bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic Polymorphism and Zoonotic Potential of
Enterocytozoon bieneusi
from Nonhuman Primates in China
Authors: Karim Md Robiul , Wang Rongjun , Dong Haiju , Zhang Longxian , Li Jian , Zhang Sumei , Rume Farzana Islam , Qi Meng , Jian Fuchun , Sun Mingfei , Yang Guangyou , Zou Fengcai , Ning Changshen , Xiao Lihua
Published: January 2014

Enterocytozoon bieneusi
is an important zoonotic pathogen. To assess the human-infective potential of
E. bieneusi
in nonhuman primates (NHPs), we examined the prevalence and genotype distribution of
E. bieneusi
in 23 NHP species by PCR and sequence analysis of the ribosomal internal transcribed spacer (ITS). A total of 1,386 fecal specimens from NHPs from five provinces in China were examined, and
E. bieneusi
was detected in 158 (11.4%) specimens from five NHP species, including cynomolgus monkey (67.7%), rhesus macaque (8.8%), Japanese macaque (33.3%), white-headed langur (13.6%), and golden snub-nosed monkey (3.5%) (
P
< 0.0001). The infection rates were 70.2%, 21.5%, 8.5%, 7.5%, and 5.6% in Guangdong, Yunnan, Guangxi, Henan, and Sichuan Provinces, respectively (
P
< 0.0001). The prevalence was significantly higher in captive (13.7%) than in free-range (5.0%) animals (
P
< 0.0001). Altogether, 16 ITS genotypes were observed, including nine known genotypes (IV, D, Henan V, Peru8, PigEBITS7, EbpC, Peru11, BEB6, and I) and seven new genotypes (CM1 to CM7). The common genotypes included CM1, IV, and D, which were detected in 43, 31, and 30 specimens, respectively. Phylogenetic analysis revealed that seven known genotypes (but not BEB6 and I) and four new genotypes (CM1, CM2, CM3, and CM6) belonged to the previously described group 1 with zoonotic potential. Genotypes CM5 and CM7 clustered with group 2, whereas genotype CM4 did not belong to any of the previously proposed groups. It was concluded that humans and NHPs residing in the same geographical location shared the same
E. bieneusi
genotypes, indicating a potential role of these animals in the zoonotic transmission of
E. bieneusi
.
Triacylglyceride Production and Autophagous Responses in Chlamydomonas reinhardtii Depend on Resource Allocation and Carbon Source
Authors: Davey Matthew P. , Horst Irmtraud , Duong Giang-Huong , Tomsett Eleanor V. , Litvinenko Alexander C. P. , Howe Christopher J. , Smith Alison G.
Published: January 2014

To improve the economic viability of microalgal biodiesel, it will be essential to optimize the productivity of fuel molecules such as triacylglyceride (TAG) within the microalgal cell. To understand some of the triggers required for the metabolic switch to TAG production, we studied the effect of the carbon supply (acetate or CO
2
) in
Chlamydomonas reinhardtii
(wild type and the starchless
sta6
mutant) grown under low N availability. As expected, initial rates of TAG production were much higher when acetate was present than under strictly photosynthetic conditions, particularly for the
sta6
mutant, which cannot allocate resources to starch. However, in both strains, TAG production plateaued after a few days in mixotrophic cultures, whereas under autotrophic conditions, TAG levels continued to rise. Moreover, the reduced growth of the
sta6
mutant meant that the greatest productivity (measured as mg TAG liter
−1
day
−1
) was found in the wild type growing autotrophically. Wild-type cells responded to low N by autophagy, as shown by degradation of polar (membrane) lipids and loss of photosynthetic pigments, and this was less in cells supplied with acetate. In contrast, little or no autophagy was observed in
sta6
mutant cells, regardless of the carbon supply. Instead, very high levels of free fatty acids were observed in the
sta6
mutant, suggesting considerable alteration in metabolism. These measurements show the importance of carbon supply and strain selection for lipid productivity. Our findings will be of use for industrial cultivation, where it will be preferable to use fast-growing wild-type strains supplied with gaseous CO
2
under autotrophic conditions rather than require an exogenous supply of organic carbon.
Role for Mycobacterium tuberculosis Membrane Vesicles in Iron Acquisition
Authors: Prados-Rosales Rafael , Weinrick Brian C. , Piqué Daniel G. , Jacobs William R. , Casadevall Arturo , Rodriguez G. Marcela
Published: January 2014

Mycobacterium tuberculosis
releases membrane vesicles packed with molecules that can modulate the immune response. Because environmental conditions often influence the production and content of bacterial vesicles, this study examined
M. tuberculosis
microvesicles released under iron limitation, a common condition faced by pathogens inside the host. The findings indicate that
M. tuberculosis
increases microvesicle production in response to iron restriction and that these microvesicles contain mycobactin, which can serve as an iron donor and supports replication of iron-starved mycobacteria. Consequently, the results revealed a role of microvesicles in iron acquisition in
M. tuberculosis
, which can be critical for survival in the host.
Lipoteichoic Acids, Phosphate-Containing Polymers in the Envelope of Gram-Positive Bacteria
Authors: Schneewind Olaf , Missiakas Dominique
Published: January 2014

