bluuebunny/crossref_metadata_2025 huggingface dataset:
A Single Regulator Mediates Strategic Switching between Attachment/Spread and Growth/Virulence in the Plant Pathogen
Ralstonia solanacearum
Authors: Khokhani Devanshi , Lowe-Power Tiffany M. , Tran Tuan Minh , Allen Caitilyn
Published: September 2017

The PhcA virulence regulator in the vascular wilt pathogen
Ralstonia solanacearum
responds to cell density via quorum sensing. To understand the timing of traits that enable
R. solanacearum
to establish itself inside host plants, we created a Δ
phcA
mutant that is genetically locked in a low-cell-density condition. Comparing levels of gene expression of wild-type
R. solanacearum
and the Δ
phcA
mutant during tomato colonization revealed that the PhcA transcriptome includes an impressive 620 genes (>2-fold differentially expressed; false-discovery rate [FDR], ≤0.005). Many core metabolic pathways and nutrient transporters were upregulated in the Δ
phcA
mutant, which grew faster than the wild-type strain in tomato xylem sap and on dozens of specific metabolites, including 36 found in xylem. This suggests that PhcA helps
R. solanacearum
to survive in nutrient-poor environmental habitats and to grow rapidly during early pathogenesis. However, after
R. solanacearum
reaches high cell densities
in planta
, PhcA mediates a trade-off from maximizing growth to producing costly virulence factors.
R. solanacearum
infects through roots, and low-cell-density-mode-mimicking Δ
phcA
cells attached to tomato roots better than the wild-type cells, consistent with their increased expression of several adhesins. Inside xylem vessels, Δ
phcA
cells formed aberrantly dense mats. Possibly as a result, the mutant could not spread up or down tomato stems as well as the wild type. This suggests that aggregating improves
R. solanacearum
survival in soil and facilitates infection and that it reduces pathogenic fitness later in disease. Thus, PhcA mediates a second strategic switch between initial pathogen attachment and subsequent dispersal inside the host. PhcA helps
R. solanacearum
optimally invest resources and correctly sequence multiple steps in the bacterial wilt disease cycle.

IMPORTANCE
Ralstonia solanacearum
is a destructive soilborne crop pathogen that wilts plants by colonizing their water-transporting xylem vessels. It produces its costly virulence factors only after it has grown to a high population density inside a host. To identify traits that this pathogen needs in other life stages, we studied a mutant that mimics the low-cell-density condition. This mutant (the Δ
phcA
mutant) cannot sense its own population density. It grew faster than and used many nutrients not available to the wild-type bacterium, including metabolites present in tomato xylem sap. The mutant also attached much better to tomato roots, and yet it failed to spread once it was inside plants because it was trapped in dense mats. Thus, PhcA helps
R. solanacearum
succeed over the course of its complex life cycle by ensuring avid attachment to plant surfaces and rapid growth early in disease, followed by high virulence and effective dispersal later in disease.
A Novel Calcium Uptake Transporter of Uncharacterized P-Type ATPase Family Supplies Calcium for Cell Surface Integrity in
Mycobacterium smegmatis
Authors: Gupta Hemant Kumar , Shrivastava Shruti , Sharma Rakesh
Published: September 2017

Ca
2+
plays an important role in the physiology of bacteria. Intracellular Ca
2+
concentrations are tightly maintained in the nanomolar range. Molecular mechanisms of Ca
2+
uptake in bacteria remain elusive. Here we show that CtpE is responsible for Ca
2+
uptake in
Mycobacterium smegmatis
. It represents a previously uncharacterized P-type ATPase family in bacteria. Disruption of
ctpE
in
M. smegmatis
resulted in a mutant with impaired growth under Ca
2+
-deficient conditions. The growth defect of the mutant could be rescued by Ca
2+
or by ectopic expression of
ctpE
from
M. smegmatis
or the orthologous gene (
Rv0908
) from
Mycobacterium tuberculosis
H37Rv. Radioactive transport assays revealed that CtpE is a Ca
2+
-specific transporter. Ca
2+
deficiency increased expression of
ctpE
, resulting in increased
45
Ca
2+
accumulation in cells.
ctpE
is a gene that is part of an operon, which is negatively regulated by Ca
2+
. The
ctpE
mutant also showed hypersensitivity to polymyxin B, increased biofilm formation, and higher cell aggregation, indicating cell envelope defects. Our work establishes, for the first time, the presence of Ca
2+
uptake pumps of the energy-dependent P-type ATPase superfamily in bacteria and also implicates that intracellular Ca
2+
is essential for growth and cell envelope integrity in
M. smegmatis
.

IMPORTANCE
Ca
2+
is essential for gene regulation, enzymatic activity, and maintenance of structural integrity of cell walls in bacteria. Bacteria maintain intracellular calcium concentrations in a narrow range, creating a gradient with low cytoplasmic calcium concentration and high extracellular calcium concentration. Due to this steep gradient, active pumps belonging to family 2 of P-type ATPases and antiporters are used for Ca
2+
efflux, whereas Ca
2+
uptake is usually carried out by channels. Molecular mechanisms of Ca
2+
uptake in bacteria are still elusive and are mainly limited to a nonproteinaceous channel in
Escherichia coli
and a pH-dependent channel protein from
Bacillus subtilis
. Energy-dependent active transporters are not reported for Ca
2+
uptake from any organism. Here we show that CtpE belonging to a family of previously uncharacterized bacterial P-type ATPases is involved in specific uptake of Ca
2+
into
Mycobacterium smegmatis
. We also demonstrate that intracellular Ca
2+
obtained through CtpE is essential for growth and maintenance of cell surface properties under Ca
2+
-deficient conditions.
Structural Basis for EarP-Mediated Arginine Glycosylation of Translation Elongation Factor EF-P
Authors: Krafczyk Ralph , Macošek Jakub , Jagtap Pravin Kumar Ankush , Gast Daniel , Wunder Swetlana , Mitra Prithiba , Jha Amit Kumar , Rohr Jürgen , Hoffmann-Röder Anja , Jung Kirsten , Hennig Janosch , Lassak Jürgen
Published: September 2017

