Published systematic reviews provide evidence linking positive and negative digital experiences to adolescent mental health. However, these reviews focus on the general public rather than the digital experiences of adolescents with different pre‐existing mental health conditions and so may be limited in their clinical relevance. We review publications relating to anxiety, depression, eating disorders and nonsuicidal self‐injury to identify common and condition‐specific digital experiences and how these may be implicated in the origins and maintenance of these mental health conditions.A systematic literature search using a combination of mental health, digital experience , and age of the target population terms was conducted on four databases. Detailed findings from the included studies were summarised using a combination of thematic and narrative methods.n = 5021). Nine studies included adolescents with depression, one with eating problems, two with nonsuicidal self‐injury and 14 with multiple emotional health conditions. The review identified six themes related to the target populations' digital experiences: (a) social connectivity and peer support; (b) escape and/or distraction; (c) social validation and social comparison; (d) accessing/creation of potentially harmful content; (e) cyberbullying; and (f) difficulties with self‐regulation during engagement with digital media.Five qualitative and 21 quantitative studies met the eligibility criteria for inclusion (Digital practices of adolescents with pre‐existing clinical vulnerabilities are complex and encompass a range of positive and negative experiences, which appear to have common elements across different clinical populations. The literature is currently too limited to identify disorder‐specific practices, with too few direct or indirect comparisons between conditions. Digital technologies have redefined how adolescents learn, work, play and socialise. These digitally related changes in adolescent lifestyles coincide with a consistent trend of an increase in adolescent mental health problems.The digital world provides psychologically vulnerable adolescents with opportunities for social connection and support and allows distraction from their mental health problems.However, some young people find it difficult to self‐regulate their digital engagement and their digital experiences can exacerbate psychological difficulties or lead to the normalisation of pathological behaviour.Future research should be designed in a way to better understand the more nuanced impact of a multiplicity of digital experiences and how these might differ for specific clinical groups.Studies comparing data from population cohorts collected at different points across the last two decades report increases in the prevalence of adolescent mental health problems such as anxiety and depression  on adolescents with four different types of pre‐existing clinically significant mental health difficulties: anxiety, depression, eating problems and nonsuicidal self‐harm. These were selected because of prior research suggesting a role for digital experiences both in the development and maintenance of these difficulties . The searches were limited to the past 10 years to reflect the substantial changes in digital technologies that occurred during this time (e.g. the rapid rise of platforms such as Instagram and TikTok). The year 2012 also marked an important shift in the way young people used digital media, with the switch to personal devices, and 12–15‐year‐olds started using the internet as much as watching television  mental health conditions , (b) digital experience, and (c) the age group of the target population. A detailed list of the search terms is provided in the Appendix Report primary data analysis of quantitative or qualitative empirical research.Include only participants who were adolescents with a mean age of 12–19 years or, for longitudinal research, were younger than 20 during the final wave of data collection.Report findings separately for groups with clinically significant depression and/or anxiety and/or nonsuicidal self‐injury and/or eating disorders. That is, they had a diagnosis, were seeking/receiving help or were in contact with clinical services regarding any of these mental health conditions.Report data on digital experiences with social media and/or gaming and/or internet and/or web chat and/or web forum use and/or mobile phone/smartphone use.Be from a peer‐reviewed article, a book or peer‐reviewed chapter, conference proceedings, a report, a case study, a clinical commentary or a clinical position paper.For inclusion in the review studies had to:They were reported in a PhD thesis, book review, poster or conference abstract.They were a meta‐analysis or a review .Digital engagement was measured only with ‘screen time’, that is the duration of use.Clinical status was based only on symptom counts .Studies were excluded if:Given the breadth of our remit  and the anticipated shortage of relevant published papers, we included a wide range of studies reporting different types of evidence in the review. These encompassed cross‐correlation and longitudinal correlation studies, case‐control studies, qualitative analyses of interviews and focus groups and clinical guidelines and recommendations. All titles and abstracts were reviewed independently by one of three researchers using a traffic‐light system to mark the studies as ‘include’, ‘unsure’ or ‘exclude’. All studies coded as ‘unsure’ were screened by a second reviewer. The full texts were screened using the same process. Additionally, a fourth reviewer independently assessed 25% of the potentially eligible full texts. Any disagreements during the reliability check or regarding studies coded as ‘unsure’ were resolved during a group discussion.The final sample of the studies that met the eligibility criteria was subjected to a review‐specific quality appraisal and relevance assessment using a Weight of Evidence (WoE) framework Gough, . Each stAn overall average score (WoE D) between 1 and 3 was then assigned to each study. Twenty‐five of 26 studies received WoE D scores of 2.0 or above. One article  or adolescents in the sample had a disorder that did not fall within the inclusion criteria . Fifteen of the excluded studies did not include a good quality or appropriate measure of digital experience and 12 included participants outside the selected age range. The complete list of reasons for exclusion is provided in Figure The search yielded 17,893 results and 12,411 remained after the deduplication of records  and were recruited from various settings including inpatient, outpatient and community services. For a breakdown of qualitative and quantitative studies included in the review, see Table The review of included studies identified six main themes related to young people's digital experiences. These were: (a) using digital media for social connection, to seek peer support and acceptance (5 studies); (b) using digital media for escape or distraction (4 studies); (c) using digital media for social validation or social comparisons (7 studies); (d) accessing or creating harmful content (7 studies); (e) cyberbullying (5 studies); and (f) self‐regulation of digital engagement, including perceived ‘addiction’ to the internet/digital media (16 studies).Three qualitative studies explored how adolescents use digital media to connect socially and to seek support and acceptance from peers . On the one hand, lower smartphone use may be a sign of social withdrawal and anhedonia that accompany an increase in depressive symptoms. On the other hand, using smartphones and online engagement, more generally, may provide respite from worsening depression. At times, when access to this source of relief is less available, symptoms of depression may feel more severe . However, sometimes such a way of coping could be problematic and perpetuate the existing emotional problems. A group of young people with internalising disorders, who mainly used video games to ‘hide themselves away or to avoid discomfort’ also met DSM‐5 criteria for Internet Gaming Disorder  in a group of adolescents hospitalised for mental health difficulties  were positively correlated with the severity of internalising symptoms  , affective disorders , anxiety  . While the latter study did include a clinically depressed group, correlations were reported for the combined clinical and control groups, which might explain the difference in the results between the studies.Difficulties with regulating digital media use were also reported in quantitative studies. Three studies  but no correlation between depression symptoms and smartphone ‘addiction’ . Further, Firat et al.  in a group of adolescents receiving inpatient treatment. Finally, 46% of the sample of adolescents receiving help for internet or video game problems had a comorbid internalising disorder . When the internet was not available to them, 59% of these adolescents reported feeling helpless and 26% reported feeling bored , while the positive correlation between problematic use and self‐reported depression symptoms approached significance (p = .05)  are shared by adolescents with different mental health difficulties. The digital world provides adolescents with opportunities for social connection, and support and allows distraction from their psychological problems. At the same time, some young people may find it difficult to self‐regulate how they engage with the digital world and their digital experiences can exacerbate mental health difficulties or lead to the normalisation of pathological behaviour. Future research should directly compare the digital experiences of individuals with different pre‐existing mental health conditions and be designed in a way to better understand the more nuanced impact of digital experiences on the specific clinical groups.This is a review of the published studies, for which ethical approval is not required.Table S1. Review data extraction table.Click here for additional data file.Appendix S1. Search Terms.Click here for additional data file.


