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In the summer of 1883 Belgian travel writer Jules Leclercq spent ten days on horseback in Yellowstone, the world's first national park, exploring myriad natural wonders: astonishing geysers, majestic waterfalls, the vast lake, and the breathtaking canyon. He also recorded the considerable human activity, including the rampant vandalism. Leclercq's account of his travels is itself a small marvel blending natural history, firsthand impressions, scientific lore, and anecdote. Along with his observations on the park's long-rumored fountains of boiling water and mountains of glass, Leclercq describes camping near geysers, washing clothes in a bubbling hot spring, and meeting such diverse characters as local guides and tourists from the United States and Europe. Notables including former president Ulysses S. Grant and then-president Chester A. Arthur were also in the park that summer to inaugurate the newly completed leg of the Northern Pacific Railroad. A sensation in Europe, the book was never published in English. This deft translation at long last makes available to English-speaking readers a masterpiece of western American travel writing that is a fascinating historical document in its own right.

Will the government send my rebate to those who do not pay hydro, like they did the gas rebate?

Summary Neutrophil extracellular traps (NETs) are a recently discovered addition to the defensive armamentarium of neutrophils, assisting in the immune response against rapidly dividing bacteria. Although older adults are more susceptible to such infections, no study has examined whether aging in humans influences NET formation. We report that TNF‐α‐primed neutrophils generate significantly more NETs than unprimed neutrophils and that lipopolysaccharide (LPS)‐ and interleukin‐8 (IL‐8)‐induced NET formation exhibits a significant age‐related decline. NET formation requires generation of reactive oxygen species (ROS), and this was also reduced in neutrophils from older donors identifying a mechanism for reduced NET formation. Expression of IL‐8 receptors (CXCR1 and CXCR2) and the LPS receptor TLR4 was similar on neutrophils from young and old subjects, and neutrophils challenged with phorbol‐12‐myristate‐13‐acetate (PMA) showed no age‐associated differences in ROS or NET production. Taken together, these data suggest a defect in proximal signalling underlies the age‐related decline in NET and ROS generation. TNF‐α priming involves signalling through p38 MAP kinase, but activation kinetics were comparable in neutrophils from young and old donors. In a clinical setting, we assessed the capacity of neutrophils from young and older patients with chronic periodontitis to generate NETs in response to PMA and hypochlorous acid (HOCL). Neutrophil extracellular trap generation to HOCL, but not PMA, was lower in older periodontitis patients but not in comparison with age‐matched controls. Impaired NET formation is thus a novel defect of innate immunity in older adults but does not appear to contribute to the increased incidence of periodontitis in older adults.

Background The position of invasive urodynamic testing (IUT) in diagnostic pathways for urinary incontinence is unclear, and systematic reviews have called for further trials evaluating clinical utility. The objective of this study was to inform the decision whether to proceed to a definitive randomised trial of IUT compared to clinical assessment with non-invasive tests, prior to surgery in women with stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI). Methods A mixed methods study comprising a pragmatic multicentre randomised pilot trial, a qualitative face-to face interview study with patients eligible for the trial, an exploratory economic evaluation including value of information study, a survey of clinicians’ views about IUT, and qualitative telephone interviews with purposively sampled survey respondents. Only the first and second of these elements are reported here. Trial participants were randomised to either clinical assessment with non-invasive tests (control arm) or clinical assessment with non-invasive tests plus IUT (intervention arm). The main outcome measures of these feasibility studies were confirmation that units can identify and recruit eligible women, acceptability of investigation strategies and data collection tools, and acquisition of outcome data to determine the sample size for a definitive trial. The primary outcome proposed for a definitive trial was ICIQ-FLUTS (total score) 6 months after surgery or the start of nonsurgical treatment. Results Of 284 eligible women, 222 (78 %) were recruited, 165/219 (75 %) returned questionnaires at baseline, and 125/200 returned them (63 %) at follow-up. Most women underwent surgery; management plans were changed in 19 (19 %) participants following IUT. Participants interviewed were positive about the trial and the associated documentation. Conclusions All elements of a definitive trial were rehearsed. Such a trial would require between 232 and 922 participants, depending on the target difference in the primary outcome. We identified possible modifications to our protocol for application in a definitive trial including clarity over inclusion/exclusions, screening processes, reduction in secondary outcomes, and modification to patient questionnaire booklets and bladder diaries. A definitive trial of IUT versus clinical assessment prior to surgery for SUI or stress predominant MUI is feasible and remains relevant. Trial registration Current Controlled Trials: ISRCTN71327395 , registered 7 June 2010.

The role of nurse preceptor in the UK functions to support and nurture newly qualified staff during transition to accountable practitioners. Transition is a stressful time for all new staff, whether diplomates or graduates. Preceptors are in a prime position to assess the competence and confidence of new staff, and observe their fitness for practice. Studies show variable evidence concerning the benefit to practice of nurses with degree compared to diploma education. This exploratory study investigated preceptors’ perceptions of differences in the knowledge and skills displayed by staff from a three-year Diploma programme (DNs), and four-year pre-registration Master in Nursing degree (MNs), run by one School of Nursing. In the first months DNs were said to exhibit more confidence in practical skills while MNs showed academic and analytic skills. Although DNs related well to patients, MNs were better able to communicate with professional colleagues. By six months MNs overtook DNs in their overall confidence. Preceptors valued both DNs and MNs for the skill mix they brought to nursing and the benefit of patient care. Further exploration of preceptors’ views would inform education staff and advise preceptors and managers regarding newly qualified nurses.