Blunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A blunt chest injury care bundle was to be implemented at two sites to guide care.
To identify ...facilitators and barriers to the implementation of a blunt chest injury care bundle and design strategies tailored to promote future implementation.
1) A mixed-method survey based on the theoretical domains framework (TDF) was used to identify barriers and facilitators to the implementation of a blunt chest injury care bundle. This survey was distributed to 441 staff from 12 departments across two hospitals. Quantitative data were analysed using SPSS and qualitative using inductive content analysis. 2) The quantitative and qualitative results from the survey were integrated and mapped to each of the TDF domains. 3) The facilitators and barriers were evaluated using the Behaviour Change Wheel to extract specific intervention functions, policies, behaviour change techniques and implementation strategies. Each phase was assessed against the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects or safety and Equity (APEASE) criteria.
One hundred ninety eight staff completed the survey. All departments surveyed were represented. Nine facilitators and six barriers were identified from eight domains of the TDF. Facilitators (TDF domains) were: understanding evidence-informed patient care and understanding risk factors (Knowledge); patient assessment skills and blunt chest injury management skills (Physical skills); identification with professional role (Professional role and identity); belief of consequences of care bundle (Belief about consequences); provision of training and protocol design (Environmental context and resources); and social supports (Social influences). Barriers were: not understanding the term 'care bundle' (Knowledge); lacking regional analgesia skills (Physical skills); not remembering to follow protocol (Memory, attention, and decision processes); negative emotions relating to new protocols (Emotions); equipment and protocol access (Environmental context and resources). Implementation strategies were videos, education sessions, visual prompt for electronic medical records and change champions.
Multiple facilitators and barriers were identified that may affect the implementation of a blunt chest injury care bundle. Implementation strategies developed through this process have been included in a plan for implementation in the emergency departments of two hospitals. Evaluation of the implementation is underway.
We report the genome of the facultative intracellular parasite Rhodococcus equi, the only animal pathogen within the biotechnologically important actinobacterial genus Rhodococcus. The 5.0-Mb R. equi ...103S genome is significantly smaller than those of environmental rhodococci. This is due to genome expansion in nonpathogenic species, via a linear gain of paralogous genes and an accelerated genetic flux, rather than reductive evolution in R. equi. The 103S genome lacks the extensive catabolic and secondary metabolic complement of environmental rhodococci, and it displays unique adaptations for host colonization and competition in the short-chain fatty acid-rich intestine and manure of herbivores--two main R. equi reservoirs. Except for a few horizontally acquired (HGT) pathogenicity loci, including a cytoadhesive pilus determinant (rpl) and the virulence plasmid vap pathogenicity island (PAI) required for intramacrophage survival, most of the potential virulence-associated genes identified in R. equi are conserved in environmental rhodococci or have homologs in nonpathogenic Actinobacteria. This suggests a mechanism of virulence evolution based on the cooption of existing core actinobacterial traits, triggered by key host niche-adaptive HGT events. We tested this hypothesis by investigating R. equi virulence plasmid-chromosome crosstalk, by global transcription profiling and expression network analysis. Two chromosomal genes conserved in environmental rhodococci, encoding putative chorismate mutase and anthranilate synthase enzymes involved in aromatic amino acid biosynthesis, were strongly coregulated with vap PAI virulence genes and required for optimal proliferation in macrophages. The regulatory integration of chromosomal metabolic genes under the control of the HGT-acquired plasmid PAI is thus an important element in the cooptive virulence of R. equi.
