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Background: Gut microbiota play a key role in the nutrition of many marine herbivorous fishes through hindgut fermentation of seaweed. Gut microbiota composition in the herbivorous fish Kyphosus sydneyanus (family Kyphosidae) varies between individuals and gut sections, raising two questions: (i) is community composition stable over time, especially given seasonal shifts in storage metabolites of dietary brown algae, and (ii) what processes influence community assembly in the hindgut? Results: We examined variation in community composition in gut lumen and mucosa samples from three hindgut sections of K. sydneyanus collected at various time points in 2020 and 2021 from reefs near Great Barrier Island, New Zealand. 16S rRNA gene analysis was used to characterize microbial community composition, diversity and estimated density. Differences in community composition between gut sections remained relatively stable over time, with little evidence of temporal variation. Clostridia dominated the proximal hindgut sections and Bacteroidia the most distal section. Differences were detected in microbial composition between lumen and mucosa, especially at genus level. Conclusions: High variation in community composition and estimated bacterial density among individual fish combined with low variation in community composition temporally suggests that initial community assembly involved environmental selection and random sampling/neutral effects. Community stability following colonisation could also be influenced by historical contingency, where early colonizing members of the community may have a selective advantage. The impact of temporal changes in the algae may be limited by the dynamics of substrate depletion along the gut following feeding, i.e. the depletion of storage metabolites in the proximal hindgut. Estimated bacterial density, showed that Bacteroidota has the highest density (copies/mL) in distal-most lumen section V, where SCFA concentrations are highest. Bacteroidota genera Alistipes and Rikenella may play important roles in the breakdown of seaweed into useful compounds for the fish host. [ABSTRACT FROM AUTHOR]

Background: Despite diversity initiatives, inequities persist in medicine with negative implications for the workforce and patients. Little is known about workplace inequity in nephrology. Aim: To describe perceptions and experiences of bias by health professionals in the Australian and New Zealand Society of Nephrology (ANZSN), focussing on gender and race. Methods: A web‐based survey of ANZSN members recorded degree of perceived inequity on a Likert scale, ranging from 1 (none) to 5 (complete). Groups were compared using Mann–Whitney U‐test and logistic regression. Comments were synthesised using qualitative methods to explore themes of inequity and pathways to an inclusive future. Results: Of the 620 members of the ANZSN, there were 134 (22%) respondents, of whom 57% were women and 67% were White. The majority (88%) perceived inequities in the workforce. Perceived drivers of inequity were gender (84/113; 75%), carer responsibilities (74/113; 65%) and race (64/113; 56%). Half (74/131) had personally experienced inequity, based on gender in 70% (52/74) and race in 39% (29/75) with perceived discrimination coming from doctors, patients, academics and health administrators. White males were least likely (odds ratio 0.39; 95% confidence interval 0.18–0.90) to experience inequity. Dominant themes from qualitative analysis indicated that the major impacts of inequity were limited opportunities for advancement and lack of formal assistance for those experiencing inequities. Proposed solutions to reduce inequity included normalising the discourse on inequity at an organisational level, with policy changes to ensure diverse representation on committees and in executive leadership positions. Conclusions: Inequity, particularly driven by gender and race, is common for nephrology health professionals in Australia and New Zealand and impacts career progression. [ABSTRACT FROM AUTHOR]

Digitate siliceous hot spring deposits are a form of biomediated sinter that is relatively common in the Taupo Volcanic Zone (TVZ), New Zealand, and elsewhere on Earth. Such deposits have gained prominence recently because of their morphological similarity to opaline silica rocks of likely hot spring origin found by the Spirit rover on Mars and the consequent implications for potential biosignatures there. Here, we investigate the possible relationship between microbial community composition and morphological diversity among digitate structures from actively forming siliceous hot spring sinters depositing subaerially in shallow discharge channels and around pool rims at several physicochemically distinct geothermal fields in the TVZ. The TVZ digitate sinters range in morphologic subtype from knobby to spicular, and are shown to be microstromatolites that grow under varied pH ranges, temperatures, and water chemistries. Scanning electron microscopy and molecular analyses revealed that TVZ digitate sinters are intimately associated with a diverse array of bacterial, archaeal and eukaryotic micro‐organisms, and for most digitate structures the diversity and quantity of prokaryotes was higher than that of eukaryotes. However, microbial community composition was not correlated with morphologic subtypes of digitate sinter, and observations provided limited evidence that pH (acidic versus alkali) affects morphology. Instead, results suggest hydrodynamics may be an important factor influencing variations in morphology, while water chemistry, pH, and temperature are strong drivers of microbial composition and diversity. [ABSTRACT FROM AUTHOR]

