Identification of two novel subtypes of hepatitis C virus genotype 8 and a potential new genotype successfully treated with direct acting antivirals.

BACKGROUND: Hepatitis C virus (HCV) has a high genetic diversity and is classified into 8 genotypes and over 90 subtypes with some endemic to specific world regions. This could compromise direct-acting antiviral (DAA) efficacy and global HCV elimination. METHODS: We characterised HCV subtypes 'rare' to the UK (non-1a/1b/2b/3a/4d) by whole genome sequencing via a national surveillance programme. Genetic analyses to determine the genotype of samples with unresolved genotypes were undertaken by comparison with ICTV HCV reference sequences. RESULTS: Two HCV variants were characterised as being closely related to the recently identified genotype 8 (GT8), with >85% pairwise genetic distance similarity to GT8 sequences and within the typical inter-subtype genetic distance range. The individuals infected by the variants were UK residents originally from Pakistan and India. In contrast, a third variant was only confidently identified to be more similar to GT6 compared to other genotypes across 6% of the genome and was isolated from a UK resident originally from Guyana. All three were cured with pangenotypic DAAs (Sofosbuvir + Velpatasvir or Glecaprevir + Pibrentasvir) despite the presence of resistance polymorphisms in NS3 (80 K/168E), NS5A (28 V/30S/62L/92S/93S) and NS5B (159F). CONCLUSIONS: This study expands our knowledge of HCV diversity by identifying two new GT8 subtypes and potentially a new genotype.

Ureteric Clipping for the Treatment of Urinary Incontinence in Girls With Ectopic Ureters: Predicting Who Is Going to Dilate and Does It Matter?

OBJECTIVE: To assess the effectiveness and midterm follow-up of laparoscopic upper pole ectopic ureteral clipping to treat urinary incontinence in girls with duplex kidneys and non/poorly functioning upper pole moieties. To see if preoperative characteristics increased the likelihood of significant postoperative dilatation and whether this dilation has clinical significance. METHODS: A database review identified children who had undergone ureteric clipping at our institution. Patient details assessed included: age at presentation, age at procedure, significant past medical history, preoperative investigations, operative time, length of stay, postoperative symptoms, postoperative renal tract ultrasound findings and the need for subsequent intervention. RESULTS: Six girls underwent clipping between March 2018 and May 2021. The mean age at presentation and surgery were 77months (39-186) and 86months (44-193), respectively. The mean operative time was 94 minutes (range 66-128 minutes). The median length of stay was 1 day (range 0-3days). All the girls were dry immediately after the procedure. During a mean follow-up of 51months (29-66) all children have remained symptom-free and required no further intervention. Two children have developed significant (>30 mm) but stable ureteric dilatation after clipping but have remained asymptomatic and therefore are continuing on conservative follow-up. Both these children had dilated ureters (>10 mm) preoperatively. CONCLUSION: Ureteric clipping is quick, safe, and effective option in dealing with incontinence due to ectopic upper pole ureters in girls. Children with preoperative ureteric dilation seem to be at increased risk of postoperative dilation. However, as they remain asymptomatic, the clinical significance of this dilatation is unclear.

What Proportion of Children With Complex Oesophageal Atresia Require Oesophageal Lengthening Procedures?

