bluuebunny/crossref_metadata_2025 huggingface dataset:
RNase III Is Required for Actinomycin Production in Streptomyces antibioticus
Authors: Lee Jung-Hoon , Gatewood Marcha L. , Jones George H.
Published: August 2013

Using insertional mutagenesis, we have disrupted the RNase III gene,
rnc
, of the actinomycin-producing streptomycete,
Streptomyces antibioticus
. Disruption was verified by Southern blotting. The resulting strain grows more vigorously than its parent on actinomycin production medium but produces significantly lower levels of actinomycin. Complementation of the
rnc
disruption with the wild-type
rnc
gene from
S. antibioticus
restored actinomycin production to nearly wild-type levels. Western blotting experiments demonstrated that the disruptant did not produce full-length or truncated forms of RNase III. Thus, as is the case in
Streptomyces coelicolor
, RNase III is required for antibiotic production in
S. antibioticus
. No differences in the chemical half-lives of bulk mRNA were observed in a comparison of the
S. antibioticus rnc
mutant and its parental strain.
Impact of Environmental Conditions on the Form and Function of Candida albicans Biofilms
Authors: Daniels Karla J. , Park Yang-Nim , Srikantha Thyagarajan , Pujol Claude , Soll David R.
Published: August 2013

Candida albicans
, like other pathogens, can form complex biofilms on a variety of substrates. However, as the number of studies of gene regulation, architecture, and pathogenic traits of
C. albicans
biofilms has increased, so have differences in results. This suggests that depending upon the conditions employed, biofilms may vary widely, thus hampering attempts at a uniform description. Gene expression studies suggest that this may be the case. To explore this hypothesis further, we compared the architectures and traits of biofilms formed in RPMI 1640 and Spider media at 37°C in air. Biofilms formed by
a
/α cells in the two media differed to various degrees in cellular architecture, matrix deposition, penetrability by leukocytes, fluconazole susceptibility, and the facilitation of mating. Similar comparisons of
a/a
cells in the two media, however, were made difficult given that in air, although
a/a
cells form traditional biofilms in RPMI medium, they form polylayers composed primarily of yeast cells in Spider medium. These polylayers lack an upper hyphal/matrix region, are readily penetrated by leukocytes, are highly fluconazole susceptible, and do not facilitate mating. If, however, air is replaced with 20% CO
2
,
a/a
cells make a biofilm in Spider medium similar architecturally to that of
a
/α cells, which facilitates mating. A second, more cursory comparison is made between the disparate cellular architectures of
a/a
biofilms formed in air in RPMI and Lee's media. The results demonstrate that
C. albicans
forms very different types of biofilms depending upon the composition of the medium, level of CO
2
in the atmosphere, and configuration of the
MTL
locus.
Temporal Behavior of Capsule Enlargement by Cryptococcus neoformans
Authors: Cordero Radames J. B. , Bergman Aviv , Casadevall Arturo
Published: August 2013

Microbial capsules are important virulence traits that mediate cell-host interactions and provide protection against host immune defense mechanisms.
Cryptococcus neoformans
is a yeast-like fungus that is capable of synthesizing a complex polysaccharide (PS) capsule that is required for causing disease. Microscopic visualization of capsule enlargement is difficult, because the capsule is a highly hydrated structure with an index of refraction that is very close to that of aqueous medium. In this study, we took advantage of the capsular reaction (“quellung” effect) produced by IgM monoclonal antibody (MAb) 13F1 to increase the refraction index difference between capsule and medium such that we visualized the capsule using differential interference contrast (DIC) microscopy. Time-lapse size measurements allowed us to quantify the growth rate of the capsule relative to that of the cell body. The increase in capsule volume per unit of time was consistent with a logistic variable slope model in which the capsule's final size was proportional to the rate of its growth. The rate of capsule growth (0.3 to 2.5 µm
3
/min) was at least 4-fold faster than the rate of cell body growth (0.1 to 0.3 µm
3
/min), and there was large cell-to-cell variation in the temporal kinetics of capsule and cellular growth. Previous to the first cellular replication event, both the capsule and cell body enlarged simultaneously, and their differences showed monotonic growth, which was affected only by its rate of volume increase per unit of time. Using these results, we provide an updated model for cryptococcal capsule biogenesis.
Acrylyl-Coenzyme A Reductase, an Enzyme Involved in the Assimilation of 3-Hydroxypropionate by Rhodobacter sphaeroides
Authors: Asao Marie , Alber Birgit E.
Published: August 2013

The anoxygenic phototroph
Rhodobacter sphaeroides
uses 3-hydroxypropionate as a sole carbon source for growth. Previously, we showed that the gene (RSP_1434) known as
acuI
, which encodes a protein of the medium-chain dehydrogenase/reductase (MDR) superfamily, was involved in 3-hydroxypropionate assimilation via the reductive conversion to propionyl-coenzyme A (CoA). Based on these results, we speculated that
acuI
encoded acrylyl-CoA reductase. In this work, we characterize the
in vitro
enzyme activity of purified, recombinant AcuI using a coupled spectrophotometric assay. AcuI from
R. sphaeroides
catalyzes the NADPH-dependent acrylyl-CoA reduction to produce propionyl-CoA. Two other members of the MDR012 family within the MDR superfamily, the products of SPO_1914 from
Ruegeria pomeroyi
and
yhdH
from
Escherichia coli
, were shown to also be part of this new class of NADPH-dependent acrylyl-CoA reductases. The activities of the three enzymes were characterized by an extremely low

