bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disentangling the Taxonomy of Rickettsiales and Description of Two Novel Symbionts (“Candidatus Bealeia paramacronuclearis” and “Candidatus Fokinia cryptica”) Sharing the Cytoplasm of the Ciliate Protist Paramecium biaurelia
Authors: Szokoli Franziska , Castelli Michele , Sabaneyeva Elena , Schrallhammer Martina , Krenek Sascha , Doak Thomas G. , Berendonk Thomas U. , Petroni Giulio 
Published: October 2016

ABSTRACT

In the past 10 years, the number of endosymbionts described within the bacterial order
Rickettsiales
has constantly grown. Since 2006, 18 novel
Rickettsiales
genera inhabiting protists, such as ciliates and amoebae, have been described. In this work, we characterize two novel bacterial endosymbionts from
Paramecium
collected near Bloomington, IN. Both endosymbiotic species inhabit the cytoplasm of the same host. The Gram-negative bacterium “
Candidatus
Bealeia paramacronuclearis” occurs in clumps and is frequently associated with the host macronucleus. With its electron-dense cytoplasm and a distinct halo surrounding the cell, it is easily distinguishable from the second smaller symbiont, “
Candidatus
Fokinia cryptica,” whose cytoplasm is electron lucid, lacks a halo, and is always surrounded by a symbiontophorous vacuole. For molecular characterization, the small-subunit rRNA genes were sequenced and used for taxonomic assignment as well as the design of species-specific oligonucleotide probes. Phylogenetic analyses revealed that “
Candidatus
Bealeia paramacronuclearis” clusters with the so-called “basal”
Rickettsiales
, and “
Candidatus
Fokinia cryptica” belongs to “
Candidatus
Midichloriaceae.” We obtained tree topologies showing a separation of
Rickettsiales
into at least two groups: one represented by the families
Rickettsiaceae
,
Anaplasmataceae
, and “
Candidatus
Midichloriaceae” (RAM clade), and the other represented by “basal
Rickettsiales
,” including “
Candidatus
Bealeia paramacronuclearis.” Therefore, and in accordance with recent publications, we propose to limit the order
Rickettsiales
to the RAM clade and to raise “basal
Rickettsiales
” to an independent order,
Holosporales
ord. nov., inside
Alphaproteobacteria
, which presently includes four family-level clades. Additionally, we define the family “
Candidatus
Hepatincolaceae” and redefine the family
Holosporaceae
.

IMPORTANCE
In this paper, we provide the characterization of two novel bacterial symbionts inhabiting the same
Paramecium
host (Ciliophora, Alveolata). Both symbionts belong to “traditional”
Rickettsiales
, one representing a new species of the genus “
Candidatus
Fokinia” (“
Candidatus
Midichloriaceae”), and the other representing a new genus of a “basal”
Rickettsiales
. According to newly characterized sequences and to a critical revision of recent literature, we propose a taxonomic reorganization of “traditional”
Rickettsiales
that we split into two orders:
Rickettsiales sensu stricto
and
Holosporales
ord. nov. This work represents a critical revision, including new records of a group of symbionts frequently occurring in protists and whose biodiversity is still largely underestimated.
Effect of a national urgent care telephone triage service on population perceptions of urgent care provision: controlled before and after study
Authors: Knowles E , O'Cathain A , Turner J , Nicholl J 
Published: October 2016

