Phylogenetically Widespread Multiple Paternity in New World Natricine Snakes

We used microsatellite DNA markers to identify the extent to which multiple paternity within litters occurs among species of New World natricine snakes. We selected seven species to represent the three major clades of Natricinae and all three subclades of the gartersnake clade. Microsatellite DNA genotyping of dams and litters confirmed multiple paternity within litters of six species, including Thamnophis radix, T. sauritus, Storeria dekayi, S. occipitomaculata, Nerodia rhombifer, and Regina septemvittata. Multiple paternity was not evident in one litter of nine Thamnophis melanogaster. Together with published data documenting multiple paternity in T. bulteri, T. elegans, T. sirtalis, and N. sipedon, these results confirm the phylogenetically widespread occurrence of multiple paternity among New World natricines, emphasizing the need to consider phylogenetic (historical) explanations when analyzing snake mating systems

Using Open Public Meetings and Elections to Promote Inward Transparency and Accountability: Lessons from Zambia

BackgroundCommunity-led governance can ensure that leaders are accountable to the populations they serve and strengthen health systems for maternal care. A key aspect of democratic accountability is electing respective governance bodies, in this case community boards, and holding public meetings to inform community members about actions taken on their behalf. After helping build and open 10 maternity waiting homes (MWHs) in rural Zambia as part of a randomized controlled trial, we assisted community governance committees to plan and execute annual meetings to present performance results and, where needed, to elect new board members. MethodsWe applied a principally qualitative design using observation and analysis of written documentation of public meetings to answer our research question: how do governance committees enact inward transparency and demonstrate accountability to their communities. The analysis measured participation and stakeholder representation at public meetings, the types and purposes of accountability sought by community members as evidenced by questions asked of the governance committee, and responsiveness of the governance committee to issues raised at public meetings. ResultsPublic meetings were attended by 6 out of 7 possible stakeholder groups, and reports were generally transparent. Stakeholders asked probing questions focused mainly on financial performance. Governance committee members were responsive to questions raised by participants, with 59% of answers rated as fully or mostly responsive (showing understanding of and answering the question). Six of the 10 sites held elections to re-elect or replace governance committee members. Only 2 sites reached the target set by local stakeholder committees of 50% female membership, down from 3 at formation. To further improve transparency and accountability, community governance committees need to engage in advance preparation of reports, and should consult with stakeholders on broader measures for performance assessment. Despite receiving training, community-level governance committees lacked understanding of the strategic purpose of open public meetings and elections, and how these relate to democratic accountability. They were therefore not motivated to engage in tactics to manage stakeholders effectively. ConclusionWhile open meetings and elections have potential to enhance good governance at the community level, continuous training and mentoring are needed to build capacity and enhance sustainability

Developing a typology of interventions to support doctors’ mental health and wellbeing

Background: The problem of mental ill-health in doctors is complex, accentuated by the COVID-19 pandemic, and impacts on healthcare provision and broader organisational performance. There are many interventions to address the problem but currently no systematic way to categorise them, which makes it hard to describe and compare interventions. As a result, implementation tends to be unfocussed and fall short of the standards developed for implementing complex healthcare interventions. This study aims to develop: 1) a conceptual typology of workplace mental health and wellbeing interventions and 2) a mapping tool to apply the typology within research and practice. Methods: Typology development was based on iterative cycles of analysis of published and in-practice interventions, incorporation of relevant theories and frameworks, and team and stakeholder group discussions. Results: The newly developed typology and mapping tool enable interventions to be conceptualised and/or mapped into different categories, for example whether they are designed to be largely preventative (by either improving the workplace or increasing personal resources) or to resolve problems after they have arisen. Interventions may be mapped across more than one category to reflect the nuance and complexity in many mental health and wellbeing interventions. Mapping of interventions indicated that most publications have not clarified their underlying assumptions about what causes outcomes or the theoretical basis for the intervention. Conclusion: The conceptual typology and mapping tool aims to raise the quality of future research and promote clear thinking about the nature and purpose of interventions, In doing so it aims to support future research and practice in planning interventions to improve the mental health and wellbeing of doctors

