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Temperature isoclines are shifting with global warming. To survive, species with thermal niches must shift their geographical ranges to stay within the bounds of their suitable habitat, or acclimate to a new environment. Mathematical models that study range shifts are called moving-habitat models. The literature is rich and includes modelling with reaction-diffusion equations. Much of this literature represents space by the real line, with a handful studying 2-dimensional domains that are unbounded in at least one direction. The suitable habitat is represented by the set over which the demographics (reaction term) has a positive net growth rate. In some cases, this is a bounded set, in others, it is not. The unsuitable habitat is represented by the set over which the net growth rate is negative. The environmental shift is captured by an imposed shift of the suitable habitat. Individuals respond to their environment via their movement behaviour and many display habitat-dependent dispersal rates and a habitat bias. Such behaviour corresponds to a jump in density across the interface of suitable and unsuitable habitat. The questions motivating moving-habitat models are: when can a species track its shifting habitat and what is the impact of an environmental shift on a persisting species. Without closed form solutions, researchers rely on numerical methods to study the latter, and depending on the movement of the interface, the former may require numerical tools as well. We construct and analyse two numerical methods, a finite difference (FD) scheme and a finite element (FE) method in 1- and 2-dimensional space, respectively. The FD scheme can capture arbitrary movement of the boundary, and the FE method rather general shapes for the suitable habitat. The difficulty arises in capturing the jump across a shifting interface. We construct a reference frame in which the interfaces are fixed in time. We capture the jump in density with a clever placing of the nodes in the FD scheme, and through a Lagrange multiplier in the FE method. With biological applications, we demonstrate the power of our solvers in advancing research for moving-habitat models.

Percy Dearmer’s time as a visiting lecturer at Berkeley Divinity School in Connecticut, USA, at the invitation of Dean William Palmer Ladd, from July 1918 to February 1919, marked a turning point in his life and career. As author of The Parson’s Handbook (1899) and Vicar of St Mary’s Primrose Hill (1901–1915), he was immersed in the Church of England. From 1919, when he left Berkeley Divinity School, with no offer of a clergy post until 1931, he worked on the margins of the church as a university lecturer, writer, and co-director of an experimental worshipping community. The experiences he had between 1915 and 1919 shaped this ‘second’ Dearmer: loss in the war; a second wife and new family; work with the YMCA in France and India; travels in the Anglican Communion and, not least, time at Berkeley where he consolidated these experiences, becoming attuned to those who wanted a spiritual life but were disillusioned by institutional religion, as expressed in The Art of Worship (1919).

ObjectivesTo describe the design, development and pilot of a multicomponent intervention aimed at supporting withdrawal of opioids for people with chronic non-malignant pain for future evaluation in the Improving the Wellbeing of people with Opioid Treated CHronic pain (I-WOTCH) randomised controlled trial.DesignThe I-WOTCH intervention draws on previous literature and collaboration with stakeholders (patient and public involvement). Intervention mapping and development activities of Behaviour Change Taxonomy are described.SettingThe intervention development was conducted by a multidisciplinary team with clinical, academic and service user perspectives. The team had expertise in the development and testing of complex health behaviour interventions, opioid tapering and pain management in primary and secondary care, I.T programming, and software development—to develop an opioid tapering App.ParticipantsThe I-WOTCH trial participants are adults (18 years and over) with chronic non-malignant pain using strong opioids for at least 3 months and on most days in the preceding month.OutcomesA multicomponent self-management support package to help people using opioids for chronic non-malignant pain reduce opioid use.Interventions and resultsReceiving information on the impact of long-term opioid use, and potential adverse effects were highlighted as important facilitators in making the decision to reduce opioids. Case studies of those who have successfully stopped taking opioids were also favoured as a facilitator to reduce opioid use. Barriers included the need for a ‘trade-off to fill the deficit of the effect of the drug’. The final I-WOTCH intervention consists of an 8–10 week programme incorporating: education; problem-solving; motivation; group and one to one tailored planning; reflection and monitoring. A detailed facilitator manual was developed to promote consistent delivery of the intervention across the UK.ConclusionsWe describe the development of an opioid reduction intervention package suitable for testing in the I-WOTCH randomised controlled trial.Trial registration numberISRCTN49470934.

