bluuebunny/crossref_metadata_2025 huggingface dataset:
Microbial Nursery Production of High-Quality Biological Soil Crust Biomass for Restoration of Degraded Dryland Soils
Authors: Velasco Ayuso Sergio , Giraldo Silva Ana , Nelson Corey , Barger Nichole N. , Garcia-Pichel Ferran
Published: November 2016

Biological soil crusts (biocrusts) are slow-growing, phototroph-based microbial assemblages that develop on the topsoils of drylands. Biocrusts help maintain soil fertility and reduce erosion. Because their loss through human activities has negative ecological and environmental health consequences, biocrust restoration is of interest. Active soil inoculation with biocrust microorganisms can be an important tool in this endeavor. We present a culture-independent, two-step process to grow multispecies biocrusts in open greenhouse nursery facilities, based on the inoculation of local soils with local biocrust remnants and incubation under seminatural conditions that maintain the essence of the habitat but lessen its harshness. In each of four U.S. Southwest sites, we tested and deployed combinations of factors that maximized growth (gauged as chlorophyll
a
content) while minimizing microbial community shifts (assessed by 16S rRNA sequencing and bioinformatics), particularly for crust-forming cyanobacteria. Generally, doubling the frequency of natural wetting events, a 60% reduction in sunlight, and inoculation by slurry were optimal. Nutrient addition effects were site specific. In 4 months, our approach yielded crusts of high inoculum quality reared on local soil exposed to locally matched climates, acclimated to desiccation, and containing communities minimally shifted in composition from local ones. Our inoculum contained abundant crust-forming cyanobacteria and no significant numbers of allochthonous phototrophs, and it was sufficient to treat ca. 6,000 m
2
of degraded dryland soils at 1 to 5% of the typical crust biomass concentration, having started from a natural crust remnant as small as 6 to 30 cm
2
.

IMPORTANCE
Soil surface crusts can protect dryland soils from erosion, but they are often negatively impacted by human activities. Their degradation causes a loss of fertility, increased production of fugitive dust and intensity of dust storms with associated traffic problems, and provokes general public health hazards. Our results constitute an advance in the quest to actively restore biological soil covers by providing a means to obtain high-quality inoculum within a reasonable time (a few months), thereby allowing land managers to recover essential, but damaged, ecosystem services in a sustainable, self-perpetuating way as provided by biocrust communities.
Biogeography of Oenococcus oeni Reveals Distinctive but Nonspecific Populations in Wine-Producing Regions
Authors: El Khoury Mariette , Campbell-Sills Hugo , Salin Franck , Guichoux Erwan , Claisse Olivier , Lucas Patrick M.
Published: November 2016

Understanding the mechanisms behind the typicity of regional wines inevitably brings attention to microorganisms associated with their production.
Oenococcus oeni
is the main bacterial species involved in wine and cider making. It develops after the yeast-driven alcoholic fermentation and performs the malolactic fermentation, which improves the taste and aromatic complexity of most wines. Here, we have evaluated the diversity and specificity of
O. oeni
strains in six regions. A total of 235 wines and ciders were collected during spontaneous malolactic fermentations and used to isolate 3,212 bacterial colonies. They were typed by multilocus variable analysis, which disclosed a total of 514
O. oeni
strains. Their phylogenetic relationships were evaluated by a second typing method based on single nucleotide polymorphism (SNP) analysis. Taken together, the results indicate that each region holds a high diversity of strains that constitute a unique population. However, strains present in each region belong to diverse phylogenetic groups, and the same groups can be detected in different regions, indicating that strains are not genetically adapted to regions. In contrast, greater strain identity was seen for cider, white wine, or red wine of Burgundy, suggesting that genetic adaptation to these products occurred.

IMPORTANCE
This study reports the isolation, genotyping, and geographic distribution analysis of the largest collection of
O. oeni
strains performed to date. It reveals that there is very high diversity of strains in each region, the majority of them being detected in a single region. The study also reports the development of an SNP genotyping method that is useful for analyzing the distribution of
O. oeni
phylogroups. The results show that strains are not genetically adapted to regions but to specific types of wines. They reveal new phylogroups of strains, particularly two phylogroups associated with white wines and red wines of Burgundy. Taken together, the results shed light on the diversity and specificity of wild strains of
O. oeni
, which is crucial for understanding their real contribution to the unique properties of wines.
The EbpA-RpoN Regulatory Pathway of the Pathogen Leptospira interrogans Is Essential for Survival in the Environment
Authors: Hu Wei-Lin , Pappas Christopher J. , Zhang Jun-Jie , Yang You-Yun , Yan Jie , Picardeau Mathieu , Yang X. Frank
Published: November 2016