INTRODUCTION: Babies with oesophageal atresia (OA) who cannot achieve a primary anastomosis (complex OA) may be treated by attempted oesophageal lengthening. We contrast reported outcomes of lengthening with our experience of managing complex OA. PATIENTS AND METHODS: A consecutive series treated in an English regional centre was completed. Outcomes of interest were the rate of retention of the native oesophagus, complications requiring thoracotomy, rates of anastomotic leak, stricture, fundoplication, and mortality. Possible explanatory variables were the surgical techniques applied. RESULTS: 29/215 (13%) OA were complex, and 25/207 survived to repair. 14/25 (56%) had no distal fistula, pure OA, while 11/25 (44%) had a long gap with distal fistula. 18/25 (72%) had delayed primary anastomosis, while 7/25 (28%) required oesophageal replacement. However, 2 of the replacements were salvage procedures following failed traction. Only 4/207 (2%) of OA were potentially treatable by traction. Salvage surgery was required in 2/23 (9%) complex OA not subjected to lengthening. The native oesophagus was retained without utilising lengthening in 200/207 (97%). Amongst complex OA where traction techniques had not been attempted, the native oesophagus was retained in 18/23 (78%) of cases, with median time to oesophageal continuity of 77 days. There was no in hospital mortality following treatment of complex OA, and overall survival was identical to non-complex OA among cases surviving to anastomosis. DISCUSSION: Management of complex OA without lengthening procedures leads a similar rate of retention of the native oesophagus as reports describing lengthening, but with significantly less morbidity. We see little need for oesophageal lengthening in the management of complex OA. LEVEL OF EVIDENCE: IV.

Locust gut epithelia do not become more permeable to fluorescent dextran and bacteria in the cold.

The insect gut, which plays a role in ion and water balance, has been shown to leak solutes in the cold. Cold stress can also activate insect immune systems, but it is unknown whether the leak of the gut microbiome is a possible immune trigger in the cold. We developed a novel feeding protocol to load the gut of locusts (Locusta migratoria) with fluorescent bacteria before exposing them to -2°C for up to 48 h. No bacteria were recovered from the hemolymph of cold-exposed locusts, regardless of exposure duration. To examine this further, we used an ex vivo gut sac preparation to re-test cold-induced fluorescent FITC-dextran leak across the gut and found no increased rate of leak. These results question not only the validity of FITC-dextran as a marker of paracellular barrier permeability in the gut, but also to what extent the insect gut becomes leaky in the cold.

Time Required for Nanopore Whole-Genome Sequencing of Neisseria gonorrhoeae for Identification of Phylogenetic Relationships.

BACKGROUND: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global health challenge. Limitations to AMR surveillance reporting, alongside reduction in culture-based susceptibility testing, has resulted in a need for rapid diagnostics and strain detection. We investigated Nanopore sequencing time, and depth, to accurately identify closely related N. gonorrhoeae isolates, compared to Illumina sequencing. METHODS: N. gonorrhoeae strains collected from a London sexual health clinic were cultured and sequenced with MiSeq and MinION sequencing platforms. Accuracy was determined by comparing variant calls at 68 nucleotide positions (37 resistance-associated markers). Accuracy at varying MinION sequencing depths was determined through retrospective time-stamped read analysis. RESULTS: Of 22 MinION-MiSeq pairs reaching sufficient sequencing depth, agreement of variant call positions passing quality control criteria was 185/185 (100%; 95% confidence interval [CI], 98.0%-100.0%), 502/503 (99.8%; 95% CI, 98.9%-99.9%), and 564/565 (99.8%; 95% CI, 99.0%-100.0%) at 10x, 30x, and 40x MinION depth, respectively. Isolates identified as closely related by MiSeq, within one yearly evolutionary distance of ≤5 single nucleotide polymorphisms, were accurately identified via MinION. CONCLUSIONS: Nanopore sequencing shows utility as a rapid surveillance tool, identifying closely related N. gonorrhoeae strains, with just 10x sequencing depth, taking a median time of 29 minutes. This highlights its potential for tracking local transmission and AMR markers.

Collateral sensitivity profiling in drug-resistant Escherichia coli identifies natural products suppressing cephalosporin resistance.