In addition to well-known roles in RNA metabolism, the nucleolus and Cajal bodies (CBs), both located within the nucleus, are involved in plant responses to biotic and abiotic stress. Previously we showed that plants in which expression of the CB protein coilin is downregulated are more susceptible to certain viruses including tobacco rattle virus (TRV), suggesting a role of coilin in antiviral defence. Experiments with coilin-deficient plants and the deletion mutant of the TRV 16K protein showed that both 16K and coilin are required for restriction of systemic TRV infection. The potential mechanisms of coilin-mediated antiviral defence were elucidated via experiments involving co-immunoprecipitation, use of NahG transgenic plants deficient in salicylic acid (SA) accumulation, measurement of endogenous SA concentrations and assessment of SA-responsive gene expression. Here we show that TRV 16K interacts with and relocalizes coilin to the nucleolus. In wild-type plants these events are accompanied by activation of SA-responsive gene expression and restriction of TRV systemic infection. By contrast, viral systemic spread was enhanced in NahG plants, implicating SA in these processes. Our findings suggest that coilin is involved in plant defence, responding to TRV infection by recognition of the TRV-encoded 16K protein and activating SA-dependent defence pathways.

Background Emerging studies indicate that some COVID-19 patients suffer from persistent symptoms including breathlessness and chronic fatigue; however the long-term immune response in these patients presently remains ill-defined. Methods Here we describe the phenotypic and functional characteristics of B and T cells in hospitalised COVID-19 patients during acute disease and at 3-6 months of convalescence. Findings We report that the alterations in B cell subsets observed in acute COVID-19 patients were largely recovered in convalescent patients. In contrast, T cells from convalescent patients displayed continued alterations with persistence of a cytotoxic programme evident in CD8+ T cells as well as elevated production of type-1 cytokines and IL-17. Interestingly, B cells from patients with acute COVID-19 displayed an IL-6/IL-10 cytokine imbalance in response to toll-like receptor activation, skewed towards a pro-inflammatory phenotype. Whereas the frequency of IL-6+ B cells was restored in convalescent patients irrespective of clinical outcome, recovery of IL-10+ B cells was associated with resolution of lung pathology. Conclusions Our data detail lymphocyte alterations in previously hospitalized COVID-19 patients up to 6 months following hospital discharge and identify 3 subgroups of convalescent patients based on distinct lymphocyte phenotypes, with one subgroup associated with poorer clinical outcome. We propose that alterations in B and T cell function following hospitalisation with COVID-19 could impact longer term immunity and contribute to some persistent symptoms observed in convalescent COVID-19 patients. Funding Provided by UKRI, Lister Institute of Preventative Medicine, The Wellcome Trust, The Kennedy Trust for Rheumatology Research and 3M Global Giving., Graphical Abstract, Shuwa et al examine lymphocyte characteristics in acute and convalescent COVID-19 patients, detailing persistent alterations in lymphocyte phenotype up to 6 months following hospital discharge. In this report they identify 3 subgroups of convalescent patients based on distinct lymphocyte signatures, with one subgroup associated with poorer clinical outcome.

The aims of the Oncoplastic Breast Consortium initiative were to identify important knowledge gaps in the field of oncoplastic breast-conserving surgery and nipple-sparing or skin-sparing mastectomy with immediate breast reconstruction, and to recommend appropriate research strategies to address these gaps. A total of 212 surgeons and 26 patient advocates from 55 countries prioritised the 15 most important knowledge gaps from a list of 38 in two electronic Delphi rounds. An interdisciplinary panel of the Oncoplastic Breast Consortium consisting of 63 stakeholders from 20 countries obtained consensus during an in-person meeting to select seven of these 15 knowledge gaps as research priorities. Three key recommendations emerged from the meeting. First, the effect of oncoplastic breast-conserving surgery on quality of life and the optimal type and timing of reconstruction after nipple-sparing or skin-sparing mastectomy with planned radiotherapy should be addressed by prospective cohort studies at an international level. Second, the role of adjunctive mesh and the positioning of implants during implant-based breast reconstruction should ideally be investigated by randomised controlled trials of pragmatic design. Finally, the BREAST-Q questionnaire is a suitable tool to assess primary outcomes in these studies, but other metrics to measure patient-reported outcomes should be systematically evaluated and quality indicators of surgical morbidity should be further assessed.

