Key lessons from the establishment of a nurse-led infection prevention and control program for COVID-19 in an Australian hotel quarantine and isolation service.

BACKGROUND: A key aspect of Australia's response to the COVID-19 pandemic was to control transmission through legislated quarantine and isolation of overseas returning travellers and potentially infectious community members. In New South Wales, Special Health Accommodation (SHA) was rapidly established as a comprehensive health service for individuals that were at risk of having COVID-19, were confirmed to have COVID-19 or for those with complex health needs that were deemed inappropriate for management in Police managed Quarantine Hotels. SHA services were later expanded to care for community members who were COVID-19 positive and unable to effectively isolate, or contacts of individuals who were unable to quarantine effectively in their homes. SHA's unique nurse-led Infection Prevention and Control (IPC) program offers key lessons that may impact future programs. METHODS: A reflection on the experience of leading an Infection Prevention and Control program in SHA was undertaken. This was supported by a review of SHA admission, workforce and transmission data and data obtained from a cross-sectional questionnaire aimed to better understand the experiences of a novel population of health workers (HW) in a comprehensive health-led quarantine and isolation service. RESULTS: SHA program data demonstrates how its IPC program implementation prevented transmission of COVID-19 to SHA staff and patients. Responses from the questionnaire suggested staff felt safe and well-prepared through the IPC education they received. They also gained transferrable knowledge and skills, which they intend to use in future healthcare roles. CONCLUSION: The SHA nurse-led IPC program offered successful quarantine and isolation for COVID-19 in non-purpose-built facilities. A review of IPC strategies and key lessons from the establishment of the SHA IPC program are of critical importance to planning and management of current and future pandemics.

Microbial communities reveal impacts of unconventional oil and gas development on headwater streams.

The demand for natural gas has led to the development of techniques used to access unconventional oil and natural gas (UOG) resources, due to the novelty of UOG, the potential impacts to freshwater ecosystems are not fully understood. We used a dual pronged approach to study the effects of UOG development on microbial biodiversity and function via a laboratory microcosm experiment and a survey study of streams with and without UOG development within their watersheds. The microcosm experiment simulated stream contamination with produced water, a byproduct of UOG operations, using sediment collected from one high water-quality stream and two low water-quality streams. For the survey study, biofilm and sediment samples were collected from streams experiencing varying levels of UOG development. In the microcosm experiment, produced water decreased microbial aerobic and anaerobic CO2 production in the high water-quality stream sediment but had a positive effect on this microbial activity in the lower water-quality stream sediments, suggesting habitat degradation alters the response of microbes to contaminants. Results from the stream survey indicate UOG development alters stream water temperature, chemistry, sediment aerobic and anaerobic CO2 production, and microbial community biodiversity in both sediments and biofilms. Correlations among UOG associated land use, environmental, and microbial variables suggest increases in light availability and sediment delivery to streams, due to deforestation and land disturbance, impact stream microbial communities and their function. Consistent changes in the relative abundance of bacterial taxa suggest microorganisms may be good indicators of the environmental changes associated with UOG development. The observed impacts of UOG development on microbial community composition and carbon cycling could have cascading effects on stream health and broader ecosystem function.

Brook trout distributional response to unconventional oil and gas development: Landscape context matters.

We conducted a large-scale assessment of unconventional oil and gas (UOG) development effects on brook trout (Salvelinus fontinalis) distribution. We compiled 2231 brook trout collection records from the Upper Susquehanna River Watershed, USA. We used boosted regression tree (BRT) analysis to predict occurrence probability at the 1:24,000 stream-segment scale as a function of natural and anthropogenic landscape and climatic attributes. We then evaluated the importance of landscape context (i.e., pre-existing natural habitat quality and anthropogenic degradation) in modulating the effects of UOG on brook trout distribution under UOG development scenarios. BRT made use of 5 anthropogenic (28% relative influence) and 7 natural (72% relative influence) variables to model occurrence with a high degree of accuracy [Area Under the Receiver Operating Curve (AUC)=0.85 and cross-validated AUC=0.81]. UOG development impacted 11% (n=2784) of streams and resulted in a loss of predicted occurrence in 126 (4%). Most streams impacted by UOG had unsuitable underlying natural habitat quality (n=1220; 44%). Brook trout were predicted to be absent from an additional 26% (n=733) of streams due to pre-existing non-UOG land uses (i.e., agriculture, residential and commercial development, or historic mining). Streams with a predicted and observed (via existing pre- and post-disturbance fish sampling records) loss of occurrence due to UOG tended to have intermediate natural habitat quality and/or intermediate levels of non-UOG stress. Simulated development of permitted but undeveloped UOG wells (n=943) resulted in a loss of predicted occurrence in 27 additional streams. Loss of occurrence was strongly dependent upon landscape context, suggesting effects of current and future UOG development are likely most relevant in streams near the probability threshold due to pre-existing habitat degradation.

