Search

To eliminate the destructive impact of rodents on islands, conservation practitioners commonly use rodenticides to eradicate these pests. Frequently used rodenticides, such as brodifacoum, are non-specific. Consequently, non-target species may be susceptible to the poison. While mitigation actions to protect against unwanted impacts on non-target species are often included in eradication planning, such impacts are rarely measured or reported. In 2019, a rodent eradication program was implemented on Lord Howe Island to remove ship rats and house mice. To protect the island's unique suite of endemic avian fauna, a comprehensive monitoring and mitigation plan was implemented. Following assessments of potential effects of baiting on island-species, two endemic species were taken into captive management during the eradication. To assess effects on other species, a total of 243 ha of bushland was searched over a 14-week period and an additional 190 ha was searched in the island's settlement area for carcasses of non-targets. These surveys found that buff-banded rails suffered the highest level of mortality, but few carcasses of endemic species were found. The captive management program was successful with more than 95% of individuals that were taken into captivity being released at the end of the program. Post-eradication surveys of captive-managed species have shown that the endemic woodhen population has increased by nearly five-fold on pre-eradication levels and that endemic currawong numbers have also increased. Surveys of other bush birds have found higher numbers for most species and shows that pre-eradication assessments of these species being at lower risk were appropriate. [ABSTRACT FROM AUTHOR]

Maintenance of genetic diversity within species is a key objective of biodiversity conservation, and small, isolated populations are particularly vulnerable to genetic erosion. Conservation management actions such as predator removal, captive breeding and reintroduction can facilitate numerical recovery of a population, but species often remain at risk from depleted genetic diversity and inbreeding. We investigated dispersal, genetic bottlenecks and genetic population structuring in the island‐dwelling Lord Howe woodhen, a species that came perilously close to extinction in the 1970s. Analyses of mark‐resighting records and variable genetic markers (single‐nucleotide polymorphisms) collected from the contemporary population and 100‐year‐old museum specimens found strong evidence of restricted dispersal at fine spatial scales, with both the contemporary and historic populations exhibiting strong population structuring between mountain and lowland/slopes sites. Additionally, genetic comparison of the contemporary population and historic specimens demonstrated a decline in genetic diversity over the past century. Specifically for the Lord Howe woodhen, we recommend ongoing genetic monitoring and translocations to increase genetic diversity within the re‐established lowland subpopulation. More generally, our results demonstrate how pronounced genetic erosion can arise in species subject to human persecution and predation by introduced predators, and how genetic fragmentation of natural populations can be present at fine geographical scales (less than hundreds of metres). Moreover, without prior information about genetic structure and subsequent genetic monitoring, conservation management can have unexpected negative consequences for the genetic health of populations. Therefore, genetic monitoring and management early in the recovery of populations is desirable to maximize their adaptive potential. [ABSTRACT FROM AUTHOR]

Natural enemies of insect pests of annual crops have been hypothesized either to lag, or alternatively not to lag, behind their prey in dispersing to and colonizing new habitat. We examined parasitoid dispersal and parasitism of the cereal leaf beetle ( Oulema melanopus [ L.]; Coleoptera: Chrysomelidae) by the host-specific wasp Tetrastichus julis [ Walker] ( Hymenoptera: Eulophidae) in wheat fields of northern Utah to assess whether a colonization lag occurred. Equally high rates of parasitism of beetle larvae (including second instars early in the year) occurred in 2010 and 2011 in fields that were newly planted to wheat vs. in fields where wheat had been grown also the previous year. A caging experiment demonstrated that parasitism in these newly planted wheat fields did not arise from parasitoid adults that had matured within the fields; instead, upon emerging in other fields, parasitoid females dispersed a minimum of 100-250 m to parasitize beetle larvae early in the spring in the newly planted fields. A transect study in 2012 revealed that T. julis females dispersed rapidly at least 600 m into a newly planted wheat field to parasitize most of the early maturing beetle larvae, which occurred at very low density. Thus, the parasitoid has very strong ability to match its host in dispersal over long distances across a highly disturbed agricultural landscape, and colonization lag appears of little importance in affecting biological control associated with this host-parasitoid interaction. [ABSTRACT FROM AUTHOR]

