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Background/objectives: Evidence-based guidelines and care standards recommend offering oral nutrition supplements to all older adults with hip fracture, not just those already malnourished. This study aimed to identify the proportion of inpatients in a sample of hospitals in two countries that were provided with oral nutritional supplementation (ONS) following a hip fracture and to identify factors associated with ONS provision., Methods: An analysis of prospectively collected data from a bi-national Hip Fracture Registry nutrition sprint and registry audit data limited to older adults (≥65 years) undergoing surgical intervention for a fractured hip from 1 to 31 August 2021. Multivariable logistic regression was used to identify factors associated with providing ONS., Results: Patient-level data was available for 385 older adults (median 85 years; 60.5% female) admitted to twenty-nine hospitals. Less than half ( n = 47.3%) of the audited inpatients were provided ONS. After adjusting for covariates, ONS was more likely to be provided to older adults who were identified as malnourished on formal testing (OR 11.92; 95%CI 6.57, 21.69). Other factors associated with prescription of ONS included those who did not have a preoperative medical assessment (OR 2.26; 95%CI 1.19, 4.27) or were cognitively impaired (OR 1.83; 95%CI 1.01, 3.32), severely frail, or terminally ill (OR 3.17; 95%CI 1.10, 9.17)., Conclusions: ONS was provided in line with evidence-based recommendations for less than half of the older adults with a hip fracture in 29 hospitals in two countries. A structured approach to implementation may be required to reduce complications and improve outcomes for all older adults after a hip fracture, not just those assessed as cognitively impaired, frail, and/or malnourished.

Marine heatwaves (MHWs) are increasing in frequency, duration and intensity, disrupting global marine ecosystems. While most reported impacts have been in tropical areas, New Zealand experienced its strongest and longest MHW in 2022, profoundly affecting marine sponges. Sponges are vital to rocky benthic marine communities, with their abundance influencing ecosystem functioning. This study examines the impact of this MHW on the photosynthetic sponge Cymbastella lamellata in Fiordland, New Zealand. We describe the extent, physiological responses, mortality, microbial community changes and ecological impact of this MHW on C. lamellata. The Fiordland MHW reached a maximum temperature of 4.4°C above average, lasting for 259 days. Bleaching occurred in >90% of the C. lamellata Fiordland population. The population size exceeded 66 million from 5 to 25 m, making this the largest bleaching event of its kind ever recorded. We identified the photosynthetic symbiont as a diatom, and bleached sponges had reduced photosynthetic efficiency. Post-MHW surveys in 2023 found that over 50% of sponges at sampling sites had died but that the remaining sponges had mostly recovered from earlier bleaching. Using a simulated MHW experiment, we found that temperature stress was a driver of necrosis rather than bleaching, despite necrosis only rarely being observed in the field (<2% of sponges). This suggests that bleaching may not be the cause of the mortality directly. We also identified a microbial community shift in surviving sponges, which we propose represents a microbial-mediated adaptive response to MHWs. We also found that C. lamellata are key contributors of dissolved organic carbon to the water column, with their loss likely impacting ecosystem function. We demonstrate the potential for MHWs to disrupt key marine phyla in temperate regions, highlighting how susceptible temperate sponges globally might be to MHWs., (© 2024 The Author(s). Global Change Biology published by John Wiley & Sons Ltd.)

The ecology and function of rocky temperate mesophotic ecosystems (TMEs) remain poorly understood globally despite their widespread distribution. They typically occur at 20-150 m (the limit of photosynthesis), and on rocky substratum they support rich benthic communities and mobile fauna. We determined the distribution of rocky TMEs, their conservation status, and their most characteristic biological groups. Rocky TMEs were dominated by algae, turf-invertebrate matrices (<50 m only), sponges, bryozoans, and cnidarians. The community composition of TMEs differed significantly from shallow (0-15 m) subtidal reefs. Data were geographically biased and variable, available only from the North and South Atlantic, Mediterranean, and Temperate Australasia. Degree of protection of rocky TMEs varied considerably across the world. The biggest threats to rocky TMEs were identified changes in temperature, sedimentation rates, nutrient concentrations, and certain fishing types. We propose a conservation framework to inform future rocky TME management and conservation, highlighting the need to recognize the importance of these biologically diverse and functionally important ecosystems., (© 2022 The Authors. Conservation Biology published by Wiley Periodicals LLC on behalf of Society for Conservation Biology.)

Corals provide a complex 3D framework that offers habitat to diverse coral reef fauna. However, future reefs are likely to experience reduced coral abundance. Sponges have been proposed as one potential winner on future coral reefs, but little is known of how they contribute to reef 3D structure. Given the ecological importance of structural complexity, it is critical to understand how changes in the abundance of structure-building organisms will affect the three-dimensional properties of coral reefs. To investigate the potentially important functional role of coral reef sponges as providers of structural complexity, we compared the structural complexity of coral- and sponge-dominated areas of an Indonesian coral reef, using 3D photogrammetry at a 4 m 2 spatial scale. Structural complexity of 31 4 m 2 quadrats was expressed as rugosity indicating reef contour complexity (R), vector dispersion indicating heterogeneity of angles between reef surfaces (1/k), and fractal dimension indicating geometrical complexity at five different spatial scales between 1 and 120 cm (D 1-5 ). Quadrats were identified as high- or low-complexity using hierarchical clustering based on the complexity metrics. At high structural complexity, coral- and sponge-dominated quadrats were similar in terms of R and 1/k. However, smallest-scale refuge spaces (1-5 cm) were more abundant in coral-dominated quadrats, whereas larger scale refuge spaces (30-60 cm) were more abundant in sponge-dominated quadrats. Branching and massive corals contributed the most to structural complexity in coral-dominated quadrats, and barrel sponges in sponge-dominated quadrats. We show that smaller-scale refugia (1-5 cm) are reduced on sponge-dominated reefs at the spatial scale considered here (4 m 2 ), with potential negative implications for smaller reef fauna., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Bioeroding sponges can cause extensive damage to aquaculture and wild shellfish fisheries. It has been suggested that heavy sponge infestations that reach the inner cavity of oysters may trigger shell repair and lead to adductor detachment. Consequently, energy provision into shell repair could reduce the energy available for other physiological processes and reduce the meat quality of commercially fished oysters. Nevertheless, the impacts of boring sponges on oysters and other shellfish hosts are inconclusive. We studied the interaction between boring sponges and their hosts and examined potential detrimental effects on an economically important oyster species Ostrea chilensis from Foveaux Strait (FS), New Zealand. We investigated the effect of different infestation levels with the bioeroding sponge Cliona sp. on commercial meat quality, condition, reproduction, and disease susceptibility. Meat quality was assessed with an index based on visual assessments used in the FS O. chilensis fishery. Meat condition was assessed with a common oyster condition index, while histological methods were used to assess sex, gonad stage, reproductive capacity, and pathogen presence. Commercial meat quality and condition of O. chilensis were unaffected by sponge infestation. There was no relationship between sex ratio, gonad developmental stage, or gonad index and sponge infestation. Lastly, we found no evidence that sponge infestation affects disease susceptibility in O. chilensis. Our results suggest that O. chilensis in FS is largely unaffected by infestation with Cliona sp. and therefore reinforces the growing body of evidence that the effects of sponge infestation can be highly variable among different host species, environments, and habitats.

