighbours .We focus on a particular node in this network whereby, in early embryos, two gap genes, his time ,46. Proteve expression noise is higher than the respective noise in hb or Kr expression (b). The information content of eve must therefore be lower than that carried by either of its two inputs. Due to the curvature of the embryo (a), the positional information of a real morphogen is only approximately related to that derived from projection onto the imaginary AP axis. Therefore, to estimate the information content for each of the three genes, we consider ‘idealized’ Gaussian-noise profiles (c) with mean and noise obtained by smoothing the measured values in real embryos. This approach neglects correlations in the fluctuations of these genes which may be significant in practice  must satisfy. This corresponds to the information in a hypothetical pair of noiseless Hb and Kr and cannot be achieved in practice; it is a theoretical best-case scenario for any strategy lacking Eve.The answer becomes clear when we consider the accessibility of information encoded in these morphogens, namely on of η0 d. A pattη0 is zero, Iη0acc coincides with the raw information content, which for perfectly noiseless Hb and Kr would be infinite. However, as readout noise increases, the performance bound becomes finite and drops quickly . This behaviour contrasts with the joint accessible information of the triplet  (magenta curve) as calculated for the idealized profiles using their actual measured noise. The accessible information content in the triplet is, of course, always finite, but it is also more tolerant to readout noise: due to the steeper slopes of the Eve profile, as η0 increases, the accessible information content of the triplet  decreases slowly: importantly, more slowly than the black curve. Therefore, a crossing point is observed, whose presence does not qualitatively depend on the specifics of the readout noise model . Remarkably, although Eve is measurably noisier than either of its inputs, its presence enables the system to access more information than could have been extracted from Hb and Kr alone, even if these inputs could be rendered perfectly noiseless. In practice, the enhancers of the pair-rule genes also contain binding sites for maternal transcription factors [When the readout noise  factors ,41, whic3.Drosophila patterning network has been described as performing a ‘transition from analogue to digital specification’ of cell identity [figure 3b has the same information content for all λ. Noise tolerance—a critically important feature in biological systems—becomes manifest only when the readout process is considered explicitly, for example, as we have done in our definition of accessible information. This point is implicit in the theoretical work investigating the so-called ‘input noise’ [The identity . The ‘diidentity ; nevertht noise’ , but hast noise’ ,49). HowDrosophila with combinatorial, cooperative regulation.For example, it has been suggested that certain signalling circuits may have evolved towards optimal information transmission ,5. AlthoUnfortunately, considering hundreds of genes is intractable, and the constraint on regulatory complexity is hard to formulate. The usual, more economical approach to patterning recognizes that the bulk of the patterning task is accomplished by only a small subset of dedicated, cross-regulated genes that establish the pattern that all other genes can then interpret simply. If we focus only on this core subset, the problem becomes tractable, and the ‘economy of complexity’ constraint is conveniently imposed by construction. We must, however, realize that maximizing information transmission to the target genes (downstream of the patterning core) imposes a different requirement than merely efficient information transfer within the core itself. Instead, the core circuit must function as a format converter, re-encoding information at its input into a format that can be accessed with a simpler and faster readout, that of a patterning cue by a functional gene.Curiously, it has been shown that in small networks with a realistic model of noise, maximizing raw information transmission leads to network structures exhibiting features such as tiling of patterned range with amplifying input/output readouts –52, i.e.X↦Y , the relation between mutual information I and the ability to use Y to determine X is only asymptotic: Shannon [in the limit of infinite uses of the channel. Importantly, in development and biological signalling, the number of channel uses  is fundamentally finite [Information theory is a powerful tool; its formalism does not, however, aim to replace considerations of what constitutes useful information or how it might be used by the system. As it is gaining popularity in biological applications, it is important to remember that for a channel  Shannon  proved ty finite . Furthery finite . This asy finite , but in y finite , and theTaken narrowly, the results presented here explain an architectural property shared by multiple patterning circuits responding to a graded signal. Perhaps more importantly, the example we construct highlights a general theoretical point: assessing the usefulness of a signal must always take into account the input noise of the downstream circuit interpreting this signal. Here, this type of noise manifests itself in the distinction that we draw between ‘raw’ and ‘accessible’ information. Our definition of the latter relied on a simplistic noise model; in general, encoding the effects of input noise in a re-defined notion of information content is not possible. In general, quantifying the usefulness of information-bearing signals in contexts where channel uses are limited will require reinstating considerations of rate/fidelity trade-off, which Shannon could eliminate by taking the limit of infinite-time communication. Nevertheless, information theory remains a most adequate framework to address these issues, provided its limitations are understood.


