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As anthropogenic disturbances continue to drive habitat loss and range contractions, the maintenance of evolutionary processes will increasingly require targeting measures to the population level, even for common and widespread species. Doing so requires detailed knowledge of population genetic structure, both to identify populations of conservation need and value, as well as to evaluate suitability of potential donor populations. We conducted a range-wide analysis of the genetic structure of red foxes in the contiguous western U.S., including a federally endangered distinct population segment of the Sierra Nevada subspecies, with the objectives of contextualizing field observations of relative scarcity in the Pacific mountains and increasing abundance in the cold desert basins of the Intermountain West. Using 31 autosomal microsatellites, along with mitochondrial and Y-chromosome markers, we found that populations of the Pacific mountains were isolated from one another and genetically depauperate (e.g., estimated Ne range = 3-9). In contrast, red foxes in the Intermountain regions showed relatively high connectivity and genetic diversity. Although most Intermountain red foxes carried indigenous western matrilines (78%) and patrilines (85%), the presence of nonindigenous haplotypes at lower elevations indicated admixture with fur-farm foxes and possibly expanding midcontinent populations as well. Our findings suggest that some Pacific mountain populations could likely benefit from increased connectivity (i.e., genetic rescue) but that nonnative admixture makes expanding populations in the Intermountain basins a non-ideal source. However, our results also suggest contact between Pacific mountain and Intermountain basin populations is likely to increase regardless, warranting consideration of risks and benefits of proactive measures to mitigate against unwanted effects of Intermountain gene flow.

Aims Shared decision-making is recommended for patients considering treatment options for severe aortic stenosis (AS) and chronic coronary artery disease (CAD). This review aims to systematically identify and assess patient decision aids (PtDAs) for chronic CAD and AS and evaluate the international evidence on their effectiveness for improving the quality of decision-making. Methods and results Five databases (Cochrane, CINAHL, Embase, MEDLINE, and PsycInfo), clinical trial registers, and 30 PtDA repositories/websites were searched from 2006 to March 2023. Screening, data extraction, and quality assessments were completed independently by multiple reviewers. Meta-analyses were conducted using Stata statistical software. Eleven AS and 10 CAD PtDAs were identified; seven were less than 5 years old. Over half of the PtDAs were web based and the remainder paper based. One AS and two CAD PtDAs fully/partially achieved international PtDA quality criteria. Ten studies were included in the review; four reported on the development/evaluation of AS PtDAs and six on CAD PtDAs. Most studies were conducted in the USA with White, well-educated, English-speaking participants. No studies fulfilled all quality criteria for reporting PtDA development and evaluation. Meta-analyses found that PtDAs significantly increased patient knowledge compared with 'usual care' (mean difference: 0.620; 95% confidence interval 0.396–0.845, P < 0.001) but did not change decisional conflict. Conclusion Patients who use PtDAs when considering treatments for AS or chronic CAD are likely to be better informed than those who do not. Existing PtDAs may not meet the needs of people with low health literacy levels as they are rarely involved in their development. Registration PROSPERO: CRD42021264700. [ABSTRACT FROM AUTHOR]

Background: Patients who sustain a hip fracture whilst taking direct oral anticoagulants (DOACs) experience delays to surgery, which can increase morbidity and mortality. Achievement of the prompt surgery aspect of the National Hip Fracture Database (NHFD) best practice tariff (BPT) stipulates surgery within 36 h, which these patients often fail to meet. Patients and methods: Our protocol for expedited hip fracture surgery in patients taking DOACs was implemented. We compared surgery within 36 h (primary outcome) and peri-operative blood transfusions, 30-day mortality, wound leakage, return to theatre and length of hospital stay (secondary outcomes) with standard care of 80 matched non-anticoagulated controls. Results: Median times to theatre were 26.0 h (IQR 16.2 h) in DOAC patients and 22.4 h (IQR 16.9 h) in controls: bootstrapped 95% CI for the difference (−0.935, 7.52). Bias-corrected related samples bootstrapped t -test revealed no evidence for a group difference on the primary outcome (p = 0.133) or any secondary outcome, including post-operative transfusions (χ2(1) = 0.533; p = 0.465, 95% CI for the difference −18.3% to 8.37%); death within 30 days (χ2(1) = 0.667; p = 0.414, 95% CI for the difference −3.48% to 8.48%); wound leakage (χ2(1) = 0.571; p = 0.450, 95% CI −1.79% to 0.792%); return to theatre (χ2(1) = 0.00; p = 1.00); and median length of hospital stay (p = 0.678, bias-corrected bootstrapped 95% CI for the difference −4.47 to 6.68). Discussion: Our protocol is simple, does not require plasma DOAC level testing and can be used to achieve the NHFD recommendation of surgery within 36 h without increasing peri-operative transfusions, wound leakage, return to theatre, length of stay or mortality. [ABSTRACT FROM AUTHOR]

The Aim of this study was to examine the attitudes of mental health service users towards spirituality and spiritually competent practice. A validated quantitative questionnaire was designed to elicit the perceptions of spirituality and spiritually competent practice. Participants were invited to participate in the study via social media. Standard statistical procedures, including reliability analyses, were applied. Respondents who viewed spirituality as distinct from religion were likely to place a higher value on Spirituality in Everyday Life. Those who had experienced the integration of spirituality within services they had received also placed a higher value on the place of Spirituality in Practice. The relationship between these measures and the distinction between religion and spirituality and how far spirituality had been integrated in services received and reasons for these associations are discussed in the light of the importance of spiritual care as a part of person-centred care. The evaluation by service users, of the concept of spiritually competent practice and the need for spiritual competencies in mental health staff were the most positive of all the findings. [ABSTRACT FROM AUTHOR]

The study aimed to evaluate the effect of an intervention on the prevalence and severity of incontinence‐associated dermatitis (IAD) in six hospitals in one state in Australia. This quasi‐experimental pre‐and post‐study, conducted in 18 wards, was part of a larger implementation science study on incontinence‐associated dermatitis. Skin and incontinence assessments were conducted on patients during February and March 2020 (pre‐intervention) and July and August 2021 (post‐intervention). The intervention comprised continence assessment and management, an education brochure for patients, family and caregivers on IAD, the Ghent Global IAD Categorisation Tool (GLOBIAD) and a skin care regime with patient skin protection measures (three‐in‐one barrier cream cloths, minimisation of bed protection layers, use of appropriate continence aid). A total of 1897 patients were assessed (pre‐intervention = 964, post‐intervention = 933). A total of 343 (35.6%) pre‐intervention patients and 351 (37.6%) post‐intervention patients had incontinence. The prevalence of hospital‐acquired IAD was 6.71% in the pre‐intervention group and 4.27% in the post‐intervention group; a reduction of 36.3% (p = 0.159) despite higher patient acuity, prevalence of double incontinence and the COVID‐19 pandemic in the post‐intervention group compared with the pre‐intervention group. Our multisite best practice IAD prevention and treatment intervention was able to reduce the prevalence and severity of hospital‐acquired IAD, suggesting enduring effectiveness of the intervention. [ABSTRACT FROM AUTHOR]