To exclose nests or not: structured decision making for the conservation of a threatened species

Decisions regarding endangered species recovery often face sparse data and multiple sources of uncertainty about the effects of management. Structured decision making (SDM) provides a framework for assembling knowledge and expert opinion and evaluating the tradeoffs between different objectives while formally incorporating uncertainty. The Atlantic Coast piping plover provides an illustrative case for the utility of SDM in endangered species management because its population growth is simple to model, most populations are monitored, decision alternatives are well defined, and many managers are open to recovery recommendations. We built a model to evaluate the decision to use nest exclosures to protect piping plover eggs from predators, where the objective was to maximize λ and the tradeoff was between nest survival and adult survival. The latter can be reduced by exclosures. We used a novel mixed multinomial logistic exposure model to predict daily nest fates and incorporated the results into a stochastic projection matrix that included renesting after nest failure, and adult mortality associated with abandonment. In our test data set (n = 329 nests from 28 sites over four years), the mean nest survival over 34 days was markedly higher for exclosed nests (0.76 ± 0.03 SE) than for unexclosed nests (0.37 ± 0.07). Abandonment rates were also higher for exclosed nests (0.092 ± 0.017) than for unexclosed nests (0.045 ± 0.017), but the difference was not statistically signifi- cant and the loss rate to “other sources” (mostly predators) was much lower for exclosed nests (0.15 ± 0.03) than for unexclosed nests (0.58 ± 0.07). Population growth rate (λ) was clearly improved by exclosure use at the sites with high background nest loss rates, but λ was still \u3c1 with exclosure use. Where the background nest loss rates were low, the decision to use exclosures was ambiguous, and λ could benefit from reducing uncertainty in vital rates. Our process demonstrated that geographic and temporal variation in nest mortality determines whether exclosures will be useful in attaining positive population growth rates and that other management options must be considered where the background nest mortality rates are high

C9 ORF 72 expansion in a family with bipolar disorder

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98405/1/bdi12063.pd

Developing a typology of interventions to support doctors' mental health and wellbeing

This is the final version. Available from BMC via the DOI in this record. Availability of data and materials: The secondary data which was used to develop the typology and mapping tool is located within Carrieri D, Pearson M, Mattick K, Papoutsi C, Briscoe S, Wong G & Jackson M. Interventions to minimise doctors' mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review. Health Serv Deliv Res 2020;8(19). https://doi.org/https://doi.org/10.3310/hsdr08190.BACKGROUND: The problem of mental ill-health in doctors is complex, accentuated by the COVID-19 pandemic, and impacts on healthcare provision and broader organisational performance. There are many interventions to address the problem but currently no systematic way to categorise them, which makes it hard to describe and compare interventions. As a result, implementation tends to be unfocussed and fall short of the standards developed for implementing complex healthcare interventions. This study aims to develop: 1) a conceptual typology of workplace mental health and wellbeing interventions and 2) a mapping tool to apply the typology within research and practice. METHODS: Typology development was based on iterative cycles of analysis of published and in-practice interventions, incorporation of relevant theories and frameworks, and team and stakeholder group discussions. RESULTS: The newly developed typology and mapping tool enable interventions to be conceptualised and/or mapped into different categories, for example whether they are designed to be largely preventative (by either improving the workplace or increasing personal resources) or to resolve problems after they have arisen. Interventions may be mapped across more than one category to reflect the nuance and complexity in many mental health and wellbeing interventions. Mapping of interventions indicated that most publications have not clarified their underlying assumptions about what causes outcomes or the theoretical basis for the intervention. CONCLUSION: The conceptual typology and mapping tool aims to raise the quality of future research and promote clear thinking about the nature and purpose of interventions, In doing so it aims to support future research and practice in planning interventions to improve the mental health and wellbeing of doctors.National Institute for Health Researc

How can NHS trusts in England optimise strategies to improve the mental health and well-being of hospital doctors? The Care Under Pressure 3 (CUP3) realist evaluation study protocol

