Clinical leadership is part of the curriculum for all doctors in training. This article describes one deanery's approach to developing leadership skills while improving collaborative working.

The glassy-winged sharpshooter, Homalodisca vitripeninis Germar (Hemiptera: Cicadellidae), is a xylophagous insect that is an endemic pest of several economically important plants in Texas. H. vitripennis is the main vector of Xylella fastidiosa Wells (Xanthomonadales: Xanthomonadaceae), the bacterium that causes Pierce's disease of grapevine and can travel long distances putting much of Texas grape production at risk. Understanding the movement of H. vitripennis populations capable of transmitting X. fastidiosa into Pierce's-disease-free areas is critical for developing a management program for Pierce's disease. To that end, the USDA-APHIS has developed a program to sample vineyards across Texas to monitor populations of H. vitripennis. From this sampling, H vitripennis collected during 2005 and 2006 over the months of May, June, and July from eight vineyards in different regions of Texas were recovered from yellow sticky traps and tested for the presence of X. fastidiosa. The foregut contents were vacuum extracted and analyzed using RT-PCR to determine the percentage of H. vitripennis within each population that harbor X. fastidiosa and have the potential to transmit this pathogen. H. vitripennis from vineyards known to have Pierce's disease routinely tested positive for the presence of X. fastidiosa. While almost all H. vitripennis collected from vineyards with no history of Pierce's disease tested negative for the presence of the pathogen, three individual insects tested positive. Furthermore, all three insects were determined, by DNA sequencing, to be carrying a strain of X. fastidiosa homologous to known Pierce's disease strains, signifying them as a risk factor for new X. fastidiosa infections.

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Aims To review the literature focusing on anxiety and music therapy as a non-pharmacological anxiolytic for patients receiving mechanical ventilation and to determine the contexts, mechanisms and outcomes of what works for whom and under what circumstances. Background Mechanical ventilation is one of the numerous processes that a critically ill patient requiring single or multi organ support may experience. This is often frightening and perplexing for the patient, particularly when mechanically ventilated. The abundance of interventions, monitoring and unfamiliar noises can precipitate feelings of stress and anxiety which is common within this population of patients leading to prolonged hospital stay and increases in mortality and morbidity. Methods A rapid realist review was undertaken applying the realist methodology to a search of the literature using CINHAL, MEDLINE and Cochrane library, PsycIFNO, PubMed and EMBASE along with searching for the grey literature using an experience library technician, Google Scholar, Google, OpenGrey and the British Library ETHOS. Results Twenty-one studies were included in the review. From the heterogeneity amongst the literature and the poor quality of evidence it was ascertained what worked for whom and under what circumstances. No negative outcomes for patients were noted in the review thus suggesting that music may have a place within critical care to help reduce anxiety. Given the heterogeneity of the evidence there is scope to review this topic further. Conclusion The overarching conclusion was that music could help reduce anxiety in the critically ill mechanically ventilated patient. Thematic analysis helped identify what quantifies the markers of anxiety, furthermore, it noted alternative themes that could be explored through more research. Theories could be developed and implemented into a protocol for practice, however, it would be based on the researchers' own experience due to the poor-quality heterogeneous evidence.

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