bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of 3-Chloroaniline on the Biofilm Lifestyle of Comamonas testosteroni and Its Implications on Bioaugmentation
Authors: Wu Yichao , Mohanty Anee , Chia Wu Siang , Cao Bin
Published: May 2016

Bioaugmentation has been frequently proposed in wastewater and soil treatment to remove toxic aromatic compounds. The performance of bioaugmentation is affected by a number of biological and environmental factors, including the interaction between the target pollutant and the augmented bacterial cells. In this study, using
Comamonas testosteroni
and 3-chloroaniline (3-CA) as the model organism and target pollutant, we explored the influence of toxic aromatic pollutants on the biofilm lifestyle of bacteria capable of degrading aromatic compounds toward a better understanding of cell-pollutant interaction in bioaugmentation. Our results showed that the exposure to 3-CA greatly reduced the retention of
C. testosteroni
cells in packed-bed bioreactors (from 22% to 15% after three pore volumes), which could be attributed to the altered bacterial motility and cell surface hydrophobicity. To further understand the molecular mechanisms, we employed an integrated genomic and transcriptomic analysis to examine the influence of 3-CA on the expression of genes important to the biofilm lifestyle of
C. testosteroni
. We found that exposure to 3-CA reduced the intracellular c-di-GMP level by downregulating the expression of genes encoding c-di-GMP synthases and induced massive cell dispersal from the biofilms. Our findings provide novel environmental implications on bioaugmentation, particularly in biofilm reactors, for the treatment of wastewater containing recalcitrant industrial pollutants.

IMPORTANCE
Bioaugmentation is a bioremediation approach that often has been described in the literature but has almost never been successfully applied in practice. Many biological and environmental factors influence the overall performance of bioaugmentation. Among these, the interaction between the target pollutant and the augmented bacterial cells is one of the most important factors. In this study, we revealed the influence of toxic aromatic pollutants on the biofilm lifestyle of bacteria capable of degrading aromatic compounds toward a better understanding of cell-pollutant interaction in bioaugmentation. Our findings provide novel environmental implications on bioaugmentation for the treatment of wastewater containing recalcitrant industrial pollutants; in particular, the exposure to toxic pollutants may reduce the retention of augmented organisms in biofilm reactors by reducing the c-di-GMP level, and approaches to elevating or maintaining a high c-di-GMP level may be promising to establish and maintain sustainable bioaugmentation activity.
Energetics and Application of Heterotrophy in Acetogenic Bacteria
Authors: Schuchmann Kai , Müller Volker
Published: May 2016

Acetogenic bacteria are a diverse group of strictly anaerobic bacteria that utilize the Wood-Ljungdahl pathway for CO2fixation and energy conservation. These microorganisms play an important part in the global carbon cycle and are a key component of the anaerobic food web. Their most prominent metabolic feature is autotrophic growth with molecular hydrogen and carbon dioxide as the substrates. However, most members also show an outstanding metabolic flexibility for utilizing a vast variety of different substrates. In contrast to autotrophic growth, which is hardly competitive, metabolic flexibility is seen as a key ability of acetogens to compete in ecosystems and might explain the almost-ubiquitous distribution of acetogenic bacteria in anoxic environments. This review covers the latest findings with respect to the heterotrophic metabolism of acetogenic bacteria, including utilization of carbohydrates, lactate, and different alcohols, especially in the model acetogenAcetobacterium woodii. Modularity of metabolism, a key concept of pathway design in synthetic biology, together with electron bifurcation, to overcome energetic barriers, appears to be the basis for the amazing substrate spectrum. At the same time, acetogens depend on only a relatively small number of enzymes to expand the substrate spectrum. We will discuss the energetic advantages of coupling CO2reduction to fermentations that exploit otherwise-inaccessible substrates and the ecological advantages, as well as the biotechnological applications of the heterotrophic metabolism of acetogens.
Mechanism of Antiactivation at the Pseudomonas sp. Strain ADP σN-Dependent PatzTPromoter
Authors: Platero Ana Isabel , López-Sánchez Aroa , Tomás-Gallardo Laura , Santero Eduardo , Govantes Fernando
Published: May 2016

PatzTis an internal promoter of theatzRSTUVWoperon that directs the synthesis of AtzT, AtzU, AtzV, and AtzW, components of an ABC-type cyanuric acid transport system. PatzTis σNdependent, activated by the general nitrogen control regulator NtrC with the assistance of protein integration host factor (IHF), and repressed by the LysR-type transcriptional regulator (LTTR) AtzR. We have used a variety ofin vivoandin vitrogene expression and protein-DNA interaction assays to assess the mechanisms underlying AtzR-dependent repression of PatzT. Here, we show that repression only occurs when AtzR and NtrC interact simultaneously with the PatzTpromoter region, indicating that AtzR acts as an antiactivator to antagonize activation by NtrC. Furthermore, repression requires precise rotational orientation of the AtzR and NtrC binding sites, strongly suggesting protein-protein interaction between the two proteins on the promoter region. Further exploration of the antiactivation mechanism showed that although AtzR-dependent repression occurs prior to open complex formation, AtzR does not alter the oligomerization state of NtrC or inhibit NtrC ATPase activity when bound to the PatzTpromoter region. Taken together, these results strongly suggest that PatzT-bound AtzR interacts with NtrC to prevent the coupling of NtrC-mediated ATP hydrolysis with the remodeling of the interactions between E-σNand PatzTthat lead to open complex formation.