AbstractMarleyimyiaxylocopae Marshall & Evenhuis, sp. n., an apparent mimic of the carpenter bee Xylocopaflavicollis (De Geer), is described from South Africa on the basis of photographs only. The pros and cons of species descriptions in the absence of preserved type specimens are discussed.A new bombyliid species  Collecting specimens is no longer required to describe a species or to document its rediscovery.”“—Describing a new species without depositing a holotype when a specimen can be preserved borders on taxonomic malpractice.”“—Science by A recent paper in Describing a new species without depositing a holotype when a specimen can be preserved borders on taxonomic malpractice” (p. 815), but at issue here is the caveat of when a specimen can be preserved. We do not accept opposition to killing and preserving invertebrate specimens on moral or conservation biology grounds, but there are circumstances under which a type cannot be preserved. Furthermore, there is no doubt that collection of potential type specimens will become more and more difficult as restrictions on collecting and transporting specimens continue to increase. These difficulties, along with the rapidly increasing numbers of skilled ‘digital collectors’ who are building collections of images instead of specimens, will inevitably force the biodiversity community to adapt to growing numbers of new taxa recognized without benefit of dead, preserved type specimens. Fortunately, as collecting specimens is no longer required to describe a species.... (p. 260)”. Collecting specimens is highly desirable, but it is indeed no longer required.First of all, let us reiterate the obvious reasons that collecting specimens is highly desirable, and briefly consider and reject arguments against collecting. Specimens are indeed the ‘gold standard’ for species descriptions. Not only do they allow for consideration of a full suite of characters including internal morphology, microscopic and genetic characters, they preserve data for future access with future technologies and future questions. Specimen collections are our greatest treasure trove of biodiversity information and continued collection development must remain a priority. Arguments against specimen collections usually pivot on the potential impact of collecting on fragile populations. Such arguments are weak, since there are vanishingly few examples of scientific collecting having a detrimental effect at the population or species levels and there are very few circumstances under which the removal of a few individuals from a population might seriously harm the ultimate survival of the species. Most, by orders of magnitude, of the animal species awaiting description are invertebrates, and it is especially difficult to make a case against invertebrate collecting on the basis of conservation biology. As invertebrate taxonomists, we therefore agree with the letter of PageBreak“Designation of an illustration of a single specimen as a holotype is to be treated as designation of the specimen illustrated; the fact that the specimen no longer exists or can be traced does not of itself invalidate the designation”. Additionally, we interpret the wording of Article 16.4 to allow for description of a new species on the basis of a lost or escaped holotype, where the term “extant” means a physically “existing” specimen. Thus a lost, escaped, or purposefully released specimen is not “extant”.As explained by Even in the absence of a collected type specimen, current technologies such as high-resolution photography can often provide enough information for a proper description resulting in a readily recognizable and unequivocally distinct newly named species, and in some cases can provide more information  than could be extracted from a preserved specimen. The few previous descriptions of extant new species without a type (or part thereof) have for the most part been restricted to large vertebrates, for example primate species known from only small populations . We provIn the example provided here, a highly distinctive fly species belonging to an extremely rare genus (only three other known specimens of two species) was photographed on two occasions and then collected in the field, but the captured individual escaped before it could be preserved as a traditional dead type specimen. Our description, based on photographs of two different living flies, is complete and adequate to identify this species and adds an interesting and easily recognized species to the literature. It not only increases our knowledge of the biodiversity of the area in which it was collected and of the genus in which it is placed but, as we explain below, also provides some interesting ecological and biological information.Diptera), we predict that a growth in descriptions without physical type specimens is inevitable, and that this growth will result not as much from accidental loss of specimens as from increasing restrictions on collecting. Every taxonomist has been in the position of completing a revision that needs to be rounded out with species from places from which specimens are difficult or impossible to obtain, often because of laws preventing collection or export of specimens. For many of these required taxa, the solution to this problem is for the taxonomist to instead “collect” digital images that, in the case of new species, can represent type specimens. We are not arguing that this practice is generally desirable, only that it is inevitable and increasingly practical when diagnostic characters are distinct and discernable through photographs.The situation leading to this approach is a simple one to understand, since it pivots on an accidentally lost type specimen that might not be collected again due to its rarity. Although this description is by definition singular because it is the first of its kind . As these image collections become curated just as dead specimens are curated today, these digital “specimens” will find their way into the work of practicing taxonomists, and they will need names. At a time when we need more than ever to identify the In recognizing the need to name species without dead type specimens we are not arguing for a loosening of taxonomic standards. In fact, we expect that descriptions unsupported by existing physical type specimens will be subject to especially critical scrutiny by skeptical editors and responsible reviewers. We expect that such descriptions that do not render new species unequivocally recognizable will be rejected, just as they should be if they were based on dead type specimens. Once published, digital representations of type specimens will be much more widely available for use and scrutiny than physical type specimens archived in distant museums.The species described below was photographed in nature using a Nikon D800 with a 105 macro lens