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Introduction: The challenges related to providing continuing education and competence management for emergency nurses are not unique to any one organization, health system, or geographic location. These shared challenges, along with a desire to ensure high-quality practice of emergency nursing, were the catalyst for an international collaboration between emergency nurse leaders in Region Zealand, Denmark, and nurse leaders and educators from a large academic medical center in Boston, Massachusetts. The goal of the collaboration was to design a competency-based education framework to support high-quality emergency nursing care in Region Zealand. The core objectives of the collaboration included the following: (1) elevation of nursing practice, (2) development of a sustainable continuing education framework, and (3) standardization of training and nursing practice across the 4 emergency departments in Region Zealand., Methods: To accomplish the core objectives, a multi-phased strategic approach was implemented. The initial phase, the needs assessment, included semi-structured interviews, a self-evaluation of skills of all regional emergency nurses, and a survey regarding nursing competency completed by emergency nurse leadership. Two hundred ninety emergency nurses completed the self-evaluation. The survey results were utilized to inform the strategic planning and design of a regional competency-based education framework., Results: In 18 months, and through an international collaboration, emergency nursing education, training, and evaluation tools were developed and integrated into the 4 regional emergency departments. Initial feedback indicates that the education has had a positive impact. The annual competency day program has continued through 2021 and is now fully institutionalized within the regional emergency nursing continuing education program. Furthermore, use of this innovative education framework has expanded beyond the emergency department to other regional nursing specialties., Discussion and Conclusion: Through this unique collaboration with regional and international participants, a sustainable, regional emergency nursing education program was developed that has elevated and standardized the practice of emergency nurses in Region Zealand, Denmark. This program development can serve as a model for region-wide or health care system-wide collaborations in other countries., (Copyright © 2021 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Exacerbations of chronic obstructive pulmonary disease (COPD) represent a significant clinical problem, and are associated with decreased lung function, worsening quality of life and decreased physical activity levels, with even a single exacerbation having detrimental effects. The occurrence of COPD exacerbations can also have a considerable impact on healthcare costs and mortality rates, with over one-fifth of patients hospitalized for a COPD exacerbation for the first time dying within one year of discharge. This highlights the need for COPD exacerbations to be a major focus in clinical practice. Furthermore, the substantial effect that COPD exacerbations can have on patient mental health should not be underestimated. Despite their clinical importance, COPD exacerbations are poorly recognized and reported by patients, and improving patient understanding and reporting of exacerbations to ensure prompt treatment may minimize their deleterious effects. Renewed focus on improving current clinical practice with support from evidence-based guidelines is required. This also raises a challenge to payors, healthcare systems and government policies to do more to tackle the considerable outstanding burden of COPD exacerbations., Competing Interests: Declaration of Competing Interest J.R. Hurst reports grants, personal fees and non-financial support from pharmaceutical companies that make medicines to treat COPD. N. Skolnik reports nonfinancial support from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Sanofi; personal fees from AstraZeneca, Boehringer Ingelheim and Eli Lilly; and has served on advisory boards for AstraZeneca, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Intarcia, Janssen Pharmaceuticals, Merck, Mylan, Sanofi and Teva Pharmaceutical. G.J. Hansen reports no conflicts of interest. A. Anzueto reports grants or fees from AstraZeneca, Boehringer Ingelheim, Forest Laboratories, GlaxoSmithKline and Novartis. G.C. Donaldson reports personal fees from the American Thoracic Society, AstraZeneca, Micom Ltd and the Research Foundation Flanders (FWO) outside the submitted work. M.T. Dransfield reports grants from the American Lung Association, the Department of Defense, the Department of Veterans Affairs and the National Heart, Lung, and Blood Institute; personal fees from Mereo and Quark; personal fees and other from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and PneumRx; and other from Boston Scientific, Pulmonx, Novartis and Yungjin. P. Varghese is an employee of AstraZeneca., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Spices are added in order to enhance the organoleptic characteristics of food and culinary dishes, making them more attractive for consumers. The use of illicit cheap colourants might be profitable along the food supply chain, posing undue risks to human health. This work evaluates the feasibility of NIR spectroscopy with chemometrics as a rapid, simple, non-destructive and affordable screening tool to determine the presence of Sudan I, II, III, IV and Para-red dyes in paprika. The dataset comprised unadulterated and adulterated samples with the five studied dyes at different concentration levels. Several multivariate classification models were built with Linear Discriminant Analysis (LDA) and different machine learning techniques. Preliminary results show that a classifier based on only six wavenumbers is able to determine the presence of some of these dyes in food samples in levels that may represent risk to human health. Sensitivities and specificities above 90% were obtained in almost all cases. These results show the feasibility of inexpensive and portable devices that can be useful for screening out adulterated stock along the food chain supply.

Temperate lakes may contain both coolwater fish species such as walleye (Sander vitreus) and warmwater fish species such as largemouth bass (Micropterus salmoides). Recent declining walleye and increasing largemouth bass populations have raised questions regarding the future trajectories and management actions for these species. We developed a thermodynamic model of water temperatures driven by downscaled climate data and lake-specific characteristics to estimate daily water temperature profiles for 2148 lakes in Wisconsin, US, under contemporary (1989-2014) and future (2040-2064 and 2065-2089) conditions. We correlated contemporary walleye recruitment and largemouth bass relative abundance to modeled water temperature, lake morphometry, and lake productivity, and projected lake-specific changes in each species under future climate conditions. Walleye recruitment success was negatively related and largemouth bass abundance was positively related to water temperature degree days. Both species exhibited a threshold response at the same degree day value, albeit in opposite directions. Degree days were predicted to increase in the future, although the magnitude of increase varied among lakes, time periods, and global circulation models (GCMs). Under future conditions, we predicted a loss of walleye recruitment in 33-75% of lakes where recruitment is currently supported and a 27-60% increase in the number of lakes suitable for high largemouth bass abundance. The percentage of lakes capable of supporting abundant largemouth bass but failed walleye recruitment was predicted to increase from 58% in contemporary conditions to 86% by mid-century and to 91% of lakes by late century, based on median projections across GCMs. Conversely, the percentage of lakes with successful walleye recruitment and low largemouth bass abundance was predicted to decline from 9% of lakes in contemporary conditions to only 1% of lakes in both future periods. Importantly, we identify up to 85 resilient lakes predicted to continue to support natural walleye recruitment. Management resources could target preserving these resilient walleye populations., (© 2016 The Authors. Global Change Biology published by John Wiley & Sons Ltd.)