Lipoteichoic acids (LTA) are polymers of alternating units of a polyhydroxy alkane, including glycerol and ribitol, and phosphoric acid, joined to form phosphodiester units that are found in the envelope of Gram-positive bacteria. Here we review four different types of LTA that can be distinguished on the basis of their chemical structure and describe recent advances in the biosynthesis pathway for type I LTA,
d
-alanylated polyglycerol-phosphate linked to di-glucosyl-diacylglycerol. The physiological functions of type I LTA are discussed in the context of inhibitors that block their synthesis and of mutants with discrete synthesis defects. Research on LTA structure and function represents a large frontier that has been investigated in only few Gram-positive bacteria.
Global Identification of Genes Affecting Iron-Sulfur Cluster Biogenesis and Iron Homeostasis
Authors: Hidese Ryota , Mihara Hisaaki , Kurihara Tatsuo , Esaki Nobuyoshi
Published: January 2014

Iron-sulfur (Fe-S) clusters are ubiquitous cofactors that are crucial for many physiological processes in all organisms. In
Escherichia coli
, assembly of Fe-S clusters depends on the activity of the iron-sulfur cluster (ISC) assembly and sulfur mobilization (SUF) apparatus. However, the underlying molecular mechanisms and the mechanisms that control Fe-S cluster biogenesis and iron homeostasis are still poorly defined. In this study, we performed a global screen to identify the factors affecting Fe-S cluster biogenesis and iron homeostasis using the Keio collection, which is a library of 3,815 single-gene
E. coli
knockout mutants. The approach was based on radiolabeling of the cells with [2-
14
C]dihydrouracil, which entirely depends on the activity of an Fe-S enzyme, dihydropyrimidine dehydrogenase. We identified 49 genes affecting Fe-S cluster biogenesis and/or iron homeostasis, including 23 genes important only under microaerobic/anaerobic conditions. This study defines key proteins associated with Fe-S cluster biogenesis and iron homeostasis, which will aid further understanding of the cellular mechanisms that coordinate the processes. In addition, we applied the [2-
14
C]dihydrouracil-labeling method to analyze the role of amino acid residues of an Fe-S cluster assembly scaffold (IscU) as a model of the Fe-S cluster assembly apparatus. The analysis showed that Cys37, Cys63, His105, and Cys106 are essential for the function of IscU
in vivo
, demonstrating the potential of the method to investigate
in vivo
function of proteins involved in Fe-S cluster assembly.
Assessment of the Requirements for Magnesium Transporters in Bacillus subtilis
Authors: Wakeman Catherine A. , Goodson Jonathan R. , Zacharia Vineetha M. , Winkler Wade C.
Published: January 2014

Magnesium is the most abundant divalent metal in cells and is required for many structural and enzymatic functions. For bacteria, at least three families of proteins function as magnesium transporters. In recent years, it has been shown that a subset of these transport proteins is regulated by magnesium-responsive genetic control elements. In this study, we investigated the cellular requirements for magnesium homeostasis in the model microorganism
Bacillus subtilis
. Putative magnesium transporter genes were mutationally disrupted, singly and in combination, in order to assess their general importance. Mutation of only one of these genes resulted in strong dependency on supplemental extracellular magnesium. Notably, this transporter gene,
mgtE
, is known to be under magnesium-responsive genetic regulatory control. This suggests that the identification of magnesium-responsive genetic mechanisms may generally denote primary transport proteins for bacteria. To investigate whether
B. subtilis
encodes yet additional classes of transport mechanisms, suppressor strains that permitted the growth of a transporter-defective mutant were identified. Several of these strains were sequenced to determine the genetic basis of the suppressor phenotypes. None of these mutations occurred in transport protein homologues; instead, they affected housekeeping functions, such as signal recognition particle components and ATP synthase machinery. From these aggregate data, we speculate that the
mgtE
protein provides the primary route of magnesium import in
B. subtilis
and that the other putative transport proteins are likely to be utilized for more-specialized growth conditions.
Bacterial Flagellin-Specific Chaperone FliS Interacts with Anti-Sigma Factor FlgM
Authors: Galeva Anna , Moroz Natalia , Yoon Young-Ho , Hughes Kelly T. , Samatey Fadel A. , Kostyukova Alla S.
Published: January 2014

Flagella are extracellular organelles that propel bacteria. Each flagellum consists of a basal body, a hook, and a filament. The major protein of the filament is flagellin. Induction of flagellin gene expression coincides with secretion of FlgM. The role of FlgM is to inhibit FliA (σ
28
), a flagellum-specific RNA polymerase responsible for flagellin transcription. To prevent premature polymerization of newly synthesized flagellin molecules, FliS, the flagellin-specific chaperone, binds flagellin and facilitates its export. In this study, the interaction between FlgM and FliS from
Salmonella enterica
serovar Typhimurium was characterized using gel shift, intrinsic tryptophan fluorescence, circular dichroism, limited proteolysis, and cross-linking. We have demonstrated that (i) FliS and FlgM interact specifically, forming a 1:1 complex, (ii) the FliS binding site on FlgM is proximal to or even overlaps the binding site for FliA, and (iii) FliA competes with FliS for FlgM binding.
Calvin Cycle Mutants of Photoheterotrophic Purple Nonsulfur Bacteria Fail To Grow Due to an Electron Imbalance Rather than Toxic Metabolite Accumulation
Authors: Gordon Gina C. , McKinlay James B.
Published: January 2014