Metastasis from small‐cell lung cancer to the colon is very rare. A 74‐year‐old man without respiratory or abdominal symptoms underwent a follow‐up lower gastrointestinal endoscopy after a polypectomy. He was diagnosed with a 5 mm IIa non‐hyperplastic polyp in the cecum and underwent a cold snare polypectomy. The histopathological findings confirmed the diagnosis of small cell carcinoma. The tumor was positive in the deep margins of the submucosal layer. Subsequent systemic examination revealed a mass in the lower lobe of the left lung. Thus, the tumor in the cecum was determined to be a colorectal metastasis from primary small‐cell carcinoma of the lung. Metastasis to the colon was diagnosed as small‐cell lung cancer based on local positivity for thyroid transcription factor‐1 and morphologic and immunochemical features. To our best knowledge, this is the first report of colon metastasis from small cell carcinoma identified by endoscopic treatment. Lung cancer is a leading cause of cancer‐related deaths worldwide.Due to its asymptomatic progression, gastrointestinal metastases are often diagnosed at advanced stages, leading to an extremely poor prognosis. In this case, polypectomy was performed for the initial diagnosis of primary SCLC. We report this case to emphasize the potential beneficial value of this diagnostic process for informing future clinical practice to improve patient outcomes.A 74‐year‐old male patient underwent a follow‐up lower gastrointestinal endoscopy after polypectomy. As a result, a 5 mm IIa polyp Figure  was founImmunohistological analysis of the left lung tumor biopsy specimen also revealed positive results for TTF‐1 Figure , Mib‐1 , and synThis study was approved by the Ethics Committee of our hospital . Written informed consent was obtained from the patient for the publication of this case report and any accompanying images.This is the first report of colon metastasis from primary small cell carcinoma identified through endoscopic treatment of colorectal polyp. In this case, lower endoscopy was initially performed, followed by CSP to identify a 5 mm polyp that differed from a hyperplastic polyp or adenoma. It was diagnosed as a small cell carcinoma. Additionally, subsequent systemic examination led to the final diagnosis of colon metastasis from primary SCLC.Endoscopic findings of metastatic colorectal cancer have been reported to be diverse, including colon wall thickening, obstruction due to mucosal swelling, erythema, and erosions. Metastatic colorectal cancers generally manifest with submucosal tumor‐like growths or extraintestinal wall compression as they grow inside or outside the intestinal wall.Immunohistochemical techniques are useful for identifying the primary site of metastatic gastrointestinal tumors. Similarly, immunostaining for TTF‐1 has been found to be useful in identifying primary lung cancer.In this case, a 5 mm polyp was found in the cecum during a follow‐up lower endoscopy after polypectomy. Furthermore, CSP was performed for both diagnosis and treatment. Although the endoscopic images later reviewed showed that narrow‐band imaging of the margins of the raised lesion was a regular vascular structure, clearly different from an adenoma, CSP was performed. According to an American study, endoscopic resection of all adenomatous polyps was effective in preventing colorectal cancer and consequently indicated.In conclusion, polypectomy was performed for the initial diagnosis of primary SCLC in this case and is preferred for the diagnosis of small non‐hyperplastic polyps.None.All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.The patient has provided written informed consent for the publication of this report.


Average volume‐assured pressure support (AVAPS) mode has been available since 2009 and allows the ventilator to deliver a constant pre‐set tidal volume by automatically adjusting the inspiratory pressures within a set range. Data in AVAPS mode use is limited in both paediatric populations, and in patients who are ventilated through a tracheostomy. This case series reports on the successful use of AVAPS mode in four paediatric patients with tracheostomy ventilation. Average volume assured pressure support (AVAPS) mode enables the ventilator to deliver a constant pre‐set tidal volume by automatically adjusting the inspiratory pressures within a set range. Although AVAPS mode has been available since 2009, data on its use in children are limited. We report safe and successful use of the AVAPS mode in four paediatric patients with tracheostomy ventilation. Average volume assured pressure support (AVAPS) mode enables the ventilator to deliver a constant pre‐set tidal volume by automatically adjusting the inspiratory pressures within a set range. Although AVAPS mode has been available since 2009, data on its use in children are limited. The authors recently published their experience with the non‐invasive use of AVAPS in a cohort of children resulting in improved gas exchange and hypoventilation compared to use of conventional bilevel positive airway pressure (BPAP).2O, EPAP 5 cm H2O, back up rate 20 breaths per minute, inspiratory time 1.2 s, rise time 1) through a tracheostomy. There was improvement in gas exchange however, PCO2 on venous gases remained elevated to 60 mmHg. To improve hypoventilation, AVAPS was trialled through tracheostomy. The gas exchange recording from the sleep study are depicted in Figure A 14‐year‐old with Prader–Willi syndrome and a background of non‐accidental traumatic brain injury with severe developmental delay was referred to our facility at a young age for monitoring for sleep disordered breathing. He was commenced on BPAP for evidence of obstructive and central hypoventilation at 7 years of age. However, adherence remained unsatisfactory. He had multiple presentations to the hospital with lower respiratory tract infection and respiratory failure. Eventually, a tracheostomy was performed for a secure airway. Ventilation was commenced on conventional BPAP  was managed by our institute since his initial presentation at 2 years of age with a hypoglycaemic seizure and severe hypoventilation. Subsequent genetic testing revealed PHOX2B mutation. A tracheostomy was performed to ensure a secure airway. Conventional BPAP was trialled through tracheostomy at pressures of IPAP 16 cm HA 6‐year‐old boy with a background of Gullian–Barre syndrome and tracheostomy ventilation was commenced on AVAPS mode. His ventilatory status remains stable on the AVAPS mode through a tracheostomy for a period of 3 years now.An 8‐year‐old boy with a background of Moebius type syndrome with severe congenital central hypotonia, who also had a tracheostomy for left vocal cord palsy, laryngomalacia and bulbar dysfunction was managed by our facility for hypoventilation. He was trialled on AVAPS mode due to difficulties with sleep maintenance and comfort. He tolerated this well with good gas exchange.Although several paediatric case reports and case series have demonstrated efficacy of AVAPS mode used non‐invasively,In our cases, AVAPS was delivered through the tracheostomy using recommendations similar to its use in patients ventilated non‐invasively. Ideal body weight was calculated for all cases. The recommended range of a tidal volume of 6–10 mL/kg of ideal body weight was used.Compared with the more conventional modes for ventilation delivered invasively, AVAPS is limited in its ability to be delivered to younger infants. This is due to the minimum tidal volume threshold of 50 mL and high trigger sensitivity limits. In addition, there is a paucity of data of the use of the AVAPS mode in tracheostomy patents. Other issues such as leak compromising ventilation are not isolated to those receiving invasive ventilation via the AVAPS mode and is a potential problem in all those receiving positive pressure ventilation via the tracheostomy.In summary, our case reports the successful use of the AVAPS mode in four paediatric patients with tracheostomy. The cases highlight that the AVAPS mode may be safe and effective when delivered invasively through a tracheostomy tube. Prospective, longitudinal studies are needed to evaluate the benefits of invasive ventilation using the AVAPS mode.Vishal Saddi: Responsible for conceptualization of work; drafting and preparing the original manuscript; editing the manuscript. Antonia O'Connor: Responsible for drafting and preparing the manuscript; editing the manuscript. Ganesh Thambipillay: Responsible for conceptualization of work; editing the manuscript and supervision. Arthur Teng: Responsible for conceptualization of work; editing the manuscript and supervision.None declared.The authors declare that appropriate informed consent was obtained for the publication of this manuscript and accompanying images.


Speciation rates vary substantially across the tree of life. These rates should be linked to the rate at which population structure forms if a continuum between micro and macroevolutionary patterns exists. Previous studies examining the link between speciation rates and the degree of population formation in clades have been shown to be either correlated or uncorrelated depending on the group, but no study has yet examined the relationship between speciation rates and population structure in a young group that is constrained spatially to a single‐island system. We examine this correlation in 109 gemsnakes (Pseudoxyrhophiidae) endemic to Madagascar and originating in the early Miocene, which helps control for extinction variation across time and space. We find no relationship between rates of speciation and the formation rates of population structure over space in 33 species of gemsnakes. Rates of speciation show low variation, yet population structure varies widely across species, indicating that speciation rates and population structure are disconnected. We suspect this is largely due to the persistence of some lineages not susceptible to extinction. Importantly, we discuss how delimiting populations versus species may contribute to problems understanding the continuum between shallow and deep evolutionary processes. Rates of speciation should be linked to the rate at which population structure forms if a continuum between micro and macroevolutionary processes exists. We find no relationship between rates of speciation and the formation rates of population structure in the Malagasy gemsnakes likely due to differences in species persistence and undetectable extinction among groups. A negative correlation would suggest that high rates of speciation are associated with little population structure, suggesting that clades with high speciation rate contain young species that simply have not had time to form strong population structure. This might be the case given that metrics for