Can brook trout survive climate change in large rivers? If it rains.

We provide an assessment of thermal characteristics and climate change vulnerability for brook trout (Salvelinus fontinalis) habitats in the upper Shavers Fork sub-watershed, West Virginia. Spatial and temporal (2001-2015) variability in observed summer (6/1-8/31) stream temperatures was quantified in 23 (9 tributary, 14 main-stem) reaches. We developed a mixed effects model to predict site-specific mean daily stream temperature from air temperature and discharge and coupled this model with a hydrologic model to predict future (2016-2100) changes in stream temperature under low (RCP 4.5) and high (RCP 8.5) emissions scenarios. Observed mean daily stream temperature exceeded the 21°C brook trout physiological threshold in all but one main-stem site, and 3 sites exceeded proposed thermal limits for either 63- and 7-day mean stream temperature. We modeled mean daily stream temperature with a high degree of certainty (R2=0.93; RMSE=0.76°C). Predicted increases in mean daily stream temperature in main-stem and tributary reaches ranged from 0.2°C (RCP 4.5) to 1.2°C (RCP 8.5). Between 2091 and 2100, the average number of days with mean daily stream temperature>21°C increased within main-stem sites under the RCP 4.5 (0-1.2days) and 8.5 (0-13) scenarios; however, no site is expected to exceed 63- or 7-day thermal limits. During the warmest 10years, ≥5 main-stem sites exceeded the 63- or 7-day thermal tolerance limits under both climate emissions scenarios. Years with the greatest increases in stream temperature were characterized by low mean daily discharge. Main-stem reaches below major tributaries never exceed thermal limits, despite neighboring reaches having among the highest observed and predicted stream temperatures. Persistence of thermal refugia within upper Shavers Fork would enable persistence of metapopulation structure and life history processes. However, this will only be possible if projected increases in discharge are realized and offset expected increases in air temperature.

Evaluating expected outcomes of acid remediation in an intensively mined Appalachian watershed.

Assessments of watershed-based restoration efforts are rare but are essential for the science of stream restoration to advance. We conducted a watershed scale assessment of Abram Creek before and after implementation of a watershed-based plan designed to maximize ecological recovery from acid mine drainage (AMD) impairment. We surveyed water chemistry, physical habitat, benthic macroinvertebrates, and fish community structure in three stream types: AMD-impacted (14 streams), AMD-treated (13 streams), and unimpaired reference (4 streams). We used in-stream measurements to quantify ecological loss from AMD, the amount of ecological recovery expected through remediation, and the observed degree of post-treatment recovery. Sites impaired by AMD improved in water quality with AMD treatment. Dissolved metals and acidity declined significantly in treated streams, but sulfate and specific conductance did not. Likewise, sites impaired by AMD improved in bio-condition scores with AMD treatment. EPT genera increased significantly but were lower compared to unimpaired streams. We found fish at nine treated sites that had none before treatment. Community-level analyses indicated improved but altered assemblages with AMD treatment. Analysis of pre-treatment conditions indicated that only 30% of the historic fishery remained. Remediation was expected to recover 66% of the historic fishery value, and assessment of post-treatment conditions indicates that 52% of the historic fishery has been recovered after 3 years. Developing expected endpoints for restoration outcomes provides a tool to objectively evaluate successes and can guide adaptive management strategies.

Watershed Planning within a Quantitative Scenario Analysis Framework.