Temporal patterns of species abundance, although less well-studied than spatial patterns, provide valuable insight to the processes governing community assembly. We compared temporal abundance distributions of two communities, phytoplankton and fish, in a north temperate lake. We used both 17 years of observed relative abundance data as well as resampled data from Monte Carlo simulations to account for the possible effects of non-detection of rare species. Similar to what has been found in other communities, phytoplankton and fish species that appeared more frequently were generally more abundant than rare species. However, neither community exhibited two distinct groups of "core" (common occurrence and high abundance) and "occasional" (rare occurrence and low abundance) species. Both observed and resampled data show that the phytoplankton community was dominated by occasional species appearing in only one year that exhibited large variation in their abundances, while the fish community was dominated by core species occurring in all 17 years at high abundances. We hypothesize that the life-history traits that enable phytoplankton to persist in highly dynamic environments may result in communities dominated by occasional species capable of reaching high abundances when conditions allow. Conversely, longer turnover times and broad environmental tolerances of fish may result in communities dominated by core species structured primarily by competitive interactions.

Invasive species are leading drivers of environmental change. Their impacts are often linked to their population size, but surprisingly little is known about how frequently they achieve high abundances. A nearly universal pattern in ecology is that species are rare in most locations and abundant in a few, generating right-skewed abundance distributions. Here, we use abundance data from over 24,000 populations of 17 invasive and 104 native aquatic species to test whether invasive species differ from native counterparts in statistical patterns of abundance across multiple sites. Invasive species on average reached significantly higher densities than native species and exhibited significantly higher variance. However, invasive and native species did not differ in terms of coefficient of variation, skewness, or kurtosis. Abundance distributions of all species were highly right skewed (skewness>0), meaning both invasive and native species occurred at low densities in most locations where they were present. The average abundance of invasive and native species was 6% and 2%, respectively, of the maximum abundance observed within a taxonomic group. The biological significance of the differences between invasive and native species depends on species-specific relationships between abundance and impact. Recognition of cross-site heterogeneity in population densities brings a new dimension to invasive species management, and may help to refine optimal prevention, containment, control, and eradication strategies.

Rapid transitions in ecosystem structure, or regime shifts, are a hallmark of alternative stable states (ASS). However, regime shifts can occur even when feedbacks are not strong enough to cause ASS. We investigated the potential for ASS to explain transitions between dominance of an invasive species, rusty crayfish (Orconectes rusticus), and native sunfishes (Lepomis spp.) in northern Wisconsin (USA) lakes. A rapid transition from Lepomis to rusty crayfish dominance occurred as rusty crayfish invaded Trout Lake, and the reverse transition resulted from an eight-year experimental removal of rusty crayfish from Sparkling Lake. We fit a stage-structured population model of species interactions to 31 years of time-series data from each lake. The model identified water level as an important driver, with drought conditions reducing rusty crayfish recruitment and allowing Lepomis dominance. The maximum-likelihood parameter estimates of the negative interaction between rusty crayfish and Lepomis led to ASS in the model, where each species was capable of excluding the other within a narrow range of environmental conditions. However, uncertainty in parameter estimates made it impossible to exclude the potential that rapid transitions were caused by a simpler threshold response lacking alternative equilibria. Simulated forward and backward transitions between species dominance occurred at different environmental conditions (i.e., hysteresis), even when the parameters used for simulation did not predict ASS as a result of slow species responses to environmental drivers. Thus, ASS are possible, but by no means certain, explanations for rapid transitions in this system, and our results highlight the difficulties associated with distinguishing ASS from other types of threshold responses. However, whether regime shifts are caused by ASS may be relatively unimportant in this system, as the range of conditions over which transitions occur is narrow, and under most conditions, the system is predicted to exist in only a single state.

An economical process for the enzymatic oxidation of cephalosporin C to glutaryl-7-ACA was developed at a pilot plant scale. The process utilized nonviable whole cells of the yeast Triginopsis variabilis containing high levels of D-amino acid oxidase. Prior to use, the whole cells were permeabilized with a 25% acetone/water solution which enhanced their apparent activity by 20- to 50-fold. After permeabilization, the whole cells were incubated at pH 11, which served to selectively deactivate catalase which was present in very large quantities. Deactivation of catalase was critical to achieving high reaction yields. The whole cells were utilized within a "cross-flow filter-reactor" which allowed easy and economical recycle of the cells for repeated use. The overall yield of glutaryl-7-ACA from cephalosporin C was 90-95%. The overall productivity of the yeast was 13 kg cephalosporin C oxidized per kilogram yeast (dry basis). The reaction was run at a concentration of 40 g cephalosporin CL-1 and the overall reactor productivity was 11 g glutaryl-7-ACA l-1 h-1. The process has been thoroughly demonstrated on a 35-l scale, and it should be directly scaleable to 10,000 l or more.