Background: To determine the impact of personalized risk communication and opioid prescribing on nonprescribed opioid use, we conducted a secondary analysis of randomized controlled trial participants followed prospectively for 90 days after an emergency department (ED) visit for acute back or kidney stone pain., Methods: A total of 1301 individuals were randomized during an encounter at four academic EDs into a probabilistic risk tool (PRT) arm, a narrative-enhanced PRT arm, or a general risk information arm (control). In this secondary analysis, both risk tool arms were combined and compared with the control arm. We used logistic regressions to determine associations between receiving personalized risk information, receiving an opioid prescription in the ED, and nonprescribed opioid use in general and by race., Results: Complete follow-up data were available for 851 participants; 23.3% (n = 198) were prescribed opioids (34.2% of White vs. 11.6% of Black participants, p < 0.001). Fifty-six (6.6%) participants used nonprescribed opioids. Participants in the personalized risk communication arms had lower nonprescribed opioid use odds (adjusted odds ratio [aOR] 0.58, 95% confidence interval [CI] 0.4-0.83). Black versus White participants had greater nonprescribed opioid use odds (aOR 3.47, 95% CI 2.05-5.87, p < 0.001). Black participants who were prescribed opioids had a lower marginal probability of using nonprescribed opioids versus those who were not (0.06, 95% CI 0.04-0.08, p < 0.001 vs. 0.10, 95% CI 0.08-0.11, p < 0.001). The absolute risk difference in nonprescribed opioid use for Black and White participants, respectively, in the risk communication versus the control arm, was 9.7% and 0.1% (relative risk ratio 0.43 vs. 0.95)., Conclusions: Among Black but not White participants, personalized opioid risk communication and opioid prescribing were associated with lower odds of nonprescribed opioid use. Our findings suggest that racial disparities in opioid prescribing-which have been previously described within the context of this trial-may paradoxically increase nonprescribed opioid use. Personalized risk communication may effectively reduce nonprescribed opioid use, and future research should be designed specifically to explore this possibility in a larger cohort., (© 2023 Society for Academic Emergency Medicine.)

Marine heatwaves are increasingly subjecting organisms to unprecedented stressful conditions, but the biological consequences of these events are still poorly understood. Here we experimentally tested the presence of carryover effects of heatwave conditions on the larval microbiome, settlers growth rate and metamorphosis duration of the temperate sponge Crella incrustans . The microbial community of adult sponges changed significantly after ten days at 21°C. There was a relative decrease in symbiotic bacteria, and an increase in stress-associated bacteria. Sponge larvae derived from control sponges were mainly characterised by a few bacterial taxa also abundant in adults, confirming the occurrence of vertical transmission. The microbial community of sponge larvae derived from heatwave-exposed sponges showed significant increase in the endosymbiotic bacteria Rubritalea marina. Settlers derived from heatwave-exposed sponges had a greater growth rate under prolonged heatwave conditions (20 days at 21°C) compared to settlers derived from control sponges exposed to the same conditions. Moreover, settler metamorphosis was significantly delayed at 21°C. These results show, for the first time, the occurrence of heatwave-induced carryover effects across life-stages in sponges and highlight the potential role of selective vertical transmission of microbes in sponge resilience to extreme thermal events.

Oceans are rapidly warming and acidifying in the context of climate change, threatening sensitive marine biota including coral reef sponges. Ocean warming (OW) and ocean acidification (OA) can impact host health and associated microbiome, but few studies have investigated these effects, which are generally studied in isolation, on a specific component of the holobiont. Here we present a comprehensive view of the consequences of simultaneous OW and OA for the tropical sponge Stylissa flabelliformis. We found no interactive effect on the host health or microbiome. Furthermore, OA (pH 7.6 versus pH 8.0) had no impact, while OW (31.5 °C versus 28.5 °C) caused tissue necrosis, as well as dysbiosis and shifts in microbial functions in healthy tissue of necrotic sponges. Major taxonomic shifts included a complete loss of archaea, reduced proportions of Gammaproteobacteria and elevated relative abundances of Alphaproteobacteria. OW weakened sponge-microbe interactions, with a reduced capacity for nutrient exchange and phagocytosis evasion, indicating lower representations of stable symbionts. The potential for microbially-driven nitrogen and sulphur cycling was reduced, as was amino acid metabolism. Crucially, the dysbiosis annihilated the potential for ammonia detoxification, possibly leading to accumulation of toxic ammonia, nutrient imbalance, and host tissue necrosis. Putative defence against reactive oxygen species was greater at 31.5 °C, perhaps as microorganisms capable of resisting temperature-driven oxidative stress were favoured. We conclude that healthy symbiosis in S. flabelliformis is unlikely to be disrupted by future OA but will be deeply impacted by temperatures predicted for 2100 under a "business-as-usual" carbon emission scenario., (© 2023. Crown.)

Sponges are a key component of coral reef ecosystems and play an important role in carbon and nutrient cycles. Many sponges are known to consume dissolved organic carbon and transform this into detritus, which moves through detrital food chains and eventually to higher trophic levels via what is known as the sponge loop. Despite the importance of this loop, little is known about how these cycles will be impacted by future environmental conditions. During two years (2018 and 2020), we measured the organic carbon, nutrient recycling, and photosynthetic activity of the massive HMA, photosymbiotic sponge Rhabdastrella globostellata at the natural laboratory of Bouraké in New Caledonia, where the physical and chemical composition of seawater regularly change according to the tide. We found that while sponges experienced acidification and low dissolved oxygen at low tide in both sampling years, a change in organic carbon recycling whereby sponges stopped producing detritus (i.e., the sponge loop) was only found when sponges also experienced higher temperature in 2020. Our findings provide new insights into how important trophic pathways may be affected by changing ocean conditions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Inpatient malnutrition is a key determinant of adverse patient and healthcare outcomes. The engagement of patients as active participants in nutrition care processes that support informed consent, care planning and shared decision making is recommended and has expected benefits. This study applied patient-reported measures to identify the proportion of malnourished inpatients seen by dietitians that reported engagement in key nutrition care processes., Methods: A subset analysis of a multisite malnutrition audit limited to patients with diagnosed malnutrition who had at least one dietitian chart entry and were able to respond to patient-reported measurement questions., Results: Data were available for 71 patients across nine Queensland hospitals. Patients were predominantly older adults (median 81 years, IQR 15) and female (n = 46) with mild/moderate (n = 50) versus severe (n = 17) or unspecified severity (n = 4) malnutrition. The median length of stay at the time of audit was 7 days (IQR 13). More than half of the patients included had two or more documented dietitian reviews. Nearly all patients (n = 68) received at least one form of nutrition support. A substantial number of patients reported not receiving a malnutrition diagnosis (n = 37), not being provided information about malnutrition (n = 30), or not having a plan for ongoing nutrition care or follow-up (n = 31). There were no clinically relevant trends between patient-reported measures and the number of dietitian reviews or severity of malnutrition., Conclusions: Malnourished inpatients seen by dietitians across multiple hospitals almost always receive nutritional support. Urgent attention is required to identify why these same patients do not routinely report receiving malnutrition diagnostic advice, receiving information about being at risk of malnutrition, and having a plan for ongoing nutrition care, regardless of how many times they are seen by dietitians.

Marine heat waves (MHWs) are extended periods of excessively warm water 1 that are increasing in frequency, duration, intensity, and impact, and they likely represent a greater threat to marine ecosystems than the more gradual increases in sea surface temperature. 2 , 3 , 4 Sponges are major and important components of global benthic marine communities, 5 , 6 , 7 with earlier studies identifying tropical sponges as potential climate change "winners." 8 , 9 , 10 , 11 In contrast, cold-water sponges may be less tolerant to predicted ocean warming and concurrent MHWs. Here, we report how a series of unprecedented MHWs in New Zealand have impacted millions of sponges at a spatial scale far greater than previously reported anywhere in the world. We reported sponge tissue necrosis 12 and bleaching (symbiont loss/dysfunction), 13 which have been previously associated with temperature stress, 6 , 12 , 14 for three common sponge species across multiple biogeographical regions, with the severity of impact being correlated with MHW intensity. Given the ecological importance of sponges, 15 their loss from these rocky temperate reefs will likely have important ecosystem-level consequences., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Sponges are ecologically important benthic organisms with many important functional roles. However, despite increasing global interest in the functions that sponges perform, there has been limited focus on how such functions will be impacted by different anthropogenic stressors. In this review, we describe the progress that has been made in our understanding of the functional roles of sponges over the last 15 years and consider the impacts of anthropogenic stressors on these roles. We split sponge functional roles into interactions with the water column and associations with other organisms. We found evidence for an increasing focus on functional roles among sponge-focused research articles, with our understanding of sponge-mediated nutrient cycling increasing substantially in recent years. From the information available, many anthropogenic stressors have the potential to negatively impact sponge pumping, and therefore have the potential to cause ecosystem level impacts. While our understanding of the importance of sponges has increased in the last 15 years, much more experimental work is required to fully understand how sponges will contribute to reef ecosystem function in future changing oceans., (Copyright © 2023. Published by Elsevier Ltd.)