and a hand-held flash. The holotype specimen was not captured, so the image presented serves as representation of the holotype. Morphological terminology follows Taxon classificationAnimaliaDipteraBombyliidaeGenusHesseMarleyimyiaMarleyimyianatalensis Hesse, 1956, by original designation. Hesse, 1956: 521. Type species: Marleyimyia Hesse, 1956 was originally described based on a single male specimen with vestigial mouthparts and bred from a log containing cossid larvae. The genus is currently known from only three specimens representing two described species from widely disjunct localities: Marleyimyiagoliath (Oldroyd) from Peninsular Malaysia and Marleyimyianatalensis Hesse from southern Africa. In proposing his new genus, Marleyimyia from Oestranthrax Bezzi, 1921 by the larger body, the head wider than the thorax, and the differently shaped, although reduced, proboscis . Hesse distinguished Marleyimyia from Villoestrus Paramonov, 1931 by the same body and head features as above, but also the presence of a reduced proboscis . Oestranthraxgoliath based on a single male and female bred from the pupa of a cossid moth and claimed it to be the largest in bulk of any bee fly he had seen. Oestranthraxgoliath to Marleyimyia and Marleyimyiagoliath . The antennal shape in the new species described here is not found in the male holotype of the type species, Marleyimyianatalensis, but it is found in the female of the undescribed species of Marleyimyia from Nigeria mentioned by Marleyimyia.Taxon classificationAnimaliaDipteraBombyliidaeMarshall & Evenhuissp. n.http://zoobank.org/02D005F8-59D4-4FD7-B0D2-FAA8BC017BC826°54'31.07"S; 32°18'57.85"E.REPUBLIC OF SOUTH AFRICA: KwaZulu Natal: Ndumo Nature Preserve, Ndumo Campground, 26°54'31.07"S; 32°18'57.85"E, 74.0 m elev., 1 Dec 2014, S.A. Marshall. Holotype represented in photograph No. 7007 .Holotype female from SOUTH AFRICA: KwaZulu Natal: Ndumo Nature Preserve, Ndumo Campground, Marleyimyiagoliath and Marleyimyianatalensis), and the mesonotal pattern of black hairs anteriorly and yellow hairs posteriorly .Separated from its congeners by the all black infuscated wing  in a larger habitus photograph [No. 7009]). Head ; mesonotum with dense short “clipped-looking” black pile anteriorly to level of wing base, yellow pile from wing base to posterior edge of mesonotal disc including postalar calli, long, shaggy laterally, short and “clipped-looking” on disc; scutellum densely shaggy yellow pilose; pleura thickly black haired, those hairs on anepisternum with dark brownish sheen. .Legs. (Hind femur obscured in photographs). Fore and mid legs (and hind legs beyond femur) black with a shiny greasy appearance, some bluish highlights on femora and tarsi. Fore and mid femora short, stout, with long black hairs ventrally, longest basally, tapering to shorter apical hairs; tibiae shorter than femora, with short black spicules.Wing ; tergite II and III with admixed short silvery white hair PageBreakand tomentum dorsolaterally and sparse silvery tomentum with bluish highlights dorsomedially; tergites IV–VII with adpressed black tomentum and sparse silvery white tomentum dorsomedially. Genitalia. Not dissected.Marleyimyiagoliath, which occurs in Peninsular Malaysia. These characters differ from the smaller and more slender type species, Marleyimyianatalensis . Marleyimyia from Nigeria which, from photographs of the specimen in the BMNH, appears to be more similar to Marleyimyianatalensis in size and coloration than either Marleyimyiagoliath or Marleyimyiaxylocopae sp. n., but the Nigerian species has the same antennal shape as Marleyimyiagoliath and Marleyimyiaxylocopae sp. n. Because of the similarity of Marleyimyiaxylocopae to characters shown in Marleyimyiagoliath, we feel confident of its current generic placement. Further material of this genus should be secured in order to better assess the true generic limits.Two different specimens were photographed . That they are different is evidenced by the rubbed frons in the Red Cliffs paratype (photos taken on 27 November) and that the photos taken later at the Campground site (on 1 December) were of a specimen without a rubbed frons. This new species shares its unusual large body, wing shape, wing venation, and antennal flagellomere shape with sis Fig. , from SyPageBreakXylocopaflavicollis (De Geer), which was also photographed at around the same time in the Ndumo area . Previous published records of African xylocopid biologies are few and the only recorded bee fly associate is in the genus Anthrax (The striking yellow and black vestiture pattern on the thorax and abdomen, and the body shape, are unusual in bombyliids and show a remarkable similarity to xylocopid bees. The model for this possible case of Batesian mimicry appears to be rea Fig.  and is f Anthrax . More bi


Nnt) gene [GenBank: AH009385.2], resulting in impairment of steroidogenic mitochondria of the adrenal gland, and a multitude of indirect modifier effects, coming from alteration of glucocorticoid-regulated processes. Over time, the popular strain has been used, by means of gene targeting technology, to assign “essential” and “redundant” qualifiers to numerous genes, thus creating an internally consistent “parallel universe” of knowledge. It is unrealistic to suggest phasing-out of this strain, given the scope of shared resources built around it, however, continuing on the road of “strain-unawareness” will result in profound waste of effort, particularly where translational research is concerned. The review analyzes the historical roots of this phenomenon and proposes that building of “parallel universes” should be urgently made visible to a critical reader by obligatory use of unambiguous and persistent tags in publications and databases, such as hypertext links, pointing to a vendor’s strain description web page, or to a digital object identifier (d.o.i.) of the original publication, so that any research done exclusively in C57BL/6J, could be easily identified.Creation of lethal and synthetic lethal mutations in an experimental organism is a cornerstone of genetic dissection of gene function, and is related to the concept of an essential gene. Common inbred mouse strains carry background mutations, which can act as genetic modifiers, interfering with the assignment of gene essentiality. The inbred strain C57BL/6J, commonly known as “Black Six”, stands out, as it carries a spontaneous homozygous deletion in the nicotinamide nucleotide transhydrogenase (This article was reviewed by Dr. Neil Smalheiser and Dr. Miguel Andrade-Navarro. Drosophila as early as in 1922  but theA major portion of our current knowledge about gene function in mammals is derived from the phenotypes of mouse strains with targeted or random gene inactivation . The mouIn recent times, it has been found that the most common inbred mouse strains carry