Purple nonsulfur bacteria grow photoheterotrophically by using light for energy and organic compounds for carbon and electrons. Disrupting the activity of the CO
2
-fixing Calvin cycle enzyme, ribulose 1,5-bisphosphate carboxylase (RubisCO), prevents photoheterotrophic growth unless an electron acceptor is provided or if cells can dispose of electrons as H
2
. Such observations led to the long-standing model wherein the Calvin cycle is necessary during photoheterotrophic growth to maintain a pool of oxidized electron carriers. This model was recently challenged with an alternative model wherein disrupting RubisCO activity prevents photoheterotrophic growth due to the accumulation of toxic ribulose-1,5-bisphosphate (RuBP) (D. Wang, Y. Zhang, E. L. Pohlmann, J. Li, and G. P. Roberts, J. Bacteriol. 193:3293-3303, 2011,
http://dx.doi.org/10.1128/JB.00265-11
). Here, we confirm that RuBP accumulation can impede the growth of
Rhodospirillum rubrum
(
Rs. rubrum
) and
Rhodopseudomonas palustris
(
Rp. palustris
) RubisCO-deficient (ΔRubisCO) mutants under conditions where electron carrier oxidation is coupled to H
2
production. However, we also demonstrate that
Rs. rubrum
and
Rp. palustris
Calvin cycle phosphoribulokinase mutants that cannot produce RuBP cannot grow photoheterotrophically on succinate unless an electron acceptor is provided or H
2
production is permitted. Thus, the Calvin cycle is still needed to oxidize electron carriers even in the absence of toxic RuBP. Surprisingly, Calvin cycle mutants of
Rs. rubrum
, but not of
Rp. palustris
, grew photoheterotrophically on malate without electron acceptors or H
2
production. The mechanism by which
Rs. rubrum
grows under these conditions remains to be elucidated.
An Archaeal Glutamate Decarboxylase Homolog Functions as an Aspartate Decarboxylase and Is Involved in β-Alanine and Coenzyme A Biosynthesis
Authors: Tomita Hiroya , Yokooji Yuusuke , Ishibashi Takuya , Imanaka Tadayuki , Atomi Haruyuki
Published: January 2014

β-Alanine is a precursor for coenzyme A (CoA) biosynthesis and is a substrate for the bacterial/eukaryotic pantothenate synthetase and archaeal phosphopantothenate synthetase. β-Alanine is synthesized through various enzymes/pathways in bacteria and eukaryotes, including the direct decarboxylation of Asp by aspartate 1-decarboxylase (ADC), the degradation of pyrimidine, or the oxidation of polyamines. However, in most archaea, homologs of these enzymes are not present; thus, the mechanisms of β-alanine biosynthesis remain unclear. Here, we performed a biochemical and genetic study on a glutamate decarboxylase (GAD) homolog encoded by TK1814 from the hyperthermophilic archaeon
Thermococcus kodakarensis
. GADs are distributed in all three domains of life, generally catalyzing the decarboxylation of Glu to γ-aminobutyrate (GABA). The recombinant TK1814 protein displayed not only GAD activity but also ADC activity using pyridoxal 5′-phosphate as a cofactor. Kinetic studies revealed that the TK1814 protein prefers Asp as its substrate rather than Glu, with nearly a 20-fold difference in catalytic efficiency. Gene disruption of TK1814 resulted in a strain that could not grow in standard medium. Addition of β-alanine, 4′-phosphopantothenate, or CoA complemented the growth defect, whereas GABA could not. Our results provide genetic evidence that TK1814 functions as an ADC in
T. kodakarensis
, providing the β-alanine necessary for CoA biosynthesis. The results also suggest that the GAD activity of TK1814 is not necessary for growth, at least under the conditions applied in this study. TK1814 homologs are distributed in a wide range of archaea and may be responsible for β-alanine biosynthesis in these organisms.
Behavioural activation versus mindfulness-based guided self-help treatment administered through a smartphone application: a randomised controlled trial
Authors: Ly Kien Hoa , Trüschel Anna , Jarl Linnea , Magnusson Susanna , Windahl Tove , Johansson Robert , Carlbring Per , Andersson Gerhard
Published: January 2014

Objectives

Evaluating and comparing the effectiveness of two smartphone-delivered treatments: one based on behavioural activation (BA) and other on mindfulness.

Design

Parallel randomised controlled, open, trial. Participants were allocated using an online randomisation tool, handled by an independent person who was separate from the staff conducting the study.

Setting

General community, with recruitment nationally through mass media and advertisements.

Participants

40 participants diagnosed with major depressive disorder received a BA treatment, and 41 participants received a mindfulness treatment. 9 participants were lost at the post-treatment.

Intervention

BA: An 8-week long behaviour programme administered via a smartphone application. Mindfulness: An 8-week long mindfulness programme, administered via a smartphone application.

Main outcome measures

The Beck Depression Inventory-II (BDI-II) and the nine-item Patient Health Questionnaire Depression Scale (PHQ-9).