Background To improve nutritional care for community-dwelling older adults before, during, and after hospitalization, factors influencing nurses' current behavior should be targeted. The aim of this study was to obtain expert consensus on which factors influencing the behavior of hospital and home care nurses are most relevant, modifiable, and feasible to influence. Method In a two-round Delphi study, nine pre-selected factors were rated by 26 experts. Results Eight factors were rated as relevant, modifiable, and feasible to influence: (1) lack of sufficient knowledge, (2) mainly neutral attitude, (3) low prioritization, (4) ambiguous motivation to routinely use guidelines and screening tools, (5) moderate awareness about risk factors, (6) lack of sense of involving informal caregivers, (7) ambiguous motivation to follow education and training, and (8) strong focus on medical nutrition. Conclusion The expert panel reached consensus on eight factors influencing nurses' current behavior. To enhance nutritional care to prevent malnutrition in older adults, strategies are needed for targeting these factors in nursing practice, education, and research. [ J Contin Educ Nurs . 2022;53(12):545-556.] .

Introduction and Aims: Room service is a hospital meal service model with demonstrated improved nutrition intake, reduced wastage and cost benefits in some settings compared with traditional models. However, uptake across public hospital settings appears low; the underlying reasons require exploration. In 2019, room service was introduced in a Queensland Hospital and Health Service site. The aim of this article is to identify the barriers and enablers to implementing room service to provide recommendations for future implementation of this model., Methods: The current qualitative descriptive study utilized semistructured interviews with project members and key stakeholders involved in implementation of the room service meal delivery model at the Prince Charles Hospital (Queensland, Australia). A convenience sample of participants were recruited. Interviews explored project experiences from commencement to completion, barriers and enablers to implementation, strategies to overcome challenges and recommendations for implementation at other sites. Interviews were coded to identify themes and subthemes., Results: Nine participants were interviewed. Key themes with associated subthemes were (1) foundations of transformation, (2) navigating implementation and (3) embedding sustainable practices., Conclusion: The current study adds rich information to understand factors that support the implementation of a room service model in a large public hospital. Future implementation of room service should not only consider measuring quantifiable outcomes, but also the importance of qualitative descriptive studies surveying project members and key stakeholders to further explore experiences, barriers and enablers to implementation and develop strategies to overcome challenges to assist further sites implement this model., (Copyright © 2022 JBI. Unauthorized reproduction of this article is prohibited.)

Sponges are major components of benthic communities across the world and have been identified as potential "winners" on coral reefs in the face of global climate change as result of their tolerance to ocean warming and acidification (OA). Previous studies have also hypothesised that photosymbiont-containing sponges might have higher productivity under future OA conditions as a result of photosymbionts having increased access to CO 2 and subsequently greater carbon production. Here we test this hypothesis for a widespread and abundant photosymbiont-containing sponge species Lamellodysidea herbacea at a CO 2 seep in Papua New Guinea simulating OA conditions. We found seep sponges had relatively higher cyanobacterial abundance, chlorophyll concentrations and symbiont photosynthetic efficiency than non-seep sponges, and a three-fold higher sponge abundance at the seep site. However, while gross oxygen production was the same for seep and non-seep sponges, seep sponge dark respiration rates were higher and instantaneous photosynthesis: respiration (P:R) ratios were lower. We show that while photosymbiont containing sponges may not have increased productivity under OA, they are able to show flexibility in their relationships with microbes and offset increased metabolic costs associated with climate change associated stress., (© 2022 John Wiley & Sons Ltd.)

Current rates of greenhouse gas emissions are leading to a rapid increase in global temperatures and a greater occurrence of extreme climatic events such as marine heatwaves. In this study, we assessed the effects of thermal conditions predicted to occur within the next 40 years (SSP3-7.0 scenario of IPCC, 2021) on the respiration rate, buoyant weight, morphology and recruitment of the temperate model sponge Crella incrustans. Under predicted average temperatures (+ 2.5 °C, over the local mean), C. incrustans did not show any physiological and morphological changes compared to current conditions. However, when exposed to a simulated marine heatwave (16 days duration and a thermal peak at 22 °C), there was a large increase in sponge respiration rate, significant weight loss resulting from tissue regression, and sponge mortality. The simulated marine heatwave resulted also in a shorter period of recruitment, lower recruitment rate and higher mortality of settlers. Despite the tissue regression, the majority of sponges that survived the extreme temperatures showed respiration rates similar to controls 13 days after the thermal peak, indicating some resilience of C. incrustans to extreme thermal events. Our study shows that marine heatwaves will significantly impact the physiology, morphology, and recruitment of temperate sponges under near-future conditions, but that these sponges are likely to persist in warmer oceans., Competing Interests: Declaration of competing interest The authors declare no known competing for financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Aim: Room service is a patient-focused foodservice model gaining interest in Australian hospitals following demonstrated patient and organisational benefits. This study aimed to compare nutritional intake, waste, patient satisfaction, meal costs and meal quality between a bought-in, thaw-retherm foodservice model and a cook-fresh, on-demand room service model at a large tertiary public hospital., Methods: A retrospective analysis of quality assurance data compared thaw-retherm to room service. Nutritional intake and plate waste were measured using a visual intake analysis tool; production waste was measured using weighted analysis methodology; patient satisfaction was measured using a validated patient satisfaction survey; meal quality was assessed using a validated meal quality audit tool, and meal costs were obtained from hospital finance reports. Independent sample t-tests or nonparametric equivalent (Mann-Whitney U-test) for continuous variables and Pearson's Chi-square for categorical data were applied for comparative purposes., Results: Average energy and protein intake, as well as percentage requirements met, improved between thaw-retherm and room service (4320 kJ/day vs 7265 kJ/day; 42.4 g/day vs 82.5 g/day; and 46% vs 80.7%; 49.9% vs 98.4%; all P < .001. Reductions in plate waste (40% vs 15%) and production waste (15% vs 5.6%, P < .001) were observed and food costs decreased by 9% with room service. Meal quality audit results improved, and patient satisfaction increased with % respondents satisfied increasing from 75.0% to 89.8% (χ 2 9.985[2]; P = .007) for room service., Conclusions: This research demonstrates significant improvements in patient and organisational outcomes with room service compared to a thaw-retherm model in a large public hospital., (© 2021 Dietitians Australia.)

Despite the global focus on the occurrence of regime shifts on shallow-water tropical coral reefs over the last two decades, most of this research continues to focus on changes to algal-dominated states. Here, we review recent reports (in approximately the last decade) of regime shifts to states dominated by animal groups other than zooxanthellate Scleractinian corals. We found that while there have been new reports of regime shifts to reefs dominated by Ascidacea, Porifera, Octocorallia, Zoantharia, Actiniaria and azooxanthellate Scleractinian corals, some of these changes occurred many decades ago, but have only just been reported in the literature. In most cases, these reports are over small to medium spatial scales (<4 × 104 m2 and 4 × 104 to 2 × 106 m2, respectively). Importantly, from the few studies where we were able to collect information on the persistence of the regime shifts, we determined that these non-scleractinian states are generally unstable, with further changes since the original regime shift. However, these changes were not generally back to coral dominance. While there has been some research to understand how sponge- and octocoral-dominated systems may function, there is still limited information on what ecosystem services have been disrupted or lost as a result of these shifts. Given that many coral reefs across the world are on the edge of tipping points due to increasing anthropogenic stress, we urgently need to understand the consequences of non-algal coral reef regime shifts., (© 2022 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society and the Royal Society of Biology.)