Leptospira interrogans
is the agent of leptospirosis, a reemerging zoonotic disease. It is transmitted to humans through environmental surface waters contaminated by the urine of mammals chronically infected by pathogenic strains able to survive in water for long periods. Little is known about the regulatory pathways underlying environmental sensing and host adaptation of
L. interrogans
during its enzootic cycle. This study identifies the EbpA-RpoN regulatory pathway in
L. interrogans
. In this pathway, EbpA, a σ
54
activator and putative prokaryotic enhancer-binding protein (EBP), and the alternative sigma factor RpoN (σ
54
) control expression of at least three genes, encoding AmtB (an ammonium transport protein) and two proteins of unknown function. Electrophoresis mobility shift assay demonstrated that recombinant RpoN and EbpA bind to the promoter region and upstream of these three identified genes, respectively. Genetic disruption of
ebpA
in
L. interrogans
serovar Manilae virtually abolished expression of the three genes, including
amtB
in two independent
ebpA
mutants. Complementation of the
ebpA
mutant restored expression of these genes. Intraperitoneal inoculation of gerbils with the
ebpA
mutant did not affect mortality. However, the
ebpA
mutant had decreased cell length
in vitro
and had a significantly lowered cell density at stationary phase when grown with
l
-alanine as the sole nitrogen source. Furthermore, the
ebpA
mutant has dramatically reduced long-term survival ability in water. Together, these studies identify a regulatory pathway, the EbpA-RpoN pathway, that plays an important role in the zoonotic cycle of
L. interrogans
.

IMPORTANCE
Leptospirosis is a reemerging disease with global importance. However, our understanding of gene regulation of the spirochetal pathogen
Leptospira interrogans
is still in its infancy, largely due to the lack of robust tools for genetic manipulation of this spirochete. Little is known about how the pathogen achieves its long-term survival in the aquatic environment. By utilizing bioinformatic, genetic, and biochemical methods, we discovered a regulatory pathway in
L. interrogans
, the EbpA-RpoN pathway, and demonstrated that this pathway plays an important role in environmental survival of this pathogen.
Salad Leaf Juices Enhance Salmonella Growth, Colonization of Fresh Produce, and Virulence
Authors: Koukkidis Giannis , Haigh Richard , Allcock Natalie , Jordan Suzanne , Freestone Primrose
Published: November 2016

We show in this report that traces of juices released from salad leaves as they become damaged can significantly enhance colonization of salad leaves by
Salmonella enterica
. Salad juices in water increased
Salmonella
growth by 110% over the level seen with the unsupplemented control and in host-like serum-based media by more than 2,400-fold over control levels. In serum-based media, salad juices induced growth of
Salmonella
via provision of Fe from transferrin, and siderophore production was found to be integral to the growth induction process. Other aspects relevant to salad leaf colonization and retention were enhanced, such as motility and biofilm formation, which were increased over control levels by >220% and 250%, respectively; direct attachment to salad leaves increased by >350% when a salad leaf juice was present. In terms of growth and biofilm formation, the endogenous salad leaf microbiota was largely unresponsive to leaf juice, suggesting that
Salmonella
gains a marked growth advantage from fluids released by salad leaf damage. Salad leaf juices also enhanced pathogen attachment to the salad bag plastic. Over 5 days of refrigeration (a typical storage time for bagged salad leaves), even traces of juice within the salad bag fluids increased
Salmonella
growth in water by up to 280-fold over control cultures, as well as enhancing salad bag colonization, which could be an unappreciated factor in retention of pathogens in fresh produce. Collectively, the study data show that exposure to salad leaf juice may contribute to the persistence of
Salmonella
on salad leaves and strongly emphasize the importance of ensuring the microbiological safety of fresh produce.

IMPORTANCE
Salad leaves are an important part of a healthy diet but have been associated in recent years with a growing risk of food poisoning from bacterial pathogens such as
Salmonella enterica
. Although this is considered a significant public health problem, very little is known about the behavior of
Salmonella
in the actual salad bag. We show that juices released from the cut ends of the salad leaves enabled the
Salmonella
cells to grow in water, even when it was refrigerated. Salad juice exposure also helped the
Salmonella
cells to attach to the salad leaves so strongly that washing could not remove them. Collectively, the results presented in this report show that exposure to even traces of salad leaf juice may contribute to the persistence of
Salmonella
on salad leaves as well as priming it for establishing an infection in the consumer.
Insights into the Biosynthesis of Duramycin
Authors: Huo Liujie , Ökesli Ayşe , Zhao Ming , van der Donk Wilfred A.
Published: November 2016

Lantibiotics are ribosomally synthesized and posttranslationally modified antimicrobial peptides that are characterized by the thioether cross-linked bisamino acids lanthionine (Lan) and methyllanthionine (MeLan). Duramycin contains 19 amino acids, including one Lan and two MeLans, an unusual lysinoalanine (Lal) bridge formed from the ε-amino group of lysine 19 and a serine residue at position 6, and an
erythro
-3-hydroxy-
l
-aspartic acid at position 15. These modifications are important for the interactions of duramycin with its biological target, phosphatidylethanolamine (PE). Based on the binding affinity and specificity for PE, duramycin has been investigated as a potential therapeutic, as a molecular probe to investigate the role and localization of PE in biological systems, and to block viral entry into mammalian cells. In this study, we identified the duramycin biosynthetic gene cluster by genome sequencing of
Streptomyces cinnamoneus
ATCC 12686 and investigated the
dur
biosynthetic machinery by heterologous expression in
Escherichia coli
. In addition, the analog duramycin C, containing six amino acid changes compared to duramycin, was successfully generated in
E. coli
. The substrate recognition motif of DurX, an α-ketoglutarate/iron(II)-dependent hydroxylase that carries out the hydroxylation of aspartate 15 of the precursor peptide DurA, was also investigated using mutagenesis of the DurA peptide. Both
in vivo
and
in vitro
results demonstrated that Gly16 is important for DurX activity.