K
m

for acrylyl-CoA (<3 μM) and turnover numbers of 45 to 80 s
−1
. These homodimeric enzymes were highly specific for NADPH (

K
m

= 18 to 33 μM), with catalytic efficiencies of more than 10-fold higher for NADPH than for NADH. The introduction of codon-optimized SPO_1914 or
yhdH
into a Δ
acuI
::
kan
mutant of
R. sphaeroides
on a plasmid complemented 3-hydroxypropionate-dependent growth. However, in their native hosts, SPO_1914 and
yhdH
are believed to function in the metabolism of substrates other than 3-hydroxypropionate, where acrylyl-CoA is an intermediate. Complementation of the Δ
acuI
::
kan
mutant phenotype by crotonyl-CoA carboxylase/reductase from
R. sphaeroides
was attributed to the fact that the enzyme also uses acrylyl-CoA as a substrate.
FeoC from Klebsiella pneumoniae Contains a [4Fe-4S] Cluster
Authors: Hsueh Kuang-Lung , Yu Liang-Kun , Chen Yung-Han , Cheng Ya-Hsin , Hsieh Yin-Cheng , Ke Shyue-chu , Hung Kuo-Wei , Chen Chun-Jung , Huang Tai-huang
Published: August 2013

Iron is essential for pathogen survival, virulence, and colonization. Feo is suggested to function as the ferrous iron (Fe2+) transporter. The enterobacterial Feo system is composed of 3 proteins: FeoB is the indispensable component and is a large membrane protein likely to function as a permease; FeoA is a small Src homology 3 (SH3) domain protein that interacts with FeoB; FeoC is a winged-helix protein containing 4 conserved Cys residues in a sequence suitable for harboring a putative iron-sulfur (Fe-S) cluster. The presence of an iron-sulfur cluster on FeoC has never been shown experimentally. We report that under anaerobic conditions, the recombinantKlebsiella pneumoniaeFeoC (KpFeoC) exhibited hyperfine-shifted nuclear magnetic resonance (NMR) and a UV-visible (UV-Vis) absorbance spectrum characteristic of a paramagnetic center. The electron paramagnetic resonance (EPR) and extended X-ray absorption fine structure (EXAFS) results were consistent only with the [4Fe-4S] clusters. Substituting the cysteinyl sulfur with oxygen resulted in significantly reduced cluster stability, establishing the roles of these cysteines as the ligands for the Fe-S cluster. When exposed to oxygen, the [4Fe-4S] cluster degraded to [3Fe-4S] and eventually disappeared. We propose thatKpFeoC may regulate the function of the Feo transporter through the oxygen- or iron-sensitive coordination of the Fe-S cluster.
FeoA and FeoC Are Essential Components of the Vibrio cholerae Ferrous Iron Uptake System, and FeoC Interacts with FeoB
Authors: Weaver Emily A. , Wyckoff Elizabeth E. , Mey Alexandra R. , Morrison Rebecca , Payne Shelley M.
Published: August 2013

The ferrous iron transport system Feo is widely distributed among bacterial species, yet its physical structure and mechanism of iron transport are poorly understood. In
Vibrio cholerae
, the
feo
operon consists of three genes,
feoABC. feoB
encodes an 83-kDa protein with an amino-terminal GTPase domain and a carboxy-terminal domain predicted to be embedded in the inner membrane. While FeoB is believed to form the pore for iron transport, the roles of FeoA and FeoC are unknown. In this work, we show that FeoA and FeoC, as well as the more highly conserved FeoB, are all required for iron acquisition by
V. cholerae
Feo. An in-frame deletion of
feoA
,
feoB
, or
feoC
eliminated iron acquisition. The loss of transport activity in the
feoA
and
feoC
mutants was not due to reduced transcription of the
feo
operon, suggesting that these two small proteins are required for activity of the transporter.
feoC
was found to encode a protein that interacts with the cytoplasmic domain of FeoB, as determined using the BACTH bacterial two-hybrid system. Two conserved amino acids in FeoC were found to be necessary for the interaction with FeoB in the two-hybrid assay, and when either of these amino acids was mutated in the context of the entire
feo
operon, iron acquisition via Feo was reduced. No interaction of FeoA with FeoB or FeoC was detected in the BACTH two-hybrid assay.
Physiological and Transcriptional Responses to Osmotic Stress of Two Pseudomonas syringae Strains That Differ in Epiphytic Fitness and Osmotolerance
Authors: Freeman Brian C. , Chen Chiliang , Yu Xilan , Nielsen Lindsey , Peterson Kelly , Beattie Gwyn A.
Published: August 2013