The article discusses the financial statement impact of the International Financial Reporting Standards (IFRS) implemented in New Zealand, particularly the International Accounting Standard (IAS) 12 which concerns income taxes. Topics explored include the IFRS adjustments for tax expense, other comprehensive income and equity, the handling of deferred tax by the New Zealand generally accepted accounting practice (GAAP), and the adoption of IAS 12 by the Canterbury Building Society (CBS).

An editorial is presented on examining emergency department inequities for outcomes in emergency department (ED) equitable. Topics include socioeconomic gradient of increasing proportion of ED presentations associated with increasing levels of socioeconomic deprivation appears steeper for Maori than non-Maori; and finding of increased proportion of Maori ED presentations in triage categories with longer waiting times should give all EDs pause for reflection.

A new chronology of large magnitude rainfall events derived from the continuous high-resolution Lake Tutira storm sediment record covers the last 6800 years and provides the first insight into changes in El Niño-Southern Oscillation (ENSO) teleconnections to the higher southern latitudes to be obtained from New Zealand. Synthesis with independent paleoclimate records from the tropical Pacific and Antarctica also reveals a millennial-scale waxing and waning of the teleconnections that were not visible in the narrow historical window previously used to view interactions between ENSO and the Southern Annular Mode (SAM). Consistent with modern ENSO behaviour, we find teleconnections to the Southwest Pacific varied throughout the middle and late Holocene, depending on the strength and phase of ENSO and the phase of the SAM. We suggest that precession-driven changes in the seasonal cycle of solar radiation exert a first-order control on the interaction between the two climate modes. Consequently, their present status may neither be indicative of conditions that prevailed earlier in the Holocene, nor of those that might be associated with future climate changes in the Southern Hemisphere extratropics. [ABSTRACT FROM AUTHOR]

Objective: To investigate adult presentations to North Shore Hospital, Auckland, New Zealand, following deliberate self-harm, determine re-presentation and suicide rates and investigate the characteristics of those patients who re-present. Methods: Retrospective review of a cohort of adult patients presenting to North Shore Hospital Emergency Care Centre in Auckland, New Zealand, with deliberate self-harm between 1 January 2001 and 31 August 2002, using data from the National Minimum Data Set and Hospital Discharge Database. The re-presentation rate was calculated as the percentage of patients presenting a second time within 1 year of their index presentation. The suicide rate was calculated as the percentage of patients with a coroner's verdict of suicide within 1 year of their index presentation of deliberate self-harm. Results: There were 1055 presentations by 754 people during the presentation period. Of these 754 people, 136 presented for a second time within a year of the index case (136/754 [18.0%, 95% CI 15.5–21.0]). Eight of the seven hundred and fifty-four people went on to commit suicide within 1 year (8/754 [1.1%, 95% CI 0.5–2.1]). Self-poisoning was the most common method of self-harm. Minor tranquillizers were used more commonly in the group who re-presented. Conclusion: Re-presentation and suicide rates in our study were similar to previously published rates. Further research is needed to identify strategies to reduce re-presentations and excess mortality in all people who deliberately self-harm. [ABSTRACT FROM AUTHOR]

