Recent developments in plant-downy mildew interactions.

Downy mildews are obligate oomycete pathogens that attack a wide range of plants and can cause significant economic impacts on commercial crops and ornamental plants. Traditionally, downy mildew disease control relied on an integrated strategies, that incorporate cultural practices, deployment of resistant cultivars, crop rotation, application of contact and systemic pesticides, and biopesticides. Recent advances in genomics provided data that significantly advanced understanding of downy mildew evolution, taxonomy and classification. In addition, downy mildew genomics also revealed that these obligate oomycetes have reduced numbers of virulence factor genes in comparison to hemibiotrophic and necrotrophic oomycetes. However, downy mildews do deploy significant arrays of virulence proteins, including so-called RXLR proteins that promote virulence or are recognized as avirulence factors. Pathogenomics are being applied to downy mildew population studies to determine the genetic diversity within the downy mildew populations and manage disease by selection of appropriate varieties and management strategies. Genome editing technologies have been used to manipulate host disease susceptibility genes in different plants including grapevine and sweet basil and thereby provide new soucres of resistance genes against downy mildews. Previously, it has proved difficult to transform and manipulate downy mildews because of their obligate lifestyle. However, recent exploitation of RNA interference machinery through Host-Induced Gene Silencing (HIGS) and Spray-Induced Gene Silencing (SIGS) indicate that functional genomics in downy mildews is now possible. Altogether, these breakthrough technologies and attendant fundamental understanding will advance our ability to mitigate downy mildew diseases.

Stakeholder perspectives on co-designing a post-registration mental health nursing curriculum: A case study.

INTRODUCTION: Globally, healthcare regulatory bodies require providers of academic programs to involve service users in the design and delivery of education, yet concrete and tested directions for operationalising this are lacking. Service users' involvement in education is often passive, ad-hoc and tokenistic, with limited input at the program development level. AIM: To explore the co-design processes and outcomes of a collaborative revision of an Australian post-registration mental health nursing curriculum. METHOD: Using qualitative case study design, the experiences and collaborative practices of five stakeholders (one mental health service user, two carers and two academics) co-designing a post-registration mental health nursing curriculum were explored. RESULTS: Commonly identified barriers to meaningful involvement were overcome through planning and collaborative execution of the group's work. Participants reported a strong sense of successful collaboration in reviewing the curriculum, trusting relationships and mutual respect. DISCUSSION: While it was possible to support and augment stakeholder knowledge in the context of post-registration education, co-design processes were ultimately bound by the university's relatively inflexible bureaucratic context. IMPLICATIONS FOR PRACTICE: To ensure effective stakeholder collaboration beyond classroom teaching, mental health nurse academics must prepare service users for the role, explaining the language and practices of the tertiary health education and nursing context. As part of co-design processes, organisational mandates must be explored and negotiated, and mutual clarity regarding expectations and roles must be established. A Design Thinking approach can support meaningful engagement of stakeholders in curriculum development.

Bumblebee responses to variation in pollinator-attracting traits of Vicia faba flowers.

Adaptations that attract pollinators to flowers are central to the reproductive success of insect-pollinated plants, including crops. Understanding the influence of these non-rewarding traits on pollinator preference is important for our future food security by maintaining sufficient crop pollination. We have identified substantial variation in flower shape, petal size, corolla-tube length, petal spot size and floral volatile compounds among a panel of 30 genetically distinct lines of Vicia faba. Using this variation, we found that Bombus terrestris was able to distinguish between natural variation in petal spot size, floral volatile emissions and corolla-tube length. Foragers showed some innate preference for spotted flowers over non-spotted flowers and preferred shorter corolla-tube lengths over longer tubes. Our results suggest that some floral traits may have significant potential to enhance pollinator attraction to V. faba crops, particularly if paired with optimised rewards.

Development of the ‘AusPROM’ recommendations for elective surgery patients.

Objective Implementing the routine collection of patient reported outcome measures (PROMs) is key to improving healthcare quality and patient satisfaction. The implementation process can be strengthened through staff and patient co-design. The aim of this project was to develop a set of Australian PROM implementation recommendations ('AusPROM') to guide rapid translation into practice. Methods Staff working across 29 Australian private hospitals participated in the project. The hospitals provided elective surgery and spanned each state and territory of Australia. Staff engaged in a Delphi technique to develop the AusPROM, which involved three iterative focus groups. To ensure full disclosure, staff were also provided with additional project-related data sources throughout the Delphi technique. This included data from a patient focus group (patient co-design), patient survey, technical feasibility testing, 3 months of pilot testing (four sites), 3 months of national implementation (29 sites) and global evidence. This process ensured that staff and patient feedback was used to co-design the three iterations of the AusPROM recommendations until the final agreed version was established. Results A total of 22 AusPROM recommendations were included in the final iteration. The recommendations covered the domains of PROM characteristics, healthcare organisation characteristics, external influences, staff and patient characteristics, and facilitators to implementing AusPROMS in routine practice. Conclusion The AusPROM recommendations offer practical considerations for the implementation of PROMs in hospitals. The iterative nature of the Delphi technique ensured that staff and patient co-design were central to the development of the AusPROM recommendations.

Introducing the youth residential rehabilitation service: An operational and experiential overview of a psychosocial residential support option for young people experiencing mental health challenges.