The rapid emergence of antimicrobial resistance presents serious health challenges to the management of infectious diseases, a problem that is further exacerbated by slowing rates of antimicrobial drug discovery in recent years. The phenomenon of collateral sensitivity (CS), whereby resistance to one drug is accompanied by increased sensitivity to another, provides new opportunities to address both these challenges. Here, we present a high-throughput screening platform termed Collateral Sensitivity Profiling (CSP) to map the difference in bioactivity of large chemical libraries across 29 drug-resistant strains of E. coli. CSP screening of 80 commercial antimicrobials demonstrated multiple CS interactions. Further screening of a 6195-member natural product library revealed extensive CS relationships in nature. In particular, we report the isolation of known and new analogues of borrelidin A with potent CS activities against cephalosporin-resistant strains. Co-dosing ceftazidime with borrelidin A slows broader cephalosporin resistance with no recognizable resistance to borrelidin A itself.

Indigenous and introduced Collembola differ in desiccation resistance but not its plasticity in response to temperature.

Biological invasions have significant ecological and economic impacts. Much attention is therefore focussed on predicting establishment and invasion success. Trait-based approaches are showing much promise, but are mostly restricted to investigations of plants. Although the application of these approaches to animals is growing rapidly, it is rare for arthropods and restricted mostly to investigations of thermal tolerance. Here we study the extent to which desiccation tolerance and its phenotypic plasticity differ between introduced (nine species) and indigenous (seven species) Collembola, specifically testing predictions of the 'ideal weed' and 'phenotypic plasticity' hypotheses of invasion biology. We do so on the F2 generation of adults in a full factorial design across two temperatures, to elicit desiccation responses, for the phenotypic plasticity trials. We also determine whether basal desiccation resistance responds to thermal laboratory natural selection. We first show experimentally that acclimation to different temperatures elicits changes to cuticular structure and function that are typically associated with water balance, justifying our experimental approach. Our main findings reveal that basal desiccation resistance differs, on average, between the indigenous and introduced species, but that this difference is weaker at higher temperatures, and is driven by particular taxa, as revealed by phylogenetic generalised least squares approaches. By contrast, the extent or form of phenotypic plasticity does not differ between the two groups, with a 'hotter is better' response being most common. Beneficial acclimation is characteristic of only a single species. Laboratory natural selection had little influence on desiccation resistance over 8-12 generations, suggesting that environmental filtering rather than adaptation to new environments may be an important factor influencing Collembola invasions.

Peer mentoring in nursing education: A concept analysis.

AIM: This peer-mentoring concept analysis aimed to explore and define the concept of peer mentoring in nursing education and the impact it may have on nursing education. BACKGROUND: A lack of literature exists explicitly defining peer mentoring in nursing education. The interchangeable use of processes, terms, and applications may contribute to the lack of consistency and obscurity of nursing education scholarship on peer mentoring. Since peer mentoring can be used to enhance student success, there is a need to clarify the concept of peer mentoring in nursing education for accuracy in future nursing education research. DESIGN/REVIEW METHOD: Using Walker and Avant's framework, the authors identified defining attributes, antecedents, and consequences of peer mentoring. DATA SOURCE: The literature search involved a combination of terms in the MEDLINE with Full Text, Academic Search Complete, Humanities International, ERIC, CINAHL, Health Source: Nursing/Academic Edition, and Consumer Health Complete-EBSCOhost databases. RESULTS: This concept analysis revealed a consistent definition of peer mentoring for use in nursing education. The definition of peer mentoring in nursing education is a formal learning partnership between two individuals (mentor and mentee) with differing levels of nursing school experience. The peer mentor promotes a positive academic and emotionally supportive environment, decreasing stress and increasing the mentee's confidence and competency. CONCLUSION: A shared definition and understanding of peer mentoring within nursing education can contribute to the consistent use of the concept in research and advance the scholarship of nursing education.

The first documentation of the Nearctic-Paleotropical migratory route of the Arctic Warbler.