Results

81 participants were randomised (mean age 36.0 years (SD=10.8)) and analysed. Results showed no significant interaction effects of group and time on any of the outcome measures either from pretreatment to post-treatment or from pretreatment to the 6-month follow-up. Subgroup analyses showed that the BA treatment was more effective than the mindfulness treatment among participants with higher initial severity of depression from pretreatment to the 6-month follow-up (PHQ-9: F (1, 362.1)=5.2, p<0.05). In contrast, the mindfulness treatment worked better than the BA treatment among participants with lower initial severity from pretreatment to the 6-month follow-up (PHQ-9: F (1, 69.3)=7.7, p<0.01); BDI-II: (F(1, 53.60)=6.25, p<0.05).

Conclusions

The two interventions did not differ significantly from one another. For participants with higher severity of depression, the treatment based on BA was superior to the treatment based on mindfulness. For participants with lower initial severity, the treatment based on mindfulness worked significantly better than the treatment based on BA.

Trial registration

Clinical TrialsNCT01463020.
Effectiveness of a pharmacist-based gout care management programme in a large integrated health plan: results from a pilot study
Authors: Goldfien Robert D , Ng Michele S , Yip Goldie , Hwe Alice , Jacobson Alice , Pressman Alice , Avins Andrew L
Published: January 2014

Objectives

The study objective was to determine the feasibility of using a pharmacist-staffed, protocol-based structured approach to improving the management of chronic, recurrent gout.

Setting

The study was carried out in the outpatient clinic of a single Kaiser Permanente medical centre. This is a community-based clinic.

Participants

We report on 100 consecutive patients between the ages of 21 and 94 (75% men) with chronic or recurrent gout, referred by their primary physicians for the purpose of management of urate-lowering therapy. Patients with stage 5 chronic kidney disease or end-stage kidney disease were excluded.

Interventions

The programme consisted of a trained clinical pharmacist and a rheumatologist. The pharmacist contacted each patient by phone, provided educational and dietary materials, and used a protocol that employs standard gout medications to achieve and maintain a serum uric acid (sUA) level of 6 mg/dL or less. Incident gout flares or adverse reactions to medications were managed in consultation with the rheumatologist.

Primary outcome measure

The primary outcome measure was the achievement and maintenance of an sUA of 6 or less for a period of at least 3 months.

Results

In 95 evaluable patients enrolled in our pilot programme, an sUA of 6 mg/dL or less was achieved and maintained in 78 patients with 4 still in the programme to date. Five patients declined to participate after referral, and another 13 patients did not complete the programme. (The majority of these were due to non-adherence.)

Conclusions

A structured pharmacist-staffed programme can effectively and safely lower and maintain uric acid levels in a high percentage of patients with recurrent gout in a primary care setting. This care model is simple to implement, efficient and warrants further validation in a clinical trial.
To close or not to close? Analysis of 4 year's data from national surveillance of norovirus outbreaks in hospitals in England
Authors: Harris John P , Adak Goutam K , O'Brien Sarah J
Published: January 2014

Objective

To assess the impact of ward or bay closures, specifically, whether prompt closure of an affected ward shortens the duration of norovirus outbreaks and the resulting disruption in hospitals.

Design

Analysis of summary data from hospitals on outbreaks of norovirus from 2009 to 2012.

Methods

Using a large outbreak surveillance dataset, we examined the duration of outbreaks, duration of disruption, ward closures, the number of patients and staff affected and the number of lost bed-days, as functions of the timing of closure. We conducted Quasi-Poisson regression analyses to assess the effect of ward closure (timing of closure) on outcome measures, controlling for time of year (winter or summer), ward size and ward type (elderly care wards).

Results

Regression analysis indicates that after controlling for season ward size and type, the duration of outbreak and duration of disruption were shorter, fewer patients were affected by the time of closure and fewer patients were affected overall, when closure occurred promptly (within 3 days of the first case becoming ill) compared with non-prompt closure groups. However, in outbreaks where wards were not closed, the length of outbreaks were similar to the prompt closure group and also had fewer patients and staff affected and fewer cases per day of outbreak compared with prompt closure.

Conclusions

Closing a bay or ward promptly in an outbreak of norovirus leads to a shorter duration of outbreaks, a shorter duration of disruption and fewer patients being affected compared with outbreaks where wards were not promptly closed. However, the interpretation of these results is not straightforward. The outbreaks where the ward was not closed at all have similar characteristics in terms of the duration of outbreak and fewer people were affected compared with the baseline prompt closure group.
Can the relationship between ethnicity and obesity-related behaviours among school-aged children be explained by deprivation? A cross-sectional study
Authors: Falconer Catherine L , Park Min Hae , Croker Helen , Kessel Anthony S , Saxena Sonia , Viner Russell M , Kinra Sanjay
Published: January 2014

Objectives

It is unclear whether cultural differences or material disadvantage explain the ethnic patterning of obesogenic behaviours. The aim of this study was to examine ethnicity as a predictor of obesity-related behaviours among children in England, and to assess whether the effects of ethnicity could be explained by deprivation.

Setting

Five primary care trusts in England, 2010–2011.

Participants

Parents of white, black and South Asian children aged 4–5 and 10–11 years participating in the National Child Measurement Programme (n=2773).

Primary outcome measures

Parent-reported measures of child behaviour: low level of physical activity, excessive screen time, unhealthy dietary behaviours and obesogenic lifestyle (combination of all three obesity-related behaviours). Associations between these behaviours and ethnicity were assessed using logistic regression analyses.