Purpose of review Pulmonary hypertension is a deadly disease, the causes of which vary between geographical regions. Eighty four percentage of the world's population lives in majority countries (also called low-income and middle-income countries), yet data on pulmonary hypertension in these settings are proportionally scarce. This article provides a review of pulmonary hypertension in majority countries, focusing in detail on the most common causes in these regions, and highlights contextual challenges faced. Recent findings Epidemiological data confirms a complex and overlapping array of causes, with pulmonary hypertension because of conditions such as rheumatic heart disease, HIV, schistosomiasis, chronic lung disease and sickle cell disease. Delayed pulmonary hypertension diagnosis remains a concern and is ascribed to a lack of resources and lack of pulmonary hypertension awareness by health professionals. Pulmonary hypertension diagnosis is frequently considered once signs of right heart failure emerge, while echocardiography and right heart catheterization are unavailable in many settings. Accurate data on the prevalence of pulmonary hypertension in many of these regions are needed and could be achieved by establishing and frequent review of national databases where the incident and prevalent pulmonary hypertension cases are captured. Summary There is urgent need for pulmonary hypertension advocacy among clinicians in the primary, secondary and tertiary healthcare sectors of majority countries, and validated noninvasive diagnostic algorithms are needed. Increased awareness and early diagnosis are likely to improve outcomes of pulmonary hypertension patients in these regions, and potentially stimulate locally relevant research.

BACKGROUND Australia has successfully controlled the COVID-19 pandemic. Similar to other high-income countries, Australia has extensively used telehealth services. Virtual health care, including telemedicine in combination with remote patient monitoring, has been implemented in certain settings as part of new models of care that are aimed at managing patients with COVID-19 outside the hospital setting. OBJECTIVE This study aimed to describe the implementation of and early experience with virtual health care for community management of patients with COVID-19. METHODS This observational cohort study was conducted with patients with COVID-19 who availed of a large Australian metropolitan health service with an established virtual health care program capable of monitoring patients remotely. We included patients with COVID-19 who received the health service, could self-isolate safely, did not require immediate admission to an in-patient setting, had no major active comorbid illness, and could be managed at home or at other suitable sites. Skin temperature, pulse rate, and blood oxygen saturation were remotely monitored. The primary outcome measures were care escalation rates, including emergency department presentation, and hospital admission. RESULTS During March 11-29, 2020, a total of 162 of 173 (93.6%) patients with COVID-19 (median age 38 years, range 11-79 years), who were diagnosed locally, were enrolled in the virtual health care program. For 62 of 162 (38.3%) patients discharged during this period, the median length of stay was 8 (range 1-17) days. The peak of 100 prevalent patients equated to approximately 25 patients per registered nurse per shift. Patients were contacted a median of 16 (range 1-30) times during this period. Video consultations (n=1902, 66.3%) comprised most of the patient contacts, and 132 (81.5%) patients were monitored remotely. Care escalation rates were low, with an ambulance attendance rate of 3% (n=5), emergency department attendance rate of 2.5% (n=4), and hospital admission rate of 1.9% (n=3). No deaths were recorded. CONCLUSIONS Community-based virtual health care is safe for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian setting for pandemic management. Health services implementing virtual health care should anticipate challenges associated with rapid technology deployments and provide adequate support to resolve them, including strategies to support the use of health information technologies among consumers.

The author evokes the ways in which art, beauty, community life and justice were threaded through her English childhood, and how they have shaped her theology and how she ‘got to’ God. She concludes by relating this autobiographical element to the work of two early twentieth-century Anglican theologians: Percy Dearmer and Kenneth E. Kirk.