The foliar pathogenPseudomonas syringaeis a useful model for understanding the role of stress adaptation in leaf colonization. We investigated the mechanistic basis of differences in the osmotolerance of twoP. syringaestrains, B728a and DC3000. Consistent with its higher survival rates following inoculation onto leaves, B728a exhibited superior osmotolerance over DC3000 and higher rates of uptake of plant-derived osmoprotective compounds. A global transcriptome analysis of B728a and DC3000 following an osmotic upshift demonstrated markedly distinct responses between the strains; B728a showed primarily upregulation of genes, including components of the type VI secretion system (T6SS) and alginate biosynthetic pathways, whereas DC3000 showed no change or repression of orthologous genes, including downregulation of the T3SS. DC3000 uniquely exhibited improved growth upon deletion of the biosynthetic genes for the compatible soluteN-acetylglutaminylglutamine amide (NAGGN) in a minimal medium, due possibly to NAGGN synthesis depleting the cellular glutamine pool. Both strains showed osmoreduction ofglnA1expression, suggesting that decreased glutamine synthetase activity contributes to glutamate accumulation as a compatible solute, and both strains showed osmoinduction of 5 of 12 predicted hydrophilins. Collectively, our results demonstrate that the superior epiphytic competence of B728a is consistent with its strong osmotolerance, a proactive response to an osmotic upshift, osmoinduction of alginate synthesis and the T6SS, and resiliency of the T3SS to water limitation, suggesting sustained T3SS expression under the water-limited conditions encountered during leaf colonization.
Vancomycin dosing in children: what is the question?
Authors: Cole Theresa S , Riordan Andrew
Published: August 2013

Vancomycin has been in clinical use for over 60 years, but it is still not clear what dose should be given to children. Effective treatment with vancomycin requires a serum concentration well above the minimum inhibitory concentration (MIC) of the bacteria being treated. This is predicted by the area under the concentration curve (AUC) divided by the MIC being >400 (AUC/MIC). Recent concerns about increasing MIC in staphylococci have lead to recommendations to aim for higher trough vancomycin levels (15–20 mg/L). In current practice, most children do not achieve these trough levels. Modelling and pharmacokinetic studies in children suggest these trough levels may not be necessary if the MIC of the organisms is 1 mg/L or less. Further, large-scale studies are needed to determine the most appropriate dosing of vancomycin in children. While awaiting these, it is time to consider moving to 15 mg/kg 6 h as a standard starting regime for vancomycin. It is also vital to determine the MIC of the organism being treated, as this may give some guidance about suitable trough levels to be aimed for. There is currently little evidence to guide the use of loading doses or continuous vancomycin infusions in children.
Sphenoidal sinus mucocele presenting with acute visual loss in a scuba diver
Authors: Mowatt Lizette , Foster Tecah
Published: August 2013

A 43-year-old male scuba diver presented with an acute history of painful unilateral visual loss after scuba diving. He had right-sided retrobulbar pain and headache. He was known to have sinusitis and had transient visual loss in two previous episodes after scuba diving. His visual acuity was hand motions and 20/20 in the right and left eye, respectively. There was no proptosis. He had a right relative afferent pupillary defect. Colour vision was normal in the left eye and absent in the right eye. Fundal examination revealed healthy discs and macula bilaterally. He was assessed as a right optic neuropathy, possibly secondary to compression. An MRI of the brain revealed a large sphenoidal mucocele extending into the right optic foramen. He was treated with oral steroids, antibiotics and nasal decongestants. He underwent endoscopic intranasal sphenoidectomy and marsupialisation with return of his visual acuity to 20/25 in that eye.
Fusobacterium necrophorum:a rare cause of hepatic abscess in an immunocompetent individual
Authors: Fatakhov Eduard , Patel Maharsh K , Santha Savini , Koch Christopher F
Published: August 2013

In the present case a 30-year-old African American man was admitted with fever and chills secondary to two large hepatic abscesses diagnosed on an ultrasound. The patient was started on antibiotics after blood cultures were drawn. Initially the abscess was drained and showed dramatic improvement upon repeat imaging. The blood cultures revealed Gram-negative rods that were identified asFusobacterium necrophorum. At that time the patient was switched to levofloxacin and metronidazole based on sensitivities. On this new antibiotic regime the patient improved dramatically. After just 5 days the patient was discharged home on oral antibiotics and was scheduled to follow-up in 1 week. In the present case we present a healthy 30-year-old man with no significant co-morbidities who developed a hepatic abscess fromF necrophorumbut successfully recovered after appropriate antibiotic treatment.
Sports participation of individuals with major upper limb deficiency
Authors: Bragaru Mihai , Dekker Rienk , Dijkstra Pieter U , Geertzen Jan H B , van der Sluis Corry K
Published: August 2013

Background

The aim of this study was to analyse sports participation of individuals with upper limb deficiency (ULD) and associated factors.

Methods

Individuals with ULD originating from the Netherlands were invited, via their attending physiatrist or prosthetist, to answer a digital or paper questionnaire. The questionnaire consisted of 34 items related to personal characteristics, type of deficiency and participation in sports.

Results

Of the 175 respondents, 57% participated in sports for at least 60 min/week (athletes). Results of logistic regression analyses indicated that the presence of an additional health problem hindering sports participation (β=−1.31, p<0.001) and a more proximal onset of the limb deficiency (β=0.76, p=0.022) had a negative influence on sports participation. For individuals with an acquired ULD, a medium education level (β=0 0.77, p=0.108) and participation in sports before their amputation (β=1.11, p=0.007) had a positive influence on sports participation. The desire to stay healthy and the pleasure derived from sports participation represented the main reasons for participation in sports according to athletes. The presence of an additional medical problem and a lack of motivation were reasons for non-athletes to not participate in sports.

