t-parasite relationships. Moreover, phylogenetic analyses corroborated the polyphyletic character of C. syrius, the unclear status of C. cornutus and the separate position of Cotylurus raabei Bezubik, 1958 within Cotylurus. The data demonstrate the inconsistent taxonomic status of the sequenced tetracotyle of Australapatemon, resulting, in our opinion, from the limited availability of fully reliable, comparative sequences of related taxa in GenBank. Randomised controlled trials (RCTs) are considered the 'gold standard' of medical evidence; however, recruitment can be challenging. The MACRO trial is a NIHR-funded RCT for chronic rhinosinusitis (CRS) addressing the challenge of comparing surgery, antibiotics and placebo. The embedded MACRO conversation study (MCS) used qualitative research techniques pioneered by the University of Bristol QuinteT team to explore recruitment issues during the pilot phase, to maximise recruitment in the main trial. Setting Five outpatient Ear Nose and Throat (ENT) departments recruiting for the pilot phase of the MACRO trial (ISRCTN Number 36962030, prospectively registered 17 October 2018). We conducted a thematic analysis of telephone interviews with 18 recruiters and 19 patients and 61 audio-recordings of recruitment conversations. We reviewed screening and recruitment data and mapped patient pathways at participating sites. We presented preliminary findings to individual site teams. Group discussions enabled further ecking patient understanding, had the potential to allay patient concerns. The MACRO conversation study contributed to the learning process of optimising recruitment by helping to identify and address recruitment issues. Although some issues were trial-specific, others have applicability to many clinical trial situations. Using qualitative research techniques to identify/explore barriers and facilitators to recruitment may be valuable during the pilot phase of many RCTs including those with complex designs.The MACRO conversation study contributed to the learning process of optimising recruitment by helping to identify and address recruitment issues. Although some issues were trial-specific, others have applicability to many clinical trial situations. Using qualitative research techniques to identify/explore barriers and facilitators to recruitment may be valuable during the pilot phase of many RCTs including those with complex designs. For many rare diseases, few treatments are supported by strong evidence. Patients, family members, health care providers, and policy-makers thus have to consider whether to accept, recommend, or fund treatments with uncertain clinical effectiveness. They must also consider whether and how to contribute to clinical research that may involve receiving or providing the therapy being evaluated. To understand why and how patients and families with rare metabolic diseases, specialist metabolic physicians, and health policy advisors choose whether to participate in studies and how they use and value research. We conducted separate focus group interviews with each stakeholder group (three groups in total); two groups were conducted by telephone and the third was held in-person. Participants were recruited using purposive sampling. We analyzed each interview transcript sequentially using a qualitative description approach to inductively identify key themes. Several strategies to ensure credibility and trustworth perspectives on rare disease research but share concerns about the risks versus benefits of therapies when making individual- and population-level decisions.Stakeholders differ in their perspectives on rare disease research but share concerns about the risks versus benefits of therapies when making individual- and population-level decisions. The leg muscles are important for balance, posture, and movement during static and dynamic activity. Obtaining cross-sectional area measurements (CSA) of the leg muscles helps researchers understand the health and force production capability of individual leg muscles. Therefore, having an easy to use and readily available method to assess leg muscle CSA is needed. Thus, the purpose of this study was to compare the magnitude, repeatability, and validity of CSA measurements of select leg muscles from ultrasound (US) and the current gold standard, magnetic resonance imaging (MRI). 20 healthy volunteers participated in this study. Each participant was imaged via US and MRI. The muscles of interest obtained on each participant consisted of the tibialis anterior at both 30 and 50% of the shank length, tibialis posterior at both 30 and 50% of the shank length, the flexor digitorum longus, the fibularis (peroneus) longus, and the fibularis (peroneus) brevis. Strong Pearson correlations were seen for all of the muscles when comparing US to MRI with a range from .7840 to .9676. For all measurements, standard error of the measurement ranged from .003 to 0.260 cm . Eprenetapopt price Minimum detectable difference for muscle measurements ranged from .008 cm for MRI fibularis longus and fibularis brevis to .693 cm for MRI of tibialis anterior at 30%. US minimum detectable difference ranged from .125 cm for the tibialis posterior muscle at 30% to .449 cm for the tibialis anterior muscle at 50%. Based on these results ultrasound is a valid method to obtain CSA of muscles of the leg when compared with MRI.Based on these results ultrasound is a valid method to obtain CSA of muscles of the leg when compared with MRI.Diabetes-related foot disease, particularly when associated with amputation, affects quality of life and has a significant impact on health care costs. A pilot study using enhanced technology to facilitate remote access and video conferencing from rural locations to the diabetes MDT through a new service pathway confirmed high levels of patient satisfaction with 89% of foot ulcers improved or stable and only two minor amputations. A health economic analysis suggested potential for significant cost savings if this was scaled up regionally. Further evaluation of an integrated pathway, impact on lower limb amputation rates and full health economic assessment is recommended.