The Arctic Warbler (Phylloscopus borealis) is a cryptically plumed songbird with an uncommon Nearctic-Paleotropical migratory strategy. Using light-level geolocators, we provide the first documentation of the migratory routes and wintering locations of two territorial adult male Arctic Warblers from Denali National Park and Preserve, Alaska. After accounting for position estimation uncertainties and biases, we found that both individuals departed their breeding grounds in early September, stopped over in southeastern Russia and China during autumn migration, then wintered in the Philippines and the island of Palau. Our documentation of Arctic Warbler wintering on Palau suggests that additional study is needed to document their wintering range. Our study provides hitherto unknown information on stopover and wintering locations for Arctic Warblers and indicates that this species may migrate further overwater than previously thought.

Facilitators and barriers for clinical implementation of a 30-minute point-of-care test for Neisseria gonorrhoeae and Chlamydia trachomatis into clinical care: A qualitative study within sexual health services in England.

Point-of-care tests (POCTs) to diagnose sexually transmitted infections (STIs) have potential to positively impact patient management and patient perceptions of clinical services. Yet there remains a disconnect between development of new technologies and their implementation into clinical care. With the advent of new STI POCTs arriving to the global market, guidance for their successful adoption and implementation into clinical services is urgently needed. We conducted qualitative in-depth interviews with professionals prior to and post-implementation of a Chlamydia trachomatis/Neisseria gonorrhoeae POCT into clinical services in England to define key stakeholder roles and explore the process of POCT integration. Participants self-identified themselves as key stakeholders in the STI POCT adoption and/or implementation processes. Data consisted of interview transcripts, which were analysed thematically using NVIVO 11. Six sexual health services were included in the study; three of which have implemented POCTs. We conducted 40 total interviews: 31 prior to POCT implementation and 9 follow-up post-implementation. Post-implementation data showed that implementation plans required little or no change during service evaluation. Lead clinicians and managers self-identified as key stakeholders for the decision to purchase, while nurses self-identified as "change champions" for implementation. Many identified senior clinical staff as those most likely to introduce and drive change. However, participants stressed the importance of engaging all clinical staff in implementation. While the accuracy of the POCT, its positive impact on patient management and the ease of its integration within existing pathways were considered essential, costs of purchasing and utilising the technology were identified as central to the decision to purchase. Our study shows that key decision-makers for adoption and implementation require STI POCTs to have laboratory-comparable accuracy and be affordable for purchase and ongoing use. Further, successful integration of POCTs into sexual health services relies on supportive interpersonal relationships between all levels of staff.

Improving species-based area protection in Antarctica.

Area protection is a major mechanism deployed for environmental conservation in Antarctica. Yet, the Antarctic protected areas network is widely acknowledged as inadequate, in part because the criteria for area protection south of 60°S are not fully applied. The most poorly explored of these criteria is the type locality of species, which provides the primary legal means for Antarctic species-based area protection and a method for conserving species even if little is known about their habitat or distribution. The type locality criterion has not been systematically assessed since its incorporation into the Protocol on Environmental Protection to the Antarctic Treaty in 1991, so the extent to which the criterion is being met or might be useful for area protection is largely unknown. To address the matter, we created and analyzed a comprehensive database of Antarctic type localities of terrestrial and lacustrine lichens, plants, and animals. We compiled the database via a literature search of key taxonomic and geographic terms and then analyzed the distance between type localities identifiable to a ≤ 25km2 resolution and current Antarctic Specially Protected Areas (ASPAs) and human infrastructure. We used a distance-clustering approach for localities outside current ASPAs to determine candidate protected areas that could contain these unprotected localities. Of the 386 type localities analyzed, 108 were within or overlapped current ASPAs. Inclusion of the remaining 278 type localities in the ASPA network would require the designation of a further 105 protected areas. Twenty-four of these areas included human infrastructure disturbance. Given the slow rate of ASPA designation, growing pace of human impacts on the continent, and the management burden associated with ASPAs, we propose ways in which the type locality criterion might best be deployed. These include a comprehensive, systematic conservation planning approach and an alternative emphasis on the habitat of species, rather than on a single locality.