AIM: A range of residential supports is available for young people experiencing mental health challenges. One Australian example is the Youth Residential Rehabilitation Service, which provides up to 12 months of intensive psychosocial support in a residential setting to young people aged 16-25 experiencing serious mental health challenges. This paper aimed to add to the scant literature on these services, describing the experiences of young people and staff members across the duration of a stay. METHODS: This study drew on collaborative autoethnography to engage and centre the direct lived experience of young people who had lived, and staff who had worked, in a Youth Residential Rehabilitation Service. RESULTS: We identified three phases that young people typically journey through during their stay at the service. The Arriving phase was marked by appropriate referrals, a warm welcome, a period of settling in and the development of trusting relationships. The Discovering phase saw young people identifying and enacting their strengths, hopes and values. Community connections were a focus of the Continuing phase as lives after service exit were envisioned and created. CONCLUSIONS: Drawing on collaborative autoethnography methods represents one approach to amplify the voice of young people in service design and evaluation. This paper richly described some of the possibilities and complexities of the Youth Residential Rehabilitation Service experience, which can be used to inform the service's pacing and structure of support.

Co-producing to understand what matters to young people living in youth residential rehabilitation services.

AIM: Residential group care is an important service for vulnerable young people experiencing mental health, substance abuse and/or behavioural challenges. Yet little is written about specific models and their outcomes, especially from the perspectives of the young people who use these services. This project aimed to explore what matters to young people living in a 12-month voluntary residential program for young people aged 16-25. METHODS: This participatory action research study was co-produced with Youth Residential Rehabilitation Service residents and staff as co-researchers. A steering group comprising residents, staff and researchers oversaw all research stages. 18 young people and 17 staff members participated in either individual or group interviews to discuss what was important in Youth Residential Rehabilitation Services. Data analysis drew on grounded theory techniques; subsequent codes and themes were refined in the steering group. RESULTS: We identified the 'change work' that young people were expected to do, and the milieu factors that created a supportive environment. As young people were figuring out their directions and learning new skills, they needed to be understood as the developing expert of their own lives. Real relationships with staff and other young people created a culture of belonging, safety and feeling known. These findings are metaphorically captured in the image of an egg. CONCLUSIONS: Our study highlights that real relationships between all Youth Residential Rehabilitation Service community members are central to creating the atmosphere of safety and belonging that enables healing and self-development to occur.

Bioluminescence in the ghost fungus Omphalotus nidiformis does not attract potential spore dispersing insects.

Bioluminescence has been known from fungi since ancient times, but little work has been done to establish its potential role. There is evidence that some bioluminescent fungi differentially attract potential spore-dispersing insects, and we aimed to establish if this was the case for the ghost fungus, Omphalotus nidiformis (Agaricales,Marasmiaceae), a widespread Australian temperate zone species. We examined three corroborative lines of evidence: circadian rhythmicity of bioluminescence; field-recorded insect abundance at the time of basidiome production; and attractiveness of glowing fungi to flying insects. Basidiomes glowed continuously day and night, and were present in winter (June-July) when insect abundance was low. To assess attractiveness, we deployed sticky-traps in open woodland in the absence of light pollution, in Treatment (baited with fresh bioluminescent O. nidiformis) and Control pairs, for 480 trap-hours on moonless nights. There was no statistical difference in mean insect abundance between Treatment and Control traps (mean 0.33 and 0.54 individuals per trap night, respectively). To interpret these results, we provide a brief review of competing hypotheses for fungal bioluminescence, and conclude that for some fungi, bioluminescence may be an incidental by-product of metabolism rather than conferring any selective advantage. It is possible that the role of bioluminescence differs among evolutionary lineages of fungi and/or with attributes of their growth environments that could affect spore dispersal, such as wind and insect abundance.

Prevalence of Hypertension among Patients Attending Mobile Medical Clinics in the Philippines after Typhoon Haiyan.

INTRODUCTION: On November 8, 2013, Super Typhoon Haiyan struck the Philippines, causing a humanitarian emergency. According to the World Health Organization, non-communicable diseases (NCDs), also known as chronic diseases, are the leading cause of death and disability around the world. NCDs kill 38 million people each year.  Sixteen million NCD deaths occur before the age of 70; 82% of which occurred in low- and middle-income countries.  NCDs are further exacerbated during a crisis, and addressing them should be a concern of any medical disaster response. METHODS: We conducted a retrospective observational study to determine the prevalence of hypertension among patients seeking medical care at mobile medical clinics after Typhoon Haiyan in the Philippines. RESULTS: A total of 3,730 adults were evaluated at the mobile medical clinics. Analysis of the medical records revealed that the overall prevalence of hypertension among adult patients was 47%. Approximately 24% of adult females and 27% of adult males were classified with stage 2 Hypertension. CONCLUSIONS: Evidence-based guidelines on the management of hypertension and other NCDs (diabetes mellitus, cardiovascular disease, chronic lung disease and mental health) during humanitarian emergencies are limited. Clinical care of victims of humanitarian emergencies suffering with NCDs should be a critical part of disaster relief and recovery efforts.  We therefore recommend the development of best practices and evidence based management guidelines of hypertension and other NCDs in post-disaster settings.

CE: Responding to the cholera epidemic in Haiti.

OVERVIEW: While Haiti was still recovering from the January 12, 2010, magnitude-7 earthquake, an outbreak of cholera spread throughout the nation, soon reaching epidemic proportions. Working through the faith-based nongovernmental organization Samaritan's Purse, an NP, an epidemiologist, and a physician joined the effort to prevent the spread of disease and treat those affected. Here they describe the prevention and intervention campaigns their organization initiated, how they prepared for each, and the essential elements of their operations.