Identification of potential welfare and survival indicators for stranded cetaceans through international, interdisciplinary expert opinion.

Management of live cetacean strandings generally focuses on refloating animals, yet there is a lack of scientific data to inform decision-making. Valid indicators that are practical to measure are needed to assess welfare status and survival likelihood for stranded cetaceans. The Delphi method was applied to gather international and interdisciplinary expert opinion to provide face validity to potential indicators of stranded cetacean welfare and survival likelihood. Two online questionnaires were conducted. In the first questionnaire these experts identified potential indicators of stranded cetacean welfare and survival likelihood. These indicators were subsequently scored by the same experts in questionnaire two, based on their value for assessing welfare/survival likelihood and being practical to measure. Indicators considered valuable and practical for assessing welfare and survival likelihood at strandings included animal-based indices of body and skin condition, signs of physical trauma, respiration rate and various behaviours. Resource-/management-based indicators related mainly to human intervention and should be correlated with animal-based indices to provide relevant evaluations. Importantly, inextricable links between welfare and survival for stranded cetaceans are emphasized, with 90% of indicators being similar for both. Investigations into these indicators should be conducted to develop a practical, science-based assessment framework to inform decision-making during stranding events.

Evaluating Potential Cetacean Welfare Indicators from Video of Live Stranded Long-Finned Pilot Whales (Globicephala melas edwardii).

Despite the known benefit of considering welfare within wildlife conservation and management, there remains a lack of data to inform such evaluations. To assess animal welfare, relevant information must be captured scientifically and systematically. A key first step is identifying potential indicators of welfare and the practicality of their measurement. We assessed the feasibility of evaluating potential welfare indicators from opportunistically gathered video footage of four stranded odontocete species (n = 53) at 14 stranding events around New Zealand. The first stranded cetacean ethogram was compiled, including 30 different behaviours, 20 of which were observed in all four species. Additionally, thirteen types of human intervention were classified. A subset of 49 live stranded long-finned pilot whales (Globicephala melas edwardii) were assessed to determine indicator prevalence and to quantify behaviours. Four 'welfare status' and six 'welfare alerting' non-behavioural indicators could be consistently evaluated from the footage. Additionally, two composite behavioural indicators were feasible. Three human intervention types (present, watering, and touching) and five animal behaviours (tail flutter, dorsal fin flutter, head lift, tail lift, and head side-to-side) were prevalent (>40% of individuals). Our study highlights the potential for non-invasive, remote assessments via video footage and represents an initial step towards developing a systematic, holistic welfare assessment framework for stranded cetaceans.

Fourier transform infrared (FTIR) analysis identifies microplastics in stranded common dolphins (Delphinus delphis) from New Zealand waters.

Here we provide a first assessment of microplastics (MPs) in stomach contents of 15 common dolphins (Delphinus delphis) from both single and mass stranding events along the New Zealand coast between 2019 and 2020. MPs were observed in all examined individuals, with an average of 7.8 pieces per stomach. Most MPs were fragments (77%, n = 90) as opposed to fibres (23%, n = 27), with translucent/clear (46%) the most prevalent colour. Fourier transform infrared (FTIR) spectroscopy revealed polyethylene terephthalate (65%) as the most predominant polymer in fibres, whereas polypropylene (31%) and acrylonitrile butadiene styrene (20%) were more frequently recorded as fragments. Mean fragment and fibre size was 584 µm and 1567 µm, respectively. No correlation between total number of MPs and biological parameters (total body length, age, sexual maturity, axillary girth, or blubber thickness) was observed, with similar levels of MPs observed between each of the mass stranding events. Considering MPs are being increasingly linked to a wide range of deleterious effects across taxa, these findings in a typically pelagic marine sentinel species warrants further investigation.

The Effects of General Anaesthesia and Light on Behavioural Rhythms and GABAA Receptor Subunit Expression in the Mouse SCN.

General anaesthesia (GA) is known to affect the circadian clock. However, the mechanisms that underlie GA-induced shifting of the clock are less well understood. Activation of γ-aminobutyric acid (GABA)-type A receptors (GABAAR) in the suprachiasmatic nucleus (SCN) can phase shift the clock and thus GABA and its receptors represent a putative pathway via which GA exerts its effect on the clock. Here, we investigated the concurrent effects of the inhalational anaesthetic, isoflurane, and light, on mouse behavioural locomotor rhythms and on α1, ß3, and γ2 GABAAR subunit expression in the SCN of the mouse brain. Behavioural phase shifts elicited by exposure of mice to four hours of GA (2% isoflurane) and light (400 lux) (n = 60) were determined by recording running wheel activity rhythms in constant conditions (DD). Full phase response curves for the effects of GA + light on behavioural rhythms show that phase shifts persist in anaesthetized mice exposed to light. Daily variation was detected in all three GABAAR subunits in LD 12:12. The γ2 subunit expression was significantly increased following GA in DD (compared to light alone) at times of large behavioural phase delays. We conclude that the phase shifting effect of light on the mouse clock is not blocked by GA administration, and that γ2 may potentially be involved in the phase shifting effect of GA on the clock. Further analysis of GABAAR subunit expression in the SCN will be necessary to confirm its role.