Results

South Asian ethnic groups made up 22% of the sample, black ethnic groups made up 8%. Compared with white children, higher proportions of Asian and black children were overweight or obese (21–27% vs16% of white children), lived in the most deprived areas (24–47% vs 14%) and reported obesity-related behaviours (38% with obesogenic lifestyle vs 16%). After adjusting for deprivation and other sociodemographic characteristics, black and Asian children were three times more likely to have an obesogenic lifestyle than white children (OR 3.0, 95% CI 2.1 to 4.2 for Asian children; OR 3.4, 95% CI 2.7 to 4.3 for black children).

Conclusions

Children from Asian and black ethnic groups are more likely to have obesogenic lifestyles than their white peers. These differences are not explained by deprivation. Culturally specific lifestyle interventions may be required to reduce obesity-related health inequalities.
A qualitative investigation into patients’ views on visual field testing for glaucoma monitoring
Authors: Glen Fiona C , Baker Helen , Crabb David P
Published: January 2014

Objectives

To investigate the views and experiences of patients regarding their glaucoma follow-up, particularly towards the type and frequency of visual field (VF) testing.

Design

A qualitative investigation using focus groups. The group discussion used broad open questions around the topics in a prompt guide relating to experiences of glaucoma follow-up, and in particular, VF monitoring. All the groups were taped, transcribed and coded using manual and computer-aided methods.

Setting

Three National Health Service (NHS) hospitals in England; two focus groups took place at each hospital.

Participants

28 patients (mean (SD) age: 74 (9) years; 54% women) diagnosed with glaucoma for at least 2 years. Each focus group consisted of 3–6 patients.

Primary and secondary outcomes

(1) Attitudes and experiences of patients with glaucoma regarding VF testing. (2) Patients’ opinions about successful follow-up in glaucoma.

Results

These patients did not enjoy the VF test but they recognised the importance of regular monitoring for preserving their vision. These patients would agree to more frequent VF testing on their clinician's recommendation. A number of themes recurred throughout the focus groups representing perceived barriers to follow-up care. The testing environment, waiting times, efficiency of appointment booking and travel to the clinic were all perceived to influence the general clinical experience and the quality of assessment data. Patients were also concerned about aspects of patient–doctor communication, and often received little to no feedback about their results.

Conclusions

Patients trust the clinician to make the best decisions for their glaucoma follow-up. However, patients highlighted a number of issues that could compromise the effectiveness of VF testing. Addressing patient-perceived barriers could be an important step for devising optimal strategies for follow-up care.
Effects of smoking, gender and occupational exposure on the risk of severe pulmonary fibrosis: a population-based case-control study
Authors: Ekström Magnus , Gustafson Torbjörn , Boman Kurt , Nilsson Kenneth , Tornling Göran , Murgia Nicola , Torén Kjell
Published: January 2014

Objectives

To estimate the effects of smoking, gender and occupational exposure on the risk of developing severe pulmonary fibrosis (PF), including dose-response and interaction effects.

Methods

National case–control study of 171 patients (cases) who had started a long-term oxygen therapy for PF in Sweden between February 1997 and April 2000, and 719 random control participants from the general population. Of these cases, 137 had probable idiopathic PF (IPF). The ORs for smoking, gender and occupational exposure were estimated using Mantel-Haenszel analysis and conditional logistic regression, controlling for age and year of diagnosis.

Results

The adverse effect of smoking was amplified by male gender and occupational exposure, OR 4.6 (95% CI 2.1 to 10.3) for PF, and OR 3.0 (1.3 to 6.5) for IPF, compared with in non-exposed women. Higher cumulative smoking exposure was linearly associated with increased risks. Compared with smoking less than 10 pack-years, smoking ≥20 pack-years was associated with increased risk of PF and IPF, OR 2.6 (1.4 to 4.9) and OR 2.5 (1.3 to 5.0), respectively.

Conclusions

Smoking has a dose-related association with increased risk of severe PF. Men with a history of smoking and occupational exposure is a particular risk group for developing severe PF.
High-intensity interval exercise training before abdominal aortic aneurysm repair (HIT-AAA): protocol for a randomised controlled feasibility trial
Authors: Tew Garry A , Weston Matthew , Kothmann Elke , Batterham Alan M , Gray Joanne , Kerr Karen , Martin Denis , Nawaz Shah , Yates David , Danjoux Gerard
Published: January 2014

Introduction

In patients with large abdominal aortic aneurysm (AAA), open surgical or endovascular aneurysm repair procedures are often used to minimise the risk of aneurysm-related rupture and death; however, aneurysm repair itself carries a high risk. Low cardiopulmonary fitness is associated with an increased risk of early post-operative complications and death following elective AAA repair. Therefore, fitness should be enhanced before aneurysm repair. High-intensity interval exercise training (HIT) is a potent, time-efficient strategy for enhancing cardiopulmonary fitness. Here, we describe a feasibility study for a definitive trial of a pre-operative HIT intervention to improve post-operative outcomes in patients undergoing elective AAA repair.