ObjectiveTo measure the effect of an urgent care telephone service NHS 111 on population perceptions of urgent care.DesignControlled before and after population survey, using quota sampling to identify 2000 respondents reflective of the age/sex profile of the general population.SettingEngland. 4 areas where NHS 111 was introduced, and 3 control areas where NHS 111 had yet to be introduced.Participants28 071 members of the general population, including 2237 recent users of urgent care.InterventionNHS 111 offers advice to members of the general population seeking urgent care, recommending the best service to use or self-management. Policymakers introduced NHS 111 to improve access to urgent care.Outcomes measuresThe primary outcome was change in satisfaction with recent urgent care use 9 months after the launch of NHS 111. Secondary outcomes were change in satisfaction with urgent care generally and with the national health service.ResultsThe overall response rate was 28% (28 071/100 408). 8% (2237/28 071) had used urgent care in the previous 3 months. Of the 652 recent users of urgent care in the NHS 111 intervention areas, 9% (60/652) reported calling NHS 111 in the ‘after’ period. There was no evidence that the introduction of NHS 111 was associated with a changed perception of recent urgent care. For example, the percentage rating their experience as excellent remained at 43% (OR 0.97, 95% CI 0.69 to 1.37). Similarly, there was no change in population perceptions of urgent care generally (1.06, 95% CI 0.95 to 1.17) or the NHS (0.94, 95% CI 0.85 to 1.05) following the introduction of NHS 111.ConclusionsA new telephone triage service did not improve perceptions of urgent care or the health service. This could be explained by the small amount of NHS 111 activity in a large emergency and urgent care system.
State of the art of chronic spontaneous urticaria in Italy: a multicentre survey to evaluate physicians’ and patients’ perspectives
Authors: Rimoldi Marco , Rossi Oliviero , Rota Nadia 
Published: October 2016

ObjectiveTo assess the clinical status of chronic spontaneous urticaria (CSU) and understand treatment approaches in Italy through specialists who treat CSU (dermatologists and allergy specialists) and CSU patients' experience.DesignMulticentre survey.SettingOnline structured questionnaires (one for physicians and one for patients).ParticipantsPhysicians and patients with CSU in Italy.InterventionsNone.Primary/secondary outcomesPhysician and patient attitudes/experiences.ResultsSurvey results from 160 allergy and 160 dermatology specialists show that specialists see a median of 40 (IQR 20–80) patients with CSU/year. While most specialists (56%) know the CSU guidelines, only 27% use them regularly (36% of allergy specialists vs 18% of dermatologists). This is reflected in treatment choices with differences between physicians who use guidelines regularly and those who do not: 91.6% vs 71.7% choose standard-dose, non-sedating antihistamines as first-line treatment; 85.9% vs 56.0% select up-dosing for second-line treatment and 65.3% vs 37.2% add leukotriene receptor antagonists or H2-antihistamines as third-line treatment. The diaries from 1385 patients highlight that, regardless of treatment regimen, 29.4% of currently treated patients are refractory to therapy. Specialists aim to resolve symptoms and only 7.8% report improving quality of life (QoL) as a priority. Only 16.6% of specialists are familiar with and use the Urticaria Activity Score while 46.9% do not know it. Overall, 537 patients with CSU were surveyed (median age 37 years, IQR 30–46; 44.3% men; median disease duration 5 years, IQR 3–20). Approximately 62% confirm that CSU negatively impacts their QoL. Patients also complain of difficulties in getting information and support: <5% of medical centres provide patient support services.ConclusionsIn Italy, the gap between guideline-based care and QoL-related needs in CSU patients affects treatment satisfaction. This information could be used to improve the management of CSU in Italy.
Are prenatal mercury levels associated with subsequent blood pressure in childhood and adolescence? The Avon prebirth cohort study
Authors: Gregory Steve , Iles-Caven Yasmin , Hibbeln Joseph R , Taylor Caroline M , Golding Jean 
Published: October 2016