General Anaesthesia Shifts the Murine Circadian Clock in a Time-Dependant Fashion.

Following general anaesthesia (GA), patients frequently experience sleep disruption and fatigue, which has been hypothesized to result at least in part by GA affecting the circadian clock. Here, we provide the first comprehensive time-dependent analysis of the effects of the commonly administered inhalational anaesthetic, isoflurane, on the murine circadian clock, by analysing its effects on (a) behavioural locomotor rhythms and (b) PER2::LUC expression in the suprachiasmatic nuclei (SCN) of the mouse brain. Behavioural phase shifts elicited by exposure of mice (n = 80) to six hours of GA (2% isoflurane) were determined by recording wheel-running rhythms in constant conditions (DD). Phase shifts in PER2::LUC expression were determined by recording bioluminescence in organotypic SCN slices (n = 38) prior to and following GA exposure (2% isoflurane). Full phase response curves for the effects of GA on behaviour and PER2::LUC rhythms were constructed, which show that the effects of GA are highly time-dependent. Shifts in SCN PER2 expression were much larger than those of behaviour (c. 0.7 h behaviour vs. 7.5 h PER2::LUC). We discuss the implications of this work for understanding how GA affects the clock, and how it may inform the development of chronotherapeutic strategies to reduce GA-induced phase-shifting in patients.

Building on Antimicrobial Stewardship Programs Through Integration with Electronic Medical Records: The Australian Experience.

Antimicrobial stewardship (AMS) is well established in Australian hospitals. Electronic medical record (EMR) implementation has lagged in Australia, with two Healthcare Information and Management Systems Society (HIMSS) Stage 6 hospitals and one Stage 7 hospital as of September 2020. Specific barriers faced by AMS teams with paper-based prescribing and medical records include real-time identification of antimicrobials orders; the ability to prospectively monitor antimicrobial use; and the integration of fundamental point of prescribing AMS principles into routine clinical practice. There are few local guidelines to assist Australian hospitals and AMS teams beyond "out of the box" EMR functionality. EMR implementation has enormous potential to positively impact AMS teams through more efficient workflows and the ability to expand the reach and coverage of AMS activities. There are inevitable limitations associated with EMR implementation that must be considered. In this paper, four Australian hospitals share their experience with EMR roll out, AMS customisation and how they have overcome specific barriers in local AMS practice.

The efficacy of pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography.

BACKGROUND: During magnetic resonance cholangiopancreatography (MRCP), the pancreatobiliary ducts can be obscured by the high-intensity signal from the stomach and duodenum. Pineapple juice may be an alternative to commercially available negative contrast agents, but has not been evaluated locally. OBJECTIVES: To evaluate the efficacy of a local, off-the-shelf pineapple juice preparation as a negative oral contrast agent for MRCP. METHOD: An observational, analytical study was conducted during January-December 2017. A 1.5 Tesla MRCP sequence was performed immediately before and after ingestion of 250 mL of a local, commercially-available pineapple juice preparation. Image evaluation was performed by two radiologists with independent, blind assessment of gastric/duodenal signal intensity and biliary /pancreatic duct visibility, before and after pineapple juice. RESULTS: Fifty adult patients (F = 44, 88%) with median age 44 years (IQR: 34.75, 57) were included. After pineapple juice administration, there was significant measured (1661.51 vs. 1409.94, p < 0.01) and perceived (2.16 vs. 2.72, p < 0.01) duodenal signal reduction but no significant change in measured (1081.17 vs. 1044.38, p = 0.34) or perceived (2.73 vs. 2.84, p = 0.14) gastric signal intensity. Visibility of the common bile duct was significantly improved (3.67 vs. 3.86, p < 0.01), whilst that of the main pancreatic duct showed no significant change (2.92 vs. 2.86, p = 0.44). CONCLUSION: The local pineapple juice preparation used in this study is an effective, affordable and natural negative oral contrast agent for enhancement of MRCP images, and specifically improves visualisation of the common bile duct.

