The emergence of custodial health nursing as a specialty whose time has come: An Australian experience

BACKGROUND

Nurses provide healthcare in prisons worldwide. Working within security restraints, in environments not designed for nursing care, custodial health nurses (CHNs) use specialist nursing skills and knowledge to do essential work. Rapid increases in prisoner age, infirmity and ill-health of prisoners mandate their access to these nurses.

AIM

To raise awareness of the CHNs struggle for specialty status within the nursing profession, public health frameworks and prisons.

SOURCES OF EVIDENCE

Publicly available information is organised and analysed through the author's lens of 20 years working in the Australian prison system as a general nurse and nurse practitioner.

DISCUSSION

CHNs efforts towards becoming a specialty within nursing, public health and prisons are ongoing. Overcoming barriers and maximising facilitators to effective CHN practice would be indicators of successful incorporation of nursing models that assist prisoner patients. Prison healthcare contexts are unique regarding prisoner health and funding that impacts the CHNs resourcing, their scope of practice and acceptance of nursing in prison systems and the broader healthcare sectors.

CONCLUSION

Greater visibility of the CHNs will help promote policy reforms regarding nursing services within a changing prisoner demographic. Changes to educational and professional support for CHNs are needed. Policy restrictions on funding for CHN models in Australia fall short of international standards for prison healthcare; however, political and organisational commitment in this area will be necessary to attain community-equivalent healthcare standards across the custodial setting.

IMPLICATIONS FOR NURSING AND OTHER POLICIES

Professional structures, competencies and specialty policy frameworks are required to promote CHNs as advocates for prisoners needing care and their professional development. CHNs at the forefront of policy development and review will benefit all stakeholders in custodial health.

Links to rare climates do not translate into distinct traits for island endemics

Current models of island biogeography treat endemic and non-endemic species as if they were functionally equivalent, focussing primarily on species richness. Thus, the functional composition of island biotas in relation to island biogeographical variables remains largely unknown. Using plant trait data (plant height, leaf area and flower length) for 895 native species in the Canary Islands, we related functional trait distinctiveness and climate rarity for endemic and non-endemic species and island ages. Endemics showed a link to climatically rare conditions that is consistent with island geological change through time. However, functional trait distinctiveness did not differ between endemics and non-endemics and remained constant with island age. Thus, there is no obvious link between trait distinctiveness and occupancy of rare climates, at least for the traits measured here, suggesting that treating endemic and non-endemic species as functionally equivalent in island biogeography is not fundamentally wrong.

Division of Labour and Parental Mental Health and Relationship Well-Being during COVID-19 Pandemic-Mandated Homeschooling

While the COVID-19 pandemic has impacted the way parents partition tasks between one another, it is not clear how these division of labour arrangements affect well-being. Pre-pandemic research offers two hypotheses: economic theory argues optimal outcomes result from partners specialising in different tasks, whereas psychological theory argues for a more equitable division of labour. The question of which approach optimizes well-being is more pressing in recent times, with COVID-19 school closures leaving many couples with the burden of homeschooling. It is unknown whether specialisation or equity confer more benefits for mandated homeschoolers, relative to non-homeschoolers or voluntary homeschoolers. Couples (n = 962) with children in grades 1-5 completed measures of workload division and parental well-being. A linear mixed modelling in the total sample revealed that specialisation, but not equity, promoted increased parental emotional and relationship well-being. These relations were moderated by schooling status: voluntary homeschoolers' well-being benefitted from specialisation, whereas mandated homeschoolers' well-being did not benefit from either strategy; non-homeschoolers well-being benefitted from both strategies. Across the mixed-gender couples, mothers' and fathers' well-being both benefitted from specialisation; equity was only beneficial for mothers' well-being. Overall, couples might be advised to adopt highly equitable and specialised arrangements to promote both parents' well-being.

(2022)

Luna et al. (2022) concluded that the environment contributes to explaining specialisation in open plant-pollinator networks. When reproducing their study, we instead found that network size alone largely explained the variation in their specialisation metrics. Thus, we question whether empirical network specialisation is driven by the environment.

Losing out to improve group fitness

A mathematical model provides clues as to why members of a group divide tasks between them even when specialisation reduces the performance of individuals.

Work situation and prospects of recently graduated dentists in the Netherlands

INTRODUCTION

Dentists who have graduated recently from a Dutch dental school work mainly in the Netherlands, where collaboration and differentiation are relevant factors. Furthermore, the Netherlands face regional undersupplies of dentists. The objective of this study was to describe choices and aims of recently graduated dentists for the near future.

MATERIALS AND METHODS

An invitation for the web questionnaire was sent by e-mail to 945 dentists who had graduated from a Dutch dental school between 2013 and 2017, of whom 230 (24.3%) participated in the survey.

RESULTS

Approximately three quarters (77%) of the recently graduated dentists worked as a general dentist in a practice of some else, primarily in urban areas. The choice for a practice was affected by location, earnings, and the opportunity to gain experience. Furthermore, the career choices were affected most by the desired length of the working week and financial security. The narrow majority (53%) of the recently graduated dentists believed that in 5 years they will be practice owner; 49% expected to be a differentiated dentist. Furthermore, 41% believed they will work in a smaller municipality.

DISCUSSION

Although recently graduated dentists seem receptive to work in smaller municipalities, the peripheral regions are conceivably less appealing. Practice ownership conceivably is an option for the near future for a narrow majority of the recently graduated dentists.

CONCLUSION

Recently graduated dentists have different preferences regarding their work situation in 5 years.

The evolution of division of labour in structured and unstructured groups

Recent theory has overturned the assumption that accelerating returns from individual specialisation are required to favour the evolution of division of labour. Yanni et al., 2020, showed that topologically constrained groups, where cells cooperate with only direct neighbours such as for filaments or branching growths, can evolve a reproductive division of labour even with diminishing returns from individual specialisation. We develop a conceptual framework and specific models to investigate the factors that can favour the initial evolution of reproductive division of labour. We find that selection for division of labour in topologically constrained groups: (1) is not a single mechanism to favour division of labour-depending upon details of the group structure, division of labour can be favoured for different reasons; (2) always involves an efficiency benefit at the level of group fitness; and (3) requires a mechanism of coordination to determine which individuals perform which tasks. Given that such coordination must evolve prior to or concurrently with division of labour, this could limit the extent to which topological constraints favoured the initial evolution of division of labour. We conclude by suggesting experimental designs that could determine why division of labour is favoured in the natural world.

