Ecological divergence of wild birds drives avian influenza spillover and global spread.

The diversity of influenza A viruses (IAV) is primarily hosted by two highly divergent avian orders: Anseriformes (ducks, swans and geese) and Charadriiformes (gulls, terns and shorebirds). Studies of IAV have historically focused on Anseriformes, specifically dabbling ducks, overlooking the diversity of hosts in nature, including gull and goose species that have successfully adapted to human habitats. This study sought to address this imbalance by characterizing spillover dynamics and global transmission patterns of IAV over 10 years at greater taxonomic resolution than previously considered. Furthermore, the circulation of viral subtypes in birds that are either host-adapted (low pathogenic H13, H16) or host-generalist (highly pathogenic avian influenza-HPAI H5) provided a unique opportunity to test and extend models of viral evolution. Using Bayesian phylodynamic modelling we uncovered a complex transmission network that relied on ecologically divergent bird hosts. The generalist subtype, HPAI H5 was driven largely by wild geese and swans that acted as a source for wild ducks, gulls, land birds, and domestic geese. Gulls were responsible for moving HPAI H5 more rapidly than any other host, a finding that may reflect their long-distance, pelagic movements and their immuno-naïve status against this subtype. Wild ducks, long viewed as primary hosts for spillover, occupied an optimal space for viral transmission, contributing to geographic expansion and rapid dispersal of HPAI H5. Evidence of inter-hemispheric dispersal via both the Pacific and Atlantic Rims was detected, supporting surveillance at high latitudes along continental margins to achieve early detection. Both neutral (geographic expansion) and non-neutral (antigenic selection) evolutionary processes were found to shape subtype evolution which manifested as unique geographic hotspots for each subtype at the global scale. This study reveals how a diversity of avian hosts contribute to viral spread and spillover with the potential to improve surveillance in an era of rapid global change.

Ecosystem response persists after a prolonged marine heatwave.

Some of the longest and most comprehensive marine ecosystem monitoring programs were established in the Gulf of Alaska following the environmental disaster of the Exxon Valdez oil spill over 30 years ago. These monitoring programs have been successful in assessing recovery from oil spill impacts, and their continuation decades later has now provided an unparalleled assessment of ecosystem responses to another newly emerging global threat, marine heatwaves. The 2014-2016 northeast Pacific marine heatwave (PMH) in the Gulf of Alaska was the longest lasting heatwave globally over the past decade, with some cooling, but also continued warm conditions through 2019. Our analysis of 187 time series from primary production to commercial fisheries and nearshore intertidal to offshore oceanic domains demonstrate abrupt changes across trophic levels, with many responses persisting up to at least 5 years after the onset of the heatwave. Furthermore, our suite of metrics showed novel community-level groupings relative to at least a decade prior to the heatwave. Given anticipated increases in marine heatwaves under current climate projections, it remains uncertain when or if the Gulf of Alaska ecosystem will return to a pre-PMH state.

Heatwave-induced synchrony within forage fish portfolio disrupts energy flow to top pelagic predators.

During the Pacific marine heatwave of 2014-2016, abundance and quality of several key forage fish species in the Gulf of Alaska were simultaneously reduced throughout the system. Capelin (Mallotus catervarius), sand lance (Ammodytes personatus), and herring (Clupea pallasii) populations were at historically low levels, and within this community abrupt declines in portfolio effects identify trophic instability at the onset of the heatwave. Although compensatory changes in age structure, size, growth or energy content of forage fish were observed to varying degrees among all these forage fish, none were able to fully mitigate adverse impacts of the heatwave, which likely included both top-down and bottom-up forcing. Notably, changes to the demographic structure of forage fish suggested size-selective removals typical of top-down regulation. At the same time, changes in zooplankton communities may have driven bottom-up regulation as copepod community structure shifted toward smaller, warm water species, and euphausiid biomass was reduced owing to the loss of cold-water species. Mediated by these impacts on the forage fish community, an unprecedented disruption of the normal pelagic food web was signaled by higher trophic level disruptions during 2015-2016, when seabirds, marine mammals, and groundfish experienced shifts in distribution, mass mortalities, and reproductive failures. Unlike decadal-scale variability underlying ecosystem regime shifts, the heatwave appeared to temporarily overwhelm the ability of the forage fish community to buffer against changes imposed by warm water anomalies, thereby eliminating any ecological advantages that may have accrued from having a suite of coexisting forage species with differing life-history compensations.

An empirical Bayesian approach to incorporate directional movement information from a forage fish into the Arnason-Schwarz mark-recapture model.

