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We propose a Bayesian model which produces probabilistic reconstructions of hydroclimatic variability in Queensland Australia. The model provides a standardized approach to hydroclimate reconstruction using multiple palaeoclimate proxy records derived from natural archives such as speleothems, ice cores and tree rings. The method combines time-series modeling with inverse prediction to quantify the relationships between a given hydroclimate index and relevant proxies over an instrumental period and subsequently reconstruct the hydroclimate back through time. We present case studies for Brisbane and Fitzroy catchments focusing on two hydroclimate indices, the Rainfall Index (RFI) and the Standardized Precipitation-Evapotranspiration Index (SPEI). The probabilistic nature of the reconstructions allows us to estimate the probability that a hydroclimate index in any reconstruction year was lower (higher) than the minimum (maximum) value observed over the instrumental period. In Brisbane, the RFI is unlikely (probabilities < 5%) to have exhibited extremes beyond the minimum/maximum values observed between 1889 and 2019. However, in Fitzroy there are several years during the reconstruction period where the RFI is likely (>50% probability) to have exhibited behavior beyond the minimum/maximum of what has been observed, during the instrumental period. For SPEI, the probability of observing such extremes prior to the beginning of the instrumental period in 1889 doesn't exceed 30% in any reconstruction year in Brisbane, but exceeds 50% in multiple years in Fitzroy.

The Royal Botanic Garden Edinburgh (RBGE) has put the climate emergency and biodiversity crisis at the centre of its organisational strategy and is making changes to reduce the environmental impact of its activities and to adapt to the conditions created by changes in climate. This article looks at actions towards the Sustainable Development Goals (SDGs) within the physical boundaries of the four gardens of RBGE in Scotland. The article considers two areas. Firstly, the Horticultural sphere, including the reduction of the impacts on the environment made by horticultural practice to maintain the gardens, and adaptation of the landscapes to improve visitor access and the biodiversity benefits of plantings. Secondly, influencing behaviour and engaging visitors with respect to growing food and the enjoyment of being with plants for health and wellbeing. In both these areas, RBGE activities are contributing to targets within SDGs 11, 12, 13 and 15. These targets, the actions to realise them and subsequent outcomes are described below. Finally, a major project underway at the Garden which will significantly reduce the environmental impacts of the institution, the Edinburgh Biomes, is introduced.

The aim of this special issue is to better understand the strategy and change interface, in particular, the (sub)processes and cognitions that enable strategies to be successfully implemented and organizations effectively changed. The ten papers selected for this special issue reflect a range of scholarly traditions and, thus, as our review and integration of the relevant literatures, and our introductions to the ten papers demonstrate, they shed light on the strategy and change interface in starkly different ways. Collectively, the papers give us more insight into the recursive activities, and structural, organizational learning and cognitive mechanisms that are encouraged or deliberately established at organizations to allow their people to successfully implement a strategy and effect change, including achieve greater levels of horizontal alignment. Moreover, they demonstrate the benefits associated with establishing platforms and/or routines designed to overcome decision-makers’ cognitive shortcomings while implementing a strategy or making timely adjustments to it. We conclude our editorial by identifying some yet unanswered questions.

Purpose CTNNA1 is a potential diffuse gastric cancer risk gene, however CTNNA1 testing on multigene panel testing (MGPT) remains unstudied. Methods De-identified data from 151,425 individuals who underwent CTNNA1 testing at a commercial laboratory between October 2015 and July 2019 were reviewed. Tissue α-E-catenin immunohistochemistry was performed on CTNNA1 c.1351C>T (p.Arg451*) carriers. Results Fifty-two individuals (0.03% tested) had CTNNA1 loss-of-function (LOF) variants and 1057 individuals (0.7% tested) had a total of 302 distinct missense variants of uncertain significance. Detailed history was available on 33 CTNNA1 LOF carriers, with 21 unique CTNNA1 LOF variants. Four (12%) individuals had diffuse gastric cancer and 22 (67%) had breast cancer. Six (21%) and 24 (83%) of the 29 families reported a history of gastric or breast cancer, respectively. The CTNNA1 c.1351C>T nonsense variant was identified in three separate families with early-onset diffuse gastric cancer or breast cancer. Immunohistochemistry showed decreased α-E-catenin expression in gastric cancers. Conclusion CTNNA1 LOF variants are detected on MGPT with a majority of these individuals having gastric or breast cancer. The overall risk of gastric cancer for CTNNA1 LOF carriers may be lower than expected. Given the uncertain phenotype and penetrance, management of individuals with CTNNA1 LOF variants remains challenging.