background mutations -18 that Nnt gene . It would be even more appropriate, if a vendor-independent Reference Laboratory Strain Database could be created, to which the hypertext links could be directed. For now, it is within the power of such public databases as NCBI’s PubMed to introduce an obligatory strain identity tag on every on-line abstract. Ideally, journal editors should be the ones to elevate the correct strain information to the same level of importance as currently applied to chemical formulae and nucleotide/protein sequences. Currently, despite the existence of the ARRIVE guidelines for animal research . Maybe say something like, If Hans Selye were alive today,.... c) In the third paragraph of Conclusions, I would rephrase or remove the first sentence .I accept all of the reviewer’s suggestions. The text has been changed to accommodate them.Author's response: Dr. Miguel A. Andrade-Navarro, Max Delbrück Center for Molecular Medicine, GermanyThe manuscript from Kraev points to a serious issue affecting 30 years of research in mouse genetics: the widespread use of the inbred strain C57BL/6J (or Black Six) with known and often ignored genetic and physiological defects, and the failure of many reports to indicate whether they use this or other mouse strains. As a result, the relevance of many published experimental results remains questionable until these experiments are repeated in mouse strains of “more robust” genetics. The author proposes that mouse strains should be clearly annotated in publications, and that the use of Black Six for genetics research should be carefully considered. While, as he admits, he is not the first to state these claims, this manuscript collects the bibliography relevant to the problem and insists on the annotation approach.Major commentsThe author needs to be more clear about whether he proposes that mouse strains must be tagged, or some strains not be used, or what. I think he suggests both and then this should be stated in the abstract.I am grateful to the reviewer for in-depth analysis of the manuscript and many constructive suggestions. I do suggest that mouse strains should be more clearly tagged in publications, but I do not suggest any kind of prohibition on certain strains. Rather, the authors should be aware of the background mutations and their possible effect on their studies. Ideally, more than one strain should be used to evaluate a newly discovered effect of a targeted gene modification (knock-in or knock-out), particularly the one that results in lethality.Author's response: The technical details of how to annotate mouse strains in future and past manuscripts are loosely defined as “hypertext tagging”. In the absence of a deeper discussion on how the annotations will be achieved, I suggest to be simpler and I would change the sentence in page 2: “by obligatory hypertext tagging of proper use, as well of as misuse and omission, of exact animal strain names in publications and databases.” to “by obligatory tagging of exact animal strain names in publications and databases.”I agree with this comment. In the revised text, I give specific suggestions. Please also see below the response to “Page 4” comment on the proposed format of the strain tag.Author's response: Also in page 11, I would simplify “This should start with biomedical literature, so that experiments done exclusively on C57BL/6J are clearly tagged with hypertext links and become identifiable for subsequent machine analysis.” to “This should start with biomedical literature, so that experiments done exclusively on C57BL/6J are clearly tagged.”I agree with this suggestion, the Abstract and the body of the text have been changed to accommodate it.Author's response: Then, the author might need to be more specific about whom is he addressing: are journal editors supposed to enforce the proper description of mouse strains in new papers? Should researchers stop using certain strains for particular topics of research? Should database centers like the NCBI and the EBI back-annotate existing bibliographic records (e.g. MEDLINE) to include missing strain annotation? Should authors of published literature contribute to annotate their database records?: Ideally, journal editors should be the ones to elevate obligatory strain designation to the same importance level as chemical formulae and nucleotide/protein sequences. Strain identity is one of the central issues in the ARRIVE guidelines, published in 2010, which are, admittedly, voluntary, and are currently supported by only a few journals. In this review, I did not plan to elaborate on which strains are bad choices for specific fields of research, it is an attractive topic for more focused future publications. It would certainly be desirable that database centers back-annotate existing bibliographic records, but this needs a specialized discussion, which hopefully follows after the publication of this review. The back-annotation would obviously be incomplete without active participation of the authors of the original research.Author's responsehttp://www.nlm.nih.gov/cgi/mesh/2014/MB_cgi?mode=dcms&term=Mice,+Inbred+Strains&field=entry#TreeB01.050.050.157.520Regarding database records, there are already MeSH terms for mouse strains that are used to annotate records in MEDLINE. See for example term: Mice, Inbred C57BL [B01.050.150.900.649.865.635.505.500.400.420]. There are many others that the author could examine at: If the author thinks that these terms are incomplete then he could say so and suggest how these terms should be completed.: I have expanded a portion of the Conclusions into a separate section to discuss this point. Indeed, relevant MESH terms are useful, but they are in need of update. The reference, suggested by the reviewer, contains MESH terms for only a few most common mouse strains, but does not allow distinction between the strains of the C57BL family, two of which are the topic of this review.Author's responsePage 4: “The purpose of this review is not to raise another concern about the importance of exact mouse nomenclature, but to expose the particular danger of a single mutation, which has aided in creation of an internally consistent parallel universe of knowledge. I suggest a simple way to stop this trend.” May be it would help here to explain shortly what the suggestion is.: I created a new subsection to elaborate on this point. Essentially, it amounts to the use of unambiguous strain identifier, such as a hypertext tag pointing to the vendor’s description web page , or to the “digital object identifier” (doi) of the original publication, if the strain was obtained by other means. Here is how the strain C57BL/6J would be identified by the hypertext link: C57BL/6J [http://jaxmice.jax.org/strain/000664.html].Author's responsePage 9. While I am sympathetic with the point being made, I am not sure to agree with the dramatic example given in page 9: “if a new drug for human consumption were suggested as a result of experimentation in C57BL/6J alone [?]”