This article looks at the ways in which the Panacea Society – a heterodox, millenarian group based in Bedford during the inter-war years – spread its ideas: through personal, familial and shared belief networks across the British empire; by building new modes of attracting adherents, in particular a global healing ministry; and by shipping its publications widely. It then examines how the society appealed to its (white) members in the empire in three ways: through its theology, which put Britain at the centre of the world; by presuming the necessity and existence of a ‘Greater Britain’ and the British empire, while in so many other quarters these entities were being questioned in the wake of World War I; and by a deliberately cultivated and nostalgic notion of ‘Englishness’. The Panacea Society continued and developed the idea of the British empire as providential at a time when the idea no longer held currency in most circles. The article draws on the rich resource of letters in the Panacea Society archive to contribute to an emerging area of scholarship on migrants’ experience in the early twentieth-century British empire (especially the dominions) and their sense of identity, in this case both religious and British.

Kenneth E. Kirk is regarded as the person who revived moral theology in the Anglican tradition in the early to mid-twentieth century. This article argues that a renewal of interest in mysticism, led especially by W.R. Inge and Evelyn Underhill in the first two decades of the twentieth century, was influential upon Kirk’s outlook, especially his association of moral theology with ascetic theology (or mystical theology), and linking of personal holiness with ethics. Kirk made prayer – especially contemplative prayer – and worship primary in the education of the soul, the forging of Christian character and therefore the creation of a moral agent.

Purpose Junior doctors rotating through psychiatry often practise in isolated environments with little prior experience in this field. This can cause anxiety amongst doctors, and may potentially lead to patient safety concerns. The paper aims to discuss these issues. Design/methodology/approach A novel peer-led simulation style teaching session was developed to improve junior doctor knowledge and confidence when working with psychiatry rotations out of hours. Findings Following successful completion of two iterations of the teaching, junior doctors reported increased confidence, reduced anxiety and a more positive attitude following the session. Facilitators were similarly positive in their feedback, being able to gain formal teaching experience and appraisal. Originality/value A novel, inexpensive and easily replicable teaching session is introduced, which can improve junior doctors’ practice and experience when working in psychiatry settings out of hours.

There is a range of risk factors that can lead to peripheral intravenous (IV) cannula failure, and several failed cannulation attempts can result in the patient experiencing increased pain, discomfort and delays in receiving IV therapy. The Vessel Health and Preservation (VHP) framework is a tool that can be used to improve clinical decision-making and the patient experience in relation to vascular access and IV therapy. Use of the VHP framework can ensure the right vein and right vascular access device (VAD) is selected at the right time for each patient. This article describes how healthcare practitioners can use the VHP framework to support and enhance vein assessment and VAD selection. It outlines the various types of VAD available, focusing on short-term peripheral IV cannulae, which are the most commonly used devices. It also explores the potential benefits of implementing the VHP framework in clinical areas.

Peptide hormones are implicated in many important aspects of plant life and are usually synthesized as precursor proteins. In contrast to animals, data for plant peptide hormone maturation are scarce and the specificity of processing enzyme(s) is largely unknown. Here we tested a hypothesis that processing of prosystemin, a precursor of tomato (Solanum lycopersicum) wound hormone systemin, is performed by phytaspases, aspartate-specific proteases of the subtilase family. Following the purification of phytaspase from tomato leaves, two tomato phytaspase genes were identified, the cDNAs were cloned and the recombinant enzymes were obtained after transient expression in Nicotiana benthamiana. The newly identified tomato phytaspases hydrolyzed prosystemin at two aspartate residues flanking the systemin sequence. Site-directed mutagenesis of the phytaspase cleavage sites in prosystemin abrogated not only the phytaspase-mediated processing of the prohormone in vitro, but also the ability of prosystemin to trigger the systemic wound response in vivo. The data show that the prohormone prosystemin requires processing for signal biogenesis and biological activity. The identification of phytaspases as the proteases involved in prosystemin maturation provides insight into the mechanisms of wound signaling in tomato. Our data also suggest a novel role for cell death-related proteases in mediating defense signaling in plants.

In 1902, William James gave his Gifford Lectures in Edinburgh, entitled The Varieties of Religious Experience, in which he claimed that such experience was a part of human nature, and was necessarily the foundation of all institutional religion. His work has often been singled out as leading to an increasingly private and individualistic understanding of religion, but this paper places his work in a broader movement of the early twentieth century that heralded a revival of interest in religious experience and, especially, mysticism. It explores the work of two English writers, W.R. Inge and Evelyn Underhill, in relation to James, and argues that the revival of interest in mysticism was a significant response to the intellectual challenges to faith in modernity.