Ocean deoxygenation is one of the major consequences of climate change. In coastal waters, this process can be exacerbated by eutrophication, which is contributing to an alarming increase in the so-called 'dead zones' globally. Despite its severity, the effect of reduced dissolved oxygen has only been studied for a very limited number of organisms, compared to other climate change impacts such as ocean acidification and warming. Here, we experimentally assessed the response of sponges to moderate and severe simulated hypoxic events. We ran three laboratory experiments on four species from two different temperate oceans (NE Atlantic and SW Pacific). Sponges were exposed to a total of five hypoxic treatments, with increasing severity (3.3, 1.6, 0.5, 0.4 and 0.13 mg O 2  L -1 , over 7-12-days). We found that sponges are generally very tolerant of hypoxia. All the sponges survived in the experimental conditions, except Polymastia crocea, which showed significant mortality at the lowest oxygen concentration (0.13 mg O 2  L -1 , lethal median time: 286 h). In all species except Suberites carnosus, hypoxic conditions do not significantly affect respiration rate down to 0.4 mg O 2  L -1 , showing that sponges can uptake oxygen at very low concentrations in the surrounding environment. Importantly, sponges displayed species-specific phenotypic modifications in response to the hypoxic treatments, including physiological, morphological and behavioural changes. This phenotypic plasticity likely represents an adaptive strategy to live in reduced or low oxygen water. Our results also show that a single sponge species (i.e., Suberites australiensis) can display different strategies at different oxygen concentrations. Compared to other sessile organisms, sponges generally showed higher tolerance to hypoxia, suggesting that sponges could be favoured and survive in future deoxygenated oceans., (© 2021 John Wiley & Sons Ltd.)

Objectives. To compare the effectiveness of 3 approaches for communicating opioid risk during an emergency department visit for a common painful condition. Methods. This parallel, multicenter randomized controlled trial was conducted at 6 geographically disparate emergency department sites in the United States. Participants included adult patients between 18 and 70 years of age presenting with kidney stone or musculoskeletal back pain. Participants were randomly assigned to 1 of 3 risk communication strategies: (1) a personalized probabilistic risk visual aid, (2) a visual aid and a video narrative, or 3) general risk information. The primary outcomes were accuracy of risk recall, reported opioid use, and treatment preference at time of discharge. Results. A total of 1301 participants were enrolled between June 2017 and August 2019. There was no difference in risk recall at 14 days between the narrative and probabilistic groups (43.7% vs 38.8%; absolute risk reduction = 4.9%; 95% confidence interval [CI] = -2.98, 12.75). The narrative group had lower rates of preference for opioids at discharge than the general risk information group (25.9% vs 33.0%; difference = 7.1%; 95% CI = 0.64, 0.97). There were no differences in reported opioid use at 14 days between the narrative, probabilistic, and general risk groups (10.5%, 10.3%, and 13.3%, respectively; P  = .44). Conclusions. An emergency medicine communication tool incorporating probabilistic risk and patient narratives was more effective than general information in mitigating preferences for opioids in the treatment of pain but was not more effective with respect to opioid use or risk recall. Trial Registration. Clinical Trials.gov identifier: NCT03134092. ( Am J Public Health . 2022;112(S1):S45-S55. https://doi.org/10.2105/AJPH.2021.306511).

Tropical lagoon-inhabiting organisms live in highly irradiated ecosystems and are particularly susceptible to thermal stress resulting from climate change. However, despite living close to their thermal maxima, stress response mechanisms found in these organisms are poorly understood. We used a novel physiological-proteomic approach for sponges to describe the stress response mechanisms of the lagoon-inhabiting sponge Amphimedon navalis, when exposed to elevated seawater temperatures of +2°C and +4°C relative to a 26°C ambient temperature for 4 weeks. After 4 weeks of thermal exposure, the buoyant weight of the sponge experienced a significant decline, while its pumping rates and oxygen consumption rates significantly increased. Proteome dynamics revealed 50 differentially abundant proteins in sponges exposed to elevated temperature, suggesting that shifts in the sponge proteome were potential drivers of physiological dysfunction. Thermal stress promoted an increase in detoxification proteins, such as catalase, suggesting that an excess of reactive oxygen species in sponge cells was responsible for the significant increase in oxygen consumption. Elevated temperature also disrupted cellular growth and cell proliferation, promoting the loss of sponge biomass, and the high abundance of multiple α-tubulin chain proteins also indicated an increase in cytoskeletal activities within sponge cells, which may have induced the increase in sponge pumping rate. Our results show that sustained thermal exposure in susceptible lagoonal sponges may induce significant disruption of cellular homeostasis, leading to physiological dysfunction, and that a combined physiological-proteomic approach may provide new insights into physiological functions and cellular processes occurring in sponges., Competing Interests: Competing interests The authors declare no competing or financial interests., (© 2021. Published by The Company of Biologists Ltd.)

Aim: Models of hospital malnutrition care reliant on dietitians can be inefficient and of limited effectiveness. This study evaluated whether implementing the Systematised, Interdisciplinary Malnutrition Program for impLementation and Evaluation (SIMPLE) improved hospital nutrition care processes and patientreported experiences compared with traditional practice., Methods: A multi-site (five hospitals) prospective, pre-post study evaluated the facilitated implementation of SIMPLE, a malnutrition care pathway promoting proactive nutrition support delivered from time of malnutrition screening by the interdisciplinary team, without need for prior dietetic assessment. Implementation was tailored to local site needs and resources. Nutrition care processes delivered to inpatients who were malnourished or at-risk of malnutrition were identified across diagnosis, intervention, and monitoring domains using standardised audits from medical records, foodservice systems and patient-reported nutrition experience measures., Results: Pre-implementation (n = 365) and post-implementation (n = 397) cohorts were similar for age (74 vs 73 years), gender (47.1% vs 48.6% female), and nutrition risk status (46.6% vs 45.3% at-risk). Post-implementation, at-risk participants were more likely to receive enhanced food and fluids (68.5% vs 83.9%; P < .01), nutrition information (30.9% vs 47.2%; P < .01), mealtime assistance where required (61.4% vs 77.9% P = .04), nutrition monitoring (25.2% vs 46.3%; P < .01) and care planning (17.8% vs 27.7%; P = .01). Patient-reported nutrition experience measures confirmed improved nutrition care. There was no difference in dietetic occasions of service per patient (1.51 vs 1.25; P = .83)., Conclusions: Tailored SIMPLE implementation improves nutrition care processes and patient reported nutrition experience measures for at-risk inpatients within existing dietetic resources., (© 2021 Dietitians Australia.)

Temperate Mesophotic Ecosystems (TMEs) are stable habitats, usually dominated by slow-growing, long-lived sessile invertebrates and sciaphilous algae. Organisms inhabiting TMEs can form complex three-dimensional structures and support many commercially important species. However, TMEs have been poorly studied, with little known about their vulnerability to environmental impacts. Lough Hyne Marine Nature Reserve (Ireland) supports TMEs in shallower waters (12-40 m) compared with other locations (30-150+ m) as a result of the unusual hydrodynamic conditions. Here, we report changes that have occurred on the sponge-dominated cliffs at Lough Hyne between 1990 and 2019, providing insights into TME long-term stability and vulnerability to environmental impacts. Our main finding was a marked decline in most three-dimensional sponges at the internal sites of the lough. This was likely the result of one or more mass mortality events that occurred between 2010 and 2015. We also found an increase in ascidians, which might have been more tolerant and benefited from the space freed by the sponge mortality. Finally, in the most recent surveys, we found a high abundance of sponge recruits, indicating that a natural recovery may be underway. The possible factors involved in these community changes include eutrophication, increased temperature, and a toxic event due to an anomaly in the oxycline breakdown. However, the absence of comprehensive monitoring of biotic and abiotic variables makes it impossible to identify the cause with certainty. Our Lough Hyne example shows the potential vulnerability of TMEs to short-term disturbance events, highlighting the importance of monitoring these habitats globally to ensure they are appropriately conserved., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Sponges that excavate and inhabit calcareous substrate, predominantly of the Clionaidae, are widely distributed in marine habitats, but are particularly diverse and abundant on coral reefs. Unfortunately, their cryptic habit and difficult taxonomy mean respective taxa are poorly understood, and therefore they are rarely included in reef surveys. This is particularly true of the Southeast Asian Indo-Pacific, where a diverse faunistic record is contrasted with a very limited understanding of eco-physiological requirements of these sponges. In light of this, in situ surveys of the most common bioeroding sponges in the Wakatobi region of Southeast Sulawesi, Indonesia were conducted, followed by morphological and molecular analysis. The seven most common species in the Wakatobi included five species with a wide Indo-Pacific distribution and two new species. Four species, Cliona orientalis, Cliona aff. schmidtii, Spheciospongia cf. vagabunda trincomaliensis and Cliothosa hancocki have been previously reported from Indonesian waters, while Zyzzya criceta is a new record for Indonesia. Two brown sponges belonging to the Cliona viridis species complex, Cliona wakatobiensis sp. nov. and Cliona cribripora sp. nov., are here described as new to science. They were morphologically distinct from other species in the sample region and could not conclusively be allocated to any other known clionaid species. A maximum likelihood analysis of ITS1 rDNA revealed them to be phylogenetically closer to other Indo-Pacific species such as Cliona orientalis and Cliona thomasi than to other species within this taxon complex.