. There are so many differences between mice and humans that I doubt the “abnormalities” of Black Six would specifically result in dangerous drugs. In general I would here just insist on the danger of extracting conclusions on booby-trapped genetic backgrounds.: The anticipation of dramatic consequences, possibly associated with this problem, hinges on how much one believes in the existence of the great translational divide, also known as the“Valley of Death”, which separates pre-clinical studies from the clinical ones. I expanded this portion into suggesting that the systemic defect, such as glucocorticoid deficiency, can both make a seemingly promising drug to go further into clinical studies and subsequently rejected, as well as, more importantly, make an actually promising drug to fail in animal studies, and thus prevent it from crossing the translational divide. Either outcome will likely result in a wasted effort, rather than invoke a medical catastrophe, so, indeed, the original drama was exaggerated.Author's responseMinor commentsThe first sentence in abstract and introduction are the same. This is a bit distracting. I would change either.The phrases have been changed.Author's response: Page 3: “Even though mouse models of disease are not limited to targeted gene mutation or inactivation, it has made an undisputable impact on biology and medicine.” This sentence is not clear. What is “it” referring to?: This phrase appeared as an error of article shortening. I am grateful to the reviewer for pointing to the ambiguous phrase, which has been corrected.Author's responseA number of references seem not to be cited in the main manuscript and could be removed from the reference list. In the current version these are Ref 16 (page 3), Refs 30-31 (page 5), Ref 43 (page 6),: Orphan references were removed and the reference list is updated to reflect the revised text.Author's responseThe author declares that he has no competing interests.


In 2006, the South African Department of Health adopted and scaled-up loveLife’s Youth Friendly Services (YFS) initiative to a national policy to improve youth utilization of health programmes by strengthening community sensitisation and counselling services. As these services roll-out, alternative services to target young people are also becoming more popular. Success of any of these services, however, is dependent upon young people’s perceptions of these health services as a whole.This paper aims to examine the knowledge and perceptions of current health services oriented towards young people and examine potential alternative approaches to health service delivery.The study was conducted in urban Soweto, South Africa. Twenty-five in-depth interviews were conducted between May-July 2012. Twenty-three of these were analysed according to modified grounded theory.Knowledge of YFS was very low with no thorough knowledge of the programme’s purpose or activities. In general, young people were dissatisfied with the current health services in Soweto citing a lack of resources, long waiting times, and poor quality of care heightened by an underlying lack of choice and perceived inequity. When compared to alternative models of service delivery, no particular model was preferred over another.Greater knowledge of whether and to what extent local clinics in Soweto are implementing YFS standards is needed. If implemented, improved outreach and advertisement is suggested. In-service training of nurses should be prioritized with a focus on sensitivity and equitable treatment to all. At 1.8 billion, there are now more young people aged 10–24 years) than at any point in human history 4 years t. While yIn South Africa, the average age at first intercourse is 15 years for boys and 14 for years for girls . In spitIn 1999, loveLife was established as a joint initiative of leading South African Non-Government Organizations (NGOs), private partnerships, and the South African government as a multi-faceted approach to a national HIV prevention and sexual health education programme . This prThis paper aims to examine young people’s knowledge and perceptions of current health services oriented towards this age group, and to examine potential alternative models for health service delivery.We conducted this study in Soweto, South Africa, an urban township situated to the southwest of Johannesburg. We purposively sampled twenty-three Black African young men and women from a subset of fifty BT20 cohort members. This subset had been randomly-selected from the full cohort to participate in a pilot of the periodic Young Adolescent Health Survey (YAHS). We selected the sub-set of participants for this study based on gender  and utilization of health services within the last six months (15 users/8 non-users). The BT20 cohort is the largest and longest running study of child and adolescent development on the African continent. Full details of the design of the cohort study are described elsewhere ,12.We used modified grounded theory to guide our work  semi-structured 1-on-1 interview between one of the Principal Investigators (PIs) and the participant in English, (b) semi-structured 1-on-1 interview between a Zulu-speaking research assistant and the participant in Zulu and English, and (c) interview between one of the PIs and the participant with the Zulu-speaking research assistant present for translation if participant felt more comfortable expressing themselves in Zulu. Pilot interviews indicated that participants were most comfortable expressing their opinions in option a.Project staff contacted participants by phone and invited them to be interviewed. We obtained informed consent from all participants and held interviews in private interview rooms at the BT20 cohort offices. A range of topics were discussed including sources of health information, perceptions of current health services, and opinions on alternative health services. Daily meetings between the PIs assisted in the reflexive process during both the pilot and data collection phases.We submitted protocol granted exemption by Emory University IRB (ID 58317). We were granted local ethics approval by the University of Witwatersrand under the BT20 approval (ID M120138).We conducted all interviews in English; interviews varied in length between 45 minutes and two hours. We recorded and transcribed all interviews verbatim. The two PIs independently read all transcripts and developed codebooks based on emerging themes. As guided by modified grounded theory, we developed codes deductively, informed by the themes of availability, accessibility, and acceptability as previously discussed in literature ,15-17, aThis study utilized the BT20 