BackgroundDigital health innovations are being prioritized on international policy agendas in the hope that they will help to address the existing health system challenges. ObjectiveThe aim of this study was to explore the setup, design, facilities, and strategic priorities of leading United Kingdom and United States health care innovation centers to identify transferable lessons for accelerating their creation and maximizing their impact. MethodsWe conducted qualitative case studies consisting of semistructured, audio-recorded interviews with decision makers and center staff in 6 innovation centers. We also conducted nonparticipant observations of meetings and center tours, where we took field notes. Qualitative data were analyzed initially within and then across cases facilitated by QSR International’s NVivo software. ResultsThe centers had different institutional arrangements, including university-associated institutes or innovation laboratories, business accelerators or incubators, and academic health science partnership models. We conducted interviews with 34 individuals, 1 group interview with 3 participants, and observations of 4 meetings. Although the centers differed significantly in relation to their mission, structure, and governance, we observed key common characteristics. These included high-level leadership support and incentives to engage in innovation activities, a clear mission to address identified gaps within their respective organizational and health system settings, physical spaces that facilitated networking through open-door policies, flat managerial structures characterized by new organizational roles for which boundary spanning was key, and a wider innovation ecosystem that was strategically and proactively engaged with the center facilitating external partnerships. ConclusionsAlthough innovation in health care settings is unpredictable, we offer insights that may help those establishing innovation centers. The key in this respect is the ability to support different kinds of innovations at different stages through adequate support structures, including the development of new career pathways.

Variation in weather among years may affect biological control of insect pests by influencing how well matched in phenology specialist parasitoids are with their pest hosts. A 10-year study in western North America ( Utah) revealed greater change with warm versus cool springs in the life cycle timing of the cereal leaf beetle ( CLB), Oulema melanopus ( L.), than of its principal enemy, the parasitoid wasp Tetrastichus julis ( Walker). The beetle laid eggs, and larval populations developed in crop fields earlier on a calendar-day basis, but nonetheless after more degree-days had accumulated, in warmer than in cooler springs. The phenology of parasitism by wasps, in contrast, varied little among springs in relation to accumulated degree-days. Consequently, in warmer springs, larval phenology of the CLB was delayed relative to adult parasitoid activity, and parasitism was reduced. Presently, a significant degree of biological control of the CLB results from parasitism by T. julis. By promoting phenological mismatch between host and parasitoid, however, a warming climate could weaken this biological control of the insect pest. [ABSTRACT FROM AUTHOR]

BackgroundPhotographs are important tools to record, track, and communicate clinical findings. Mobile devices with high-resolution cameras are now ubiquitous, giving clinicians the opportunity to capture and share images from the bedside. However, secure and efficient ways to manage and share digital images are lacking. ObjectiveThe aim of this study is to describe the implementation of a secure application for capturing and storing clinical images in the electronic health record (EHR), and to describe initial user experiences. MethodsWe developed CliniCam, a secure Apple iOS (iPhone, iPad) application that allows for user authentication, patient selection, image capture, image annotation, and storage of images as a Portable Document Format (PDF) file in the EHR. We leveraged our organization’s enterprise service-oriented architecture to transmit the image file from CliniCam to our enterprise clinical data repository. There is no permanent storage of protected health information on the mobile device. CliniCam also required connection to our organization’s secure WiFi network. Resident physicians from emergency medicine, internal medicine, and dermatology used CliniCam in clinical practice for one month. They were then asked to complete a survey on their experience. We analyzed the survey results using descriptive statistics. ResultsTwenty-eight physicians participated and 19/28 (68%) completed the survey. Of the respondents who used CliniCam, 89% found it useful or very useful for clinical practice and easy to use, and wanted to continue using the app. Respondents provided constructive feedback on location of the photos in the EHR, preferring to have photos embedded in (or linked to) clinical notes instead of storing them as separate PDFs within the EHR. Some users experienced difficulty with WiFi connectivity which was addressed by enhancing CliniCam to check for connectivity on launch. ConclusionsCliniCam was implemented successfully and found to be easy to use and useful for clinical practice. CliniCam is now available to all clinical users in our hospital, providing a secure and efficient way to capture clinical images and to insert them into the EHR. Future clinical image apps should more closely link clinical images and clinical documentation and consider enabling secure transmission over public WiFi or cellular networks.

