Structure and function of natural sulphide-oxidizing microbial mats under dynamic input of light and chemical energy

We studied the interaction between phototrophic and chemolithoautotrophic sulphide-oxidizing microorganisms in natural microbial mats forming in sulphidic streams. The structure of these mats varied between two end-members: one characterized by a layer dominated by large sulphur-oxidizing bacteria (SOB; mostly Beggiatoa-like) on top of a cyanobacterial layer (B/C mats) and the other with an inverted structure (C/B mats). C/B mats formed where the availability of oxygen from the water column was limited (<5 mu M). Aerobic chemolithotrophic activity of the SOB depended entirely on oxygen produced locally by cyanobacteria during high light conditions. In contrast, B/C mats formed at locations where oxygen in the water column was comparatively abundant (445 mu M) and continuously present. Here SOB were independent of the photosynthetic activity of cyanobacteria and outcompeted the cyanobacteria in the uppermost layer of the mat where energy sources for both functional groups were concentrated. Outcompetition of photosynthetic microbes in the presence of light was facilitated by the decoupling of aerobic chemolithotrophy and oxygenic phototrophy. Remarkably, the B/C mats conserved much less energy than the C/B mats, although similar amounts of light and chemical energy were available. Thus ecosystems do not necessarily develop towards optimal energy usage. Our data suggest that, when two independent sources of energy are available, the structure and activity of microbial communities is primarily determined by the continuous rather than the intermittent energy source, even if the time-integrated energy flux of the intermittent energy source is greater

Improving induction of labour for women through the development of a new pathway

Background: Although induction of labour is a safe procedure for the pregnant woman at term, the process is not without risk. In recognition of these challenges associated with induction, an audit of local service provision was undertaken. Aim: To identify problems with the existing induction service. Methods: This was a retrospective analysis of women’s notes from May to December 2016. All patient records of pregnant women who had received induction during this time (n=870) were examined, as well as complaints and feedback received by the service. Findings: The audit identified several issues that would need to be addressed if the service was to be improved. These concerns were divided into two groups: the pregnant woman’s perspective and service provision issues. Conclusion: A new induction of labour pathway was created that aimed to address some of the concerns identified by the audit, and improve the care that women received. A further audit was conducted to assess the improvement in care as a result

Using stories to assist storytelling in a pastoral setting: Four female pastors in dialogue with Mary Magdalene

Sometimes we need a source of encouragement for restoring our own lives, to help us re-create ourselves. Using text as narrative texts opens up a multitude of possibilities in the work with clients in therapy. The story of Mary Magdalene told in John 20:11–18 is considered to be a healing story. This article aims to retell the story of her encounter with the resurrected Jesus, using the Gospel of Mary as an enlightening intertext. Because the story of Mary Magdalene’s encounter with Jesus is used as a healing story, the basic principles of transformative narrative theory are considered tobe useful in the analysis of this text. Mary Magdalene’s story is then discussed with three female pastors of the Netherdutch Reformed Church of Africa. The research opened up a discussion about spirituality. This article would be incomplete without reflecting on the spirituality stories of the group of co-researchers

The provision of education and training for healthcare professionals through the medium of the internet

This paper describes a new initiative to provide Internet based courses to student and professional occupational therapists in four centres in the UK, Belgium the Netherlands and Sweden. The basis of this collaborative Occupational Therapy Internet School (OTIS) is the concept of the “Virtual College”. This comprises the design and implementation of a sophisticated Internet-based system through which courses can be managed, prepared and delivered online in an effective fashion, and where students can communicate both with the staff and their peers. The aim is to support and facilitate the whole range of educational activities within a remote electronic environment. A major feature of the course organisation is the adoption of a problem-based approach in which students will collaborate internationally to propose effective intervention in given case study scenarios. The paper outlines the rationale for OTIS, the content and structure of the courseware, the technical specification of the system and evaluation criteria. In addition to the more conventional web-based learning facilities generally offered, a number of agent-based approaches are being adopted to assist in the management of the course by ensuring the proper delivery of course materials and to assist the functioning of project groups. </p

A Killing Disease Epidemic Among Displaced Sudanese Population Identified as Visceral Leishmaniasis.

A fatal disease epidemic affected the Bentiu area in southern Sudan and led to a mass migration of the Nuer tribe searching for treatment. The initially available information revealed a high mortality rate due to a possible occurrence of tuberculosis, malaria, enteric fever or visceral leishmaniasis (VL). Serological screening of 53 of the most severely affected patients in an enzyme-linked immunosorbent assay (ELISA) or an improved direct agglutination test (DAT) revealed positivity for VL. In 39 of those patients, diagnosis was confirmed by identification of Leishmania donovani amastigotes in lymph node or bone-marrow aspirates. In a total of 2714 patients observed, 1195 (44.0%) had clinical symptoms suggesting VL: DAT positive titers (1:3200-greater than or equal to 1:12800) were obtained in 654 (24.1%), of whom 325 were confirmed parasitologically. Forty-two VL cases died before or during treatment, giving a mortality rate of 6.4%. Among the intercurrent infections diagnosed in the VL population (654), respiratory involvements (31.7%) and malaria (10.7%) were most prevalent. With the exception of four (0.6%), all other VL patients (509) responded readily to sodium stibogluconate. The factors initiating the outbreak are discussed. Malnutrition and nomadic movements to potential VL endemic areas appeared to be the most important. HIV infection as a possible predisposition seemed remote considering the clinical and epidemiological similarity to VL occurring in East Africa, adequate humoral response in DAT, and immediate positive response to specific anti-Leishmania chemotherapy