Morphological trait-matching in plant-Hymenoptera and plant-Diptera mutualisms across an elevational gradient

Morphological trait-matching and species abundance are thought to be the main factors affecting the frequency and strength of mutualistic interactions. However, the relative importance of trait-matching and species abundance in shaping species interactions across environmental gradients remains poorly understood, especially for plant-insect mutualisms involving generalist species. Here, we characterised variation in species and trait composition and the relative importance of trait-matching and species abundance in shaping plant-Hymenoptera and plant-Diptera mutualisms in four meadows across an elevational gradient (2,725-3,910 m) in Yulong Snow Mountain, Southwest China. We also evaluated the effects of morphological traits of flower visitors and plant composition on their foraging specialisation (d' and normalised degree). There was a high degree of dissimilarity in the composition of Hymenoptera and Diptera visitors and their visited plants between communities. This variation was mainly driven by the spatial replacement of species. Both for plant-Hymenoptera and plant-Diptera networks, trait-matching between nectar tube depth and proboscis length was a stronger predictor of the interactions between temporally co-occurring plants and flower visitors than species abundance. Fourth-corner analyses revealed statistically significant trait-matching between nectar tube depth and proboscis length in plant-Hymenoptera networks at all sites, suggesting that Hymenoptera consistently foraged on plant species with nectar tube depths matching their proboscis lengths. By contrast, significant trait-matching in plant-Diptera networks was only observed at the two lower elevation sites. The species-level specialisation d' of flower visitors increased significantly as the proboscis length and the difference in nectar tube depth between the plant community and the plants visited by flower visitors increased. Our results highlight that the importance of trait-matching in shaping pairwise interactions and niche partitioning depends on the specific features (e.g. species composition and trait availability) of the plant-pollinator system. For specialised plant-Hymenoptera systems, trait-matching is an important determinant of species interactions, whereas for generalist plant-Diptera systems, trait-matching is relatively unimportant.

Joint species distributions reveal the combined effects of host plants, abiotic factors and species competition as drivers of species abundances in fruit flies

The relative importance of ecological factors and species interactions for shaping species distributions is still debated. The realised niches of eight sympatric tephritid fruit flies were inferred from field abundance data using joint species distribution modelling and network inference, on the whole community and separately on three host plant groups. These estimates were then confronted the fundamental niches of seven fly species estimated through laboratory-measured fitnesses on host plants. Species abundances depended on host plants, followed by climatic factors, with a dose of competition between species sharing host plants. The relative importance of these factors mildly changed among the three host plant groups. Despite overlapping fundamental niches, specialists and generalists had almost distinct realised niches, with possible competitive exclusion of generalists by specialists on Cucurbitaceae. They had different assembly rules: Specialists were mainly influenced by their adaptation to host plants, while generalist abundances varied regardless of their fundamental host use.

Premature Professionalisation or Early Engagement? Examining Practise in Football Player Pathways

There is a growing debate, both in the academic and sporting worlds, about the most appropriate pathway for high potential young players in sport. In this regard, there has been a considerable focus on the age of selection into structured talent development pathways and the nature of the experience once players have been recruited. Given the economic and reputational currency associated with developing professional footballers in particular, it is unsurprising that professional football clubs continue to invest significant financial resources into their academy structures. Understandably, this recruitment policy has attracted substantial attention within the media and research community, with ethical concerns arising surrounding the impact early selection may have on the welfare and the experiences of the young players within the pathway. The aim of this perspective article was to critically consider the research underpinning the early engagement practises of football clubs and the extent to which, and how, the pathway can provide players with the most appropriate starting point for their development. This evidence points to the need to look beyond the prevalent 'early specialisation vs. diversification' debate in youth sport towards a consideration of an early engagement perspective that reflects the biopsychosocial influences on talent development and the socio-political environment that influences decisions. We provide practical recommendations focused on the quality of the early engagement experience.

Specialised training in paediatric anaesthesia: Need of the hour

Paediatric anaesthesia is an upcoming speciality which is gaining wide interest and can be a career choice for the new trainees. The need to develop paediatric anaesthesia as a speciality was realised with the progress in the field of paediatric surgery. The profile of the 'patient' encountered by a paediatric anaesthesiologist spans from an extremely premature neonate on the fringes of survival, to a full-grown adolescent equivalent to an adult. Perioperative morbidity and mortality are 2-3 times higher in infants and neonates compared to adults particularly in middle and low-income countries. The anatomical, physiological, pharmacological variations and presence of congenital cardiac, pulmonary and metabolic diseases in young children make perioperative management challenging. Special expertise and training are required for anaesthetic management of these preverbal children. In India, 3-years DM and 1-year Fellowship courses in paediatric anaesthesia are now available for specialisation. An ideal paediatric anaesthesia training centre should have substantial paediatric and neonatal patient load with exclusive intensive care facility. Paediatric anaesthesiologists, having knowledge of several facets of paediatrics and anaesthesia are capable of coordinating with health care professionals performing procedures outside the operating room. Paediatric anaesthesia, as a career thus offers a great opportunity to enhance quality and safety of anaesthesia in this high-risk surgical population. Persistent coordinated team efforts improve patient outcomes, reduce stress at work and increase job satisfaction.

Onco-Anaesthesiology and palliative medicine: Opportunities and challenges

Global cancer burden is on the rise and many more patients present for surgery or other oncological diagnostic or therapeutic interventions requiring anaesthesia. Oncology therapy is unique as it requires a multidisciplinary team of surgical, medical and radiation oncologists apart from palliative medicine (PM) specialists, and anaesthesiologists. Anaesthetic management can affect the outcome of oncology treatment both by ensuring early return to oncology treatment and some anaesthetic techniques being innately associated with recurrence. Hence, the time has come for a separate super-speciality of onco-anaesthesiology to cater to the complex unmet needs of cancer patients. PM is the fourth dimension of oncology care and so mandatory education and training should be included in the undergraduate curriculum.

A global survey on trends in advanced practice and specialisation in the pharmacy workforce

OBJECTIVES

Despite the increasingly complex care and demanding health challenges shaping pharmacy, little work has been carried out to understand the global status of advanced and/or specialised pharmacy practice scopes and the models in which they exist. This study aims to describe the current global status of initiatives relating to advancement of pharmacy practice.

METHODS

A global survey was conducted between January and May 2015 to collect country-level data from member organisations of the International Pharmaceutical Federation (FIP), and national-level contacts from regulatory, professional and government agencies or universities; data requests were sent to 109 countries. The collected data were triangulated (comparing multiple sources from single countries, e.g.), cleaned and analysed by descriptive and comparative statistics.

KEY FINDINGS

Full data sets from 48 countries and territories were obtained. The findings demonstrate varying systems of advanced pharmacy practice and specialisation often linked to income level. The study found that there are variations within terminology and definitions, frameworks for specialisation and advanced practice, professional recognition mechanisms and benefits across countries.

CONCLUSIONS

This survey of 48 countries and territories was the first of its kind to describe the range of specialisation and professional recognition systems for advanced pharmacy practice worldwide. Despite the variance, it is clear from this global study that professional advancement and the recognition of advancement in practice are developing around the world and this could be due to the increasingly complex nature of pharmaceutical care delivery and a consequent need to be able to endorse professional capabilities.