ObjectivesThere have been conflicting data suggesting that prenatal mercury exposure is associated with adverse cardiovascular measures in children. We therefore analysed a large prospective population study to investigate whether prenatal mercury exposure might influence offspring blood pressure (BP) and heart rate adversely.DesignProspective birth cohort.SettingThe Avon Longitudinal Study of Parents and Children (ALSPAC).ParticipantsMaternal whole blood collected in the first half of pregnancy was assayed for mercury and selenium. The offspring were followed throughout childhood and adolescence.Outcome measuresOffspring resting BP and heart rates measured under standard conditions on six occasions between ages 7 and 17 years (numbers analysed: 1754 at 7 years to 1102 at 17).ResultsStatistical analyses took account of various factors present in pregnancy, including family adversity, maternal age, parity, smoking and alcohol intake. Unadjusted and adjusted regression analyses assessed the relationship between maternal prenatal mercury levels and offspring resting systolic and diastolic BP, and heart rates. A final set of analyses took account of selenium. Each analysis was carried out for all offspring, those whose mothers had, and those that had not, consumed fish during pregnancy. Further analysis for all offspring ascertained whether there were significant interaction effects between the sexes. There was little evidence to suggest that prenatal mercury exposure resulted in a clinically important increase in offspring BP in the whole group, since no effect size for an increase of 1 SD of blood mercury level was >0.3 mm Hg. Only 1 association was significant at p<0.05 and therefore likely due to chance.ConclusionsThis study reveals no evidence to support the hypothesis that prenatal mercury exposure has adverse long-term effects on offspring BP or heart rates during childhood or adolescence.
Does a modified STarT Back Tool predict outcome with a broader group of musculoskeletal patients than back pain? A secondary analysis of cohort data
Authors: Hill J C , Afolabi E K , Lewis M , Dunn K M , Roddy E , van der Windt D A , Foster N E 
Published: October 2016

ObjectivesThe STarT Back Tool has good predictive performance for non-specific low back pain in primary care. We therefore aimed to investigate whether a modified STarT Back Tool predicted outcome with a broader group of musculoskeletal patients, and assessed the consequences of using existing risk-group cut-points across different pain regions.SettingSecondary analysis of prospective data from 2 cohorts: (1) outpatient musculoskeletal physiotherapy services (PhysioDirect trial n=1887) and (2) musculoskeletal primary–secondary care interface services (SAMBA study n=1082).ParticipantsPatients with back, neck, upper limb, lower limb or multisite pain with a completed modified STarT Back Tool (baseline) and 6-month physical health outcome (Short Form 36 (SF-36)).OutcomesArea under the receiving operator curve (AUCs) tested discriminative abilities of the tool's baseline score for identifying poor 6-month outcome (SF-36 lower tertile Physical Component Score). Risk-group cut-points were tested using sensitivity and specificity for identifying poor outcome using (1) Youden's J statistic and (2) a clinically determined rule that specificity should not fall below 0.7 (false-positive rate <30%).ResultsIn PhysioDirect and SAMBA, poor 6-month physical health was 18.5% and 28.2%, respectively. Modified STarT Back Tool score AUCs for predicting outcome in back pain were 0.72 and 0.79, neck 0.82 and 0.88, upper limb 0.79 and 0.86, lower limb 0.77 and 0.83, and multisite pain 0.83 and 0.82 in PhysioDirect and SAMBA, respectively. Differences between pain region AUCs were non-significant. Optimal cut-points to discriminate low-risk and medium-risk/high-risk groups depended on pain region and clinical services.ConclusionsA modified STarT Back Tool similarly predicts 6-month physical health outcome across 5 musculoskeletal pain regions. However, the use of consistent risk-group cut-points was not possible and resulted in poor sensitivity (too many with long-term disability being missed) or specificity (too many with good outcome inaccurately classified as ‘at risk’) for some pain regions. The draft tool is now being refined and validated within a new programme of research for a broader musculoskeletal population.Trial registration numberISRCTN55666618; Post results.
Mental health associations with eczema, asthma and hay fever in children: a cross-sectional survey
Authors: Hammer-Helmich Lene , Linneberg Allan , Obel Carsten , Thomsen Simon Francis , Tang Møllehave Line , Glümer Charlotte 
Published: October 2016