Glycosylation is a universal strategy to posttranslationally modify proteins. The recently discovered arginine rhamnosylation activates the polyproline-specific bacterial translation elongation factor EF-P. EF-P is rhamnosylated on arginine 32 by the glycosyltransferase EarP. However, the enzymatic mechanism remains elusive. In the present study, we solved the crystal structure of EarP from
Pseudomonas putida
. The enzyme is composed of two opposing domains with Rossmann folds, thus constituting a B pattern-type glycosyltransferase (GT-B). While dTDP-β-
l
-rhamnose is located within a highly conserved pocket of the C-domain, EarP recognizes the KOW-like N-domain of EF-P. Based on our data, we propose a structural model for arginine glycosylation by EarP. As EarP is essential for pathogenicity in
P. aeruginosa
, our study provides the basis for targeted inhibitor design.

IMPORTANCE
The structural and biochemical characterization of the EF-P-specific rhamnosyltransferase EarP not only provides the first molecular insights into arginine glycosylation but also lays the basis for targeted-inhibitor design against
Pseudomonas aeruginosa
infection.
Structured lifestyle intervention based on a trans-cultural diabetes-specific nutrition algorithm (tDNA) in individuals with type 2 diabetes: a randomized controlled trial
Authors: Chee Winnie S S , Gilcharan Singh Harvinder Kaur , Hamdy Osama , Mechanick Jeffrey I , Lee Verna K M , Barua Ankur , Mohd Ali Siti Zubaidah , Hussein Zanariah
Published: September 2017

Objective

Trans-cultural diabetes nutrition algorithm (tDNA) was created by international task force and culturally customized for Malaysian population. This study was designed to evaluate its effectiveness versus usual diabetes care in primary care settings.

Research design and methods

We randomized 230 patients with overweight/obesity, type 2 diabetes, and glycated hemoglobin (A1c) 7%–11% to receive usual care (UC) or UC with tDNA for 6 months. The tDNA intervention consisted of structured low-calorie meal plan, diabetes-specific meal replacements, and increased physical activity. Participants were counseled either through motivational interviewing (tDNA-MI) or conventional counseling (tDNA-CC). The UC group received standard dietary and exercise advice through conventional counseling. All patients were followed for another 6 months after intervention.

Results

At 6 months, A1c decreased significantly in tDNA-MI (−1.1±0.1%, p<0.001) and tDNA-CC (−0.5±0.1%, p=0.001) but not in UC (−0.2±0.1%, p=NS). Body weight decreased significantly in tDNA-MI (−6.9±1.3 kg, p<0.001) and tDNA-CC (−5.3±1.2 kg, p<0.001) but not in UC (−0.8±0.5 kg, p=NS). tDNA-MI patients had significantly lower fasting plasma glucose (tDNA-MI: −1.1±0.3 mmol/L, p<0.001; tDNA-CC: −0.6±0.3 mmol/L, p=NS; UC: 0.1±0.3 mmol/L, p=NS) and systolic blood pressure (tDNA-MI: −9±2 mm Hg, p<0.001; tDNA-CC: −9±2 mm Hg, p=0.001; UC: −1±2 mm Hg, p=NS). At 1 year, tDNA-MI patients maintained significant reduction in A1c (tDNA-MI: −0.5±0.2%, p=0.006 vs tDNA-CC: 0.1±0.2%, p=NS and UC: 0.02±0.01%, p=NS) and significant weight loss (tDNA-MI: −5.8±1.3 kg, p<0.001 vs tDNA-CC: −3.3±1.2 kg, p=NS and UC: 0.5±0.6 kg, p=NS).

Conclusions

Structured lifestyle intervention through culturally adapted nutrition algorithm and motivational interviewing significantly improved diabetes control and body weight in primary care setting.
A systematic review of cost-effectiveness, comparing traction to intramedullary nailing of femoral shaft fractures, in the less economically developed context
Authors: Parkes Rebekah J , Parkes Gary , James Kyle
Published: September 2017

Introduction

Femoral shaft fractures carry considerable morbidity and are increasingly common in less economically developed countries (LEDCs). Treatment options include traction and intramedullary (IM) nailing but in a limited-resource environment; cost-effectiveness is fundamental to policy development.

The objective herein was to evaluate the cost-effectiveness of moving from traction to IM nailing for femoral shaft fractures, in adults, in LEDCs. Incorporating a systematic review of complications and functional outcomes and a cost-minimization analysis.

Methods

PubMed, EMBASE, Africa Journals Online and the Cochrane Library were searched from inception using the terms: femur* AND fracture AND traction AND (sign OR nail* OR intramedullary) AND (cost-effectiveness OR cost* OR outcome OR function) NOT paed* NOT child* NOT elastic NOT neck NOT intertrochanteric NOT periprosthetic (where asterisks indicate an unlimited truncation strategy). Abstracts were reviewed for all titles returned and full texts obtained as indicated. References of all relevant papers were also examined for further studies.

