Climate change fluctuations can increase population abundance and range size.

Climate change threatens many species by a poleward/upward movement of their thermal niche. While we know that faster movement has stronger impacts, little is known on how fluctuations of niche movement affect population outcomes. Environmental fluctuations often affect populations negatively, but theory and experiments have revealed some positive effects. We study how fluctuations around the average speed of the niche impact a species' persistence, abundance and realized niche width under climate change. We find that the outcome depends on how fluctuations manifest and what the relative time scale of population growth and climate fluctuations are. When populations are close to extinction with the average speed, fluctuations around this average accelerate population decline. However, populations not yet close to extinction can increase in abundance and/or realized niche width from such fluctuations. Long-lived species increase more when their niche size remains constant, short-lived species increase more when their niche size varies.

Evaluating the multiple sulfur isotope signature of Eoarchean rocks from the Isua Supracrustal Belt (Southwest-Greenland) by MC-ICP-MS: Volcanic nutrient sources for early life.

On the anoxic Archean Earth, prior to the onset of oxidative weathering, electron acceptors were relatively scarce, perhaps limiting microbial productivity. An important metabolite may have been sulfate produced during the photolysis of volcanogenic SO2 gas. Multiple sulfur isotope data can be used to track this sulfur source, and indeed this record indicates SO2 photolysis dating back to at least 3.7 Ga, that is, as far back as proposed evidence of life on Earth. However, measurements of multiple sulfur isotopes in some key strata from that time can be challenging due to low sulfur concentrations. Some studies have overcome this challenge with NanoSIMS or optimized gas-source mass spectrometry techniques, but those instruments are not readily accessible. Here, we applied an aqua regia leaching protocol to extract small amounts of sulfur from whole rocks for analyses of multiple sulfur isotopes by multi-collector inductively coupled plasma mass spectrometry (MC-ICP-MS). Measurements of standards and replicates demonstrate good precision and accuracy. We applied this technique to meta-sedimentary rocks with putative biosignatures from the Eoarchean Isua Supracrustal Belt (ISB, >3.7 Ga) and found positive ∆33S (1.40-1.80‰) in four meta-turbidites and negative ∆33S (-0.80‰ and -0.66‰) in two meta-carbonates. Two meta-basalts do not display significant mass-independent fractionation (MIF, -0.01‰ and 0.16‰). In situ Re-Os dating on a molybdenite vein hosted in the meta-turbidites identifies an early ca. 3.7 Ga hydrothermal phase, and in situ Rb-Sr dating of micas in the meta-carbonates suggests metamorphism affected the rocks at ca. 2.2 and 1.7 Ga. We discuss alteration mechanisms and conclude that there is most likely a primary MIF-bearing phase in these meta-sediments. Our new method is therefore a useful addition to the geochemical toolbox, and it confirms that organisms at that time, if present, may indeed have been fed by volcanic nutrients.

The gastrointestinal antibiotic resistome in pediatric leukemia and lymphoma patients.