Objectives: To determine previous computer training and current computer confidence of emergency medicine (EM) specialists and trainees, and to determine the accessibility of computer and Internet resources in New Zealand ED. Methods: A prospective, cross-sectional study of all New Zealand EM specialists and trainees between July 2005 and October 2005, using a 47-item postal questionnaire. Descriptive statistics with 95% confidence intervals were compiled. Fisher's exact test was used to compare proportions, with t-test and Mann–Whitney U-test to compare continuous variables. Results: A total of 226 EM specialists and trainees were sent questionnaires. In total, 144 (62 specialists and 82 trainees) out of 224 were analysed (response rate 64.3%). The majority of respondents (136, 94.4% (95% CI 89.4–97.6)) had access to a computer at home. Almost all respondents (143, 99.3% (95% CI 96.2–100.0)) also had computer access in the ED 24 h/day. The vast majority (140, 97.2% (95% CI 93.0–99.2)) had access to medical educational materials via the Internet in the ED 24 h/day. Most respondents had limited prior computer training. Respondents felt most confident using word processing and e-mail/communications applications, and least confident using statistical and graphics programs. Compared with specialists, trainees were significantly less confident with spreadsheets ( P = 0.002), literature searching ( P = 0.034), and e-mail/communications ( P = 0.040). Conclusions: Increased access to computer technology has not been parallelled by increased confidence in the use of computers among EM specialists and trainees. Training must address gaps in computer literacy if computer technology is to be used to its full potential. [ABSTRACT FROM AUTHOR]

This research examined what proportion of adults aged 65 years and over from the Canterbury and West Coast regions of New Zealand adhere to physical activity guidelines that recommend 30 minutes of physical activity on most, but preferably all, days of the week (Criterion 1). Alternatively, a physical activity threshold of 2.5 hours a week has been utilised by some New Zealand agencies to determine physical activity compliance (criterion 2). Participants' heart rates (hr) were continuously monitored and recorded every minute for 4 days, from waking in the morning until night. Sixty-two (31 female, 31 male) older individuals (age 71.6 ± 6.4 years, body weight 72.4 ± 11.7 kg, height 168.4 ± 8.8 cm, BMI 25.4 ± 3.8, mean ± sd) provided full sets of HR data. Participants were required to elevate their HR above 108 min-1 for the number of minutes necessary to meet each of the criteria. Only 18% of participants engaged in appropriate amounts of physical activity to meet criterion 1 and 40% to Criterion 2. Furthermore, physical activity participation diminished with advancing age, was relatively similar for males and females and was higher in Canterbury residents compared to their West Coast counterparts. The low compliance levels of older adults to the physical activity criteria signals the requirement for an enhanced research focus into the physical activity behaviours of older New Zealanders. [ABSTRACT FROM AUTHOR]

Abstract Objective: To examine mortality and morbidity associated with accidental poisoning in New Zealand for the period of 1993–97, and make comparisons with international trends. Methods: Poison Centre call data, and mortality and public hospital discharge data from the New Zealand Health Information Service were examined. Mortality and hospitalization rates were calculated. Statistical trends were examined using Poisson regression. Results: Poison Centre calls regarding household agents and therapeutics were most frequent. Accidental poisoning with analgesics, antipyretics and antirheumatics (18%) was a common cause of hospitalization. Children under 5 years had the highest hospitalization rates, but were less at risk of death by accidental poisoning than other age groups. Common causes of death from accidental poisoning included utility gas/carbon monoxide (16%), psychotropic agents (16%), and analgesics, etc. (15%). Mortality rates varied between 0.54 and 0.72/100 000 population. Conclusion: Mortality rates in New Zealand are lower than in many countries, but hospitalization rates are higher. Possible explanations and prevention implications are discussed. [ABSTRACT FROM AUTHOR]