Results

IM nailing has been successfully used in several institutions and reported infection, union and reoperation rates are encouraging, although no randomised control trials were identified. Three studies assessed the cost aspect and all found IM nailing to be the cheaper strategy.

Conclusion

To date, the improved complication profile and reduced cost of treatment suggest that IM nailing is more cost-effective than traction. Evidence, however, is limited and the necessity for appropriate training and audit with the introduction of new techniques must be emphasised.
Effect of removing the barrier of transportation costs on surgical utilisation in Guinea, Madagascar and the Republic of Congo
Authors: Shrime Mark G , Hamer Mirjam , Mukhopadhyay Swagoto , Kunz Lauren M , Claus Nathan H , Randall Kirsten , Jean-Baptiste Joannita H , Maevatombo Pierre H , Toh Melissa P S , Biddell Jasmin R , Bos Ria , White Michelle
Published: September 2017

Background

81 million people face impoverishment from surgical costs every year. The majority of this impoverishment is attributable to the non-medical costs of care—for transportation, for food and for lodging. Of these, transportation is the largest, but because it is not viewed as an actual medical cost, it is frequently unaddressed. This paper examines the effect on surgical utilisation of paying for transportation.

Methods

A hierarchical logistic regression was performed on 2692 patients presenting for surgical care to a non-governmental organisation operating in the Republic of the Congo, Guinea and Madagascar. Controlling for distance from the hospital, age, gender, the need for air travel and time between appointments, the effect of payment for transportation on the surgical no-show rate was evaluated.

Results

After adjustment for observed confounders, paying for transportation drops the surgical no-show rate by 45% (OR 0.55; 95% CI 0.40 to 0.77; p<0.001). Age, delay between appointments and the number of hours travelled for surgery also predict surgical no-show. For 28% of no-show patients, the cost of transportation from their homes to a nearby predetermined pick-up point remained a barrier, even when transportation from the pick-up point to the hospital was free.

Conclusion

Transportation costs are a significant barrier to surgical care in low-resource settings, and paying for it halves the no-show rate. This finding highlights that decreasing demand-side barriers to surgical care cannot be limited only to the removal of user fees.
Evolving landscape of stroke prevention in atrial fibrillation within the UK between 2012 and 2016: a cross-sectional analysis study using CPRD
Authors: Lacoin Laure , Lumley Matthew , Ridha Essra , Pereira Marta , McDonald Laura , Ramagopalan Sreeram , Lefèvre Cinira , Evans David , Halcox Julian P
Published: September 2017

Objective

To describe the changes in prescribing of oral anticoagulant (AC) and antiplatelet (AP) agents in patients with non-valvular atrial fibrillation (NVAF) in the UK and to identify the characteristics associated with deviation from guideline-based recommendations.

Design

Five cross-sectional analyses in a large retrospective population-based cohort study.

Setting

General practices contributing data to the UK Clinical Practice Research Datalink.

Participants

The study included patients with a diagnosis of NVAF and eligible for anticoagulation (CHA2DS2-VASc score ≥2) on 1 April of 2012, 2013, 2014, 2015 and 1st January 2016.

Results

The proportion of patients being treated with AC increased at each index date, showing an absolute rise of 16.7% over the study period. At the same time, the proportion of patients treated with an AP alone was reduced by half, showing an absolute decrease of 16.8%. The proportion of patients not receiving any antithrombotic (AT) treatment remained the same across the study period. A number of predictors were identified for AP alone or no treatment compared with AC treatment.

Conclusion

Major improvements in the AT management of patients with NVAF for stroke prevention in the UK were observed between April 2012 and January 2016. Despite this, nearly 20% of at-risk patients still received AP alone and over 15% were on no AT agents in January 2016.
Barriers and facilitators in the integration of oral health into primary care: a scoping review
Authors: Harnagea Hermina , Couturier Yves , Shrivastava Richa , Girard Felix , Lamothe Lise , Bedos Christophe Pierre , Emami Elham
Published: September 2017

Objective

This scoping study has been conducted to map the literature and provide a descriptive synthesis on the barriers and facilitators of the integration of oral health into primary care.

Methods

Grounded in the Rainbow conceptual model and using the Levacet alsix-stage framework, we performed a systematic search of electronic databases, organisational websites and grey literature from 1978 to April 2016. All publications with a focus on the integration of oral health into primary care were included except commentaries and editorials. Thematic analyses were performed to synthesise the results.

Results

From a total of 1619 citations, 58 publications were included in the review. Barrier-related themes included: lack of political leadership and healthcare policies; implementation challenges; discipline-oriented education; lack of continuity of care and services and patients’ oral healthcare needs. The facilitators of integration were supportive policies and resources allocation, interdisciplinary education, collaborative practices between dental and other healthcare professionals, presence of local strategic leaders and geographical proximity.