Mejoría de la Protección Basada en Especies de Áreas en la Antártida Resumen La protección de áreas es un mecanismo importante implementado para la conservación ambiental en la Antártida. Sin embargo, generalmente se identifica como inadecuada a la red de áreas antárticas protegidas porque no se aplican totalmente los criterios para la protección de áreas al sur de los 60°S. De estos criterios, el menos explorado es el de la localidad tipo de las especies, el cual proporciona el principal medio legal para la protección basada en las especies de áreas en la Antártica y un método para la conservación de especies, incluso si se sabe poco sobre su hábitat o distribución. El criterio de la localidad tipo no ha sido evaluado sistemáticamente desde que se incorporó al Protocolo Ambiental del Tratado Antártico en 1991, por lo que se desconoce en gran parte el grado al que se cumple el criterio o cuán útil podría ser para proteger el área. Creamos y analizamos una base de datos integral de las localidades tipo de líquenes, plantas, y animales terrestres y lacustres para abordar este tema. Compilamos la base de datos a partir de la búsqueda de términos geográficos y taxonómicos relevantes en la literatura y después analizamos la distancia entre las localidades tipo identificables a una resolución ≤25km2 y las Áreas Especialmente Protegidas de la Antártida (AEPA) existentes y la infraestructura humana. Usamos una estrategia de agrupamiento de distancias para las localidades externas a las AEPA existentes para determinar áreas protegidas candidatas que podrían albergar estas localidades sin protección. De las 386 las localidades tipo analizadas, 108 estaban dentro de o se traslaparon con las AEPA existentes. La inclusión de las otras 278 localidades tipo dentro de la red AEPA requeriría de la designación de 105 áreas adicionales. En 24 de estas áreas existieron alteraciones por la infraestructura humana. Debido al ritmo lento de designación de AEPA, el avance del impacto humano en el continente y el costo de la gestión asociado con las AEPA, proponemos algunas formas en las que podría implementarse de mejor manera el criterio de la localidad tipo. Estas formas incluyen una estrategia sistemática e integral de la planeación de la conservación y un énfasis alternativo en el hábitat de la especie en lugar de en una sola localidad.

Vaginal microbiota in ethnically diverse young women who did or did not develop pelvic inflammatory disease: community-based prospective study.

OBJECTIVES: A lactobacilli-dominated vaginal microbiome may protect against pelvic inflammatory disease (PID), but one dominated by Gardnerella species might increase susceptibility. Not all lactobacilli are equally protective. Recent research suggests that D(-) isomer lactic acid producing lactobacilli (Lactobacillus crispatus, Lactobacillus jensenii and Lactobacillus gasseri) may protect against infection with Chlamydia trachomatis, an important cause of PID. Lactobacillus iners , which produces L(+) isomer lactic acid, may be less protective. We investigated the microbiome in stored vaginal samples from participants who did or did not develop PID during the prevention of pelvic infection (POPI) chlamydia screening trial. METHODS: Long-read 16S rRNA gene nanopore sequencing was used on baseline vaginal samples (one per participant) from all 37 women who subsequently developed clinically diagnosed PID during 12-month follow-up, and 111 frequency matched controls who did not, matched on four possible risk factors for PID: age <20 versus ≥20, black ethnicity versus other ethnicity, chlamydia positive versus negative at baseline and ≥2 sexual partners in the previous year versus 0-1 partners. RESULTS: Samples from 106 women (median age 19 years, 40% black ethnicity, 22% chlamydia positive, 54% reporting multiple partners) were suitable for analysis. Three main taxonomic clusters were identified dominated by L. iners, L. crispatus and Gardnerella vaginalis. There was no association between a more diverse, G. vaginalis dominated microbiome and subsequent PID, although increased Shannon diversity was associated with black ethnicity (p=0.002) and bacterial vaginosis (diagnosed by Gram stain p<0.0001). Women who developed PID had similar relative abundance of protective D(-) isomer lactic acid producing lactobacilli to women without PID, but numbers of PID cases were small. CONCLUSIONS: In the first-ever community-based prospective study of PID, there was no clear association between the vaginal microbiome and subsequent development of PID. Future studies using serial samples may identify vaginal microbial communities that may predispose to PID.