estimating tip speciation rates often show higher rates of speciation in groups with many young species , we examine the correlation between speciation rates estimated over the 23 million years of evolution and extant population structure for 33 species. The Malagasy gemsnakes represent an ecologically diverse group of squamates rivaling the ecological and morphological diversity found in their older continental relatives  loci representing 109 species of Malagasy gemsnakes  were collected across Madagascar from 2013 to 2017 and stored in 100% ethanol to preserve DNA. Additional samples (N = 184) held in collections were used to complement our recently collected field data . The number of samples per previously recognized species ranged from 3 to 26 (x¯ = 9).A total of 310 tissue samples were obtained throughout the ranges for 23 previously described snake species found across the island. We note that the use of nominate species names does not indicate that we disagree with previous species delimitation analyses  following the manufacturer's instructions for the following 33 taxa representing 58% of the genera on the tree of gemsnakes Figures  and 2: Ck et al. ; therefoSamples were sent out for genotyping‐by‐sequencing  sequenced in Burbrink et al. , to estimate alternative extinction or speciation rate changes we used the Gaussian Markov random field (GMRF) model or horseshoe Markov random field (HSMRF) model (for autocorrelated rates) to generate extinction or speciation rates depending on the congruence class model. For all 11 congruence models, we generated 100 estimates per model. We used a 0.02 threshold of detection in change of speciation or extinction rate over 100 time slices since the origin of the gemsnakes (~23 my). For all increases or decreases in extinction, we used a twofold change with a maximum rate of extinction = 1.0. Similarly, we used a twofold change for speciation rates with a maximum change at 0.5; we note that values above this failed to generate simulations.A previous study found that rates of diversification in the gemsnakes declined significantly over the entire tree during the Pleistocene . The CLaDS method uses Bayesian inference to estimate diversification rates for each branch on the tree and models changes in diversification rate at every speciation event , and took the slope (βIBD) to represent population structure over space. Because Fst is generally estimated using populations, we also calculated nucleotide diversity (π) for each species. Additionally, we also estimated genetic distance in Adegenet  using both the GBS data and mtDNA. Following Singhal et al. , we estiJombart,  and EuclIBD, mean mtDNA distance, the slope of genetic distance, the slope of Euclidian distance, and π for GBS data. We then assessed phylogenetic signal for each of the three estimates of tip speciation for values of lambda , where short branches have higher rates as estimated by DR and CLaDS had higher rates for taxa with long branch lengths , .46 (p < 1.28 × 10−7), and .36 (p < .008). All of these groups showed greater variability in tip speciation rates than the gemsnakes . Both mtDNA and GBS genetic distances and slopes were significantly correlated  reflecting that both genomes were tracking the same population structure. Most species had a significant positive slope (p < .05) between geographic distance and genetic distance  or Fst/1 − 1Fst . For GBS, all measures of slope using Fst, genetic distance, and Euclidean distance were significantly correlated  from mtDNA or GBS regressed against geographic distance were significantly correlated with tip measures of speciation from CLaDS, BAMM, or DR , suggesting that nucleotide diversity was higher in those taxa with lower rates of speciation. Phylogenetic signal was only significant for CLaDS using Blomberg's K  and for DR for both lambda  and for Blomberg's K . When accounting for phylogeny and multicollinearity among population genetic metrics, we found that no models were significant for CLaDS , BAMM , or DR .No measures of slope (β4We find no association between the formation of population structure over space and speciation rates in the gemsnakes of Madagascar. This holds for mtDNA (COI) and nuclear genomes Figure . ConsideOur results are similar to studies on squamates in Brazil and Australia  are often considered the first steps for the formation of species . Therefore, while the estimated rates of speciation and population differentiation are disconnected, there is still a general trend for extant species to show significant population structure across the island associated with range size. Even though the area of Madagascar and phylogenetic diversity is smaller in comparison with most other studies examining this link, the gemsnakes and other taxa on this island show major phylogeographic structure at the intersection of six starkly contrasting biomes  estimating speciation rates with trees and (2) estimating population structure within taxa. If users cannot quantify how a population differs from a species . These considerations regarding species delimitation and how species differ from population structure in a phylogenetic context should be kept in mind when developing new ways to link the formation of population speciation rates. Perhaps to better understand this continuum, all lineages, regardless if they are species or populations, should be included in phylogenetic analyses of diversification to test for temporal autocorrelation of speciation rates between shallow (population level) and deep nodes. Results that have previously delimited species using coalescent methods ; formal analysis (lead); funding acquisition ; investigation (lead); methodology (lead); project administration (lead); supervision (lead); visualization (lead); writing – original draft (lead); writing – review and editing . Sara Ruane: Data curation ; writing – review and editing . Nirhy Rabibisoa: Investigation ; resources ; writing – review and editing . Achille P. Raselimanana: Data curation ; investigation ; writing – review and editing . Christopher J. Raxworthy: Funding acquisition ; investigation ; writing – review and editing . Arianna Kuhn: Conceptualization ; data curation ; formal analysis ; methodology ; writing – review and editing .We have no competing interests.Appendix S1:Click here for additional data file.Appendix S2:Click here for additional data file.Figure S1:Click here for additional data file.Figure S2:Click here for additional data file.Figure S3:Click here for additional data file.


Fungal lithiasis is a rare but serious complication of candiduria. Frequent use of broad‐spectrum antibiotics is a contributing factor in predisposed subjects. Two CBEUs are required to confirm the diagnosis of candiduria. Anti‐fungal is found effective to eradicate the fungus ball besides surgery.Candida parapsilosis. Antifungal was effective with good evolution. Broad‐spectrum antibiotic therapy is one favoring factor.Lithiasis by fungus ball is a serious complication of candiduria. Our case was a 58‐year‐old man who presented an acute obstructive pyelonephritis. Ultrasound revealed a left ureteral lithiasis. Biological examination revealed  The emergence of new species of Candida with an increase in their resistance to antifungal drugs is the reason for this.Candida parapsilosis fungus ball and to discuss the factors that may contribute to it.Candida urinary tract infection is actually on the rise, especially in hospitals. The most frequent species found among candidiasis is 2Escherichia coli infection 1 month before his admission. About surgical history: he has a double J catheterization in October 2020 with the removal of a left calcium lithiasis and a left renal cystectomy, removal of the double J catheter in 2021. During his hospitalization, the patient presented pollakiuria and mictional burning with a preserved diuresis of 2 L/24 h with clear urine, all evolving in an apyretic context. The biological examinations found a biological inflammatory syndrome with a neutrophilic hyperleukocytosis  showed a Quinolone‐resistant l Figure . We thus3Candida parapsilosis is responsible for 4.3% of candidiasis,C. albicans and C. tropicalis, but Aspergillus flavus, Aspergillus nidulans, Rhizopus, and C. parapsilosis also are reported.Candida parapsilosis with an antifungiogram without resistance to the usual antifungals. The responsible factors found in our case were frequent use of broad‐spectrum antibiotics, previous placement of a DJ stent, and possible underlying chronic renal failure. The differential diagnoses in front of the fungus ball are calcic lithiasis and uric acid lithiasis. We need to look for a candida infection in subjects who has a severe urinary tract infection with a high‐risk factor. Do not use broad‐spectrum antibiotics without clear bacteriologic evidence in subjects who has risk factors for fungal infection. For patients with symptomatic candida urinary tract infections, a variety of treatment options are available. Fluconazole is the antifungal agent of choice, achieving high urine concentrations with the oral formulation at the posology 200–400 mg per day for 14 days.Candida urinary tract infection is difficult to differentiate from simple urinary colonization. It is reported in the literature that the most frequent manifestation of candiduria is pyelonephritis followed by signs of cystitis and others.A possible systematic treatment with antifungal agents in subjects at risk would be an efficient way to decrease the recrudescence of fungal infections in hospitals.4Candida urinary tract infection is one of the candidiasis currently on the rise in hospitals. It occurs in patients with already defined immunodepressive factors, either because the patient is deficient or because of iatrogenic causes. The clinical forms are often pyelonephritis and cystitis. The occurrence of obstruction by fungal lithiasis should not be overlooked. Two cytobacteriological and mycosal examination of urine are necessary to make the diagnosis, with imaging if necessary. The treatment is based on the identified species and the antifungal.Rajo Païdia Radinasoa: Conceptualization; data curation; investigation; project administration; writing – original draft. Armel Mamihaja Andrianiaina: Funding acquisition; investigation; methodology; resources. Haingotiana Randriamamizoly: Data curation; formal analysis; investigation; methodology; writing – review and editing. Adrien Andrianarivony: Resources; software; visualization; writing – review and editing. Harilalaina Willy Franck Randriamarotia: Supervision; validation; visualization; writing – review and editing. Hanta Marie Danielle Vololontiana: Supervision; validation; visualization.We do not have any conflict of interest.Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.