IMPORTANCEHere, we describe a unique mechanism by which the regulatory protein AtzR prevents the activation of the σN-dependent promoter PatzT. Promoters of this family are always positively regulated, but there are a few examples of overlapping negative regulation. The mechanism described here is highly unconventional and involves an interaction between the repressor and activator proteins to prevent the action of the repressor protein on the RNA polymerase-promoter complex.
Exogenous Fatty Acids Protect Enterococcus faecalis from Daptomycin-Induced Membrane Stress Independently of the Response Regulator LiaR
Authors: Harp John R. , Saito Holly E. , Bourdon Allen K. , Reyes Jinnethe , Arias Cesar A. , Campagna Shawn R. , Fozo Elizabeth M.
Published: May 2016

Enterococcus faecalis
is a commensal bacterium of the gastrointestinal tract that can cause nosocomial infections in immunocompromised humans. The hallmarks of this organism are its ability to survive in a variety of stressful habitats and, in particular, its ability to withstand membrane damage. One strategy used by
E. faecalis
to protect itself from membrane-damaging agents, including the antibiotic daptomycin, involves incorporation of exogenous fatty acids from bile or serum into the cell membrane. Additionally, the response regulator LiaR (a member of the LiaFSR [lipid II-interacting antibiotic response regulator and sensor] system associated with cell envelope stress responses) is required for the basal level of resistance
E. faecalis
has to daptomycin-induced membrane damage. This study aimed to determine if membrane fatty acid changes could provide protection against membrane stressors in a LiaR-deficient strain of
E. faecalis
. We noted that despite the loss of LiaR, the organism readily incorporated exogenous fatty acids into its membrane, and indeed growth in the presence of exogenous fatty acids increased the survival of LiaR-deficient cells when challenged with a variety of membrane stressors, including daptomycin. Combined, our results suggest that
E. faecalis
can utilize both LiaR-dependent and -independent mechanisms to protect itself from membrane damage.

IMPORTANCE
Enterococcus faecalis
is responsible for a significant number of nosocomial infections. Worse, many of the antibiotics used to treat
E. faecalis
infection are no longer effective, as this organism has developed resistance to them. The drug daptomycin has been successfully used to treat some of these resistant strains; however, daptomycin-resistant isolates have been identified in hospitals. Many daptomycin-resistant isolates are found to harbor mutations in the genetic locus
liaFSR
, which is involved in membrane stress responses. Another mechanism shown to increase tolerance to daptomycin involves the incorporation of exogenous fatty acids from host fluids like serum or bile. This improved tolerance was found to be independent of
liaFSR
and suggests that there are additional ways to impact sensitivity to daptomycin. Thus, further studies are needed to understand how host fatty acid sources can influence antibiotic susceptibility.
Molecular Epidemiology of Campylobacter coli Strains Isolated from Different Sources in New Zealand between 2005 and 2014
Authors: Nohra Antoine , Grinberg Alex , Midwinter Anne C. , Marshall Jonathan C. , Collins-Emerson Julie M. , French Nigel P.
Published: May 2016

Campylobacteriosis is one of the most important foodborne diseases worldwide and a significant health burden in New Zealand.
Campylobacter jejuni
is the predominant species worldwide, accounting for approximately 90% of human cases, followed by
Campylobacter coli
. Most studies in New Zealand have focused on
C. jejuni
; hence, the impact of
C. coli
strains on human health is not well understood. The aim of this study was to genotype
C. coli
isolates collected in the Manawatu region of New Zealand from clinical cases, fresh poultry meat, ruminant feces, and environmental water sources, between 2005 and 2014, to study their population structure and estimate the contribution of each source to the burden of human disease.
Campylobacter
isolates were identified by PCR and typed by multilocus sequence typing.
C. coli
accounted for 2.9% (
n =
47/1,601) of
Campylobacter
isolates from human clinical cases, 9.6% (
n =
108/1,123) from poultry, 13.4% (
n =
49/364) from ruminants, and 6.4% (
n =
11/171) from water. Molecular subtyping revealed 27 different sequence types (STs), of which 18 belonged to clonal complex ST-828. ST-1581 was the most prevalent
C. coli
sequence type isolated from both human cases (
n =
12/47) and poultry (
n =
44/110). When classified using cladistics, all sequence types belonged to clade 1 except ST-7774, which belonged to clade 2. ST-854, ST-1590, and ST-4009 were isolated only from human cases and fresh poultry, while ST-3232 was isolated only from human cases and ruminant sources. Modeling indicated ruminants and poultry as the main sources of
C. coli
human infection.