BackgroundMobile health (mHealth) technologies provide many potential benefits to the delivery of health care. Medical decision support tools have shown particular promise in improving quality of care and provider workflow. Frontline health workers such as Community Health Workers (CHWs) have been shown to be effective in extending the reach of care, yet only a few medicine dosing tools are available to them. ObjectiveWe developed an mHealth medicine dosing tool tailored to the skill level of CHWs to assist in the delivery of care. The mHealth tool was created for CHWs with primary school education working in rural Mexico and Guatemala. Perceptions and impressions of this tool were collected and compared to an existing paper-based medicine dosing tool. MethodsSeventeen Partners In Health CHWs in rural Mexico and Guatemala completed a one-day training in the mHealth medicine dosing tool. Following the training, a prescription dosing test was administered, and CHWs were given the choice to use the mHealth or paper-based tool to answer 7 questions. Subsequently, demographic and qualitative data was collected using a questionnaire and an in-person interview conducted in Spanish, then translated into English. The qualitative questions captured data on 4 categories: comfort, acceptability, preference, and accuracy. Qualitative responses were analyzed for major themes and quantitative variables were analyzed using SAS. Results82% of the 17 CHWs chose the mHealth tool for at least 1 of 7 questions compared to 53% (9/17) who chose to use the paper-based tool. 93% (13/14) rated the phone as being easy or very easy to use, and 56% (5/9) who used the paper-based tool rated it as easy or very easy. Dosing accuracy was generally higher among questions answered using the mHealth tool relative to questions answered using the paper-based tool. Analysis of major qualitative themes indicated that the mHealth tool was perceived as being quick, easy to use, and as having complete information. The mHealth tool was seen as an acceptable dosing tool to use and as a way for CHWs to gain credibility within the community. ConclusionsA tailored cell phone-based mHealth medicine dosing tool was found to be useful and acceptable by CHWs in rural Mexico and Guatemala. The streamlined workflow of the mHealth tool and benefits such as the speed and self-lighting were found to be particularly useful features. Well designed and positioned tools such as this may improve effective task shifting by reinforcing the tasks that different cadres of workers are asked to perform. Further studies can explore how to best implement this mHealth tool in real-world settings, including how to incorporate the best elements of the paper-based tool that were also found to be helpful.

Understanding the demography of wildlife populations is a key component for ecological research, and where necessary, supporting the conservation and management of long-lived animals. However, many animals lack phenological changes with which to determine individual age; therefore, gathering this fundamental information presents difficulties. More so for species that are rare, highly mobile, migratory and those that reside in inaccessible habitats. Until recently, the primary method to measure demography is through labour intensive mark-recapture approaches, necessitating decades of effort for long-lived species. Gadfly petrels (genus: Pterodroma) are one such taxa that are overrepresented with threatened and declining species, and for which numerous aspects of their ecology present challenges for research, monitoring and recovery efforts. To overcome some of these challenges, we developed the first DNA methylation (DNAm) demography technique to estimate the age of petrels, using the epigenetic clock of Gould's petrels (Pterodroma leucoptera). We collected reference blood samples from known-aged Gould's petrels at a long-term monitored population on Cabbage Tree Island, Australia. Epigenetic ages were successfully estimated for 121 individuals ranging in age from zero (fledgling) to 30 years of age, showing a mean error of 2.24 ± 0.17 years between the estimated and real age across the population. This is the first development of an epigenetic clock using multiplex PCR sequencing in a bird. This method enables demography to be measured with relative accuracy in a single sampling trip. This technique can provide information for emerging demographic risks that can mask declines in long-lived seabird populations and be applied to other Pterodroma populations., (© 2024 The Author(s). Molecular Ecology Resources published by John Wiley & Sons Ltd.)

Objectives:  Variability in cardiopulmonary arrest training and management leads to inconsistent outcomes during in-hospital cardiac arrest. Existing clinical decision aids, such as American Heart Association (AHA) advanced cardiovascular life support (ACLS) pocket cards and third-party mobile apps, often lack comprehensive management guidance. We developed a novel, guided ACLS mobile app and evaluated user performance during simulated cardiac arrest according to the 2020 AHA ACLS guidelines via randomized controlled trial., Methods:  Forty-six resident physicians were randomized to lead a simulated code team using the AHA pockets cards ( N  = 22) or the guided app ( N  = 24). The primary outcome was successful return of spontaneous circulation (ROSC). Secondary outcomes included code leader stress and confidence, AHA ACLS guideline adherence, and errors. A focus group of 22 residents provided feedback. Statistical analysis included two-sided t -tests and Fisher's exact tests., Results:  App users showed significantly higher ROSC rate (50 vs. 18%; p  = 0.024), correct thrombolytic administration (54 vs. 23%; p  = 0.029), backboard use (96 vs. 27%; p  < 0.001), end-tidal CO2 monitoring (58 vs. 27%; p  = 0.033), and confidence compared with baseline (1.0 vs 0.3; p  = 0.005) compared with controls. A focus group of 22 residents indicated unanimous willingness to use the app, with 82% preferring it over AHA pocket cards., Conclusion:  Our guided ACLS app shows potential to improve user confidence and adherence to the AHA ACLS guidelines and may help to standardize in-hospital cardiac arrest management. Further validation studies are essential to confirm its efficacy in clinical practice., Competing Interests: J.C. and A.C. are co-creators of the AHA ACLS mobile app (iOS and Android) in collaboration with the American Heart Association., (Thieme. All rights reserved.)