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Selective androgen receptor modulators (SARMs) represent non-steroidal agents commonly abused in human and animal (i.e. equine, canine) sports, with potential for further misuse as ...growth promoting agents in livestock-based farming. As a direct response to the real and possible implications of illicit application in both sport as well as food production systems, this study incorporated enzymatic hydrolysis (β-glucuronidase/arylsulfatase) into a previously established protocol while maintaining the minimal volume (200 µL) of urine sample required to detect SARMs encompassing various pharmacophores in urine from a range of species (i.e. equine, bovine, human, canine and rodent). The newly presented semi-quantitative UHPLC-MS/MS-based assay is shown to be fit-for-purpose, being rapid and offering high-throughput, with validation findings fulfilling criteria stipulated within relevant doping and food control legislation.•CCβ values determined at 1 ng mL−1 for majority of analytes.•Deconjugation step included in the method led to significantly increased relative abundance of ostarine in analysed incurred urine samples demonstrating the requirement for hydrolysis to detect a total form of emerging SARMs.•Assay amenable for use within routine testing to ensure fair play in animal and human sports and that animal-derived food is free from contamination with SARM residues.
BACKGROUND: Streptococcus equi ssp. equi is the causative agent of ‘Strangles’ in horses. This is a debilitating condition leading to economic loss, yard closures and cancellation of equestrian ...events. There are multiple genotypes of S. equi ssp. equi which can cause disease, but to date there has been no systematic study of strains which are prevalent in Ireland. This study identified and classified Streptococcus equi ssp. equi strains isolated from within the Irish equine industry. RESULTS: Two hundred veterinary isolates were subjected to SLST (single locus sequence typing) based on an internal sequence from the seM gene of Streptococcus equi ssp equi. Of the 171 samples which successfully gave an amplicon, 162 samples (137 Irish and 24 UK strains) gave robust DNA sequence information. Analysis of the sequences allowed division of the isolates into 19 groups, 13 of which contain at least 2 isolates and 6 groups containing single isolates. There were 19 positions where a DNA SNP (single nucleotide polymorphism) occurs, and one 3 bp insertion. All groups had multiple (2–8) SNPs. Of the SNPs 17 would result in an amino acid change in the encoded protein. Interestingly, the single isolate EI8, which has 6 SNPs, has the three base pair insertion which is not seen in any other isolate, this would result in the insertion of an Ile residue at position 62 in that protein sequence. Comparison of the relevant region in the determined sequences with the UK Streptococcus equi seM MLST database showed that Group B (15 isolates) and Group I (2 isolates), as well as the individual isolates EI3 and EI8, are unique to Ireland, and some groups are most likely of UK origin (Groups F and M), but many more probably passed back and forth between the two countries. CONCLUSIONS: The strains occurring in Ireland are not clonal and there is a considerable degree of sequence variation seen in the seM gene. There are two major clades causing infection in Ireland and these strains are also common in the UK.
Urine stability during storage is essential in metabolomics to avoid misleading conclusions or erroneous interpretations. Facing the lack of comprehensive studies on urine metabolome stability, the ...present work performed a follow-up of potential modifications in urinary chemical profile using LC-HRMS on the basis of two parameters: the storage temperature (+4 °C, −20 °C, −80 °C and freeze-dried stored at −80 °C) and the storage duration (5–144 days). Both HILIC and RP chromatographies have been implemented in order to globally monitor the urinary metabolome. Using an original data processing associated to univariate and multivariate data analysis, our study confirms that chemical profiles of urine samples stored at +4 °C are very rapidly modified, as observed for instance for compounds such as:N-acetyl Glycine, Adenosine, 4-Amino benzoic acid, N-Amino diglycine, creatine, glucuronic acid, 3-hydroxy-benzoic acid, pyridoxal, l-pyroglutamic acid, shikimic acid, succinic acid, thymidine, trigonelline and valeryl-carnitine, while it also demonstrates that urine samples stored at −20 °C exhibit a global stability over a long period with no major modifications compared to −80 °C condition. This study is the first to investigate long term stability of urine samples and report potential modifications in the urinary metabolome, using both targeted approach monitoring individually a large number (n > 200) of urinary metabolites and an untargeted strategy enabling assessing for global impact of storage conditions.