BACKGROUND: Over the past two decades, various species of forage fish have been successfully implanted with miniaturized acoustic transmitters and subsequently monitored using stationary acoustic receivers. When acoustic receivers are configured in an array, information related to fish direction can potentially be determined, depending upon the number and relative orientation of the acoustic receivers. However, it can be difficult to incorporate directional information into frequentist mark-recapture methods. Here we show how an empirical Bayesian approach can be used to develop a model that incorporates directional movement information into the Arnason-Schwarz modeling framework to describe survival and migration patterns of a Pacific herring (Clupea pallasii) population in coastal Alaska, USA. METHODS: We acoustic-tagged 326 adult Pacific herring during April 2017 and 2018 while on their spawning grounds in Prince William Sound Alaska, USA. To monitor their movements, stationary acoustic receivers were deployed at strategic locations throughout the Sound. Receivers located at the major entrances to the Gulf of Alaska were arranged in parallel arrays to determine the directional movements of the fish. Informative priors were used to incorporate the directional information recorded at the entrance arrays into the model. RESULTS: A seasonal migratory pattern was found at one of Prince William Sound's major entrances to the Gulf of Alaska. At this entrance, fish tended to enter the Gulf of Alaska during spring and summer after spawning and return to Prince William Sound during the fall and winter. Fish mortality was higher during spring and summer than fall and winter in both Prince William Sound and the Gulf of Alaska. CONCLUSIONS: An empirical Bayesian modeling approach can be used to extend the Arnason-Schwarz modeling framework to incorporate directional information from acoustic arrays to estimate survival and characterize the timing and direction of migratory movements of forage fish.

Structure of winter groundfish feeding guilds in Pacific herring Clupea pallasii and walleye pollock Gadus chalcogrammus nursery fjords.

The contents of 1056 stomachs were included in a trophic-guild analysis to document separation amongst 16 groundfish species inhabiting Pacific herring Clupea pallasii and walleye pollock Gadus chalcogrammus nursery fjords in Prince William Sound, Alaska and to determine the relative contribution of C. pallasii and G. chalcogrammus to that separation. A total of five multi-species feeding guilds and one outlier species were determined through multivariate analyses. Major gradients of trophic separation spanned from invertebrates (mostly shrimps, crabs and unidentified decapods) to fishes (mostly unidentified fishes, C. pallasii and G. chalcogrammus) a pattern that was influenced by intra and interspecific differences in predator lengths. While C. pallasii and G. chalcogrammus were important to the overall guild structure, within-guild similarities were consistently highest due to unidentified fishes. In general, larger predators consumed the largest C. pallasii and G. chalcogrammus, with the smaller-on-average predators consuming smaller C. pallasii and fewer or smaller G. chalcogrammus. Regardless of guild inclusion, groundfishes primarily consumed pre-recruit C. pallasii and G. chalcogrammus (i.e., younger than age 3 years fishes), which has the potential to negatively influence recruitment of these forage fishes to the adult, spawning population.

Transcriptional profiling of the mutualistic bacterium Vibrio fischeri and an hfq mutant under modeled microgravity.

For long-duration space missions, it is critical to maintain health-associated homeostasis between astronauts and their microbiome. To achieve this goal it is important to more fully understand the host-symbiont relationship under the physiological stress conditions of spaceflight. To address this issue we examined the impact of a spaceflight analog, low-shear-modeled microgravity (LSMMG), on the transcriptome of the mutualistic bacterium Vibrio fischeri. Cultures of V. fischeri and a mutant defective in the global regulator Hfq (∆hfq) were exposed to either LSMMG or gravity conditions for 12 h (exponential growth) and 24 h (stationary phase growth). Comparative transcriptomic analysis revealed few to no significant differentially expressed genes between gravity and the LSMMG conditions in the wild type or mutant V. fischeri at exponential or stationary phase. There was, however, a pronounced change in transcriptomic profiles during the transition between exponential and stationary phase growth in both V. fischeri cultures including an overall decrease in gene expression associated with translational activity and an increase in stress response. There were also several upregulated stress genes specific to the LSMMG condition during the transition to stationary phase growth. The ∆hfq mutants exhibited a distinctive transcriptome profile with a significant increase in transcripts associated with flagellar synthesis and transcriptional regulators under LSMMG conditions compared to gravity controls. These results indicate the loss of Hfq significantly influences gene expression under LSMMG conditions in a bacterial symbiont. Together, these results improve our understanding of the mechanisms by which microgravity alters the physiology of beneficial host-associated microbes.

Effects of geolocators on hatching success, return rates, breeding movements, and change in body mass in 16 species of Arctic-breeding shorebirds.