Discussion and public health implications

This work has advanced the knowledge on the barriers and facilitators at each integration domain and level, which may be helpful if the healthcare organisations decide to integrate oral health and dental services into primary care. The scoping review findings could be useful for both dental and medical workforce and allied primary healthcare providers. They could also guide the development of healthcare policies that support collaborative practices and patient-centred care in the field of primary care.
Effects of a new parallel primary healthcare centre and on-campus training programme on history taking, physical examination skills and medical students' preparedness: a prospective comparative study in Taiwan
Authors: Yang Ying-Ying , Wang Shuu-Jiun , Yang Ling-Yu , Lirng Jiing-Feng , Huang Chia-Chang , Liang Jen-Feng , Lee Fa-Yauh , Hwang Shinn-Jang , Huang Chin-Chou , Kirby Ralph
Published: September 2017

Objectives

The primary healthcarecentre (PHCC) is the first place that medical students experience patient contact. Usually, medical students are frustrated by a lack of proper skills training for on-campus history taking (HT), physical examination (PE) and self-directed learning (SDL) to prepare for their PHCC and inhospital patient contact. For pre-clerks, this study aims to compare the effectiveness of PHCC training and PHCC training in combination with on-campus HT and PE training modules (PHCC+on-campus) on their clerkship preparedness.

Design

This comparative study utilised prospective, consecutive, end of pre-clerkship group objective structured clinical examination (GOSCE), beginning of clerkship OSCE and self-administered Preparation for Hospital Practice Questionnaire (PHPQ).

Setting/participants

128 pre-clinical clerk volunteers (64 each year) receiving PHCC training (7 week PHCCtraining in addition to 7 week assignment based group learning, academic year 2014, controls) and PHCC training in combination with on-campus module training (academic year 2015, 7 week PHCCtraining in addition to 7 week on-campus sessions) were sequentially assessed before the module (week 1), at the end of the module (week 14) and at the beginning of clerkship (week 25).

Results

For overall HT and PE skills, both PHCC and PHCC+on-campus module trained pre-clerks performed better on OSCE than GOSCE. Additionally, the improvement was accompanied by higher self-reported PHPQ scores in ‘confidence/coping’ and ‘SDL’ domains. At the end of the pre-clerkship and the beginning of the clerkship stages, the degree of improvement in preparedness in ‘confidence/coping’ and ‘SDL’ domains was higher for those in the PHCC+on-campus group than for those in the PHCC group. Among the PHCC+on-campus module participants, a positive association was observed between high mean PHPQ-SDL scores and high OSCE scores.

Conclusions

Our study suggests that the PHCC+on-campus module, which is paired faculty led and pre-trained dyad student assisted, is effective in developing a preclinical clerk’s HT and PE skills and intensifying SDL/patient management abilities to prepare for hospital practice in clerkship.
Perforated appendicitis in patients with schizophrenia: a retrospective cohort study
Authors: Nishihira Yoshimasa , McGill Rita L , Kinjo Mitsuyo
Published: September 2017

Objective

Altered pain sensitivity may affect the outcome of appendicitis in patients with schizophrenia. We aimed to compare the prevalence of perforation in appendicitis between patients with and without schizophrenia.

Design

Retrospective cohort study with random matching.

Setting

A single tertiary medical centre in Japan.

Participants

From 1985 to 2013, 1821 cases of appendicitis requiring appendectomy were collected. Patients with schizophrenia and a cohort of randomly selected control subjects without schizophrenia who underwent appendectomy were identified.

Primary and secondary outcome measures

The primary outcome was the rate of perforated appendicitis in patients with and without schizophrenia. Secondary outcome was the odds of perforated appendicitis by different clinical factors.

Results

62 patients with schizophrenia and randomly sampled 200 non-schizophrenic patients were compared. The prevalence of perforation was 53% in patients with schizophrenia versus 17% in controls (p<0.0001). The adjusted OR for perforation were 4.87 (95% CI: 2.33 to 10.2) for schizophrenia, 3.35 (95% CI 1.51 to 7.45) for age >55 years and 2.18 (95% CI: 1.12 to 4.27) for delayed presentation.

Conclusion

Appendiceal perforation was more frequent in patients with schizophrenia than controls, which may be partly attributable to delayed presentation and altered responses to pain.
Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: protocol for a systematic review and meta-analysis
Authors: Ruiz-Goikoetxea Maite , Cortese Samuele , Aznarez-Sanado Maite , Magallon Sara , Luis Elkin O , Zallo Noelia Alvarez , Castro-Manglano Pilar de , Soutullo Cesar , Arrondo Gonzalo
Published: September 2017

Introduction

Attention-deficit hyperactivity disorder (ADHD) has been related to increased rates of unintentional injuries. However, the magnitude of the effect and to which extent variables such as sex, age or comorbidity can influence this relationship is unknown. Additionally, and importantly, it is unclear if, and to which degree, ADHD medications can decrease the number of unintentional injuries. Due to the amount of economic and social resources invested in the treatment of injuries, filling these gaps in the literature is highly relevant from a public health standpoint. Here, we present a protocol for a systematic review and meta-analysis to estimate the relationship between ADHD and unintentional injuries and assess the impact of pharmacological treatment for ADHD

Methods and analysis

We will combine results from 114 bibliographic databases for studies relating ADHD and risk of injuries. Bibliographic searches and data extraction will be carried out independently by two researchers. The studies’ risk of bias will be assessed using the Newcastle-Ottawa Scale. Articles reporting ORs or HRs of suffering an injury in ADHD compared with controls (or enough data to calculate them) will be combined using Robust Variance Estimation, a method that permits to include multiple non-independent outcomes in the analysis. All analyses will be carried out in Stata. Age, sex and comorbid conduct disorders will be considered as potential causes of variance and their effect analysed through meta-regression and subgroup analysis. Sensitivity analyses will exclude articles with longer follow-ups, non-stringent definitions of ADHD or controls and statistically uncontrolled/controlled outcomes. Studies implementing a self-controlled case series methodology to investigate if ADHD drugs reduce the risk of injuries will be combined with a generalised linear mixed model using the Poisson distribution and a log link function.