cohort, which has been studied regularly for over 20 years, exposing participants to more regular screenings and health education than the general population of young people. This may have impacted answers related to knowledge of healthy behaviors and expectations of health services. Additionally, all participants were aged 21 or 22 at the time of the interview. While this falls in the age range of “young people” (aged 10–24), it falls in the upper limit and might not be representative of younger persons perceptions. Lastly, the data in this study may be subject to contextual effects that may affect data quality. This may include characteristics of the interviewer, differences in reactions to each PI interviewing, level of comfort with the interview process, and setting. Efforts were made to minimize these effects, through rapport building, the informed consent process, and reflexive meetings between the PIs after each interview.We conducted a total of 25 interviews (including pilot interviews), 23  of which were used for data analysis. We did not use two pilot interviews (methods b&c) in analysis as they did not reflect the overall data collection methodology used (method a). Interviews captured perceptions and opinions for both recent users and non-users (reported visited within the past six months) of local health services (15 users/8 non-users), including knowledge and perception of YFS initiatives. Additionally, participant’s opinions on two potential alternative health service delivery methods were collected.‘They’ll give you Panado©. Any pain killer or they’ll just say they’re out of stock. So you might as well just buy your own pain killer and not go to the clinic’ .Young people were generally dissatisfied with the current public health services in Soweto. Dissatisfaction was linked to a lack of resources, long waiting times, and poor quality of care. These reflect well-documented barriers to acceptable health care services ,15. StafYouth who did visit local clinics often faced extensive waiting times. Young people interviewed reported waiting between 30 minutes and several hours to see a nurse or doctor. Discontent was aggravated by a perception that their wait was often a result of nurses taking prolonged tea-breaks, leaving early, or dismissing their duties. Overall, participants felt nurses were rude, did not establish a sense of confidentiality or show respect to their needs. Some differentiated this behaviour from doctors, indicating that while doctors were scarce they perceived them to be more attentive and committed to their jobs.Dissatisfaction was heightened by underlying feelings of inequity in choice and access to quality services. Participants described a distinct variability and hierarchy of services. Private clinics were viewed as the pinnacle of health care services, described as trustworthy, clean, fast, reliable, and better staffed and stocked than publicly funded healthcare facilities. Those who had accessed private health services (6 interviewees) indicated not only satisfaction with the services, but gratefulness in their ability to pay and avoid the public system. Chemists or pharmacists, who can do quick diagnosis and prescribe over-the-counter drugs, were considered to be better than public health facilities but not as good as private clinics. When neither of these services was accessible due to financial barriers, young people relied on free public services.‘At what point would you think about going to the clinic?’Interviewer: : ‘When it is serious. But I don’t like clinics so I don’t usually go.’Participant: ‘What makes it serious?’Interviewer: ‘When you have taken all other methods and they don’t help… you must go’ .Participant“Ah, it’s it’s it’s quite bad. Some people don’t even have the money to go to private doctors, so they have no choice. They they have to go there, and be in the queue for long hours. It’s not it’s not good” .When faced with attending a public clinic, participants discussed three action strategies: avoidance, fatalistic acceptance, and manipulation of the system. When not feeling well, patients first reported avoiding the public clinics. Those interviewed primarily relied upon home remedies or information from libraries, the Internet and online chat rooms. Utilisation of the public health system often only came after all other treatments failed and access to private services was financially infeasible. At this point, there was a sense of fatalistic acceptance.take advantage’ of free services that are not ‘meant for them’. Others discussed feeling that if clinic workers judged them to be of a lower class, they treated them as if they were deserving of poor services and treatment. When faced with this type of treatment, young people felt they did not have the social capital to make complaints or demand better service because the services were free. One patient discussed how this perpetuates poor treatment from the nursing staff because they will not be held accountable for their behaviour.“Cause some—they do go to the clinic but then, like I said, the other problem is that you find people who are judgmental or rude. You know? So that’s the reason why they are afraid to go” .‘The one in [neighbourhood 1], like, there are nurses who are treating white people, colours, like there are all types of people who are going there. So I think maybe first that the advantages is that you have people who treat people good because they know there are other people who will generate results. When they are treated bad, the report it right away. So I feel like they should always treat us like people. [At neighbourhood 2], they take advantage. There are only black people there. They take advantage of that… they just mistreat people because they are at the local’ .Some participants discussed being gossiped about, judged, or even turned away if they were perceived to have the ability to afford private services. They were told they were trying to ‘“Yeah so you just go there and just write my name and the new address where I’ll stay at that moment in that village. So just write there and they’ll say ‘ok, fine”.: ‘Well… there are some good clinics…but these days they’re strict at clinics. They’ll check your address so you can’t go to any clinic you want. Cause then you want to go to the favourite clinic, so they get packed there and other clinics are empty. So now they first check your address before attending you’.Participant: ‘How do you feel about that?’Interviewer: ‘No… it’s bad. Because we go there knowing we get the better service than the other clinics. But we can’t go… unless I change my address’ .ParticipantThere were, however, clinics that participants reported as being ‘good’ clinics, those that were regarded as having greater resources, shorter waiting times, and friendlier staff. Access to these clinics was limited. A National Department of Health policy states that patients must visit their nearest clinic first and get subsequent referrals if the patient would like to go elsewhere . To acce‘I think there is one at our clinic, but I’ve never been to that… I’ve never heard people say, speaking anything about or going there. Yeah, like cause sometimes they don’t know about it. It’s just there’s a centre there, people don’t really know what’s going on… they’re not really clued in on what’s going on’ .