Methods and analysis

A minimum of 50 patients awaiting elective repair of a 5.5–7.0 cm infrarenal AAA will be allocated by minimisation to HIT or usual care control in a 1:1 ratio. The patients allocated to HIT will complete three hospital-based exercise sessions per week, for 4 weeks. Each session will include 2 or 4 min of high-intensity stationary cycling followed by the same duration of easy cycling or passive recovery, repeated until a total of 16 min of high-intensity exercise is accumulated. Outcomes to be assessed before randomisation and 24–48 h before aneurysm repair include cardiopulmonary fitness, maximum AAA diameter and health-related quality of life. In the post-operative period, we will record destination (ward or critical care unit), organ-specific morbidity, mortality and the durations of critical care and hospital stay. Twelve weeks after the discharge, participants will be interviewed to reassess quality of life and determine post-discharge healthcare utilisation. The costs associated with the exercise intervention and healthcare utilisation will be calculated.

Ethics and dissemination

Ethics approval was secured through Sunderland Research Ethics Committee. The findings of the trial will be disseminated through peer-reviewed journals, and national and international presentations.

Trial registration

Current Controlled TrialsISRCTN09433624.
Postoperative vascular complications in unrecognised Obstructive Sleep apnoea (POSA) study protocol: an observational cohort study in moderate-to-high risk patients undergoing non-cardiac surgery
Authors: Chan Matthew T V , Wang Chew-Yin , Seet Edwin , Tam Stanley , Lai Hou-Yee , Walker Stuart , Short Timothy G , Halliwell Richard , Chung Frances ,   for the POSA Investigators
Published: January 2014

Introduction

Emerging epidemiological data suggest that obstructive sleep apnoea (OSA) is common in the general surgical population. Unfortunately, the majority of these patients are unrecognised and untreated at the time of surgery. There is substantial biological rationale to indicate that patients with unrecognised OSA are at a higher risk of postoperative vascular events. However, the extent of this morbidity is currently unknown. We have initated thepostoperative vascular complications in the unrecognisedobstructivesleepapnoea (POSA) study to determine the associations between OSA, nocturnal hypoxia and major postoperative vascular events in 1200 moderate-to-high risk patients undergoing major non-cardiac surgery.

Methods and analysis

The POSA study is an international prospective observational cohort study. Using a type 3 portable sleep monitoring device and ambulatory oximetry, we will quantify the severity of OSA. The primary outcome is a composite of vascular death, myocardial infarction; non-fatal cardiac arrest; stroke; pulmonary embolism; congestive heart failure and new arrhythmia within 30 days of surgery. As of November 2013, we have recruited over 700 patients from nine centres in six countries. The mean age is 68 years, the mean body mass index is 27 kg/m2and 55% of patients are men. 27.9% of patients have known coronary artery disease, over 76% have diabetes. The majority of patients underwent orthopaedic surgery (28%) and colorectal resection (18.5%).

Ethics and dissemination

The POSA study has received ethics approval from all study sites before patient recruitment. Informed consent will be obtained from all patients. The POSA study will determine the risk of unrecognised OSA in major non-cardiac surgery. We will publish these findings in peer-reviewed journals.

Trial Registration:

ClinicalTrials.gov Identifier:NCT01494181
Diagnostic rates and treatment of dementia before and after launch of a national dementia policy: an observational study using English national databases
Authors: Mukadam Naaheed , Livingston Gill , Rantell Khadija , Rickman Sam
Published: January 2014

Objectives

To assess the 2009 National Dementia Strategy's (NDS) impact on dementia diagnosis and treatment.

Setting and participants

Primary care data for England before and after launch of the NDS.

Primary outcome measures

We used nationally available data to estimate the trends over time in rates of dementia diagnoses recorded on the Quality Outcomes Framework (QOF) in Primary Care Trusts (PCT) and antidementia medication prescriptions from 2006/2007 (the first available figures) and the associated increase in cost relative to all other prescriptions. To establish PCT general practitioner (GP) QOF dementia recording validity, we correlated it with medication prescription using the NIC (net ingredient cost).

Results

Regression analysis showed that dementia diagnosis rate was lower prior to launch of the NDS and increased significantly after it was launched. The number of antidementia prescriptions and the cost of antidementia drugs relative to total PCT prescribing costs increased significantly after 2009. GP recording of dementia diagnosis correlated highly with prescription of cholinesterase inhibitors and memantine in the same area (p<0.001 each year).

Conclusions

The launch of the NDS was associated with a significant increase in dementia diagnosis rates and prescriptions of antidementia drugs. We cannot establish the causality but this was a change from the prelaunch pattern. Further assessment of any intervention to increase the diagnoses should include an assessment of harm as well as potential benefit.
Systematic analysis of funding awarded for mycology research to institutions in the UK, 1997–2010
Authors: Head Michael G , Fitchett Joseph R , Atun Rifat , May Robin C
Published: January 2014

Objectives

Fungal infections cause significant global morbidity and mortality. We have previously described the UK investments in global infectious disease research, and here our objective is to describe the investments awarded to UK institutions for mycology research and outline potential funding gaps in the UK portfolio.

Design

Systematic analysis.

Setting

UK institutions carrying out infectious disease research.

Primary and secondary outcome measures

Primary outcome is the amount of funding and number of studies related to mycology research. Secondary outcomes are describing the investments made to specific fungal pathogens and diseases, and also the type of science along the R&D value chain.