Malnutrition risk is identified in over one-third of inpatients; reliance on dietetics-delivered nutrition care for all "at-risk" patients is unsustainable, inefficient, and ineffective. This study aimed to identify and prioritise low-value malnutrition care activities for de-implementation and articulate systematised interdisciplinary opportunities. Nine workshops, at eight purposively sampled hospitals, were undertaken using the nominal group technique. Participants were asked "What highly individualised malnutrition care activities do you think we could replace with systematised, interdisciplinary malnutrition care?" and "What systematised, interdisciplinary opportunities do you think we should do to provide more effective and efficient nutrition care in our ward/hospital?" Sixty-three participants were provided five votes per question. The most voted de-implementation activities were low-value nutrition reviews (32); education by dietitian (28); assessments by dietitian for patients with malnutrition screening tool score of two (22); assistants duplicating malnutrition screening (19); and comprehensive, individualised nutrition assessments where unlikely to add value (15). The top voted alternative opportunities were delegated/skill shared interventions (55), delegated/skill shared education (24), abbreviated malnutrition care processes where clinically appropriate (23), delegated/skill shared supportive food/fluids (14), and mealtime assistance (13). Findings highlight opportunities to de-implement perceived low-value malnutrition care activities and replace them with systems and skill shared alternatives across hospital settings.

Background: Health insurance coverage may be associated with pediatric diabetes mellitus (DM) management. However, it is unknown how continuity of insurance coverage is associated with health care use outcomes in pediatric DM., Methods: We used the nationally representative 2016-2019 National Survey of Children's Health to examine how interruption of health insurance coverage may affect health care use among children with DM. Children ages 0-17 years with DM were included in the analysis. Outcomes included emergency department visits, specialist visits, and unmet health care needs in the last 12 months. Insurance coverage was classified as continuous private, continuous public, or discontinuous (including gaps in coverage and year-round lack of coverage)., Results: Based on a sample of 548 children, 56% percent had continuous private insurance coverage, as compared to 32% with continuous public insurance, and 12% with discontinuous coverage. Thirty-five percent of children had visited the ED in the past 12 months, and only 47% had visited any specialist in the past 12 months, including but not limited to a pediatric endocrinologist. An estimated 19% of children had unmet health care needs over the past 12 months. On multivariable analysis, children with coverage gaps were significantly less likely than children with continuous private coverage to have a visited a specialist in the past 12 months (adjusted odds ratio: 0.27; 95% CI: 0.08, 0.88; p = 0.030)., Conclusions: This study points to a need to establish and maintain specialist follow-up for children with DM, especially those from socioeconomically disadvantaged backgrounds., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Cognitive comorbidities often follow early-life seizures (ELS), especially in the setting of autism and other neurodevelopmental syndromes. However, there is an incomplete understanding of whether neuronal and synaptic development are concomitantly dysregulated. We have previously shown that hypoxia-induced seizures (HS) in postnatal day (P)10 rats increase acute and later-life hippocampal glutamatergic neurotransmission and spontaneous recurrent seizures, and impair cognition and behavior. As dendritic spines critically regulate synaptic function, we hypothesized that ELS can induce developmentally specific changes in dendritic spine maturation. At intervals during one month following HS in P10 rats, we assessed dendritic spine development on pyramidal neurons in the stratum radiatum of hippocampal area CA1. Compared to control rats in which spine density significantly decreased from P10 to early adulthood (P38), post-seizure rats failed to show a developmental decrease in spine density, and spines from P38 post-seizure rats appeared more immature-shaped (long, thin). In addition, compared to P38 control rats, post-seizure P38 rats expressed significantly more synaptic PSD-95, a marker of mature synapses. These changes were preceded by a transient increase in hippocampal expression of cofilin phosphorylated at Ser3, representing a decrease in cofilin activity. These results suggest that early-life seizures may impair normal dendritic spine maturation and pruning in CA1 during development, resulting in an excess of less efficient synapses, via activity-dependent modification of actin-regulating proteins such as cofilin. Given that multiple neurodevelopmental disorders show similar failures in developmental spine pruning, the current findings may represent a deficit in structural plasticity that could be a component of a mechanism leading to later-life cognitive consequences associated with early-life seizures., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background/aims: Crude diagnostic parameters such as BMI limit recognition of malnutrition in overweight and obese patients. This study applied a robust malnutrition diagnostic measure to investigate whether malnutrition impacts clinical outcomes in overweight or obese hip fracture inpatients., Methods: A prospective, consecutive 12-month audit of inpatients admitted to a dedicated hip fracture unit with a BMI of ≥25 for surgical intervention. Univariate and logistic regression analyses were performed to investigate the relationship of demographics (age, gender), comparative measures (type of fracture, Charlson Comorbidity Index (CCI) on admission, time to surgery, type of surgery and anaesthesia, nutrition status) and outcome measures (delirium, time to mobilise post-operatively, length of stay, 12-month mortality). Malnutrition was defined using the International Classification of Diseases, Tenth Revision - Australian Modification protein-energy malnutrition criteria., Results: 127 overweight or obese hip fracture patients for surgical intervention were included in analyses. Patients were predominantly older females (median 81.0, range 48-97 years; 66.9%). Malnutrition prevalence was not infrequent (18.3%) despite the median BMI of 28.3 (range 25.0-63.9). Mortality at 12-months (17.3%) was lower than routinely reported across broader hip fracture populations. Logistic regression modelling demonstrated that malnutrition increased the likelihood of 12-month mortality (OR: 4.47, 95% CI 1.27-15.77; p = 0.020), post-operative delirium (OR: 3.64, 95% CI 1.00 to 13.33; p = 0.051), and delayed post-operative mobility (OR: 3.29, 95% CI 1.05 to 10.31; p = 0.041), in overweight or obese hip fracture patients. Length of stay demonstrated poor association with all predictor measures., Conclusion: Hip fracture patients who are both overweight or obese, and malnourished, have significantly and substantially worse clinical outcomes than their well-nourished, albeit overweight or obese, counterparts. Comprehensive nutrition assessment measures should be applied to all hip fracture inpatients to ensure appropriate clinical nutrition care is appropriately directed., Competing Interests: Conflict of Interest The authors have no conflicts of interest to declare., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Aim: Restrictive diets are commonly prescribed to cardiac patients for therapeutic and preventative reasons. However, these are often contraindicated for malnourished, older patients. The present study aimed to explore dietary behaviours of malnourished older cardiac inpatients and identify sources of nutritional information., Methods: A cross-sectional study was conducted over 4 months in a cardiology ward. Data on inpatients' habitual dietary behaviour, duration and reasons for dietary practices, and sources of nutrition advice were obtained during a dietetic assessment. From the reported reasons for dietary practices, diets were categorised by the treating dietitian into 'clinically indicated' (CI) or 'not clinically indicated' (NCI) diets., Results: Sixty-seven malnourished patients were included, with mean age 76.6 ± 8.3 years and BMI 19.5 ± 6.2 kg/m 2 . Twenty-six (38.8%) reported at least one dietary restriction, 14 (20.9%) were on a high energy-high protein diet prior to hospitalisation and 27 (40.3%) were on nonrestrictive diets. Five (19.2%) restrictive diets were assessed as CI at the time of admission, while 21 (80.8%) were NCI diets. CI diets were mostly recommended by dietitians (n = 15, 78.9%). Recommendations for NCI restrictive diets came mainly from 'Other' sources (n = 10, 55.6%) including the internet, friends and family., Conclusions: Restrictive diets are common among malnourished cardiac inpatients with the majority no longer clinically indicated. It is important for dietitians to explore current dietary practices of malnourished older inpatients on admission. Inpatients following NCI diets may require additional time for education around nutritional priorities., (© 2019 Dietitians Association of Australia.)

