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© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.BACKGROUND Urological surgical trainees who underperform are difficult to identify, manage and require significant resources in an already stretched system relying on pro bono supervisors that often have no formal training. While there are commentaries on how to manage underperforming surgical trainees, there is a lack of data detailing the complex reasons for underperformance. It is important to understand the complexities contributing to underperformance so that improved remediation plans can be developed which can better help trainees meet expectations and succeed. METHODS In this qualitative study, individual semi-structured interviews were conducted with key persons identified as having very high levels of background knowledge and involvement with current underperforming urological surgery trainees. Transcribed interviews were thematically analysed. RESULTS Ten interviews were conducted, including nine urology consultants and one educational manager. Five themes were identified underperformance is a small but profound issue; spiral of failure; the changing trainee; lack of insight and under supported supervisors and posts. CONCLUSION Causes of underperformance in urology trainees are complex and multifactorial. Behavioural issues were considered the most likely cause, which are also the most challenging to remedy. Guanosine 5'-monophosphate cost However, in addition to trainee factors, causative factors related to supervision and training were identified. Addressing all of these issues is paramount if effective remediation of these trainees is to occur. © 2020 Royal Australasian College of Surgeons.The prevalence of elevated blood pressure (BP) among US children and adolescents has reportedly declined over the past decade. As no Korean data have been analyzed, we aimed to determine recent trends in BP levels among Korean children and adolescents. This study examines data from the Korea National Health and Nutrition Examination Survey segregated into 3 time periods (2007-2009, 2010-2012, and 2013-2015). A total of 7804 Korean children and adolescents aged 10-18 years were included in the analysis. Hypertension (≥95th percentile) and elevated BP (>90th percentile) were defined using the sex-, age-, and height-specific BP standards from 2017 American Academy of Pediatrics guidelines. Mean systolic BP from 2007-2009 to 2013-2015 increased by 3.9 mm Hg, and there was no significant change in diastolic BP. Body mass index (BMI) z-scores significantly increased in the total population from 2007-2009 to 2013-2015. In 2013-2015, the prevalence rates of elevated BP and hypertension were 8.8% and 9.0%, respectively. The prevalence of hypertension in 2013-2015 increased in the total population compared with those in 2007-2009, especially in the obese subgroup, in which the hypertension prevalence was 27.7% in 2013-2015. The prevalence of elevated BP increased during these time period. Associated factors were sex, age, BMI z-score, and survey period for elevated BP; and sex, age, and BMI z-score for hypertension. During our study, mean systolic BP increased, and the prevalence of hypertension in 2013-2015 increased in the pediatric population. A possible influencing factor is obesity, and further long-term data are necessary. © 2020 Wiley Periodicals, Inc.Few topics in geobiology have been as extensively debated as the role of Earth's oxygenation in controlling when and why animals emerged and diversified. All currently described animals require oxygen for at least a portion of their life cycle. Therefore, the transition to an oxygenated planet was a prerequisite for the emergence of animals. Yet, our understanding of Earth's oxygenation and the environmental requirements of animal habitability and ecological success is currently limited; estimates for the timing of the appearance of environments sufficiently oxygenated to support ecologically stable populations of animals span a wide range, from billions of years to only a few million years before animals appear in the fossil record. In this light, the extent to which oxygen played an important role in controlling when animals appeared remains a topic of debate. When animals originated and when they diversified are separate questions, meaning either one or both of these phenomena could have been decoupled from oxygenation. Here, we present views from across this interpretive spectrum-in a point-counterpoint format-regarding crucial aspects of the potential links between animals and surface oxygen levels. We highlight areas where the standard discourse on this topic requires a change of course and note that several traditional arguments in this "life versus environment" debate are poorly founded. We also identify a clear need for basic research across a range of fields to disentangle the relationships between oxygen availability and emergence and diversification of animal life. © 2020 John Wiley & Sons Ltd.BACKGROUND Infective endocarditis (IE) of the mitral valve is an illness associated with significant morbidity and mortality. We describe the long-term outcomes of mitral valve endocarditis at a single centre. METHODS All patients who presented with IE to the study institution between 2000 and 2015 were included. Data were obtained by retrospective review of the medical records. RESULTS There were 163 patients who presented with mitral valve IE. Mean age was 58 ± 16.8 years. A history of intravenous drug use was present in 18% (30/163) of patients. The most common infective agents were Staphylococcus aureus in 42% (69/163) (7% (5/69) were methicillin resistant), viridans Streptococus species in 15% (25/163) and Enterococcus faecalis in 10% (17/163). Surgery was performed in 29% (47/163) of patients. Hospital mortality was 23% (38/163). Survival was 71% (95% confidence interval (CI) 63.1-77.6%) at 1 year, 56% (95% CI 46.0-64.9%) at 5 years and 44% (95% CI 36.4-59.7%) at 10 years follow-up. There was no survival difference between medical and surgical management (P = 0.55). On multivariate Cox regression analysis, need for renal replacement therapy (P = 0.003) and increasing age (P = 0.014) were found to be risk factors while infectious diseases consult during index admission (P = 0.007) was found to be protective. CONCLUSION Mitral valve endocarditis is associated with survival of less then 50% at 10 years follow-up. Surgical and medical management were associated with similar outcomes. Increasing age and need for renal replacement therapy were associated with mortality, and infectious diseases consultation was associated with improved survival. © 2020 Royal Australasian College of Surgeons.