Introduction: Most children with leukemia and lymphoma experience febrile neutropenia. These are treated with empiric antibiotics that include ß-lactams and/or vancomycin. These are often administered for extended periods, and the effect on the resistome is unknown. Methods: We examined the impact of repeated courses and duration of antibiotic use on the resistome of 39 pediatric leukemia and lymphoma patients. Shotgun metagenome sequences from 127 stool samples of pediatric oncology patients were examined for abundance of antibiotic resistance genes (ARGs) in each sample. Abundances were grouped by repeated courses (no antibiotics, 1-2 courses, 3+ courses) and duration (no use, short duration, long and/or mixed durationg) of ß-lactams, vancomycin and "any antibiotic" use. We assessed changes in both taxonomic composition and prevalence of ARGs among these groups. Results: We found that Bacteroidetes taxa and ß-lactam resistance genes decreased, while opportunistic Firmicutes and Proteobacteria taxa, along with multidrug resistance genes, increased with repeated courses and/or duration of antibiotics. Efflux pump related genes predominated (92%) among the increased multidrug genes. While we found ß-lactam ARGs present in the resistome, the taxa that appear to contain them were kept in check by antibiotic treatment. Multidrug ARGs, mostly efflux pumps or regulators of efflux pump genes, were associated with opportunistic pathogens, and both increased in the resistome with repeated antibiotic use and/or increased duration. Conclusions: Given the strong association between opportunistic pathogens and multidrug-related efflux pumps, we suggest that drug efflux capacity might allow the opportunistic pathogens to persist or increase despite repeated courses and/or duration of antibiotics. While drug efflux is the most direct explanation, other mechanisms that enhance the ability of opportunistic pathogens to handle environmental stress, or other aspects of the treatment environment, could also contribute to their ability to flourish within the gut during treatment. Persistence of opportunistic pathogens in an already dysbiotic and weakened gastrointestinal tract could increase the likelihood of life-threatening blood borne infections. Of the 39 patients, 59% experienced at least one gastrointestinal or blood infection and 60% of bacteremia's were bacteria found in stool samples. Antimicrobial stewardship and appropriate use and duration of antibiotics could help reduce morbidity and mortality in this vulnerable population.

Audiologists' perspective on the treatment of ear-related ear, nose, and throat conditions in rural Victoria.

OBJECTIVES: To understand the experience of audiologists in managing and treating ear-related ear, nose and throat conditions in rural areas, and to identify the compounding factors that influence patient outcomes and potential targets for intervention. DESIGN: A focus group was conducted using a qualitative descriptive approach. Responses were audio-recorded, transcribed and thematically analysed. SETTING: The focus group was conducted in the rural town of Mildura in the state of Victoria, Australia. PARTICIPANTS: A sample of 19 audiologists from Victoria participated, of which 14 were rurally based and 5 were metropolitan-based. The length of participants' professional experience ranged from 1 to 43 years. RESULTS: Long wait lists, and a lack of locally based ear, nose and throat surgeons were identified as barriers to the treatment of ear-related ear, nose and throat conditions. Open communication between health services and efficient care for time-sensitive conditions were seen as outcomes of good practice. Hand hygiene, nose-blowing, reducing tobacco smoke exposure and promoting the use of noise protective equipment were the 4 community health campaigns mentioned to support ear care for those residing in rural areas. Additional themes of ear conditions, treatment, management and primary health care were identified. CONCLUSION: Improving referral pathways for the treatment of ear-related ear, nose and throat conditions, and providing education about ear, nose and throat assessment and treatment in primary health care settings could increase appropriate referrals, improve patient outcomes and reduce wait periods for treatment.

Moving-habitat models: A numerical approach.

As the global climate changes, biological populations have to adapt in place or move in space to stay within their preferred temperature regime. Empirical evidence suggests that shifting speeds of temperature isoclines are location and elevation dependent and may accelerate over time. We present a mathematical tool to study transient behaviour of population dynamics within such moving habitats to discern between populations at high and low risk of extinction. We introduce a system of reaction-diffusion equations to study the impact of varying shifting speeds on the persistence and distribution of a single species. Our model includes habitat dependent movement behaviour and habitat preference of individuals. These assumptions result in a jump in density across habitat types and generalize previous studies. We build and validate a numerical finite difference scheme to solve the resulting equations. Our numerical scheme uses a coordinate system where the location of the moving suitable habitat is fixed in space and a modification of a finite difference scheme to capture the jump in density. We explore a variety of shifting-speed scenarios and contribute insights into the mechanisms that support population persistence through time in shifting habitats. One common finding is that a strong bias for the suitable habitat helps the population persist at faster shifting speeds, yet sustains a smaller total population at slower shifting speeds.

Individual behavior at habitat edges may help populations persist in moving habitats.

Moving-habitat models aim to characterize conditions for population persistence under climate-change scenarios. Existing models do not incorporate individual-level movement behavior near habitat edges. These small-scale details have recently been shown to be crucially important for large-scale predictions of population spread and persistence in patchy landscapes. In this work, we extend previous moving-habitat models by including individual movement behavior. Our analysis shows that populations might be able to persist under faster climate change than previous models predicted. We also find that movement behavior at the trailing edge of the climatic niche is much more important for population persistence than at the leading edge.