Investigating historical gene flow in species complexes can indicate how environmental and reproductive barriers shape genome divergence during speciation. The processes influencing species diversification under environmental change remain one of the central focal points of evolutionary biology, particularly for marine organisms with high dispersal potential. We investigated genome-wide divergence, introgression patterns and inferred demographic history between species pairs of all six extant rock lobster species (Jasus spp.), which have a long larval duration of up to two years and have populated continental shelf and seamount habitats around the globe at approximately 40 o S. Genetic differentiation patterns reflected geographic isolation and the environment (i.e. habitat structure). Eastern Pacific species (J. caveorum and J. frontalis) were geographically more distant and genetically more differentiated from the remaining four species. Species associated with continental shelf habitats shared a common ancestry, but are geographically distant from one another. Similarly, species associated with island/seamount habitats in the Atlantic and Indian Oceans shared a common ancestry, but are also geographically distant. Benthic temperature was the environmental variable that explained most of the genetic differentiation (F ST ), while controlling for the effects of geographic distance. Eastern Pacific species retained a signal of strict isolation following ancient migration, whereas species pairs from Australia and Africa, and seamounts in the Indian and Atlantic oceans, included events of introgression after secondary contact. Our results reveal important effects of habitat and demographic processes on the recent divergence of species within the genus Jasus, providing one of the first empirical studies of genome-wide drivers of diversification that incorporates all extant species in a marine genus with long pelagic larval duration., (© 2020 John Wiley & Sons Ltd.)

While there is now strong evidence that many factors can shape dispersal, the mechanisms influencing connectivity patterns are species-specific and remain largely unknown for many species with a high dispersal potential. The rock lobsters Jasus tristani and Jasus paulensis have a long pelagic larval duration (up to 20 months) and inhabit seamounts and islands in the southern Atlantic and Indian Oceans, respectively. We used a multidisciplinary approach to assess the genetic relationships between J. tristani and J. paulensis , investigate historic and contemporary gene flow, and inform fisheries management. Using 17,256 neutral single nucleotide polymorphisms we found low but significant genetic differentiation. We show that patterns of connectivity changed over time in accordance with climatic fluctuations. Historic migration estimates showed stronger connectivity from the Indian to the Atlantic Ocean (influenced by the Agulhas Leakage). In contrast, the individual-based model coupled with contemporary migration estimates inferred from genetic data showed stronger inter-ocean connectivity in the opposite direction from the Atlantic to the Indian Ocean driven by the Subtropical Front. We suggest that the J. tristani and J. paulensis historical distribution might have extended further north (when water temperatures were lower) resulting in larval dispersal between the ocean basis being more influenced by the Agulhas Leakage than the Subtropical Front. As water temperatures in the region increase in accordance with anthropogenic climate change, a southern shift in the distribution range of J. tristani and J. paulensis could further reduce larval transport from the Indian to the Atlantic Ocean, adding complexity to fisheries management., Competing Interests: All authors declare that they have no competing interests., (© 2021 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Background: This study aimed to report (i) the prevalence of enteral tube feeding (ETF), (ii) investigate whether implementing a decision support tool influenced ETF rates, and (iii) understand reasons influencing decisions to offer ETF., Methods: A pre/post evaluation included consecutive patients admitted to a hip fracture unit. Following baseline data collection, a published ETF Decision Support Tool was implemented by the multidisciplinary team to determine the necessity and influencing reasons for offering ETF., Results: Pre-post groups ( n = 90,86) were well matched for age (83 vs. 84.5 years; p = 0.304) and gender (females 57 vs. 57; p = 0.683). ETF rates remained low across groups (pre/post n = 4,2; p = 0.683) despite high malnutrition prevalence (41.6% vs. 50.6%; p = 0.238). Diverse and conflicting reasons were identified regarding decisions to offer ETF., Conclusion: A complex interplay of factors influences the team decision-making process to offer ETF to nutritionally vulnerable patients. These demands are individualised, rather than algorithmic, involving shared decision-making and informed consent processes.

Aim: Shifting to models of care that incorporate delegation of nutrition care process actions to dietitian assistants could facilitate effective and efficient nutrition care delivery. This review aimed to determine if delegation of malnutrition care activities to dietitian assistants, when compared with routine nutrition care practices influences patient, healthcare and/or workforce outcomes for adult hospital inpatients with or at risk of malnutrition., Methods: This review was undertaken in accordance with PRISMA guidelines, with five databases (CINAHL, Medline, PsycINFO, Embase and Scopus) searched systematically for studies published up to and including February 2020. Exclusion criteria included review articles and studies conducted in community settings., Results: The search yielded 3431 results, with 11 studies eligible for inclusion. Across all domains of the nutrition care process, there is emerging evidence dietitian assistants may improve the delivery of nutrition care practices, patient, healthcare and workforce outcomes. Findings demonstrated various roles and scope of dietitian assistants' practice throughout the studies. Positive patient outcomes were found when dietitian assistants were part of a multi-disciplinary model of care., Conclusions: Implementing delegation of components of the nutrition care process to dietitian assistants is vital in the current health climate and should be considered in a future multidisciplinary model of nutrition care. Exploration of dietitian assistant roles and opportunities are required to expand and strengthen the evidence., (© 2020 Dietitians Australia.)

Sponges are a major component of benthic ecosystems across the world and fulfil a number of important functional roles. However, despite their importance, there have been few attempts to compare sponge assemblage structure and ecological functions across large spatial scales. In this review, we examine commonalities and differences between shallow water (<100 m) sponges at bioregional (15 bioregions) and macroregional (tropical, Mediterranean, temperate, and polar) scales, to provide a more comprehensive understanding of sponge ecology. Patterns of sponge abundance (based on density and area occupied) were highly variable, with an average benthic cover between ~1 and 30%. Sponges were generally found to occupy more space (percentage cover) in the Mediterranean and polar macroregions, compared to temperate and tropical macroregions, although sponge densities (sponges m -2 ) were highest in temperate bioregions. Mean species richness standardised by sampling area was similar across all bioregions, except for a few locations that supported very high small-scale biodiversity concentrations. Encrusting growth forms were generally the dominant sponge morphology, with the exception of the Tropical West Atlantic, where upright forms dominated. Annelids and Arthropods were the most commonly reported macrofauna associated with sponges across bioregions. With respect to reproduction, there were no patterns in gametic development (hermaphroditism versus gonochorism), although temperate, tropical, and polar macroregions had an increasingly higher percentage of viviparous species, respectively, with viviparity being the sole gamete development mechanism reported for polar sponges to date. Seasonal reproductive timing was the most common in all bioregions, but continuous timing was more common in the Mediterranean and tropical bioregions compared to polar and temperate bioregions. We found little variation across bioregions in larval size, and the dominant larval type across the globe was parenchymella. No pattens among bioregions were found in the limited information available for standardised respiration and pumping rates. Many organisms were found to predate sponges, with the abundance of sponge predators being higher in tropical systems. While there is some evidence to support a higher overall proportion of phototrophic species in the Tropical Austalian bioregion compared to the Western Atlantic, both also have large numbers of heterotrophic species. Sponges are important spatial competitors across all bioregions, most commonly being reported to interact with anthozoans and algae. Even though the available information was limited for many bioregions, our analyses demonstrate some differences in sponge traits and functions among bioregions, and among macroregions. However, we also identified similarities in sponge assemblage structure and function at global scales, likely reflecting a combination of regional- and local-scale biological and physical processes affecting sponge assemblages, along with common ancestry. Finally, we used our analyses to highlight geographic bias in past sponge research, and identify gaps in our understanding of sponge ecology globally. By so doing, we identified key areas for future research on sponge ecology. We hope that our study will help sponge researchers to consider bioregion-specific features of sponge assemblages and key sponge-mediated ecological processes from a global perspective., (© 2020 Cambridge Philosophical Society.)