There is a critical need for tools and methodologies capable of managing aquatic systems within heavily impacted watersheds. Current efforts often fall short as a result of an inability to quantify and predict complex cumulative effects of current and future land use scenarios at relevant spatial scales. The goal of this manuscript is to provide methods for conducting a targeted watershed assessment that enables resource managers to produce landscape-based cumulative effects models for use within a scenario analysis management framework. Sites are first selected for inclusion within the watershed assessment by identifying sites that fall along independent gradients and combinations of known stressors. Field and laboratory techniques are then used to obtain data on the physical, chemical, and biological effects of multiple land use activities. Multiple linear regression analysis is then used to produce landscape-based cumulative effects models for predicting aquatic conditions. Lastly, methods for incorporating cumulative effects models within a scenario analysis framework for guiding management and regulatory decisions (e.g., permitting and mitigation) within actively developing watersheds are discussed and demonstrated for 2 sub-watersheds within the mountaintop mining region of central Appalachia. The watershed assessment and management approach provided herein enables resource managers to facilitate economic and development activity while protecting aquatic resources and producing opportunity for net ecological benefits through targeted remediation.

More than a corridor: use of a main stem stream as supplemental foraging habitat by a brook trout metapopulation.

Coldwater fishes in streams, such as brook trout (Salvelinus fontinalis), typically are headwater specialists that occasionally expand distributions downstream to larger water bodies. It is unclear, however, whether larger streams function simply as dispersal corridors connecting headwater subpopulations, or as critical foraging habitat needed to sustain large mobile brook trout. Stable isotopes (δ(13)C and δ(15)N) and a hierarchical Bayesian mixing model analysis was used to identify brook trout that foraged in main stem versus headwater streams of the Shavers Fork watershed, West Virginia. Headwater subpopulations were composed of headwater and to a lesser extent main stem foraging individuals. However, there was a strong relationship between brook trout size and main stem prey contributions. The average brook trout foraging on headwater prey were limited to 126 mm standard length. This size was identified by mixing models as a point where productivity support switched from headwater to main stem dependency. These results, similar to other studies conducted in this watershed, support the hypothesis that productive main stem habitat maintain large brook trout and potentially facilitates dispersal among headwater subpopulations. Consequently, loss of supplementary main stem foraging habitats may explain loss of large, mobile fish and subsequent isolation of headwater subpopulations in other central Appalachian watersheds.

Under siege: Isolated tributaries are threatened by regionally impaired metacommunities.

Pristine streams are often targeted as conservation priorities because of their ability to preserve regional biodiversity. However, isolation within heavily degraded regions likely alters important metapopulation and metacommunity processes (e.g., rescue and mass effects), affecting the ability of in-tact communities to boost regional conditions. To test this hypothesis, we sampled invertebrate communities and physicochemical conditions from 168 streams within the mountaintop removal-valley fill mining region of West Virginia. We used redundancy analysis to first test for significant effects of local (observed physicochemical conditions) and neighborhood (streams within a 5km buffer) degradation on assemblage structure across all taxa and stress tolerance (low, moderate, high) and dispersal (low, high) categories. We then used generalized linear and hurdle models to characterize changes in community metrics and individual taxa, respectively. Local condition consistently explained the majority of variation (partial R(2) up to 5× those of neighborhood condition) in community structure and was the only factor affecting sensitive taxa. Neighborhood condition explained significant variation in moderately tolerant taxa with low dispersal capacity and highly tolerant taxa, regardless of dispersal. Decreased occurrence (Baetis) and abundance (Maccaffertium) of key taxa and corresponding metrics (%E, %EPT) suggest decreased dispersal and associated mass and rescue effects within degraded neighborhoods. Decreased neighborhood conditions also resulted in the proliferation of tolerant taxa (Chironomidae, Chimarra, Hemerodromia). Our results suggest communities within even the most pristine streams are at risk when isolated within heavily impacted regions. Consequently, protection of regional species' pools in heavily impacted regions will require more than simply conserving un-impacted streams.

Complex contaminant mixtures in multistressor Appalachian riverscapes.