Methods

We systematically searched databases and websites for information on research studies from public and philanthropic funding institutions awarded between 1997 and 2010, and highlighted the mycology-related projects.

Results

Of 6165 funded studies, we identified 171 studies related to mycology (total investment £48.4 million, 1.9% of all infection research, with mean annual funding £3.5 million). Studies related to global health represented 5.1% of this funding (£2.4 million, compared with 35.6% of all infectious diseases). Leading funders were the Biotechnology and Biological Sciences Research Council (£14.8 million, 30.5%) and Wellcome Trust (£12.0 million, 24.7%). Preclinical studies received £42.2 million (87.3%), with clinical trials, intervention studies and implementation research in total receiving £6.2 million (12.7%). By institution, University of Aberdeen received most funding (£16.9 million, 35%). Studies investigating antifungal resistance received £1.5 million (3.2%).

Conclusions

There is little translation of preclinical research into clinical trials or implementation research in spite of substantial disease burden globally, and there are few UK institutions that carry out significant quantities of mycology research of any type. In the context of global health and the burden of disease in low-income countries, more investment is required for mycology research.
Exploring areas of consensus and conflict around values underpinning public involvement in health and social care research: a modified Delphi study
Authors: Snape D , Kirkham J , Preston J , Popay J , Britten N , Collins M , Froggatt K , Gibson A , Lobban F , Wyatt K , Jacoby A
Published: January 2014

Objective

There is growing interest in the potential benefits of public involvement (PI) in health and social care research. However, there has been little examination of values underpinning PI or how these values might differ for different groups with an interest in PI in the research process. We aimed to explore areas of consensus and conflict around normative, substantive and process-related values underpinning PI.

Design

Mixed method, three-phase, modified Delphi study, conducted as part of a larger multiphase project.

Setting

The UK health and social care research community.

Participants

Stakeholders in PI in research, defined as: clinical and non-clinical academics, members of the public, research managers, commissioners and funders; identified via research networks, online searches and a literature review.

Results

We identified high levels of consensus for many normative, substantive and process-related issues. However, there were also areas of conflict in relation to issues of bias and representativeness, and around whether the purpose of PI in health and social care research is to bring about service change or generate new knowledge. There were large differences by group in the percentages endorsing the ethical justification for PI and the argument that PI equalises power imbalances. With regard to practical implementation of PI, research support infrastructures were reported as lacking. Participants reported shortcomings in the uptake and practice of PI. Embedding PI practice and evaluation in research study designs was seen as fundamental to strengthening the evidence base.

Conclusions

Our findings highlight the extent to which PI is already embedded in research. However, they also highlight a need for ‘best practice’ standards to assist research teams to understand, implement and evaluate PI. These findings have been used in developing a Public Involvement Impact Assessment Framework (PiiAF), which offers guidance to researchers and members of the public involved in the PI process.
Improving transition from paediatric to adult cystic fibrosis care: programme implementation and evaluation
Authors: Okumura Megumi J , Ong Thida , Dawson Diana , Nielson Dennis , Lewis Nancy , Richards Martha , Brindis Claire D , Kleinhenz Mary Ellen
Published: January 2014

Background

The paradigm of cystic fibrosis (CF) care has changed as effective therapies extend the lives of patients well into adulthood. Preparing for and maintaining high quality CF care into the adult healthcare setting is critical for prolonged survival. Unfortunately, this transfer process from the paediatric to the adult CF centre is met with a variety of challenges.

Objective and methods

The objective of this quality improvement (QI) project was to develop, implement and evaluate a theory-based programme for transition from paediatric to adult CF care. In a multi-phase process, the paediatric and adult programmes developed a transition curriculum, addressed care standards and standardised patient transfer protocols. We evaluated the impact of this process through staff surveys, review of field notes from QI meetings, tracking transfers and responses of patients to the Transition Readiness Assessment Questionnaire (TRAQ) at the start of the programme and 18 months after initiation.

Results

The collaboration between the paediatric and adult teams continued through quarterly meetings over the past 4 years. This has provided a forum that sustained our transition programme, harmonised care across CF centres and addressed other needs of our CF centre. Discussion of transition with families in the paediatric centre increased twofold (35% to 73% p<0.001), and resulted in a trend towards improved patient TRAQ self-advocacy scores and decreased in-hospital transfer.

Conclusions

We successfully created a curriculum and process for transition from paediatric to adult CF care at our centres. This collaboration shapes the communication between our paediatric and adult CF care teams and enables ongoing feedback among patients, families and providers. The impact of our transition programme on long-term patient morbidity will require future evaluation.
Injury reporting via SMS text messaging in community sport
Authors: Ekegren Christina L , Gabbe Belinda J , Finch Caroline F
Published: January 2014

Background

The use of text messaging or short message service (SMS) for injury reporting is a recent innovation in sport and has not yet been trialled at the community level. Considering the lack of personnel and resources in community sport, SMS may represent a viable option for ongoing injury surveillance. The aim of this study was to evaluate the feasibility of injury self-reporting via SMS in community Australian football.

Methods

A total of 4 clubs were randomly selected from a possible 22 men's community Australian football clubs. Consenting players received an SMS after each football round game asking whether they had been injured in the preceding week. Outcome variables included the number of SMS-reported injuries, players’ response rates and response time. Poisson regression was used to evaluate any change in response rate over the season and the association between response rate and the number of reported injuries.