IMPORTANCE
We performed a molecular epidemiological study of
Campylobacter coli
infection in New Zealand, one of few such studies globally. This study analyzed the population genetic structure of the bacterium and included a probabilistic source attribution model covering different animal and water sources. The results are discussed in a global context.
Toward a Predictive Understanding of Earth’s Microbiomes to Address 21st Century Challenges
Authors: Blaser Martin J. , Cardon Zoe G. , Cho Mildred K. , Dangl Jeffrey L. , Donohue Timothy J. , Green Jessica L. , Knight Rob , Maxon Mary E. , Northen Trent R. , Pollard Katherine S. , Brodie Eoin L.
Published: May 2016

Microorganisms have shaped our planet and its inhabitants for over 3.5 billion years. Humankind has had a profound influence on the biosphere, manifested as global climate and land use changes, and extensive urbanization in response to a growing population. The challenges we face to supply food, energy, and clean water while maintaining and improving the health of our population and ecosystems are significant. Given the extensive influence of microorganisms across our biosphere, we propose that a coordinated, cross-disciplinary effort is required to understand, predict, and harness microbiome function. From the parallelization of gene function testing to precision manipulation of genes, communities, and model ecosystems and development of novel analytical and simulation approaches, we outline strategies to move microbiome research into an era of causality. These efforts will improve prediction of ecosystem response and enable the development of new, responsible, microbiome-based solutions to significant challenges of our time.
Electroacupuncture for Reproductive Hormone Levels in Patients with Diminished Ovarian Reserve: A Prospective Observational Study
Authors: Wang Yang , Li Yanhong , Chen Ruixue , Cui Xiaoming , Yu Jinna , Liu Zhishun
Published: May 2016

Background

Effective methods for the treatment of reproductive dysfunction are limited. Previous studies have reported that acupuncture can modulate female hormone levels, improve menstrual disorders, alleviate depression and improve pregnancy rates. However, studies of acupuncture for diminished ovarian reserve (DOR) are lacking.

Objective

To carry out a prospective observational study aimed at assessing the effect of EA on the reproductive hormone levels of patients with DOR seeking fertility support and consider its safety.

Methods

Eligible patients with DOR received EA for 12 weeks: five times a week for 4 weeks followed by three times a week for 8 weeks. The primary outcome was the change in mean follicle-stimulating hormone (FSH) level at week 12. Mean luteinising hormone (LH) and serum oestradiol (E2) levels, FSH/LH ratios and symptom scale scores were simultaneously observed.

Results

Twenty-one patients with DOR were included in the final analysis. Mean FSH levels fell from 19.33±9.47 mIU/mL at baseline to 10.58±6.34 mIU/mL at week 12 and 11.25±6.68 mIU/mL at week 24. Change in mean FSH from baseline was −8.75±11.13 mIU/mL at week 12 (p=0.002) and −8.08±9.56 mIU/mL at week 24 (p=0.001). Mean E2 and LH levels, FSH/LH ratios and irritability scores were improved at weeks 12 and/or 24. Approximately 30% patients reported subjective increases in menstrual volume after treatment.

Conclusions

EA may modulate reproductive hormone levels and the effects seem to persist for at least 12 weeks after treatment with no significant side effects. EA may improve the ovarian reserve of patients with DOR, though further research is needed.

Trial Registration Number

NCT02229604; Results.
Role of sTREM-1 in predicting mortality of infection: a systematic review and meta-analysis
Authors: Su Longxiang , Liu Dan , Chai Wenzhao , Liu Dawei , Long Yun
Published: May 2016

Objectives

Several studies have investigated the prognostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in patients with infection. However, the result was controversial. Thus, the purpose of the present meta-analysis was to determine the prognostic value of the sTREM-1 level in predicting mortality at the initial stage of infection.

Methods

The literature was searched in the PubMed, EMBASE, Web of Knowledge and Cochrane databases. A 2×2 contingency table was constructed on the basis of mortality and sTREM-1 levels in patients with infection. 2 authors independently judged study eligibility and extracted data. The prognostic value of sTREM-1 in predicting mortality was determined using a bivariate meta-analysis model. Q-test and I2index were used to test heterogeneity.

Results

9 studies were selected from 803 studies. An elevated sTREM-1 level was associated with a higher risk of death in infection, with pooled risk ratio (RR) was 2.54 (95% CI 1.77 to 3.65) using a random-effects model (I2=53.8%). With the bivariate random-effects regression model, the pooled sensitivity and specificity of sTREM-1 to predict mortality in infection were 0.75 (95% CI 0.61 to 0.86) and 0.66 (95% CI 0.54 to 0.75), respectively. The diagnostic OR was 6 (95% CI 3 to 10). The overall area under the summary receiver operator characteristic (SROC) curve was 0.76 (95% CI 0.72 to 0.79). When we calculated the sepsis subgroup, the pooled RR was 2.98 (95% CI 2.19 to 4.40). The pooled sensitivity and specificity were 0.74 (95% CI 0.58 to 0.85) and 0.72 (95% CI 0.62 to 0.80), respectively. The overall area under the SROC curve was 0.78 (95% CI 0.74 to 0.81).

Conclusions

Elevated sTREM-1 concentrations had a moderate prognostic significance in assessing the mortality of infection in adult patients. However, sTREM-1 alone is insufficient to predict mortality as a biomarker.
Stroke survivors', caregivers' and GPs' attitudes towards a polypill for the secondary prevention of stroke: a qualitative interview study
Authors: Jamison James , Graffy Jonathan , Mullis Ricky , Mant Jonathan , Sutton Stephen
Published: May 2016

Objectives

To understand the perspectives of stroke survivors, caregivers and general practitioners (GPs) on a polypill approach, consisting of blood pressure and cholesterol-lowering therapies, with or without aspirin, for the secondary prevention of stroke.