Runoff from watersheds altered by mountaintop mining in the Appalachian region (USA) is known to pollute headwater streams, yet regional-scale assessments of water quality have focused on salinization and selenium. The authors conducted a comprehensive survey of inorganic contaminants found in 170 stream segments distributed across a spectrum of historic and contemporary human land use. Principal component analysis identified 3 important dimensions of variation in water chemistry that were significantly correlated with contemporary surface mining (principal component 1: elevated dominant ions, sulfate, alkalinity, and selenium), coal geology and legacy mines (principal component 2: elevated trace metals), and residential development (principal component 3: elevated sodium and chloride). The combination of these 3 dominant sources of pollutants produced a complex stream-to-stream patchwork of contaminant mixtures. Seventy-five percent of headwater streams (catchments < 5 km(2) ) had water chemistries that could be classified as either reference (49%), development only (18%), or mining only (8%). Only 21% of larger streams (catchments > 5 km(2) ) were classified as having reference chemistries, and chemistries indicative of combined mining and development contaminants accounted for 47% of larger streams (compared with 26% of headwater streams). Extreme degradation of larger streams can be attributed to accumulation of contaminants from multiple human land use activities that include contemporary mountaintop mining, underground mining, abandoned mines, and untreated domestic wastewater. Consequently, water quality improvements in this region will require a multicontaminant remediation approach.

Density-dependent regulation of brook trout population dynamics along a core-periphery distribution gradient in a central Appalachian watershed.

Spatial population models predict strong density-dependence and relatively stable population dynamics near the core of a species' distribution with increasing variance and importance of density-independent processes operating towards the population periphery. Using a 10-year data set and an information-theoretic approach, we tested a series of candidate models considering density-dependent and density-independent controls on brook trout population dynamics across a core-periphery distribution gradient within a central Appalachian watershed. We sampled seven sub-populations with study sites ranging in drainage area from 1.3-60 km(2) and long-term average densities ranging from 0.335-0.006 trout/m. Modeled response variables included per capita population growth rate of young-of-the-year, adult, and total brook trout. We also quantified a stock-recruitment relationship for the headwater population and coefficients of variability in mean trout density for all sub-populations over time. Density-dependent regulation was prevalent throughout the study area regardless of stream size. However, density-independent temperature models carried substantial weight and likely reflect the effect of year-to-year variability in water temperature on trout dispersal between cold tributaries and warm main stems. Estimated adult carrying capacities decreased exponentially with increasing stream size from 0.24 trout/m in headwaters to 0.005 trout/m in the main stem. Finally, temporal variance in brook trout population size was lowest in the high-density headwater population, tended to peak in mid-sized streams and declined slightly in the largest streams with the lowest densities. Our results provide support for the hypothesis that local density-dependent processes have a strong control on brook trout dynamics across the entire distribution gradient. However, the mechanisms of regulation likely shift from competition for limited food and space in headwater streams to competition for thermal refugia in larger main stems. It also is likely that source-sink dynamics and dispersal from small headwater habitats may partially influence brook trout population dynamics in the main stem.

Pragmatic intervention for increasing self-directed exercise behaviour and improving important health outcomes in people with multiple sclerosis: a randomised controlled trial.

BACKGROUND: Exercise programmes that can demonstrate evidence of long-lasting clinical effectiveness are needed for people with multiple sclerosis (PwMS). OBJECTIVE: The objective of this study was to assess the effects of a practically implemented exercise programme on self-directed exercise behaviour and important health outcomes in PwMS to nine months of follow-up. METHODS: We conducted a parallel-arm, randomised controlled trial: 120 PwMS (Expanded Disability Status Scale (EDSS) 1.0-6.5) randomised to a three-month exercise intervention plus usual care, or usual care only. Two supervised plus one home-exercise session (weeks 1-6) were followed by one supervised and two home-exercise sessions (weeks 7-12). Cognitive-behavioural techniques promoted long-term exercise behaviour change. Outcomes were blindly assessed at baseline and at three and nine months after randomisation. The primary outcome was self-reported exercise behaviour (Godin Leisure Time Exercise Questionnaire (GLTEQ)). Secondary outcomes included fatigue and health-related quality of life (HRQoL). RESULTS: The intervention increased self-reported exercise (9.6 points; 95% CI: 2.0 to 17.3 points; p = 0.01) and improved fatigue (p < 0.0001) and many HRQoL domains (p ≤ 0.03) at three months. The improvements in emotional well-being (p = 0.01), social function (p = 0.004) and overall quality of life (p = 0.001) were sustained for nine months. CONCLUSION: This pragmatic approach to implementing exercise increases self-reported exercise behaviour, improves fatigue and leads to a sustained enhancement of HRQoL domains in PwMS.

