bluuebunny/crossref_metadata_2025 huggingface dataset:
An Amoebal Grazer of Cyanobacteria Requires Cobalamin Produced by Heterotrophic Bacteria
Authors: Ma Amy T. , Beld Joris , Brahamsha Bianca
Published: March 2017

Amoebae are unicellular eukaryotes that consume microbial prey through phagocytosis, playing a role in shaping microbial food webs. Many amoebal species can be cultivated axenically in rich media or monoxenically with a single bacterial prey species. Here, we characterize heterolobosean amoeba LPG3, a recent natural isolate, which is unable to grow on unicellular cyanobacteria, its primary food source, in the absence of a heterotrophic bacterium, aPseudomonasspecies coisolate. To investigate the molecular basis of this requirement for heterotrophic bacteria, we performed a screen using the defined nonredundant transposon library ofVibrio cholerae, which implicated genes in corrinoid uptake and biosynthesis. Furthermore, cobalamin synthase deletion mutations inV. choleraeand thePseudomonasspecies coisolate do not support the growth of amoeba LPG3 on cyanobacteria. While cyanobacteria are robust producers of a corrinoid variant called pseudocobalamin, this variant does not support the growth of amoeba LPG3. Instead, we show that it requires cobalamin that is produced by thePseudomonasspecies coisolate. The diversity of eukaryotes utilizing corrinoids is poorly understood, and this amoebal corrinoid auxotroph serves as a model for examining predator-prey interactions and micronutrient transfer in bacterivores underpinning microbial food webs.

IMPORTANCECyanobacteria are important primary producers in aquatic environments, where they are grazed upon by a variety of phagotrophic protists and, hence, have an impact on nutrient flux at the base of microbial food webs. Here, we characterize amoebal isolate LPG3, which consumes cyanobacteria as its primary food source but also requires heterotrophic bacteria as a source of corrinoid vitamins. Amoeba LPG3 specifically requires the corrinoid variant produced by heterotrophic bacteria and cannot grow on cyanobacteria alone, as they produce a different corrinoid variant. This same corrinoid specificity is also exhibited by other eukaryotes, including humans and algae. This amoebal model system allows us to dissect predator-prey interactions to uncover factors that may shape microbial food webs while also providing insight into corrinoid specificity in eukaryotes.
Molecular Viability Testing of UV-Inactivated Bacteria
Authors: Weigel Kris M. , Nguyen Felicia K. , Kearney Moira R. , Meschke John S. , Cangelosi Gerard A.
Published: March 2017

PCR is effective in detecting bacterial DNA in samples, but it is unable to differentiate viable bacteria from inactivated cells or free DNA fragments. New PCR-based analytical strategies have been developed to address this limitation. Molecular viability testing (MVT) correlates bacterial viability with the ability to rapidly synthesize species-specific rRNA precursors (pre-rRNA) in response to brief nutritional stimulation. Previous studies demonstrated that MVT can assess bacterial inactivation by chlorine, serum, and low-temperature pasteurization. Here, we demonstrate that MVT can detect inactivation of
Escherichia coli
,
Aeromonas hydrophila
, and
Enterococcus faecalis
cells by UV irradiation. Some UV-inactivated
E. coli
cells transiently retained the ability to synthesize pre-rRNA postirradiation (generating false-positive MVT results), but this activity ceased within 1 h following UV exposure. Viable but transiently undetectable (by culture)
E. coli
cells were consistently detected by MVT. An alternative viability testing method, viability PCR (vPCR), correlates viability with cell envelope integrity. This method did not distinguish viable bacteria from UV-inactivated bacteria under some conditions, indicating that the inactivated cells retained intact cell envelopes. MVT holds promise as a means to rapidly assess microbial inactivation by UV treatment.

IMPORTANCE
UV irradiation is increasingly being used to disinfect water, food, and other materials for human use. Confirming the effectiveness of UV disinfection remains a challenging task. In particular, microbiological methods that rely on rapid detection of microbial DNA can yield misleading results, due to the detection of remnant DNA associated with dead microbial cells. This report describes a novel method that rapidly distinguishes living microbial cells from dead microbial cells after UV disinfection.
Corexit 9500 Enhances Oil Biodegradation and Changes Active Bacterial Community Structure of Oil-Enriched Microcosms
Authors: Techtmann Stephen M. , Zhuang Mobing , Campo Pablo , Holder Edith , Elk Michael , Hazen Terry C. , Conmy Robyn , Santo Domingo Jorge W.
Published: March 2017

To better understand the impacts of Corexit 9500 on the structure and activity levels of hydrocarbon-degrading microbial communities, we analyzed next-generation 16S rRNA gene sequencing libraries of hydrocarbon enrichments grown at 5 and 25°C using both DNA and RNA extracts as the sequencing templates. Oil biodegradation patterns in both 5 and 25°C enrichments were consistent with those reported in the literature (i.e., aliphatics were degraded faster than aromatics). Slight increases in biodegradation were observed in the presence of Corexit at both temperatures. Differences in community structure were observed between treatment conditions in the DNA-based libraries. The 25°C consortia were dominated by
Vibrio
,
Idiomarina
,
Marinobacter
,
Alcanivorax
, and
Thalassospira
species, while the 5°C consortia were dominated by several species of the genera
Flavobacterium
,
Alcanivorax
, and
Oleispira
. Most of these genera have been linked to hydrocarbon degradation and have been observed after oil spills.
Colwellia
and
Cycloclasticus
, known aromatic degraders, were also found in these enrichments. The addition of Corexit did not have an effect on the active bacterial community structure of the 5°C consortia, while at 25°C, a decrease in the relative abundance of
Marinobacter
was observed. At 25°C,
Thalassospira
,
Marinobacter
, and
Idiomarina
were present at higher relative abundances in the RNA than DNA libraries, suggesting that they were active in degradation. Similarly,
Oleispira
was greatly stimulated by the addition of oil at 5°C.