The 'Dog Doctors' of Edwardian London: Elite Canine Veterinary Care in the Early Twentieth Century

This article offers the first historical account of Edwardian London's elite canine veterinarians. Previous historiography identifies increasing veterinary interest in dogs as a mid-twentieth century phenomenon. Despite tension with the mainstream profession, however, an earlier group of specialist veterinarians provided sophisticated canine medical care to London society. Their activities included the policing and investigation of two key threats to the fashionable and lucrative 'dog fancy': the devastating infectious disease distemper and the issue of 'faking' (show ring cosmetic fraud). This prestigious work gave the canine veterinarians a competitive advantage over their various rivals and enabled the dog fancy to combat the unintended consequences of its own practices on the canine body. This article consequently reveals an early instance of veterinary specialisation, co-driven by client demands and professional politics, and foregrounds the importance of canine biology in the social history of pedigree dog breeding.

Trait matching and phenological overlap increase the spatio-temporal stability and functionality of plant-pollinator interactions

Morphology and phenology influence plant-pollinator network structure, but whether they generate more stable pairwise interactions with higher pollination success remains unknown. Here we evaluate the importance of morphological trait matching, phenological overlap and specialisation for the spatio-temporal stability (measured as variability) of plant-pollinator interactions and for pollination success, while controlling for species' abundance. To this end, we combined a 6-year plant-pollinator interaction dataset, with information on species traits, phenologies, specialisation, abundance and pollination success, into structural equation models. Interactions among abundant plants and pollinators with well-matched traits and phenologies formed the stable and functional backbone of the pollination network, whereas poorly matched interactions were variable in time and had lower pollination success. We conclude that phenological overlap could be more useful for predicting changes in species interactions than species abundances, and that non-random extinction of species with well-matched traits could decrease the stability of interactions within communities and reduce their functioning.

Overview of paediatric urology practice in lagos state university teaching hospital, Ikeja, Lagos, Nigeria

INTRODUCTION

Paediatric urology is one of the subspecialities of urology, and in most climes, it is practised by the urologists and paediatric surgeons, and likewise in the Lagos State University Teaching Hospital (LASUTH). The urologists see and manage most of these cases in LASUTH. There has been no formal training in this subspeciality. However, both the urologists and paediatric surgeons in LASUTH have acquired some measure of skill and experience over time by virtue of the relatively high volume of the cases seen. This study is aimed at reviewing the practice of paediatric urology in the urology division of LASUTH and to advocate for formal training in an otherwise rare but direly needed subspeciality.

PATIENTS AND METHODS

The ports of entry of paediatric patients with urologic conditions were assessed retrospectively over a 5-year period (2014-2018). The paediatric age range based on the Lagos State Government policy for health care is from birth to 12 years old. The ports of entry included the urologic outpatient department, paediatric and the adult surgical emergency units and the paediatric wards. Patients referred to and managed by the paediatric surgery division were excluded from this study.

RESULTS

The total paediatric urology cases seen and managed by the urologist in LASUTH within the period of review were 421. A total of 363 paediatric urology cases were seen during the period under review, making up 7.96% of the urology cases seen at the surgical outpatient department. The most common cases managed were hypospadias, posterior urethral valves and hydronephrosis. A variety of other cases include priapism, circumcision and post-circumcision injuries, urethral prolapse, testicular torsion, cystic renal dysplasia, disorder of sexual differentiation and several others. Three hundred and seven surgical procedures were done in the period of review on 272 (64.6%) patients.

CONCLUSION

There is a need for subspecialisation in paediatric urology to harness more specialists with a specific focus, training and interest in children and their urological conditions.

Trends in advanced practice and specialisation in the global pharmacy workforce: a synthesis of country case studies

OBJECTIVES

This study aims to gain a better understanding of the drivers and barriers to the development of advanced practice and specialised systems around the world. Through the synthesis of in-depth country case studies, this paper aims to identify current models of advanced practice and specialisation in pharmacy and illustrate trends, drivers and barriers in policy development. This is the first analysis of its kind to examine pharmacy specialisation and advanced practice in this depth from a global perspective.

METHODS

A synthesis of country case studies was carried out. The country case study template was reviewed and approved by an expert working group drawn from a cross section of International Pharmaceutical Federations (FIP) experts and special-interest groups. FIP member organisations and country-level contacts from regulatory, professional and government agencies and universities were approached to contribute to the case study database. The data were collected between January and May 2015. Descriptive comparative analysis and qualitative thematic analysis were both used to analyse the data.

KEY FINDINGS

Case study submissions were received from 17 countries. The findings demonstrate that the pace and depth of change in advanced practice and specialisation are occurring at different rates across countries and regions, although many countries appear to be moving towards recognising advanced and specialised practice of pharmacists and developing frameworks and/or formalised recognition systems.

CONCLUSIONS

Country-specific examples are useful in identifying factors that may contribute to the rate at which developments in advanced practice and specialisation in pharmacy are taking place and enable progress in around the world.

A specialised pollination system using nectar-seeking thynnine wasps in Caladenia nobilis (Orchidaceae)

Caladenia is a diverse Australian genus that is exceptional among orchids in having both species pollinated by food-seeking and sexually deceived insects. Here, we investigated the pollination of Caladenia nobilis, a species predicted to be food-deceptive due to its large, cream-coloured and apparently nectarless flowers. Pollinator observations were made using experimental clumps of flowers. Measurements of floral colour were undertaken with a spectrometer, nectar was tested using GC-MS, and reproductive success was quantified for 2 years. While C. nobilis attracted nine species of insect, only males of the thynnine wasp Rhagigaster discrepans exhibited the correct size and behaviour to remove and deposit pollen. Male R. discrepans attempted to feed from the surface of the labellum, often crawling to multiple flowers, but showed no evidence of sexual attraction. Most flowers produced little or no nectar, although some may provide enough sucrose to act as a meagre reward to pollinators. Floral colouration was similar to a related Caladenia species pollinated by sexual deception, although the sexually deceptive species had a dull-red labellum. Reproductive success was generally low and highly variable between sites and years. In addition to most visitors being of inappropriate size for pollinia removal, the lack of response to the orchid by several co-occurring species of thynnine wasp suggests filtering of potential pollinators at the attraction phase. Our discovery of a pollination strategy that may be intermediate between food deception and food reward raises the question, how many putatively rewardless orchids actually produce meagre amounts of nectar?

Pollination outcomes reveal negative density-dependence coupled with interspecific facilitation among plants

Pollination is thought to be under positive density-dependence, destabilising plant coexistence by conferring fitness disadvantages to rare species. Such disadvantage is exacerbated by interspecific competition but can be mitigated by facilitation and intraspecific competition. However, pollinator scarcity should enhance intraspecific plant competition and impose disadvantage on common over rare species (negative density-dependence, NDD). We assessed pollination proxies (visitation rate, pollen receipt, pollen tubes) in a generalised plant community and related them to conspecific and heterospecific density, expecting NDD and interspecific facilitation due to the natural pollinator scarcity. Contrary to usual expectations, all proxies indicated strong intraspecific competition for common plants. Moreover interspecific facilitation prevailed and was stronger for rare than for common plants. Both NDD and interspecific facilitation were modulated by specialisation, floral display and pollinator group. The combination of intraspecific competition and interspecific facilitation fosters plant coexistence, suggesting that pollination can be a niche axis maintaining plant diversity.