Plastic pollution is distributed patchily around the world's oceans. Likewise, marine organisms that are vulnerable to plastic ingestion or entanglement have uneven distributions. Understanding where wildlife encounters plastic is crucial for targeting research and mitigation. Oceanic seabirds, particularly petrels, frequently ingest plastic, are highly threatened, and cover vast distances during foraging and migration. However, the spatial overlap between petrels and plastics is poorly understood. Here we combine marine plastic density estimates with individual movement data for 7137 birds of 77 petrel species to estimate relative exposure risk. We identify high exposure risk areas in the Mediterranean and Black seas, and the northeast Pacific, northwest Pacific, South Atlantic and southwest Indian oceans. Plastic exposure risk varies greatly among species and populations, and between breeding and non-breeding seasons. Exposure risk is disproportionately high for Threatened species. Outside the Mediterranean and Black seas, exposure risk is highest in the high seas and Exclusive Economic Zones (EEZs) of the USA, Japan, and the UK. Birds generally had higher plastic exposure risk outside the EEZ of the country where they breed. We identify conservation and research priorities, and highlight that international collaboration is key to addressing the impacts of marine plastic on wide-ranging species., (© 2023. The Author(s).)

Importance: Communication of information has emerged as a critical component of diagnostic quality. Communication of diagnostic uncertainty represents a key but inadequately examined element of diagnosis., Objective: To identify key elements facilitating understanding and managing diagnostic uncertainty, examine optimal ways to convey uncertainty to patients, and develop and test a novel tool to communicate diagnostic uncertainty in actual clinical encounters., Design, Setting, and Participants: A 5-stage qualitative study was performed between July 2018 and April 2020, at an academic primary care clinic in Boston, Massachusetts, with a convenience sample of 24 primary care physicians (PCPs), 40 patients, and 5 informatics and quality/safety experts. First, a literature review and panel discussion with PCPs were conducted and 4 clinical vignettes of typical diagnostic uncertainty scenarios were developed. Second, these scenarios were tested during think-aloud simulated encounters with expert PCPs to iteratively draft a patient leaflet and a clinician guide. Third, the leaflet content was evaluated with 3 patient focus groups. Fourth, additional feedback was obtained from PCPs and informatics experts to iteratively redesign the leaflet content and workflow. Fifth, the refined leaflet was integrated into an electronic health record voice-enabled dictation template that was tested by 2 PCPs during 15 patient encounters for new diagnostic problems. Data were thematically analyzed using qualitative analysis software., Main Outcomes and Measures: Perceptions and testing of content, feasibility, usability, and satisfaction with a prototype tool for communicating diagnostic uncertainty to patients., Results: Overall, 69 participants were interviewed. A clinician guide and a diagnostic uncertainty communication tool were developed based on the PCP interviews and patient feedback. The optimal tool requirements included 6 key domains: most likely diagnosis, follow-up plan, test limitations, expected improvement, contact information, and space for patient input. Patient feedback on the leaflet was iteratively incorporated into 4 successive versions, culminating in a successfully piloted prototype tool as an end-of-visit voice recognition dictation template with high levels of patient satisfaction for 15 patients with whom the tool was tested., Conclusions and Relevance: In this qualitative study, a diagnostic uncertainty communication tool was successfully designed and implemented during clinical encounters. The tool demonstrated good workflow integration and patient satisfaction.