BACKGROUND: Geolocators are useful for tracking movements of long-distance migrants, but potential negative effects on birds have not been well studied. We tested for effects of geolocators (0.8-2.0 g total, representing 0.1-3.9 % of mean body mass) on 16 species of migratory shorebirds, including five species with 2-4 subspecies each for a total of 23 study taxa. Study species spanned a range of body sizes (26-1091 g) and eight genera, and were tagged at 23 breeding and eight nonbreeding sites. We compared breeding performance and return rates of birds with geolocators to control groups while controlling for potential confounding variables. RESULTS: We detected negative effects of tags for three small-bodied species. Geolocators reduced annual return rates for two of 23 taxa: by 63 % for semipalmated sandpipers and by 43 % for the arcticola subspecies of dunlin. High resighting effort for geolocator birds could have masked additional negative effects. Geolocators were more likely to negatively affect return rates if the total mass of geolocators and color markers was 2.5-5.8 % of body mass than if tags were 0.3-2.3 % of body mass. Carrying a geolocator reduced nest success by 42 % for semipalmated sandpipers and tripled the probability of partial clutch failure in semipalmated and western sandpipers. Geolocators mounted perpendicular to the leg on a flag had stronger negative effects on nest success than geolocators mounted parallel to the leg on a band. However, parallel-band geolocators were more likely to reduce return rates and cause injuries to the leg. No effects of geolocators were found on breeding movements or changes in body mass. Among-site variation in geolocator effect size was high, suggesting that local factors were important. CONCLUSIONS: Negative effects of geolocators occurred only for three of the smallest species in our dataset, but were substantial when present. Future studies could mitigate impacts of tags by reducing protruding parts and minimizing use of additional markers. Investigators could maximize recovery of tags by strategically deploying geolocators on males, previously marked individuals, and successful breeders, though targeting subsets of a population could bias the resulting migratory movement data in some species.

Reducing Missed Primary Care Appointments in a Learning Health System: Two Randomized Trials and Validation of a Predictive Model.

BACKGROUND: Collaborations between clinical/operational leaders and researchers are advocated to develop "learning health systems," but few practical examples are reported. OBJECTIVES: To describe collaborative efforts to reduce missed appointments through an interactive voice response and text message (IVR-T) intervention, and to develop and validate a prediction model to identify individuals at high risk of missing appointments. RESEARCH SUBJECTS AND DESIGN: Random assignment of 8804 adults with primary care appointments to a single IVR-T reminder or no reminder at an index clinic (IC) and 7497 at a replication clinic (RC) in an integrated health system in Denver, CO. MEASURES: Proportion of missed appointments; demographic, clinical, and appointment-specific predictors of missed appointments. RESULTS: Patients receiving IVR-T had a lower rate of missed appointments than those receiving no reminder at the IC (6.5% vs. 7.5%, relative risk=0.85, 95% confidence interval, 0.72-1.00) and RC (8.2% vs. 10.5%, relative risk=0.76, 95% confidence interval, 0.65-0.89). A 10-variable prediction model for missed appointments demonstrated excellent discrimination (C-statistic 0.90 at IC, 0.89 at RC) and calibration (P=0.99 for Osius and McCullagh tests). Patients in the 3 lowest-risk quartiles missed 0.4% and 0.4% of appointments at the IC and RC, respectively, whereas patients in the highest-risk quartile missed 24.1% and 28.9% of appointments, respectively. CONCLUSIONS: A single IVR-T call reduced missed appointments, whereas a locally validated prediction model accurately identified patients at high risk of missing appointments. These rigorous studies promoted dissemination of the intervention and prompted additional research questions from operational leaders.

'I'm Not Calling Him!': Disruptive Physician Behavior in the Acute Care Setting.

Results of a qualitative study of the experience of 15 acute care nurses with disruptive physician behavior and its impact on communication are reported. Findings will help educators and leaders prepare nurses by coaching and educating them on the importance of communication and patient advocacy.

Work engagement of older registered nurses: the impact of a caring-based intervention.

AIM: The aim of this evaluation research was to measure the impact of a caring-based intervention on the level of work engagement in older nurses. BACKGROUND: Every effort is needed to retain older nurses at the bedside by assisting them to revitalise the internal motivation and self- reward that brought them to nursing. METHOD: A mixed method evaluation research approach using both qualitative and quantitative measurements was used to determine the impact of a caring-based programme on improving the work engagement scores of older Registered Nurses (RNs). RESULT: The results of this study suggest that leadership strategies aimed at improving work engagement using caring theories have a significant positive impact. CONCLUSION: The findings contribute to our understanding of how work engagement can be enhanced through building work environments where there is a sense of belonging and teamwork, where staff are allowed time to decompress as well as build positive work relationships. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse Leaders (NLs) bear a responsibility to partner with older Registered Nurses (RNs) to build engagement in their work life while enhancing the quality of care. Successful leaders will find ways to meet these unique challenges by creating a healthy work environment.