This is the final version. Available from BMJ Publishing via the DOI in this record. Data availability statement: This study did not generate any new data.Introduction: The growing incidence of mental ill health in doctors was a major issue in the UK and internationally, even prior to the COVID-19 pandemic. It has significant and far-reaching implications, including poor quality or inconsistent patient care, absenteeism, workforce attrition and retention issues, presenteeism, and increased risk of suicide. Existing approaches to workplace support do not take into account the individual, organisational and social factors contributing to mental ill health in doctors, nor how interventions/programmes might interact with each other within the workplace. The aim of this study is to work collaboratively with eight purposively selected National Health Service (NHS) trusts within England to develop an evidence-based implementation toolkit for all NHS trusts to reduce doctors’ mental ill health and its impacts on the workforce. Methods and analysis: The project will incorporate three phases. Phase 1 develops a typology of interventions to reduce doctors’ mental ill health. Phase 2 is a realist evaluation of the existing combinations of strategies being used by acute English healthcare trusts to reduce doctors’ mental ill health (including preventative promotion of well-being), based on 160 interviews with key stakeholders. Phase 3 synthesises the insights gained through phases 1 and 2, to create an implementation toolkit that all UK healthcare trusts can use to optimise their strategies to reduce doctors’ mental ill health and its impact on the workforce and patient care.National Institute for Health Researc

An Anthropocene Without Archaeology—Should We Care?

For more than a decade, a movement has been gathering steam among geoscientists to designate an Anthropocene Epoch and formally recognize that we have entered a new geological age in which Earth’s systems are dominated by humans. Chemists, climatologists, and other scientists have entered the discussion, and there is a growing consensus that we are living in the Anthropocene. Nobel Prize-winning atmospheric chemist Paul Crutzen (2002a, 2002b; Crutzen and Stoermer 2000) coined the term, but the idea that humans are a driver of our planet’s climate and ecosystems has much deeper roots. Italian geologist Antonio Stoppani wrote of the “anthropozoic era” in 1873 (Crutzen 2002a), and many others have proposed similar ideas, including journalist Andrew Revkin’s (1992) reference to the “Anthrocene” and Vitousek and colleagues (1997) article about human domination of earth’s ecosystems. It was not until Crutzen (2002a, 2002b) proposed that the Anthropocene began with increased atmospheric carbon levels caused by the Industrial Revolution in the late eighteenth century (including the invention of the steam engine in A.D. 1784), however, that the concept began to gain serious traction among scientists and inspire debate

Esophageal sphincter device for gastroesophageal reflux disease

BACKGROUND Patients with gastroesophageal reflux disease who have a partial response to proton-pump inhibitors often seek alternative therapy. We evaluated the safety and effectiveness of a new magnetic device to augment the lower esophageal sphincter. METHODS We prospectively assessed 100 patients with gastroesophageal reflux disease before and after sphincter augmentation. The study did not include a concurrent control group. The primary outcome measure was normalization of esophageal acid exposure or a 50% or greater reduction in exposure at 1 year. Secondary outcomes were 50% or greater improvement in quality of life related to gastroesophageal reflux disease and a 50% or greater reduction in the use of proton-pump inhibitors at 1 year. For each outcome, the prespecified definition of successful treatment was achievement of the outcome in at least 60% of the patients. The 3-year results of a 5-year study are reported. RESULTS The primary outcome was achieved in 64% of patients (95% confidence interval [CI], 54 to 73). For the secondary outcomes, a reduction of 50% or more in the use of proton-pump inhibitors occurred in 93% of patients, and there was improvement of 50% or more in quality-of-life scores in 92%, as compared with scores for patients assessed at baseline while they were not taking proton-pump inhibitors. The most frequent adverse event was dysphagia (in 68% of patients postoperatively, in 11% at 1 year, and in 4% at 3 years). Serious adverse events occurred in six patients, and in six patients the device was removed. CONCLUSIONS In this single-group evaluation of 100 patients before and after sphincter augmentation with a magnetic device, exposure to esophageal acid decreased, reflux symptoms improved, and use of proton-pump inhibitors decreased. Follow-up studies are needed to assess long-term safety. (Funded by Torax Medical; ClinicalTrials.gov number, NCT00776997.