Objectives: Opioid misuse has resulted in significant morbidity and mortality in the United States, and safer opioid use represents an important challenge in the primary care setting. This article describes a research collaborative of health service researchers, systems engineers, and clinicians seeking to improve processes for safer chronic opioid therapy management in an academic primary care center. We present implementation results and lessons learned along with an intervention toolkit that others may consider using within their organization., Methods: Using iterative improvement lifecycles and systems engineering principles, we developed a risk-based workflow model for patients on chronic opioids. Two key safe opioid use process metrics-percent of patients with recent opioid treatment agreements and urine drug tests-were identified, and processes to improve these measures were designed, tested, and implemented. Focus groups were conducted after the conclusion of implementation, with barriers and lessons learned identified via thematic analysis., Results: Initial surveys revealed a lack of knowledge regarding resources available to patients and prescribers in the primary care clinic. In addition, 18 clinicians (69%) reported largely "inheriting" (rather than initiating) their chronic opioid therapy patients. We tracked 68 patients over a 4-year period. Although process measures improved, full adherence was not achieved for the entire population. Barriers included team structure, the evolving opioid environment, and surveillance challenges, along with disruptions resulting from the 2019 novel coronavirus., Conclusions: Safe primary care opioid prescribing requires ongoing monitoring and management in a complex environment. The application of a risk-based approach is possible but requires adaptability and redundancies to be reliable., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The COVID-19 pandemic is unprecedented in terms of the extent and rapidity of the disruption forced upon formal clinical education, most notably the extensive transition of clinical skills learning to interactive video-based clinical education., Methods: In a phenomenologic study, we used thematic analysis to explore the COVID-19 disruption to clinical training and understand processes relating to adaptation in a large academic medical center. We conducted semi-structured interviews with 14 clinical teachers and 16 trainees representing all levels of clinical learning. Interviews occurred within the initial three months of the crisis, and data were analyzed following a thematic analysis coding process., Results: We constructed eight themes synthesizing our participants' perceptions of the immediate unanticipated disruption, noting in the process their alignment with a change management framework. These included: urgency in adapting, with an obvious imperative for change; overcoming inconsistent involvement and support through the formation of self-organized frontline coalitions; attempts to develop strategy and vision via initially reactive but eventually consistent communication; empowering a volunteer army through co-creation and a flattened hierarchy; and efforts to sustain improvement and positive momentum with celebration of trial, error, and growth. The majority of participants found positive outcomes resulting from the tumultuous change process. Moreover, they were now more readily accepting of change, and tolerant of the ambiguous and iterative nature inherent in the education change process. Many anticipated that some innovation would, or would at least deserve to, continue post- crisis., Conclusions: The COVID-19 pandemic afforded an opportunity to study the content and process of change during an active crisis. In this case of clinical education, our findings provide insight into the ways an academic medical system adapts to unanticipated circumstances. We found alignment with broader organizational change management models and that, compared with crisis management models (and their shorter term focus on resolving such crises), stakeholders self-organized in a reliable manner that carries the potential advantage of preserving such beneficial change., (© 2022. The Author(s).)

Objective: Physician burnout is at epidemic proportions, impacts clinical outcomes, and is very costly. Although there is emerging data about effective interventions, most physicians at risk of burnout do not seek help. Survey-based measures exist which can quantify burnout within populations, but these are usually only administered episodically. We hypothesized that a novel modality for real-time measurement of happiness and stressors would be acceptable, scalable, and could provide new actionable insights., Materials: We developed a novel informatics system consisting of a networked smart button device, server, and analytics for measuring happiness, and stressors in real-time during clinical work. We performed an observational cohort study in 3 primary care clinics. Random and fixed effects modeling was used to analyze predictors of stress and happiness and we conducted a survey of usability and user acceptance of the novel system., Results: We captured 455 recordings across 392 provider days from 14 primary care providers. In total, 85% of users found the device easy to use, and 87% would recommend the system to their colleagues. Happiness and stressors were observed in all working hours of the day, with a 22% reduction in feeling (the proportion of happiness to stressors) across a clinical day., Discussion: We tested a novel system which providers found easy to use and enabled collection of detailed data. Limitations included being an observational study within a small number of clinics. A simple, unintrusive, scalable informatics system capable of measuring happiness, and stressors in real-time could be useful to healthcare organizations and teams., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Problem: The SARS-CoV-2 (COVID-19) pandemic presented numerous challenges to inpatient care, including overtaxed inpatient medicine services, surges in patient censuses, disrupted patient care and educational activities for trainees, underused providers in certain specialties, and personal protective equipment shortages and new requirements for physical distancing. In March 2020, as the COVID-19 surge began, an interdisciplinary group of administrators, providers, and trainees at Brigham and Women's Hospital created an inpatient virtual staffing model called the Virtual Team Rounding Program (VTRP)., Approach: The conceptual framework guiding VTRP development was rapid-cycle innovation. The VTRP was designed iteratively using feedback from residents, physician assistants, attendings, and administrators from March to June 2020. The VTRP trained and deployed a diverse set of providers across specialties as "virtual rounders" to support inpatient teams by joining and participating in rounds via videoconference and completing documentation tasks during and after rounds. The program was rapidly scaled up from March to June 2020., Outcomes: In a survey of inpatient providers at the end of the pilot phase, 10/10 (100%) respondents reported they were getting either "a lot" or "a little" benefit from the VTRP and did not find the addition of the virtual rounder burdensome. During the scaling phase, the program grew to support 24 teams. In a survey at the end of the contraction phase, 117/187 (62.6%) inpatient providers who worked with a virtual rounder felt the rounder saved them time. VTRP leadership collaboratively and iteratively developed best practices for challenges encountered during implementation., Next Steps: Virtual rounding provides a valuable extension of inpatient teams to manage COVID-19 surges. Future work will quantitatively and qualitatively assess the impact of the VTRP on inpatient provider satisfaction and well-being, virtual rounders' experiences, and patient care outcomes., (Copyright © 2021 by the Association of American Medical Colleges.)