IMPORTANCE
Duramycin is a natural product produced by certain bacteria that binds to phosphatidylethanolamine (PE). Because PE is involved in many cellular processes, duramycin is an antibiotic that kills bacteria, but it has also been used as a molecular probe to detect PE and monitor its localization in mammalian cells and even whole organisms, and it was recently shown to display broad-spectrum inhibition of viral entry into host cells. In addition, the molecule has been evaluated as treatment for cystic fibrosis. We report here the genes that are involved in duramycin biosynthesis, and we produced duramycin by expressing those genes in
Escherichia coli
. We show that duramycin analogs can also be produced. The ability to access duramycin and analogs by production in
E. coli
opens opportunities to improve duramycin as an antibiotic, PE probe, antiviral, or cystic fibrosis therapeutic.
Mitochondrial Superoxide Dismutase and Yap1p Act as a Signaling Module Contributing to Ethanol Tolerance of the Yeast Saccharomyces cerevisiae
Authors: Zyrina Anna N. , Smirnova Ekaterina A. , Markova Olga V. , Severin Fedor F. , Knorre Dmitry A.
Published: November 2016

There are two superoxide dismutases in the yeast
Saccharomyces cerevisiae
—cytoplasmic and mitochondrial enzymes. Inactivation of the cytoplasmic enzyme, Sod1p, renders the cells sensitive to a variety of stresses, while inactivation of the mitochondrial isoform, Sod2p, typically has a weaker effect. One exception is ethanol-induced stress. Here we studied the role of Sod2p in ethanol tolerance of yeast. First, we found that repression of
SOD2
prevents ethanol-induced relocalization of yeast hydrogen peroxide-sensing transcription factor Yap1p, one of the key stress resistance proteins. In agreement with this, the levels of Trx2p and Gsh1p, proteins encoded by Yap1 target genes, were decreased in the absence of Sod2p. Analysis of the ethanol sensitivities of the cells lacking Sod2p, Yap1p, or both indicated that the two proteins act in the same pathway. Moreover, preconditioning with hydrogen peroxide restored the ethanol resistance of yeast cells with repressed
SOD2
. Interestingly, we found that mitochondrion-to-nucleus signaling by Rtg proteins antagonizes Yap1p activation. Together, our data suggest that hydrogen peroxide produced by Sod2p activates Yap1p and thus plays a signaling role in ethanol tolerance.

IMPORTANCE
Baker's yeast harbors multiple systems that ensure tolerance to high concentrations of ethanol. Still, the role of mitochondria under severe ethanol stress in yeast is not completely clear. Our study revealed a signaling function of mitochondria which contributes significantly to the ethanol tolerance of yeast cells. We found that mitochondrial superoxide dismutase Sod2p and cytoplasmic hydrogen peroxide sensor Yap1p act together as a module of the mitochondrion-to-nucleus signaling pathway. We also report cross talk between this pathway and the conventional retrograde signaling cascade activated by dysfunctional mitochondria.
Prevalence of Antibiotic Resistance Genes among Human Gut-Derived Bifidobacteria
Authors: Duranti Sabrina , Lugli Gabriele Andrea , Mancabelli Leonardo , Turroni Francesca , Milani Christian , Mangifesta Marta , Ferrario Chiara , Anzalone Rosaria , Viappiani Alice , van Sinderen Douwe , Ventura Marco
Published: November 2016

The microbiota of the human gastrointestinal tract (GIT) may regularly be exposed to antibiotics, which are used to prevent and treat infectious diseases caused by bacteria and fungi. Bacterial communities of the gut retain a reservoir of antibiotic resistance (AR) genes, and antibiotic therapy thus positively selects for those microorganisms that harbor such genetic features, causing microbiota modulation. During the first months following birth, bifidobacteria represent some of the most dominant components of the human gut microbiota, although little is known about their AR gene complement (or resistome). In the current study, we assessed the resistome of the
Bifidobacterium
genus based on phenotypic and genotypic data of members that represent all currently recognized bifidobacterial (sub)species. Moreover, a comparison between the bifidobacterial resistome and gut metagenome data sets from adults and infants shows that the bifidobacterial community present at the first week following birth possesses a reduced AR arsenal compared to that present in the infant bifidobacterial population in subsequent weeks of the first year of life. Our findings reinforce the concept that the early infant gut microbiota is more susceptible to disturbances by antibiotic treatment than the gut microbiota developed at a later life stage.