Methods

A qualitative interview study was undertaken in 5 GP surgeries in the East of England. 28 survivors of stroke/transient ischaemic attack (TIA) were interviewed, 14 of them with a caregiver present, along with a convenience sample of 5 GPs, to assess attitudes towards a polypill and future use. Topic guides explored participants attitudes, potential uptake and long-term use, management of polypill medication and factors influencing the decision to prescribe. Data were analysed using a grounded theory approach. Key themes are presented and illustrated with verbatim quotes.

Results

The analysis identified 3 key themes: polypill benefits, polypill concerns and polypill lessons for implementation. Stroke/TIA survivors were positive about the polypill concept and considered it acceptable in the secondary prevention of stroke. Perceived benefits of a polypill included convenience resulting in improved adherence and reduced burden of treatment. Caregivers felt that a polypill would improve medication-taking practices, and GPs were open to prescribing it to those at increased cardiovascular risk. However, concerns raised included whether a polypill provided equivalent therapeutic benefit, side effects through combining medications, consequences of non-adherence, lack of flexibility in regulating dosage, disruption to current treatment and suitability to the wider stroke population.

Conclusions

Participants acknowledged potential advantages in a polypill approach for secondary prevention of stroke; however, significant concerns remain. Further research on the efficacy of a polypill is needed to reassure practitioners whose concerns around inflexibility and treatment suitability are likely to influence the decision to prescribe a polypill for secondary prevention of stroke. Acceptability among survivors, caregivers and GPs is likely to determine the uptake and subsequent use of a polypill in the future.
Economic evaluation of manual therapy for musculoskeletal diseases: a protocol for a systematic review and narrative synthesis of evidence
Authors: Kim Chang-Gon , Mun Su-Jeong , Kim Ka-Na , Shin Byung-Cheul , Kim Nam-Kwen , Lee Dong-Hyo , Lee Jung-Han
Published: May 2016

Introduction

Manual therapy is the non-surgical conservative management of musculoskeletal disorders using the practitioner's hands on the patient's body for diagnosing and treating disease. The aim of this study is to systematically review trial-based economic evaluations of manual therapy relative to other interventions used for the management of musculoskeletal diseases.

Methods and analysis

Randomised clinical trials (RCTs) on the economic evaluation of manual therapy for musculoskeletal diseases will be included in the review. The following databases will be searched from their inception: Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Econlit, Mantis, Index to Chiropractic Literature, Science Citation Index, Social Science Citation Index, Allied and Complementary Medicine Database (AMED), Cochrane Database of Systematic Reviews (CDSR), National Health Service Database of Abstracts of Reviews of Effects (NHS DARE), National Health Service Health Technology Assessment Database (NHS HTA), National Health Service Economic Evaluation Database (NHS EED), CENTRAL, five Korean medical databases (Oriental Medicine Advanced Searching Integrated System (OASIS), Research Information Service System (RISS), DBPIA, Korean Traditional Knowledge Portal (KTKP) and KoreaMed) and three Chinese databases (China National Knowledge Infrastructure (CNKI), VIP and Wanfang). The evidence for the cost-effectiveness, cost-utility and cost-benefit of manual therapy for musculoskeletal diseases will be assessed as the primary outcome. Health-related quality of life and adverse effects will be assessed as secondary outcomes. We will critically appraise the included studies using the Cochrane risk of bias tool and the Drummond checklist. Results will be summarised using Slavin's qualitative best-evidence synthesis approach.

Ethics and dissemination

The results of the study will be disseminated via a peer-reviewed journal and/or conference presentations.

Trial registration number

PROSPERO CRD42015026757.
General practitioners’ justifications for therapeutic inertia in cardiovascular prevention: an empirically grounded typology
Authors: Lebeau Jean-Pierre , Cadwallader Jean-Sébastien , Vaillant-Roussel Hélène , Pouchain Denis , Yaouanc Virginie , Aubin-Auger Isabelle , Mercier Alain , Rusch Emmanuel , Remmen Roy , Vermeire Etienne , Hendrickx Kristin
Published: May 2016

Objective

To construct a typology of general practitioners’ (GPs) responses regarding their justification of therapeutic inertia in cardiovascular primary prevention for high-risk patients with hypertension.

Design

Empirically grounded construction of typology. Types were defined by attributes derived from the qualitative analysis of GPs’ reported reasons for inaction.

Participants

256 GPs randomised in the intervention group of a cluster randomised controlled trial.

Setting

GPs members of 23 French Regional Colleges of Teachers in General Practice, included in the EffectS of a multifaceted intervention on CArdiovascular risk factors in high-risk hyPErtensive patients (ESCAPE) trial.

Data collection and analysis

The database consisted of 2638 written responses given by the GPs to an open-ended question asking for the reasons why drug treatment was not changed as suggested by the national guidelines. All answers were coded using constant comparison analysis. A matrix analysis of codes per GP allowed the construction of a response typology, where types were defined by codes as attributes. Initial coding and definition of types were performed independently by two teams.

