Evolutionary Relationships and Range Evolution of Greenhood Orchids (Subtribe Pterostylidinae): Insights From Plastid Phylogenomics

Australia harbours a rich and highly endemic orchid flora with over 90% of native species found nowhere else. However, little is known about the assembly and evolution of Australia's orchid flora. Here, we used a phylogenomic approach to infer evolutionary relationships, divergence times and range evolution in Pterostylidinae (Orchidoideae), the second largest subtribe in the Australian orchid flora, comprising the genera Pterostylis and Achlydosa. Phylogenetic analysis of 75 plastid genes provided well-resolved and supported phylogenies. Intrageneric relationships in Pterostylis were clarified and monophyly of eight of 10 sections supported. Achlydosa was found to not form part of Pterostylidinae and instead merits recognition at subtribal level, as Achlydosinae. Pterostylidinae were inferred to have originated in eastern Australia in the early Oligocene, coinciding with the complete separation of Australia from Antarctica and the onset of the Antarctic Circumpolar Current, which led to profound changes in the world's climate. Divergence of all major lineages occurred during the Miocene, accompanied by increased aridification and seasonality of the Australian continent, resulting in strong vegetational changes from rainforest to more open sclerophyllous vegetation. The majority of extant species were inferred to have originated in the Quaternary, from the Pleistocene onwards. The rapid climatic oscillations during the Pleistocene may have acted as important driver of speciation in Pterostylidinae. The subtribe underwent lineage diversification mainly within its ancestral range, in eastern Australia. Long-distance dispersals to southwest Australia commenced from the late Miocene onwards, after the establishment of the Nullarbor Plain, which constitutes a strong edaphic barrier to mesic plants. Range expansions from the mesic into the arid zone of eastern Australia (Eremaean region) commenced from the early Pleistocene onwards. Extant distributions of Pterostylidinae in other Australasian regions, such as New Zealand and New Caledonia, are of more recent origin, resulting from long-distance dispersals from the Pliocene onwards. Temperate eastern Australia was identified as key source area for dispersals to other Australasian regions.

Barriers and Challenges in Performing Pharmacokinetic Studies to Inform Dosing in the Neonatal Population

A number of barriers and challenges must be overcome in order to conduct the pharmacokinetic studies that are urgently needed to inform the selection and dosing of medication in neonates. However, overcoming these barriers can be difficult. This review outlines the common barriers researchers are confronted with, including issues with ethics approval and consent, study design for pharmacokinetic studies and the ability to measure the drug concentrations in the blood samples obtained. Strategies to overcome these challenges are also proposed.

The effectiveness of the Older prisoner Health and Social Care Assessment and Plan (OHSCAP): a randomised controlled trial

Background

Older people are the fastest-growing group in prisons in England and Wales and have complex health and social care needs that often remain unmet.

Objectives

(1) Evaluate the efficacy of the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) in improving (i) the ability to meet older male prisoners’ health and social care needs, (ii) health-related quality of life (HRQoL), (iii) depressive symptoms and (iv) functional health and well-being and activities of daily living; (2) assess the quality of care plans produced; (3) explore the experiences of older prisoners receiving, and staff conducting, the OHSCAP; and (4) evaluate the cost-effectiveness of the OHSCAP compared with treatment as usual (TAU).

Design

Multicentre, parallel-group randomised controlled trial (RCT) with follow-up at 3 months, with a nested qualitative study and quality audit of care plans (n = 150, 68%).

Setting

Ten English prisons.

Participants

Four hundred and ninety-seven newly arrived male prisoners aged ≥ 50 years with a discharge date at least 3 months from recruitment. A total of 14 prisoners and 11 staff participated in qualitative interviews.

Intervention

Randomisation to OHSCAP or TAU. The OHSCAP group had health and social needs assessed by a trained health-care worker or prison officer. Care plans were devised and subsequent actions included professional support and appropriate referrals.

Main outcome measures

Primary outcome measure – mean number of unmet health and social care needs as measured by the Camberwell Assessment of Need – Short Forensic Version. Secondary outcome measures – measures of functional health and well-being, depressive symptoms and HRQoL. A health economic evaluation was undertaken using service contact between baseline and follow-up and appropriate unit cost information.

Results

A total of 497 prisoners were recruited (248 to OHSCAP and 249 to TAU). The 404 completed follow-ups were split evenly between the trial arms. No significant differences were observed between the intervention and TAU groups in relation to the primary outcome measure. The OHSCAP did not demonstrate convincing benefits in HRQoL over TAU, and there were no significant differences in relation to costs. Audit and qualitative data suggest that the intervention was not implemented as planned.

Limitations

As a result of the limited follow-up period, potential long-term gains of the intervention were not measured. Some of the standardised tools had limited applicability in prison settings. Cost-effectiveness data were limited by unavailability of relevant unit cost data.

Conclusions

The OHSCAP failed in its primary objective but, fundamentally, was not implemented as planned. This appears to have been attributable, in some part, to wider difficulties currently affecting the prison landscape, including reduced levels of staffing, the loss of specialist support roles for such initiatives and increased prevalence of regime disruption.

Future work

Partnership working and information sharing across disciplines within prison settings require improvement. Research should explore the potential involvement of other prisoners and third-sector organisations in identifying and addressing older prisoners’ health and social care needs to better match community provision. Further examination should be undertaken of how the prison regime and system affects the well-being of older prisoners. Future prison-based RCTs should carefully balance the fidelity of initiatives being evaluated and testing in a ‘real-life’ setting.

Trial registration

Current Controlled Trials ISRCTN11841493.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 5, No. 31. See the NIHR Journals Library website for further project information.