IMPORTANCE
While dispersants such as Corexit 9500 can be used to treat oil spills, there is still debate on the effectiveness on enhancing oil biodegradation and its potential toxic effect on oil-degrading microbial communities. The results of this study provide some insights on the microbial dynamics of hydrocarbon-degrading bacterial populations in the presence of Corexit 9500. Operational taxonomic unit (OTU) analyses indicated that several OTUs were inhibited by the addition of Corexit. Conversely, a number of OTUs were stimulated by the addition of the dispersant, many of which were identified as known hydrocarbon-degrading bacteria. The results highlight the value of using RNA-based methods to further understand the impact of dispersant on the overall activity of different hydrocarbon-degrading bacterial groups.
Requirement of a Functional Flavin Mononucleotide Prenyltransferase for the Activity of a Bacterial Decarboxylase in a Heterologous Muconic Acid Pathway in Saccharomyces cerevisiae
Authors: Weber Heike E. , Gottardi Manuela , Brückner Christine , Oreb Mislav , Boles Eckhard , Tripp Joanna
Published: March 2017

Biotechnological production of
cis
,
cis
-muconic acid from renewable feedstocks is an environmentally sustainable alternative to conventional, petroleum-based methods. Even though a heterologous production pathway for
cis
,
cis
-muconic acid has already been established in the host organism
Saccharomyces cerevisiae
, the generation of industrially relevant amounts of
cis
,
cis
-muconic acid is hampered by the low activity of the bacterial protocatechuic acid (PCA) decarboxylase AroY isomeric subunit C
iso
(AroY-C
iso
), leading to secretion of large amounts of the intermediate PCA into the medium. In the present study, we show that the activity of AroY-C
iso
in
S. cerevisiae
strongly depends on the strain background. We could demonstrate that the strain dependency is caused by the presence or absence of an intact genomic copy of
PAD1
, which encodes a mitochondrial enzyme responsible for the biosynthesis of a prenylated form of the cofactor flavin mononucleotide (prFMN). The inactivity of AroY-C
iso
in strain CEN.PK2-1 could be overcome by plasmid-borne expression of Pad1 or its bacterial homologue AroY subunit B (AroY-B). Our data reveal that the two enzymes perform the same function in decarboxylation of PCA by AroY-C
iso
, although coexpression of Pad1 led to higher decarboxylase activity. Conversely, AroY-B can replace Pad1 in its function in decarboxylation of phenylacrylic acids by ferulic acid decarboxylase Fdc1. Targeting of the majority of AroY-B to mitochondria by fusion to a heterologous mitochondrial targeting signal did not improve decarboxylase activity of AroY-C
iso
, suggesting that mitochondrial localization has no major impact on cofactor biosynthesis.

IMPORTANCE
In
Saccharomyces cerevisiae
, the decarboxylation of protocatechuic acid (PCA) to catechol is the bottleneck reaction in the heterologous biosynthetic pathway for production of
cis
,
cis
-muconic acid, a valuable precursor for the production of bulk chemicals. In our work, we demonstrate the importance of the strain background for the activity of a bacterial PCA decarboxylase in
S. cerevisiae
. Inactivity of the decarboxylase is due to a nonsense mutation in a gene encoding a mitochondrial enzyme involved in the biosynthesis of a cofactor required for decarboxylase function. Our study reveals functional interchangeability of Pad1 and a bacterial homologue, irrespective of their intracellular localization. Our results open up new possibilities to improve muconic acid production by engineering cofactor supply. Furthermore, the results have important implications for the choice of the production strain.
Comparative effectiveness and safety of erythropoiesis-stimulating agents (biosimilars vs originators) in clinical practice: a population-based cohort study in Italy
Authors: Trotta Francesco , Belleudi Valeria , Fusco Danilo , Amato Laura , Mecozzi Alessandra , Mayer Flavia , Sansone Massimo , Davoli Marina , Addis Antonio
Published: March 2017

Objectives

To evaluate the benefit/risk profile of epoetin α biosimilar with the erythropoiesis-stimulating agents (ESAs) originators when administered to naïve patients from clinical practice.

Design

Population-based observational cohort study.

Setting

All residents in the Lazio Region, Italy, with chronic kidney disease (CKD) or cancer retrieved from the Electronic Therapeutic Plan (ETP) Register for ESA between 2012 and 2014.

Participants

Overall, 13 470 incident ESA users were available for the analysis, 8161 in the CKD and 5309 in the oncology setting, respectively.