Relationship based care - how general practice developed and why it is undermined within contemporary healthcare systems

Objective: Investigating the state of generalism in medicine from the outlook of general practice. Line of argument: General practice developed when its pioneers, in continuing relationships, learnt to know their patients through the variety of medical situations. From the 50s, there is an increasing literature on the virtues and challenges of relationship based general practice, and register-based research indicate its benefits. Generalist perspectives and person-centeredness are implemented in specialised care and medical education but need to be complemented by an input from relationship based general practice. The politically defined aim of primary care is not to balance the draw-backs of specialisation, but to provide medicine at the primary care level. In Sweden, and increasingly even in traditional strongholds of general practice, team-based primary care is thought to respond to increasing demands, filtering out non- and minor disease through triage, practicing task distribution, and moving the GP to a secondary level working with the 'really sick', in all a decline in direct contact between patient and GP. Conclusions: When this happens, clinical medicine as a whole becomes drained of the practice of its human dimension. The lack of absolute proof of medical benefits cannot justify a disregard of the value of mutual knowledge and trust in the relationship, but still, in several countries, relationshipbased general practice will be hard to achieve for GPs planning their career. If the political winds should change, a sustaining profession of GPs preserving their relational ethos inside the team model, may be prepared to reform primary care. KEY POINTS Proclaiming both biomedical breadth and the trustful relationship between doctor and patient, as a specialty, general practice embodies medical generalism. A direct input from the patient's personal GP is necessary to make specialised care become more comprehensive and individualised. In reality, the team, practicing triage and task distribution, is increasingly replacing the doctor-patient relationship as working mode in primary care When the disease rather than the doctor-patient relationship, becomes the organising principle of primary care, medicine as a whole will be drained of the practice of its human dimension.

The same or different psychiatrists for in- and out-patient treatment? A multi-country natural experiment

AIMS

A core question in the debate about how to organise mental healthcare is whether in- and out-patient treatment should be provided by the same (personal continuity) or different psychiatrists (specialisation). The controversial debate drives costly organisational changes in several European countries, which have gone in opposing directions. The existing evidence is based on small and low-quality studies which tend to favour whatever the new experimental organisation is.We compared 1-year clinical outcomes of personal continuity and specialisation in routine care in a large scale study across five European countries.

METHODS

This is a 1-year prospective natural experiment conducted in Belgium, England, Germany, Italy and Poland. In all these countries, both personal continuity and specialisation exist in routine care. Eligible patients were admitted for psychiatric in-patient treatment (18 years of age), and clinically diagnosed with a psychotic, mood or anxiety/somatisation disorder.Outcomes were assessed 1 year after the index admission. The primary outcome was re-hospitalisation and analysed for the full sample and subgroups defined by country, and different socio-demographic and clinical criteria. Secondary outcomes were total number of inpatient days, involuntary re-admissions, adverse events and patients' social situation. Outcomes were compared through mixed regression models in intention-to-treat analyses. The study is registered (ISRCTN40256812).

RESULTS

We consecutively recruited 7302 patients; 6369 (87.2%) were followed-up. No statistically significant differences were found in re-hospitalisation, neither overall (adjusted percentages: 38.9% in personal continuity, 37.1% in specialisation; odds ratio = 1.08; confidence interval 0.94-1.25; p = 0.28) nor for any of the considered subgroups. There were no significant differences in any of the secondary outcomes.

CONCLUSIONS

Whether the same or different psychiatrists provide in- and out-patient treatment appears to have no substantial impact on patient outcomes over a 1-year period. Initiatives to improve long-term outcomes of psychiatric patients may focus on aspects other than the organisation of personal continuity v. specialisation.

Specialisation and diversity of multiple trophic groups are promoted by different forest features

While forest management strongly influences biodiversity, it remains unclear how the structural and compositional changes caused by management affect different community dimensions (e.g. richness, specialisation, abundance or completeness) and how this differs between taxa. We assessed the effects of nine forest features (representing stand structure, heterogeneity and tree composition) on thirteen above- and belowground trophic groups of plants, animals, fungi and bacteria in 150 temperate forest plots differing in their management type. Canopy cover decreased light resources, which increased community specialisation but reduced overall diversity and abundance. Features increasing resource types and diversifying microhabitats (admixing of oaks and conifers) were important and mostly affected richness. Belowground groups responded differently to those aboveground and had weaker responses to most forest features. Our results show that we need to consider forest features rather than broad management types and highlight the importance of considering several groups and community dimensions to better inform conservation.

Career choices for nephrology and factors influencing them: surveys of UK medical graduates

Objectives

To study early and eventual career choices for nephrology among UK medical graduates and investigate factors which influenced career preferences.

Design

Self-completed survey questionnaires mailed to medical graduates 1, 3, 5 and 10 years after graduation.

Setting

United Kingdom.

Participants

UK medical graduates in 15 year-of-qualification cohorts between 1974 and 2015.

Main outcome measures

Early career specialty choices, career specialty destinations at 10 years and ratings of factors affecting career choices.

Results

Around 0.4%–1.1% of these junior doctors expressed a career preference for nephrology, varying by year of qualification and years after qualification. Among all graduates of 1993–2002 combined, 0.4% expressed a career preference for nephrology 1 year after qualification rising to 1.0% in year 5. Among graduates of 2005–2008, the corresponding figures were 1.0% in year 1 falling to 0.7% in year 5. Only 18% of doctors who chose nephrology in year 1 eventually became nephrologists. Of doctors who were practising as nephrologists for 10 years and more after qualification, 74% of the women and 56% of the men had decided to pursue a career in nephrology by year 5 after qualification. ‘Enthusiasm/commitment’ had a great deal of influence on those who chose nephrology, for all cohorts and all years studied.

Conclusions

The most recent data suggest that the proportion of young doctors who sustain an interest in nephrology through the early postgraduate training years may be lower than among their predecessors. Efforts are needed to reverse the declining trend and increase interest in nephrology.

Generalisation and specialisation in hoverfly (Syrphidae) grassland pollen transport networks revealed by DNA metabarcoding

Pollination by insects is a key ecosystem service and important to wider ecosystem function. Most species-level pollination networks studied have a generalised structure, with plants having several potential pollinators, and pollinators in turn visiting a number of different plant species. This is in apparent contrast to a plant's need for efficient conspecific pollen transfer. The aim of this study was to investigate the structure of pollen transport networks at three levels of biological hierarchy: community, species and individual. We did this using hoverflies in the genus Eristalis, a key group of non-Hymenopteran pollinators. We constructed pollen transport networks using DNA metabarcoding to identify pollen. We captured hoverflies in conservation grasslands in west Wales, UK, removed external pollen loads, sequenced the pollen DNA on the Illumina MiSeq platform using the standard plant barcode rbcL, and matched sequences using a pre-existing plant DNA barcode reference library. We found that Eristalis hoverflies transport pollen from 65 plant taxa, more than previously appreciated. Networks were generalised at the site and species level, suggesting some degree of functional redundancy, and were more generalised in late summer compared to early summer. In contrast, pollen transport at the individual level showed some degree of specialisation. Hoverflies defined as "single-plant visitors" varied from 40% of those captured in early summer to 24% in late summer. Individual hoverflies became more generalised in late summer, possibly in response to an increase in floral resources. Rubus fruticosus agg. and Succisa pratensis were key plant species for hoverflies at our sites Our results contribute to resolving the apparent paradox of how generalised pollinator networks can provide efficient pollination to plant species. Generalised hoverfly pollen transport networks may result from a varied range of short-term specialised feeding bouts by individual insects. The generalisation and functional redundancy of Eristalis pollen transport networks may increase the stability of the pollination service they deliver.