IMPORTANCE
The spread of resistance to antibiotics among bacterial communities has represented a major concern since their discovery in the last century. The risk of genetic transfer of resistance genes between microorganisms has been extensively investigated due to its relevance to human health. In contrast, there is only limited information available on antibiotic resistance among human gut commensal microorganisms such as bifidobacteria, which are widely exploited by the food industry as health-promoting microorganisms or probiotic ingredients. In the current study, we explored the occurrence of antibiotic resistance genes in the genomes of bifidobacteria and evaluated their genetic mobility to other human gut commensal microorganisms.
Histone Deacetylase HDA-2 Regulates Trichoderma atroviride Growth, Conidiation, Blue Light Perception, and Oxidative Stress Responses
Authors: Osorio-Concepción Macario , Cristóbal-Mondragón Gema Rosa , Gutiérrez-Medina Braulio , Casas-Flores Sergio
Published: November 2016

Fungal blue-light photoreceptors have been proposed as integrators of light and oxidative stress. However, additional elements participating in the integrative pathway remain to be identified. In
Trichoderma
atroviride
, the blue-light regulator (BLR) proteins BLR-1 and -2 are known to regulate gene transcription, mycelial growth, and asexual development upon illumination, and recent global transcriptional analysis revealed that the histone deacetylase-encoding gene
hda-2
is induced by light. Here, by assessing responses to stimuli in wild-type and Δ
hda-2
backgrounds, we evaluate the role of HDA-2 in the regulation of genes responsive to light and oxidative stress. Δ
hda-2
strains present reduced growth, misregulation of the
con-1
gene, and absence of conidia in response to light and mechanical injury. We found that the expression of
hda-2
is BLR-1 dependent and HDA-2 in turn is essential for the transcription of early and late light-responsive genes that include
blr-1
, indicating a regulatory feedback loop. When subjected to reactive oxygen species (ROS), Δ
hda-2
mutants display high sensitivity whereas Δ
blr
strains exhibit the opposite phenotype. Consistently, in the presence of ROS, ROS-related genes show high transcription levels in wild-type and Δ
blr
strains but misregulation in Δ
hda-2
mutants. Finally, chromatin immunoprecipitations of histone H3 acetylated at Lys9/Lys14 on
cat-3
and
gst-1
promoters display low accumulation of H3K9K14ac in Δ
blr
and Δ
hda-2
strains, suggesting indirect regulation of ROS-related genes by HDA-2. Our results point to a mutual dependence between HDA-2 and BLR proteins and reveal the role of these proteins in an intricate gene regulation landscape in response to blue light and ROS.

IMPORTANCE
Trichoderma
atroviride
is a free-living fungus commonly found in soil or colonizing plant roots and is widely used as an agent in biocontrol as it parasitizes other fungi, stimulates plant growth, and induces the plant defense system. To survive in various environments, fungi constantly sense and respond to potentially threatening external factors, such as light. In particular, UV light can damage biomolecules by producing free-radical reactions, in most cases involving reactive oxygen species (ROS). In
T. atroviride
, conidiation is essential for its survival, which is induced by light and mechanical injury. Notably, conidia are typically used as the inoculum in the field during biocontrol. Therefore, understanding the linkages between responses to light and exposure to ROS in
T. atroviride
is of major basic and practical relevance. Here, the histone deacetylase-encoding gene
hda-2
is induced by light and ROS, and its product regulates growth, conidiation, blue light perception, and oxidative stress responses.
The Acceptor Side of Photosystem II Is the Initial Target of Nitrite Stress in Synechocystis sp. Strain PCC 6803
Authors: Zhang Xin , Ma Fei , Zhu Xi , Zhu Junying , Rong Junfeng , Zhan Jiao , Chen Hui , He Chenliu , Wang Qiang
Published: November 2016

Nitrite, a common form of inorganic nitrogen (N), can be used as a nitrogen source through N assimilation. However, high levels of nitrite depress photosynthesis in various organisms. In this study, we investigated which components of the photosynthetic electron transfer chain are targeted by nitrite stress in
Synechocystis
sp. strain PCC 6803 cells. Measurements of whole-chain and photosystem II (PSII)-mediated electron transport activities revealed that high levels of nitrite primarily impair electron flow in PSII. Changes in PSII activity in response to nitrite stress occurred in two distinct phases. During the first phase, which occurred in the first 3 h of nitrite treatment, electron transfer from the primary quinone acceptor (Q
A
) to the secondary quinone acceptor (Q
B
) was retarded, as indicated by chlorophyll (Chl)
a
fluorescence induction, S-state distribution, and Q
A
−
reoxidation tests. In the second phase, which occurred after 6 h of nitrite exposure, the reaction center was inactivated and the donor side of photosystem II was inhibited, as revealed by changes in Chl fluorescence parameters and thermoluminescence and by immunoblot analysis. Our data suggest that nitrite stress is highly damaging to PSII and disrupts PSII activity by a stepwise mechanism in which the acceptor side is the initial target.