Interventions

ESAs identified through the ATC B03XA were divided into 3 groups: (1) biosimilars; (2) epoetin α originator and (3) other originators. Patients were exposed to ESAs from the date of activation of the ETP, until the end of a 6-month follow-up period.

Outcome measures

Effectiveness (all-cause mortality and blood transfusion) and safety (major cardiovascular events, blood dyscrasia). A composite outcome including all-cause mortality, blood transfusion and major cardiovascular events was predefined. HRs of any outcome were estimated through Cox regression.

Results

We found no differences between patients on biosimilars or all originators with regard to the risk estimates of all-cause mortality, blood transfusion, major cardiovascular events and blood dyscrasia in the CKD setting. The composite outcome confirmed these results (biosimilars vs epoetin α originators: adjusted HR=1.02, 95% CI 0.78 to 1.33; biosimilars vs other originators: adjusted HR=1.09, 95% CI 0.85 to 1.41). Comparable risk estimates were observed between biosimilars and all originators in the oncology setting.

Conclusions

In both settings, our findings are suggestive of no difference between biosimilars and originators on relevant effectiveness and safety outcomes. This study may contribute to settling future drug policy for the health services and provides reassurance on the approval pathway for biosimilars. The oncology setting merits further research, taking into account tumour types, tumour stage and anticancer chemotherapy administered.
QUIT EMR trial: a prospective, observational, multicentre study to evaluate quality and 24 hours post-transport morbidity of interhospital transportation of critically ill patients: study protocol
Authors: Strauch Ulrich , Bergmans Dennis C J J , Habers Joachim , Jansen Jochen , Winkens Bjorn , Veldman Dirk J , Roekaerts Paul M H J , Beckers Stefan K
Published: March 2017

Introduction

It is widely accepted that transportation of critically ill patients is high risk. Unfortunately, however, there are currently no evidence-based criteria with which to determine the quality of various interhospital transport systems and their impact on the outcomes for patients. We aim to rectify this by assessing 2 scores which were developed in our hospital in a prospective, observational study. Primarily, we will be examining the Quality of interhospital critical care transportation in the Euregion Meuse-Rhine (QUIT EMR) score, which focuses on the quality of the transport system, and secondarily the SEMROS (Simplified EMR outcome score) which detects changes in the patient's clinical condition in the 24 hours following their transportation.

Methods and analysis

A web-based application will be used to document around 150 pretransport, intratransport and post-transport items of each patient case.

To be included, patients must be at least 18-years of age and should have been supervised by a physician during an interhospital transport which was started in the study region.

The quality of the QUIT EMR score will be assessed by comparing 3 predefined levels of transport facilities: the high, medium and low standards. Subsequently, SEMROS will be used to determine the effect of transport quality on the morbidity 24 hours after transportation.

It is estimated that there will be roughly 3000 appropriate cases suitable for inclusion in this study per year. Cases shall be collected from 1 April 2015 until 31 December 2017.

Ethics and dissemination

This trial was approved by the Ethics committees of the university hospitals of Maastricht (Netherlands) and Aachen (Germany). The study results will be published in a peer reviewed journal. Results of this study will determine if a prospective randomised trial involving patients of various categories being randomly assigned to different levels of transportation system shall be conducted.

Trial registration number

NTR4937.
From breathless to failure: symptom onset and diagnostic meaning in patients with heart failure—a qualitative study
Authors: Taylor C J , Hobbs F D R , Marshall T , Leyva-Leon F , Gale N
Published: March 2017

Objectives

To explore 2 key points in the heart failure diagnostic pathway—symptom onset and diagnostic meaning—from the patient perspective.

Design

Qualitative interview study.

Setting

Participants were recruited from a secondary care clinic in central England following referral from primary care.

Participants

Over age 55 years with a recent (<1 year) diagnosis of heart failure confirmed by a cardiologist following initial presentation to primary care.

Methods

Semistructured interviews were carried out with 16 participants (11 men and 5 women, median age 78.5 years) in their own homes. Data were audio-recorded and transcribed. Participants were asked to describe their diagnostic journey from when they first noticed something wrong up to and including the point of diagnosis. Data were analysed using the framework method.

Results

Participants initially normalised symptoms and only sought medical help when daily activities were affected. Failure to realise that anything was wrong led to a delay in help-seeking. Participants' understanding of the term ‘heart failure’ was variable and 1 participant did not know he had the condition. The term itself caused great anxiety initially but participants learnt to cope with and accept their diagnosis over time.

Conclusions

Greater public awareness of symptoms and adequate explanation of ‘heart failure’ as a diagnostic label, or reconsideration of its use, are potential areas of service improvement.
Quality of clinical practice guidelines in delirium: a systematic appraisal
Authors: Bush Shirley H , Marchington Katie L , Agar Meera , Davis Daniel H J , Sikora Lindsey , Tsang Tammy W Y
Published: March 2017

Objective

To determine the accessibility and currency of delirium guidelines, guideline summary papers and evaluation studies, and critically appraise guideline quality.

Design

Systematic literature search for formal guidelines (in English or French) with focus on delirium assessment and/or management in adults (≥18 years), guideline summary papers and evaluation studies.

