Predicting virus evolution: the relationship between genetic robustness and evolvability of thermotolerance.

Evolutionary biologists often seek to infer historical patterns of relatedness among organisms using phylogenetic methods and to gauge the evolutionary processes that determine variation among individuals in extant populations. But relatively less effort is devoted to making evolutionary biology a truly predictive science, where future evolutionary events are precisely foreseen. Accurate predictions of evolvability would be particularly useful in the evolution of infectious diseases, such as the ability to preemptively address the challenge of pathogens newly emerging in humans and other host populations. Experimental evolution of microbes allows the possibility to rigorously test hypotheses regarding pathogen evolvability. Here, we review how genetic robustness was a useful predictor in gauging which variants of RNA virus varphi6 should evolve faster in a novel high-temperature environment. We also present new data on the relative survival of robust and brittle viruses across elevated temperatures and durations of ultraviolet exposure, to infer a possible mechanism for robustness. Our work suggests that virus adaptability in a new environment can be predicted given knowledge of virus canalization in the face of mutational input. These results hint that accurate predictions of virus evolvability are a realistic possibility, at least under circumstances of adaptive thermotolerance.

An audit of current discharge planning arrangements and their effectiveness on elderly care wards and community nursing services together with aspects of client satisfaction.

This paper is a review of a clinical audit conducted on the elderly care wards of a National Health Service (NHS) Trust hospital in the East Midlands. The audit examined current discharge planning arrangements and their effectiveness on elderly care wards, community nursing services and client satisfaction. Sixty sets of nursing notes were examined, 27 community nurses received a questionnaire and 60 patients and 26 carers or significant others were interviewed in the patient's place of residence. The audit findings revealed that, of the 60 sets of notes examined, only 10% of patient discharge plans commenced on admission. Liaison between ward and community nursing staff to discuss the needs of patients being discharged was minimal. Only 50% of community nurses believed they were adequately informed about, and 40% adequately involved in, patient discharge. Little consultation between ward staff, patients and their carers occurred during the discharge planning phase. The majority of patients (63%) and carers (81%) interviewed said that the patient's needs were not discussed prior to discharge home. The report ended by formulating a list of 11 recommendations which includes a thorough review of current policies, procedures and standards. A multidisciplinary steering group has been formed to assist in the implementation of the recommendations.

Paragordius varius.

We describe a 30-year-old man who presented with a tangled knot of worms that he "passed per rectum." The worms were identified as Paragordius varius. This is an uncommon pseudoparasite that is ingested from contaminated food or water. Identifying characteristics and the life cycle of Gordian worms are briefly discussed. Identification of this worm is important to distinguish it from true parasitic worms.