• Although the molecular structure of β-keratins from the Archosaurs (birds, crocodiles), testudines (turtles) and squamates (lizards and snakes) has been studied for more than 50 years and the key parameters established by X-ray diffraction, infrared spectroscopy and sequence analysis, the research has lacked data on the Rhynchocephalia, the last branch of the lepidosaurs in the phylogenetic map. • This paper represents the culmination of the very considerable efforts that have been made over many years by a diverse group from New Zealand, Australia, Italy and the UK to collect and analyse the beta-keratin sequence data from tuatara, the sole representative of the Rhynchocephalia. • Also described is the X-ray diffraction pattern from tuatara claw and this is compared with those from other β-keratins. • In so doing this research advances the β-keratin story structure-wise for the sauropsids in general (birds and reptiles). • Now, at last, we have a totally consistent structural model across all members of the sauropsids. The birds and reptiles, collectively known as the sauropsids, can be subdivided phylogenetically into the archosaurs (birds, crocodiles), the testudines (turtles), the squamates (lizards, snakes) and the rhynchocephalia (tuatara). The structural framework of the epidermal appendages from the sauropsids, which include feathers, claws and scales, has previously been characterised by electron microscopy, infrared spectroscopy and X-ray diffraction analyses, as well as by studies of the amino acid sequences of the constituent β-keratin proteins (also referred to as the corneous β-proteins). An important omission in this work, however, was the lack of sequence and structural data relating to the epidermal appendages of the rhynchocephalia (tuatara), one of the two branches of the lepidosaurs. Considerable effort has gone into sequencing the tuatara genome and while this is not yet complete, there are now sufficient sequence data for conclusions to be drawn on the similarity of the β-keratins from the tuatara to those of other members of the sauropsids. These results, together with a comparison of the X-ray diffraction pattern of tuatara claw with those from seagull feather and goanna claw, confirm that there is a common structural plan in the β-keratins of all of the sauropsids, and not just those that comprise the archosaurs (birds and crocodiles), the testudines (turtles) and the squamates (lizards and snakes). [ABSTRACT FROM AUTHOR]

Kerr et al. interpret the perspectives of First Nations People striving for kidney health within the United States, Canada, Aotearoa (New Zealand), and Australia. The urgency for First Nations Peoples' perspectives and leadership in kidney health care, research, quality reporting, and publishing was confirmed. Advancing this internationally is within scope of high-impact journals, such as Kidney International. Tracking Sovereignty is a proposed framework supporting First Nation Peoples' representation and leadership within journal submission and publication processes., (Copyright © 2022 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)

Aims: Multidisciplinary team (MDT) meetings are a standard of care for lung cancer management in many regions around the world. Clinical quality indicators (CQIs) can be used to assess the proficiency of these multidisciplinary teams and compare their performance against those recommended by local and international guidelines. The effectiveness of the lung cancer MDT meeting at Dunedin Public Hospital has been evaluated using CQIs with a focus on the timeliness of surgical management., Methods: Medical records for all 108 patients who underwent curative intent oncological lung surgery at Dunedin Public Hospital between 2014-2020 were obtained. All patients were discussed at the lung cancer MDT meeting. Performance in six CQIs were evaluated as per the results below., Results: The CQI for timing of referral to first contact with a respiratory medicine specialist was met in all years studied by mean days. In all years bars for 2014 and 2017, the standard for time by mean days from referral date to surgery was met. In 2017, the mean time to surgery exceeded this standard by only one day. The mean time between respiratory specialist review and surgery was less than 56 days in all years except for 2014. By mean days, 2018 was the only year that surgery was performed within 31 days of discussion at the lung cancer MDT. Computed tomography (CT) guided biopsies and endobronchial ultrasound (EBUS) were only performed within a mean of seven days in only two years (2015 and 2017) out of the seven years of data. The target of all patients with curative small or non-small cell lung cancer receiving a positron emission tomography (PET) scan was not achieved in any year. Post-operative upstaging was more frequent than downstaging (19.4% vs 14.8%), and 71.4% of those upstaged received a PET scan pre-operatively. Māori patients and those with significant socio-economic deprivation were less likely to meet standards of lung cancer care., Conclusions: Between 2014-2020, the standards for lung cancer management in surgical patients were frequently achieved as measured by mean days. However, a target of ≥95% (90% for CQI 2; 100% for CQI 6) of patients receiving care at the standard was rarely met. Timing of CT biopsy and EBUS was consistently longer than recommended, and pre-operative PET utilisation was less than 100%. Thus, there is still room for improvement in surgical lung cancer management in the Southern Health District., Competing Interests: Nil.

A lysosomal storage disease, identified as a mucopolysaccharidosis (MPS), was diagnosed in a free-living Kaka (Nestor meridionalis), an endemic New Zealand parrot, which exhibited weakness, incoordination, and seizures. Histopathology showed typical colloid-like cytoplasmic inclusions in Purkinje cells and many other neurons throughout the brain. Electron microscopy revealed that storage bodies contained a variety of linear, curved, or circular membranous profiles and electron-dense bodies. Because the bird came from a small isolated population of Kaka in the northern South Island, a genetic cause was deemed likely. Tandem mass spectrometry revealed increased levels of heparan sulfate-derived disaccharides in the brain and liver compared with tissues from controls. Enzymatic assays documented low levels of iduronate-2-sulfatase activity, which causes a lysosomal storage disorder called MPS type II or Hunter syndrome. A captive breeding program is currently in progress, and the possibility of detecting carriers of this disorder warrants further investigation., (© Wildlife Disease Association 2021.)

