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Supplemental Digital Content is Available in the Text. Background: The World Health Organization (WHO) recommends tuberculosis (TB) diagnostic evaluation for children with HIV (CHIV) who have history of TB contact, poor weight gain, cough, or fever. These screening criteria were developed based on studies of symptomatic CHIV with incomplete microbiologic confirmation. We performed routine TB microbiologic evaluation of hospitalized CHIV with and without symptoms to develop a data-driven TB symptom screen. Methods: Among hospitalized antiretroviral therapy–naive Kenyan CHIV enrolled in the Pediatric Urgent Start of Highly Active Antiretroviral Therapy (PUSH) trial, we performed Xpert MTB/RIF and mycobacterial culture of respiratory and stool specimens independent of TB symptoms. We evaluated performance of WHO and other published pediatric TB screening criteria and derived optimized criteria using a combination of symptoms. Results: Of 168 CHIV who underwent TB microbiologic evaluation, 13 (8%) had confirmed TB. WHO TB symptom screening had 100% sensitivity and 4% specificity to detect confirmed TB. Published TB screening criteria that relied on prolonged symptoms missed cases of confirmed TB (sensitivity 85%–92%). An optimized symptom screen including weight loss, cough, anorexia, or TB contact had 100% sensitivity and improved specificity (31%) compared with the WHO pediatric TB symptom screen. Conclusions: The WHO TB symptom screen was highly sensitive but resulted in a high proportion of hospitalized CHIV who would require TB diagnostic evaluation. Other published TB screening criteria missed CHIV with confirmed TB. Our optimized screening tool increased specificity while preserving sensitivity. Future multicenter studies are needed to improve TB screening tools for CHIV in both inpatient and outpatient settings. [ABSTRACT FROM AUTHOR]

The article discusses research which examined preexposure prophylaxis against HIV-1 infection in women in Africa. Topics covered include the use of oral tenofovir disoproxil fumarate, oral tenofovir-emtricitabine or tenofovir vaginal gel in patients, the incidence of HIV-1 infection among study participants and the elevations of serum creatinine levels among participants.

Background: Approximately 102,000 individuals live with an excretory stoma in the UK. Existing research shows huge variation in how individuals experience living with a new stoma but little is known of the individual experience of contemporary health care from the patient perspective. Objective: To explore the individual experience of living with a new stoma and interactions with healthcare over time with the purpose of informing health care services. Design: An existential phenomenological methodology underpinned interviews with twelve people with a new stoma at three, nine and fifteen months post-surgery. Ten healthcare professionals were interviewed on one occasion to provide adjunct data. Methods: Open one-to one exploratory interviews lasting 35-90 min were conducted by one researcher using topic guides. A five-staged analytical framework facilitated iterative scrutiny of data to give a universal understanding of the experience. Results: Three themes of healthcare experiences of people following stoma-forming surgery were identified: Relationships with health care professionals; being prepared; and regaining autonomy. They revealed how building a new sense of embodied self and increasing social confidence was facilitated by regaining physical capacity, mastering stoma function, purposeful care, and acceptance and support of others. Some conflict between the role of specialist and ward-based nurses is highlighted. Provision of responsive healthcare from all disciplines helped to establish patient self-determination in adaptation to and acceptance of self-with-a-stoma. Conclusions: The study contributes to defining a plan of care that assists individuals with a new stoma to adapt to and accept a changed sense of embodied self. It highlights the powerful influence of health care professionals in facilitating this process through their knowledge, experience and individual approaches to care. There is an identified need for ongoing review of the work of nurses and others providing care for patients following stomaforming surgery. The findings of this UK study can have resonance with patient healthcare experiences in other countries, if, despite cultural differences in delegation of professional duties and responsibilities, the global aim is to facilitate meeting individual patient needs. [ABSTRACT FROM AUTHOR]