Registration details

PROSPERO—Prospective Register of Systematic Reviews (CRD42017064967)
Interprofessional collaboration among care professionals in obstetrical care: are perceptions aligned?
Authors: Romijn Anita , Teunissen Pim W , de Bruijne Martine C , Wagner Cordula , de Groot Christianne J M
Published: September 2017

Background

In an obstetrical team, obstetricians, midwives and nurses work together in a dynamic and complex care setting. Different professional cultures can be a barrier for effective interprofessional collaboration. Although the different professional cultures in obstetrical care are well known, little is understood about discrepancies in mutual perceptions of collaboration. Similar perceptions of collaboration are important to ensure patient safety. We aimed to understand how different care professionals in an obstetrical team assess interprofessional collaboration in order to gain insight into the extent to which their perceptions are aligned.

Methods

This cross-sectional study was performed in the north-western region of the Netherlands. Care professionals from five hospitals and surrounding primary-care midwifery practices were surveyed. The respondents consisted of four groups of care professionals: obstetricians (n=74), hospital-based midwives known as clinical midwives (n=42), nurses (n=154) and primary-care midwives (n=109). The overall response rate was 80.8%. We used the Interprofessional Collaboration Measurement Scale (IPCMS) to assess perceived interprofessional collaboration. The IPCMS distinguishes three subscales: communication, accommodation and isolation. Data were analysed using non-parametrical tests.

Results

Overall, ratings of interprofessional collaboration were good. Obstetricians rated their collaboration with clinical midwives, nurses and primary-care midwives more positively than these three groups rated the collaboration with obstetricians. Discrepancies in mutual perceptions were most apparent in the isolation subscale, which is about sharing opinions, discussing new practices and respecting each other.

Conclusion

We found relevant discrepancies in mutual perceptions of collaboration in obstetrical care in the Netherlands. Obstetrical care is currently being reorganised to enable more integrated care, which will have consequences for interprofessional collaboration. The findings of this study indicate opportunities for improvement especially in terms of perceived isolation.
Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative
Authors: Smith Shawna N , Greene M Todd , Mody Lona , Banaszak-Holl Jane , Petersen Laura D , Meddings Jennifer
Published: September 2017

Background

Recent efforts to reduce patient infection rates emphasise the importance of safety culture. However, little evidence exists linking measures of safety culture and infection rates, in part because of the difficulty of collecting both safety culture and infection data from a large number of nursing homes.

Objective

To examine the association between nursing home safety culture, measured with the Nursing Home Survey on Patient Safety Culture (NHSOPS), and catheter-associated urinary tract infection rates (CAUTI) using data from a recent national collaborative for preventing healthcare-associated infections in nursing homes.

Methods

In this prospective cohort study of nursing homes, facility staff completed the NHSOPS at intervention start and 11 months later. National Healthcare Safety Network-defined CAUTI rates were collected monthly for 1 year. Negative binomial models examined CAUTI rates as a function of both initial and time-varying facility-aggregated NHSOPS components, adjusted for facility characteristics.

Results

Staff from 196 participating nursing homes completed the NHSOPS and reported CAUTI rates monthly. Nursing homes saw a 52% reduction in CAUTI rates over the intervention period. Seven of 13 NHSOPS measures saw improvements, with the largest improvements for ‘Management Support for Resident Safety’ (3.7 percentage point increase in facility-level per cent positive response, on average) and ‘Communication Openness’ (2.5 percentage points). However, these increases were statistically insignificant, and multivariate models did not find significant association between CAUTI rates and initial or over-time NHSOPS domains.

Conclusions

This large national collaborative of nursing homes saw declining CAUTI rates as well as improvements in several NHSOPS domains. However, no association was found between initial or over-time NHSOPS scores and CAUTI rates.
A randomised trial of the effect of omega-3 polyunsaturated fatty acid supplements on the human intestinal microbiota
Authors: Watson Henry , Mitra Suparna , Croden Fiona C , Taylor Morag , Wood Henry M , Perry Sarah L , Spencer Jade A , Quirke Phil , Toogood Giles J , Lawton Clare L , Dye Louise , Loadman Paul M , Hull Mark A
Published: September 2017

Objective

Omega-3 polyunsaturated fatty acids (PUFAs) have anticolorectal cancer (CRC) activity. The intestinal microbiota has been implicated in colorectal carcinogenesis. Dietary omega-3 PUFAs alter the mouse intestinal microbiome compatible with antineoplastic activity. Therefore, we investigated the effect of omega-3 PUFA supplements on the faecal microbiome in middle-aged, healthy volunteers (n=22).

Design

A randomised, open-label, cross-over trial of 8 weeks’ treatment with 4 g mixed eicosapentaenoic acid/docosahexaenoic acid in two formulations (soft-gel capsules and Smartfish drinks), separated by a 12-week ‘washout’ period. Faecal samples were collected at five time-points for microbiome analysis by 16S ribosomal RNA PCR and Illumina MiSeq sequencing. Red blood cell (RBC) fatty acid analysis was performed by liquid chromatography tandem mass spectrometry.

Results

Both omega-3 PUFA formulations induced similar changes in RBC fatty acid content, except that drinks were associated with a larger, and more prolonged, decrease in omega-6 PUFA arachidonic acid than the capsule intervention (p=0.02). There were no significant changes in α or β diversity, or phyla composition, associated with omega-3 PUFA supplementation. However, a reversible increased abundance of several genera, including Bifidobacterium, Roseburia and Lactobacillus was observed with one or both omega-3 PUFA interventions. Microbiome changes did not correlate with RBC omega-3 PUFA incorporation or development of omega-3 PUFA-induced diarrhoea. There were no treatment order effects.