Creating and sustaining peace within for the journey of nursing leadership.

Peace within self or an inner calmness may be created and sustained by caring for self at a deep level, committing to an inner journey, and by dedication to maintaining a practice of self-care. Suggestions for creating and sustaining peace within self, using the model "Listen, Envision and Take Action" (LET or allow), are explored as a guide to support and maintain an inner journey. The authors describe how a peaceful presence may guide the journey of nursing leadership. Along the path of self-care focused on the inner journey, the nursing leader may experience enhanced health, self-knowledge, resilience, and a transformation of relationships personally and professionally. As nursing leaders' role model care for self in the workplace, the organization may experience an increase in nurse satisfaction.

Educating nurses about veno-thrombolytic events (VTE).

This study determined the effect of a computer-based educational program in preparing nurses to complete an assessment for veno-thrombotic risk on all patients admitted to a community hospital. The educational program included information on appropriate prophylaxis for patients at risk for veno-thrombolytic events (VTEs). Nurses were encouraged to work with physicians and pharmacists to obtain the appropriate VTE prophylaxis for all patients based on risk. Findings showed that one class may not be sufficient for long-term understanding of VTE risk and prophylaxis.

Extensive geographic mosaicism in avian influenza viruses from gulls in the northern hemisphere.

Due to limited interaction of migratory birds between Eurasia and America, two independent avian influenza virus (AIV) gene pools have evolved. There is evidence of low frequency reassortment between these regions, which has major implications in global AIV dynamics. Indeed, all currently circulating lineages of the PB1 and PA segments in North America are of Eurasian origin. Large-scale analyses of intercontinental reassortment have shown that viruses isolated from Charadriiformes (gulls, terns, and shorebirds) are the major contributor of these outsider events. To clarify the role of gulls in AIV dynamics, specifically in movement of genes between geographic regions, we have sequenced six gull AIV isolated in Alaska and analyzed these along with 142 other available gull virus sequences. Basic investigations of host species and the locations and times of isolation reveal biases in the available sequence information. Despite these biases, our analyses reveal a high frequency of geographic reassortment in gull viruses isolated in America. This intercontinental gene mixing is not found in the viruses isolated from gulls in Eurasia. This study demonstrates that gulls are important as vectors for geographically reassorted viruses, particularly in America, and that more surveillance effort should be placed on this group of birds.

An in situ, individual-based approach to quantify connectivity of marine fish: ontogenetic movements and residency of lingcod.

As modern fishery assessments change in an effort to be more accurate and encompass the range of potential ecosystem interactions, critical information on the ecology of species including life history, intra and inter-specific competitive interactions and habitat requirements must be added to the standard fishery-dependent and independent data sets. One species whose movements and habitat associations greatly affects exploitation patterns is lingcod, Ophiodon elongatus, which support an economically important fishery along the coastal waters of the Pacific Coast of North America. High site fidelity and limited movements within nearshore areas are hypothesized to have resulted in high catchability, a major factor that has contributed to overfished stocks. Thus, assessing the level of movement and connectivity among lingcod subpopulations inhabiting nearshore habitats is a prerequisite to determining the condition of lingcod stocks. We used the Pacific Ocean Shelf Tracking (POST) Project acoustic receiver array in Alaska's Prince William Sound to monitor movements and residency of 21 acoustic-tagged lingcod for up to 16 months. Eight of sixteen lingcod (50%) initially aged at 2.5- to 3.5- years-old dispersed from their tag site. Dispersal was highly seasonal, occurring in two, five-week periods from mid-December through January and from mid-April through May. Dispersal in winter may be related to sexually immature lingcod or newly-mature male lingcod being displaced by territorial males. Spring dispersal may be indicative of the onset of migratory behavior where lingcod move out into Prince William Sound and possibly the offshore waters of the Gulf of Alaska. Our results reveal a pattern of ontogenetic dispersal as lingcod approach 4-years-old and exceed 50 cm total length. The large proportion of tagged fish migrating out of Port Gravina, their tagging site, reflects a high level of connectivity among Prince William Sound subpopulations. Our results also support the hypotheses that these subpopulations may be highly susceptible to overfishing because most fish show long residence times.

Application of acoustic telemetry to assess residency and movements of rockfish and lingcod at created and natural habitats in Prince William Sound.