Full appraisal of delirium guidelines published between 2008 and 2013 and obtaining a ‘Rigour of Development’ domain screening score cut-off of >40% using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.

Data sources

Multiple bibliographic databases, guideline organisation databases, complemented by a grey literature search.

Results

3327 database citations and 83 grey literature links were identified. A total of 118 retrieved delirium guidelines and related documents underwent full-text screening. A final 21 delirium guidelines (with 10 being >5 years old), 12 guideline summary papers and 3 evaluation studies were included. For 11 delirium guidelines published between 2008 and 2013, the screening AGREE II ‘Rigour’ scores ranged from 3% to 91%, with seven meeting the cut-off score of >40%. Overall, the highest rating AGREE II domains were ‘Scope and Purpose’ (mean 80.1%, range 64–100%) and ‘Clarity and Presentation’ (mean 76.7%, range 38–97%). The lowest rating domains were ‘Applicability’ (mean 48.7%, range 8–81%) and ‘Editorial Independence’ (mean 53%, range 2–90%). The three highest rating guidelines in the ‘Applicability’ domain incorporated monitoring criteria or audit and costing templates, and/or implementation strategies.

Conclusions

Delirium guidelines are best sourced by a systematic grey literature search. Delirium guideline quality varied across all six AGREE II domains, demonstrating the importance of using a formal appraisal tool prior to guideline adaptation and implementation into clinical settings. Adding more knowledge translation resources to guidelines may improve their practical application and effective monitoring. More delirium guideline evaluation studies are needed to determine their effect on clinical practice.
Maternal education, empowerment, economic status and child polio vaccination uptake in Pakistan: a population based cross sectional study
Authors: Khan Muhammad Tahir , Zaheer Sidra , Shafique Kashif
Published: March 2017

Objectives

To explore the association of maternal education and empowerment with childhood polio vaccination using nationally representative data of Pakistani mothers in a reproductive age group.

Design

Cross-sectional.

Setting

Secondary analysis of Pakistan Demographic and Health Survey (PDHS), 2012–2013 data was performed.

Participants

Of the 13 558 mothers included in the survey sample, 6982 mothers were able to provide information regarding polio vaccinations.

Main outcome measures

Polio vaccination coverage among children aged up to 5 years was categorised as complete vaccination (all four oral polio vaccine (OPV) doses), incomplete vaccination, and no vaccination (zero OPV dose received). Mothers' empowerment status was assessed using standard ‘Measure DHS’ questions regarding their involvement in decision-making related to health, household possessions and visits among family and friends. Education was categorised as no education, primary, secondary and higher education. Results of multinomial regression analyses were reported as adjusted OR with 95% CI. We adjusted for age, wealth index, urban/rural residence, place of delivery, and antenatal and postnatal visits.

Results

Only 56.4% (n=3936) of the children received complete polio vaccination. Women with no education had significantly higher odds of their child receiving no polio vaccination (OR 2.34, 95% CI 1.05 to 5.18; p<0.01) and incomplete vaccination (OR 1.40, 95% CI 1.04 to 1.87; p<0.01). Further, unempowered women also had significantly higher odds of not taking their child for any polio vaccination (OR 1.58, 95% CI 1.17 to 2.12; p<0.01) and incomplete vaccination (OR 1.18, 95% CI 1.00 to 1.41; p=0.04).

Conclusions

Illiteracy, socioeconomic status and empowerment of women remained significant factors linked to poorer uptake of routine polio vaccination.
Implementation of ‘Goals of Patient Care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial
Authors: Martin Ruth S , Hayes Barbara J , Hutchinson Anastasia , Yates Paul , Lim Wen Kwang
Published: March 2017

Introduction

Systematic reviews demonstrate that advance care planning (ACP) has many positive effects for residents of aged care facilities, including decreased hospitalisation. The proposed Residential Aged Care Facility (RACF) ‘Goals of Patient Care’ (GOPC) form incorporates a resident's prior advance care plan into medical treatment orders. Where none exists, it captures residents' preferences. This documentation helps guide healthcare decisions made at times of acute clinical deterioration.

Methods and analysis

This is a mixed methods study. An unblinded cluster randomised controlled trial is proposed in three pairs of RACFs. In the intervention arm, GOPC forms will be completed by a doctor incorporating advance care plans or wishes. In the control arm, residents will have usual care which may include an advance care plan. The primary hypothesis is that the GOPC form is superior to standard ACP alone and will lead to decreased hospitalisation due to clearer documentation of residents' medical treatment plans. The primary outcome will be an analysis of the effect of the GOPC medical treatment orders on emergency department attendances and hospital admissions at 6 months. Secondary outcome measurements will include change in hospitalisation rates at 3 and 12 months, length of stay and external mortality rates among others. Qualitative interviews, 12 months post GOPC implementation, will be used for process evaluation of the GOPC and to evaluate staff perceptions of the form's usefulness for improving communication and medical decision-making at a time of deterioration.

Dissemination

The results will be disseminated in peer review journals and research conferences. This robust randomised controlled trial will provide high-quality data about the influence of medical treatment orders that incorporate ACP or preferences adding to the current gap in knowledge and evidence in this area.