Person or system - What leads to surgical advances?

To understand the relationship between standardisation and originality in surgery, the contributions of three surgeons in the 20th century are analysed. The individual Arbuthnot Lane, the collectivist Robert Jones and the scientist Alexis Carrel changed the practice of orthopaedic surgery. It is argued that the factors influencing innovation are not binary but multifactorial and that advances in surgery occur when individual freedom is permitted within a system. It is concluded that innovation and standardisation in orthopaedic surgery need not conflict with each other.

Intragroup competition predicts individual foraging specialisation in a group-living mammal

Individual foraging specialisation has important ecological implications, but its causes in group-living species are unclear. One of the major consequences of group living is increased intragroup competition for resources. Foraging theory predicts that with increased competition, individuals should add new prey items to their diet, widening their foraging niche ('optimal foraging hypothesis'). However, classic competition theory suggests the opposite: that increased competition leads to niche partitioning and greater individual foraging specialisation ('niche partitioning hypothesis'). We tested these opposing predictions in wild, group-living banded mongooses (Mungos mungo), using stable isotope analysis of banded mongoose whiskers to quantify individual and group foraging niche. Individual foraging niche size declined with increasing group size, despite all groups having a similar overall niche size. Our findings support the prediction that competition promotes niche partitioning within social groups and suggest that individual foraging specialisation may play an important role in the formation of stable social groupings.

"The Early Specialised Bird Catches the Worm!" - A Specialised Sampling Model in the Development of Football Talents

Characteristics of learning activities in early sport participation play a key role in the development of the sporting talent. Therefore, pathways of specialisation or diversification/sampling are as well debated as the implementation of practice- or play-oriented activities. The related issues are currently perceived as a two-dimensional construct of domain specificity and performance orientation. In this context, it has been shown that early specialisation, with experiences in practice and play, has led to Swiss junior national team football players reaching higher success levels as adults. This study aimed to examine whether a similar approach improves chances of even being selected for junior national teams from a broader sample. Hence, 294 youth players answered retrospective questionnaires on their early sport participation when entering the Swiss football talent development programme. Using the person-oriented Linking of Clusters after removal of a Residue (LICUR) method, volumes of in-club practice, free play and activities besides football until 12 years of age were analysed along with age at initial club participation. According to the results, clusters of Football enthusiasts (p = 0.01) with the most free play and above average in-club practice and Club players (p = 0.02) with the most in-club practice and average free play had a greater chance of reaching junior national team level. Thus, high levels of domain-specific activities seem to increase the chances of junior national team participation. Furthermore, the most successful constellation (Football enthusiasts) may illustrate the relevance of domain-specific diversity, induced by several types of practice and play. In line with previous studies, specialising in football and sampling different experiences within this specific domain seems to be the most promising pathway. Therefore, we argue that the optimal model for the development of football talents is a specialised sampling model.

Schizophrenia and Category-Selectivity in the Brain: Normal for Faces but Abnormal for Houses

Face processing is regularly found to be impaired in schizophrenia (SZ), thus suggesting that social malfunctioning might be caused by dysfunctional face processing. Most studies focused on emotional face processes, whereas non-emotional face processing received less attention. While current reports on abnormal face processing in SZ are mixed, examinations of non-emotional face processing compared to adequate control stimuli may clarify whether SZ is characterized by a face-processing deficit. Patients with SZ (n = 28) and healthy controls (n = 30) engaged in an fMRI scan where images of non-emotional faces and houses were presented. A simple inverted-picture detection task warranted the participants' attention. Region of interest (ROI) analyses were conducted on face-sensitive regions including the fusiform face area, the occipital face area, and the superior temporal sulcus. Scene-sensitivity was assessed in the parahippocampal place area (PPA) and served as control condition. Patients did not show aberrant face-related neural processes in face-sensitive regions. This finding was also evident when analyses were done on individually defined ROIs or on in-house-localizer ROIs. Patients revealed a decreased specificity toward house stimuli as reflected in decreased neural response toward houses in the PPA. Again, this result was supported by supplementary analyses. Neural activation toward neutral faces was not found to be impaired in SZ, therefore speaking against an overall face-processing deficit. Aberrant activation in scene-sensitive PPA is also found in assessments of memory processes in SZ. It is up to future studies to show how impairments in PPA relate to functional outcome in SZ.

Status of Geriatrics in 22 Countries

OBJECTIVES

The aim of this article is to describe the current status of geriatrics and position of geriatricians in 22 countries of three continents, and to portray their attitudes towards and resources allocated to geriatrics.

METHODS

An electronic survey was delivered to a convenience sample of 22 geriatricians in leading positions of their countries.

RESULTS

The time required in post graduation specialist training to become a geriatrician varied from one year (subspecialty in the USA) to six years (independent specialty in Belgium). The number in the population aged 80+ per geriatrician varied from 450 (Austria) to 25,000 (Turkey). Of respondents, 55% reported that geriatrics is not a popular specialty in their country. Acute geriatric wards, rehabilitation and outpatient clinics were the most common working places for geriatricians. Nearly half of the respondents had an opinion that older patients who were acutely ill, were receiving subacute rehabilitation or had dementia should be cared for by geriatricians whereas half of the respondents would place geriatricians also in charge of nursing home and orthogeriatric patients. The biggest problems affecting older people's clinical care in their countries were: lack of geriatric knowledge, lack of geriatricians, and attitudes towards older people. Half of respondents thought that older people's health promotion and comprehensive geriatric assessment were not well implemented in their countries, although a majority felt that they could promote good geriatric care in their present position as a geriatrician.

CONCLUSION

The position of geriatric, geriatricians' training and contents of work has wide international variety.

Final-Year Dental Undergraduate Attitudes towards Specialisation

The aim of this study was to explore the attitudes towards postgraduate specialisation of final-year students at one UK dental school and to identify any possible influencing factors. A cross-sectional survey of all 73 final-year students using an anonymous self-report questionnaire was carried out. The response rate was 79%, of which nearly two-thirds were female. Age, ethnicity and parental occupation did not have an effect on the intention to specialise, although student gender did, with more females not wishing to specialise (p = 0.006). Having a ‘talent in the field’ had the largest positive influence on pursuing a specialist career (37.9% of responses), whilst the length of time needed to obtain a specialist qualification was seen as the largest negative influence (41.1% of responses). The two most popular subjects were Restorative Dentistry and Orthodontics with 24.1% and 20.7% of students listing them as their first choices, respectively. Further research could be carried out to determine if the intentions of UK undergraduates to specialise will meet the increasing specialist oral health needs of the population and which could ultimately influence future dental workforce planning.