Background: Terrestrial hot spring settings span a broad spectrum of physicochemistries. Physicochemical parameters, such as pH and temperature, are key factors influencing differences in microbial composition across diverse geothermal areas. Nonetheless, analysis of hot spring pools from the Taupo Volcanic Zone (TVZ), New Zealand, revealed that some members of the bacterial genus, Acidithiobacillus, are prevalent across wide ranges of hot spring pHs and temperatures. To determine the genomic attributes of Acidithiobacillus that inhabit such diverse conditions, we assembled the genomes of 19 uncultivated hot spring Acidithiobacillus strains from six geothermal areas and compared these to 37 publicly available Acidithiobacillus genomes from various habitats., Results: Analysis of 16S rRNA gene amplicons from 138 samples revealed that Acidithiobacillus comprised on average 11.4 ± 16.8% of hot spring prokaryotic communities, with three Acidithiobacillus amplicon sequence variants (ASVs) (TVZ&#95;G1, TVZ&#95;G2, TVZ&#95;G3) accounting for > 90% of Acidithiobacillus in terms of relative abundance, and occurring in 126 out of 138 samples across wide ranges of temperature (17.5-92.9 °C) and pH (1.0-7.5). We recovered 19 environmental genomes belonging to each of these three ASVs, as well as a fourth related group (TVZ&#95;G4). Based on genome average nucleotide identities, the four groups (TVZ&#95;G1-TVZ&#95;G4) constitute distinct species (ANI < 96.5%) of which three are novel Acidithiobacillus species (TVZ&#95;G2-TVZ&#95;G4) and one belongs to Acidithiobacillus caldus (TVZ&#95;G1). All four TVZ Acidithiobacillus groups were found in hot springs with temperatures above the previously known limit for the genus (up to 40 °C higher), likely due to significantly higher proline and GC contents than other Acidithiobacillus species, which are known to increase thermostability. Results also indicate hot spring-associated Acidithiobacillus have undergone genome streamlining, likely due to thermal adaptation. Moreover, our data suggest that Acidithiobacillus prevalence across varied hot spring pHs is supported by distinct strategies, whereby TVZ&#95;G2-TVZ&#95;G4 regulate pH homeostasis mostly through Na + /H + antiporters and proton-efflux ATPases, whereas TVZ&#95;G1 mainly relies on amino acid decarboxylases., Conclusions: This study provides insights into the distribution of Acidithiobacillus species across diverse hot spring physichochemistries and determines genomic features and adaptations that potentially enable Acidithiobacillus species to colonize a broad range of temperatures and pHs in geothermal environments. Video Abstract.