Results

The sample of 139 football players reported 167 injuries via SMS over the course of the season. The total response rate ranged from 90% to 98%. Of those participants who replied on the same day, 47% replied within 5 min. The number of reported injuries decreased as the season progressed but this was not significantly associated with a change in the response rate.

Conclusions

The number of injuries reported via SMS was consistent with previous studies in community Australian football. Injury reporting via SMS yielded a high response rate and fast response time and should be considered a viable injury reporting method for community sports settings.
The patient experience: measuring the quality of care in the Defence Medical Services
Authors: Piper Neale , Lamb D
Published: January 2014

Healthcare provided by the Defence Medical Services (DMS) is acknowledged to be of a high standard but patients’ experiences of it has not been measured and collated in a consistent and meaningful way, which has limited strategic quality improvement initiatives. Responsibility for implementing and delivering a programme of healthcare governance and assurance for the DMS rests with the Inspector General (IG). An important aspect of this role is to nurture a culture of continuous improvement in the DMS and under this leadership the IG team has prioritised a number of projects to address this. The project to improve patient experience data capture was prioritised in the work schedule as it incorporated initiatives that would lead to improved quality in DMS healthcare, information exploitation and ultimately patient safety. This is the first in a series of articles that will document this important work and describe the methodological considerations associated with the initial questionnaire design, collaboration with NHS partners, the pilot study and progress towards the introduction of the definitive DMS tool later this year.
The fentanyl ‘lozenge’ story: from books to battlefield
Authors: Aldington Dominic , Jagdish S
Published: January 2014

This article outlines the process that led to the introduction of the fentanyl lozenge for acute pain management. It starts with the historical context before discussing the recognition of an ongoing problem and then identifies the options that were considered. There follows a description of the pharmacology of fentanyl before describing the trial of concept that was conducted. This leads into an outline of the meetings and committees that had to be engaged with before the final acceptance and subsequent ushering in. The final section describes an option that was unsuccessful.
Elevations in serum muscle enzyme activities in racehorses due to unaccustomed exercise and training
Authors: Mack S. J. , Kirkby K. , Malalana F. , McGowan C. M.
Published: January 2014

Hereditary muscular disease is well described in racehorses, yet little is known about traumatic muscle disease associated with unaccustomed exercise or training. The objective of the study was to compare sedentary horses, racehorses undergoing training for the first time (unaccustomed exercise), and experienced racehorses during a training season (accustomed exercise) to investigate the effect of exercise and training on serum muscle enzyme activities and other variables. Horses were sampled prior to exercise for serum activities of aspartate amino transferase (AST), creatine kinase and other variables γ glutamyl transferase (GGT) and serum amyloid A (SAA) in a three‐part study. Serum activities of AST and GGT were higher in fit racehorses (n=47) compared with sedentary horses (n=57) at a single time point (P<0.05). The monthly serum activity of AST in two‐year‐old racehorses (n=10) increased from month 1 to 4 of unaccustomed training (P<0.05). The serum activities of AST and GGT in three‐year‐old racehorses (n=12) previously accustomed to exercise sampled fortnightly to monthly showed a linear increase (P<0.05) with cumulative training days over the seven months of training, but showed minimal increase during the first four months of accustomed training. SAA was weakly correlated to cumulative training days. In conclusion, AST activity was increased by unaccustomed exercise and cumulative training stress in the racehorse. GGT appeared to be correlated to cumulative training load. Mild to moderate elevations in serum AST in racehorses may be associated with cumulative muscle damage from training or trauma associated with unaccustomed exercise.
Characterization of an alluvial silt and clay deposit for monotonic, cyclic, and post-cyclic behavior
Authors: Dahl Karina R. , DeJong Jason T. , Boulanger Ross W. , Pyke Robert , Wahl Douglas
Published: January 2014

This paper presents a detailed characterization of the monotonic, cyclic, and post-cyclic behavior of two strata within a recent Holocene alluvial deposit of silty sand, sandy silt, silt, and clay. Stratum A is composed predominantly of very soft clay and very loose silt with plasticity indices ranging from 5 to 27, whereas stratum B is composed predominantly of very loose silty sand and sandy silt with plasticity indices ranging from 0 to 10. Characterization included in situ testing, undisturbed soil sampling and laboratory testing, and a field surcharge test section. Consolidation tests and monotonic, cyclic, and post-cyclic direct simple shear tests were used to evaluate the effects of varying the consolidation stress, consolidation stress history, and initial static shear stress ratio. The field and laboratory test data show distinct differences in behavior between the two soil strata, which can be related to their different index test characteristics. These results are compared with their respective behaviors predicted using common engineering correlations. The field and laboratory test data summarized herein contribute to the database and understanding of the monotonic, cyclic, and post-cyclic behaviors of low-plasticity fine-grained soils.
THE ρ MESON IN FINITE VOLUME
Authors: CHEN HUA-XING , OSET E.
Published: January 2014

We evaluate energy levels of the ππ system in the ρ channel in finite volume using chiral unitary theory. We investigate ππ phase shifts and ρ meson properties using Lattice QCD data with high precision. We also investigate the dependence on the π mass.