The evolution of host specialisation in avian brood parasites

Traditional ecological theory predicts that specialisation can promote speciation; hence, recently derived species are specialists. However, an alternative view is that new species have broad niches, which become narrower and specialised over time. Here, we test these hypotheses using avian brood parasites and three different measures of host specialisation. Brood parasites provide an ideal system in which to investigate the evolution of specialisation, because some exploit more than 40 host species and others specialise on only one. We find that young brood parasite species are smaller and specialise on a narrower range of host sizes, as expected, if specialisation is linked with the generation of new species. Moreover, we show that highly virulent parasites are more specialised, supporting findings in other host-parasite systems. Finally, we demonstrate that different measures of specialisation can lead to different conclusions, and specialisation indices should be designed taking into account the biology of each system.

Shifts from specialised to generalised pollination systems in Miconieae (Melastomataceae) and their relation with anther morphology and seed number

Most species in Melastomataceae have poricidal anthers related to specialised bee buzz-pollination, while some have anthers with large openings associated to non-bee pollination systems. We tracked the evolution of anther morphology and seed number on the Miconieae phylogenetic tree to understand the evolutionary shifts in such pollination systems. Anther morphometric data and seed number were recorded for 54 taxa. Pollinators (bees, flies, wasps) were recorded for 20 available species. Ancestral state reconstruction was made using Maximum Likelihood from nrITS sequences. We used phylogenetic eigenvector regressions to estimate phylogenetic signal and the adaptive component for these traits. Species pollinated by bees or bees and wasps tend to have smaller pores and fruits with more seeds. Species pollinated by flies or flies and bees and/or wasps tend to have larger pores and fruits with less seeds. Independent evolution occurred three times for anthers with large pores and twice for fruits with few seeds. We detected a phylogenetic signal in both traits, and negative correlated evolution between them. In actinomorphic small-flowered Miconieae, changes in anther morphology can be related to generalisation in the pollination system incorporating flies and wasps as pollinators and lessening the importance of buzzing bees in such process. Differences in pollen removal and deposition may explain differences in anther morphology and seed number in Miconieae.

Hospital and Community Pharmacists' Perceptions of Which Competences Are Important for Their Practice

The objective of the PHAR-QA (Quality assurance in European pharmacy education and training) project was to investigate how competence-based learning could be applied to a healthcare, sectoral profession such as pharmacy. This is the first study on evaluation of competences from the pharmacists’ perspective using an improved Delphi method with a large number of respondents from all over Europe. This paper looks at the way in which hospital pharmacists rank the fundamental competences for pharmacy practice. European hospital pharmacists (n = 152) ranked 68 competences for pharmacy practice of two types (personal and patient care), arranged into 13 clusters. Results were compared to those obtained from community pharmacists (n = 258). Generally, hospital and community pharmacists rank competences in a similar way. Nevertheless, differences can be detected. The higher focus of hospital pharmacists on knowledge of the different areas of science as well as on laboratory tests reflects the idea of a hospital pharmacy specialisation. The difference is also visible in the field of drug production. This is a necessary competence in hospitals with requests for drugs for rare diseases, as well as paediatric and oncologic drugs. Hospital pharmacists give entrepreneurship a lower score, but cost-effectiveness a higher one than community pharmacists. This reflects the reality of pharmacy practice where community pharmacists have to act as entrepreneurs, and hospital pharmacists are managers staying within drug budgets. The results are discussed in the light of a “hospital pharmacy” specialisation.

Functional homogenization of flower visitor communities with urbanization

Land-use intensification and resulting habitat loss are put forward as the main causes of flower visitor decline. However, the impact of urbanization, the prime driver of land-use intensification in Europe, is poorly studied. In particular, our understanding of whether and how it affects the composition and functioning of flower visitor assemblages is scant, yet required to cope with increasing urbanization worldwide. Here, we use a nation-wide dataset of plant-flower visitor (Coleoptera, Diptera, Hymenoptera, Lepidoptera) interactions sampled by citizen scientists following a standardized protocol to assess macroecological changes in richness and composition of flower visitor communities with urbanization. We measured the community composition by quantifying the relative occurrence of generalist and specialist flower visitors based on their specialisation on flowering plant families. We show that urbanization is associated with reduced flower visitor richness and a shift in community composition toward generalist insects, indicating a modification of the functional composition of communities. These results suggest that urbanization affects not only the richness of flower visitor assemblages but may also cause their large-scale functional homogenization. Future research should focus on designing measures to reconcile urban development with flower visitor conservation.

The wrong end of the telescope: neuromuscular mimics of movement disorders (and vice versa)

The rapid advances in modern neurology have led to increased specialisation in clinical practice. Being an expert in a neurology subspecialty offers advantages for diagnosing and managing specific disorders. However, specialisation also risks tunnel vision: interpreting symptoms and signs within one's own framework of reference, while ignoring differential diagnostic options from other subspecialties. This is particularly relevant when the patient's presentation potentially belongs to different neurological subspecialties. We illustrate this challenge by highlighting a series of clinical features that partially overlap between two common subspecialties: movement disorders and neuromuscular disorders. An overlap in clinical presentation is not rare, and includes, for example, involuntary eyelid closure (which could be active eye closure due to blepharospasm, or ptosis due to weakness). Other overlapping features include abnormal postures, involuntary movements and gait changes. We describe two of these overlapping features in more detail and emphasise the possible consequences of 'looking through the wrong end of the telescope' in such patients, as this may lead to a wrong differential diagnosis, unnecessary investigations and a delayed treatment start.

Expressive and Instrumental Offending: Reconciling the Paradox of Specialisation and Versatility

Although previous research into specialisation has been dominated by the debate over the existence of specialisation versus versatility, it is suggested that research needs to move beyond the restrictions of this dispute. The current study explores the criminal careers of 200 offenders based on their criminal records, obtained from a police database in the North West of England, aiming to understand the patterns and nature of specialisation by determining the presence of differentiation within their general offending behaviours and examining whether the framework of Expressive and Instrumental offending styles can account for any specialised tendencies that emerge. Fifty-eight offences were subjected to Smallest Space Analysis. Results revealed that a model of criminal differentiation could be identified and that any specialisation is represented in terms of Expressive and Instrumental offending styles.

British Romantic Generalism in the Age of Specialism, 1870-1990

This essay explores the impact of 'generalism' and 'general practice' on the specialisation of British medicine using the case of neurology in Britain to reveal characteristics of British 'generalist medical culture' from 1870 to 1990. It argues that 'generalism' represented a particular epistemological position in Victorian medicine, one that then created a natural bridge between science and medicine over which almost all physicians and scientists were comfortable walking. The legacies of that Victorian 'generalist preference' exerted an enduring impact on the specialisation process as physicians experienced it in the twentieth century and as this case of neurology reveals so clearly. Neurologists and general physicians would still be arguing about the relative merits of a general medical education into the 1980s. By then, however, the emergence of government bodies promoting specialist labour conditions would have rendered the process seemingly inexorable.