AbstractOn isolated islands, large arthropods can play an important functional role in ecosystem dynamics. On the Norfolk Islands group, South Pacific, we monitored the diet and foraging activity of an endemic chilopod, the Phillip Island centipede ( Cormocephalus coynei ), and used a stable isotope mixing model to estimate dietary proportions. Phillip Island centipede diet is represented by vertebrate animals (48%) and invertebrates (52%), with 30.5% consisting of squamates, including the Lord Howe Island skink ( Oligosoma lichenigera ) and Günther's island gecko ( Christinus guentheri ); 7.9% consisting of black-winged petrel ( Pterodroma nigripennis ) nestlings; and 9.6% consisting of marine fishes scavenged from regurgitated seabird meals. Centipede predation was the principal source of petrel nestling mortality, with annual rates of predation varying between 11.1% and 19.6% of nestlings. This means that 2,109-3,724 black-winged petrel nestlings may be predated by centipedes annually. Petrels produce a single offspring per year; therefore, predation of nestlings by centipedes represents total breeding failure for a pair in a given year. Our work demonstrates that arthropods can play a leading role in influencing vertebrate reproductive output and modifying trophic structures and nutrient flow in island ecosystems.

Background: New inpatient virtual care models have proliferated in response to the challenges presented by the coronavirus disease 2019 (COVID-19) pandemic; however, few of these programs have yet been evaluated for acceptability and feasibility., Objective: Assess feasibility and provider experience with the Virtual Team Rounding Program (VTRP), a quality improvement project developed and rapidly scaled at Brigham and Women's Hospital in Boston, MA, in response to the surge of COVID-19 patients in the spring of 2020., Methods: We surveyed 777 inpatient providers and 41 providers who served as 'virtual rounders' regarding their experience with the program. Inpatient providers were asked about their overall satisfaction with the program, whether the program saved them time, and if so, how much and their interest in working with a similar program in the future. Providers who had worked as virtual rounders were asked about their overall satisfaction with the program, the overall difficulty of the work and their interest in participating in a similar program in the future., Results: We find that among both groups the program was well-received, with 72.5% of inpatient providers and 85.7% of virtual rounders reporting that they were 'satisfied' or 'very satisfied' with their experience with the program. Among inpatient providers who worked with the program, two-thirds reported the program saved them time on a daily basis. Inpatient respondents who had worked with virtual rounders were more likely to say that they would be interested in working with the VTRP in the future compared with respondents who never worked with a virtual rounder (75.3 vs 52.5%, P < 0.001)., Conclusion: As the pandemic continues, rapidly implementing and studying virtual care delivery programs is crucial for hospitals and health systems. We demonstrate the feasibility and acceptability of a 'virtual rounding' program assisting inpatient providers. Future work should examine the impact of these programs on patient outcomes., (© The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Globally, seabird populations have been in decline due to multiple threats throughout their range. Separating simultaneous pressures is challenging and can require significant amounts of data over long periods of time. We use spatial contrasts to investigate the relative importance of several drivers for the purported decline in a species listed as in decline as an example species, the Flesh-footed shearwater (Ardenna carneipes). On Lord Howe Island in the Tasman Sea, Australia, this seabird suffers from habitat loss due to housing development, intensive mortality in fisheries, plastic ingestion, and roadkill due to vehicular traffic on its breeding island. We repeated a quantitative survey of the population to ascertain whether the decline previously reported had continued and to evaluate the purported mortality sources (Reid et al. in PLoS ONE 8(4):e58230, 2013, Lavers et al. in Global Ecol Conserv 17:e00579, 2019). We measured burrow density, area of occurrence, occupancy and breeding success, integrating them with previous surveys using a Bayesian statistical model to generate longer term estimates of demographic rates. We used spatial patterns to test whether mortality on roads or proximity to human habitation was influencing population demographics. In contrast to predictions, we found the population had stabilised or increased. Characteristics such as burrow occupancy and breeding success showed little pattern, with weak evidence for impacts from road mortality and housing development. Such a data-rich approach is substantially more informative and can better support seabird conservation and management efforts does require more field-time and additional equipment than most contemporary surveys, the data is substantially more informative and can better clarify the results of efforts in seabird conservation and management.