The role of a Coronavirus disease 2019 pharmacist: an Australian perspective.

The coronavirus disease 2019 (COVID-19) pandemic has greatly impacted healthcare services around the world. Pharmacists are front-line healthcare professionals and integral members of the healthcare team. The deployment of a specialized 'COVID pharmacist' within our institution has demonstrated that the skills of the pharmacist can be adapted, expanded and utilized to alleviate the pressure of doctor shortages, reduce healthcare worker exposure to infected patients, contribute to therapeutic decisions and work collaboratively to tackle the challenges faced during this pandemic. This commentary details an Australian hospital pharmacy response to the COVID-19 pandemic, describing the unique clinical and practical contributions made by a specialized COVID pharmacist in our institution.

Ergometrine stability in postpartum haemorrhage kits: Does temperature and light matter?

BACKGROUND: Postpartum haemorrhage (PPH) kits containing uterotonics are used on obstetric units for the timely management of PPH. Visible discolouration of ergometrine and ergometrine-oxytocin injections was observed in PPH kits stored in medical refrigerators on the obstetric unit at our hospital. AIM: To investigate the stability of ergometrine and ergometrine-oxytocin injections in PPH kits under simulated clinical storage conditions and to determine the potency of ampoules quarantined from PPH kits on our obstetric unit. MATERIAL AND METHODS: Ergometrine and ergometrine-oxytocin injection ampoules were stored exposed to and protected from light at 4°C and room temperature (25°C) for up to three months, and assayed by high-performance liquid chromatography. Stability was based on the time for the ergometrine or oxytocin concentration to fall to 90% of the original concentration (t90 ). The potency of quarantined discoloured ampoules also was determined. RESULTS: Ergometrine was stable at both temperatures for >6 months, when stored protected from light in simulated clinical conditions. When exposed to light, ergometrine was stable for approximately 4 days at 25°C and 10 days at 4°C. Discoloured ergometrine and ergometrine-oxytocin injection ampoules were found to be <90% of the nominal concentration. CONCLUSION: Stability of ergometrine in PPH kits is largely unaffected by temperature fluctuations (at 4°C and 25°C) over 6 months when protected from light. Ergometrine and ergometrine-oxytocin ampoules should be inspected prior to use and any discoloured ampoules discarded.

Non-adherence to antimicrobial stewardship prospective audit and feedback advice: Risk factors and clinical consequences.

Amongst 325 patients receiving restricted antimicrobials whose management was subject to antimicrobial stewardship prospective audit and feedback, adherence to advice was 78%. Non-adherence was associated with diabetic patients, giving more than 1 piece of advice and receipt of piperacillin/tazobactam therapy, and was inversely associated with liver disease. Adherence to advice was associated with a one third reduction in duration of antimicrobial use without adversely impacting other infection-related patient outcomes.

Impact of anaesthesia on circadian rhythms and implications for laboratory experiments.

General anaesthesia is a widely used tool to enable surgery in animal experimentation. There is now convincing evidence that general anaesthesia can cause profound and strongly time-dependant shifts in circadian rhythms of behaviour (sleep-wake cycles), physiology (core body temperature, blood pressure, heart rate and hormone release) and cognitive parameters (learning and memory) in a range of species. These effects have the potential to confound laboratory experiments, and may lead to misinterpretation of results. Here, we summarise these effects and advise caution to those conducting laboratory experiments in which anaesthesia forms part of the protocol.

Correction: Challenges of implementing Mark-recapture studies on poorly marked gregarious delphinids.

[This corrects the article DOI: 10.1371/journal.pone.0198167.].

Challenges of implementing Mark-recapture studies on poorly marked gregarious delphinids.