Certified nursing assistants' experiences with self-compassion training in the nursing home setting.

Certified nursing assistants (CNAs) in nursing home (NH) settings experience considerable work-related and personal stress. Self-compassion is a personal resource linked to improved stress coping and may be particularly relevant to health care workers. In this study, we explored NH CNA's experiences with self-compassion training based on their narrative replies. Twenty-two CNAs (100% female, mean age 48 years, 82% Black/African American) from 3 mid-sized, non-profit NHs in the Southeast US completed either a standard 8-week, 20 h self-compassion training or a 6-week, 6 h modified version designed for health care providers. Qualitative data analyses from post-training focus group discussions identified four themes pertaining to changes in: (1) stress management, (2) appreciation and support, (3) caregiver role, and (4) connection to others. Findings suggested self-compassion training is feasible and beneficial for the stressors that CNAs experience. In the era of COVID-19 and beyond, self-compassion training is a promising method to improve CNAs' well-being.

Microbe-dependent heterosis in maize.

Hybrids account for nearly all commercially planted varieties of maize and many other crop plants because crosses between inbred lines of these species produce first-generation [F1] offspring that greatly outperform their parents. The mechanisms underlying this phenomenon, called heterosis or hybrid vigor, are not well understood despite over a century of intensive research. The leading hypotheses-which focus on quantitative genetic mechanisms (dominance, overdominance, and epistasis) and molecular mechanisms (gene dosage and transcriptional regulation)-have been able to explain some but not all of the observed patterns of heterosis. Abiotic stressors are known to impact the expression of heterosis; however, the potential role of microbes in heterosis has largely been ignored. Here, we show that heterosis of root biomass and other traits in maize is strongly dependent on the belowground microbial environment. We found that, in some cases, inbred lines perform as well by these criteria as their F1 offspring under sterile conditions but that heterosis can be restored by inoculation with a simple community of seven bacterial strains. We observed the same pattern for seedlings inoculated with autoclaved versus live soil slurries in a growth chamber and for plants grown in steamed or fumigated versus untreated soil in the field. In a different field site, however, soil steaming increased rather than decreased heterosis, indicating that the direction of the effect depends on community composition, environment, or both. Together, our results demonstrate an ecological phenomenon whereby soil microbes differentially impact the early growth of inbred and hybrid maize.

An unusually diverse genus of Collembola in the Cape Floristic Region characterised by substantial desiccation tolerance.

Trait-environment interactions have contributed to the remarkable plant radiations in the Cape Floristic Region (CFR) of southern Africa. Whether such interactions have also resulted in the diversification of the invertebrate fauna, independently of direct associations with plants is, however, not clear. One candidate where this may be the case is the unusually diverse Collembola genus Seira. Including 89 species in the CFR, many of which are localised habitat specialists, this genus includes many species inhabiting the warm, dry fynbos shrubland-a habitat atypical of usually desiccation-sensitive Collembola. Here, we investigate whether desiccation tolerance may have contributed to the considerable diversity of Seira in the CFR. First, we demonstrate, by measuring vapour pressure deficits (VPD) of the species' microhabitats (fynbos shrubland and moister Afrotemperate Forests), that the fynbos shrublands are dry environments (mean ± S.E. maximum VPD 5.2 ± 0.1 kPa) compared with the Afrotemperate Forest patches (0.3 ± 0.02 kPa) during the summer activity period of Seira. Then we show that Seira species living in these shrublands are more desiccation tolerant (mean ± S.E. survival time at 76% relative humidity: 74.3 ± 3.3 h) than their congeners in the cooler, moister Afrotemperate Forests (34.3 ± 2.8 h), and compared with Collembola species globally (3.7 ± 0.2 h). These results, and a previous demonstration of pronounced thermal tolerance in the fynbos shrubland species, suggest that the diversity of Seira in the CFR is at least partly due to pronounced desiccation and thermal tolerance, which has enabled species in the genus to exploit the hot and dry habitats of the CFR.