Articulating nurse practitioner practice using King's theory of goal attainment.

PURPOSE: To further understand the interactions between nurse practitioners (NPs) and patients, King's nursing theory of goal attainment was applied as the conceptual framework to describe the interactions between NPs and patients in the primary care setting. DATA SOURCES: Six dyads of NPs and their patients were video- and audio-taped over three consecutive clinic visits. For the purposes of this arm of the study, the audio-taped interactions were transcribed and then coded using King's concepts in her theory of goal attainment. CONCLUSIONS: King's theory was applicable to describe NP practice. King's concepts and processes of nurse-patient interactions, such as disturbances, mutual goal setting, and transactions, were observed in NP-patient interactions. IMPLICATIONS FOR PRACTICE: Disturbances during clinical encounters were essential in the progression toward goal attainment. Elements, such as social exchange, symptom reporting, role explanation, and information around clinical processes facilitated relationship building. NPs as practitioners need to be reflective of their own practice, embrace disturbances in the clinical encounter, and attend to these as opportunities for mutual goal setting.

Implementing arthritis clinical practice guidelines in primary care.

BACKGROUND: Multi-faceted interventions are among the strongest methods for changing provider behavior. AIMS: This paper reports the design, implementation and process evaluation of an educational program to disseminate clinical practice guidelines (CPGs) on the management of rheumatoid arthritis (RA) and osteoarthritis (OA) in primary care. METHODS: Organizations were invited to participate in inter-professional workshops on OA and RA followed by six months of activities to support the delivery of care in the community. Confidence in ability to manage arthritis was assessed at baseline using a 10 point numerical rating scale. Qualitative assessments were done immediately and 3-12 months post workshop. RESULTS: 646 multidisciplinary providers from 216 organizations attended one of 30 workshops. Providers (n = 584) reported moderate confidence in managing arthritis: family physicians: mean: SD = 7.46(1.42), n = 145; nurse practitioners: 6.10(1.84), n = 73; other health care professionals: 5.23(2.83), n = 389. Participants identified team learning, the opportunity to network and the involvement of trained patient educators as strong features of the workshops. At follow-up, participants indicated the greatest impact of the program was on collaborative care (83%) and patient self-management (79%). CONCLUSIONS: Qualitative results suggest that inter-professional learning may be a successful strategy for improving the delivery of collaborative arthritis care and supporting patient self-management.

An outbreak of infectious syphilis in Wellington, New Zealand.

AIMS: To estimate the incidence of infectious syphilis in the Wellington region between 2004 and 2006, and to characterise those with infectious syphilis, in terms of demographic and risk factors, in order to inform control of the disease. METHODS: Based on information from regional laboratories, a questionnaire was sent to the requesting clinician for all individuals with positive syphilis serology between January 2004 and December 2005. The questionnaire was also used for cases of infectious syphilis seen at regional sexual health clinics in 2006. All information was recorded anonymously. RESULTS: 120 questionnaires were returned (67%), and 15 cases of infectious syphilis were identified (5 in 2004, 10 in 2005), including 3 cases not known to the sexual health clinics and hence not reported to the Institute of Environmental & Scientific Research (ESR). Another 15 cases of infectious syphilis were identified from sexual health clinic records in 2006 up to October. These 30 cases of infectious syphilis were predominantly men who have sex with men (MSM) (80%), and mainly born in New Zealand (83%). Few cases reported recent sex overseas, indicating local transmission, and anonymous partners were common. The annual incidence (per 100,000 population) of infectious syphilis is estimated at 1.3 in 2004, 2.6 in 2005, and 5.9 in 2006. CONCLUSION: Wellington is experiencing an outbreak of infectious syphilis, principally amongst MSM, but with crossover into the heterosexual community. Efforts are being made to control this outbreak through education of clinicians, partner notification, and offering screening and education in non-medical settings to at risk groups. We call on the Ministry of Health to enhance syphilis surveillance as a matter of urgency.