Population parameters of poorly marked gregarious species are difficult to estimate. This is the case for common dolphins (Delphinus sp.), a genus known for its lack of distinctive marks resulting in a low mark ratio. Furthermore, the widespread nature of common dolphins results in low recaptures. We developed reliable photo-identification protocols to ensure accurate identification of individuals in the Hauraki Gulf, New Zealand. These protocols combined the use of nicks and notches and pigmentation patterns for identification and included the development of a distinctiveness threshold. The data were further stratified by the level of distinctiveness of each individual (as distinctive or highly-distinctive). Photo-identification surveys were conducted from January 2010 to December 2013. Mark-recapture techniques were implemented through a POPAN super-population approach to estimate seasonal apparent survival, capture probability and abundance of dolphins. A total of 2,083 unique adult common dolphins were identified, 51.3% were classified as D1 (highly distinctive; n = 1,069) and 48.7% as D2 (distinctive; n = 1,014). Of all individuals identified, 34.3% (n = 704) were re-sighted over subsequent years. The proportion of marked dolphins (when compared to unmarked dolphins) was 26.3% for D1 and 46.4% for D1 & D2, respectively. Apparent survival was estimated at 0.767 (CI = 0.694-0.827) for D1 animals, and 0.796 (CI = 0.729-0.850) for D1 & D2 combined. For D1 only, seasonal abundance varied from 732 (CI = 460-1,177) in autumn 2010 to 5,304 (CI = 4,745-5,930) in spring 2013. While the inclusion of D2 individuals may offer a more precise estimate of total abundance, the inability to determine additional sources of bias (for example, arising from under or overestimated mark ratios) meant that estimates for D1 individuals were deemed the least biased for this population. The photo-identification protocol, stratification of the data and steps taken to eliminate potential model violations provided a useful and novel approach to estimate population parameters for common dolphins. These approaches could be implemented for other large gregarious populations (≥500 individuals) of animals with poor natural markings.

Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds.

OBJECTIVE: To evaluate the impact of the adaptation of an existing electronic referral application for use in antimicrobial stewardship prospective audit and feedback rounds (antimicrobial rounds). DESIGN: Retrospective, single-centre observational study between March 2015 and February 2016. SETTING: A new quaternary referral centre. STUDY PARTICIPANTS: Adults referred for antimicrobial rounds outside of the intensive care and haematology units. INTERVENTION: Adaptation of an electronic referral application used by medical and allied health staff. A questionnaire-style referral form was designed to capture patient clinical details using a combination of free text and dropdown menus. Clinical pharmacists were educated and granted access to the system. MAIN OUTCOME MEASURES: The proportion of completed electronic referrals of total round reviews by month for the 12 months after implementation. The time from request to completion of reviews. The impact on adherence to advice provided on rounds. The impact on the institutional usage of broad-spectrum antibiotics: glycopeptides, carbapenems, third and fourth generation cephalosporins, fluoroquinolones and piperacillin/tazobactam. RESULTS: Over the study period, the proportion of electronic referrals of completed antimicrobial round reviews increased from 59% to 88% (P < 0.001); 75.7% of accepted electronic referrals were seen within 48 h of request. The proportion of advice ignored fell from 18% to 8.5% (P < 0.001). Piperacillin/tazobactam, fluoroquinolone and glycopeptide usage decreased. CONCLUSIONS: The adaptation of an electronic referral application for antimicrobial rounds was associated with increased adherence to advice and reduction in use in target antibiotics. Our model is now used at other institutions.

So much for the city: Urban-rural song variation in a widespread Asiatic songbird.

Song plays a fundamental role in intraspecific communication in songbirds. The temporal and structural components of songs can vary in different habitats. These include urban habitats where anthropogenic sounds and alteration of habitat structure can significantly affect songbird vocal behavior. Urban-rural variations in song complexity, song length and syllable rate are not fully understood. In this study, using the oriental magpie-robin (Copsychus saularis) as a model, we investigated urban-rural variation in song complexity, song length, syllable rate, syllable length and inter-syllable interval. Comparing urban and rural songs from 7 countries across its natural Asiatic range (Bangladesh, India, Malaysia, Nepal, Singapore, Sri Lanka and Thailand), we found no significant differences in oriental magpie-robin song complexity. However, we found significant differences in temporal song variables between urban and rural sites. Longer songs and inter-syllable intervals in addition to slower syllable rates within urban sites contributed the most to this variance. This indicates that the urban environment may have driven production of longer and slower songs to maximize efficient transmission of important song information in urban habitats.

Optimizing adherence to advice from antimicrobial stewardship audit and feedback rounds.

We examined adherence to antimicrobial stewardship prospective audit and feedback rounds in a rehabilitation service compared with the remainder of the acute hospital, and explored the reasons for this. Between October 2014 and December 2015, we retrospectively assessed the rate of non-adherence to advice from antimicrobial stewardship prospective audit and feedback rounds between the rehabilitation service and the acute hospital, along with the source of the patient referral. Compared with the rehabilitation service, acute hospital medical staff were almost twice as likely to not adhere to advice provided on antimicrobial stewardship prospective audit and feedback rounds (13.8% vs. 7.6%, p < 0.0001, relative risk 1.8 [95% confidence interval 1.3, 2.5]). In the rehabilitation service, referrals were more likely to come from medical staff (61.9% vs. 16.3%, p < 0.0001). These findings may be explained by regular, direct engagement of the antimicrobial stewardship team with the rehabilitation service clinical team, a model potentially applicable to other settings.