Upeneichthys lineatus, a temperate marine teleost species. Upeneichthus lineatus can change in a matter of seconds, from a uniform white colour to display prominent, vertical, dark red stripes. Initial observations suggested that rapid colour change in U. lineatus was associated with feeding and may act as a signal to both conspecifics and heterospecifics that are frequently observed to follow feeding goatfish. Field observations of the colour and behaviour of individual U. lineatus were collected to (1) document the repertoire of behaviours that U. lineatus displays and categorise associated colour patterns; (2) quantify the speed of dynamic colour change; (3) establish the context in which U. lineatus changes colour and pattern; and (4) test whether the behaviour of follower fishes is influenced by colour patterning or specific behaviours of the focal goatfish. We found that U. lineatus changed colouration from white to the red banded pattern in less than 10 s. The key driver of rapid colour change in U. lineatus was feeding, particularly when the fish fed with its head buried in sediment. Conspecific followers were most likely to be white in colour and adopt searching behaviour, regardless of the focal fish colour or behaviour. Other species of follower fish spent significantly more time following U. lineatus that were displaying dark red stripes when searching or eating, implying the red stripes may be an interspecific signalling mechanism. Our findings indicate that rapid colour change in teleost fish may be used for social communication and may provide U. lineatus with increased protection from predation when feeding via a safety‐in‐numbers approach.Many animal species can rapidly change their body colouration and patterning, but often the ecological drivers of such changes are unknown. Here, we explored dynamic colour change in the bluelined goatfish,  Bluelined goatfish can dynamically change their body pattern and colour from a neutral white to a dark red banded pattern under 10 s. Goatfish are more likely to adopt a dark red banded pattern when actively feeding. Furthermore, associated fishes spend more time with goatfish displaying the red banding. It is likely bluelined goatfish use rapid colour change as a social signalling tool. Animal colour is not always fixed and many invertebrates and poikilothermic vertebrates, including fish, change their colouration and/or patterning depending on their developmental or environmental context  develop bright orange bellies in the breeding season to attract male mates  advertises its readiness to spawn by shifting its usual abdomen colour to red , for example, display a temporary ornament of evenly spaced vertical black bars to signal their competitive ability to other females as well as attract male pipefish  will alter luminance when interacting with their pair mate  employ three key achromatic patterns to switch between: (1) a ‘non‐specific’ and uniformly dark colouration that is often displayed when feeding; (2) a bullseye on the caudal fin frequently shown by non‐schooling juveniles and thought to reduce mortality through predation given its resemblance to an eyespot; and (3) longitudinal stripes that aid predator evasion by breaking up the outline of the animal, particularly when displayed in a large school of fish  is an aggressive mimic that can rapidly change colour to imitate several different reef fish, depending on the availability of other species nearby  flash through four different colours in less than 3 s  can rapidly change its body colour from blue to red  exhibits dynamic changes in both integument colour and patterning , which occur in coastal waters along the southeastern coast of Australia, have also been observed to rapidly change both colour and pattern . Typically, U. lineatus change from a pale buff/white colour to a prominent, vertically striped, red pattern in seconds. There are anecdotal reports these fish adopt a red colour when resting at night, but during the day they regularly transform their body colour and pattern when foraging, seemingly making them more conspicuous  are regularly seen to follow feeding goatfish. Furthermore, Upeneichthys lineatus can likely discriminate colours at longer wavelengths where the red elements of their body colouration have high reflectance, and it is possible that this provides advantages in distinguishing visual signals from conspecifics  changed colour or behaviour in response to the focal fish. We hypothesise that U. lineatus will rapidly change colour when undertaking a particular behaviour, specifically feeding, rather than in response to the underlying substrate. Given that U. lineatus appear to be using the red body pattern when feeding, we predict that both conspecifics and heterospecifics will spend more time following the focal goatfish when it is displaying the red colouration. Further, if the red body pattern is indeed a foraging signal, we expect to see an increase in the searching and feeding behaviour by follower fish when the focal goatfish is red.In this study, we assessed the drivers of daytime dynamic colour change in 22.1This study was minimally invasive and complied with the Australian Code for the Care and Use of Animals for Scientific Purposes. The study design was assessed and approved by the Macquarie University Ethics Committee (ARA 2016/020).U. lineatus in 3‐min sessions. Data were collected during the morning (09:00–12:00) between November 2016 and May 2017 using SCUBA. Recordings were made at depths of 5–10 m at three temperate locations in Sydney, Australia, where U. lineatus occur regularly: Gordons Bay , Shelly Beach  and Bare Island . These areas are adjacent to rocky shorelines with predominantly sandy bottom interspersed with rocky reefs. As it has been previously reported that U. lineatus feeds predominately on sandy substrate, while remaining close to the shelter provided by rocky reefs  video cameras attached to a 1 m‐long PVC pole. All videos were shot in 1080p resolution, at 30 fps and with protune turned off. The GoPro was kept 0.5–1 m away from the focal fish, meaning that the diver was always 1.5–2 m away from the focal fish. During each dive, the first adult goatfish (>20 cm) spotted by a diver was followed. The fish was approached slowly by the diver to 1.5 m and a recording was made if the fish did not obviously alter its behaviour or location in response to the diver. In most cases, goatfish did not appear to change behaviour on a diver's approach. Moreover, an initial pilot study showed no differences in goatfish activity, which included feeding behaviour, between recordings where divers remained at either 1 or 5 m distance from the focal fish (data not shown). Given this, it was decided that a diver remaining 1.5 m from the goatfish was a suitable distance from which to record its behaviour. During recording, the diver would track the fish at a constant distance for three continuous minutes, ensuring that the focal fish remained in the centre of the video. At the end of filming the diver would move to different area of the reef so that a new individual could be located. To avoid filming the same fish twice we used only two divers on each dive that recorded in diverse areas of the site. Further, we recorded at multiple locations to reduce the likelihood of recording the same fish twice. Where possible, individuals were followed for three continuous minutes but in the case that the fish was lost or it hid for more than 30 s the recording was stopped and a new fish was identified. All effort was made to ensure that the divers did not disturb the fish or surrounds.2.2U. lineatus were followed. Videos were first assessed to obtain a summary of U. lineatus behaviours. Footage was examined in its entirety with the commonly observed behaviours detailed and described in Table U. lineatus behaviours were then binned into three broad behavioural categories: travelling, searching and eating. Film clips showing representative examples of these behaviours are displayed in Videos U. lineatus colour change). The white  phase was defined as a pale buff/white colour with a horizontal darker lateral band. When goatfish were in the white phase, no vertical banding was evident. The pale red phase was defined by the appearance of a vertical striped patterning, often a light red or pink colouration with the horizontal dark lateral band still distinguishable on the body of the fish. The dark red phase was described as a distinctive dark red vertical banding where little lateral banding was present  components in a colour image. To determine the contrast ratio range for each colour pattern, we first obtained two relative luminance values from 630 frames of video footage (every 10 s). Frames were imported into Adobe Photoshop 2021 (v 22.4.2) and the colour working space was assigned to sRGB via the colour settings in Adobe Photoshop. Using the ‘Info’ panel, we calculated relative luminance using the RGB values for the lighter (L1) and darker band (L2) for each fish . From the 35 videos recorded, there were 38 occurrences of rapid colour change. Goatfish appeared to rapidly shift colour from white to pale red when they stopped swimming and searched the substratum. The rapid change from pale red to the dark red distinct banded pattern mostly took place when the fish appeared to locate a food patch and actively ate. At the commencement of each colour change event, times were recorded at the point that the fish was white, when it displayed a pale red colouration and again when the fish had adopted the distinct dark red banded patterning with no lateral band visible. Only colour change events where individual U. lineatus changed entirely from white to dark red were recorded, such colour change events could take place more than once during one 3‐min track. To determine whether the rate of colour change was similar for individuals from dark red back to white, the time for the fish to shift back to the neutral white colouration following a colour change event was also recorded. Here, the final moment that each fish displayed the distinct dark red banded pattern was recorded and then the time was recorded again the moment it turned pale red and/or white.To obtain the rate at which 2.4U. lineatus but naïve to the overall research questions. Each 3‐min video was watched at half speed using VLC media player and information recorded as per the study objectives. At each 5‐s interval, the behaviour  and colour  was recorded for the focal goatfish. The substrate underlying the goatfish  was also recorded at each 5‐s interval. A second observer confirmed the colour morphs that were recorded using the contrast values outlined above. We also recorded all individuals of other fish species (conspecifics or other associated fish species) that actively interacted with or followed the focal goatfish within a radius of approximately 1 m. At each 5‐s time interval each individual follower fish, as well as its behaviour, was recorded. If the follower fish was a conspecific, we recorded its behaviour  and colour  in the same manner as the focal goatfish. The behaviours of other follower fishes were categorised in a slightly different manner to that of the focal fish. We recorded travelling behaviour , eating behaviour  and whether they were attracted to the focal fish. Rather than searching for food in the same manner as goatfish, follower fish would regularly demonstrate interest in the focal fish by changing swim direction towards the focal fish, or by closely following the focal goatfish, and it was these interactions that we logged as attracted.Video footage was analysed by an independent observer trained in the behavioural categories and colour morphs of 2.52.5.1clmm function in the ordinal package  transformed and the models met regression assumptions of linearity and homogeneity of variances with normal distribution of residuals. Log‐likelihood ratios were used to check for significance of the interaction. Pairwise comparisons for significant interactions were obtained using glht function in the multcomp