The genome sequence of the Western Capercaillie Tetrao urogallus Linnaeus, 1758.

We present a genome assembly from an individual male Tetrao urogallus (the Western Capercaillie; Chordata; Aves; Galliformes; Phasianidae). The genome sequence is 1,013.2 megabases in length. Most of the assembly is scaffolded into 39 chromosomal pseudomolecules, including the Z sex chromosome. The mitochondrial genome has also been assembled and is 16.68 kilobases in length.

Accessing and engaging with antenatal care: an interview study of teenage women.

BACKGROUND: Pregnant teenagers in rural and regional areas experience distinct disadvantages, that are not simply a function of their age, and these have a substantial impact on their health and that of their baby. Studies demonstrate that antenatal care improves pregnancy outcomes amongst pregnant women, especially adolescents. Understanding teenager's views and experiences of pregnancy and motherhood is important to ensure antenatal care meets young women's needs. This study explored teenage women's experiences and perceptions of barriers and facilitators to engaging in pregnancy care in rural and regional Victoria, Australia. METHODS: Between February-October 2017, pregnant women aged ≤19 years were purposively recruited from one regional and two rural health services in Victoria. Semi-structured, face-to-face interviews guided by naturalistic inquiry were conducted and an inductive approach to analysis was applied. RESULTS: Four key themes emerged from the analysis of the transcripts of 16 interviews: Valuing pregnancy care, Interactions with Maternity Service, Woman-centred care, and Support systems. Teenage women primary motivation to attend care was to ensure their baby's wellbeing and lack of engagement occurred when the relevance of antenatal care was not understood. Appointment flexibility and an accessible location was important; most participants were reliant on others for transport. Continuity of carer and respectful, non-judgement communication by staff was highly valued. Many young women had fractured families with pregnancy diminishing their social world, yet having a baby gave them purpose in their lives. CONCLUSION: Maternity services and health professionals that provide flexible, adaptable women-centred care and support through pregnancy and early motherhood will assist young women's engagement in antenatal care.

Implementing an intervention to promote normal labour and birth: A study of clinicians' perceptions.

OBJECTIVE: Prior to implementation of a Normal Labour and Birth Bundle (NLBB) at a regional maternity service in Victoria, Australia, this study aimed to understand clinician factors that may influence the uptake, acceptance and use of the NLBB. DESIGN: This was a mixed methods study in which The Theory of Planned Behaviour (TPB) provided the framework for the conduct and analysis of the staff survey and focus groups. Descriptive and multiple regression were used to analyse the survey data and thematic analysis was used for the focus group data. PARTICIPANTS: Participants for the survey and focus groups included clinicians providing publicly funded care and management of labour for women birthing at the health service. Maternity care clinicians were invited to participate in both the survey and the focus groups. FINDINGS: Seventy-six clinicians (88.8%) responded to the survey. Mean scores for TPB constructs were well above the mid-scale score of 4, indicating strong positive attitudes, high levels of self-efficacy and positive social pressure to use the NLBB and strong intentions to use it in the future. Self-efficacy was the strongest independent predictor (ß = 0.45, p < 0.001) of intention to use the NLBB (overall model R2=0.38). A valued consequence of implementing standardised and objective guidelines, highlighted in the focus groups, was the positive impact on clinicians' confidence in their decision-making. KEY CONCLUSIONS: This study found that midwives and obstetricians were in favour of using a normal labour and birth care bundle and perceived the bundle to align with the expectations of work colleagues and the women they care for. The findings of this study show that clinicians at the health service had strong intentions to use the normal labour and birth care bundle in the future. IMPLICATIONS FOR PRACTICE: Implementation science is important in embedding and sustaining practice change. Understanding staff perceptions is an essential first step of this process.

The role of the nurse practitioner in the diagnosis and early management of type 2 diabetes.

PURPOSE: To review the early diagnosis and early effective treatment of type 2 diabetes and its role in reducing the risk of complications. This article discusses the diagnosis of T2D and the initial stages of disease management with oral monotherapy. DATA SOURCES: Extensive literature review of textbooks and clinical, medical, and nursing journals. CONCLUSIONS: There are clear evidence-based recommendations for disease management in the early stages of T2D, with therapy focusing on implementation of lifestyle changes and use of pharmacologic monotherapy. A vital part of early T2D treatment is patient education, which can lay the foundation for treatment throughout the disease continuum. The lifestyle changes recommended for management of T2D can be difficult for patients to sustain, and treatment regimens are often complex. IMPLICATIONS FOR PRACTICE: Type 2 diabetes (T2D) is a progressive disease, associated with a long-term risk of morbidity and mortality. Therefore, it is important that treatment is individualized, and that ongoing support is provided to maximize the possibility of achieving treatment goals. Current standards for T2D treatment are designed for a patient-centered treatment approach managed by team of healthcare practitioners, in which the nurse practitioner (NP) is central.

Nitric oxide regulates BDNF release from nodose ganglion neurons in a pattern-dependent and cGMP-independent manner.