IMPORTANCE
In our previous studies, an alga-based technology was proposed to fix the large amounts of nitrite that are released from NO
X
-rich flue gases and proved to be a promising industrial strategy for flue gas NO
X
bioremediation (W. Chen et al., Environ Sci Technol 50:1620–1627, 2016,
https://doi.org/10.1021/acs.est.5b04696
; X. Zhang et al., Environ Sci Technol 48:10497–10504, 2014,
https://doi.org/10.1021/es5013824
). However, the toxic effects of high concentrations of nitrite on algal cells remain obscure. The analysis of growth rates, photochemistry, and protein profiles in our study provides important evidence that the inhibition by nitrite occurs in two phases: in the first phase, electron transfer between Q
A
−
and Q
B
is retarded, whereas in the second, the donor side of PSII is affected. This is an excellent example of investigating the “early” inhibitory effects (i.e., within the first 6 h) on the PSII electron transfer chain
in vivo
. This paper provides novel insights into the mechanisms of nitrite inhibition of photosynthesis in an oxygenic phototrophic cyanobacterium.
Spiritual issues of people living and dying with advanced heart failure in Kenya: a qualitative serial interview study
Authors: Kimani Kellen N , Murray Scott A , Grant Liz
Published: November 2016

Background

Exploring patients' spiritual issues is vital for informing holistic care. The spiritual concerns of patients living and dying with advanced heart failure in sub-Saharan Africa remains unknown. Our aim was to describe spiritual issues in the context of the lived experiences of patients with heart failure in Kenya.

Methods

We purposively recruited 18 patients admitted with advanced heart failure at a rural district hospital in Kenya. We conducted serial in-depth interviews with patients at 0, 3 and 6 months after recruitment. We conducted bereavement interviews with their carers. Interviews were recorded, transcribed into English and analysed using a thematic approach, assisted by Nvivo software package.

Results

Patients expressed traditional and Christian spiritual beliefs in response to their illness. At diagnosis, some patients felt their illness had occurred because they had wronged God, while others felt betrayed by God. Some expressed comfort from God and optimism believing that God was in control and would heal their illness. During acute episodes patients questioned whether witchcraft or curses caused their illness. Younger patients experienced more spiritual distress. Although church fellowship generally offered spiritual and social support, some patients felt let down by the church which they perceived to favour those who offered more tithes.

Conclusions

This is the first study to explore the spiritual issues of people living with advanced heart failure in Kenya. Understanding patients' spiritual concerns is important for developing evidence-based patient-centred holistic care to promote multidimensional well-being.
‘Once there is life, there is hope’ Ebola survivors' experiences, behaviours and attitudes in Sierra Leone, 2015
Authors: Karafillakis Emilie , Jalloh Mohamed F , Nuriddin Azizeh , Larson Heidi J , Whitworth Jimmy , Lees Shelley , Hageman Kathy M , Sengeh Paul , Jalloh Mohammad B , Bunnell Rebecca , Carroll Dianna D , Morgan Oliver
Published: November 2016

Background

In Sierra Leone, over 4000 individuals survived Ebola since the outbreak began in 2014. Because Ebola survivorship was largely unprecedented prior to this outbreak, little is known about survivor experiences during and post illness.

Methods

To assess survivors' experiences and attitudes related to Ebola, 28 in-depth interviews and short quantitative surveys with survivors from all four geographic regions of Sierra Leone were conducted in May 2015.

Results

Survivor experiences, emotions and attitudes changed over time as they moved from disease onset to treatment, discharge and life post-discharge. Survivors mentioned experiencing acute fear and depression when they fell ill. Only half reported positive experiences in holding centres but nearly all were positive about their treatment centre experiences. Survivor euphoria on discharge was followed by concerns about their financial situation and future. While all reported supportive attitudes from family members, about a third described discrimination and stigma from their communities. Over a third became unemployed, especially those previously engaged in petty trade. Survivor knowledge about sexual transmission risk reflected counselling messages. Many expressed altruistic motivations for abstinence or condom use. In addition, survivors were strongly motivated to help end Ebola and to improve the healthcare system. Key recommendations from survivors included improved counselling in holding centres and long-term government support for survivors, including opportunities for participation in Ebola response efforts.

Conclusions

Survivors face myriad economic, social and health challenges. Addressing survivor concerns, including the discrimination they face, could facilitate their reintegration into communities and their contributions to future Ebola responses.
Retrospective analysis of age-adjusted body mass index among pre-pregnant women in the Lithuanian urban area during three decades
Authors: Francaite-Daugeliene Migle , Petrenko Vladimiras , Baliutaviciene Dalia , Velickiene Dzilda
Published: November 2016

Background

The prevalence of maternal obesity at the beginning of pregnancy is increasing. However, there are some studies reporting the stabilisation of obesity epidemic or even the downward trend in the general population.

Objective

To determine the prevalence of overweight and obesity in Lithuanian pre-pregnant women during 3 decades.

Methods

This observational retrospective study included a sample of 2827, women aged 18–44 years who gave birth in 1987–1989, 1996–1997 and 2007–2010: 861 (30.5%), 995 (35.2%) and 971 (34.3%), respectively. All women were divided into groups by body mass index (BMI) calculated from self-reported weight and height, and age reported during the first antenatal visit. Quantitative parametric variables were expressed as mean and SD; qualitative variables, as absolute numbers (n) and percentage (%). For parametric data, analysis of variance (ANOVA) was used. Differences were considered statistically significant at p<0.05.