package. The interaction term was dropped if it was not significant, and the main effects were analysed. Significance of the main effects were obtained with an ANOVA type III table using the anova function in the lmertest package  was first aggregated and summed by individual focal goatfish, goatfish colour and behaviour to provide the total intervals that conspecifics or associated fish followed the focal goatfish. The total intervals were then multiplied by five  to obtain an approximation of the total time (in seconds) that conspecifics and associated fish followed the focal goatfish. Linear mixed‐effects models were constructed in R using the lme4 package . We also included the behaviour of the conspecific as an ordinal factor (travelling < searching < eating). We constructed clmm models using the Lüdecke, .2.5.4The behaviour of other heterospecific follower fish in response to focal goatfish colour and behaviour were analysed using clmm models using follower fish behaviour as an ordinal response term. In the models, the strongest response was eating with travelling as the weakest response (travelling < attracted < eating). Models were constructed using the same approach as outlined for the behaviour of conspecific followers above.33.1U. lineatus rapidly changing from the neutral white colour to the dark red banded pattern. We observed that U. lineatus changed colouration from neutral white to the pale red colouration in 1.92 ± 0.1 (mean ± 1 SE) s. Individuals changed from the white to the dark red banded patterning in 6.19 ± 0.3 s. At the completion of a foraging event, when the fish was no longer in the nose‐down position or actively chewing, it rapidly shifted back to the white colouration. We did not observe any occurrences where the fish transitioned from dark red to pale red following an active foraging event. The time for goatfish to change from the dark red pattern back to white was 2.52 ± 0.1 s.We followed 35 individual goatfish for 3 min each, within which we observed 38 occurrences of 3.2U. lineatus displayed the white colouration 37.3%, the dark red colouration 38.9% and the pale red 23.8% of the time. The goatfish were travelling 28.1%, searching 63.7% and eating for 8.1% of the observation time. No significant interaction was observed between the behaviour and the underlying substrate on the probability of U. lineatus displaying a particular colour . Analysis of the main effects showed no impact of substrate on U. lineatus colour . However, their behaviour did have a significant effect on how likely U. lineatus were to adopt a particular colour . When travelling, the probability of U. lineatus adopting the white colouration was 78.5%  = 62.9, 94.1), significantly higher that the probability of adopting the pale red  or dark red  colour display. When U. lineatus was searching for food, the probability of displaying a pale red colouration was 49.5% , significantly higher than the probability of adopting a white  or dark red colouration . When goatfish were actively eating, the probability of adopting dark red colouration was 77.3% , significantly higher than adopting the pale red  or white colouration , 3.3O. lineolatus. No significant interaction was observed between focal goatfish colour and behaviour on following time of the conspecifics . Analysis of the main effects showed the focal goatfish colour did not affect following time of conspecifics , but there was a significant effect of the focal goatfish behaviour on the conspecific's follow time . Conspecifics spent significantly more time following focal goatfish that were searching compared with those that were travelling . There was no difference in the amount of time conspecifics spent following focal fish when they were eating compared with searching  or travelling , occurring in 32.4% of all individual tracks. The heterospecific fishes were generally resident fishes that typically inhabit inshore rocky reefs. Of the 17 species observed, 13 are carnivores with a diet predominately of benthic invertebrates, two are omnivores with a diet of algae and benthic invertebrates, and one species, the mado (Atypicaths stigatus), is predominately a planktivore with reports suggesting they are often attracted to benthic feeders due to the potential disturbance of a food source into the water column . When focal fish were eating, heterospecifics spent significantly more time interacting with them when the focal fish was dark red compared with pale red  or white . There was no difference in interaction between heterospecifics and focal fish when the focal individual was between pale red and white . When focal fish were searching, heterospecifics spent significantly longer interacting when the focal fish were dark red compared to white  or pale red . However, no difference between the pale red and white colour  when searching was observed. There were no differences in the time heterospecifics spent following the focal fish when it was travelling regardless of its colour . Conspecifics were also most likely to engage in search behaviour around focal goatfish irrespective of focal fish colour . The likelihood of follower conspecifics engaging in a particular behaviour was influenced by the behaviour of the focal goatfish . When focal goatfish were travelling, conspecifics were most likely to also adopt travelling behaviour rather than searching or eating. When focal goatfish were searching or eating, the probability of conspecifics also searching was significantly higher than travelling or eating . When the focal fish was white, heterospecifics were more likely to be travelling or showing attraction to the focal fish than eating. When focal goatfish were pale red, the probability of heterospecifics displaying attraction was significantly higher than the probability of heterospecifics travelling or eating. When focal goatfish were dark red, the probability that the heterospecific followers would show attraction to the focal fish was significantly higher than the probability of them travelling, they were also more likely to feed around dark red focal fish than travel.Both the colour and behaviour of the focal goatfish had a significant effect on the likelihood of heterospecific follower fishes displaying a particular behaviour  foragers perform a waggle dance to reveal the presence and location of profitable food sources to nest mates  use a vocal ‘squeak call’ to alert conspecifics of food discovery  will signal associated fishes to commence cooperative hunting through posturing with changes to skin colour and texture  on a Caribbean Reef  of the signal potentially benefit by obtaining information about food patch locality and gain access to otherwise unobtainable food. The focal fish (sender) benefits from increased predator detection, allowing more time to forage in the substrate and increasing their capacity to track food resources ; data curation (lead); formal analysis (lead); funding acquisition ; investigation (lead); methodology ; project administration ; resources ; software ; visualization ; writing – original draft (lead); writing – review and editing . Nathan S. Hart: Formal analysis (supporting); funding acquisition ; investigation (supporting); methodology (supporting); project administration ; resources ; supervision ; validation ; writing – review and editing . Jane E. Williamson: Conceptualization ; formal analysis (supporting); funding acquisition ; investigation (supporting); methodology ; project administration ; resources ; supervision ; validation ; writing – review and editing .This study was funded through the Holsworth Wildlife Research Endowment Fund and the Department of Biological Sciences  and Macquarie University.The authors have no competing interests to declare.Appendix S1‐S2:Click here for additional data file.Appendix S3:Click here for additional data file.Table S1:Click here for additional data file.Video S1:Click here for additional data file.Video S2:Click here for additional data file.Video S3:Click here for additional data file.Video S4:Click here for additional data file.


We aimed to test whether ratjaku or predator activity at burrow entrances varied with cover and how ratjaku respond to predator presence. Using time‐lapse photography, we monitored ratjaku and predator activity at the largest entrance of 12 burrows ranging from high (>70%) to low (<50%) cover and at multiple entrances of two other burrows. Overall activity did not vary between burrows with high and low cover. Within burrow systems ratjaku were more active at sparsely vegetated entrances, often sitting wholly or partly inside the burrow. However, consistent between and within burrow systems, skinks spent proportionally more time fully outside where cover was higher. Predators—mostly native—were detected at most burrows, with no apparent relationship between predator activity and cover. Skinks also did not appear to modify their activity in response to predator visits. Our results indicate that ratjaku may spend more time outside burrow entrances when cover is higher but there was no direct evidence that this related to perceived or real predation risk. Differences in food availability, thermoregulatory opportunities and opportunities for ambush foraging associated with differences in vegetation cover or composition are other factors likely to be important in determining the activity of ratjaku at burrows. Our research demonstrates the usefulness of camera traps for behavioural studies of ectothermic burrowing animals. The complex relationships between ratjaku activity and vegetation cover thereby revealed, suggest outcomes of fire‐mediated habitat change on predator–prey interactions are not easily predictable.Increased predation where ground cover is reduced after severe wildfire is increasingly implicated as a factor causing decline of vulnerable prey populations. In arid central Australia, one species detrimentally affected by repeated wildfire is the great desert skink or  tjakura, desert‐dwelling communal burrowing skinks, spend more time fully outside their burrow where cover is higher and more time sitting just within burrow entrances where cover is lower. This behavioural response to proximate environmental features may reduce the predation risk for tjakura when fire or other disturbances remove cover.Loss of vegetation cover following fire may increase predation risk, even for prey that spend most of their time in burrows. We found  Of the skinks sampled, those from Uluru were the most genetically distinctive, leading to the recommendation that the population should be considered its own delineation for the purpose of conservation management  , over one active season. The ratjaku population is restricted to the sand plain areas of the park which are dominated by spinifex (Triodia spp.) and tussock grasses with a very sparse over‐storey of honey grevillea (Grevillea eriostachya) and desert oaks (Allocasuarina decaisneana) and contains a mosaic of vegetation with different fire histories.This study was conducted within Ulu2.1ratjaku burrows were chosen for monitoring out of a larger sample of 20 burrows that were being actively used by skinks at the time of our study. The 20 burrows were a subset of burrows that had previously been mapped and regularly monitored by the National Park rangers  for monitoring. The six burrows with the lowest vegetation cover  around the main entrance were classed as low cover. The six burrows with the highest vegetation cover  were classed as high cover. The three burrows with the lowest cover (26%–36%) were in areas that had been burnt 3 years previously in a 2012 wildfire, and the other three low cover burrows (41%–49% cover) had not been burnt for 12 years. High cover burrows were all in areas unburnt for at least 12 years. Burrows varied in size and number of entrances (Table 2.2raTjaku activity was monitored using 10 Reconyx HC600 and 2 Reconyx HC800 cameras. One camera was set up at each burrow at what appeared to be the main entrance. Every burrow had multiple entrances and the main entrance was determined as the biggest