Trial registration number

ACTRN12615000298516, Results.
Factors influencing young men's decision to undergo health screening in Malaysia: a qualitative study
Authors: Teo Chin Hai , Ng Chirk Jenn , White Alan
Published: March 2017

Objectives

Uptake of health screening is low in men, particularly among those aged <40 years. This study aimed to explore factors that influence health screening behaviour in younger men.

Design

This qualitative study employed an interpretive descriptive approach. Two trained researchers conducted in-depth interviews (IDIs) and focus group discussions (FGDs) using a semi-structured topic guide, which was developed based on literature review and behavioural theories. All IDIs and FGDs were audio-recorded and transcribed verbatim. Two researchers analysed the data independently using a thematic approach.

Participants and setting

Men working in a banking institution in Kuala Lumpur were recruited to the study. They were purposively sampled according to their ethnicity, job position, age and screening status in order to achieve maximal variation.

Results

Eight IDIs and five FGDs were conducted (n=31) and six themes emerged from the analysis. (1) Young men did not consider screening as part of prevention and had low risk perception. (2) The younger generation was more receptive to health screening due to their exposure to health information through the internet. (3) Health screening was not a priority in young men except for those who were married. (4) Young men had limited income and would rather invest in health insurance than screening. (5) Young men tended to follow doctors' advice when it comes to screening and preferred doctors of the same gender and ethnicity. (6) Medical overuse was also raised where young men wanted more screening tests while doctors tended to promote unnecessary screening tests to them.

Conclusions

This study identified important factors that influenced young men's screening behaviour. Health authorities should address young men's misperceptions, promote the importance of early detection and develop a reasonable health screening strategy for them. Appropriate measures must be put in place to reduce low value screening practices.
Prevalence of latent TB infection and TB disease among adolescents in high TB burden countries in Africa: a systematic review protocol
Authors: Bunyasi Erick Wekesa , Schmidt Bey-Marrie , Abdullahi Leila Hussein , Mulenga Humphrey , Tameris Michele , Luabeya Angelique , Shenje Justin , Scriba Thomas , Geldenhuys Hennie , Wood Robin , Hatherill Mark
Published: March 2017

Introduction

Almost a third of the world population has latent tuberculosis (TB) infection (LTBI), ∼10 million of whom develop TB disease annually, despite existence of effective, but lengthy, preventive and curative drug regimens. Although adolescents appear to have a very high force of LTBI, their reported incidence of TB disease is less than that of their corresponding general population. The few available studies on adolescent TB infection and disease prevalence are not sufficient to address the apparent discordance between rates of infection and disease in high TB burden countries in Africa. Therefore, we aim to perform a systematic review to examine the relationship between adolescent LTBI and TB disease, benchmarked against national TB disease burden data.

Methods and analysis

A comprehensive literature search will be performed for cross-sectional studies and screening data in cohort studies to determine the prevalence of LTBI and TB disease among adolescents in high TB burden countries in Africa in the following databases:PubMed,Scopus,Cochrane library,Web of Science,Africa Wide,CINAHL and the Africa Index Medicus. This will be supplemented by a search of reference lists of selected articles for potentially relevant articles. We will restrict our search to articles published in the English language between 1990 and 2016 among adolescents in order to obtain estimates reflective of the mature HIV epidemic in most high TB burden countries in Africa that occurred over this critical period. Primary end points are: prevalence of LTBI and TB disease. We will use the random-effects or fixed-effects modelling for our meta-analysis based on heterogeneity estimates.

Ethics and dissemination

No ethics approval is required given that this is a systematic review. Findings will be disseminated in a peer-reviewed journal in line with thePreferred Reporting Items for Systematic reviews and Meta-Analyses(PRISMA).

Trial registration number

CRD42015023495.
Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing
Authors: Grant Aileen , Dreischulte Tobias , Guthrie Bruce
Published: March 2017

Objective

To explore how different practices responded to the Data-driven Quality Improvement in Primary Care (DQIP) intervention in terms of their adoption of the work, reorganisation to deliver the intended change in care to patients, and whether implementation was sustained over time.

Design

Mixed-methods parallel process evaluation of a cluster trial, reporting the comparative case study of purposively selected practices.

Setting

Ten (30%) primary care practices participating in the trial from Scotland, UK.

Results

Four practices were sampled because they had large rapid reductions in targeted prescribing. They all had internal agreement that the topic mattered, made early plans to implement including assigning responsibility for work and regularly evaluated progress. However, how they internally organised the work varied. Six practices were sampled because they had initial implementation failure. Implementation failure occurred at different stages depending on practice context, including internal disagreement about whether the work was worthwhile, and intention but lack of capacity to implement or sustain implementation due to unfilled posts or sickness. Practice context was not fixed, and most practices with initial failed implementation adapted to deliver at least some elements. All interviewed participants valued the intervention because it was an innovative way to address on an important aspect of safety (although one of the non-interviewed general practitioners in one practice disagreed with this). Participants felt that reviewing existing prescribing did influence their future initiation of targeted drugs, but raised concerns about sustainability.