Background: The clinical spectrum of septic arthritis in the era of the opioid crisis is ill-defined., Methods: This is a retrospective chart review of 1465 cases of culture-positive native joint septic arthritis at Boston teaching hospitals between 1990 and 2018., Results: Between 1990-2008 and 2009-2018, the proportion of septic arthritis cases involving people who inject drugs (PWID) rose from 10.3% to 20% ( P  < .0000005). Overall, methicillin-sensitive Staphylococcus aureus (MSSA) caused 41.5% of cases, and methicillin-resistant Staphylococcus aureus (MRSA) caused 17.9%. Gram-negative rods caused only 6.2% of cases. Predictors of MRSA septic arthritis included injection drug use ( P  < .001), bacteremia ( P  < .001), health care exposure ( P  < .001), and advancing age ( P  = .01). Infections with MSSA were more common in PWID (56.3% vs 38.8%; P  < .00001), as were infections with MRSA (24% vs 16.8%; P  = .01) and Serratia sp. (4% vs 0.4%; P  = .002). Septic arthritis in the setting of injection drug use was significantly more likely to involve the sacroiliac, acromioclavicular, and facet joints; 36.8% of patients had initial synovial fluid cell counts of <50 000 cells/mm 3 ., Conclusions: Injection drug use has become the most common risk factor for septic arthritis in our patient population. Septic arthritis in PWID is more often caused by MRSA, MSSA, and Serratia sp., and is more prone to involve the sacroiliac, acromioclavicular, sternoclavicular, and facet joints. Synovial fluid cell counts of <50   000 cells/mm 3 are common in culture-positive septic arthritis., (© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Acceptance and commitment therapy (ACT), a form of cognitive behavioral therapy, predominately focuses on addressing one's relationship with thoughts and emotions rather than attempting to alter them. The use of ACT has demonstrated efficacy in interactions with patients suffering from a variety of mental health concerns. While there are no specific criteria for the use of ACT, one compelling argument that exists in support of its use is that ACT may be more efficacious than other control-based protocols in treating experiential avoidance. Further, there is some evidence available to suggest that ACT is more effective than other active treatments for depression. Here, the six core processes of ACT therapy are discussed and the application of ACT techniques in clinical practice is explored., Competing Interests: FUNDING:No funding was provided. DISCLOSURES:The authors have no conflicts of interest relevant to the content of this article., (Copyright © 2019. Matrix Medical Communications. All rights reserved.)

Background: Paging still represents an important form of communication within hospitals, but it results in interruptions, and other more modern approaches could be superior. This study aims to describe how paging is currently used in an academic medical centre, including the frequency, type, urgency and sender of pages, so that improvements in communication can be better informed., Study Sample: In order to understand what communication needs paging fulfils in a modern academic medical centre, we analysed a database of 1252 pages sent to internal medicine residents within an academic medical centre. We assessed all pages from 3 separate general medicine rotations over a total of 56 days encompassing 602 h., Results: Residents were paged an average of 22.4 times per day, with a maximum of 50 pages per day. Most pages were deemed clinically relevant (76%) and important (76%) to patient care. Overall, 59% of pages required a response. A mean of 7.7 pages were sent per patient, up to a maximum of 70 pages for one patient. Nurses (28%), consultants (16%) and the clinical laboratory (15%) were responsible for the majority of pages. Almost all pages from nurses (82%) and consultants (82%) required a response. Regionalised services had significantly fewer pages per day than non-regionalised services (19 vs 37, p≤0.00001)., Conclusions: Paging remains widely used for communications within hospitals about patient care. Although the majority of pages were judged to be clinically relevant and important, they frequently required a response potentially leading to interruptions in workflow, and communication waste. Paging rate and volume has not decreased in 25 years despite significant penetration of newer technologies. For the majority of current uses of pages, we believe other approaches may now be more appropriate. Regionalisation significantly reduces the number and urgency of the pages., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

