Explore the vast range of titles available.

Effective teamwork is critical for safe, high-quality care in the operating room (OR); however, teamwork interventions have not consistently resulted in the expected gains for patient safety or surgical culture. In order to optimize OR teamwork in a targeted and evidence-based manner, it is first necessary to conduct a comprehensive, theory-informed assessment of barriers and enablers from an interprofessional perspective. This qualitative study was informed by the Theoretical Domains Framework (TDF). Volunteer, purposive and snowball sampling were conducted primarily across four sites in Ontario, Canada and continued until saturation was reached. Interviews were recorded, transcribed, and de-identified. Directed content analysis was conducted in duplicate using the TDF as the initial coding framework. Codes were then refined whereby similar codes were grouped into larger categories of meaning within each TDF domain, resulting in a list of domain-specific barriers and enablers. A total of 66 OR healthcare professionals participated in the study (19 Registered Nurses, two Registered Practical Nurses, 17 anaesthesiologists, 26 surgeons, two perfusionists). The most frequently identified teamwork enablers included people management, shared definition of teamwork, communication strategies, positive emotions, familiarity with team members, and alignment of teamwork with professional role. The most frequently identified teamwork barriers included others' personalities, gender, hierarchies, resource issues, lack of knowledge of best practices for teamwork, negative emotions, conflicting norms and perceptions across professions, being unfamiliar with team members, and on-call/night shifts. We identified key factors influencing OR teamwork from an interprofessional perspective using a theoretically informed and systematic approach. Our findings reveal important targets for future interventions and may ultimately increase their effectiveness. Specifically, achieving optimal teamwork in the OR may require a multi-level intervention that addresses individual, team and systems-level factors with particular attention to complex social and professional hierarchies.

The simplest and arguably the most ubiquitous pattern in seed dispersal mutualisms is size coupling: large frugivores tend to consume larger fruits and small frugivores tend to consume smaller fruits. Despite the simplicity of this pattern, the potential mechanisms responsible for fruit–frugivore size coupling are mechanistically divergent and poorly resolved. Size coupling could arise deterministically, if large frugivores actively seek out larger fruits to maximize their foraging efficiency. Alternatively, size coupling could also arise passively, if frugivores forage randomly, but are able to consume only those fruit species that are smaller than their gape width. I observed birds forage for fruits in a New Zealand forest reserve at approximately five‐day intervals for six years to test for fruit–frugivore size coupling. I then derived a suite of network analyses to establish whether fruit–frugivore size coupling was best explained by active or passive foraging by frugivores. Results showed a strikingly strong pattern in size coupling; the average size of fruits consumed by each frugivore species increased with their maximum gape width. Simulation analyses revealed that over 70% of variation in interaction frequencies in the observed fruit–frugivore web could be explained by a size‐constrained, passive, foraging model. Foraging models in which birds foraged actively for different‐sized fruits to improve their foraging efficiency performed more poorly. Results were therefore consistent with the hypothesis that apparently nonrandom patterns in seed dispersal mutualisms can sometimes arise from simple stochastic processes.

The aim of this Intensive Care Medicine Rapid Practice Guideline (ICM-RPG) is to formulate an evidence-based guidance for the use of neuromuscular blocking agents (NMBA) in adults with acute respiratory distress syndrome (ARDS). The panel comprised 20 international clinical experts from 12 countries, and 2 patient representatives. We adhered to the methodology for trustworthy clinical practice guidelines and followed a strict conflict of interest policy. We convened panelists through teleconferences and web-based discussions. Guideline experts from the guidelines in intensive care, development, and evaluation Group provided methodological support. Two content experts provided input and shared their expertise with the panel but did not participate in drafting the final recommendations. We followed the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of evidence and grade recommendations and suggestions. We used the evidence to decision framework to generate recommendations. The panel provided input on guideline implementation and monitoring, and suggested future research priorities. The overall certainty in the evidence was low. The ICM-RPG panel issued one recommendation and two suggestions regarding the use of NMBAs in adults with ARDS. Current evidence does not support the early routine use of an NMBA infusion in adults with ARDS of any severity. It favours avoiding a continuous infusion of NMBA for patients who are ventilated using a lighter sedation strategy. However, for patients who require deep sedation to facilitate lung protective ventilation or prone positioning, and require neuromuscular blockade, an infusion of an NMBA for 48 h is a reasonable option.

Assessing the cultural benefits provided by non-market ecosystem services can contribute previously unknown information to supplement conservation decision-making. The concept of sense of place embeds all dimensions of peoples’ perceptions and interpretations of the environment, such as attachment, identity or symbolic meaning, and has the potential to link social and ecological issues. This review contains: (1) an evaluation of the importance of sense of place as an ecosystem service; and (2) comprehensive discussion as to how incorporating sense of place in an evaluation can uncover potential benefits for both biodiversity conservation and human well-being. Sense of place provides physical and psychological benefits to people, and has neglected economic value. The biodiversity-related experiences are essential components of the service that need to be further explored. A conceptual framework was used to explore how the existing knowledge on sense of place derived from other fields can be used to inform conservation decision-making, but further research is needed to fill existing gaps in knowledge. This review contributes to a better understanding of the role biodiversity plays in human well-being, and should inform the Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES).

