SummarySafe vascular access is integral to anaesthetic and critical care practice, but procedures are a frequent source of patient adverse events. Ensuring safe and effective approaches to vascular catheter insertion should be a priority for all practitioners. New technology such as ultrasound and other imaging has increased the number of tools available. This guidance was created using review of current practice and literature, as well as expert opinion. The result is a consensus document which provides practical advice on the safe insertion and removal of vascular access devices.
Aim: Mangrove forests are among the world's most important ecosystems but are declining rapidly worldwide. Effective conservation management requires a better understanding of the patterns and drivers of gene flow across a range of spatial scales. Despite the capacity for long-distance propagule dispersal, field studies suggest that mangrove propagules tend not to disperse far from the release point, which has important implications for the impact of habitat discontinuities on gene flow. We use a comprehensive seascape genomics approach to investigate this concept in the world's most widely distributed mangrove species, Avicennia marina.Location: Twenty-one sites along 2,400 km of Western Australian coastline. Methods:We used 6,162 neutral SNP loci and a hierarchical sampling design to investigate patterns of gene flow and structuring among 21 populations of A. marina.We combined these data with GIS spatial analyses in a regression model to test the relative influence of habitat continuity and geographic distance on patterns of genetic differentiation. Results:We found a complex pattern of gene flow; broadscale isolation-by-distance, disrupted by strong genetic discontinuities that coincided with gaps in mangrove distribution. These genetic discontinuities formed seven discrete subpopulations with negligible evidence for recent migration among them. The regression model combining marine geographic distance and habitat continuity as explanatory variables best fit the data, explaining 86% of the total genetic variation. Main Conclusions:Our results validate previous assertions that propagule dispersal in A. marina is spatially limited and demonstrate that significant gaps in mangrove distribution present strong barriers to stepping-stone gene flow in this species. This reiterates that dispersive life history features cannot be assumed to lead to widespread connectivity and demonstrates that effective management of these important ecosystem builders should prioritize restoring habitat continuity and minimizing further fragmentation. K E Y W O R D SAvicennia marina, genotyping-by-sequencing, habitat discontinuities, mangrove, marine connectivity, propagule dispersal, seascape genomics | 299 BINKS et al.
Leptospermum is an ecologically and economically important genus with a long unresolved taxonomic issue concerning polyphyly, as indicated from early molecular analysis on two chloroplast regions. To resolve this, we used genome skimming to obtain high‐copy chloroplast and nuclear ribosomal DNA for a comprehensive phylogenomic analysis of 110 accessions comprising of 38 Leptospermum taxa, 6 closely allied genera and 5 outgroup genera. Maximum likelihood and Bayesian analyses resolved congruent clades for the chloroplast (132,143 bp: 80 CDSs, 4 rRNA genes, 29 tRNA genes, 17 introns and 97 IGSs) and nuclear (1219 bp: ITS1, ITS2, ETS, 5.8S) alignments to provide a robust interpretation of evolutionary relationships. Together, these data confirmed extensive polyphyly of Leptospermum that separated the genus into five monophyletic clades spread amongst clades representing six closely allied genera: Agonis, Asteromyrtus, Homalospermum, Kunzea, Neofabricia and Pericalymma. These five Leptospermum clades share some similarities with morphological and genetic groupings identified previously but provide greater resolution to inform a clear pathway to taxonomic revision. The evidence presented here provides support for resolution of the current polyphyly of Leptospermum through the recognition of five genera, while retaining all other genera of Leptospermeae in their current circumscription.
Background This paper summarises a series of presentations on telemedicine given at a UK eHealth Week conference session in 2016. The formal evidence base for telemedicine is equivocal, but practical experience suggests that implementations of technology that support telemedicine initiatives can result in improved patient outcomes, better patient and carer experience and reduced expenditure. Objective To answer the questions 'Is an investment in telemedicine worth it'? and 'How do I make a telemedicine implementation work'? Methods Summary of systematic review evidence and an illustrative case study. Discussion of implications for industry and policy. Results Realisation of telemedicine benefits is much less to do with the technology itself and much more around the context of the implementing organisation and its ability to implement. Conclusion We recommend that local organisations consider deployment of telemedicine initiatives but with a greater awareness of the growing body of implementation best practice. We also recommend, for the National Health Service, that the centre takes a greater role in the collation and dissemination of best practice to support successful implementations of telemedicine and other health informatics initiatives.
For plants with mixed reproductive capabilities, asexual reproduction is more frequent in rare species and is considered a strategy for persistence when sexual recruitment is limited. We investigate whether asexual reproduction contributes to the persistence of two co-occurring, rare sedges that both experience irregular seed set and if their differing geographic distributions have a role in the relative contribution of clonality. Genotypic richness was high (R = 0.889 ± 0.02) across the clustered populations of Lepidosperma sp. Mt Caudan and, where detected, clonal patches were small, both in ramet numbers (⩽3 ramets/genet) and physical size (1.3 ± 0.1 m). In contrast, genotypic richness was lower in the isolated L. sp. Parker Range populations, albeit more variable (R = 0.437 ± 0.13), with genets as large as 17 ramets and up to 5.8 m in size. Aggregated clonal growth generated significant fine-scale genetic structure in both species but to a greater spatial extent and with additional genet-level structure in L. sp. Parker Range that is likely due to restricted seed dispersal. Despite both species being rare, asexual reproduction clearly has a more important role in the persistence of L. sp. Parker Range than L. sp. Mt Caudan. This is consistent with our prediction that limitations to sexual reproduction, via geographic isolation to effective gene exchange, can lead to greater contributions of asexual reproduction. These results demonstrate the role of population isolation in affecting the balance of alternate reproductive modes and the contextual nature of asexual reproduction in rare species.
The many spatial and temporal configurations in which species can be classified as rare may result in various genetic signatures, despite a persistent generalization that populations of rare species are genetically depauperate and highly differentiated. We assessed genetic diversity and differentiation in two narrow endemics with contrasting geographical distributions using 12 nuclear and six chloroplast microsatellite loci. Consistent with both marker types, the smaller, more isolated Lepidosperma sp. Parker Range populations were characterized by lower diversity and stronger divergence, relative to higher diversity and extensive connectivity among the geographically clustered L. sp. Mt Caudan populations. However, neither species exhibited low diversity, despite high inbreeding. Together, our results suggest that these species are naturally rare and have long persisted in this landscape while maintaining genetic diversity and tolerating considerable inbreeding. Their resilience is probably due to large population sizes and the flexibility afforded by employing sexual and asexual reproduction. Their contrasting genetic dynamics demonstrate that not all rare species share generalized patterns, even within the same rarity category. Moreover, these patterns were better predicted by fine‐scale descriptors of rarity, population size and distribution, rather than the more typically used geographical range. This study highlights the complex dynamics of rare species and cautions against using broad assumptions to classify and manage rare species. © 2015 State of Western Australia, Biological Journal of the Linnean Society, 2015, 114, 873–886.
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