Prevalence and risk factors for Chlamydia trachomatis infection in female New Zealand university students.

AIMS: To measure the prevalence of urogenital Chlamydia trachomatis infection in a sample of sexually active female university students, to identify risk factors associated with infection, and to measure the uptake of screening. METHODS: Female students aged 18-25 years, presenting to a university student health service from March to October 2003, were invited to participate. Information on demographic details and sexual behaviour was collected with a self-completed questionnaire. The students were tested for Chlamydia infection using the Roche Amplicor CT/NG PCR test of first void urine specimens. RESULTS: Chlamydia prevalence was 2.7% (19/715). Infection was associated with previous sexually transmitted infection (STI), non-European ethnicity, and irregular use of condoms. Most participants were not using condoms regularly despite the risk of STI. Screening was technically straightforward and the participation rate was 59.9% (718/1199). CONCLUSIONS: New Zealand needs to develop and implement an adequately resourced and evidence-based Chlamydia control strategy. This strategy should contain national guidelines on screening in a range of settings, including universities, as well as strategies for primary prevention of Chlamydia and other STI. Clinicians treating university-aged students should consider opportunistic Chlamydia screening for all of those who are sexually active. Further research, preferably in conjunction with intervention studies, is essential to assess the prevalence of Chlamydia in other populations.

Rates of Chlamydia trachomatis testing and chlamydial infection in pregnant women.

AIMS: To determine the rate of Chlamydia trachomatis testing and chlamydial infection in pregnancy (by auditing a community medical laboratory database). METHODS: Data for women registered with a maternity care provider between 1999 and 2002 were matched with a community medical laboratory database for patients who met one of three criteria: tested for C. trachomatis, or had a first or second antenatal blood screen at that laboratory. The rate of C. trachomatis testing and of chlamydial infection was then calculated in this sample. RESULTS: The overall rate of C. trachomatis testing for 6614 matched deliveries was 37.5%, with 4.8% of those tests positive for chlamydial infection. The rate of testing differed significantly between age-bands (p<0.0001), and by ethnicity (p<0.0001). The rate of infection showed a significant effect of age (p<0.0001) and ethnicity (p<0.0001). Maori and Pacific women, and those under the age of 25 years, had the highest rates--both of testing and of C. trachomatis infection. CONCLUSIONS: There is a high rate of maternal C. trachomatis in under 25-year-olds, and in Maori and Pacific women, together with incomplete testing for the infection in pregnancy. This highlights the need to instigate routine testing for C. trachomatis in pregnancy--to reduce the significant, yet preventable, morbidity associated with chlamydia in both the mother and the neonate.

Routine questioning about non-consenting sex: a survey of practice in Australasian sexual health clinics.

The objectives of the study were, 1. To ascertain if sexual health physicians and practitioners believe a question concerning a past history of non-consensual sex should be asked routinely and are asking it. 2. To identify whether sexual health services have established protocols to integrate this question into practice. 3. To identify the barriers to this becoming part of a routine sexual health history. A questionnaire covering demographics, protocols and practice around asking the question and reasons for not asking was sent to all (20) sexual health clinics in New Zealand and 7 sexual health clinics in Australia, inviting participation from all staff who took routine sexual health histories. Twenty-seven sexual health clinics participated with a total of 122 (69% response rate) questionnaires completed and returned. One hundred and thirteen (93%) participants believed it was a relevant question to ask. Seventy-eight (63%) said asking the question was encouraged, and routinely or mostly asked the question. Only 40 (33%) identified their workplace had a written policy and 52 (43%) had not received specific training in asking the question. The majority who asked routinely said their client never or rarely objected and that it did not often add significantly to the time. The main reasons for not asking were the belief it was nothing to do with the person's presenting complaint, concern the client would find it too disturbing, inadequate training, and lack of time. Sexual health clinics should develop protocols and guidelines and provide appropriate training to ensure that routine questioning about non-consenting sex is integrated into safe practice.