Conclusions

The majority of individuals with ULD participate in sports regularly. The presence of an additional medical problem, as well as the level of ULD, educational level and participation in sports before amputation, was related to participation in sports.
Body composition in sport: interobserver reliability of a novel ultrasound measure of subcutaneous fat tissue
Authors: Müller Wolfram , Horn Martin , Fürhapter-Rieger Alfred , Kainz Philipp , Kröpfl Julia M , Ackland Timothy R , Lohman Timothy G , Maughan Ronald J , Meyer Nanna L , Sundgot-Borgen Jorunn , Stewart Arthur D , Ahammer Helmut
Published: August 2013

Background

Very low body mass, extreme mass changes, and extremely low per cent body fat are becoming increasingly common in many sports, but sufficiently reliable and accurate field methods for body composition assessment in athletes are missing.

Methods

Nineteen female athletes were investigated (mean (SD) age: 19.5 (±3.3) years; body mass: 59.6 (±7.6) kg; height: 1.674 (±0.056) m; BMI: 21.3 (±2.3) kg/m2). Three observers applied diagnostic B-mode-ultrasound (US) combined with the evaluation software for subcutaneous adipose tissue measurements at eight ISAK sites (International Society for the Advancement of Kinanthrometry). Regression and reliability analyses are presented.

Results

US measurements and evaluation of subcutaneous adipose tissue (SAT) thicknesses (including fibrous structures: Dincluded; n=378) resulted in an SE of estimate SEE=0.60 mm, R2=0.98 (p<0.001), limit of agreement LOA=1.18, ICC=0.968 (0.957–0.977). Similar values were found for Dexcluded: SEE=0.68 mm, R2=0.97 (p<0.001). Dincludedat individual ISAK sites: atbiceps, R2=0.87 and intraclass-correlation coefficient ICC=0.811 were lowest and SEE=0.79 mm was highest. Values at all other sites ranged from R2: 0.94–0.99, SEE: 0.42–0.65 mm, and ICC: 0.917–0.985. Interobserver coefficients ranged from 0.92 to 0.99, except forbiceps(0.74, 0.83 and 0.87). Evaluations of 20 randomly selected US images by three observers (Dincluded) resulted in: SEE=0.15 mm, R2=0.998(p<0.001), ICC=0.997 (0.993, 0999).

Conclusions

Subject to optimal choice of sites and certain standardisations, US can offer a highly reliable field method for measurement of uncompressed thickness of the SAT. High accuracy and high reliability of measurement, as obtained with this US approach, are essential for protection of the athlete’s health and also for optimising performance.
NCAA concussion education in ice hockey: an ineffective mandate
Authors: Kroshus Emily , Daneshvar Daniel H , Baugh Christine M , Nowinski Christopher J , Cantu Robert C
Published: August 2013

Background/aim

Despite concussion education being increasingly mandated by states and sports leagues, there has been limited evaluation of what education is in fact effective. The National Collegiate Athletic Association (NCAA) currently mandates that institutions provide concussion education, without specifying content or delivery. The present study evaluated the effectiveness of this general mandate, as enacted for male collegiate ice hockey teams within one conference of competition.

Methods

In a prospective cohort design, 146 players from 6 male collegiate ice hockey teams in one Division 1 conference completed written surveys before and after receiving their institution-determined concussion education. Knowledge, attitudes, perceived norms and behavioural intention were assessed using validated measures. Education content and delivery was assessed by open-ended responses and consultation with team athletic trainers.

Results

All teams received concussion education material; however, content and delivery varied. Rates of material recall differed by delivery format. Considering all teams together, there were no significant improvements in knowledge and only a very small decrease in intention to continue playing while experiencing symptoms of a concussion. Pre-education and post-education, there were significant between-team differences in attitudes towards concussion reporting and behavioural intention.

Conclusions

The NCAA's general education mandate was divergently enacted; it did not significantly change the constructs of interest nor did it mitigate the pre-education team differences in these constructs. Existing educational materials should be evaluated, theory and evidence-driven materials developed, and mandates extended to, at a minimum, recommend materials found to be effective in changing concussion-reporting behaviour.
Incidence and clinical presentation of groin injuries in sub-elite male soccer
Authors: Hölmich Per , Thorborg Kristian , Dehlendorff Christian , Krogsgaard Kim , Gluud Christian
Published: August 2013

Background

Groin injuries cause major problems in the football codes, as they are prevalent and lead to prolonged symptoms and high recurrence. The aim of the present study was to describe the occurrence and clinical presentation of groin injuries in a large cohort of sub-elite soccer players during a season.

Methods

Physiotherapists allocated to each of the participating 44 soccer clubs recorded baseline characteristics and groin injuries sustained by a cohort of 998 sub-elite male soccer players during a full 10-month season. All players with groin injuries were examined using the clinical entity approach, which utilises standardised reproducible examination techniques to identify the injured anatomical structures. The exposure time and the injury time were also recorded. Injury time was analysed using multiple regression on the log of the injury times as the data were highly skewed. Effects are thus reported at relative injury time (RIT).

Results

Adductor-related groin injury was the most common entity found followed by iliopsoas-related and abdominal-related injuries. The dominant leg was significantly more often injured. Age and previous groin injury were significant risk factors for sustaining a groin injury. Groin injuries were generally located on the same side as previously reported groin injuries. Adductor-related injuries with no abdominal pain had significantly longer injury times compared to injuries with no adductor and no abdominal pain (RIT 2.28, 95% CI 1.22 to 4.25, p=0.0096). Having both adductor and abdominal pain also increased the injury time significantly when compared to injuries with no adductor and no abdominal pain (RIT=4.56, 95% CI 1.91 to 10.91, p=0.001).