Background and Purpose. The health system is increasingly engaging in a wider concept of health which includes lifestyle conditions and well being as well as disease. This challenges physiotherapy educators to take an active role in preparing students for modern health care. Few studies have explored the experience of learning to be a physiotherapist from the student perspective to help illuminate the learning process. The aim of this study was to gain a higher level of theoretical understanding of the longitudinal process of students' learning to be a physiotherapist across the curriculum. Methods. A metasynthesis design was used to analyse the findings of four individual research studies, based on interviews with a cohort of 18 physiotherapy students. A qualitative phenomenographic approach to analysis was adopted within the metasynthesis. Results. Three patterns of learning, described as ‘Learning to cure body structure’, ‘Learning to educate about movement problems’ and ‘Learning to manage peoples' health’ indicate differences in the focus of learning, the ways in which learning occurs, the learning partners and the context of learning. Conclusion. A variation in patterns of learning identified in students' experience of learning to be a physiotherapist reflects different views of knowledge and learning throughout the education programme which progresses the theoretical base on which models of education can be developed. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Healthcare education across Europe aims to prepare students for service in healthcare provision that increasingly focuses on client-centred care. Broadening access to professional courses can result in student cohorts that include a range of ages and educational backgrounds. The aim of this study was to explore the learning experiences valued by first-year physiotherapy students in two European universities. Eighteen students were strategically selected for diversity of gender, age, educational background and previous work experiences. A qualitative approach was taken. A commonly developed interview guide was used to guide data collection through semistructured interviews that were carried out at the end of the first and second semester of the first year. Thematic analysis of interview transcripts, within and across countries, revealed themes of valued learning experiences from participation in clinical contexts, observation in clinical practice settings, learning from others and self, and learning from support and feedback. The findings suggest that educators should look more closely to ensure a match between the learning experiences valued by their students and their own approach to teaching, if they want to enhance students' preparation for the contemporary needs of the profession. [ABSTRACT FROM AUTHOR]

Functional traits determine an organism's performance in a given environment and as such determine which organisms will be found where. Species respond to local conditions, but also to larger scale gradients, such as climate. Trait ecology links these responses of species to community composition and species distributions. Yet, we often do not know which environmental gradients are most important in determining community trait composition at either local or biogeographical scales, or their interaction. Here we quantify the relative contribution of local and climatic conditions to the structure and composition of functional traits found within bromeliad invertebrate communities. We conclude that climate explains more variation in invertebrate trait composition within bromeliads than does local conditions. Importantly, climate mediated the response of traits to local conditions; for example, invertebrates with benthic life‐history traits increased with bromeliad water volume only under certain precipitation regimes. Our ability to detect this and other patterns hinged on the compilation of multiple fine‐grained datasets, allowing us to contrast the effect of climate versus local conditions. We suggest that, in addition to sampling communities at local scales, we need to aggregate studies that span large ranges in climate variation in order to fully understand trait filtering at local, regional and global scales. [ABSTRACT FROM AUTHOR]

Aim: Locally abundant species are usually widespread, and this pattern has been related to properties of the niches and traits of species. However, such explanations fail to account for the potential of traits to determine species niches and often overlook statistical artefacts. Here, we examine how trait distinctiveness determines the abilities of species to exploit either common habitats (niche position) or a range of habitats (niche breadth) and how niche position and breadth, in turn, affect abundance and occupancy. We also examine how statistical artefacts moderate these relationships. Location: Sixteen sites in the Neotropics. Time period: 1993–2014. Major taxa studied: Aquatic invertebrates from tank bromeliads. Methods: We measured the environmental niche position and breadth of each species and calculated its trait distinctiveness as the average trait difference from all other species at each site. Then, we used a combination of structural equation models and a meta‐analytical approach to test trait–niche relationships and a null model to control for statistical artefacts. Results: The trait distinctiveness of each species was unrelated to its niche properties, abundance and occupancy. In contrast, niche position was the main predictor of abundance and occupancy; species that used the most common environmental conditions found across bromeliads were locally abundant and widespread. Contributions of niche breadth to such patterns were attributable to statistical artefacts, indicating that effects of niche breadth might have been overestimated in previous studies. Main conclusions: Our study reveals the generality of niche position in explaining one of the most common ecological patterns. The robustness of this result is underscored by the geographical extent of our study and our control of statistical artefacts. We call for a similar examination across other systems, which is an essential task to understand the drivers of commonness across the tree of life. [ABSTRACT FROM AUTHOR]