The human pathogens Neisseria gonorrhoeae and Neisseria meningitidis share high genome identity. Retrospective analysis of surveillance data from New Zealand indicates the potential cross-protective effect of outer membrane vesicle (OMV) meningococcal serogroup B vaccine (MeNZB) against N. gonorrhoeae A licensed OMV-based MenB vaccine, MenB-4C, consists of a recombinant FHbp, NhbA, NadA, and the MeNZB OMV. Previous work has identified several abundantly expressed outer membrane proteins (OMPs) as major components of the MenB-4C OMV with high sequence similarity between N. gonorrhoeae and N. meningitidis , suggesting a mechanism for cross-protection. To build off these findings, we performed comparative genomic analysis on 970 recent N. gonorrhoeae isolates collected through a U.S surveillance system against N. meningitidis serogroup B (NmB) reference sequences. We identified 1,525 proteins that were common to both Neisseria species, of which 57 proteins were predicted to be OMPs using in silico methods. Among the MenB-4C antigens, NhbA showed moderate sequence identity (73%) to the respective gonococcal homolog, was highly conserved within N. gonorrhoeae , and was predicted to be surface expressed. In contrast, the gonococcal FHbp was predicted not to be surface expressed, while NadA was absent in all N. gonorrhoeae isolates. Our work confirmed recent observations (E. A. Semchenko, A. Tan, R. Borrow, and K. L. Seib, Clin Infect Dis, 2018, https://doi.org/10.1093/cid/ciy1061) and describes homologous OMPs from a large panel of epidemiologically relevant N. gonorrhoeae strains in the United States against NmB reference strains. Based on our results, we report a set of OMPs that may contribute to the previously observed cross-protection and provide potential antigen targets to guide the next steps in gonorrhea vaccine development. IMPORTANCE Gonorrhea, a sexually transmitted disease, causes substantial global morbidity and economic burden. New prevention and control measures for this disease are urgently needed, as strains resistant to almost all classes of antibiotics available for treatment have emerged. Previous reports demonstrate that cross-protection from gonococcal infections may be conferred by meningococcal serogroup B (MenB) outer membrane vesicle (OMV)-based vaccines. Among 1,525 common proteins shared across the genomes of both N. gonorrhoeae and N. meningitidis , 57 proteins were predicted to be surface expressed (outer membrane proteins [OMPs]) and thus preferred targets for vaccine development. The majority of these OMPs showed high sequence identity between the 2 bacterial species. Our results provide valuable insight into the meningococcal antigens present in the current OMV-containing MenB-4C vaccine that may contribute to cross-protection against gonorrhea and may inform next steps in gonorrhea vaccine development.

Background: Efforts to safely reduce length of stay for emergency department patients with symptoms suggestive of acute coronary syndrome (ACS) have had mixed success. Few system-wide efforts affecting multiple hospital emergency departments have ever been evaluated. We evaluated the effectiveness of a nationwide implementation of clinical pathways for potential ACS in disparate hospitals., Methods: This was a multicenter pragmatic stepped-wedge before-and-after trial in 7 New Zealand acute care hospitals with 31 332 patients investigated for suspected ACS with serial troponin measurements. The implementation was a clinical pathway for the assessment of patients with suspected ACS that included a clinical pathway document in paper or electronic format, structured risk stratification, specified time points for electrocardiographic and serial troponin testing within 3 hours of arrival, and directions for combining risk stratification and electrocardiographic and troponin testing in an accelerated diagnostic protocol. Implementation was monitored for >4 months and compared with usual care over the preceding 6 months. The main outcome measure was the odds of discharge within 6 hours of presentation RESULTS: There were 11 529 participants in the preimplementation phase (range, 284-3465) and 19 803 in the postimplementation phase (range, 395-5039). Overall, the mean 6-hour discharge rate increased from 8.3% (range, 2.7%-37.7%) to 18.4% (6.8%-43.8%). The odds of being discharged within 6 hours increased after clinical pathway implementation. The odds ratio was 2.4 (95% confidence interval, 2.3-2.6). In patients without ACS, the median length of hospital stays decreased by 2.9 hours (95% confidence interval, 2.4-3.4). For patients discharged within 6 hours, there was no change in 30-day major adverse cardiac event rates (0.52% versus 0.44%; P =0.96). In these patients, no adverse event occurred when clinical pathways were correctly followed., Conclusions: Implementation of clinical pathways for suspected ACS reduced the length of stay and increased the proportions of patients safely discharged within 6 hours., Clinical Trial Registration: URL: https://www.anzctr.org.au/ (Australian and New Zealand Clinical Trials Registry). Unique identifier: ACTRN12617000381381., (© 2017 American Heart Association, Inc.)