Results

The prevalence of overweight and obesity among women aged 18–24 years decreased from 20.9% in 1987–1989 to 9.5% in 1996–1997 but increased to 15.7% in 2007–2010; among women aged 25–34 years, decreased from 35.5% in 1987–1989 to 23% in 1996–1997 and to 22.4% in 2007–2010; and among women aged 35–44 years decreased from 64.9% in 1987–1989 to 34% in 1996–1997 but increased to 45.3% in 2007–2010. BMI increased with an increasing age (r=0.254, p<0.05). Analysis by separate periods (1987–1989, 1996–1997 and 2007–2010) revealed a positive correlation between BMI and age at the first antenatal visit in all periods (r=0.325, p<0.01; r=0.266, p<0.01; and r=0.210, p<0.01, respectively).

Conclusions

The prevalence of overweight and obesity among pre-pregnant women tended to decrease in the Lithuanian urban area during 3 decades. A slight increase in overweight and obesity documented in 2007–2010 compared with 1996–1997 most likely was caused by older maternal age.
Determinants of the sustained employment of physician assistants in hospitals: a qualitative study
Authors: Timmermans Marijke J C , van Vught Anneke J A H , Maassen Irma T H M , Draaijer Lisette , Hoofwijk Anton G M , Spanier Marcel , van Unen Wijnand , Wensing Michel , Laurant Miranda G H
Published: November 2016

Objectives

To identify determinants of the initial employment of physician assistants (PAs) for inpatient care as well as of the sustainability of their employment.

Design

We conducted a qualitative study with semistructured interviews with care providers. Interviews continued until data saturation was achieved. All interviews were transcribed verbatim. A framework approach was used for data analysis. Codes were sorted by the themes, bringing similar concepts together.

Setting

This study was conducted between June 2014 and May 2015 within 11 different hospital wards in the Netherlands. The wards varied in medical speciality, as well as in hospital type and the organisational model for inpatient care.

Participants

Participant included staff physicians, residents, PAs and nurses.

Results

The following themes emerged to be important for the initial employment of PAs and the sustainability of their employment: the innovation, individual factors, professional interactions, incentives and resources, capacity for organisational change and social, political and legal factors.

Conclusions

10 years after the introduction of PAs, there was little discussion among the adopters about the added value of PAs, but organisational and financial uncertainties played an important role in the decision to employ and continue employment of PAs. Barriers to employ and continue PA employment were mostly a consequence of locally arranged restrictions by hospital management and staff physicians, as barriers regarding national laws, PA education and competencies seemed absent.
Impact of smoking on fertility and age of menopause: a population-based assessment
Authors: Oboni Jean-Baptiste , Marques-Vidal Pedro , Bastardot François , Vollenweider Peter , Waeber Gérard
Published: November 2016

Background and aims

Studies in patients seeking medically assisted reproduction have shown that smoking reduces fertility, but little information is available in the general population. We assessed the associations between smoking and the number of children, childbearing planning and age at menopause in a representative sample of the population of Lausanne, Switzerland.

Methods

Data from 6711 participants (3530 women, age range 35–75 years) collected between 2003 and 2006 and again in 2009 and 2012. Smoking status, number of offsprings and age of menopause were assessed.

Results

Women who currently smoke had significantly less children than former or never smokers: the number of children per women (average±SD) was 1.38±1.05, 1.45±1.07 and 1.576±1.16, respectively (p<0.001). Women who currently smoke had their first child at an earlier age than the others: 26.7±5.2, 27.4±5.4 and 26.9±5.2 years old for current, former and never smokers, respectively, (p=0.01). Similar findings were found for men: number of children per men 1.475±1.16, 1.67±1.13 and 1.55±1.22 for current, former and never smokers, respectively (p<0.001); no difference was found regarding age at the first child. The difference persisted after multivariate adjustment (adjusted for age, body mass index, Caucasian origins, alcohol consumption, caffeinated drinks consumption, educational level, receiving social help and women taking contraceptives) for the age at first child among women. No association was found between Heaviness of Smoking Index and the number of children among current smokers in both genders. Women who smoke had their menopause more than 1 year prior than never-smoking women (48.9±0.2 years compared with 47.8±0.3 years, respectively, p=0.002).

Conclusions

Smoking is associated with an earlier age of having the first child and of menopause among women.
Preventing postnatal maternal mental health problems using a psychoeducational intervention: the cost-effectiveness ofWhat Were We Thinking
Authors: Ride Jemimah , Lorgelly Paula , Tran Thach , Wynter Karen , Rowe Heather , Fisher Jane
Published: November 2016

Objectives

Postnatal maternal mental health problems, including depression and anxiety, entail a significant burden globally, and finding cost-effective preventive solutions is a public policy priority. This paper presents a cost-effectiveness analysis of the intervention,What Were We Thinking (WWWT), for the prevention of postnatal maternal mental health problems.

Design

The economic evaluation, including cost-effectiveness and cost-utility analyses, was conducted alongside a cluster-randomised trial.

Setting

48 Maternal and Child Health Centres in Victoria, Australia.

Participants

Participants were English-speaking first-time mothers attending participating Maternal and Child Health Centres. Full data were collected for 175 participants in the control arm and 184 in the intervention arm.

Intervention

WWWTis a psychoeducational intervention targeted at the partner relationship, management of infant behaviour and parental fatigue.