Cost effectiveness of a pragmatic exercise intervention (EXIMS) for people with multiple sclerosis: economic evaluation of a randomised controlled trial.

BACKGROUND: Exercise is a safe, non-pharmacological adjunctive treatment for people with multiple sclerosis but cost-effective approaches to implementing exercise within health care settings are needed. OBJECTIVE: The objective of this paper is to assess the cost effectiveness of a pragmatic exercise intervention in conjunction with usual care compared to usual care only in people with mild to moderate multiple sclerosis. METHODS: A cost-utility analysis of a pragmatic randomised controlled trial over nine months of follow-up was conducted. A total of 120 people with multiple sclerosis were randomised (1:1) to the intervention or usual care. Exercising participants received 18 supervised and 18 home exercise sessions over 12 weeks. The primary outcome for the cost utility analysis was the incremental cost per quality-adjusted life year (QALY) gained, calculated using utilities measured by the EQ-5D questionnaire. RESULTS: The incremental cost per QALY of the intervention was £10,137 per QALY gained compared to usual care. The probability of being cost effective at a £20,000 per QALY threshold was 0.75, rising to 0.78 at a £30,000 per QALY threshold. CONCLUSION: The pragmatic exercise intervention is highly likely to be cost effective at current established thresholds, and there is scope for it to be tailored to particular sub-groups of patients or services to reduce its cost impact.

Correlates of self-injurious, aggressive and destructive behaviour in children under five who are at risk of developmental delay.

AIM: Several behavioural correlates of self-injury, aggression and destructive behaviour have been identified in children and young adults with intellectual disabilities. This cross-sectional study aimed to further explore these correlates in very young children with developmental delay. METHODS: Parents of 56 children (40 male) under the age of five years (mean age 2 years 10 months) completed a questionnaire about their child's behaviour and the presence of behavioural correlates, including repetitive, over-active or impulsive behaviour and more severe developmental delay. RESULTS: Parents reported very high prevalence of self-injurious, aggressive and destructive behaviour: 51%, 64% and 51%, respectively. A binary logistic regression revealed that a higher score on a measure of overactive and impulsive behaviour significantly predicted the presence of destructive behaviour. A multiple linear regression revealed that both repetitive behaviour and number of health problems approached significance as independent predictors of severe self-injurious behaviour. INTERPRETATION: Despite the very small sample, several factors emerged as potential predictors of self-injurious, aggressive and destructive behaviour. These findings support the need for further investigation in a larger sample. Confirmation in this age group could help guide the development of targeted early intervention for these behaviours by identifying behavioural risk markers.

Pragmatic exercise intervention for people with multiple sclerosis (ExIMS trial): study protocol for a randomised controlled trial.

Exercise is an effective intervention for improving function, mobility and health-related quality of life in people with multiple sclerosis (PwMS). Questions remain however, regarding the effectiveness of pragmatic exercise interventions for evoking tangible and sustained increases in physical activity and long-term impact on important health outcomes in PwMS. Furthermore, dose-response relationships between exercise and health outcomes have not previously been reported in PwMS. These issues, and improved knowledge of cost effectiveness, are likely to influence key decisions of health policy makers regarding the implementation of exercise therapy as part of the patient care pathway for PwMS. Hence, the primary aim of this study is to investigate whether a 12-week tapered programme of supervised exercise, incorporating cognitive-behavioural techniques to facilitate sustained behaviour change, is effective for evoking improvements in physical activity and key health outcomes in PwMS over 9 months of follow-up. A total of 120 PwMS will be randomised (1:1) to either a 12-week pragmatic exercise therapy intervention or usual care control group. Participants will be included on the basis of a clinical diagnosis of MS, with an expanded disability status score (EDSS) between 1 and 6.5. Outcome measures, to be assessed before and after the intervention and 6 months later, will include physical activity, clinical and functional measures and health-related quality of life. In addition, the cost effectiveness of the intervention will be evaluated and dose-response relationships between physical activity and the primary/secondary outcomes in those with mild and more severe disease will be explored.

Psychological well-being in parents of children with Angelman, Cornelia de Lange and Cri du Chat syndromes.