New Zealand and Argentine (Late Jurassic-Recent) siliceous hot-spring deposits (sinter) reveal preservation pathways of environmentally controlled, microbe-dominated sedimentary facies over geological time scales. Texturally distinctive, laminated to thinly layered, dense and vertically oriented, microtubular "palisade" fabric is common in low-temperature (<40°C) sinter-apron terraces. In modern hot springs, the dark green to brown, sheathed, photosynthetic cyanobacterium Calothrix spp. (family Rivulariaceae) constructs felted palisade mats in shallow terrace(tte) pools actively accreting opaline silica. The resulting stacked layers of silicified coarse filaments-a stromatolite-are highly porous and readily modified by postdepositional environmental perturbations, secondary silica infill, and diagenetic silica phase mineral transformations (opal-A to quartz). Fossil preservation quality is affected by relative timing of silicification, and later environmental and geological events. A systematic approach was used to characterize palisade fabric in sinters of different ages to refine tools for recognizing biosignatures in extreme environments and to track their long-term preservation pathways into the geological record. Molecular techniques, scanning electron microscopy, Raman spectrometry, X-ray powder diffraction, petrography, and lipid biomarker analyses were applied. Results indicate that microbial communities vary at the micron scale and that early and rapid silicification is paramount to long-term preservation, especially where minimal postdepositional disturbance follows fossilization. Overall, it appears that the most robust biomarkers of fossil microbial activity in hot-spring deposits are their characteristic macro- and microtextures and laser micro-Raman identified carbon. Studies of Phanerozoic geothermal deposits with mineralized microbial components are relevant analogs for Precambrian geobiology because early life is commonly preserved as microbial microfossils and biofilms in silica, some of it hydrothermal in origin. Yet the diagenetic "movie" has already been run. Hence, studying younger sinters of a range of ages provides an opportunity to "play it again" and follow the varied influences on biosignatures into the deep-time geological record.

Objectives: The purpose of this study was to compare the effects of N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided therapy with those of intensive clinical management and with usual care (UC) on clinical outcomes in chronic symptomatic heart failure., Background: Initial trial results suggest titration of therapy guided by serial plasma B-type natriuretic peptide levels improves outcomes in patients with chronic heart failure, but the concept has not received widespread acceptance. Accordingly, we conducted a longer-term study comparing the effects of NT-proBNP-guided therapy with those of intensive clinical management and with UC of patients with heart failure., Methods: Three hundred sixty-four patients admitted to a single hospital with heart failure were randomly allocated 1:1:1 (stratified by age) to therapy guided by NT-proBNP levels or by intensive clinical management, or according to UC. Treatment strategies were applied for 2 years with follow-up to 3 years., Results: One-year mortality was less in both the hormone- (9.1%) and clinically-guided (9.1%) groups compared with UC (18.9%; p = 0.03). Three-year mortality was selectively reduced in patients

Changes in shift work patterns have meant that patients presenting to a hospital fracture clinic for follow-up may see a different doctor on each visit. Clear clinical notes are essential in this setting, for both clinical and medico-legal reasons. We tried to improve documentation in the fracture clinic by using an education intervention followed by the introduction of a fracture clinic template. Audits were performed at baseline in January 2002, then in July 2002 after the education intervention, in October 2002 after the template introduction, and finally in March 2005. The combined approach of education and involving staff in design of the template followed by introduction of the template, resulted in a significant and sustained improvement in fracture clinic documentation.

Exopolymeric substances (EPS) are an integral component of microbial biofilms; however, few studies have addressed their silicification and preservation in hot-spring deposits. Through comparative analyses with the use of a range of microscopy techniques, we identified abundant EPS significant to the textural development of spicular, microstromatolitic, siliceous sinter at Champagne Pool, Waiotapu, New Zealand. Examination of biofilms coating sinter surfaces by confocal laser scanning microscopy (CLSM), environmental scanning electron microscopy (ESEM), cryo-scanning electron microscopy (cryo-SEM), and transmission electron microscopy (TEM) revealed contraction of the gelatinous EPS matrix into films (approximately 10 nm thick) or fibrillar structures, which is common in conventional SEM analyses and analogous to products of naturally occurring desiccation. Silicification of fibrillar EPS contributed to the formation of filamentous sinter. Matrix surfaces or dehydrated films templated sinter laminae (nanometers to microns thick) that, in places, preserved fenestral voids beneath. Laminae of similar thickness are, in general, common to spicular geyserites. This is the first report to demonstrate EPS templation of siliceous stromatolite laminae. Considering the ubiquity of biofilms on surfaces in hot-spring environments, EPS silicification studies are likely to be important to a better understanding of the origins of laminae in other modern and ancient stromatolitic sinters, and EPS potentially may serve as biosignatures in extraterrestrial rocks.