To determine whether a brief leadership curriculum including high-fidelity simulation can improve leadership skills among resident physicians.This was a double-blind, randomized controlled trial among obstetrics-gynecology and emergency medicine (EM) residents across 5 academic medical centers from different geographic areas of the United States, 2015-2017. Participants were assigned to 1 of 3 study arms: the Leadership Education Advanced During Simulation (LEADS) curriculum, a shortened Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum, or as active controls (no leadership curriculum). Active controls were recruited from a separate site and not randomized to limit any unintentional introduction of materials from leadership curricula. The LEADS curriculum was developed in partnership with the Council on Resident Education in Obstetrics and Gynecology and Council of Residency Directors in Emergency Medicine as a novel way to provide a leadership toolkit. Both LEADS and the abbreviated TeamSTEPPS were designed as six 10-minute interactive web-based modules.The primary outcome of interest was the leadership performance score from the validated Clinical Teamwork Scale instrument measured during standardized high-fidelity simulation scenarios. Secondary outcomes were 9 key components of leadership from the detailed leadership evaluation measured on 5-point Likert scales. Both outcomes were rated by a blinded clinical video reviewer.One hundred ten obstetrics-gynecology and EM residents participated in this 2-year trial. Participants in both LEADS and TeamSTEPPS had statistically significant improvement in leadership scores from "average" to "good" ranges both immediately and at the 6-month follow-up, while controls remained unchanged in the "average" category throughout the study. There were no differences between LEADS and TeamSTEPPS curricula with respect to the primary outcome.Residents who participated in a brief structured leadership training intervention had improved leadership skills that were maintained at 6-month follow-up.

ObjectivesClinician well-being has been recognised as an important pillar of healthcare. However, research mainly addresses mitigating the negative aspects of stress or burnout, rather than enabling positive aspects. With the added strain of a pandemic, identifying how best to maintain and support the well-being, satisfaction and flourishing of general practitioners (GPs) is now more important than ever.DesignSystematic review.Data sourcesWe searched MEDLINE, PsycINFO, Embase, CINAHL and Scopus from 2000 to 2020.Study selectionIntervention studies with more than 50% GPs in the sample evaluating self-reported well-being, satisfaction and related positive outcomes were included. The Cochrane Risk of Bias 2 tool was applied.ResultsWe retrieved 14 792 records, 94 studies underwent full-text review. We included 19 studies in total. Six randomised controlled trials, three non-randomised, controlled trials, eight non-controlled studies of individual or organisational interventions with a total of 1141 participants. There were two quasi-experimental articles evaluating health system policy change. Quantitative and qualitative positive outcomes were extracted and analysed. Individual mindfulness interventions were the most common (k=9) with medium to large within-group (0.37–1.05) and between-group (0.5–1.5) effect sizes for mindfulness outcomes, and small-to-medium effect sizes for other positive outcomes including resilience, compassion and empathy. Studies assessing other intervention foci or other positive outcomes (including well-being, satisfaction) were of limited size and quality.ConclusionsThere is remarkably little evidence on how to improve GPs well-being beyond using mindfulness interventions, particularly for interventions addressing organisational or system factors. This was further undermined by inconsistent reporting, and overall high risk of bias. We need to conduct research in this space with the same rigour with which we approach clinical intervention studies in patients.PROSPERO registration numberCRD42020164699.Funding sourceDr Diana Naehrig is funded through the Raymond Seidler PhD scholarship.