one associated with the biggest soil mound (a distinctive feature at burrow entrances created from excavated soil), where this was obvious. Another distinctive characteristic of ratjaku burrows is the presence of a ‘latrine’ or scat pile which is consistently used as a defecation site by burrow inhabitants. If there were two entrances and mounds of similar size within a burrow system, the entrance closest to the latrine or most centrally located among the other entrances was chosen.2 field of view centred on the burrow entrance. A small plywood shelter, attached directly above each camera, shaded it from the extreme heat typical of the central Australian summer.Cameras were installed 1 m from the burrow entrance, mounted on platforms angled downwards at 60° to the ground and screwed onto metal garden stakes, 60 cm above the ground. This setup produced a 1 mCameras were set to the time‐lapse mode to take one photo every minute for two 18‐day periods in early summer (from 12:00 midday 27 November to 12:00 midday 15 December 2014), and mid‐late summer (from 12:00 midday 24 January to 12:00 midday 11 February 2015). Batteries and SD cards in cameras were replaced every 5–6 days, but battery failure led to the loss of 8 h of data from one burrow and 12 h each from two other burrows.ratjaku visible as an index of their activity at the burrow entrance. Although we refer to these periods as ‘active’, most of the time when lizards were partially or fully emerged, they remained quite stationary (i.e. were in the same place in multiple consecutive images). When there were continuous periods (i.e. consecutive images) with ratjaku present, ‘active bouts’ was used to describe this activity. When there were no ratjaku visible on an image, we assumed the residents had either retreated inside the burrow or were actively foraging (or engaging in another activity) away from the burrow entrance.We used the number of images with 2.3ratjaku visible, other vertebrate species visible or no vertebrate visible. The images with skinks present were then divided into three position categories: fully inside the burrow entrance, half emerged with front legs visible or fully emerged from the burrow entrance, with hind legs visible outside , sub‐adult or adult. Where there were two or more ratjaku in the image, each was classified separately for size and position.The images were initially sorted into three categories: one or more e Figure . There wWe were not always able to distinguish among different individuals from the same burrow. However, obvious differences in size, colour, the presence of distinguishing features (e.g. part of the tail missing) or the presence of multiple individuals in single images allowed us to determine a minimum number of individuals present at each burrow during each recording period.2.4ratjaku activity at the main burrow entrance related to the minimum number of lizards occupying the burrow, the number of entrances in the burrow system and vegetation cover at the burrow.Repeated measures analysis of variance was used to determine whether the minimum number of individuals varied between the two recording periods (within subjects effect) or between burrows with high and low vegetation cover. We then used Pearson correlations to test how 2.5ratjaku were included in analyses. The number of discrete ‘visits’ by predators to burrows was determined based on the sequence of images. If the same predator was visible in consecutive images, this was counted as a single visit. We then tested for correlations between vegetation cover at burrows and the number of predator visits.All vertebrates known or suspected to be predators of ratjaku reduced their activity in response to predator visits, graphs were produced to show the timing of their active bouts in relation to predator visits. The activity of skinks before and after predator visits was compared based on (a) the time interval (min) between a ratjaku being visible and the arrival of a predator and the interval (min) between a predator leaving and a ratjaku becoming visible again, and (b) the number of active bouts by ratjaku in the 24 h prior to predator arrival and post‐predator departure. The null hypothesis (no effect of predators) was that there would be no difference in the 24 h before and after a predator visit in the time interval between ratjaku activity and predator activity or the number of ratjaku active bouts. Time data were log transformed prior to analyses.To determine whether 2.6ratjaku spent outside the burrow against the average activity of ratjaku in the early and late active season. The early active season was considered as the time between ratjaku first emerging during spring until end of December and the late active season as roughly January to March. We then split the data into dawn, day, dusk and night. Dawn and dusk were defined as an hour‐long period during which sunrise and sunset occurred. In late 2014 dawn fell approximately between 05:00 and 06:00 (sunrise range 5:47 a.m.–5:49 a.m.) and in early 2015 dawn fell between 06:00 and 07:00 (sunrise range: 6:15 a.m.–6:58 a.m.), and dusk in both years was approximately between 19:00 and 20:00  . We used a three‐factor repeated measures ANOVA with time (dawn/day/dusk/night) and vegetation (low/high) as the fixed factors and burrow site as a random factor nested within vegetation and Tukey's post‐hoc test was used for pair‐wise comparisons. To do this, we converted number of images to images per hour to account for the different lengths of each period.To investigate patterns in daily activity we plotted the time 2.72 quadrat centred over each entrance were measured and the main entrance was identified, according to previous protocols.Two additional burrows were selected from the remaining eight of the 20 active burrows; one (burrow A) with four entrances and one (burrow B) with seven entrances. Reconyx cameras were set up at every burrow entrance in the same way as described previously. Width, height, opening, diameter and height (cm) of the mound, as well as percentage cover of vegetation in a 1 mActivity at burrow entrances was recorded at all entrances simultaneously for 4 days in early February 2015. Cameras were set to time lapse taking one picture per minute. One camera  malfunctioned, and that entrance was excluded from all analyses. We used correlations to test whether the level of activity at burrow entrances was associated with burrow size, minimum number of individuals using the system, overall activity and vegetation cover at each entrance.33.1F1,10 = 0.46; p = .52). There were at least one to six different individuals in each burrow during each survey period , or mid‐late summer  survey period. There was, however, a significant effect of time on the minimum number of lizards recorded per burrow , with more individuals detected in the second survey period , nor any time × vegetation density interaction  on the minimum number of individuals at the burrow.There was no difference in the number of entrances of burrow systems with low vegetation cover  and high vegetation cover  at a burrow. More individuals resulted in more records of activity. Subsequent analyses using either absolute measures of activity, or activity per individual ratjaku showed identical trends, so we only report absolute values here.The was no correlation between the number of entrances to the burrow system and the total number of recorded images with lizards at the main entrance. However, there was a positive relationship between the total number of images with ratjaku images or images of ratjaku inside or outside the burrow, however, the proportion of time ratjaku spent outside of the burrow was positively correlated with higher vegetation cover at the burrow site .There were no significant correlations between vegetation cover and the total number of 3.2tinka in Pitjantjatjara; Varanus gouldii; 30 visits across all burrows), followed by the mulgara  and woma python   was only detected twice and was the only introduced predator observed.Four predator species and several unidentified species were detected at the burrow entrances. The most common predator species observed was the sand goanna . The same predators were detected at low and high cover burrows, except the fox which was only detected at low cover burrows.Predators were recorded at every burrow expect for H3 and H5, two of the high cover burrows. Despite this, overall there was no significant correlation between the number of predator visits at low and high vegetation cover burrows  on the length or the number of active bouts  as an index of activity, ratjaku in burrow systems with low vegetation cover were more active, with this activity more obvious during the late active season. Average activity at burrows with high cover did not increase noticeably between the early and late active periods whereas activity at burrows with low cover was notably higher in the late active season  and outside images per hour  and the post‐hoc tests showed total images and outside images differed significantly between day (when ratjaku were least active) and dusk (when ratjaku were most active) . raTjaku were moderately active at dawn and night, but activity  was highly variable at these times and did not differ significantly from dusk or day  = 7.183, T (day/dusk) = 8.004, T (night/dusk) = 8.862, p < .05).Time of day significantly affected total images per hour , with most activity detected at entrances with less cover , the proportion of time spent outside was positively correlated with vegetation cover  was strongly negatively correlated with vegetation cover , approximately 350 km north of Uluru, based on predator scat contents and the volume of predator tracks near burrows , exhibit somewhat comparable behaviour, spending less time foraging and basking in burnt areas , when ratjaku appear to be most active and burrows are most visible due to accumulated activity over the active season. Activity commences in spring, around September or October, and in the Newhaven population mating activity has been recorded in September with females giving birth approximately 10 or 11 weeks later  appears to rely on direct line of sight to forage effectively from burrow entrances  and motion triggered settings for similar studies in the future, as this would provide further opportunity to record mammalian and avian predators that may be active in the vicinity of the burrows.Our study demonstrates the value of camera trapping for monitoring the activity of ratjaku use multiple entrances within a burrow system. Based on available information, we assumed that the main burrow entrance, identified by mound size and the proximity of the latrine (scat pile), would also be the most used entrance and therefore the most useful to monitor. However, in one of the two burrows where we monitored all available entrances, the skinks were more active at other entrances. These preliminary results suggest identifying a main entrance a priori for the purpose of monitoring ratjaku activity could be unreliable. The use of burrow entrances is likely dynamic through time and may vary among individuals and depending on what the ratjaku is doing. For example, Slater's skinks, also obligate burrow dwellers and closely related to ratjaku, spend most of their time basking at a preferred (main) entrance of their burrows and use other entrances, which‐ever is in closest proximity, when returning from feeding or if the preferred entrance becomes shaded ; data curation (lead); formal analysis (lead); investigation (lead); methodology ; project administration (supporting); writing – original draft (lead); writing – review and editing . Christine A. Schlesinger: Conceptualization ; formal analysis (supporting); methodology ; project administration (lead); supervision (lead); writing – original draft (supporting); writing – review and editing .There was no external funding for this research. The research was supported financially by Charles Darwin University, including Honours student funding allocation.The authors declare no conflict of interest.