Conclusion

Omega-3 PUFA supplementation induces a reversible increase in several short-chain fatty acid-producing bacteria, independently of the method of administration. There is no simple relationship between the intestinal microbiome and systemic omega-3 PUFA exposure.

Trial registration number

ISRCTN18662143.
Unintentional injuries among refugee and immigrant children and youth in Ontario, Canada: a population-based cross-sectional study
Authors: Saunders Natasha Ruth , Macpherson Alison , Guan Jun , Guttmann Astrid
Published: September 2017

Background

Unintentional injuries are a leading reason for seeking emergency care. Refugees face vulnerabilities that may contribute to injury risk. We aimed to compare the rates of unintentional injuries in immigrant children and youth by visa class and region of origin.

Methods

Population-based, cross-sectional study of children and youth (0–24 years) from immigrant families residing in Ontario, Canada, from 2011 to 2012. Multiple linked health and administrative databases were used to describe unintentional injuries by immigration visa class and region of origin. Poisson regression models estimated rate ratios for injuries.

Results

There were 6596.0 and 8122.3 emergency department visits per 100 000 non-refugee and refugee immigrants, respectively. Hospitalisation rates were 144.9 and 185.2 per 100 000 in each of these groups. The unintentional injury rate among refugees was 20% higher than among non-refugees (adjusted rate ratio (ARR) 1.20, 95% CI 1.16, 1.24). In both groups, rates were lowest among East and South Asians. Young age, male sex, and high income were associated with injury risk. Compared with non-refugees, refugees had higher rates of injury across most causes, including for motor vehicle injuries (ARR 1.51, 95% CI 1.40, 1.62), poisoning (ARR 1.40, 95% CI 1.26, 1.56) and suffocation (ARR 1.39, 95% CI 1.04, 1.84).

Interpretation

The observed 20% higher rate of unintentional injuries among refugees compared with non-refugees highlights an important opportunity for targeting population-based public health and safety interventions. Engaging refugee families shortly after arrival in active efforts for injury prevention may reduce social vulnerabilities and cultural risk factors for injury in this population.
Clinical and immunological characteristics of the spectrum of GFAP autoimmunity: a case series of 22 patients
Authors: Iorio Raffaele , Damato Valentina , Evoli Amelia , Gessi Marco , Gaudino Simona , Di Lazzaro Vincenzo , Spagni Gregorio , Sluijs Jacqueline A , Hol Elly M
Published: September 2017

Objective

To report the clinical and immunological characteristics of 22 new patients with glial fibrillar acidic protein (GFAP) autoantibodies.

Methods

From January 2012 to March 2017, we recruited 451 patients with suspected neurological autoimmune disease at the Catholic University of Rome. Patients’ serum and cerebrospinal fluid (CSF) samples were tested for neural autoantibodies by immunohistochemistry on mouse and rat brain sections, by cell-based assays (CBA) and immunoblot. GFAP autoantibodies were detected by immunohistochemistry and their specificity confirmed by CBA using cells expressing human GFAPα and GFAPδ proteins, by immunoblot and immunohistochemistry on GFAP-/- mouse brain sections.

Results

Serum and/or CSF IgG of 22/451 (5%) patients bound to human GFAP, of which 22/22 bound to GFAPα, 14/22 to both GFAPα and GFAPδ and none to the GFAPδ isoform only. The neurological presentation was: meningoencephalomyelitis or encephalitis in 10, movement disorder (choreoathetosis or myoclonus) in 3, anti-epileptic drugs (AED)-resistant epilepsy in 3, cerebellar ataxia in 3, myelitis in 2, optic neuritis in 1 patient. Coexisting neural autoantibodies were detected in five patients. Six patients had other autoimmune diseases. Tumours were found in 3/22 patients (breast carcinoma, 1; ovarian carcinoma, 1; thymoma, 1). Nineteen patients were treated with immunotherapy and 16 patients (84%) improved. Histopathology analysis of the leptomeningeal biopsy specimen from one patient revealed a mononuclear infiltrate with macrophages and CD8+ T cells.

Conclusions

GFAP autoimmunity is not rare. The clinical spectrum encompasses meningoencephalitis, myelitis, movement disorders, epilepsy and cerebellar ataxia. Coexisting neurological and systemic autoimmunity are relatively common. Immunotherapy is beneficial in most cases.
Insights into variations in preferred selection criteria for acute stroke endovascular therapy
Authors: Wang Feng , Campbell Bruce C V , Churilov Leonid , Mitchell Peter , Dowling Richard , Chen Ziyuan , Davis Stephen M , Yan Bernard
Published: September 2017

Background

Endovascular thrombectomy (ET) is safe, effective, and cost-effective for large artery occlusion ischemic stroke, even if under different selection criteria.

Purpose

To study the preferences for ET selection criteria by surveying clinicians and consumers, where number needed to treat to achieve functional independence is the only factor being considered.

Methods

A survey providing visual representation of the proportion of patients treated and expected functional outcomes, based on the selection criteria in each of the recent randomized trials of ET, was distributed nationwide in Australia and New Zealand to clinicians and consumers. The preferred selection criteria were identified by the frequency of first choice and using decision-analysis techniques to assess consensus by treating respondents as a panel of experts and aggregating their preferences on selection criteria.