Niche partitioning in a sympatric cryptic species complex

Competition theory states that multiple species should not be able to occupy the same niche indefinitely. Morphologically, similar species are expected to be ecologically alike and exhibit little niche differentiation, which makes it difficult to explain the co‐occurrence of cryptic species. Here, we investigated interspecific niche differentiation within a complex of cryptic bumblebee species that co‐occur extensively in the United Kingdom. We compared the interspecific variation along different niche dimensions, to determine how they partition a niche to avoid competitive exclusion. We studied the species B. cryptarum, B. lucorum, and B. magnus at a single location in the northwest of Scotland throughout the flight season. Using mitochondrial DNA for species identification, we investigated differences in phenology, response to weather variables and forage use. We also estimated niche region and niche overlap between different castes of the three species. Our results show varying levels of niche partitioning between the bumblebee species along three niche dimensions. The species had contrasting phenologies: The phenology of B. magnus was delayed relative to the other two species, while B. cryptarum had a relatively extended phenology, with workers and males more common than B. lucorum early and late in the season. We found divergent thermal specialisation: In contrast to B. cryptarum and B. magnus, B. lucorum worker activity was skewed toward warmer, sunnier conditions, leading to interspecific temporal variation. Furthermore, the three species differentially exploited the available forage plants: In particular, unlike the other two species, B. magnus fed predominantly on species of heather. The results suggest that ecological divergence in different niche dimensions and spatio‐temporal heterogeneity in the environment may contribute to the persistence of cryptic species in sympatry. Furthermore, our study suggests that cryptic species provide distinct and unique ecosystem services, demonstrating that morphological similarity does not necessarily equate to ecological equivalence.

Modelling the Progression of Male Swimmers' Performances through Adolescence

Insufficient data on adolescent athletes is contributing to the challenges facing youth athletic development and accurate talent identification. The purpose of this study was to model the progression of male sub-elite swimmers’ performances during adolescence. The performances of 446 males (12–19 year olds) competing in seven individual events (50, 100, 200 m freestyle, 100 m backstroke, breaststroke, butterfly, 200 m individual medley) over an eight-year period at an annual international schools swimming championship, run under FINA regulations were collected. Quadratic functions for each event were determined using mixed linear models. Thresholds of peak performance were achieved between the ages of 18.5 ± 0.1 (50 m freestyle and 200 m individual medley) and 19.8 ± 0.1 (100 m butterfly) years. The slowest rate of improvement was observed in the 200 m individual medley (20.7%) and the highest in the 100 m butterfly (26.2%). Butterfly does however appear to be one of the last strokes in which males specialise. The models may be useful as talent identification tools, as they predict the age at which an average sub-elite swimmer could potentially peak. The expected rate of improvement could serve as a tool in which to monitor and evaluate benchmarks.

How specialised is bird pollination in the Cactaceae?

Many cactus species produce 'bird' flowers; however, the reproductive biology of the majority of these species has not been studied. Here, we report on a study of the pollination of two species from the Cleistocactus genus, cited as an ornithophilous genus, in the context of the different ways in which they are specialised to bird pollination. In addition, we re-evaluate the level of specialisation of previous studies of cacti with bird pollination and evaluate how common phenotypic specialisation to birds is in this family. Both Cleistocactus species exhibited ornithophilous floral traits. Cleistocactus baumannii was pollinated by hummingbirds, whereas Cleistocactus smaragdiflorus was pollinated by hummingbirds and bees. Pollination by birds has been recorded in 27 cactus species, many of which exhibit ornithophilous traits; however, they show generalised pollination systems with bees, bats or moths in addition to birds being their floral visitors. Of all cactus species, 27% have reddish flowers. This trait is associated with diurnal anthesis and a tubular shape. Phenotypic specialisation to bird pollination is recognised in many cactus species; however, it is not predictive of functional and ecological specialisation in this family.

Pollination syndromes in a specialised plant-pollinator interaction: does floral morphology predict pollinators in Calceolaria?

Pollination syndromes are defined as suites of floral traits evolved in response to selection imposed by a particular group of pollinators (e.g., butterflies, hummingbirds, bats). Although numerous studies demonstrated their occurrence in plants pollinated by radically different pollinators, it is less known whether it is possible to identify them within species pollinated by one functional pollinator group. In such a framework, we expect floral traits to evolve also in response to pollinator subgroups (e.g., species, genera) within that unique functional group. On this, specialised pollination systems represent appropriate case studies to test such expectations. Calceolaria is a highly diversified plant genus pollinated by oil-collecting bees in genera Centris and Chalepogenus. Variation in floral traits in Calceolaria has recently been suggested to reflect adaptations to pollinator types. However, to date no study has explicitly tested that observation. In this paper, we quantitatively test that hypothesis by evaluating the presence of pollination syndromes within the specialised pollination system formed by several Calceolaria and their insect pollinators. To do so, we use multivariate approaches and explore the structural matching between the morphology of 10 Calceolaria taxa and that of their principal pollinators. Our results identify morphological matching between floral traits related to access to the reward and insect traits involved in oil collection, confirming the presence of pollinator syndromes in Calceolaria. From a general perspective, our findings indicate that the pollination syndrome concept can be also extended to the intra-pollinator group level.

Senior clinician views regarding introduction of a 'time to specialist' quality measure for unselected emergency admissions

The reorganisation of hospital emergency care aims to promote rapid access to specialists. In this study, we sought views from senior clinicians regarding the introduction of a 'time to specialist' (TTS) measure to evaluate healthcare delivery. We conducted a thematic analysis of transcripts from semi-structured interviews (n = 13) with clinical leads in a large National Health Service (NHS) Foundation Trust. Three main themes were identified, each with two subcategories: TTS as an appropriate measure (utility and acceptability); recording of TTS information (defining specialist contact and collection of time data); and impact (patient care and service efficiency). Interviewees perceived that a TTS target might improve clinical care for patients with severe illness and service efficiency for milder presentations. There was uncertainty about other patient groups and the definition of 'specialist' in this context. Clinical leads recognised that TTS might be helpful for describing changes in the provision of services, but the impact for patients was unclear because of heterogeneity in presentation and severity of illness for unselected admissions, and challenges in the definition of 'specialist' relative to individual clinical need.

From childhood to senior professional football: elite youth players' engagement in non-football activities

Abstract Despite the large amount of research available on how engagement in football practice relates to future performance level among football players, similar information about the contribution of non-football activities is scarce. Based on data from 745 elite youth players this study aimed to identify the characteristics and contribution of diverse participation towards elite youth and senior professional status. The data were collected using a retrospective questionnaire where the players reported the amount of time spent in other sports than football, in addition to their perceived contribution of different non-football activities for developing football skills. The accumulated hours of time spent in other sports of players who had obtained a senior professional contract were compared to non-professional players, using multilevel modelling (n = 558), while a t-test compared the activity ratings to each other. No significant differences were identified between professional and non-professional players' engagement history, but overall, the players rated sports similar to football to be significantly more relevant for developing football skills than other sports. The results suggests that spending time in non-football activities did not contribute to present differences in performance attainment in football, but also that potential advantages of such activities may be related to their characteristics.