“I think the services are ok…the only thing is: are youth attending them? You know, going and learning about them? The youngsters, they need to be more, um, what can I say, they need to be made aware of that, that these services are there for us to go” .Overall, knowledge of YFS programmes was very low; of 23 participants interviewed only three reported ever hearing about ‘youth-friendly services,’ none of whom were able to express extensive knowledge of the programme’s purpose or activities. After the interviewer described the YFS programme, some participants acknowledged these services might exist but recognised the lack of knowledge as a problem.Most participants agreed that it sounds like a good programme, and that nurses should be trained on respect for all persons, confidentiality, dedication, as well as proper sensitivities to young people’s needs. For the most part these needs were related to sexual health, including sexually transmitted infections, HIV/AIDS, and pregnancy. Additionally, general health education, diabetes, and counselling were brought up as important health issues facing these young people.YFS was developed from the loveLife programme, so participants were also asked if they had ever heard of the loveLife’s peer educators, groundBREAKERS. Eighteen of the twenty-three participants indicated that they had heard of groundBREAKERS, the majority of whom (14 of the 18) correctly matched a description to the programme. Overall, participants perceived the groundBREAKERS programme positively, and found them relatable, trustworthy and a good source of health education.‘No. It could work. I’m just thinking training nurses to be friendly and non-judgmental- Oh! [raises eyebrows in disapproval]…’ .This study also examined the participant’s opinions of two alternative health service delivery systems: School Based Health Clinics (SBHC) and Community Health Workers (CHW). There was no particular service that was preferred. While most of the participants were excited to discuss these potential services, a few participants seemed sceptical about the likelihood of these services being implemented in Soweto - potentially reflecting their feeling of disenfranchisement with current health service interventions.In general, reactions to SBHC were positive; all but one young person interviewed said they would have liked to have had a SBHC at their school when they were younger. Perceived benefits of a SBHC included fewer missed class hours to visit clinics, improved educational performance, and greater health awareness. While there was no consensus regarding the demographic characteristics  of potential SBHC staff, participants generally agreed that independent nurses not affiliated with the school should staff SBHC, pointing to uneasiness with the idea of teachers having access to the health information of the students. Another concern that arose was related to a sense of inequity- that if these services were in schools they would then only be available to current students and not be available to out-of-school youth or young adults that are no longer school-aged. Some also discussed concern for older people being excluded from these services, and suggested that more outreach services should be available to them.‘For example, they go to this house and maybe from this house you’re skipping this one and going to that one [points to three imaginary houses]. What if this person would die today? [pointing to skipped house] If I did come it would be fine and I would be seeing he would be having sickness’ .In general, the CHW model most accommodated the feeling for greater equity in access to health services. Participants liked the idea of having health services visit them in their home environment, however it was widely agreed that CHWs should not target certain houses or skip houses, to avoid stigma, promote confidentiality and ensure no one needing health services was missed.Health education and HIV testing and treatment were among the services participants would most like to see offered by CHWs. Other services that were discussed included general check-ups, health education and assessments for obesity, blood pressure, diabetes, and illness. While there was little consensus regarding the demographic characteristics  of potential CHWs, participants agreed that CHWs should be clearly identifiable (with a uniform or badge) so that safety could be ensured.Participants were generally dissatisfied with local public clinics, citing reasons reflecting literature, including the lack of availability, accessibility, and acceptability ,15-17,19There also seemed to be underlying feelings of inequity in choice and access to more acceptable services. Participants reported feeling that the services that were available to them were of lower quality because they were free and intended for those of low socio-economic status. A recent study by Harris, et al. suggests these negative perceptions of inequality could stem from policies established in the Apartheid era . When apAmong those interviewed, there was no thorough knowledge of the YFS programme. Lack of awareness of YFS has two underlying potential causes: (1) the clinics used by the participants do not implement or enforce YFS standards or (2) the clinics do adhere to YFS standards, but young people do not recognise them. The national DoH had aimed for 70% of primary healthcare facilities to be implementing the YFS program by 2012/13 , howeverWhen presented with alternative health service delivery systems, young people displayed no overall preference for the YFS, SBHC or CHW models. Evidence supporting one delivery system over another is weak ,28. FurtReflective of the 2001 Erulkar study , particiIn conclusion, greater knowledge of whether and to what extent local clinics in Soweto are implementing YFS standards is needed. If clinics are implementing YFS, greater effort should be made to publicise the purpose and standards expected of YFS and ensure awareness where YFS clinics exist. This would have two purposes- to alert young people of clinics that might suit their needs better, and keep nurses and clinic staff accountable to the advertised standards. Lastly, training for health-service workers should emphasise respect and equitable treatment while ensuring that health facilities are adequately stocked with the whole range of health services.