A total of 478 students from 8 disciplines, including social work, participated in an interprofessional education (IPE) Screening, Brief Intervention, and Referral to Treatment (SBIRT) project. A mixed methods evaluation measured student performance and perceptions of the potential impact of the training. Over 90% of student participants indicated that the IPE SBIRT experience laid the foundation for developing interprofessional collaborative care relationships and served as a cornerstone to help understand one's respective role as a member of a health care team. Furthermore, students believed the training enhanced their overall educational experience and interprofessional care would lead to improved patient outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Stoichiometric differences among organisms can affect trophic interactions and rates of nutrient cycling within ecosystems. However, we still know little about either the underlying causes of these stoichiometric differences or the consistency of these differences across large geographical extents. Here, we analyse elemental (carbon, nitrogen, phosphorus) composition of 872 aquatic macroinvertebrates (71 species) inhabiting tank bromeliads (n = 140) from five distantly located sites across Central and South America to (i) test phylogenetic, trophic and body size scaling explanations for why organisms differ in elemental composition and (ii) determine whether patterns in elemental composition are universal or context dependent. Taxonomy explained most variance in elemental composition, even though phylogenetic signals were weak and limited to regional spatial extents and to the family level. The highest elemental contents and lowest carbon:nutrient ratios were found in organisms at high trophic levels and with smaller body size, regardless of geographical location. Carnivores may have higher nutrient content and lower carbon:nutrient ratios than their prey, as organisms optimize growth by choosing the most nutrient‐rich resources to consume and then preferentially retain nutrients over carbon in their bodies. Smaller organisms grow proportionally faster than large organisms and so are predicted to have higher nutrient requirements to fuel RNA and protein synthesis. Geography influenced the magnitude, more than the direction, of the ecological and/or phylogenetic effects on elemental composition. Overall, our results show that both ecological (i.e. trophic group) and evolutionary drivers explain among‐taxa variation in the elemental content of invertebrates, whereas intraspecific variation is mainly a function of body size. Our findings also demonstrate that restricting analyses of macroinvertebrate stoichiometry solely to either the local scale or species level affects inferences of the patterns in invertebrate elemental content and their underlying mechanisms. A plain language summary is available for this article. [ABSTRACT FROM AUTHOR]

Abstract: Functional traits are commonly used in predictive models that link environmental drivers and community structure to ecosystem functioning. A prerequisite is to identify robust sets of continuous axes of trait variation, and to understand the ecological and evolutionary constraints that result in the functional trait space occupied by interacting species. Despite their diversity and role in ecosystem functioning, little is known of the constraints on the functional trait space of invertebrate biotas of entire biogeographic regions. We examined the ecological strategies and constraints underlying the realized trait space of aquatic invertebrates, using data on 12 functional traits of 852 taxa collected in tank bromeliads from Mexico to Argentina. Principal Component Analysis was used to reduce trait dimensionality to significant axes of trait variation, and the proportion of potential trait space that is actually occupied by all taxa was compared to null model expectations. Permutational Analyses of Variance were used to test whether trait combinations were clade‐dependent. The major axes of trait variation represented life‐history strategies optimizing resource use and antipredator adaptations. There was evidence for trophic, habitat, defence and life‐history niche axes. Bromeliad invertebrates only occupied 16%–23% of the potential space within these dimensions, due to greater concentrations than predicted under uniform or normal distributions. Thus, despite high taxonomic diversity, invertebrates only utilized a small number of successful ecological strategies. Empty areas in trait space represented gaps between major phyla that arose from biological innovations, and trait combinations that are unviable in the bromeliad ecosystem. Only a few phylogenetically distant genera were neighbouring in trait space. Trait combinations aggregated taxa by family and then by order, suggesting that niche conservatism was a widespread mechanism in the diversification of ecological strategies. A plain language summary is available for this article. [ABSTRACT FROM AUTHOR]

Abstract: Despite ongoing research in food web ecology and functional biogeography, the links between food web structure, functional traits and environmental conditions across spatial scales remain poorly understood. Trophic niches, defined as the amount of energy and elemental space occupied by species and food webs, may help bridge this divide. Here, we ask how the functional traits of species, the environmental conditions of habitats and the spatial scale of analysis jointly determine the characteristics of trophic niches. We used isotopic niches as a proxy of trophic niches, and conducted analyses at spatial scales ranging from local food webs and metacommunities to geographically distant sites. We sampled aquatic macroinvertebrates from 104 tank bromeliads distributed across five sites from Central to South America and compiled the macroinvertebrates’ functional traits and stable isotope values (δ15N and δ13C). We assessed how isotopic niches within each bromeliad were influenced by the functional trait composition of their associated invertebrates and environmental conditions (i.e., habitat size, canopy cover [CC] and detrital concentration [DC]). We then evaluated whether the diet of dominant predators and, consequently, energy pathways within food webs reflected functional and environmental changes among bromeliads across sites. At last, we determined the extent to which the isotopic niches of macroinvertebrates within each bromeliad contributed to the metacommunity isotopic niches within each site and compared these metacommunity‐level niches over biogeographic scales. At the bromeliad level, isotopic niches increased with the functional richness of species in the food web and the DC in the bromeliad. The diet of top predators tracked shifts in prey biomass along gradients of CC and DC. Bromeliads that grew under heterogeneous CC displayed less trophic redundancy and therefore combined to form larger metacommunity isotopic niches. At last, the size of metacommunity niches depended on within‐site heterogeneity in CC. Our results suggest that the trophic niches occupied by food webs can predictably scale from local food webs to metacommunities to biogeographic regions. This scaling process is determined by both the functional traits of species and heterogeneity in environmental conditions. A plain language summary is available for this article. [ABSTRACT FROM AUTHOR]