Linking employee burnout to medical aid provider expenditure

Background. Healthcare has become a major expense. Burnout and its connection with psychological and physical health is well researched,yet little research has been done on the connection between burnout and financial outcomes, specifically as indicated by the costs incurredby medical aid providers as a result of members’ claims.Objective. To investigate the connection between employee burnout and medical aid claims and expenditure data in a sample from theprivate sector.Method. A cross-sectional design was used. The sample comprised 3 182 participants. The available objective medical aid expendituredata connected with each participant were: total insured benefits, general practitioner visits, specialist visits, general practitioner insuredbenefits, and claims for medicine. A low and a high burnout group were extracted, based on comorbidity of the two core components ofburnout. Analysis of covariance (ANCOVA) was then applied to investigate the differences in estimated marginal means of the expenditureson the low and the high burnout contrast groups, while controlling for age and gender.Results. The high burnout group frequented a general practitioner more often, and the medical aid provider expenditure was nearly doublethat of the low burnout group, on all the variables. Specialist visits did not show a significant result.Conclusion. High burnout is associated with a higher expenditure by a medical aid provider, compared with low burnout, per member.Stakeholders should therefore address burnout to reduce expenditure and promote health

The light curve of the companion to PSR B1957+20

We present a new analysis of the light curve for the secondary star in the eclipsing binary millisecond pulsar system PSR B1957+20. Combining previous data and new data points at minimum from the Hubble Space Telescope, we have 100% coverage in the R-band. We also have a number of new K_s-band data points, which we use to constrain the infrared magnitude of the system. We model this with the Eclipsing Light Curve code (ELC). From the modelling with the ELC code we obtain colour information about the secondary at minimum light in BVRI and K. For our best fit model we are able to constrain the system inclination to 65 +/- 2 degrees for pulsar masses ranging from 1.3 -- 1.9 M_sun. The pulsar mass is unconstrained. We also find that the secondary star is not filling its Roche lobe. The temperature of the un-irradiated side of the companion is in agreement with previous estimates and we find that the observed temperature gradient across the secondary star is physically sustainable.Comment: 6 pages, 4 figures & 3tables. Accepted for publication in MNRA

Calcaneal fractures in children

Eight patients with 9 calcaneal fractures were reviewed. Of the fractures 6 were intra articular and 3 extra-articular but in children this distinction appears to have little relevance to treatment or prognosis. While these fractures are relatively uncommon in children, clinical suspicion is important in making the diagnosis, since the presentation may be subtle. The overall prognosis in children is excellent

Study to assess the effect of a structured communication approach on quality of life in secure mental health settings (Comquol): study protocol for a pilot cluster randomized trial

Background Forensic mental health services have largely ignored examining patients’ views on the nature of the service offered to them. A structured communication approach (DIALOG) has been developed with the aim of placing the patient’s perspective of their care at the heart of the discussions between patients and clinicians. The effectiveness of the structured communication approach in community mental health services has been demonstrated but no trial taken place in a secure psychiatric setting. This pilot study is evaluating a six-month intervention combining DIALOG with principles of Solution Focused Therapy (SFT) on quality of life in medium secure settings. Methods/design A cluster randomized controlled trial design is being employed to conduct a 36 months pilot study. Participants are recruited from six medium secure in–patient services with 48 patients in the intervention group and 48 in the control group. The intervention uses a structured communication approach. It comprises of six meetings between patient and nurse over held once a month a six month period. During each meeting patients rate their satisfaction with a range of life and treatment domains with responses displayed on a tablet. The rating is followed by a discussion on how to improve the current situation in those domains identified by the patient. Assessments take place prior to the intervention (baseline), at 6 months (post intervention) and at 12 months (follow-up). The primary outcome is self reported Quality of Life. Discussion: The study aims to a) establish the feasibility of the trial design as the basis for determining the viability of a large full-scale trial, b) determine the variability of the outcomes of interest (quality of life, levels of satisfaction, disturbance, ward climate, and engagement with services) c) estimate the costs of the intervention and d) refine the intervention following the outcome of the study based upon the experiences of the nurses and patients. The intervention allows patients to have a greater say in how they are treated and targets care on areas that patients identify as important to them. It is intended to establish systems that support meaningful patient (and carer) involvement and participation. Trial registration: Current Controlled Trials ISRCTN34145189 Keywords: Comquol, DIALOG, Forensic, Mental Health, Quality of Life, Solution Focused Brief Therapy

The changing patterns of group politics in Britain

Two interpretations of ways in which group politics in Britain have presented challenges to democracy are reviewed: neo-corporatism or pluralistic stagnation and the rise of single issue interest groups. The disappearance of the first paradigm created a political space for the second to emerge. A three-phase model of group activity is developed: a phase centred around production interests, followed by the development of broadly based 'other regarding' groups, succeeded by fragmented, inner directed groups focusing on particular interests. Explanations of the decay of corporatism are reviewed. Single issue group activity has increased as party membership has declined and is facilitated by changes in traditional media and the development of the internet. Such groups can overload the policy-making process and frustrate depoliticisation. Debates about the constitution and governance have largely ignored these issues and there is need for a debate