BACKGROUND: The current study focuses on mothers and fathers of children with three rare genetic syndromes that are relatively unexplored in terms of family experience: Angelman syndrome, Cornelia de Lange syndrome and Cri du Chat syndrome. METHOD: Parents of children with Angelman syndrome (n =15), Cornelia de Lange syndrome (n = 16) and Cri du Chat syndrome (n = 18), and a matched comparison group of parents of children with autism and intellectual disabilities (n = 20) completed questionnaires on both psychological distress (stress, anxiety, depression) and positive psychological functioning. RESULTS: Parents of children with Angelman syndrome consistently reported the highest levels of psychological distress, and parents of children with Cornelia de Lange syndrome the lowest, with parents of children with Cri du Chat syndrome and autism scoring between these two. Positive psychological functioning was similar across the four aetiology groups. CONCLUSIONS: Parents of children with rare genetic syndromes are at risk for high levels of stress and mental health problems. Methodological issues and the practical applications of these results are discussed.

A spatially explicit framework for quantifying downstream hydrologic conditions.

Continued improvements in spatial datasets and hydrological modeling algorithms within Geographic Information Systems (GISs) have enhanced opportunities for watershed analysis. With more detailed hydrology layers and watershed delineation techniques, we can now better represent and model landscape to water quality relationships. Two challenges in modeling these relationships are selecting the appropriate spatial scale of watersheds for the receiving stream segment, and handling the network or pass-through issues of connected watersheds. This paper addresses these two important issues for enhancing cumulative watershed capabilities in GIS. Our modeling framework focuses on the delineation of stream-segment-level watershed boundaries for 1:24,000 scale hydrology, in combination with a topological network model. The result is a spatially explicit, vector-based, spatially cumulative watershed modeling framework for quantifying watershed conditions to aid in restoration. We demonstrate the new insights available from this modeling framework in a cumulative mining index for the management of aquatic resources in a West Virginia watershed.

Glucose transporter 1 expression in canine osteosarcoma.

Hypoxia in tumours has been associated with an increased resistance to radiation and chemotherapy, and increased metastatic potential. Hypoxia-inducible factor 1-alpha (HIF-1alpha) is a transcription factor induced by hypoxia. Glucose transporter 1 (GLUT-1), a downstream product of HIF-1alpha pathway activation, is over-expressed in a variety of human tumours. The purpose of this study was to determine if GLUT-1 is expressed in canine osteosarcomas (OSAs) and if the expression is related to tumour necrosis and outcome. Immunohistochemistry was performed on 44 histologically confirmed OSA tissue samples to assess expression of GLUT-1. Of 44 cases, 27 (61%) expressed GLUT-1. There was no statistical correlation between GLUT-1 and disease-free interval, survival time or percentage of necrosis. As hypothesized, GLUT-1 is present in canine appendicular OSAs. A more objective evaluation of GLUT-1 and other proteins in the HIF-1alpha pathway may be warranted.

Water chemistry-based classification of streams and implications for restoring mined Appalachian watersheds.

We analyzed seasonal water samples from the Cheat and Tygart Valley river basins, West Virginia, USA, in an attempt to classify streams based on water chemistry in this coal-mining region. We also examined temporal variability among water samples. Principal component analysis identified two important dimensions of variation in water chemistry. This variation was determined largely by mining-related factors (elevated metals, sulfates, and conductivity) and an alkalinity-hardness gradient. Cluster analysis grouped water samples into six types that we described as reference, soft, hard, transitional, moderate acid mine drainage, and severe acid mine drainage. These types were statistically distinguishable in multidimensional space. Classification tree analysis confirmed that chemical constituents related to acid mine drainage and acid rain distinguished these six groups. Hard, soft, and severe acid mine drainage type streams were temporally constant compared to streams identified as reference, transitional, and moderate acid mine drainage type, which had a greater tendency to shift to a different water type between seasons. Our research is the first to establish a statistically supported stream classification system in mined watersheds. The results suggest that human-related stressors superimposed on geology are responsible for producing distinct water quality types in this region as opposed to more continuous variation in chemistry that would be expected in an unimpacted setting. These findings provide a basis for simplifying stream monitoring efforts, developing generalized remediation strategies, and identifying specific remediation priorities in mined Appalachian watersheds.