Food webs of freshwater ecosystems can be subsidized by allochthonous resources. However, it is still unknown which environmental factors regulate the relative consumption of allochthonous resources in relation to autochthonous resources. Here, we evaluated the importance of allochthonous resources (litterfall) for the aquatic food webs in Neotropical tank bromeliads, a naturally replicated aquatic microcosm. Aquatic invertebrates were sampled in more than 100 bromeliads within either open or shaded habitats and within five geographically distinct sites located in four different countries. Using stable isotope analyses, we determined that allochthonous sources comprised 74% (±17%) of the food resources of aquatic invertebrates. However, the allochthonous contribution to aquatic invertebrates strongly decreased from shaded to open habitats, as light incidence increased in the tanks. The density of detritus in the tanks had no impact on the importance of allochthonous sources to aquatic invertebrates. This overall pattern held for all invertebrates, irrespective of the taxonomic or functional group to which they belonged. We concluded that, over a broad geographic range, aquatic food webs of tank bromeliads are mostly allochthonous-based, but the relative importance of allochthonous subsidies decreases when light incidence favors autochthonous primary production. These results suggest that, for other freshwater systems, some of the between-study variation in the importance of allochthonous subsidies may similarly be driven by the relative availability of autochthonous resources. [ABSTRACT FROM AUTHOR]

Local habitat size has been shown to influence colonization and extinction processes of species in patchy environments. However, species differ in body size, mobility, and trophic level, andmay not respond in the same way to habitat size. Thus far, we have a limited understanding of how habitat size influences the structure of multitrophic communities and to what extent the effects may be generalizable over a broad geographic range. Here, we usedwater-filled bromeliads of different sizes as a natural model systemto examine the effects of habitat size on the trophic structure of their inhabiting invertebrate communities. We collected composition and biomass data from 651 bromeliad communities from eight sites across Central and South America differing in environmental conditions, species pools, and the presence of large-bodied odonate predators. We found that trophic structure in the communities changed dramatically with changes in habitat (bromeliad) size. Detritivore : resource ratios showed a consistent negative relationship with habitat size across sites. In contrast, changes in predator : detritivore (prey) ratios depended on the presence of odonates as dominant predators in the regional pool. At sites without odonates, predator : detritivore biomass ratios decreasedwith increasing habitat size. At sites with odonates, we found odonates to bemore frequently present in large than in small bromeliads, and predator : detritivore biomass ratios increased with increasing habitat size to the point where some trophic pyramids became inverted. Our results show that the distribution of biomass amongst food-web levels depends strongly on habitat size, largely irrespective of geographic differences in environmental conditions or detritivore species compositions. However, the presence of largebodied predators in the regional species pool may fundamentally alter this relationship between habitat size and trophic structure. We conclude that taking into account the response andmultitrophic effects of dominant, mobile species may be critical when predicting changes in community structure along a habitat-size gradient. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the experience of adults living with hepatitis C over time. Background Hepatitis C virus is a growing problem affecting thousands of people worldwide. The majority of individuals infected develop chronic liver disease, but treatment is not always successful, leaving many to live with the virus indefinitely. Experiences of living with hepatitis C are poorly understood yet essential to meet the needs of an increasing number of affected people. Design A qualitative study using a descriptive phenomenological methodology. Methods Unstructured interviews were conducted with 23 hepatitis C-positive individuals in the East of England; participants were interviewed twice within a year. Results Data analysis revealed six themes of the experience of living with hepatitis C: hepatitis C and self; hepatitis C, self and others; self and handling hepatitis C; self and handling hepatitis C treatment issues; living with the consequences of hepatitis C; self, hepatitis C and thoughts of the future. Conclusions Diagnosis of hepatitis C can disrupt people's sense of identity and trigger a life transition. A complex range of factors create uncertainty for people living with hepatitis C. Many struggle to make a healthy transition to life with the condition, instead living in a state of sustained uncertainty. Relevance to clinical practice Nurses working within a chronic care framework of ongoing advice and support can improve experiences for those living with hepatitis C. Practice aimed at reducing both the disruptive effect of the diagnosis and the uncertainties it creates can help facilitate a transition to life with the disease. [ABSTRACT FROM AUTHOR]