Conclusion

Adductor-related groin injury was the most common clinical presentation of groin injuries in male soccer players and the cause of long injury time, especially when combined with abdominal-related injury.
Ulcer healing time and antibiotic treatment before and after the introduction of the Registry of Ulcer Treatment: an improvement project in a national quality registry in Sweden
Authors: Öien Rut F , Forssell Henrik W
Published: August 2013

Objectives

To investigate changes in ulcer healing time and antibiotic treatment in Sweden following the introduction of the Registry of Ulcer Treatment (RUT), a national quality registry, in 2009.

Design

A statistical analysis of RUT data concerning the healing time and antibiotic treatment for patients with hard-to-heal ulcers in Sweden between 2009 and 2012.

Setting

RUT is a national web-based quality registry used to capture areas of improvement in ulcer care and to structure wound management by registering patients with hard-to-heal leg, foot and pressure ulcers. Registration includes variables such as gender, age, diagnosis, healing time, antibiotic treatment, and ulcer duration and size.

Population

Every patient with a hard-to-heal ulcer registered with RUT between 2009 and 2012 (n=1417) was included.

Main outcome measures

Statistical analyses were performed using Stata V.12.1. Healing time was assessed with the Kaplan-Meier analysis and adjustment was made for ulcer size. A log-rank test was used for equality of survivor functions.

Results

According to the adjusted registry in December 2012, patients’ median age was 80 years (mean 77.5 years, range 11–103 years). The median healing time for all ulcers, adjusted for ulcer size, was 146 days (21 weeks) in 2009 and 63 days (9 weeks) in 2012 (p=0.001). Considering all years between 2009 and 2012, antibiotic treatment for patients with hard-to-heal ulcers was reduced from 71% before registration to 29% after registration of ulcer healing (p=0.001).

Conclusions

Healing time and antibiotic treatment decreased significantly during 3 years after launch of RUT.
IL-6 pathway-driven investigation of response to IL-6 receptor inhibition in rheumatoid arthritis
Authors: Wang Jianmei , Platt Adam , Upmanyu Ruchi , Germer Søren , Lei Guiyuan , Rabe Christina , Benayed Ryma , Kenwright Andrew , Hemmings Andrew , Martin Mitchell , Harari Olivier
Published: August 2013

Objectives

To determine whether heterogeneity in interleukin-6 (IL-6), IL-6 receptor and other components of the IL-6 signalling pathway/network, at the gene, transcript and protein levels, correlate with disease activity in patients with rheumatoid arthritis (RA) and with clinical response to tocilizumab.

Design

Biomarker samples and clinical data for five phase 3 trials of tocilizumab were analysed using serum (3751 samples), genotype (927 samples) and transcript (217 samples) analyses. Linear regression was then used to assess the association between these markers and either baseline disease activity or treatment response.

Results

Higher baseline serum IL-6 levels were significantly associated (p<0.0001) with higher baseline DAS28, erythrocyte sedimentation rate, C reactive protein and Health Assessment Questionnaire in patients whose responses to disease-modifying antirheumatic drugs (DMARD-IR) and to antitumour necrosis factor (aTNF-IR) were inadequate and patients who were naive/responders to methotrexate (MTX). Higher baseline serum IL-6 levels were also significantly associated with better clinical response to tocilizumab (versus placebo) measured by cDAS28 in the pooled DMARD-IR (p<0.0001) and MTX-naive populations (p=0.04). However, the association with treatment response was weak. A threefold difference in baseline IL-6 level corresponded to only a 0.17-unit difference in DAS28 at week 16. IL-6 pathway single nucleotide polymorphisms and RNA levels also were not strongly associated with treatment response.

Conclusions

Our analyses illustrate that the biological activity of a disease-associated molecular pathway may impact the benefit of a therapy targeting that pathway. However, the variation in pathway activity, as measured in blood, may not be a strong predictor. These data suggest that the major contribution to variability in clinical responsiveness to therapeutics in RA remains unknown.
Effects of a team-based assessment and intervention on patient safety culture in general practice: an open randomised controlled trial
Authors: Hoffmann B , Müller V , Rochon J , Gondan M , Müller B , Albay Z , Weppler K , Leifermann M , Mießner C , Güthlin C , Parker D , Hofinger G , Gerlach F M
Published: August 2013

Background

The measurement of safety culture in healthcare is generally regarded as a first step towards improvement. Based on a self-assessment of safety culture, the Frankfurt Patient Safety Matrix (FraTrix) aims to enable healthcare teams to improve safety culture in their organisations. In this study we assessed the effects of FraTrix on safety culture in general practice.

Methods

We conducted an open randomised controlled trial in 60 general practices. FraTrix was applied over a period of 9 months during three facilitated team sessions in intervention practices. At baseline and after 12 months, scores were allocated for safety culture as expressed in practice structure and processes (indicators), in safety climate and in patient safety incident reporting. The primary outcome was the indicator error management.

Results

During the team sessions, practice teams reflected on their safety culture and decided on about 10 actions per practice to improve it. After 12 months, no significant differences were found between intervention and control groups in terms of error management (competing probability=0.48, 95% CI 0.34 to 0.63, p=0.823), 11 further patient safety culture indicators and safety climate scales. Intervention practices showed better reporting of patient safety incidents, reflected in a higher number of incident reports (mean (SD) 4.85 (4.94) vs 3.10 (5.42), p=0.045) and incident reports of higher quality (scoring 2.27 (1.93) vs 1.49 (1.67), p=0.038) than control practices.