Loss and/or degradation of nearshore habitats have led to increased efforts to restore or enhance many of these habitats, particularly those that are deemed essential for marine fishes. Copper rockfish (Sebastes caurinus) and lingcod (Ophiodon enlongatus) are dominant members of the typical reef fish community that inhabit rocky and high-relief substrates along the Pacific Northwest. We used acoustic telemetry to document their residency and movements in the nearshore waters of Prince William Sound, Alaska in order to assess use of created reef habitat in an individual-based manner. A total of 57 fish were surgically implanted with acoustic transmitters. Forty-five fish were captured and monitored in three habitats: artificial reef, low-relief natural reef, and patchy high-relief natural reef. Within each habitat, both rockfish and lingcod exhibited long periods of residency with limited movements. Twelve rockfish were captured at the natural reefs and displaced a distance of 4.0 km to the artificial reef. Five of the 12 rockfish returned within 10 d of their release to their initial capture site. Another five of the 12 displaced fish established residency at the artificial reef through the duration of our study. Our results suggest the potential for artificial reefs to provide rockfish habitat in the event of disturbances to natural habitat.

The role of nurse educators in grooming future nurse leaders.

The authors have found in their research that too often our current nurse leaders have "fallen into" their positions, rather than choosing nursing leadership as a career path. With the impending retirements of so many nurse leaders, there is a need for a more proactive approach to ensure the next generation of nurse leaders is ready to assume the leadership of our profession. Guiding the development of a leadership mindset and promoting nursing leadership as a career choice are two important strategies. Nurse educators are in a key position to influence students and start grooming our future nurse leaders. There is no time to waste.

Development and testing of a DVT risk assessment tool: providing evidence of validity and reliability.

BACKGROUND: Hospital-acquired deep vein thrombosis (DVT) and pulmonary embolisms (PE) are preventable problems that can increase mortality. Early assessment and recognition of risk as well as initiating appropriate prevention measures can prevent DVT or PE. AIMS: The purpose of this research project was to develop a DVT risk assessment tool and test the tool for validity and reliability. METHODS: Three phases were undertaken in developing and testing the JFK Medical Center DVT risk assessment tool. Investigation and clarification of risk and predisposing factors for DVT were identified from the literature, expert nursing knowledge, and medical staff input. Second, item development and weighting were undertaken. Third, parametric testing for content validity measured the differences in mean assessment tool scores between a group of patients who developed DVT in the hospital and a demographically similar group who did not develop DVT. Interrater reliability was measured by having three different nurses score each patient and compare the differences in scores among the three. FINDINGS: The DVT group had significantly higher scores on the JFK DVT assessment scale than did those who did not experience DVT. Interrater reliability showed a strong correlation among the scores of the three nurses (.98). DISCUSSION: Providing a valid and reliable tool for measuring the risk for DVT or PE in hospitalized patients will enable nurses to intervene early in patients at risk. Basing DVT risk assessment on the evidence provided in this study will assist nurses in becoming more confident in recognizing the necessity for interventions in hospitalized patients and decreasing risk. IMPLICATIONS: Nurses can now evaluate patients at risk for DVT or PE using the JFK Medial Center's risk assessment tool.

Development of a leadership competency model.

BACKGROUND: Although research findings support that the nurse manager has a pivotal role in influencing all aspects of the nursing environment, recruiting talented staff into these nursing leadership positions has become increasingly more difficult. There is a need to better understand the competencies needed by contemporary nurse managers and the challenges in the role. OBJECTIVE: The purpose of this research was to explore the viewpoints of 120 nurse manager study participants on the contemporary nurse manager role and to gain perspective on the critical leadership skills and competencies to build a nursing leadership competency model. DESIGN: A grounded theory methodology was used in this study to capture the perspectives of the nurse managers interviewed about their role. RESULTS: Six competency categories emerged from the research findings to form a nursing leadership competency model. Two major themes identified from the data included the nurse manager role as a career choice and the stressors and challenges in the role. CONCLUSION: The results of this study led to the design of a nursing leadership competency model and confirmed that there is a need to formally develop and mentor our next generation of nurse leaders.

Lost in translation.

Although there are large numbers of people in the UK who are hearing-impaired or cannot speak English, signing and translation services in the NHS are all too often woefully inadequate.

Sick and tired.

Severe anaemia can blight the lives of people with kidney disease. While effective treatment is available, its provision is patchy across the country. It has been found that: In people with renal anaemia, haemoglobin can fall to 4g/dl. Injections of erythropoietin (EPO) can increase haemoglobin levels. Patients are often unaware of what their haemoglobin levels are and should be. Early treatment with EPO can slow progression of renal disease.