Outcome measures

The evaluation considered public sector plus participant out-of-pocket costs, while outcomes were expressed in the 30-day prevalence of depression, anxiety and adjustment disorders, and quality-adjusted life years (QALYs). Incremental costs and outcomes were estimated using regression analyses to account for relevant sociodemographic, prognostic and clinical characteristics.

Results

The intervention was estimated to cost $A118.16 per participant. The analysis showed no statistically significant difference between the intervention and control groups in costs or outcomes. The incremental cost-effectiveness ratios were $A36 451 per QALY gained and $A152 per percentage-point reduction in 30-day prevalence of depression, anxiety and adjustment disorders. The estimate lies under the unofficial cost-effectiveness threshold of $A55 000 per QALY; however, there was considerable uncertainty surrounding the results, with a 55% probability thatWWWTwould be considered cost-effective at that threshold.

Conclusions

The results suggest that, althoughWWWTshows promise as a preventive intervention for postnatal maternal mental health problems, further research is required to reduce the uncertainty over its cost-effectiveness as there were no statistically significant differences in costs or outcomes.

Trial registration number

ACTRN12613000506796; results.
Reporting quality in abstracts of meta-analyses of depression screening tool accuracy: a review of systematic reviews and meta-analyses
Authors: Rice Danielle B , Kloda Lorie A , Shrier Ian , Thombs Brett D
Published: November 2016

Objective

Concerns have been raised regarding the quality and completeness of abstract reporting in evidence reviews, but this had not been evaluated in meta-analyses of diagnostic accuracy. Our objective was to evaluate reporting quality and completeness in abstracts of systematic reviews with meta-analyses of depression screening tool accuracy, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Abstracts tool.

Design

Cross-sectional study.

Inclusion Criteria

We searched MEDLINE and PsycINFO from 1 January 2005 through 13 March 2016 for recent systematic reviews with meta-analyses in any language that compared a depression screening tool to a diagnosis based on clinical or validated diagnostic interview.

Data extraction

Two reviewers independently assessed quality and completeness of abstract reporting using the PRISMA for Abstracts tool with appropriate adaptations made for studies of diagnostic test accuracy. Bivariate associations of number of PRISMA for Abstracts items complied with (1) journal abstract word limit and (2) A Measurement Tool to Assess Systematic Reviews (AMSTAR) scores of meta-analyses were also assessed.

Results

We identified 21 eligible meta-analyses. Only two of 21 included meta-analyses complied with at least half of adapted PRISMA for Abstracts items. The majority met criteria for reporting an appropriate title (95%), result interpretation (95%) and synthesis of results (76%). Meta-analyses less consistently reported databases searched (43%), associated search dates (33%) and strengths and limitations of evidence (19%). Most meta-analyses did not adequately report a clinically meaningful description of outcomes (14%), risk of bias (14%), included study characteristics (10%), study eligibility criteria (5%), registration information (5%), clear objectives (0%), report eligibility criteria (0%) or funding (0%). Overall meta-analyses quality scores were significantly associated with the number of PRISMA for Abstracts scores items reported adequately (r=0.45).

Conclusions

Quality and completeness of reporting were found to be suboptimal. Journal editors should endorse PRISMA for Abstracts and allow for flexibility in abstract word counts to improve quality of abstracts.
Predictors of care home and hospital admissions and their costs for older people with Alzheimer's disease: findings from a large London case register
Authors: Knapp Martin , Chua Kia-Chong , Broadbent Matthew , Chang Chin-Kuo , Fernandez Jose-Luis , Milea Dominique , Romeo Renee , Lovestone Simon , Spencer Michael , Thompson Gwilym , Stewart Robert , Hayes Richard D
Published: November 2016

Objectives

To examine links between clinical and other characteristics of people with Alzheimer's disease living in the community, likelihood of care home or hospital admission, and associated costs.

Design

Observational data extracted from clinical records using natural language processing and Hospital Episode Statistics. Statistical analyses examined effects of cognition, physical health, mental health, sociodemographic factors and living circumstances on risk of admission to care home or hospital over 6 months and associated costs, adjusting for repeated observations.

Setting

Catchment area for South London and Maudsley National Health Service Foundation Trust, provider for 1.2 million people in Southeast London.

Participants

Every individual with diagnosis of Alzheimer's disease seen and treated by mental health services in the catchment area, with at least one rating of cognition, not resident in care home at time of assessment (n=3075).

Interventions

Usual treatment.

Main outcome measures

Risk of admission to, and days spent in three settings during 6-month period following routine clinical assessment: care home, mental health inpatient care and general hospital inpatient care.

Results

Predictors of probability of care home or hospital admission and/or associated costs over 6 months include cognition, functional problems, agitation, depression, physical illness, previous hospitalisations, age, gender, ethnicity, living alone and having a partner. Patterns of association differed considerably by destination.