Conclusions

Applied as a team-based instrument to assess safety culture, FraTrix did not lead to measurable improvements in error management. Comparable studies with more positive results had less robust study designs. In future research, validated combined methods to measure safety culture will be required. In addition, more attention should be paid to evaluation of process parameters. Implemented actions and incident reporting may be more appropriate target endpoints.

Trial registration

German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS) No. DRKS00000145
Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents
Authors: Reilly James B , Ogdie Alexis R , Von Feldt Joan M , Myers Jennifer S
Published: August 2013

Background

Trends in medical education have reflected the patient safety movement's initial focus on systems. While the role of cognitive-based diagnostic errors has been increasingly recognised among safety experts, literature describing strategies to teach about this important problem is scarce.

Methods

48 PGY-2 internal medicine residents participated in a three-part, 1-year curriculum in cognitive bias and diagnostic error. Residents completed a multiple-choice test designed to assess the recognition and knowledge of common heuristics and biases both before and after the curriculum. Results were compared with PGY-3 residents who did not receive the curriculum. An additional assessment in which residents reviewed video vignettes of clinical scenarios with cognitive bias and debiasing techniques was embedded into the curriculum.

Results

38 residents completed all three parts of the curriculum and completed all assessments. Performance on the 13-item multiple-choice knowledge test improved post-curriculum when compared to both pre-curriculum performance (9.26 vs 8.26, p=0.002) and the PGY-3 comparator group (9.26 vs 7.69, p<0.001). All residents correctly identified at least one cognitive bias and proposed at least one debiasing strategy in response to the videos.

Conclusions

A longitudinal curriculum in diagnostic error and cognitive bias improved internal medicine residents’ knowledge and recognition of cognitive biases as measured by a novel assessment tool. Further study is needed to refine learner assessment tools and examine optimal strategies to teach clinical reasoning and cognitive bias avoidance strategies.
Determinants of assault-related violence in the community: potential for public health interventions in hospitals
Authors: Ramsay S E , Bartley A , Rodger A J
Published: August 2013

Background

Data from emergency departments (EDs) in England describe the epidemiology of violent assaults. However, the potential of such data to inform hospital-based public health interventions remains unknown.

Objective

To identify determinants of assaults using ED data to inform development of programmes delivered in acute Trusts for reducing assault-related injuries in the community.

Methods

Data were collected from a large North London acute Trust on assault-related injuries reporting to A&E over 18 months (July 2010–February 2012). Information was recorded on patient demographics and assaults (place of assault, type of assault, relation to assailant) through questionnaires administered by ED reception staff.

Results

1210 assaults were recorded between July 2010 and February 2012. 18% of assaults were severe (strangling, stabbings, sexual assaults). 75% of assault victims were men, 37% were young adults (20–30 years) and 15% were teenagers. A higher proportion of victims lived in more deprived areas. Apart from public streets (48%), the main location of assaults was at home (20%). Female compared with male victims were significantly more likely to be both assaulted at home (OR 6.13; 95% CI 4.41 to 8.54) and to be assaulted by a known assailant (family member, friend, partner/ex-partner; OR 8.20, 95% CI 5.85 to 11.48).

Conclusions

The results highlight the notable contribution of domestic violence to assaults presenting to hospital ED. Such findings can be used to plan interventions such as screening hospital patients for domestic violence. ED data have the potential to inform hospital-based initiatives to address issues such as assaults in the local population.
Controlling for exposure changes the relationship between ethnicity, deprivation and injury: an observational study of child pedestrian injury rates in London
Authors: Steinbach Rebecca , Edwards Phil , Green Judith
Published: August 2013

Background

Research has suggested that inequalities in risk exposure may help explain identified ethnic inequalities in child pedestrian injury risk. However, addressing risk exposure in epidemiological research presents theoretical and methodological challenges. This article conceptualises the risk of child pedestrian injury as related to both exposure levels (the quantity of time children spend as pedestrians) and the probability of a hazard where that exposure takes place (the quality of the road environment).

Objective

To investigate the sensitivity of results on ethnic inequalities in child pedestrian injury risk in London to control for exposure and hazard levels.

Methods

Using police records of injury 2000–2009, we modelled the relationship between ethnicity, deprivation and child pedestrian injury rates in London using characteristics of the road environment to control for hazard levels and restricting the analysis to the time of the weekday morning commute (7.00–9.00 am), when most children must make a journey to school, to control for exposure levels.

Results

Controlling for risk exposure in this way fundamentally changed the nature of the relationship between ethnicity, deprivation and child pedestrian injury. During the time of the morning commute to school, ‘Black’ children were found to have higher pedestrian injury rates in the least-deprived areas.

Conclusions

To inform effective strategies for reducing injury inequality, it is vital that exposure to risk is both acknowledged and considered.
Evaluation of a school-based violence prevention media literacy curriculum
Authors: Fingar Kathryn R , Jolls Tessa
Published: August 2013

Purpose

Evaluate whetherBeyond Blame, a violence prevention media literacy curriculum, is associated with improved knowledge, beliefs and behaviours related to media use and aggression.