Antagonistic interaction networks are structured independently of latitude and host guild

An increase in species richness with decreasing latitude is a prominent pattern in nature. However, it remains unclear whether there are corresponding latitudinal gradients in the properties of ecological interaction networks. We investigated the structure of 216 quantitative antagonistic networks comprising insect hosts and their parasitoids, drawn from 28 studies from the High Arctic to the tropics. Key metrics of network structure were strongly affected by the size of the interaction matrix (i.e. the total number of interactions documented between individuals) and by the taxonomic diversity of the host taxa involved. After controlling for these sampling effects, quantitative networks showed no consistent structural patterns across latitude and host guilds, suggesting that there may be basic rules for how sets of antagonists interact with resource species. Furthermore, the strong association between network size and structure implies that many apparent spatial and temporal variations in network structure may prove to be artefacts.

Charismatic authority in modern healthcare: the case of the 'diabetes specialist podiatrist'

Professional specialisation is broadly considered to result from increased complexity in professional knowledge and to be linked to specialist education, formalised credentials and registration. However, the degree of formal organisation may vary across professions. In healthcare, although medical specialisation is linked to rigorous selection criteria, formal training programmes and specialist registration, some forms of specialisation in the allied health professions are much less formal. Drawing on Weber's concept of charismatic authority, the establishment of a specialist role in podiatry, the 'diabetes specialist podiatrist', in the absence of codified or credentialed authority, is explored. 'Charismatic' leaders in podiatry, having attracted a following of practitioners, were able to constitute a speciality area of practice in the absence of established career pathways and acquire a degree of legitimacy in the medical field of diabetology.

A practical guide to measuring local adaptation

Patterns of local adaptation are expected to emerge when selection is spatially heterogeneous and sufficiently strong relative to the action of other evolutionary forces. The observation of local adaptation thus provides important insight into evolutionary processes and the adaptive divergence of populations. The detection of local adaptation, however, suffers from several conceptual, statistical and methodological issues. Here, we provide practical recommendations regarding (1) the definition of local adaptation, (2) the analysis of transplant experiments and (3) the optimisation of the experimental design of local adaptation studies. Together, these recommendations provide a unified approach for measuring local adaptation and understanding the adaptive divergence of populations in a wide range of biological systems.

Failing to professionalise, struggling to specialise: the rise and fall of health promotion as a putative specialism in England, 1980-2000

Significant attention has been paid to the history of public health in England during the final part of the twentieth century. Within this, however, the field that came to be known as specialist health promotion (SHP) has been relatively neglected. Between 1980 and 2000 those working in this field, generally known as health promotion specialists (HPSs), enjoyed a relative rise in policy and practice prominence before SHP was effectively abandoned by government and others charged with developing and sustaining public-health structures. This paper seeks to explain why the fall of SHP is important; to move towards explaining its rise and decline; and to argue for greater historical attention to be paid to an important but neglected field within health and health care. Essentially, SHP emerged from a set of loose and contingent practices known as health education. A range of important social, economic, organisational and political influences contributed to the slow construction of a putative specialism in health promotion, accompanied by the desire on the part of some (but not all) HPSs to ‘professionalise’ their role. Finally the projects of both specialisation and professionalisation failed, again as a result of then prevailing organisational and political influences. The importance of such a failure in a so-called era of public health is discussed. In the light of this, the paper concludes by briefly setting out an agenda for further research related to the history of SHP.

Niche breadth predicts geographical range size: a general ecological pattern

The range of resources that a species uses (i.e. its niche breadth) might determine the geographical area it can occupy, but consensus on whether a niche breadth-range size relationship generally exists among species has been slow to emerge. The validity of this hypothesis is a key question in ecology in that it proposes a mechanism for commonness and rarity, and if true, may help predict species' vulnerability to extinction. We identified 64 studies that measured niche breadth and range size, and we used a meta-analytic approach to test for the presence of a niche breadth-range size relationship. We found a significant positive relationship between range size and environmental tolerance breadth (z = 0.49), habitat breadth (z = 0.45), and diet breadth (z = 0.28). The overall positive effect persisted even when incorporating sampling effects. Despite significant variability in the strength of the relationship among studies, the general positive relationship suggests that specialist species might be disproportionately vulnerable to habitat loss and climate change due to synergistic effects of a narrow niche and small range size. An understanding of the ecological and evolutionary mechanisms that drive and cause deviations from this niche breadth-range size pattern is an important future research goal.

Postgraduate career intentions of medical students and recent graduates in Malawi: a qualitative interview study

BACKGROUND

In 2004, the Malawian Ministry of Health declared a human resource crisis and launched a six year Emergency Human Resources Programme. This included salary supplements for key health workers and a tripling of doctors in training. By 2010, the number of medical graduates had doubled and significantly more doctors were working in rural district hospitals. Yet there has been little research into the views of this next generation of doctors in Malawi, who are crucial to the continuing success of the programme. The aim of this study was to explore the factors influencing the career plans of medical students and recent graduates with regard to four policy-relevant aspects: emigration outside Malawi; working at district level; private sector employment and postgraduate specialisation.

METHODS

Twelve semi-structured interviews were conducted with fourth year medical students and first year graduates, recruited through purposive and snowball sampling. Key informant interviews were also carried out with medical school faculty. Recordings were transcribed and analysed using a framework approach.

RESULTS

Opportunities for postgraduate training emerged as the most important factor in participants' career choices, with specialisation seen as vital to career progression. All participants intended to work in Malawi in the long term, after a period of time outside the country. For nearly all participants, this was in the pursuit of postgraduate study rather than higher salaries. In general, medical students and young doctors were enthusiastic about working at district level, although this is curtailed by their desire for specialist training and frustration with resource shortages. There is currently little intention to move into the private sector.

CONCLUSIONS

Future resourcing of postgraduate training opportunities is crucial to preventing emigration as graduate numbers increase. The lesser importance put on salary by younger doctors may be an indicator of the success of salary supplements. In order to retain doctors at district levels for longer, consideration should be given to the introduction of general practice/family medicine as a specialty. Returning specialists should be encouraged to engage with younger colleagues as role models and mentors.

Increasing the speed of medical image processing in MatLab

MatLab(®) has often been considered an excellent environment for fast algorithm development but is generally perceived as slow and hence not fit for routine medical image processing, where large data sets are now available e.g., high-resolution CT image sets with typically hundreds of 512x512 slices. Yet, with proper programming practices - vectorization, pre-allocation and specialization - applications in MatLab(®) can run as fast as in C language. In this article, this point is illustrated with fast implementations of bilinear interpolation, watershed segmentation and volume rendering.