ObjectiveThis study aimed to examine the association of eczema, asthma and hay fever with mental health in a general child population and to assess the influence of parental socioeconomic position on these associations.MethodsWe conducted a cross-sectional health survey of children aged 3, 6, 11 and 15 years in the City of Copenhagen, Denmark. Individual questionnaire data on eczema, asthma, and hay fever and mental health problems assessed using the Strengths and Difficulties Questionnaire (SDQ) was linked to register data on demographics and parental socioeconomic position. 9215 (47.9%) children were included in the analyses.ResultsLinear regression analyses showed that children with current eczema symptoms had higher SDQ scores (mean difference, 95% CI) of emotional problems (0.26, 0.12 to 0.39), conduct problems (0.19, 0.09 to 0.29) and hyperactivity problems (0.32, 0.16 to 0.48); children with current asthma symptoms had higher SDQ scores of emotional problems (0.45, 0.32 to 0.58), conduct problems (0.28, 0.18 to 0.38) and hyperactivity problems (0.52, 0.35 to 0.69); and children with current hay fever symptoms had higher SDQ scores of emotional problems (0.57, 0.42 to 0.72), conduct problems (0.22, 0.11 to 0.33), hyperactivity problems (0.44, 0.26 to 0.61) and peer problems (0.14, 0.01 to 0.26), compared with children without current symptoms of the relevant disease. For most associations, parental socioeconomic position did not modify the effect.ConclusionsChildren with eczema, asthma or hay fever had more emotional, conduct and hyperactivity problems, but not peer problems, compared with children without these diseases. Atopic diseases added equally to the burden of mental health problems independent of socioeconomic position.
Predicting frequent hospital admission risk in Singapore: a retrospective cohort study to investigate the impact of comorbidities, acute illness burden and social determinants of health
Authors: Low Lian Leng , Liu Nan , Wang Sijia , Thumboo Julian , Ong Marcus Eng Hock , Lee Kheng Hock 
Published: October 2016

ObjectivesTo evaluate the impact of comorbidities, acute illness burden and social determinants of health on predicting the risk of frequent hospital admissions.DesignMultivariable logistic regression was used to associate the predictive variables extracted from electronic health records and frequent hospital admission risk. The model's performance of our predictive model was evaluated using a 10-fold cross-validation.SettingA single tertiary hospital in Singapore.ParticipantsAll adult patients admitted to the hospital between 1 January 2013 and 31 May 2014 (n=25 244).Main outcome measureFrequent hospital admissions, defined as 3 or more inpatient admissions within 12 months of discharge. Area under the receiver operating characteristic curve (AUC) of the predictive model, and the sensitivity, specificity and positive predictive values for various cut-offs.Results4322 patients (17.1%) met the primary outcome. 11 variables were observed as significant predictors and included in the final regression model. The strongest independent predictor was treatment with antidepressants in the past 1 year (adjusted OR 2.51, 95% CI 2.26 to 2.78). Other notable predictors include requiring dialysis and treatment with intravenous furosemide during the index admission. The predictive model achieved an AUC of 0.84 (95% CI 0.83 to 0.85) for predicting frequent hospital admission risk, with a sensitivity of 73.9% (95% CI 72.6% to 75.2%), specificity of 79.1% (78.5% to 79.6%) and positive predictive value of 42.2% (95% CI 41.1% to 43.3%) at the cut-off of 0.235.ConclusionsWe have identified several predictors for assessing the risk of frequent hospital admissions that achieved high discriminative model performance. Further research is necessary using an external validation cohort.
Supervisors' perspective on medical thesis projects and dropout rates: survey among thesis supervisors at a large German university hospital
Authors: Can Elif , Richter Felicitas , Valchanova Ralitsa , Dewey Marc 
Published: October 2016