Results

Initial coding resulted in a list of 69 codes in the final codebook, representing 4764 coded references in the question responses. A typology including seven types was constructed. 100 GPs were allocated to one and only one of these types, while 25 GPs did not provide enough data to allow classification. Types (numbers of GPs allocated) were: ‘optimists’ (28), ‘negotiators’ (20), ‘checkers’ (15), ‘contextualisers’ (13), ‘cautious’ (11), ‘rounders’ (8) and ‘scientists’ (5). For the 36 GPs that provided 50 or more coded references, analysis of the code evolution over time and across patients showed a consistent belonging to the initial type for any given GP.

Conclusion

This typology could provide GPs with some insight into their general ways of considering changes in the treatment/management of cardiovascular risk factors and guide design of specific physician-centred interventions to reduce inappropriate inaction.

Trial registration number

NCT00348855.
A qualitative study of diverse providers' behaviour in response to commissioners, patients and innovators in England: research protocol
Authors: Sheaff Rod , Halliday Joyce , Exworthy Mark , Allen Pauline , Mannion Russell , Asthana Sheena , Gibson Alex , Clark Jonathan
Published: May 2016

Introduction

The variety of organisations providing National Health Service (NHS)-funded services in England is growing. Besides NHS hospitals and general practitioners (GPs), they include corporations, social enterprises, voluntary organisations and others. The degree to which these organisational types vary, however, in the ways they manage and provide services and in the outcomes for service quality, patient experience and innovation, remains unclear. This research will help those who commission NHS services select among the different types of organisation for different tasks.

Research questions

The main research questions are how organisationally diverse NHS-funded service providers vary in their responsiveness to patient choice, NHS commissioning and policy changes; and their patterns of innovation. We aim to assess the implications for NHS commissioning and managerial practice which follow from these differences.

Methods and analysis

Systematic qualitative comparison across a purposive sample (c.12) of providers selected for maximum variety of organisational type, with qualitative studies of patient experience and choice (in the same sites). We focus is on NHS services heavily used by older people at high risk of hospital admission: community health services; out-of-hours primary care; and secondary care (planned orthopaedics or ophthalmology). The expected outputs will be evidence-based schemas showing how patterns of service development and delivery typically vary between different organisational types of provider.

Ethics, benefits and dissemination

We will ensure informants' organisational and individual anonymity when dealing with high profile case studies and a competitive health economy. The frail elderly is a key demographic sector with significant policy and financial implications. For NHS commissioners, patients, doctors and other stakeholders, the main outcome will be better knowledge about the relative merits of different kinds of healthcare provider. Dissemination will make use of strategies suggested by patient and public involvement, as well as DH and service-specific outlets.
Can patients be ‘attached’ to healthcare providers? An observational study to measure attachment phenomena in patient–provider relationships
Authors: Maunder Robert G , Hunter Jonathan J
Published: May 2016

Objectives

To develop and assess the validity of measures of patients' attachment-related perceptions of experiences with healthcare providers (HCPs).

Setting

Online survey.

Participants

181 people provided consent and 119 completed the survey (66%). Most participants were women (80%).

Primary and secondary outcome measures

Questions were developed to assess possible attachment functions served by an HCP and patients' attachment-related attitudes towards an HCP. Scales were constructed based on exploratory factor analysis. Measures of adult attachment, therapeutic alliance, perceived HCP characteristics and health utilisation were used to validate scales.

Results

Possible safe haven and secure base functions served by HCPs were strongly endorsed. A model with good fit (root mean square error of approximation=0.056) yielded 3 factors: ‘HCP experienced as supportive and safe’ (SUPPORT, α=0.94), ‘HCP experienced as aversive’ (AVERSE, α=0.86) and ‘more and closer contact wanted with HCP’ (WANT, α=0.85). SUPPORT was correlated with positive HCP characteristics and not with attachment insecurity. AVERSE was inversely correlated with positive HCP attributes and correlated with attachment insecurity. WANT was unrelated to positive HCP attributes, but correlated with attachment insecurity. Frequency of HCP contact was related to WANT (Kruskal-Wallis=21.9, p<0.001) and SUPPORT (Kruskal-Wallis=13.2, p=0.02), but not to AVERSE (Kruskal-Wallis=1.7, p=0.89).

Conclusions

Patients attribute attachment functions of secure base and safe haven to HCPs. SUPPORT is related to positive appraisal of HCP characteristics; AVERSE is associated with discomfort in the HCP relationship that is related with perceived HCP characteristics and patients' insecure attachment; WANT is associated with unmet needs for connection with an HCP related to insecure attachment, but not to perceived HCP characteristics. These scales may be useful in studying the application of attachment theory to the HCP–patient relationship.
Training primary care physicians to offer their patients faecal occult blood testing and colonoscopy for colorectal cancer screening on an equal basis: a pilot intervention with before–after and parallel group surveys
Authors: Selby Kevin , Cornuz Jacques , Gachoud David , Bulliard Jean-Luc , Nichita Cristina , Dorta Gian , Ducros Cyril , Auer Reto
Published: May 2016

Objectives

Primary care physicians (PCPs) should prescribe faecal immunochemical testing (FIT) or colonoscopy for colorectal cancer screening based on their patient's values and preferences. However, there are wide variations between PCPs in the screening method prescribed. The objective was to assess the impact of an educational intervention on PCPs’ intent to offer FIT or colonoscopy on an equal basis.