Coral reefs are facing increasing pressure from rising seawater temperatures and ocean acidification. Sponges have been proposed as possible winners in the face of climate change; however, little is known about the mechanisms underpinning their predicted tolerance. Here we assessed whether microbiome-mediated cross-generational acclimatization could enable the photosynthetic sponge Carteriospongia foliascens to survive under future climate scenarios. To achieve this, we first established the potential for vertical (cross-generational) transmission of symbionts. Sixty-four amplicon sequence variants accounting for >90% of the total C. foliascens microbial community were present across adult, larval and juvenile life stages, showing that a large proportion of the microbiome is vertically acquired and maintained. When C. foliascens were exposed to climate scenarios projected for 2050 and 2100, the host remained visibly unaffected (i.e. no necrosis/bleaching) and the overall microbiome was not significantly different amongst treatments in adult tissue, the respective larvae or recruits transplanted amongst climate treatments. However, indicator species analysis revealed that parental exposure to future climate scenarios altered the presence and abundance of a small suite of microbial taxa in the recruits, thereby revealing the potential for microbiome-mediated cross-generational acclimatization through both symbiont shuffling and symbiont switching within a vertically acquired microbiome., (© 2020 Commonwealth of Australia. Environmental Microbiology © 2020 John Wiley & Sons Ltd. and Society for Applied Microbiology.)

Objective: We analyzed the impact of geographic distance from the clinic on adherence to recommended clinic visits and diabetes control among patients with type 1 diabetes (T1D) seen in a pediatric endocrinology clinic serving a rural region in eastern North Carolina., Methods: We retrospectively included patients with T1D age ≤20 years seen in our clinic during 2017. Outcomes were tracked until June 2018. Distance from the clinic was determined according to the zone improvement plan (ZIP) code of patient address. Visit adherence was defined based on the number of attended visits during the study period, aiming for 1 every 3 months. Glycated hemoglobin (HbA1c) was measured at the first and last visits during the review period., Results: The analysis included 368 patients, of whom 218 (59%) completed at least 1 visit every 3 months. The median HbA1c was 9.1 (interquartile range [IQR]: 8.0, 10.3) at the initial visit, and 9.3 (IQR: 8.0, 11.1) at the final visit. Median distance from the clinic was 56 km (IQR: 35, 86). On multivariable logistic regression, greater distance from the clinic was associated with lower odds of visit adherence (odds ratio per 10 km: 0.93; 95% confidence interval: 0.87, 0.99; p=0.030). Neither distance to the clinic nor clinic visit adherence were associated with HbA1c., Conclusions: Patients living further away from the clinic were less likely to adhere to the recommended visit schedule, but distance was not correlated with HbA1c levels. Further work is needed to assist families living far from the clinic with adhering to recommended visits., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

Background: Prescription opioid misuse in the United States is a devastating public health crisis; many chronic opioid users were originally prescribed this class of medication for acute pain. Video narrative-enhanced risk communication may improve patient outcomes, such as knowledge of opioid risk and opioid use behaviors after an episode of acute pain., Objective: Our objective is to assess the effect of probabilistic and narrative-enhanced opioid risk communication on patient-reported outcomes, including knowledge, opioid use, and patient preferences, for patients who present to emergency departments with back pain and kidney stone pain., Methods: This is a multisite randomized controlled trial. Patients presenting to the acute care facilities of four geographically and ethnically diverse US hospital centers with acute renal colic pain or musculoskeletal back and/or neck pain are eligible for this randomized controlled trial. A control group of patients receiving general risk information is compared to two intervention groups: one receiving the risk information sheet plus an individualized, visual probabilistic Opioid Risk Tool (ORT) and another receiving the risk information sheet plus a video narrative-enhanced probabilistic ORT. We will study the effect of probabilistic and narrative-enhanced opioid risk communication on the following: risk awareness and recall at 14 days postenrollment, reduced use or preferences for opioids after the emergency department episode, and alignment with patient preference and provider prescription. To assess these outcomes, we administer baseline patient surveys during acute care admission and follow-up surveys at predetermined times during the 3 months after discharge., Results: A total of 1302 patients were enrolled over 24 months. The mean age of the participants was 40 years (SD 14), 692 out of 1302 (53.15%) were female, 556 out of 1302 (42.70%) were White, 498 out of 1302 (38.25%) were Black, 1002 out of 1302 (76.96%) had back pain, and 334 out of 1302 (25.65%) were at medium or high risk. Demographics and ORT scores were equally distributed across arms., Conclusions: This study seeks to assess the potential clinical role of narrative-enhanced, risk-informed communication for acute pain management in acute care settings. This paper outlines the protocol used to implement the study and highlights crucial methodological, statistical, and stakeholder involvement as well as dissemination considerations., Trial Registration: ClinicalTrials.gov NCT03134092; https://clinicaltrials.gov/ct2/show/NCT03134092., International Registered Report Identifier (irrid): DERR1-10.2196/19496., (©Zachary F Meisel, Erica B Goldberg, Abby R Dolan, Esha Bansal, Karin V Rhodes, Erik P Hess, Carolyn C Cannuscio, Marilyn M Schapira, Jeanmarie Perrone, Melissa A Rodgers, Michael M Zyla, Jeffrey J Bell, Sharon McCollum, Frances S Shofer. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 24.09.2020.)

Marine sponge reefs usually comprise a complex array of taxonomically different sponge species, many of these hosting highly diverse microbial communities. The number of microbial species known to occupy a given sponge ranges from tens to thousands, bringing numerous challenges to their analysis. One way to deal with such complexity is to use a core microbiota approach, in which only prevalent and abundant microbes are considered. Here we aimed to test the strength and sensitivity of the core microbiota approach by applying different core definitions to 20 host sponge species. Application of increasingly stringent relative abundance and/or percentage occurrence thresholds to qualify as part of the core microbiota decreased the number of 'core' OTUs and phyla and, consequently, changed both alpha- and beta-diversity patterns. Moreover, microbial co-occurrence patterns explored using correlation networks were also affected by the core microbiota definition. The application of stricter thresholds resulted in smaller and less compartmentalized networks, with different keystone species. These results highlight that the application of different core definitions to phylogenetically disparate host species can result in the drawing of markedly different conclusions. Consequently, we recommend to assess the effects of different core community definitions on the specific system of study before considering its application., (© 2020 Society for Applied Microbiology and John Wiley & Sons Ltd.)