Background and Purpose. Few studies have examined the experiences of students' professional socialization in physiotherapy. This international longitudinal study aimed to study experiences of situated learning and change in a student cohort during a physiotherapy education programme. Method. A phenomenographic design with semi-structured interviews was carried out with a cohort of physiotherapy students from two sites, strategically selected for variation in gender, age, educational background, work experience and academic level. Interviews were carried out after each of the first five semesters in the programme by a team of researchers. Seventy-six interviews explored students' learning experiences. Analysis identified the variation in experiences seen as important to becoming a physiotherapist. Results. Distinct perceptions of professional growth and progression are identified in four pathways of development: ‘Reflecting on Practice’; ‘Communicating with Others’; ‘Performing Skills’; and ‘Searching Evidence’. These pathways demonstrate qualitative differences in the focus of learning experiences and preferred learning context, and include learning in a context which supports reflection, learning as agreed by others in a context with patients and other professionals, learning physiotherapy skills in a practice context and learning formal knowledge in a context where theory can be linked with practice. Conclusions. In a cohort of students professional growth can be seen in a variety of development pathways. Each shows progress of professional growth in the ‘what’ as changes in experiences and the ‘how’ as ways of learning from them. In addition, the pattern of pathways in a cohort may change from one semester to another suggesting individuals may adopt different learning pathways throughout their education. Teaching staff are challenged to consider how they recognize a variation in development pathways in their student cohorts and how they purposefully ensure experiences to guide students through different learning pathways in socialization to become a physiotherapist. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The PREDICTS project-Projecting Responses of Ecological Diversity In Changing Terrestrial Systems (www.predicts.org.uk)-has collated from published studies a large, reasonably representative database of comparable samples of biodiversity from multiple sites that differ in the nature or intensity of human impacts relating to land use. We have used this evidence base to develop global and regional statistical models of how local biodiversity responds to these measures. We describe and make freely available this 2016 release of the database, containing more than 3.2 million records sampled at over 26,000 locations and representing over 47,000 species. We outline how the database can help in answering a range of questions in ecology and conservation biology. To our knowledge, this is the largest and most geographically and taxonomically representative database of spatial comparisons of biodiversity that has been collated to date; it will be useful to researchers and international efforts wishing to model and understand the global status of biodiversity.

Biodiversity continues to decline in the face of increasing anthropogenic pressures such as habitat destruction, exploitation, pollution and introduction of alien species. Existing global databases of species' threat status or population time series are dominated by charismatic species. The collation of datasets with broad taxonomic and biogeographic extents, and that support computation of a range of biodiversity indicators, is necessary to enable better understanding of historical declines and to project - and avert - future declines. We describe and assess a new database of more than 1.6 million samples from 78 countries representing over 28,000 species, collated from existing spatial comparisons of local-scale biodiversity exposed to different intensities and types of anthropogenic pressures, from terrestrial sites around the world. The database contains measurements taken in 208 (of 814) ecoregions, 13 (of 14) biomes, 25 (of 35) biodiversity hotspots and 16 (of 17) megadiverse countries. The database contains more than 1% of the total number of all species described, and more than 1% of the described species within many taxonomic groups - including flowering plants, gymnosperms, birds, mammals, reptiles, amphibians, beetles, lepidopterans and hymenopterans. The dataset, which is still being added to, is therefore already considerably larger and more representative than those used by previous quantitative models of biodiversity trends and responses. The database is being assembled as part of the PREDICTS project (Projecting Responses of Ecological Diversity In Changing Terrestrial Systems - http://www.predicts.org.uk). We make site-level summary data available alongside this article. The full database will be publicly available in 2015.