Spatial variation in exotic species richness is often correlated with native species richness, for reasons that are poorly understood. To better understand the mechanisms underpinning native-exotic richness relationships, I quantified the colonization and extinction of 18 exotic and 16 native plant species on 39 small islands located off the coast of New Zealand for 8 consecutive yr. Results revealed a positive native-exotic richness relationship, which could be explained by similar demographic responses of native and exotic species to island area. However, native and exotic species showed subtle differences in their response to other island attributes. Turnover in native species declined with island isolation, whereas turnover in exotic species increased with the exposure of islands to ocean-borne disturbances. Overall results illustrate how long-term observations of species turnover can be used to better understand the mechanisms underpinning native-exotic richness relationships, and demonstrate that large, exposed islands can be especially susceptible to invasions by exotic species.

Bird-pollinated flowers typically appear ‘red’. Fuchsia excorticata (Onagraceae), a gynodioecious tree species endemic to New Zealand, is a notable exception. It produces ‘green’, cauliflorous flowers at early stages in flower ontogeny, when pistils are receptive. Flowers later turn ‘red’ as they lose their receptivity. We conducted field observations and spectrographic analyses to test whether: (1) receptive, green-phase flowers are actually more conspicuous to avian pollinators against their natural backgrounds than unreceptive, red-phase flowers, (2) green-phase flowers produce more nectar, and (3) relationships between flower conspicuousness and nectar production are similar in females and hermaphrodites. Results showed that the reflectance properties of green-phase flowers sharply contrast ‘orange’ tree bark, their natural visual background, rendering them more conspicuous to the avian eye than red-phase flowers. Green-phase flowers also produced more nectar than red-phase flowers as an honest signal of rewards. Similar results were observed in both female and hermaphrodite plants. Overall results provide an unusual example of reversed flower-background colour contrasts, with ‘reddish’ hues being incorporated into the visual backgrounds of floral displays rather than being associated with the flowers themselves. They also illustrate that flower conspicuousness can serve as an honest signal of nectar rewards to pollinators.

By using a GFP reporter protein expressed selectively in neural stem cells in a mouse model of glioblastoma, a small subset of GFP-positive glioma cells is shown to be responsible for re-growth of tumours after chemotherapy. A cancer-cell hierarchy In a mouse model of glioblastoma, Luis Parada and colleagues use a green fluorescent protein (GFP) reporter protein expressed selectively in neural stem cells — in which the tumours arise — to trace cancer cells in an endogenous setting. The reporter labelled a small subset of glioma cells that were less proliferative than the bulk of the tumour cells. However, the GFP + cells were responsible for re-growth of the tumours after treatment with the cytotoxic drug temozolomide. Selective ablation of the GFP + cells combined with temozolomide was more effective at arresting tumour growth. The GFP + cells appear to be at the apex of a functional hierarchy of cancer cells so may represent cancer stem cells — a subset of tumour cells able to maintain tumour growth. Targeting both this population and the more proliferative bulk of cancer cells may lead to improved therapeutic outcome. Glioblastoma multiforme is the most common primary malignant brain tumour, with a median survival of about one year 1 . This poor prognosis is due to therapeutic resistance and tumour recurrence after surgical removal. Precisely how recurrence occurs is unknown. Using a genetically engineered mouse model of glioma, here we identify a subset of endogenous tumour cells that are the source of new tumour cells after the drug temozolomide (TMZ) is administered to transiently arrest tumour growth. A nestin-ΔTK-IRES-GFP ( Nes-ΔTK-GFP ) transgene that labels quiescent subventricular zone adult neural stem cells also labels a subset of endogenous glioma tumour cells. On arrest of tumour cell proliferation with TMZ, pulse-chase experiments demonstrate a tumour re-growth cell hierarchy originating with the Nes-ΔTK-GFP transgene subpopulation. Ablation of the GFP + cells with chronic ganciclovir administration significantly arrested tumour growth, and combined TMZ and ganciclovir treatment impeded tumour development. Thus, a relatively quiescent subset of endogenous glioma cells, with properties similar to those proposed for cancer stem cells, is responsible for sustaining long-term tumour growth through the production of transient populations of highly proliferative cells.

Many plants produce colour-polymorphic fruits. However, the processes responsible for the evolution and maintenance of fruit colour polymorphisms are poorly understood. We investigated the fruit colour polymorphism in Gaultheria depressa var. novae-zealandiae (Ericaceae), a predominantly bird-dispersed, alpine shrub from New Zealand, by testing whether colour morph frequencies vary geographically to maximise fruit-foliage colour contrasts. We also conducted a seed germination experiment to test whether fruit colour morphs vary in their susceptibility to UV damage. Results showed that ‘red’ fruits were more abundant at lower elevations, while ‘white’ fruits were predominant at higher elevations. Leaf colours shifted from ‘green’ in appearance at lower elevations to ‘red’ at higher elevations. Analyses of fruit-foliage colour contrasts showed that ‘red’ fruits were more conspicuous at lower elevations, and ‘white’ fruits were more conspicuous at higher elevations, which was consistent with the hypothesis that colour morph frequencies vary geographically to maximise their conspicuousness to dispersers. However, ‘red’ fruits were generally more conspicuous than ‘white’ fruits, regardless of elevation, indicating that the maintenance of the polymorphism could not be attributed to fruit-foliage colour contrasts alone. The seed germination experiment showed that ‘white’ fruits were more resistant to UV damage, suggesting the preponderance of ‘white’ fruited individuals in the landscape results from a greater degree of protection from UV damage. The fruit colour polymorphism in Gaultheria depressa var. novae-zealandiae therefore appears to be maintained by trade-offs between conspicuousness to dispersers and tolerance to UV damage, advocating a pluralistic approach to the problem in the future.