Succession planning in nursing education.

BACKGROUND: Succession planning in nursing is a new concept with limited evidence found in nursing education. PURPOSE: The purpose of this study was to provide a comprehensive summary of the descriptions of succession planning, as self-reported by administrators over an academic nursing division. METHODS: A qualitative descriptive methodology was utilized to obtain descriptions of succession planning from participants having personal experience with succession planning. FINDINGS: The categories discovered in the data included strategies for succession planning implementation, advantages of succession planning, and obstacles to succession planning. DISCUSSION: Succession planning can provide growth plans, leadership development, and mentoring programs allowing for positive relationships that cultivate, inspire, and assist faculty to develop the necessary skills to be successful in a leadership role. Succession planning requires adequate financial and human resources to develop potential leaders to meet the future needs of an organization, and ultimately, nursing education.

Concept analysis: Succession planning.

The aim is to understand the concept of succession planning and its application to initiate successful succession planning in nursing education. In nursing education, there is a lack of qualified academic nursing administrators associated with a national nursing faculty shortage. Succession planning is often confused with other leadership management techniques. An understanding of the concept and its application is required to initiate successful succession planning in nursing education. Walker and Avant's methodological approach was followed for this concept analysis. The electronic databases searched included CINAHL, Medline, Google Scholar, PROQUEST, ERIC, PsycINFO, along with reference and bibliographic lists, relevant books, and public domain websites. The initial search terms included: succession planning, academic deans/directors, and nursing education. A pattern of five attributes emerged related to the characteristics of the concept of succession planning: organizational support and culture, attitude, commitment, and resources. Antecedents included strategic planning, identification of potential individuals, leadership development, mentoring programs, and identification of leadership competencies. Consequences of succession planning appeared to be related to retention, recruitment, improved leadership competencies, decreased role transition stress, and a healthier work environment. Succession planning has been defined as the proactive strategy involving the purposeful identification, assessment, and development of individuals through the processes of educating and mentoring for future leadership positions and establishing leadership continuity within an institution. Succession planning is needed for the continued growth and development academic nursing leaders.

Basal tolerance but not plasticity gives invasive springtails the advantage in an assemblage setting.

As global climates change, alien species are anticipated to have a growing advantage relative to their indigenous counterparts, mediated through consistent trait differences between the groups. These insights have largely been developed based on interspecific comparisons using multiple species examined from different locations. Whether such consistent physiological trait differences are present within assemblages is not well understood, especially for animals. Yet, it is at the assemblage level that interactions play out. Here, we examine whether physiological trait differences observed at the interspecific level are also applicable to assemblages. We focus on the Collembola, an important component of the soil fauna characterized by invasions globally, and five traits related to fitness: critical thermal maximum, minimum and range, desiccation resistance and egg development rate. We test the predictions that the alien component of a local assemblage has greater basal physiological tolerances or higher rates, and more pronounced phenotypic plasticity than the indigenous component. Basal critical thermal maximum, thermal tolerance range, desiccation resistance, optimum temperature for egg development, the rate of development at that optimum and the upper temperature limiting egg hatching success are all significantly higher, on average, for the alien than the indigenous components of the assemblage. Outcomes for critical thermal minimum are variable. No significant differences in phenotypic plasticity exist between the alien and indigenous components of the assemblage. These results are consistent with previous interspecific studies investigating basal thermal tolerance limits and development rates and their phenotypic plasticity, in arthropods, but are inconsistent with results from previous work on desiccation resistance. Thus, for the Collembola, the anticipated advantage of alien over indigenous species under warming and drying is likely to be manifest in local assemblages, globally.