Conclusions

Most people with dementia prefer to remain in their own homes, and funding bodies see this as cheaper than institutionalisation. Better treatment in the community that reduces health and social care needs of Alzheimer's patients would reduce admission rates. Living alone, poor living circumstances and functional problems all raise admission rates, and so major cuts in social care budgets increase the risk of high-cost admissions which older people do not want. Routinely collected data can be used to reveal local patterns of admission and costs.
Macquarie Surgical Innovation Identification Tool (MSIIT): a study protocol for a usability and pilot test
Authors: Blakely Brette , Selwood Amanda , Rogers Wendy A , Clay-Williams Robyn
Published: November 2016

Introduction

Medicine relies on innovation to continually improve. However, innovation is potentially risky, and not all innovations are successful. Therefore, it is important to identify innovations prospectively and provide support, to make innovation as safe and effective as possible. The Macquarie Surgical Innovation Identification Tool (MSIIT) is a simple checklist designed as a practical tool for hospitals to identify planned surgical innovations. This project aims to test the usability and pilot the use of the MSIIT in a surgical setting.

Methods and analysis

The project will run in two phases at two Australian hospitals, one public and one private. Phase I will involve interviews, focus groups and a survey of hospital administrators and surgical teams to assess the usability and system requirements for the use of the MSIIT. Current practice regarding surgical innovation within participating hospitals will be mapped, and the best implementation strategy for MSIIT completion will be established. Phase II will involve trialling the MSIIT for each surgery within the trial period by various surgical personnel. Follow-up interviews, focus groups and a survey will be conducted with trial participants to collect feedback on their experience of using the MSIIT during the trial period. Comparative data on rates of surgical innovation during the trial period will also be gathered from existing hospital systems and compared to the rates identified by the MSIIT.

Ethics and dissemination

Ethical approval has been obtained. The results of this study will be presented to interested health services and other stakeholders, presented at conferences and published in a peer-reviewed MEDLINE-indexed journal.
Improving self-management of cancer risk factors, underscreening for cancer and depression among general practice patients: study protocol of a randomised controlled trial
Authors: Carey Mariko , Sanson-Fisher Rob , Oldmeadow Christopher , Mansfield Elise , Walsh Justin
Published: November 2016

Introduction

General practitioners have a key role in reducing cancer risk factors, screening for cancer and managing depression. Given the time-limited nature of consultations, a new and more time-efficient approach is needed which addresses multiple health needs simultaneously, and encourages patient self-management to address health risks. The aim of this cluster randomised controlled trial is to test the effectiveness of a patient feedback intervention in improving patient self-management of health needs related to smoking, risky alcohol consumption and underscreening for cancers at 1 month follow-up.

Methods and analysis

Adult general practice patients will be invited to participate in a baseline survey to assess cancer risk factors, screening needs and depression. A total of 360 participants identified by the baseline survey as having at least one health need (a self-reported cancer risk factor, underscreening for cancer, or an elevated depression score) will be randomised to an intervention or control group. Participants in the intervention group will receive tailored printed feedback summarising their identified health needs and recommended self-management actions to address these. All participants will be invited to complete a telephone interview 1 month following recruitment to assess self-management actions taken in relation to health needs identified in the baseline survey. Control group participants will receive tailored printed feedback on their identified health needs after their follow-up interview. A logistic regression model, with group allocation as the main predictor, will be used to assess the impact of the intervention on self-management actions.

Ethical considerations and dissemination

Participants identified as being at risk of depression will be advised to speak with their doctor. Results will be disseminated via publication in peer-reviewed journals. The study has been approved by the University of Newcastle Human Research Ethics Committee.

Trial registration number

ACTRN12616001443482.
MAGE-A family expression is correlated with poor survival of patients with lung adenocarcinoma: a retrospective clinical study based on tissue microarray
Authors: Sang Meixiang , Gu Lina , Yin Danjing , Liu Fei , Lian Yishui , Zhang Xiaochong , Liu Shina , Huang Weina , Wu Yunyan , Shan Baoen
Published: November 2016

Objectives

As the best characterised cancer/testis antigen family members, melanoma-associated antigens (MAGE) have been reported to be expressed in various malignant tumours. However, the expression pattern of MAGE-A family in lung adenocarcinoma (LAC) specimens and their prognostic and therapeutic significance for patients with LAC is still unclear.

Materials and methods

Tissue microarray-based immunohistochemistry analysis was used to examine the expression of MAGE-A family members (including MAGE-A1, A2, A3, A4, A6, A10, A11 and A12) in 105 paired LAC specimens and the corresponding pericarcinoma specimens. The association between MAGE-A expression and the clinicopathological parameters, and the 10-year overall survival of patients with LAC were analysed. In addition, the association between MAGE-A expression and the epithelial growth factor receptor (EGFR) amplification and ALK-EML4 rearrangements of patients with LAC were also analysed.

Results

The immunohistochemical evaluation revealed that MAGE-A family was expressed in 46.66% of LAC specimens, but not in the corresponding pericarcinoma specimens. MAGE-A expression was not associated with the clinicopathological factors but with worse 10-year survival, and was a poor prognostic marker for patients with LAC. MAGE-A expression was not correlated with EGFR amplification and ALK rearrangements. Interestingly, MAGE-A expression can affect the overall survival of patients with LAC without EGFR amplification or ALK rearrangements, but not affect the overall survival of patients with LAC and EGFR amplification or ALK rearrangements.

Conclusions

Molecular assessment of MAGE-A family members could be considered to improve the prognostic evaluation and to provide a new potential therapeutic strategy for patients with LAC.