Results

104 clinicians and 107 consumer respondents (43/107 (40%) stroke survivors) took part in the study. Selection criteria of EXTEND-IA were ranked as the most preferred by the consensus process analysis and were the first choice of 64 individual clinicians (61.5%; 95% CI 52% to 71%). ESCAPE trial selection criteria were ranked as the most preferred option and chosen by 42 individual consumers (39%; 95% CI 29% to 48%). Most clinicians based their choice on the ratio of patients benefiting from ET, while consumers considered the absolute number of patients benefiting.

Conclusions

Consumers favor maximization of the absolute number achieving good outcome in comparison with clinicians. This finding suggests that less restrictive criteria may be favored in clinical practice.
Left ventricular longitudinal systolic function analysed by 2D speckle-tracking echocardiography in heart failure with preserved ejection fraction: a meta-analysis
Authors: Morris Daniel Armando , Ma Xin-Xin , Belyavskiy Evgeny , Aravind Kumar Radhakrishnan , Kropf Martin , Kraft Robin , Frydas Athanasios , Osmanoglou Engin , Marquez Esteban , Donal Erwan , Edelmann Frank , Tschöpe Carsten , Pieske Burkert , Pieske-Kraigher Elisabeth
Published: September 2017

Background

The purpose of this meta-analysis was to confirm if the global longitudinal systolic function of the left ventricle (LV) is altered in patients with heart failure with preserved ejection fraction (HFpEF).

Methods

We searched in different databases (Medline, Embase and Cochrane) studies that analysed LV global longitudinal systolic strain (GLS) in patients with HFpEF and in controls (such as healthy subjects or asymptomatic patients with arterial hypertension, diabetes mellitus or coronary artery disease).

Results

Twenty-two studies (2284 patients with HFpEF and 2302 controls) were included in the final analysis. Patients with HFpEF had significantly lower GLS than healthy subjects (mean −15.7% (range −12% to −18.9%) vs mean −19.9% (range −17.1% to −21.5%), weighted mean difference −4.2% (95% CI −3.3% to −5.0%), p < 0.001, respectively). In addition, patients with HFpEF had also significantly lower GLS than asymptomatic patients (mean −15.5% (range −13.4% to −18.4%) vs mean −18.3% (range −15.1% to −20.4%), weighted mean difference −2.8%(95% CI −1.9% to −3.6%), p < 0.001, respectively). In line, 10 studies showed that the rate of abnormal GLS was significantly higher in patients with HFpEF (mean 65.4% (range 37%–95%)) than in asymptomatic subjects (mean 13% (range 0%–29.6%)). Regarding the prognostic relevance of abnormal GLS in HFpEF, two multicentre studies with large sample size (447 and 348) and high number of events (115 and 177) showed that patients with abnormal GLS had worse cardiovascular (CV) outcomes than those with normal GLS (HR for CV mortality and HF hospitalisation 2.14 (95% CI 1.26 to 3.66) and 1.94 (95% CI 1.22 to 3.07)), even adjusting these analyses for multiples clinical and echocardiographic variables.

Conclusion

The present meta-analysis analysing 2284 patients with HFpEF and 2302 controls confirms that the longitudinal systolic function of the LV is significantly altered in high proportion of patients with HFpEF. Further large multicentre studies with the aim to confirm the prognostic role of abnormal GLS in HFpEF are warranted.
Normalizability analysis of the generalized quantum electrodynamics from the causal point of view
Authors: Bufalo R. , Pimentel B. M. , Soto D. E.
Published: September 2017

The causal perturbation theory is an axiomatic perturbative theory of the S-matrix. This formalism has as its essence the following axioms: causality, Lorentz invariance and asymptotic conditions. Any other property must be showed via the inductive method order-by-order and, of course, it depends on the particular physical model. In this work we shall study the normalizability of the generalized quantum electrodynamics in the framework of the causal approach. Furthermore, we analyze the implication of the gauge invariance onto the model and obtain the respective Ward–Takahashi–Fradkin identities.
Astrophysical jets from topological currents
Authors: Flachi Antonino , Fukushima Kenji
Published: September 2017

In the presence of rotation, gravity induces, even at zero temperature, a chiral vortical current. This current is interpreted as emerging from the gravitational Chern–Simons current. We argue that this gravitational Chern–Simons chiral vortical current may provide a novel universal microscopic mechanism behind the generation of collimated jets from rotating astrophysical compact sources.
E-Learning in Jordanian Higher Education: Cultural Perspectives and Institutional Readiness
Authors: Alsmadi Duha , Chen Jiangping , Prybutok Victor , Gadgil Guruprasad
Published: September 2017

This study explores students’ acceptance of e-learning technology in Jordanian higher educational institutions. A paucity of studies that were conducted in individual institutions indicated that different cultural perspectives and resistance to change are overlaying the wide adoption of e-learning and influencing users’ perceptions pertaining the technology usefulness and/or ease of use. Our study utilises the technology acceptance model (TAM) and explores the influence of the main antecedents of accepting this technology from users’ perspectives, that is, perceived usefulness (PU) and perceived ease of use (PEU) in order to reveal the country’s readiness to adopt this technology and move from individual innovations to institutional standards. The results obtained using a survey-based methodology from three main public and private institutions distributed in multiple geographical areas show that the actual behaviour of usage is influenced by behavioural intention (BI), which is directed by PU, PEU, and attitude. Based on these results, multiple recommendations pertaining to cultural perspectives and educational institutions readiness are proposed and implications of the study are discussed.
Minimum Volume of the Longitudinal Fin with Rectangular and Triangular Profiles by a Modified Newton–Raphson Method
Authors: Quan Nguyen , Son Nguyen Hoai , Tuan Nguyen Quoc
Published: September 2017

