Quantifying functional redundancy in polysaccharide-degrading prokaryotic communities.

BACKGROUND: Functional redundancy (FR) is widely present, but there is no consensus on its formation process and influencing factors. Taxonomically distinct microorganisms possessing genes for the same function in a community lead to within-community FR, and distinct assemblies of microorganisms in different communities playing the same functional roles are termed between-community FR. We proposed two formulas to respectively quantify the degree of functional redundancy within and between communities and analyzed the FR degrees of carbohydrate degradation functions in global environment samples using the genetic information of glycoside hydrolases (GHs) encoded by prokaryotes. RESULTS: Our results revealed that GHs are each encoded by multiple taxonomically distinct prokaryotes within a community, and the enzyme-encoding prokaryotes are further distinct between almost any community pairs. The within- and between-FR degrees are primarily affected by the alpha and beta community diversities, respectively, and are also affected by environmental factors (e.g., pH, temperature, and salinity). The FR degree of the prokaryotic community is determined by deterministic factors. CONCLUSIONS: We conclude that the functional redundancy of GHs is a stabilized community characteristic. This study helps to determine the FR formation process and influencing factors and provides new insights into the relationships between prokaryotic community biodiversity and ecosystem functions. Video Abstract.

The role of the district nurse in Northern Ireland.

A district nurse is an expert generalist practitioner who uses advanced clinical skills and knowledge to fulfil an ever-evolving role. The district nurse is accountable for the care planning, coordination and management of people with multi-faceted and intricate health care needs. In addition, an interprofessional approach to health and social care is required to enable the district nurse to co-ordinate care and enable patients to be cared for and remain within their homes. As the demand on primary and community services increases, care is further enriched by working in partnership with families, carers and voluntary service providers. The nurse patient relationship is the founding component for person-centred, holistic care. Through holistic assessment and shared decision making, co-produced care planning permits people to fundamentally take ownership of their health and enhances formal care provision. This case study reflects the role of the district nurse in Northern Ireland, through comprehensive assessment in clinical practice and highlights how a therapeutic relationship, being centred on the patient and shared decision-making impact positively on the care process.

The development of a district nursing caseload review tool.

District Nursing (DN) caseloads are increasingly unwieldy. ( Queen's Nursing Institute, 2016 ). They can also be difficult to manage due to the unpredictability and increasing complexity of the patient's needs. It is an essential component of DN teams that caseloads are reviewed on a regular basis to support the delivery of efficient, effective and safe patient care. This article illustrates how a caseload review tool was developed, which would standardise the process in all teams, analyse and monitor the outcomes, identify any trends and themes and give assurance that DN caseloads were productive and safe. The testing, piloting and evaluation of the DN caseload review tool was over a period of 12 months and included 35 DN teams across the Trust. The method used was standardised and systematic, in order to ensure that the results were consistent across the pilot site. It also allowed for standardised challenges to be made by the reviewers, ensuring that the process was efficient and meaningful, the outcomes measured and documented and the clinical systems updated appropriately. Results from the initial reviews have been positive. They have produced both qualitative and quantitative data, which has supported further development of the tool. In addition, actions and outcomes identified for individual patients have been documented and addressed, where possible, at local level. A governance process is in place which supports unaddressed challenges, themes and trends. The conclusion of the pilot has confirmed that this process is valid and will continue to be used within the organisation.

The development of a district nursing caseload review tool.

District Nursing (DN) caseloads are increasingly unwieldy. ( Queen's Nursing Institute, 2016 ). They can also be difficult to manage due to the unpredictability and increasing complexity of the patient's needs. It is an essential component of DN teams that caseloads are reviewed on a regular basis to support the delivery of efficient, effective and safe patient care. This article illustrates how a caseload review tool was developed, which would standardise the process in all teams, analyse and monitor the outcomes, identify any trends and themes and give assurance that DN caseloads were productive and safe. The testing, piloting and evaluation of the DN caseload review tool was over a period of 12 months and included 35 DN teams across the Trust. The method used was standardised and systematic, in order to ensure that the results were consistent across the pilot site. It also allowed for standardised challenges to be made by the reviewers, ensuring that the process was efficient and meaningful, the outcomes measured and documented and the clinical systems updated appropriately. Results from the initial reviews have been positive. They have produced both qualitative and quantitative data, which has supported further development of the tool. In addition, actions and outcomes identified for individual patients have been documented and addressed, where possible, at local level. A governance process is in place which supports unaddressed challenges, themes and trends. The conclusion of the pilot has confirmed that this process is valid and will continue to be used within the organisation.