Another Therapeutic Role for Intravesical Botulinum Toxin: Patients with Long-stay Catheters and Refractory Bladder Pain and Catheter Bypass Leakage.

BACKGROUND: Botulinum neurotoxin (BotN) is used to treat detrusor overactivity (DO) refractory to medical treatment. Catheterised patients with symptoms of bladder spasm and catheter bypass leakage are challenging to manage and the efficacy of BotN is not established. OBJECTIVE: To review our experience using intravesical BotN to treat refractory bladder pain and catheter bypass leakage in patients with long-term indwelling catheters. DESIGN, SETTING, AND PARTICIPANTS: We carried out a review of data prospectively collected for patients with indwelling urethral or suprapubic catheters receiving BotN for the treatment of bladder spasms and catheter bypass leakage in a UK tertiary centre. An unvalidated structured questionnaire was used to ascertain quality of life (QoL) outcomes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Qualitative data were collected for patient-reported symptoms and QoL. Paired Student t tests were applied for statistical analysis. RESULTS AND LIMITATIONS: Of the 54 catheterised patients who received BotN, 14 (26%) were male and 40 (74%) were female. The mean follow-up was 38mo. Of the patients, 34 (63%) had a neurological aetiology and 94% had experienced failure of medical therapy before BotN administration. The BotN starting dose was 100 or 200U and 17 patients (31%) required dose escalation. All 34 neurogenic and six non-neurogenic patients started on 200U. After treatment, 63% of patients managed their catheter with intermittent drainage and 37% managed on free drainage; 51 patients (94%) reported that their symptoms were controlled and 38% reported being treated for a urinary tract infection following BotN. Patients reported a mean improvement in QoL of 7.7/10 following BotN, while 83% reported a significant reduction in urine leakage (p=0.0001). CONCLUSIONS: Outpatient intravesical BotN is safe and efficacious for patients with long-term catheters suffering from bladder pain and catheter bypass leakage. PATIENT SUMMARY: Outpatient administration of intravesical botulinum toxin is a safe and effective treatment for patients with a long-term indwelling catheter with bothersome urine storage symptoms. Attention should be paid to urine microbiology results before treatment to ensure appropriate prophylactic antibiotic treatment to reduce the incidence of urinary tract infections.

Development of a Clinical Prediction Model for Central Line-Associated Bloodstream Infection in Children Presenting to the Emergency Department.

OBJECTIVE: The majority of the children with a central line who present to the emergency department with fever or other signs of bacteremia do not have a central line-associated bloodstream infection (CLABSI). Our objective was to develop a clinical prediction model for CLABSI among this group of children in order to ultimately limit unnecessary hospital admissions and antibiotic use. METHODS: We performed a nested case-control study of children with a central line who presented to the emergency department of an urban, tertiary care children's hospital between January 2010 and March 2015 and were evaluated for CLABSI with a blood culture. RESULTS: The final multivariable model developed to predict CLABSI consisted of 12 factors: age younger than 5 years, black race, use of total parenteral nutrition, tunneled central venous catheter, double-lumen catheter, absence of other bacterial infection, absence of viral upper respiratory tract infection symptoms, diarrhea, emergency department temperature greater than 39.5°C, fever prior to presentation, neutropenia, and spring/summer season. The clinical prediction score had good discrimination for CLABSI with a c-statistic of 0.81 (confidence interval, 0.77-0.85). A cut point less than 6 was associated with a sensitivity of 98.5% and a negative predictive value of 99.2% for CLABSI. CONCLUSIONS: We were able to identify risk factors and develop a clinical prediction model for CLABSI in children presenting to the emergency department. Once validated in future study, this clinical prediction model could be used to assess the need for hospitalization and/or antibiotics among this group of patients.