Methods

Using a quasi-experimental design, from 2007 to 2008, teachers from schools across Southern California administered the curriculum with or without training or served as controls. Students were tested before and after the curriculum was implemented, and during the fall semester of the next academic year. Multivariate hierarchical regression was used to compare changes from baseline to follow-up between the intervention and control groups.

Results

Compared with controls, at the first post-test, students in the trained and untrained groups reported increased knowledge of five core concepts/key questions of media literacy, increased self-rated exposure to media violence, as well as stronger beliefs that media violence affects viewers and that people can protect themselves by watching less. Regarding behaviours, controls were more likely to report ≥8 h of media consumption at the second post-test than at baseline (OR=2.11; 95% CI 1.13 to 3.97), pushing or shoving another student (OR=2.16; 95% CI 1.16 to 4.02) and threatening to hit or hurt someone (OR=2.32; 95% CI 1.13 to 4.78). In comparison, there was no increase in these behaviours in the trained and untrained groups.

Conclusions

This study suggests media literacy can be feasibly integrated into schools as an approach to improving critical analysis of media, media consumption and aggression. Changing the way youth engage media may impact many aspects of health, and an important next step will be to apply this framework to other topics.
A new proxy measure for state-level gun ownership in studies of firearm injury prevention
Authors: Siegel Michael , Ross Craig S , King Charles
Published: August 2013

Since many states are considering gun control laws, researchers need reliable data on rates of gun ownership at the state level. Survey measures of gun ownership in all 50 states, however, are only available for 3 years, and no state-level data have been collected since 2004. Consequently, the National Research Council has declared the development of a valid proxy that can be constructed from accessible, annual, state-level data to be a priority. While such a proxy does exist (the proportion of suicides in a state committed using a gun (FS/S), its correlation with state estimates of gun ownership in recent years is only 0.80. Using state-level data for the years 2001, 2002 and 2004, we developed an improved proxy for state-level gun ownership that uses FS/S (firearm suicides divided by all suicides) and also the per capita number of hunting licenses. We validated this measure using data from surveys of gun ownership conducted in 48 states during 1996 and 1999, and in 21 states during 1995–1998. Adding per capita hunting licenses to the proxy increased its correlation with survey-measured gun ownership from 0.80 to 0.95. The correlations of the new proxy with gun ownership in the two validation studies were 0.95 and 0.97. We conclude that the combination of FS/S and per capita hunting licenses improves substantially upon FS/S alone. This new proxy is easily computed from data that are available annually by state and may be useful for investigating the effect of gun prevalence on firearm-related morbidity and mortality.
Longitudinal study of correlates of modern contraceptive use and impact of HIV care programmes among HIV concordant and serodiscordant couples in Rakai, Uganda
Authors: Brahmbhatt Heena , Makumbi Fredrick , Lutalo Tom , Sekasanvu Joseph , Serwadda David , Wawer Maria J , Gray Ronald H
Published: August 2013

Objective

To assess trends and determinants of family planning use and impact of HIV serostatus among couples.

Methods

Couples’ data were retrospectively linked from cohort surveys in Rakai, Uganda between 1999 and 2011, and were classified by HIV status as concordant (M+F+/M−F−) or serodiscordant (M−F+/M+F−). HIV care (HIVC) was grouped into three periods, pre-antiretroviral therapy (pre-HIVC) (<2004), HIVC roll-out (2005–2007) and HIVC scale-up (≥2008). Trends in couple contraceptive use were assessed by chi-square test (χ2) for trend, and multinomial logistic regression was used to estimate adjusted odds ratios (ORs) of predictors of contraceptive use.

Results

A toal of 6139 couples contributed 13 709 observations. Hormonal contraception (HC) use increased over time from 22.9% to 33.9%,p<0.001), with significant increases among M−F− (23.2% to 34.8%,p<0.0001) and M+F+ (20.8% to 32.2%,p=0.0005), but not serodiscordant couples. Condom use significantly increased among M+F+ (30.3% to 48.0%,p<0.001) and serodiscordant couples (24.2% to 48.7%,p<0.001), but not among M−F− couples. Dual use of HC and condoms increased over time, irrespective of HIV status. Factors associated with increases in contraceptive use were: higher education, co-resident children, male non-marital relationship and scaled-up HIVC phase. Enrolment into HIVC was associated with increased HC and condom use among HIV+ concordant [adjusted OR (adjOR)=3.03; 95% confidence interval (CI) 1.69–5.44 and adjOR=4.46, 95% CI 2.53–7.86, respectively], and serodiscordant couples (adjOR=2.21; 95% CI 1.25–3.92 and adjOR=4.75; 95% CI 2.89–7.82, respectively).

Conclusions

Use of modern contraception and dual method use increased over time, particularly after enrolment into HIVC. Integration of HIV and reproductive health services is critical for prevention of unwanted pregnancies and HIV infection.
Safety and predictors of aneurysm retreatment for remnant intracranial aneurysm after initial endovascular embolization
Authors: Teleb Mohamed S , Pandya Dhruvil J , Castonguay Alicia C , Eckardt Gerald , Sweis Rochelle , Lazzaro Marc A , Issa Mohammed A , Fitzsimmons Brian-Fred , Lynch John R , Zaidat Osama O
Published: August 2013

Introduction

Aneurysmal subarachnoid hemorrhage (SAH) is a rare but devastating form of stroke. Endovascular therapy has been criticized for its higher rate of recanalization and retreatment. The safety and predictors of retreatment are unknown. We report the clinical outcomes, imaging outcomes and predictors for aneurysm retreatment after initial endovascular embolization.