Conclusions

Variation in implementation and effectiveness was associated with differences in how practices valued, engaged with and sustained the work required. Initial implementation failure varied with practice context, but was not static, with most practices at least partially implementing by the end of the trial. Practices organised their delivery of changed care to patients in ways which suited their context, emphasising the importance of flexibility in any future widespread implementation.

Trial registration number

NCT01425502.
Identifying, highlighting and reducing polypharmacy in a UK hospice inpatient unit using improvement Science methods
Authors: Phippen Alison , Pickard Jennie , Steinke Douglas , Cope Matt , Roberts Dai
Published: March 2017

Polypharmacy, the concurrent use of multiple medications by one individual is a growing global issue driven by an ageing population and increasing prevalence of multi-morbidity[1]. Polypharmacy can be problematic: interactions between medications, reduced adherence to medication, burden of medication to patients, administration time, increased risk of errors and increased cost. Quality improvement methods were applied to identify and highlight polypharmacy patients with the aim of reducing their average number of regular tablets/capsules per day by 25%.

The project was delivered within a UK based 27 bedded hospice inpatient unit. A series of PDSA cycles studied interventions focusing on the identification of patients with polypharmacy, the highlighting of these patients to prescribers for review and the views of patients about their medication. For the purposes of the study, polypharmacy was defined as greater than ten regular medicines and/or greater than twenty regular tablets/capsules each day. The interventions tested included patients on regular paracetamol and strong opioids being offered a trial without regular paracetamol, a constipation guide promoting the use of combination laxatives, education of prescribers around dose strengths, checklist of recommendations was placed in case notes and a sticker was used on the medicine chart to highlight patients in need of polypharmacy review.

The introduction of a trial without paracetamol and a laxative guide led to reductions in polypharmacy. The sticker and checklist were successful interventions for highlighting patients with polypharmacy.

Quality improvement methods were used to plan, try, test and implement simple interventions for patients on the hospice inpatient unit. This has led to a 25% reduction in the average regular tablet/capsules burden , a 16% reduction in the average number of regular medications and a 30% reduction in the average volume of liquid medication per patient without an increase in the use of ‘as required’ medication or length of stay.
Movement and physical demands of school and university rugby union match-play in England
Authors: Read Dale , Weaving Daniel , Phibbs Padraic , Darrall-Jones Joshua , Roe Gregory , Weakley Jonathon , Hendricks Sharief , Till Kevin , Jones Ben
Published: March 2017

Background

In England, rugby union is a popular sport and is widely played within schools. Despite the large participation numbers, the movement and physical demands of the sport and how they progress by age have not been explored.

Method

Ninety-six male rugby union players wore microtechnology devices during six rugby union matches within the education pathway to investigate the movement and physical demands of match-play. To quantify the positional differences and progression by age, data were obtained for participants at the under 16 (U16) (n=31 participants), under 18 (U18) (n=34 participants) and university (n=31 participants) levels. Players were further divided in forwards and backs. Data were analysed using magnitude-based inferences.

Results

For the movement demands, U16 total distance and ‘striding’ was likely higher for forwards than backs, whereas at U18, unclear differences were observed and from university players the inverse was observed (very likely). In all age groups sprint distance was likely to very likely greater for backs than forwards. Forwards had greater physical demands than backs at all age groups. For consecutive age groups, U16 had a likely higher relative distance than U18, and U18 had a likely lower relative distance than university players. Physical demands were similar across age groups for forwards, and greater for backs at older age groups.

Conclusion

The movement and physical demands of rugby union players participating in schools (U16 and U18), may not be as expected, however, the findings from university players show a similar pattern to the senior game.
Evaluation of determinants of walking fitness in patients attending cardiac rehabilitation
Authors: Doherty Patrick , Alotaibi Jassas FM
Published: March 2017

Aim

This study aims to investigate the ability of patients’ baseline characteristics to predict the distance walked during the incremental shuttle walk test (ISWT) in the cardiac rehabilitation (CR) population and to produce reference values to guide practice.

Methods

Secondary analysis was conducted on National Audit Cardiac Rehabilitation data collected between 2010 and 2015. Patients (n=8863) were included if they were aged ≥18 years and had a recorded ISWT score assessed before starting CR. Stepwise regression was used to identify factors predicting the ISWT distance. Age, gender, body mass index, height, weight; presence of hypertension, dyslipidemia or diabetes; smoking and physical activity were independent variables. ISWT distance was the dependent variable. The 25th, 50th and 75th percentiles of the ISWT distance were used as reference values.

Results

Age and gender explained 27% of the variance of the distance covered in the ISWT (R2=0.27, adjusted R2=0.27,Standard Error of the Estimate (SEE) = 148.7, p<0.001). Reference values using age and gender categories were developed.