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•HILIC and RPLC chromatographies were used for an exhaustive metabolomic approach.•A chemical database was created (n > 200) to identify affected urine metabolites.•Urine metabolic profile is altered starting from 5 days following storage at +4C°.•A number of urine metabolites profiles start being altered after a month at −20C°.•−80 °C was considered as the most convenient urine long-term storage condition.
•Current reforestation often focuses on planting regularly-spaced pine seedlings.•‘Course correction’ depends on increasingly rare follow-up treatments.•This approach may not build early resilience ...to fire and drought stress.•An alternative is suggested that includes dividing replanting areas into three zones.•We also emphasize including cluster planting in mesic microsites.•Using prescribed fire to reduce fuels, competing vegetation and build resilience.•Limitations and areas that need further research are highlighted.
The increasing frequency and severity of fire and drought events have negatively impacted the capacity and success of reforestation efforts in many dry, western U.S. forests. Challenges to reforestation include the cost and safety concerns of replanting large areas of standing dead trees, and high seedling and sapling mortality rates due to water stress, competing vegetation, and repeat fires that burn young plantations. Standard reforestation practices have emphasized establishing dense conifer cover with gridded planting, sometimes called 'pines in lines', followed by shrub control and pre-commercial thinning. Resources for such intensive management are increasingly limited, reducing the capacity for young plantations to develop early resilience to fire and drought. This paper summarizes recent research on the conditions under which current standard reforestation practices in the western U.S. may need adjustment, and suggests how these practices might be modified to improve their success. In particular we examine where and when plantations with regular tree spacing elevate the risk of future mortality, and how planting density, spatial arrangement, and species composition might be modified to increase seedling and sapling survival through recurring drought and fire events. Within large areas of contiguous mortality, we suggest a “three zone” approach to reforestation following a major disturbance that includes; (a) working with natural recruitment within a peripheral zone near live tree seed sources; (b) in a second zone, beyond effective seed dispersal range but in accessible areas, planting a combination of clustered and regularly spaced seedlings that varies with microsite water availability and potential fire behavior; and (c) a final zone defined by remote, steep terrain that in practice limits reforestation efforts to the establishment of founder stands. We also emphasize the early use of prescribed fire to build resilience in developing stands subject to increasingly common wildfires and drought events. Finally, we highlight limits to our current understanding of how young stands may respond and develop under these proposed planting and silvicultural practices, and identify areas where new research could help refine them.
Aims and objectives
To describe the prescribing behaviours and practices of registered nurse and midwife prescribers and to explore experiences of enablers and barriers to prescribing practices.
...Background
The extension of prescriptive authority to nurses and midwives internationally has created new opportunities for them to expand their scope of practice and is of significant benefit to effective and efficient health service provision.
Design
Cross‐sectional national survey of registered nurse and midwife prescribers.
Methods
Data were collected through an online survey between April–July 2018. A total of 84 nurse and midwife prescribers participated. The STROBE checklist was applied as the reporting guideline for this study.
Results
Respondents estimated that two‐fifths of their consultations involved an episode of prescribing. Nurse and midwife prescribers engaged in similar prescribing behaviours spanning the range of activities from initiating new medications to ceasing medicines. The most frequently selected criterion for prescribing was clinical effectiveness. Prescribing was viewed as essential to respondents' clinical practice, allowing them to provide a complete episode of care and leading to a reduction in medication errors and reduced delays and waiting times for patients. Enablers of prescribing included knowledge, experience, education and access to continuous professional development, as well as support from colleagues and organisations.
Conclusion
Little is known about the prescribing behaviours and practices of registered nurse and midwife prescribers. While prescribing authority enables nurse and midwife practitioners to deliver holistic care, there remain significant barriers and challenges including increased workloads, lack of continuous professional development, lack of support and overly restrictive rules and policies governing prescribing.
Relevance to clinical practice
Addressing the barriers identified in this study could enable more nurse and midwife prescribers to work to their full scope of practice, enabling populations to fully capitalise on the contributions of registered nurse and midwife prescribing services.
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