Aims and Objectives: To identify interventions to prevent and treat malnutrition in older adults, which can be integrated in nursing care, and to evaluate the effects of these interventions on outcomes related to malnutrition., Background: Older adults are at great risk for malnutrition, which can lead to a number of serious health problems. Nurses have an essential role in nutritional care for older adults. Due to a lack of evidence for nursing interventions, adequate nursing nutritional care still lags behind., Design: Systematic review., Method: We searched for and included randomised controlled trials on interventions, which can be integrated in nursing care for older adults, to prevent and treat malnutrition. We assessed the risk of bias with the Cochrane tool and evidence for outcomes with the GRADE. The PRISMA statement was followed for reporting., Results: We included 21 studies of which 14 studies had a high risk of bias. Identified interventions were oral nutritional supplements, food/fluid fortification or enrichment, dietary counselling and educational interventions. In evaluating the effects of these interventions on 11 outcomes related to malnutrition, significant and nonsignificant effects were found. We graded the certainty of evidence as very low to moderate., Conclusion: Although slight effects were found in protein intake and body mass index, there is no convincing evidence about the effectiveness of the four identified interventions. There seems no harm in using these interventions, although it should be kept in mind that the evidence is sparse. Therefore, there is a need for high-quality research in building evidence for interventions in nursing nutritional care., Relevance to Clinical Practice: Nurses can safely provide oral nutritional supplements and food/fluid fortification or enrichment, and give dietary counselling and education to older adults, as they are well placed to lead the essential processes of nutritional care to older adults., (© 2019 John Wiley & Sons Ltd.)

Sponges are often important components of coastal lagoons, however their responses to anthropogenic stressors remain poorly understood. Here, we tested the responses of three lagoon sponges, Neopetrosia exigua, Amphimedon navalis and Spheciospongia vagabunda from Mauritius (Western Indian Ocean), to nine temperature and nitrate combinations for 14 days. We found that elevated seawater temperature resulted in significant physiological responses in all species, but there was generally little negative effect of elevated nitrate. At the end of the experiment, the buoyant weight of all three species were significantly reduced, while for the two chlorophyll a-containing species, N. exigua and S. vagabunda, effective quantum yield (ΔF/Fm') of photosystem (PS) II, photosynthetic pigment concentrations, gross photosynthetic rate and gross photosynthesis to respiration (P:R) ratio were also reduced. Dark respiration rates were higher in all three species at elevated temperature. While these lagoon sponges appeared to be impacted by elevated temperature, here, we demonstrate that these species are physiologically tolerant to excess nitrate concentrations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Marine organisms that rely on environmental cues for reproduction are likely to experience shifts in reproductive phenology and output due to global climate change. To assess the role that the environment may play in the reproductive timing for temperate sponges, this study examined sexual and asexual reproduction in New Zealand sponge species ( Tethya bergquistae and the Tethya burtoni complex) and correlated reproductive output with temperature, chlorophyll- a concentration, and rainfall. Histological analyses of sponges collected monthly (from February 2015 to February 2017) revealed that these sponges are oviparous and gonochoristic and that they sexually reproduce annually during the austral summer. Both monthly collections and in situ monitoring revealed that Tethya spp. asexually bud continuously, but with greater intensity in the austral spring and summer. Temperature was positively associated with both sexual reproduction and budding, with seasonal cues appearing important. Future shifts in the environment that alter such cues are expected to affect population dynamics of these sponges.

Backgrounds: The ASA (American Society of Anaesthesiologists) Score is the current standard for measuring comorbidity in the Australian Hip Fracture registry, however it has never been validated for this purpose. Subsequently, a more appropriate and useful measure should be investigated. This study aimed to compare the ASA and Charlson Comorbidity Index (CCI) scores in predicting 12-month mortality following acute hip fracture., Methods: A retrospective analysis was performed on an audit database of patients who were admitted to an orthogeriatric unit in a public metropolitan hospital from November 2010 to October 2011. 12-month mortality data was linked through a dual search of Queensland Health and mortality registry data. The Charlson comorbidity index was retrospectively applied. Demographics (age, gender, admission residence) and covariates including ASA, CCI, fracture type, fixation type, cognitive impairment on admission, BMI and time to surgery were analysed with logistic regression. ROC curve analysis was performed to assess varying thresholds for each comorbidity system., Results: A total of 320 patients were available for audit. Unadjusted bivariate analysis demonstrated significant difference between groups regarding increased age (p = 0.004), ASA score (p<0.001), CCI (p = 0.002), age-adjusted CCI (p = 0.002) and admission from a care facility (p<0.001). Logistic regression analysis demonstrated that only ASA (p<0.001) and admission from a care facility (p<0.001, OR=3.36, 95% CI = 1.9 - 6.0) independently predicted 12-month mortality; CCI was not a significant predictor in any models (p = 0.827, age-adjusted CCI: p = 0.864). Using ROC analysis, the ASA (AUC=0.668) outperformed either CCI (AUC=0.607 (CCI), AUC=0.614 (CCI age-adjusted)., Conclusions: The ASA score is independently associated with 12-month mortality; this was not replicated using either version of the CCI. The data does not suggest using the CCI in registry level datasets for the purposes of predicting 12-month mortality., Competing Interests: Declaration of Competing Interests All authors have acknowledged that there are no conflicts of interest to declare relating to this work., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Suspended sediments can affect the health of marine benthic suspension feeders, with concomitant effects on community diversity, abundance and ecosystem function. Suspended sediment loads can become elevated through trawling and dredging, and via resuspension of bottom sediments and/or direct input from land during storms. We assessed the functioning (survival, respiration, morphology) of a common New Zealand cushion sponge, Crella incrustans (Carter, 1885), during four weeks of exposure to a gradient of suspended sediment concentrations (SSC). Survival was high, and oxygen consumption was not affected. Sponges did, however, develop apical fistules, a phenomenon never-before observed in this species. Although sediments accumulated internally within the sponges, around a third had cleared these sediments two weeks after the elevated SSCs were removed. The environments these sponges inhabit may predispose them to coping with high SSCs. Such experiments are useful for defining SSC tolerances, which may influence how such impacts can be managed., Competing Interests: Declaration of competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Inpatient falls continue to be a significant clinical issue, and while malnutrition is a known risk factors for falls, few studies have investigated its association with inpatient falls. This study aimed to explore the independent association between malnutrition and fall risk as well as harm from falls in hospital inpatients., Methods: Malnutrition identified in annual malnutrition audits was combined with inpatient fall data captured through the electronic patient incident reporting system in the 12 months following audit days. Audit data were available for 1,849 inpatients across 2011-2015, and covariate associations between age, gender, BMI, malnutrition, falls and harmful falls were analysed. The reporting of this paper is in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations (see Appendix S1)., Results: The prevalence of malnutrition was 32.4% (n = 543), and 171 (9.2%) inpatients experienced a fall with 0.7% (n = 13) categorised as harmful. In bivariate analysis, patients who fell were more likely to be older (median 79.0 vs. 70.0 years; p < .0001) or malnourished (40.9% vs. 31.5%; p = .021). Malnutrition (p < .0001) and having a lower BMI (p = .026) were significant predictors of harmful falls. Regression modelling demonstrated that only increasing age increased the likelihood of having an inpatient fall (OR 1.022 95% CI 1.021-1.046; p < .0001). Malnourished inpatients were almost 8 times more likely to have a harmful fall than those not malnourished (OR 7.94 95% CI 1.457-43.338; p = .017), independent of age and BMI., Conclusions: Malnourished patients are more likely to experience a harmful fall. Assessment of malnutrition should be incorporated into fall risk assessments as a way of highlighting those patients at greater risk and to link to nutritional care pathways., (© 2019 John Wiley & Sons Ltd.)

We performed a quality improvement intervention to increase universal lipid screening in well-child visits (age 9 to 11 years): 12-month preintervention; phase 1 (8 months) with provider education, group monthly chart review with feedback, and electronic health record cues to order lipids; and phase 2 (16 months) with electronic health record cues and examination room phlebotomy. Outcomes were compared with clinics having no intervention. In phase 1, immediate treatment effect on the regression line for provider behavior (proportion of visits with lipids ordered) showed 34% increase in intervention and 7% decrease in comparison clinics; patient behavior (phlebotomy completed) showed 19% increase in intervention and 5% decrease in comparison clinics. At the beginning of phase 2, the intervention clinic had average 44% orders entered and 33% phlebotomy completed per well-child visit, and these proportions were maintained. Provider education and chart review with feedback were associated with the greatest gains in outcomes.