Very little is known about the extent to which eleven-year olds might consider a career in medicine. This exploratory study therefore asked children and their parents about medicine as a possible career, looking also at the relationship to a range of background measures.A longitudinal, three-wave, questionnaire study of students transferring from primary to secondary school (STARS), with data collection at primary school , in the first months of secondary school  and at the end of the first year of secondary school . Parents/carers also completed questionnaires. Children were entering ten large comprehensive secondary schools in the south-east of England; 46.3 % were female, 15.6 % receiving free-school meals, 39.8 % were Black or Minority Ethnic and 28.8 % had a first language which was not English. Of 2287 children in the study, 1936 children (84.5 %) completed at least one questionnaire of the three waves . The main outcome measures were an open-ended question in each wave, “What job would you like to do when you grow up?”, and a more detailed questionnaire in wave 3 asking about 33 different jobs.9.9 % of children spontaneously mentioned medicine as a career on at least one occasion. For the specific jobs, would-be doctors particularly preferred Hospital Medicine, followed by Surgery, General Practice and then Psychiatry. Would-be doctors were also more interested in careers such as Nurse, Archaeologist, Lawyer and Teacher, and less interested in careers such as Shopkeeper, Sportsperson, or Actor/dancer/singer/musician. Would-be doctors were less Neurotic, more Open to Experience, more Conscientious, and preferred higher prestige occupations. Those interested in medicine did not score more highly on Key Stage 2 attainment tests or Cognitive Abilities Test, did not have a higher family income or greater parental/carer education, and did not have more experience of illness or deaths among family and friends.An interest in a medical career, unlike high prestige jobs in general, is not associated with higher educational attainment or cognitive ability, and it is likely that only one in ten of the children interested in medical careers will have sufficient educational attainment at GCSE or A-level to be able to enter medical school. The study of medical student selection usually begins when candidates submit their applications to a medical school, which in the UK is via the Universities and Colleges Admissions Service (UCAS), when most applicants are about 17 years old. Occasional studies have involved students at the age of 16 who are considering applying to medical school  starting out in life, what kind of work would you like him to take up?”, to which 7.5 % of respondents said medicine, a figure similar to the 9.7 % found here [About one in ten eleven-year old children, when asked what job they would like to do when they grow up, spontaneously answer ‘doctor’, and they do so reliably across three separate occasions over a year. About one in ten of the children’s parents/carers also spontaneously say that they would like their child to be a doctor, and that does not correlate with parental/carer levels of education. Although we know of no previous studies asking eleven-year old children whether they would like to become a doctor, the und here .Children wanting to be a doctor are more likely to be female and to come from ethnic minorities , and in that sense they resemble medical students themselves, who are also more likely than the population to be female or from ethnic minorities. Compared with other schoolchildren, would-be doctors show different patterns of job interests, and are less interested in Holland’s Artistic and Conventional groups of jobs and more interested in high prestige jobs . Those thinking of studying medicine are more open to experience, more conscientious and less neurotic than other children, the latter two characteristics, along with school attainment, being associated with an interest in higher prestige jobs in general, rather than medicine as such. Although there is some evidence that medical student specialty preferences are related to personal experience of illness , 23, theSurprisingly, perhaps, given that medical students have some of the highest A-level grade attainments of any university applicants, there was no significant correlation of a preference for medicine as a career with school attainment, either with Key Stage 2 testing in year 6, or with the Cognitive Abilities Test (CAT) , 18. CATAn interesting question is therefore why so many children (and their parents/carers) have what, it is sad to say, are probably unrealistic expectations. Although wanting to be a doctor does not correlate with academic attainment, children in the sample who wished to have higher prestige jobs in general have significantly higher KS2 and CAT scores, and their parents/carers have higher levels of education, suggesting that children mostly do realise that some jobs require higher attainment levels. Medicine though does not show that pattern, despite medical schools asking for attainment in the top 1 or 2 % of the population, and academic attainment correlating with achievement at medical school . One expAn interesting question concerns the type of medicine in which children are interested. The detailed questions in C3, shown in Table Finally, is it reasonable to have made a decision to study medicine at the age of eleven? In the 1991 Cohort Study , one of This is a single study, although it is longitudinal and of a reasonable sample size, looking at entire populations within a number of schools. Care should therefore be taken in generalizing from its results.About one in ten eleven-year olds spontaneously mentions medicine as a possible career, which has implications for widening diversity in medicine. Female students and minority ethnic students were more likely to mention medicine, and would-be doctors differed in personality and other careers which would be considered. There was no relationship between considering medicine as a career and performance on cognitive ability tests or school attainment measures.