Conclusion

Age and gender were the significant factors for predicting the walking fitness in the CR population, with age being the best predictor. The age and gender reference values produced represent a potentially valuable tool to be used in the clinical setting.
Clinical presentation and outcome of dogs treated medically or surgically for thoracolumbar intervertebral disc protrusion
Authors: Crawford A. H. , De Decker S.
Published: March 2017

To date, few studies have investigated the clinical characteristics of thoracolumbar intervertebral disc protrusion (IVDP). The aim of this retrospective study was to evaluate the presentation and outcome of dogs receiving medical or surgical treatment for thoracolumbar IVDP. Eighty‐four dogs were included, with a median age of 9.4 years. German shepherd dogs and Staffordshire bull terriers were the most common breeds. Significantly more surgically treated dogs (n=53) had neurological deficits and were non‐ambulatory, compared with medically treated (n=31). Outcome data were available for 27 of 31 medically managed dogs; 11 initially improved, 7 remained stable and 9 deteriorated. Of 18 dogs that initially improved or stabilised, 10 (55.6 per cent) demonstrated recurrence of clinical signs within 12 months of diagnosis. Outcome data were available for 45 of 50 surgically treated dogs that survived to hospital discharge; 34 improved, 9 remained stable and 2 deteriorated following surgery. Of 43 dogs that improved or stabilised with surgical treatment, 11 (25.6 per cent) demonstrated recurrence of clinical signs within 12 months of surgery. Overall, significantly more surgically treated dogs (71.1 per cent) had a successful outcome, consisting of sustained clinical improvement of more than 12 months duration, compared with medically treated dogs (29.6 per cent).
Effect of peritoneal lavage solution temperature on body temperature in anaesthetised cats and small dogs
Authors: Barnes D. C. , Leece E. A. , Trimble T. A , Demetriou J. L.
Published: March 2017

A prospective, randomised, non‐blinded, clinical study to assess the effect of peritoneal lavage using warmed fluid on body temperature in anesthetised cats and dogs of less than 10 kg body mass undergoing coeliotomy. A standardised anaesthetic protocol was used. Oesophageal and rectal temperatures were measured at various time points. At the end of surgery, group 1 patients (n=10) were lavaged with 200 ml/kg sterile isotonic saline at 34±1°C and group 2 (n=10) at 40±1°C. Groups were similar with respect to age, mass, body condition and surgical incision length. Duration of anaesthesia, surgical procedures and peritoneal lavage was similar between groups. Linear regression showed no significant change in oesophageal temperature during the lavage period for group 1 (P=0.64), but a significant increase for group 2 patients (P<0.0001), with mean temperature changes of −0.5°C (from (36.3°C to 35.9°C) and +0.9°C (from 35.4°C to 36.3°C), respectively. Similar results were found for rectal temperature, with mean changes of −0.5°C and +0.8°C (P=0.922 and 0.045), respectively. The use of isotonic crystalloid solution for peritoneal lavage at a temperature of 40±1°C significantly warms small animal patients, when applied in a clinical setting, compared with lavage solution at 34±1°C.
Rates of and reasons for condemnation of poultry carcases: harmonised methodology at the slaughterhouse
Authors: Salines M. , Allain V. , Roul H. , Magras C. , Le Bouquin S.
Published: March 2017

European hygiene regulations require the condemnation of any unsafe food. However, there is little information identifying and quantifying condemnation of poultry carcases at slaughterhouses. We present an in‐depth view of rates of and reasons for the condemnation of broiler, turkey, meat and force‐feeding duck, guinea fowl carcases in France. The experiment was conducted in 10 slaughterhouses. For one year, all condemnations were recorded on a standard form following a national reference system. The rates of and reasons for condemnation, as well as factors influencing variation were investigated. The global condemnation rates were 1.04 per cent for broilers, 1.85 per cent for turkeys, 1.23 per cent for meat ducks, 1.42 per cent for force‐feeding ducks and 1.20 per cent for guinea fowl. Condemnation rates depended on several factors including slaughterhouse, animal gender and season. Reasons for condemnation varied with species, for example, the three main reasons for broilers were cachexia (41.8 per cent of condemned batches), generalised congestion (29.3 per cent) and non‐purulent cutaneous lesions (14.2 per cent) versus conformation abnormalities (58.6 per cent), cachexia (14.61 per cent) and ascites (14.56 per cent) for meat ducks. While the condemnation rates can be considered low for all species, the difference between the rates of and reasons for condemnation highlights the need to lead species‐specific epidemiological studies to improve the sanitary situation of poultry production.
Clinical parameters and adrenocortical activity to assess stress responses of alpacas using different methods of restraint either alone or with shearing
Authors: Wittek T. , Salaberger T. , Palme R. , Becker S. , Hajek F. , Lambacher B. , Waiblinger S.
Published: March 2017

Shearing of alpacas is stressful and is undertaken by restraint in the standing position, cast on the floor or on a tilt table. The objectives of the study were to evaluate and compare the stress responses between different methods. The study consisted of two parts. In part one, 15 animals were restrained applying all three methods but without shearing. In part two, 45 animals in three groups of 15 were shorn using one of the three procedures. Body temperature, heart rate, respiratory rate, salivary cortisol and faecal cortisol metabolites (FCM) were measured. Part 1: restraint in a standing position was less stressful than other procedures. Part 2: the classic clinical parameters changed significantly over time but without significant differences between the methods. The number of injuries did not differ. Saliva cortisol and FCM concentrations varied in wide ranges between animals. An increase in FCM concentrations occurred in all groups but saliva cortisol concentration increased only after shearing on the ground. The recommendations of the study are to shear calm alpacas in the standing position but animals showing severe defence reactions should be shorn either cast on the ground or on a table to decrease the risk of injuries.
High-resolution estimates of rates of depositional processes from an alluvial fan succession in the Miocene of the Ebro Basin, northern Spain
Authors: Nichols Gary
Published: March 2017