Design

Survey before and after training seminars, with a parallel comparison through a mailed survey to PCPs not attending the training seminars.

Setting

All PCPs in the canton of Vaud, Switzerland.

Participants

Of 592 eligible PCPs, 133 (22%) attended a seminar and 106 (80%) filled both surveys. 109 (24%) PCPs who did not attend the seminars returned the mailed survey.

Intervention

A 2 h-long interactive seminar targeting PCP knowledge, skills and attitudes regarding offering a choice of colorectal cancer (CRC) screening options.

Outcome measures

The primary outcome was PCP intention of having their patients screened with FIT and colonoscopy in equal proportions (between 40% and 60% each). Secondary outcomes were the perceived role of PCPs in screening decisions (from paternalistic to informed decision-making) and correct answer to a clinical vignette.

Results

Before the seminars, 8% of PCPs reported that they had equal proportions of their patients screened for CRC by FIT and colonoscopy; after the seminar, 33% foresaw having their patients screened in equal proportions (p<0.001). Among those not attending, there was no change (13% vs 14%, p=0.8). Of those attending, there was no change in their perceived role in screening decisions, while the proportion responding correctly to a clinical vignette increased (88–99%, p<0.001).

Conclusions

An interactive training seminar increased the proportion of physicians with the intention to prescribe FIT and colonoscopy in equal proportions.
Personalised long-term follow-up of cochlear implant patients using remote care, compared with those on the standard care pathway: study protocol for a feasibility randomised controlled trial
Authors: Cullington Helen , Kitterick Padraig , DeBold Lisa , Weal Mark , Clarke Nicholas , Newberry Eva , Aubert Lisa
Published: May 2016

Introduction

Many resources are required to provide postoperative care to patients who receive a cochlear implant. The implant service commits to lifetime follow-up. The patient commits to regular adjustment and rehabilitation appointments in the first year and annual follow-up appointments thereafter. Offering remote follow-up may result in more stable hearing, reduced patient travel expense, time and disruption, more empowered patients, greater equality in service delivery and more freedom to optimise the allocation of clinic resources.

Methods and analysis

This will be a two-arm feasibility randomised controlled trial (RCT) involving 60 adults using cochlear implants with at least 6 months device experience in a 6-month clinical trial of remote care. This project will design, implement and evaluate a person-centred long-term follow-up pathway for people using cochlear implants offering a triple approach of remote and self-monitoring, self-adjustment of device and a personalised online support tool for home speech recognition testing, information, self-rehabilitation, advice, equipment training and troubleshooting. The main outcome measure is patient activation. Secondary outcomes are stability and quality of hearing, stability of quality of life, clinic resources, patient and clinician experience, and any adverse events associated with remote care. We will examine the acceptability of remote care to service users and clinicians, the willingness of participants to be randomised, and attrition rates. We will estimate numbers required to plan a fully powered RCT.

Ethics and dissemination

Ethical approval was received from North West—Greater Manchester South Research Ethics Committee (15/NW/0860) and the University of Southampton Research Governance Office (ERGO 15329).

Results

Results will be disseminated in the clinical and scientific communities and also to the patient population via peer-reviewed research publications both online and in print, conference and meeting presentations, posters, newsletter articles, website reports and social media.

Trial registration number

ISRCTN14644286; Pre-results.
Modified Balance Error Scoring System (M-BESS) test scores in athletes wearing protective equipment and cleats
Authors: Azad Aftab Mohammad , Al Juma Saad , Bhatti Junaid Ahmad , Delaney J Scott
Published: May 2016

Background

Balance testing is an important part of the initial concussion assessment. There is no research on the differences in Modified Balance Error Scoring System (M-BESS) scores when tested in real world as compared to control conditions.

Objective

To assess the difference in M-BESS scores in athletes wearing their protective equipment and cleats on different surfaces as compared to control conditions.

Methods

This cross-sectional study examined university North American football and soccer athletes. Three observers independently rated athletes performing the M-BESS test in three different conditions: (1) wearing shorts and T-shirt in bare feet on firm surface (control); (2) wearing athletic equipment with cleats on FieldTurf; and (3) wearing athletic equipment with cleats on firm surface. Mean M-BESS scores were compared between conditions.

Results

60 participants were recruited: 39 from football (all males) and 21 from soccer (11 males and 10 females). Average age was 21.1 years (SD=1.8). Mean M-BESS scores were significantly lower (p<0.001) for cleats on FieldTurf (mean=26.3; SD=2.0) and for cleats on firm surface (mean=26.6; SD=2.1) as compared to the control condition (mean=28.4; SD=1.5). Females had lower scores than males for cleats on FieldTurf condition (24.9 (SD=1.9) vs 27.3 (SD=1.6), p=0.005). Players who had taping or bracing on their ankles/feet had lower scores when tested with cleats on firm surface condition (24.6 (SD=1.7) vs 26.9 (SD=2.0), p=0.002).