The Fregetta storm-petrels generally are regarded to comprise two species: black-bellied storm-petrels F. tropica (monotypic) breed at Antarctic and sub-Antarctic islands (46-63°S), and white-bellied storm-petrels F. grallaria breed at south temperate islands (28-37°S), with four recognized subspecies. Confusion surrounds the status of birds at Gough Island (40°S), central South Atlantic, which have been attributed usually to a white-bellied form of black-bellied storm-petrel F. t. melanoleuca. We use cytochrome b and nuclear β-fibrinogen gene sequences to show that F. t. melanoleuca are present during the breeding season at Gough and islands in the nearby Tristan da Cunha archipelago (37°S), exhibiting limited divergence from F. t. tropica. We also show that there is greater diversity among F. grallaria populations, with eastern South Pacific F. g. segethi and F. g. titan differing by c. 0.011, and both differing from western South Pacific nominate F. g. grallaria by c. 0.059. The Tristan archipelago supports a population of F. grallaria closely allied to the nominate form, as well as a distinct form identified as F. g. leucogaster. Further research is needed to assess how F. grallaria and F. tropica segregate in sympatry at Tristan and Gough, and why this is the only location where both species have white-bellies., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: The objective of this study was to investigate the silver gull as an indicator of environmental contamination by salmonellae and carbapenemase-producing Enterobacteriaceae (CPE) in south-east Australia., Methods: A total of 504 cloacal samples were collected from gull chicks at three nesting colonies in New South Wales, Australia [White Bay (n = 144), Five Islands (n = 200) and Montague Island (n = 160)] and were examined for salmonellae and CPE. Isolates were tested for carbapenemase genes and susceptibility to 14 antibiotics. Clonality was determined by PFGE and MLST. Genetic context and conjugative transfer of the carbapenemase gene were determined., Results: A total of 120 CPE of 10 species, mainly Escherichia coli (n = 85), carrying the gene blaIMP-4, blaIMP-38 or blaIMP-26 were obtained from 80 (40%) gulls from Five Islands. Thirty percent of birds from this colony were colonized by salmonellae. Most isolates contained the gene within a class 1 integron showing a blaIMP-4-qacG-aacA4-catB3 array. The blaIMP gene was carried by conjugative plasmids of variable sizes (80-400 kb) and diverse replicons, including HI2-N (n = 30), HI2 (11), A/C (17), A/C-Y (2), L/M (5), I1 (1) and non-typeable (6). Despite the overall high genetic variability, common clones and plasmid types were shared by different birds and bacterial isolates, respectively., Conclusions: Our data demonstrate a large-scale transmission of carbapenemase-producing bacteria into wildlife, likely as a result of the feeding habits of the birds at a local waste depot. The isolates from gulls showed significant similarities with clinical isolates from Australia, suggesting the human origin of the isolates. The sources of CPE for gulls on Five Islands should be explored and proper measures applied to stop the transmission into the environment., (© The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.)

Blood parasites are potential threats to the health of penguins and to their conservation and management. Little penguins Eudyptula minor are native to Australia and New Zealand, and are susceptible to piroplasmids (Babesia), hemosporidians (Haemoproteus, Leucocytozoon, Plasmodium) and kinetoplastids (Trypanosoma). We studied a total of 263 wild little penguins at 20 sites along the Australian southeastern coast, in addition to 16 captive-bred little penguins. Babesia sp. was identified in seven wild little penguins, with positive individuals recorded in New South Wales, Victoria and Tasmania. True prevalence was estimated between 3.4% and 4.5%. Only round forms of the parasite were observed, and gene sequencing confirmed the identity of the parasite and demonstrated it is closely related to Babesia poelea from boobies (Sula spp.) and B. uriae from murres (Uria aalge). None of the Babesia-positive penguins presented signs of disease, confirming earlier suggestions that chronic infections by these parasites are not substantially problematic to otherwise healthy little penguins. We searched also for kinetoplastids, and despite targeted sampling of little penguins near the location where Trypanosoma eudyptulae was originally reported, this parasite was not detected.