Obtaining estimates of the rates of sedimentation and frequency of depositional events at high resolution from pre-Quaternary successions is rarely possible, particularly in coarse-grained clastic successions of continental basin margins. In the Miocene strata of the Ebro Basin, northern Spain, basin-marginal deposits interpreted as the products of alluvial fans are part of the continuous aggradational fill of a basin of internal drainage. A palaeomagnetic reversal stratigraphy has been established in basin-centre sediments and correlation across to the basin margin makes it possible to estimate the rate of aggradation within the fan successions to be 90 mm ka
−1
. The deposits of one alluvial fan near the village of Linás de Marcuello have been analysed in the context of these rates to provide estimates of the frequency of depositional events. This analysis suggests that deposition on gravel bars approximately 700 mm thick in stream channel deposits occurred at intervals of 70–200 years over a 2.2 myr time period. This is the first time an estimate of the frequency of depositional events has been obtained at such high resolution from a pre-Quaternary alluvial fan succession.
Acid sphingomyelinase mediates murine acute lung injury following transfusion of aged platelets
Authors: McVey Mark J. , Kim Michael , Tabuchi Arata , Srbely Victoria , Japtok Lukasz , Arenz Christoph , Rotstein Ori , Kleuser Burkhard , Semple John W. , Kuebler Wolfgang M.
Published: March 2017

Pulmonary complications from stored blood products are the leading cause of mortality related to transfusion. Transfusion-related acute lung injury is mediated by antibodies or bioactive mediators, yet underlying mechanisms are incompletely understood. Sphingolipids such as ceramide regulate lung injury, and their composition changes as a function of time in stored blood. Here, we tested the hypothesis that aged platelets may induce lung injury via a sphingolipid-mediated mechanism. To assess this hypothesis, a two-hit mouse model was devised. Recipient mice were treated with 2 mg/kg intraperitoneal lipopolysaccharide (priming) 2 h before transfusion of 10 ml/kg stored (1–5 days) platelets treated with or without addition of acid sphingomyelinase inhibitor ARC39 or platelets from acid sphingomyelinase-deficient mice, which both reduce ceramide formation. Transfused mice were examined for signs of pulmonary neutrophil accumulation, endothelial barrier dysfunction, and histological evidence of lung injury. Sphingolipid profiles in stored platelets were analyzed by mass spectrophotometry. Transfusion of aged platelets into primed mice induced characteristic features of lung injury, which increased in severity as a function of storage time. Ceramide accumulated in platelets during storage, but this was attenuated by ARC39 or in acid sphingomyelinase-deficient platelets. Compared with wild-type platelets, transfusion of ARC39-treated or acid sphingomyelinase-deficient aged platelets alleviated lung injury. Aged platelets elicit lung injury in primed recipient mice, which can be alleviated by pharmacological inhibition or genetic deletion of acid sphingomyelinase. Interventions targeting sphingolipid formation represent a promising strategy to increase the safety and longevity of stored blood products.
Rhinovirus-bacteria coexposure synergistically induces CCL20 production from human bronchial epithelial cells
Authors: Maciejewski Barbara A. , Jamieson Kyla C. , Arnason Jason W. , Kooi Cora , Wiehler Shahina , Traves Suzanne L. , Leigh Richard , Proud David
Published: March 2017

Exacerbations of chronic obstructive pulmonary disease are triggered by viral or bacterial pathogens, with human rhinovirus (HRV) and nontypeable Hemophilus influenzae (NTHI) among the most commonly detected pathogens. Patients who suffer from concomitant viral and bacterial infection have more severe exacerbations. The airway epithelial cell is the initial site of viral and bacterial interactions, and CCL20 is an epithelial chemokine that attracts immature dendritic cells to the airways and can act as an antimicrobial. As such, it contributes to innate and adaptive immune responses to infection. We used primary cultures of human bronchial epithelial cells and the BEAS-2B cell line to examine the effects of bacterial-viral coexposure, as well as each stimulus alone, on epithelial expression of CXCL8 and, in particular, CCL20. HRV-bacterial coexposure induced synergistic production of CXCL8 and CCL20 compared with the sum of each stimulus alone. Synergistic induction of CCL20 did not require viral replication and occurred with two different HRV serotypes that use different viral receptors. Synergy was also seen with either NTHI or Pseudomonas aeruginosa. Synergistic induction of CCL20 was transcriptionally regulated. Although NF-κB was required for transcription, it did not regulate synergy, but NF-IL-6 did appear to contribute. Among MAPK inhibitors studied, neither SB203580 nor PD98059 had any effect on synergy, whereas U0126 prevented synergistic induction of CCL20 by HRV and bacteria, apparently via “off-target” effects. Thus bacterial-viral coexposure synergistically increases innate immune responses compared with individual infections. We speculate that this increased inflammatory response leads to worse clinical outcomes.