The MEN1 gene is positioned on the long arm of chromosome 11 (11q13) and results in the production of menin. A classical tumour suppressor gene; the spectrum of reported germline MEN1 mutations occur throughout the gene with no strong genotype/phenotype relationship. Mosaicism is extremely rare, a recent report citing only 2 mosaic cases by next generation sequencing1. We describe a 43-year-old female with MEN1 mosaicism associated with parathyroid adenoma and probable gastrinoma. Our patient initially presented with nephrolithiasis and nephrocalcinosis alongside biochemistry of primary hyperparathyroidism. Imaging confirmed a right lower pole parathyroid adenoma and the lesion was removed, pathology confirming the diagnosis (July 2018). Post operatively she remained hypercalcaemic. Repeat imaging suggested a further right sided culprit lesion. One year previously (August 2017) she was admitted with a perforated duodenal ulcer within the first part of the duodenum (D1), ascribed to ibuprofen use, requiring surgical repair. Whilst awaiting repeat parathyroid surgery she represented with a further duodenal ulcer and perforation (February 2019) this time in the second part of the duodenum(D2). A second parathyroidectomy was performed and genetic investigations were instigated, given the presence of classical MEN1 phenotype. Again, pathology was consistent with a parathyroid adenoma (March 2019). DNA was extracted for next generation sequencing which revealed mosaicism with a c.124 G>A variant detected in the MEN1 gene at a level of approximately 15%. Further investigations have shown normal serum prolactin and pituitary and pancreatic MRI imaging. With no other family members testing positive (parents and 2/3 children) this mutation appears to be a de novo index case. Adjusted Calcium is normal 2.53 mmol/L (2.2-2.6 mmol/L) but serum Chromogranin A is elevated (2620 µg/L (ref range The c.124 G>A variant predicts an amino acid substitution p.(Gly42Ser) in menin structure, an amino acid change previously associated with MEN12. Given the paucity of MEN1 mosaicism reported within the literature with the presence of the two cell lines and only 15% mosaicism close monitoring will be crucial to determine the genotype/phenotype relationship in our patient. 1 Choppin et al 2019 Eur J Endocrinol 1; 180(2):L1-L3 2 Itoh et al 2017 Clin Pediatr Endocrinol 26;25-28

This paper examines the customer experience of a medical tourism alliance project between a Chinese private hospital and a Thai medical center. The purpose is to evaluate the perceived value of this strategic project from the perspective ofthe patients. Qualitative data were collected through a series of interviews with Chinese patients while they were in Thailand receiving medical treatment. Additional interviews collected data from informed experts involved in the memorandum of understanding (MOU); to gain their perspective on the alliance’s success. Secondary data wassourcedfrom reports available from the hospital, medical center, business media, and scholarly publications to supplement the primary information. This paper explores the voice of the customer as an indicator of post-project success.

Sediment runoff has been cited as a major contributor to the declining health of the Great Barrier Reef (GBR), however, climate and land use drivers have not been jointly evaluated. This study used alluvial archives from fluvial benches in two tributaries of the Upper Burdekin catchment together with the best available land use history and climate proxy records to provide insights into the timing of depositional events in this region over the past 500 years. This study suggests that mining and the increased runoff variability in the latter half of the nineteenth century are the likely sources of the original excess sediment that was used to build the bench features in these catchments. Grazing also contributed to increased bench sedimentation prior to 1900, however, the contribution of grazing was likely more significant in the second half of the 20th century, and continues to be a dominant land use contributor today.