Acute‐on‐chronic liver failure (ACLF), as per the European Association for the Study of the Liver (EASL), is a syndrome that develops in patients with acute decompensation of cirrhosis (AD) which is characterised by severe systemic inflammation, immune dysfunction, organ failures and high short‐term mortality. According to the number of organ failures and dysfunction, defined with specific thresholds for each organ system , patients are categorised into distinct ACLF grades of increasing severity. Hence, ACLF grade 1 corresponds to a patient with a single kidney failure or a non‐kidney failure with kidney or brain dysfunction), grade 2 is characterised by two organ failures and grade 3 is marked by three organ failures or more. In patients with severe course of ACLF, belonging to grades 2 and 3, the 3‐month mortality escalates to a range of 70% to more than 90%.United European Gastroenterology Journal, Zanetto et al. introduced the Padua model 2.0 that identifies patients with AD at a high risk of developing ACLF.In this issue of the PSP's superiority in predicting ACLF development likely stems from its specificity to bacterial infection. PSP is released from CD14 during inflammatory responses, where CD14 and its co‐receptor toll‐like receptor 4 (TLR4) on macrophages and monocytes recognise bacterial endotoxin. This specificity probably makes PSP a more accurate predictor of ACLF compared to the hepatically produced acute‐phase protein, CRP.While PSP results from monocyte‐related inflammation, it is interesting that the latter has been investigated as a potential novel therapy for ACLF. Indeed, in an interplay between lipid metabolism and circulating immunity, dysregulation of the lysophosphatidylcholine and lysophosphatidic acid in ACLF leads to a proinflammatory monocyte phenotype and participates in the immune dysfunction that characterised the syndrome.The aim of predicting patients who will develop ACLF is that there would be earlier implementation of interventions that improve survival. In this study, the median time from AD to the onset of ACLF was 66 days leaving enough time to treat and prevent any infections or other precipitants but also, in the promising field of therapeutical approaches to prevent and treat ACLF, to refer patients to clinical trials investigating potential disease‐modifying therapies.These patients could also certainly be referred earlier for a liver transplant assessment but without developing ACLF, they would not receive priority for transplantation under current European transplant listing policies due to MELD not reaching the threshold of the median MELD at transplant. However, placing such patients on waiting lists before its occurrence is probably one of the best ways to secure access to LT during ACLF. A European multi‐centre study has indeed demonstrated that 100% of patients listed before ACLF occurrence were finally transplanted as opposed to 71% of patients listed during the ACLF episode.In summary, both Padua and Padua 2.0 models are accurate predictive models for identifying patients with AD at high risk of developing ACLF. While both need to be validated in external cohorts, their potential and critical benefits include earlier referral to transplant centres and recruitment in future clinical trials, which should focus on the development of preventative therapies for this group of patients.The authors declare no conflicts of interest related to this work.NIHR; EASL Joan Rodes Fellowship.


Eumaeus butterflies are obligate herbivores of Zamia, the most diverse neotropical genus of cycads. Eumaeus–Zamia interactions have been characterized mainly for species distributed in North and Central America. However, larval host plant use by the southern Eumaeus clade remains largely unknown, precluding a comprehensive study of co‐evolution between the genera. Here, we combine fieldwork with museum and literature surveys to expand herbivory records for Eumaeus from 21 to 38 Zamia species. We inferred a time‐calibrated phylogeny of Eumaeus to test for distinct macroevolutionary scenarios of larval host plant conservatism and co‐evolution. We found a remarkable coincidence between Eumaeus and Zamia diversification, with the butterfly stem group diverging at the same time as the most recent radiation of Zamia in the Miocene. Cophylogenetic reconciliation analyses show a strong cophylogenetic signal between cycads and their butterfly herbivores. Bipartite model‐based approaches indicate that this is because closely related Zamia species are used by the same Eumaeus species, suggesting larval host plant resource tracking by the butterfly herbivores. Our results highlight a case of tight evolution between Eumaeus butterflies and cycads, pointing to the generality of correlated evolution and phylogenetic tracking in plant–herbivore interactions across seed plants. Eumaeus herbivorous butterflies and cycads, pointing to the generality of correlated evolution and phylogenetic tracking in plant–herbivore interactions across seed plants.A case of tight evolution between  Specimens were stored in glassine envelopes and deposited in the Biological collection of CES University  and the Entomological collection of the University of Antioquia  biological collections for later identification. Larvae were collected manually on Zamia leaves and stored in 70% Ethanol or reared ex situ up to the adult stage for identification. Larval host plant species and geographical coordinates were recorded in the field upon collection.In each of the localities, adult 2.2Eumaeus specimens held in the main entomological collections in Colombia, including those at the CES University (CBUCES), the University of Antioquia (CEUA), the Francisco Luis Gallego Entomological Museum at the National University of Colombia in Medellín (MEFLG), the Natural History Museum at the National University of Colombia (ICN‐L), and the Alexander von Humboldt Biological Resources Research Institute (IAvH‐E). We also surveyed the Smithsonian National Museum of Natural History (USNM) in Washington, US; Museum of Natural History (MUSM) in Lima, Peru and the British Museum of Natural History (NHM) in London, UK.We surveyed Eumaeus taken on Zamia leaves during field trips by the Colombian Cycad Society, an academic NGO dedicated to cycad research and conservation. Most of these photographs were of either the adult or larval stages, meaning we could reliably identify the Eumaeus species as well as its larval host plant. We also checked and compiled records of adult Eumaeus from online biodiversity databases , using the R package phyr . The second describes the pattern in which a butterfly species is more likely to use a set of closely related host plants (covariance matrix g). The third describes the pattern in which closely related butterflies are more likely to use closely related host plants (covariance matrix h). The significance of these phylogenetic effects can be tested by dropping them and applying likelihood ratio tests (LTRs). The covariance matrices c and g are nested components of covariance matrices h. Therefore, we tested the significance of h by dropping it from a complete model including all terms (c + g + h), but c and g were tested by dropping them from a reduced model which did not contain the other two terms. Of the 36 species of Zamia recorded as larval host plants of Eumaeus, 33 were used in the phylogenetic analysis; the remaining species were not included in the available phylogeny  in APE  was set to a = 6, b = 2. The clock was set to independent rates (2), the tree prior to birth‐death, and the rate prior to lognormal. Due to the large size of the genomic dataset, we ran the concatenated alignment under the F84 substitution model, but to allow for dynamic partitioning we included gamma with five rate parameters. To test that the priors were adequate, we first ran an analysis without computing the likelihood (usedata = 0), followed by three independent runs to ensure convergence.As testing for co‐evolution entails accounting for the topology as well as the diversification timing of the interacting groups, we used the most recent time‐calibrated molecular phylogeny of s et al. . This ind et al.  and Valed et al. . The rem33.1Eumaeus godartii feeding on Zamia chigua and Z. amplifolia  E. toxana occurs in the Amazon Basin from Obidos to the Andes and from Venezuela/Colombia to Mato Grosso, Brazil.After reviewing museum specimens and online data sources and coupling them with our field data, we were able to create a significantly improved continental‐scale distribution map of a Figure . We expaa Figure . We alsoa Figure ; (2) E. 3.2Eumaeus butterflies show remarkably strong host plant preferences , but we did not find a similar effect of butterfly phylogeny  is remarkably similar to that of Eumaeus  crown diversification in the Miocene. Notably, the most diverse clade of Zamia, the Mainland clade, evolved  synchronously with the core Eumaeus clade , which comprises all Eumaeus species except by E. childrenae. Similarly, the divergence of the Mesoamerica clade of Zamia  coincides with the split between Caribbean E. atala and mesoamerican E. toxea .We found striking contemporaneity between n Figure . Althoug4Eumaeus butterflies and their host plant species of Zamia provide strong evidence of cophylogenetic signal between these clades. In addition, we found striking temporal overlap between the divergence times of the major Zamia and Eumaeus clades, further supporting a pattern of correlated evolution. We then dissected the pattern of phylogenetic congruence using mixed models and showed that the cophylogenetic signal is likely driven by phylogenetic tracking. This work represents a step toward a better understanding of the evolution of a recent yet specialized plant–herbivore interaction for one of the most ancient and endangered plant lineages.We present the first quantitative study of correlated phylogenies between interacting partners for a group of cycads and their insect herbivores. Our analyses of interactions between Asclepias (Apocynaceae), both cardenolides and glucosinolates in Erysimum (Brassicaceae) or furanocoumarins in Umbelliferae .Despite significant biogeographic correlations, the distributions and phylogeny of Zamia and Eumaeus interactions, host plants seem to exert stronger selection on their herbivores than the other way around. This asymmetry in selection is substantiated by previous work, showing that Eumaeus herbivory has little impact on cycad natural populations ; data curation ; formal analysis ; investigation (lead); methodology ; visualization (lead); writing – original draft (lead); writing – review and editing (lead). Michael Calonje: Data curation ; writing – review and editing . Robert K. Robbins: Data curation ; writing – review and editing . Neil Rosser: Conceptualization (supporting); formal analysis ; software (lead); writing – review and editing (lead). Naomi E. Pierce: Funding acquisition ; resources ; writing – review and editing . Cristina López‐Gallego: Conceptualization ; funding acquisition ; investigation ; methodology ; project administration (lead); resources ; supervision (lead); writing – review and editing . Wendy A. Valencia‐Montoya: Conceptualization (lead); formal analysis ; funding acquisition ; investigation ; methodology ; project administration (lead); resources ; supervision (lead); visualization ; writing – original draft (lead); writing – review and editing (lead).The authors declare no conflict of interest.Data S1Click here for additional data file.