The minimum volume of the nonlinear longitudinal fin with rectangular and triangular profiles by using the modified Newton–Raphson method is presented in this paper. The dimension of the fin profile is regarded as the optimization variable. Furthermore, a mechanism called “volume updating” is added into the modified Newton–Raphson algorithm to obtain the minimum volume of the fin. Two examples are illustrated to demonstrate the proposed method. The obtained results showed that the proposed method can be used efficiently and accurately in finding the minimum volume of the nonlinear longitudinal fin problem with rectangular and triangle profiles.
A New Revised Scheme for SPH
Authors: Imin Rahmatjan , Iminjan Ahmatjan , Halik Azhar
Published: September 2017

Based on the smoothed kernel approximation of the Smoothed Particle Hydrodynamics (SPH) method and Taylor series expansion, a new revised scheme for SPH method is proposed which significantly improves its accuracy, especially near the boundaries where the particle points do not entirely cover the compact support domain of kernel function and particles are irregularly distributed. The revised scheme is derived up to the first-and second-order derivatives both in one-dimensional and multi-dimensional cases. In order to demonstrate the ability of the proposed revised scheme, the scheme is applied to the interpolation of functions and the numerical solution of the convection–diffusion equations both in one- and two-dimensional cases.
A Probabilistic Representation Method for Interval Uncertainty
Authors: Zhou Changcong , Tang Chenghu , Liu Fuchao , Wang Wenxuan
Published: September 2017

In this work, we consider the interval uncertainty from the probabilistic point of view, focusing on the establishment of probabilistic representation of interval uncertainty. A model-free sampling technique is first introduced, which can be used to produce a considerably larger sample from a given small sample. To make sure the local statistical characteristics of these two samples coincide, an improved model-free sampling technique is introduced based on probability weighted moments. The improved model-free sampling technique is then applied to obtain a large sample based on interval data, of which the probability distribution is produced by the kernel density estimator. Highest density regions based on estimated probability density function have been considered to further investigate the underlying information. The proposed probabilistic representation method is employed in the attempt of interval uncertainty propagation with the results compared with previous studies. The research adds a possible tool in the treatment of interval uncertainty.
Hedging and pricing illiquid options with market impacts
Authors: Saito Taiga
Published: September 2017

In this paper, we consider hedging and pricing of illiquid options on an untradable underlying asset, where an alternative asset is used as a hedging instrument. Particularly, we consider the situation where the trade price of the hedging instrument is subject to market impacts caused by the hedger and the liquidity costs paid as a spread from the mid price. Pricing illiquid options, which often appears in trading of structured products, is a critical issue in practice because of its difficulties in hedging mainly due to untradability of the underlying asset as well as the liquidity costs and market impacts of the hedging instrument. First, by setting the problem under a discrete time model, where the optimal hedging strategy is defined by the local risk-minimization, we present algorithms to obtain the option price along with the hedging strategy by an asymptotic expansion. Moreover, we provide numerical examples. This model enables the estimation of the effect of both the market impacts and the liquidity costs on option prices, which is important in practice.
Revenue-based lending for SMEs
Authors: Mazengera Hassan
Published: September 2017

Most small businesses face uncertain demand for their products and services. The revenue they earn is most likely to be of stochastic nature. They face difficulties in making a fixed loan repayment throughout the life of the loan as they earn stochastic revenues. If banks are to lend to this market using the fixed loan repayment schedule/regime, it is highly likely that these businesses will default on their repayments several times in period [Formula: see text]. If default rate is high in a loan portfolio, it means that the bank has to set up a higher bad loan provision, thereby tying up its capital. This reduces the lending business, profitability and growth of the financial institution. This is one of the reasons why financial institutions perceive these small businesses as a high risk market. Only financial institutions with a very high risk appetite will tap into this market. We are proposing revenue-based lending as a solution to the problem. Stochastic repayments will reduce periodic defaults. This reduction in periodic defaults will reduce the bad loan provision thereby making more funds available for lending. We want to show that the bad loan provision for the bank will be higher for a fixed loan repayment compared to the stochastic loan repayment.
Short note on a new anurognathid pterosaur with evidence of perching behaviour from Jianchang of Liaoning Province, China
Authors: Lü Junchang , Meng Qingjin , Wang Baopeng , Liu Di , Shen Caizhi , Zhang Yuguang
Published: September 2017

A new anurognathid pterosaur,
Vesperopterylus lamadongensis
gen. et sp. nov., is erected based on a complete skeleton with a skull preserved. It is characterized by two short distinct ridges present on the ventral surface of the cervical vertebrae; coracoids slightly longer than scapula; humerus, wing phalanx 3 and tibia nearly the same in length; grooves clearly present on the posterior surface of the wing phalanges 1–3; and the first toe reversed. It is the first anurognathid pterosaur from China with a definitively short tail, and the first pterosaur with a reversed first toe. The reversed first toe of
Vesperopterylus
indicates that it had arboreal habitats. The discovery of
Vesperopterylus lamadongensis
from the Jiufotang Formation strongly expands the geological age range for anurognathid pterosaurs.
Research for practice
Authors: Bailis Peter , Dillahunt Tawanna , Mueller Stefanie , Baudisch Patrick
Published: September 2017

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