The National Botanic Garden of Nepal (NBG) lies 16km south of Kathmandu, at the base of Phulchowki, the highest mountain in the Kathmandu Valley. It was inaugurated in 1962 by King Mahendra and since that time the collections have developed, many of them into named areas and groupings. The year 2016 was the bicentenary of the establishment of diplomatic relations between Nepal and Great Britain, and this was marked in the NBG with the development of a Biodiversity Education Garden. This was created in collaboration with the Royal Botanic Garden Edinburgh (RBGE), and the occasion signified a revitalisation of collaborative relations between the NBG and British botanic gardens which started in the early 1960s with the appointment to NBG of British horticulturists Geoffrey Herklots and, later, Tony Schilling. The history of the garden, its layout and collections, and the activities and outcomes of the recent collaborations are described and illustrated with colour photographs.

The nature and timing of fluvial response and coincident changes in climate as inferred from multiple, independent proxies are examined in the wet tropics of north-eastern Australia. Chronostratigraphic data provide evidence for regionally synchronous fluvial aggradation at 30-13 ka, 8-5 ka and again from 1 ka. Terrace incision and removal occurred at 13-8 ka and 5-1 ka. A new synthesis of regional palaeoenvironmental proxy records spanning the last 30 ka highlights key periods of environmental change. Comparison of the records of fluvial and environmental change reveals the relationship is complex with no clear relationship between river aggradation/incision and wetter/drier conditions. The nature and timing of fluvial response in the wet tropics also shows broad similarities with coastal valleys in south-eastern New South Wales, suggesting continental-scale controls on fluvial response to changing climate during the Late Quaternary in Australia. Copyright (C) 2017 John Wiley & Sons, Ltd.

© 2017 Cognizant, LLC. Sport participation as a legacy of the Olympic Games (OG) has frequently featured as a component of the "legacy package" that government bodies and organizing committees promote to the local communities to gain support for the hosting of these mega-events. However, only recently increased sport participation has been explicitly included as part of a legacy plan in OG candidature files. This article examines the changes and development of sport legacy planning and implementation from Sydney 2000, London 2012, and Rio 2016. The three case studies confirm that sport participation legacies are only achieved if host governments engage the community, develop long-term strategies, and coordinate efforts between different government portfolios and with a range of relevant stakeholders. So far, there is limited evidence available to demonstrate that relevant government bodies have attempted to strategically leverage the Games with the purpose of developing a sport participation legacy for the wider population.

This research contributes to practice in the field of English for Academic Purposes (EAP) by demonstrating how business management approaches and tools can enhance the content and performance management of in-sessional academic skills provision. It was the result of a teaching and research collaboration between a Business Management (Logistics) lecturer and an EAP lecturer. The framework used in this research to evaluate student engagement with in-sessional provision is the CEM Model (Sloan & Porter, 2010) (Conceptualisation, Embedding and Mapping), and forms the basis for an evaluation, using a Best-Worst Discrete Choice Survey, to uncover from a student perspective the most valued academic skills content. From the Business Management perspective, the findings led to a reconceptualization of the CEM Model as a balanced scorecard, a strategic performance measurement tool to assess levels of student, staff and institutional engagement. For EAP practitioners the findings inform identification of in-sessional EAP provision to support international postgraduate students through enhancing the content and performance management of in-sessional EAP provision.

BackgroundPoor physical health in severe mental illness (SMI) remains a major issue for clinical practice.AimsTo use electronic health records of routinely collected clinical data to determine levels of screening for cardiometabolic disease and adverse health outcomes in a large sample (n= 7718) of patients with SMI, predominantly schizophrenia and bipolar disorder.MethodWe linked data from the Glasgow Psychosis Clinical Information System (PsyCIS) to morbidity records, routine blood results and prescribing data.ResultsThere was no record of routine blood monitoring during the preceding 2 years for 16.9% of the cohort. However, monitoring was poorer for male patients, younger patients aged 16–44, those with schizophrenia, and for tests of cholesterol, triglyceride and glycosylated haemoglobin. We estimated that 8.0% of participants had diabetes and that lipids levels, and use of lipid-lowering medication, was generally high.ConclusionsElectronic record linkage identified poor health screening and adverse health outcomes in this vulnerable patient group. This approach can inform the design of future interventions and health policy.