Conclusions

Total M-BESS scores for athletes wearing protective equipment and cleats standing on FieldTurf or a firm surface are around two points lower than M-BESS scores performed on the same athletes under control conditions.
Safe Drive Stay Alive: exploring effectiveness of a real-world driving intervention for predrivers and the utility of the health action process approach
Authors: Dale H , Scott C , Ozakinci G
Published: May 2016

Young drivers are greatly over-represented in road traffic collisions (RTCs) worldwide. Interventions attempt to change driving-related behaviours to reduce injuries and deaths from RTCs. The current study evaluated the effectiveness of the well-established Fife Safe Drive Stay Alive (SDSA) practice-based intervention on determinants of driving behaviour using the health action process approach (HAPA) model. Adolescent participants (predominantly predrivers) attending the SDSA intervention from schools and colleges in Fife, Scotland, were invited to complete an evaluation at baseline and at 3 months exploring motivational determinants of driving behaviour (eg, risk perception). Intervention content was examined for behaviour change techniques (BCTs). Eighty-seven participants completed both baseline and follow-up evaluations. The motivational HAPA model variables predicted driving intentions. There was no significant overall effect of the SDSA intervention between baseline and 3-month follow-up. Seven negatively framed BCTs were used in the intervention. The effectiveness of SDSA is questioned; however, the study supports the use of the HAPA model in explaining driving intentions, and therefore, may usefully inform driving interventions.
Factors associated with influenza vaccine uptake during a universal vaccination programme of preschool children in England and Wales: a cohort study
Authors: Hardelid Pia , Rait Greta , Gilbert Ruth , Petersen Irene
Published: May 2016

Introduction

Influenza vaccination through primary care has been recommended for all preschool children in the UK since 2013 as part of a universal immunisation programme. Vaccination is required annually and effectiveness varies by season. Factors associated with influenza vaccine receipt and those for other childhood vaccines may therefore differ.

Methods

We used The Health Improvement Network, a large primary care database, to create a cohort of children in England and Wales aged 2–4 years eligible for vaccination in the 2014/2015 season. Mixed-effects Poisson regression models were used to determine sociodemographic and clinical factors associated with influenza vaccine receipt, allowing for practice-level variation.

Results

Overall, 38.7% (95% CI 38.3% to 39.1%) of 57 545 children were vaccinated against influenza. Children in the poorest deprivation quintile were 19% less likely to receive influenza vaccine than those in the wealthiest quintile (adjusted risk ratio (ARR) 0.81, 95% CI 0.77 to 0.86). Children who received a timely first dose of measles-mumps-rubella vaccine were twice as likely to receive influenza vaccine (ARR 2.00 95% CI 1.87 to 2.13). Being 4 years old, not in a clinical risk group, or living with 2 or more other children were also significantly associated with a lower probability of vaccination.

Discussion

Children living in areas of higher deprivation and in larger families are less likely to receive influenza vaccine. Further research is required into whether interventions, such as offering vaccinations in other settings, could increase uptake in children, particularly in deprived areas.
Testing for a predicted decrease in body size in brown bears (Ursus arctos) based on a historical shift in diet
Authors: Matsubayashi Jun , Tayasu Ichiro , Morimoto Junko O. , Mano Tsutomu
Published: May 2016

A recent study found a historical decline in the proportion of meat in the diet of brown bears (Ursus arctos L., 1758) in the Hokkaido Islands, Japan. Because feeding habits are strongly correlated with the body size of animals, the shift in diet should have led to a decrease in the size of these bears. To predict the effects of this dietary shift on the skeletal size in bears, we correlated the femur length in Hokkaido brown bears with the carbon and nitrogen stable isotope values from bone samples and predicted the historical change in their body size. The variation in the femur lengths of the male and female subpopulations was positively correlated with their δ15N values, but not with their δ13C values, and the explanatory power of the constructed model was higher in males than in females. Based on the model and the δ15N values for historic and modern bears, the skeletal size of bear subpopulations in eastern Hokkaido was estimated to have decreased by 10%–18% for males and 8%–9% for females. Our results suggest that a historical dietary shift caused the decrease in the size of the Hokkaido brown bears.
Effect of water temperature on the hydrolysis of two absorbable sutures used in fish surgery
Authors: Cannizzo Sarah A. , Roe Simon C. , Harms Craig A. , Stoskopf Michael K.
Published: May 2016

Persistence of absorbable sutures in fishes in waters below 10 °C affects surgical decisions including approach, closure strategy, and suture selection. We hypothesized that the rate of suture hydrolysis would vary directly with water temperature. Two absorbable monofilament 3-0 suture materials used in fish surgery, poliglecaprone (Monocryl™) and polyglyconate (Maxon™), were evaluated. The maximum tensile load (strength) was measured for suture loops ( n = 6) maintained in filtered city water for 2, 4, 6, or 8 weeks at 4, 25, or 37 °C. For Maxon™ at 4 or 25 °C, tensile strength did not decrease over time. However, for Monocryl™ at 4 °C, 2-, 4-, and 8-week loops were stronger than baseline loops. At 25 °C, tensile strength of the suture material declined after 2 weeks. Also, at 37 °C, the optimal design temperature for both suture materials, the strength of Maxon™ decreased at 6 and 8 weeks. Two 4-week loops of Monocryl™ disintegrated when handled, and after 6 and 8 weeks, all were untestable. This study confirms that absorbable sutures lose strength more slowly at ambient temperatures lower than the optimal design temperature (e.g., human body temperature) and will likely be retained longer in fishes living in waters below 25 °C.
Palaeocommunities, diversity and sea-level change from middle Eocene shell beds of the Paris Basin
Authors: Dominici Stefano , Zuschin Martin
Published: May 2016