Commercial patch test substances do not cover all occupational contact allergens. Workplace materials and in‐house test substances are tested to complement the investigation of occupational skin disease (OSD).To quantify the additional value of testing workplace materials and non‐commercial in‐house test substances in the diagnosis of OSD.Patients files of 544 patients patch tested at the Finnish Institute of Occupational Health in 2015–2019 were reviewed for occupation, diagnoses and patch test results.OSD was diagnosed in 353 (64.9%) of the patients. A total of 206 (37.9%) patients had occupational allergic contact dermatitis (OACD). In 19 (3.5%) patients, the only clues to the diagnoses of OACD were positive reactions to workplace materials, and in 20 (3.7%) patients, the diagnosis of OACD was based on commercially unavailable test substances. In 167 OACD cases diagnosed by commercial test substances, additional causes were found in 17 by testing patients' own and non‐commercial test substances. In 43 (7.9%) cases, positive reactions to workplace materials reinforced diagnoses based on commercial test substances. The overall additive value of testing own products was 16.7% (91 cases).We would have missed 39 (18.9%) of our 206 OACD cases if we had solely used commercial test substances. At the Finnish institute of Occupational Health in 2015–2019, we would have missed 39 (18.9%) of our 206 cases of OACD if we had solely used commercial test substances. Products from the workplace are also often tested. In an Australian study, the additive value of patients' own products was 5.2%: in 1.3% of the investigated 1523 cases, a positive reaction to patients' own samples was the only clue for detecting the responsible allergen, and in 3.9% of the patients, testing with their own samples reinforced their reactions to commercial allergens.At the Finnish Institute of Occupational Health (FIOH), in addition to regular testing with patients' own products, we also prepare in‐house test substances of chemicals that are not available as commercial allergens and include them in our routine test series.The aim of this study was to quantify the additional value of testing the non‐commercial test substances and patients' own products in the diagnosis of occupational skin disease (OSD) and more closely OACD.2FIOH has a clinic of occupational dermatology. All our patients have a suspected OSD. We perform patch tests using Finn Chambers (SmartPractice), in accordance with the European Society of Contact Dermatitis guidelines.A diagnosis of an OACD requires shown exposure to the patch‐test‐positive allergen at the time of the dermatitis investigated, and the mode of exposure must be consistent with the location of the dermatitis.If a patch‐test‐positive workplace product does not contain any chemical that the patient is allergic to, we try to get the components of the product for a new patch test. If we manage to identify the culprit chemical by the second patch test, we often add this compound to a suitable routine patch test series and start to screen it in patients with similar exposure.If we cannot identify the causative allergen in a patch‐test‐positive workplace product, we routinely perform patch tests in five control patients before a diagnosis of OACD. When the culprit allergen remains unidentified, the diagnosis is less solid than in cases that are solved to the allergen level. Most new allergens discovered at FIOH have been reported, and in these cases, we usually perform at least 20 tests in control patients.OACD patients diagnosed by patch testing their own materials.OACD patients diagnosed with in‐house test substances that were commercially unavailable at the time of the investigations at the FIOH.OACD patient diagnosed with patch test substances that were commercially available at the time of the investigations at the FIOH and not included in Groups i and ii.The study material comprises all cases patch tested with the baseline series in a period of 5 years 2015–2019. We collected data on occupation and diagnosis from the patient files. Only patients diagnosed with OACD were further analysed. They were divided in three groups:m‐xylylenediamine)We also prepare in‐house test substances  ‘overall additive value’ of patch testing with patients' own products. The corresponding absolute figures in our material were quite similar , but the proportions were around triple‐fold due to the almost three‐fold total number of investigated patients in the Australian study.In the previous literature, there is a report from an Australian clinic of occupational dermatology by Slodownik et al.A recent German study assessed the value of patch testing with workplace materials in occupational dermatitis patients.In the German study,The additive value probably depends on the patient material (proportion of OACD patients) and the extent of patch testing of patients' own materials. It also depends on how well the culprit products are identified and selected for patch testing, a task that can be very challenging, if the number of products is large. Moreover, not all products are ideal for patch testing, and they may require special techniques such as ultrasonic extracts. Positive reactions to workplace materials are more common in strongly sensitized patients.The occupational dermatology unit of the FIOH is a special clinic with expertise on patch testing patients' workplace materials. That is why we receive patients who have handled sensitizing chemical products at work. Our patient material is very selected and might differ from that of other centres.Laboratory technicians and workers in the pharmaceutical industry are often exposed to chemicals that are not included in commercial patch test series. Commercial plant allergen preparations are also scarce, and own plants need to be tested in florists and gardeners.We consider protective gloves as problematic products: Although we have identified several allergens in PVC glovesN‐(2‐phenylethyl) derivativesDiagnosing OACD due to synthetic resins and their hardeners has been relatively straightforward: manufactures have usually co‐operated by sending components of their products for patch testing. Two new epoxy hardeners, 1,3‐benzenedimethanamine, 5We would have missed 39 (18.9%) of the 206 OACD diagnoses if we had confined our patch testing to commercial patch test substances. In 16 (7.8%) other cases, testing with workplace materials and in‐house test substances yielded additional causes for OACD. In further 43 (20.9%) cases, positive reactions to workplace materials reinforced the diagnosis of OACD made by testing commercial test substances. Thus, in a total of 98 (47.6%) cases of OACD, the diagnostic workup was aided by testing workplace materials and non‐commercial in‐house test substances.Kristiina Aalto‐Korte: Conceptualization; investigation; writing – original draft; data curation; visualization; methodology. Maria Pesonen: Writing – review and editing.The authors declare no conflict of interest.


Response to Letter to the EditorWe appreciate the comments from Drs. Kataoka and Imamura in their Letter to the Editor regarding our recent publication Factors Associated with Oral Anticoagulant Prescription Status Among Patients with a New Diagnosis of Atrial Fibrillation. In this manuscript, we identified patients with newly diagnosed atrial fibrillation and described patient‐level factors associated with anticoagulant prescription status in the first 6 months following diagnosis.2DS2‐VASc score, and pharmacy records that were validated by physician chart review as well as to avoid any confounding as a result of the COVID‐19 pandemic. The primary intent of our work was to explore factors associated with prescription of any appropriate oral anticoagulant (OAC) following a new diagnosis of atrial fibrillation. Trends of direct OAC (DOAC) versus vitamin K antagonist prescriptions following US Food and Drug Administration (FDA) approval of DOACs have been well described, indicating an uptick in the United States in 2012 following initial FDA approval in 2010.The study period of 2013–2018 was selected to utilize electronic health record administrative data, CHA2DS2‐VASc score ≥2 based on the established guidelines for anticoagulation in atrial fibrillation during the study period.2DS2‐VASc scores from a subgroup analysis confirmed with chart review is provided in Figure 2DS2‐VASc score in our study was 3.94 among those who received anticoagulation and 3.73 among those who did not receive anticoagulation. These scores were not statistically significant, suggesting that rates of timely OAC prescriptions were not driven by differential CHA2DS2‐VASc scores. Rates of OAC prescription in our study are also consistent with other work across the same time period, suggesting timely OAC prescription rates did not eclipse 50% even among patients with the highest CHA2DS2‐VASc scores. This further indicates that the magnitude of the CHA2DS2‐VASc score may not significantly impact the timeliness of OAC prescription.2DS2‐VASc score was lower in that study (2.8) than in our work.We focused our evaluation on patients with a CHAIn response to the third comment regarding our finding of an inverse relationship of antiarrhythmic drug prescriptions and OAC prescriptions, we appreciate that the letter writers agree with our hypothesis that this association could be due to an incorrect practice habit in terms of rate versus rhythm control, which we highlighted in our discussion of the findings.Finally, data regarding the prevalence of left atrial appendage occlusion (LAAO) devices across our cohort was not available and outside the scope of our work. However, we expect the number of patients with LAAO devices in our cohort to be small and unlikely to explain the low OAC prescription rates. Currently, given payor guidelines, LAAO is most commonly reserved for patients who demonstrate recurrent failure of therapeutic anticoagulation which only rarely occurs during the first 6 months after atrial fibrillation diagnosis. During a similar time period, one study determined that the average of time between atrial fibrillation diagnosis and LAAO was 5.9 years and even in the PROTECT AF study, which specifically randomized patients for LAAO versus warfarin, the percentage of patients who received LAAO within 1 year of AF diagnosis was 14.9%.The authors declare no conflict of interest.This study was approved by the Colorado Multiple Institution Review Board under COMIRB protocol number 18‐2328. Subjects used in this research provided informed consent before the start of study activities.