Divergent evolution peaks under intermediate population bottlenecks during bacterial experimental evolution.

There is growing evidence that parallel molecular evolution is common, but its causes remain poorly understood. Demographic parameters such as population bottlenecks are predicted to be major determinants of parallelism. Here, we test the hypothesis that bottleneck intensity shapes parallel evolution by elucidating the genomic basis of adaptation to antibiotic-supplemented media in hundreds of populations of the bacterium Pseudomonas fluorescens Pf0-1. As expected, bottlenecking decreased the rate of phenotypic and molecular adaptation. Surprisingly, bottlenecking had no impact on the likelihood of parallel adaptive molecular evolution at a genome-wide scale. However, bottlenecking had a profound impact on the genes involved in antibiotic resistance. Specifically, under either intense or weak bottlenecking, resistance predominantly evolved by strongly beneficial mutations which provide high levels of antibiotic resistance. In contrast with intermediate bottlenecking regimes, resistance evolved by a greater diversity of genetic mechanisms, significantly reducing the observed levels of parallel genetic evolution. Our results demonstrate that population bottlenecking can be a major predictor of parallel evolution, but precisely how may be more complex than many simple theoretical predictions.

Usability and Feasibility Testing of an Atrial Fibrillation Educational Website with Patients Referred to an Atrial Fibrillation Specialty Clinic.

BACKGROUND: The purpose of this study was to design, usability test, and explore the feasibility of a web-based educational platform/intervention for patients with atrial fibrillation (AF) as part of their virtual AF care. METHODS: Participants were patients attending a specialized AF clinic. The multiple mixed-methods design included website design, think-aloud usability test, 1-month unstructured pre-testing analysis using Google Analytics, follow-up interviews, and a non-randomized one-group feasibility test using pre/post online surveys and Google Analytics. RESULTS: Usability testing participants (n = 2) guided adjustments for improving navigation. Pre-testing participants' (n = 9) website activity averaged four sessions (SD = 2.6) at 10 (SD 8) minutes per session during a 1-month study period. In the feasibility test, 30 patients referred to AF specialty clinic care completed the baseline survey, and 20 of these completed the 6-month follow-up survey. A total of 19 patients accessed the website over the 6 months, and all 30 participants were sent email prompts containing information from the website. Health-related quality of life, treatment satisfaction, household activity, and AF knowledge scores were higher at follow-up than baseline. There was an overall downward trend in self-reported healthcare utilization at follow-up. CONCLUSIONS: Access to a credible education website for patients with AF has great potential to complement virtual and hybrid models of care.

Best practices of formal new graduate transition programs: An integrative review.

OBJECTIVES: The aim was to identify the best practices of formal new graduate nurse transition programs. This information would be useful for organizations in their support and development of formal transition programs for newly hired nurses. DESIGN: An integrative review of the nursing research literature (2000-2018). DATA SOURCES: The literature search included PubMed (MEDLINE), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and EMBASE (Excerpt Medica dataBASE). Studies that dealt with programs geared towards pre-registration nursing students were removed. At least two researchers evaluated the literature to determine if the article met the inclusion and exclusion criteria. The final number of articles included in this review is 76. REVIEW METHODS: Cooper's (1989) five-stage approach to integrative review guided the process: problem formulation, data collection, evaluation of data points, data analysis and interpretation, presentation of results. This approach was supplemented by the PRISMA guidelines for reporting systematic searches. RESULTS: Selected studies (n=76) included a range of new graduate nurse program types. The literature was examined according to four major themes: education (pre-registration and practice), support/satisfaction, competency and critical thinking, and workplace environment. Common elements of programs were a specified resource person(s) for new graduates, mentorship, and peer support opportunities. Gaps were observed between pre-registration and new graduate nurse practice realities. A range of educational strategies were used but few were evaluated. Most programs staggered education over time but the limited evidence showed no difference in new graduate nurse transition or satisfaction. New graduate nurse support was an important emphasis of all programs with preceptors the most common form of support and with beginning evidence showing quality vs quantity in preceptor support. Strengthening the quality of preceptor support was evident across studies with the bundling of concurrent strategies found to be helpful. Competency and confidence were found to increase over time for new graduate nurses in transition programs. Workplace environments influenced new graduate nurse transition and organizational commitment. CONCLUSIONS: The variable quality of evidence limits the conclusions that can be drawn. The strongest evidence consistently showed new graduate nurse programs enhanced critical thinking, competency and retention and there were advantages with use of bundled preceptor strategies to support new graduates.