The middle Eocene interval at some Paris Basin localities was studied through high-resolution stratigraphy. Abundance data (499 species, 37 719 individuals) on the distribution of molluscs, collected at 12 shell beds of the middle Lutetian and lower Bartonian, formed the basis for a palaeoecological study. The middle Lutetian succession is subdivided into several elementary depositional sequences (EDS) interpreted as the product of relative sea-level change. Species-abundance distributions are better correlated with EDS than with geographical locality, suggesting that sea level played an important role in the distribution of palaeocommunities. Diversities were compared with analogous data from modern subtropical and warm-temperate intertidal and subtidal communities. We found that sea-level variation is responsible for a major change in the upper part of the middle Lutetian succession, leading from high- to low-diversity palaeocommunities. From base to top sampled palaeocommunities indicate a transition from high-energy and mesotrophic (EDS 2) to oligotrophic low-energy conditions of a sandy lower shoreface (EDS 4) to an upper shoreface (EDS 5 and lower Bartonian), the last with mangroves and a seagrass cover. Notwithstanding the Lutetian cooling, we found that subtropical conditions reached as far north as the Paris Basin. Our study suggests that climatic fluctuations might be obscured by facies control.
Tectonic controls on the spatial distribution and stratigraphic architecture of a net-transgressive shallow-marine synrift succession in a salt-influenced rift basin: Middle to Upper Jurassic, Norwegian Central North Sea
Authors: Mannie Aruna S. , Jackson Christopher A.-L. , Hampson Gary J. , Fraser Alastair J.
Published: May 2016

Syndepositional deformation in salt-influenced rift basins is complex, being driven by a combination of normal faulting and the growth of salt structures such as diapirs. Owing to a lack of data with which to simultaneously constrain basin structure and synrift stratigraphic architecture, we have a poor understanding of how these processes control shallow-marine deposition in such settings. To improve our understanding we here use seismic reflection and borehole data from the Norwegian Central North Sea to investigate the role that syndepositional fault growth and salt movement played in controlling the sub-regional stratigraphic architecture of a net-transgressive shallow-marine synrift succession (Middle to Late Jurassic). The rift-related structural framework, which is usually dominated by normal fault-bound horst and graben, is strongly modified where an Upper Permian salt layer (Zechstein Supergroup) is sufficiently thick and mobile to act as an intra-stratal detachment, giving rise to decoupled rift-related basement and cover structural styles. Furthermore, cover extension allows the salt to rise diapirically, resulting in the formation of large salt diapirs and supra-salt normal faults formed owing to late-stage salt withdrawal and diapir collapse. Rift-related normal faulting and the growth of salt structures had a dual control on the depositional thickness and facies distribution within the net-transgressive, predominantly shallow-marine, Middle to Upper Jurassic synrift succession. The resulting facies architecture reflects a delicate balance between fault- and salt flow-driven accommodation creation and intra- and extra-basinal sediment supply. Where sediment supply and accumulation rate exceeded accommodation, little or no change in facies is observed across syndepositional structures. In contrast, where accommodation outpaced sediment supply and accumulation rate, footwall-attached shorelines locally developed adjacent to large, thick-skinned normal faults, with deeper water conditions persisting in the adjacent hanging wall. Flooding of structural elements was strongly diachronous and influenced by the underlying rift-related topography, which was characterized by intra-basinal horst and graben. This paper highlights the key role that salt plays in modifying the tectonostratigraphic evolution of rift basins, suggesting that existing models, based on salt-free structural templates, need to be modified.
Geotechnical characteristics of a high-porosity deep-sea clay sample retrieved from within a giant scour and its implications for local geological history
Authors: Kristinof R. E. , Marketos G.
Published: May 2016

Laboratory tests have been undertaken on a relatively undisturbed sample of a mudline clay that was retrieved from within a giant scour from
c.
4600 m below sea-level in the Atlantic Ocean to the west of the Iberian Peninsula. The geotechnical tests reported here shed light on the regional geological history and scour formation, which can be of economic importance as infill material inside fossil scours is often a hydrocarbon exploration target. Test data indicate that the scour-infill material from this site has not been exposed to sufficient vertical effective stress for it to develop any appreciable stress-induced structure. Furthermore, they confirm the hypothesis that the scour-infill sediment tested post-dates scour formation. An oxidation front is also observed in the sample, which is common in submarine sediments. Tests either side of the oxidation front have shown that the differential weathering across it changes the liquidity index of the material but does not significantly change the compressibility characteristics. The sediments tested, whose behaviour has been interpreted using sensitivity and intrinsic strength frameworks, are recently deposited, and are therefore at the initial stage of their geological life. Thus, the soil parameters derived can provide useful reference values against which other sediments, which may have undergone some diagenesis and compression, can be compared. It should be noted that the present study is unique as it has focused on high-quality samples of these highly compressible deep-sea sediments, retrieved from within the top layers of the sedimentary strata, in contrast to other studies that are normally completed on samples taken from several metres depth below the seabed and/or show more disturbance.