Method

We identified patients who underwent endovascular retreatment from July 2005 through November 2011. Aneurysm and patient data were collected. Periprocedural complications were reported as intraoperative perforation (IOP) or thromboembolic event (TEE). Aneurysm and patient characteristics were compared between aneurysms requiring retreatment and those not requiring retreatment to evaluate aneurysm retreatment predictors.

Results

A total of 111/871 (13%) aneurysms underwent retreatment. Two (0.2%) were retreated for recurrent acute SAH, 82 (74%) aneurysms were located in the anterior circulation, 47 (42%) required stent and 5 (5%) required balloon assist during retreatment. There were a total of 5 (5%) IOP and 6 (5%) TEE from which 2 (2%) and 1 (1%) were symptomatic, respectively. Overall symptomatic events rate were 2.7%. Patients were followed up for an average of 15±14 months. Seven (0.8%) aneurysms required a second retreatment without any recurrent SAH. Multivariable analysis revealed an OR for aneurysms requiring retreatment of 2.965 for aneurysms presenting as aneurysmal SAH, 1.791 for aneurysms in the posterior circulation and 1.053 for aneurysms with large dome size.

Conclusions

Aneurysm retreatment is a safe option without a significant increase in morbidity or mortality. SAH, posterior circulation aneurysms and larger aneurysm dome size are predictors of aneurysms requiring retreatment.
A cross‐sectional study of mental health in UK veterinary undergraduates
Authors: Cardwell J. M. , Lewis E. G. , Smith K. C. , Holt E. R. , Baillie S. , Allister R. , Adams V. J.
Published: August 2013

Wellbeing (positive mental health) and mental ill‐health of veterinary students from a single UK school were quantified using validated psychological scales. Attitudes towards mental ill‐health and suicide were also assessed. Results were compared with published data from the UK general population and veterinary profession. Of the total student population (N=1068), 509 (48 per cent) completed a questionnaire. Just over half (54 per cent) of the respondents had ever experienced mental ill‐health, with the majority reporting a first occurrence before veterinary school. Student wellbeing was significantly poorer (p<0.0001) than general population estimates, but not significantly different (p=0.2) from veterinary profession estimates. Degree of mental distress in students was significantly higher than in the general population (p<0.0001). Despite the majority (94 per cent) agreeing that ‘Anyone can suffer from mental health problems’, students were significantly more likely than members of the general population to agree that ‘If I were suffering from mental health problems, I wouldn't want people knowing about it’ (p<0.0001). Students were more likely to have thought about suicide, but less likely to have made an attempt (p<0.001; p=0.005), than members of the general population. The possibility of non‐response bias must be considered when interpreting findings. However, strong similarities between results from this study population and the UK veterinary profession, as well as other veterinary student populations internationally, suggest no substantial school‐level bias.
HOMOGENEOUS EINSTEIN METRICS ON GENERALIZED FLAG MANIFOLDS WITH FIVE ISOTROPY SUMMANDS
Authors: ARVANITOYEORGOS ANDREAS , CHRYSIKOS IOANNIS , SAKANE YUSUKE
Published: August 2013

We construct the homogeneous Einstein equation for generalized flag manifolds G/K of a compact simple Lie group G whose isotropy representation decomposes into five inequivalent irreducible Ad (K)-submodules. To this end, we apply a new technique which is based on a fibration of a flag manifold over another such space and the theory of Riemannian submersions. We classify all generalized flag manifolds with five isotropy summands, and we use Gröbner bases to study the corresponding polynomial systems for the Einstein equation. For the generalized flag manifolds E6/(SU(4) × SU(2) × U(1) × U(1)) and E7/(U(1) × U(6)) we find explicitly all invariant Einstein metrics up to isometry. For the generalized flag manifolds SO (2ℓ + 1)/( U (1) × U (p) × SO (2(ℓ - p - 1) + 1)) and SO (2ℓ)/( U (1) × U (p) × SO (2(ℓ - p - 1))) we prove existence of at least two non-Kähler–Einstein metrics. For small values of ℓ and p we give the precise number of invariant Einstein metrics.
SEMANTIC COMPUTING AND BUSINESS INTELLIGENCE
Authors: KIM JENNIFER , OSTROWSKI DAVID A. , YAMAGUCHI HIROSHI , SHEU PHILLIP C.-Y.
Published: August 2013

With rapidly expanding data collections becoming increasingly available, the application of Semantic Computing has become imperative to leverage this resource for industrial applications. This paper presents a survey of Semantic Computing in the area of Business Intelligence. We examine semantic analytical techniques and tools as applied for prediction analysis and decision support. We also define the role of Semantic Computing as applied in the context of Data Mining, Text Mining and Big Data Analytics. Additionally, we describe how business data is queried with Structured Natural Language as well as the use of On-Line Analytic Processing.
A COUNTEREXAMPLE TO GUILLEMIN'S ZOLLFREI CONJECTURE
Authors: SUHR STEFAN
Published: August 2013

We construct Zollfrei Lorentzian metrics on every non-trivial orientable circle bundle over an orientable closed surface. Further we prove a weaker version of Guillemin's conjecture assuming global hyperbolicity of the universal cover.