Activity of arterial baroreceptors is modulated by neurohumoral factors, including nitric oxide (NO), released from endothelial cells. Baroreceptor reflex responses can also be modulated by NO signaling in the brainstem nucleus tractus solitarius (NTS), the primary central target of cardiovascular afferents. Our recent studies indicate that brain-derived neurotrophic factor (BDNF) is abundantly expressed by developing and adult baroreceptor afferents in vivo, and released from cultured nodose ganglion (NG) neurons by patterns of baroreceptor activity. Using electrical field stimulation and ELISA in situ, we show that exogenous NO nearly abolishes BDNF release from newborn rat NG neurons in vitro stimulated with single pulses delivered at 6 Hz, but not 2-pulse bursts delivered at the same 6-Hz frequency, that corresponds to a rat heart rate. Application of L-NAME, a specific inhibitor of endogenous NO synthases, does not have any significant effect on activity-dependent BDNF release, but leads to upregulation of BDNF expression in an activity-dependent manner. The latter effect suggests a novel mechanism of homeostatic regulation of activity-dependent BDNF expression with endogenous NO as a key player. The exogenous NO-mediated effect does not involve the cGMP-protein kinase G (PKG) pathway, but is largely inhibited by N-ethylmaleimide and TEMPOL that are known to prevent S-nitrosylation. Together, our current data identify previously unknown mechanisms regulating BDNF availability, and point to NO as a likely regulator of BDNF at baroafferent synapses in the NTS.

New developments in incretin-based therapies: the current state of the field.

PURPOSE: To update readers on developments in incretin therapies since the previous JAANP supplement in 2007; specifically, to describe clinical data for currently available incretin-based therapies as well as those under consideration by regulatory agencies. DATA SOURCE: Medline search for peer-reviewed publications. CONCLUSIONS: Incretin-based therapies have pharmacologic properties that avoid some key limitations of previous treatments, such as hypoglycemia and weight gain. Certain agents also lower blood pressure and have the potential to reduce cardiovascular risk. The insulin-secreting action of incretin-based therapies only occurs under hyperglycemic conditions, thus minimizing the risk of hypoglycemia, unless combined with a sulfonylurea. The DPP-4 inhibitors are orally administered and demonstrate modest A1c reductions (0.6%-0.8%); the best results occur when combined with metformin. Glucagon-like peptide-1 (GLP-1) receptor agonists liraglutide and exenatide have shown greater A1c reductions (typically ≥ 1.1% and as high as 1.7%), and these agents have beneficial ancillary effects, including weight and systolic blood pressure reduction. Both DPP-4 inhibitors and GLP-1 receptor agonists have shown the ability to improve pancreatic beta-cell function in early studies. IMPLICATIONS FOR PRACTICE: Data are provided on the efficacy and tolerability of approved incretin therapies, and on treatments currently in regulatory review, in order to inform readers and guide their practice.

College health professionals and academic librarians: collaboration for student health.

UNLABELLED: College health professionals must find new ways of educating students on finding and evaluating consumer health information, specifically in the online environment. Librarians are trained as information professionals; however, librarians at general academic libraries are not taking a lead role in providing consumer health information. OBJECTIVE: The authors' purpose in this research was to determine the health information resource needs of college and university students and provide a model for collaboration between college health professionals and academic librarians. PARTICIPANTS AND METHODS: The authors compared data from a national survey on college health (N = 54,111) with their own results from a survey of general academic librarians (N = 17) to create recommendations for synching students' reported health information needs with librarians' resources. RESULTS: Although the Internet was students' second most-often consulted health information source, they ranked the believability of online health information above only television. In the librarian survey, although 12 respondents indicated that health information provision is a library's responsibility, the majority (n = 11) believed their library's consumer health outreach to be passive. CONCLUSIONS: The authors offer recommendations for partnerships between college healthcare professionals and academic librarians to better provide this information to students.

Physiologic insulin replacement in type 2 diabetes: optimizing postprandial glucose control.

PURPOSE: The purpose of this article is to review physiologic insulin replacement using a basal-prandial approach and focus on the role of postprandial glucose control. In addition, therapeutic options for optimizing glycemic control are described, including diabetes education, currently available agents, treatment regimens, and strategies. METHODS: This article reviews the benefits of treating with a basal-prandial insulin approach and focuses on post-prandial glucose-targeted therapies, including rapid-acting insulin analogs. RESULTS: Data from landmark clinical trials in type 2 diabetes suggest that intensive glycemic control can reduce the frequency and severity of diabetes complications. A basal-prandial insulin regimen combines a long-acting insulin analog with a rapid-acting insulin to mimic normal physiologic insulin secretion, providing a flexible tool to enhance patient self-management. CONCLUSIONS: Strategies that include patient education, improved health care provider/patient communication, and basal-prandial insulin treatment can help patients achieve good glycemic control. The optimal setting for successful diabetes treatment is a team approach with the health care provider, nurse/certified diabetes educator, and patient as essential members.

Update on diabetes diagnosis and management.

BACKGROUND: The American Diabetes Association has established recommendations for the testing of undiagnosed people. Once diagnosed, those with diabetes must strive to maintain a level of glucose control that results in a metabolism that approaches that of people without diabetes. The dentist also can provide risk-reduction strategies for people prone to develop diabetes, and refer patients with signs and symptoms suggestive of diabetes to physicians. METHODS: The authors describe criteria for establishing a diagnosis of diabetes and for identifying people at high risk of developing the disease. A combination of approaches in the medical management of type 1 and type 2 diabetes mellitus is presented, along with target outcomes. RESULTS: Patients with diabetes maintain a glycosylated hemoglobin value of no higher than 7 percent. New therapeutic research includes early clinical trials of islet cell transplantation and therapeutic cloning from human stem cells, which may provide an alternate source of insulin-producing islet cells and, thus, may offer a potential cure for diabetes. CONCLUSIONS: Rigorous metabolic control of diabetes can be achieved through a combination of therapeutic modalities and the establishment and maintenance of target outcomes. The dentist can implement preventive strategies and refer patients with signs and symptoms suggestive of diabetes to physicians. CLINICAL IMPLICATIONS: The dentist and physician must work together as a team to achieve rigorous metabolic control of diabetes in their patients.