ObjectivesTo identify underlying causes for failure of medical thesis projects and the constantly high drop-out rate in Germany from the supervisors' perspective and to compare the results with the students' perspective.SettingCross-sectional survey. Online questionnaire for survey of medical thesis supervisors among the staff of Charité—Universitätsmedizin Berlin, Germany. Published, earlier longitudinal survey among students for comparison.Participants1069 thesis supervisors participated.Data extraction and synthesisData are presented using descriptive statistics, and the χ2test served to compare the results among supervisors with the earlier data from the longitudinal survey of doctoral students.Primary and secondary outcomesNot applicable. This survey is an observational study.ResultsOf 3653 potential participants, 1069 (29.3%) supervising 3744 doctoral candidates participated in the study. Supervisors considered themselves to be highly motivated and to offer adequate supervision. On the other hand, 87% stated that they did not feel well prepared for thesis supervision. Supervisors gave lack of timeliness of doctoral students and personal differences (p=0.024 and p=0.001) as the main reasons for terminating thesis projects. Doctoral students predominantly mentioned methodological problems and difficult subjects as critical issues (p=0.001 and p<0.001). Specifically, students felt ill prepared for the statistical part of their research—49.5% stated that they never received statistical assistance, whereas 97% of supervisors claimed to help their students with statistical analysis.ConclusionsThe authors found that both thesis supervisors and medical students feel ill prepared for their roles in the process of a medical dissertation. Contradictory reasons for terminating medical thesis projects based on supervisors' and students' self-assessment suggest a lack of communication and true scientific collaboration between supervisors and doctoral students as the major underlying issue that requires resolution.
Finding consensus on frailty assessment in acute care through Delphi method
Authors: Soong John T Y , Poots Alan J , Bell Derek 
Published: October 2016

ObjectiveWe seek to address gaps in knowledge and agreement around optimal frailty assessment in the acute medical care setting. Frailty is a common term describing older persons who are at increased risk of developing multimorbidity, disability, institutionalisation and death. Consensus has not been reached on the practical implementation of this concept to assess clinically and manage older persons in the acute care setting.DesignModified Delphi, via electronic questionnaire. Questions included ranking items that best recognise frailty, optimal timing, location and contextual elements of a successful tool. Intraclass correlation coefficients for overall levels of agreement, with consensus and stability tested by 2-way ANOVA with absolute agreement and Fisher's exact test.ParticipantsA panel of national experts (academics, front-line clinicians and specialist charities) were invited to electronic correspondence.ResultsVariables reflecting accumulated deficit and high resource usage were perceived by participants as the most useful indicators of frailty in the acute care setting. The Acute Medical Unit and Care of the older Persons Ward were perceived as optimum settings for frailty assessment. ‘Clinically meaningful and relevant’, ‘simple (easy to use)’ and ‘accessible by multidisciplinary team’ were perceived as characteristics of a successful frailty assessment tool in the acute care setting. No agreement was reached on optimal timing, number of variables and organisational structures.ConclusionsThis study is a first step in developing consensus for a clinically relevant frailty assessment model for the acute care setting, providing content validation and illuminating contextual requirements. Testing on clinical data sets is a research priority.
Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study
Authors: Marino Paola J , Hannigan Ailish , Haywood Sean , Cole Jade M , Palmer Nicki , Emanuel Charlotte , Kinsella Tracey , Lewis Michael A O , Wise Matt P , Williams David W 
Published: October 2016

IntroductionDuring critical illness, dental plaque may serve as a reservoir of respiratory pathogens. This study compared the effectiveness of toothbrushing with a small-headed toothbrush or a foam-headed swab in mechanically ventilated patients.MethodsThis was a randomised, assessor-blinded, split-mouth trial, performed at a single critical care unit. Adult, orally intubated patients with >20 teeth, where >24 hours of mechanical ventilation was expected were included. Teeth were cleaned 12-hourly using a foam swab or toothbrush (each randomly assigned to one side of the mouth). Cleaning efficacy was based on plaque scores, gingival index and microbial plaque counts.ResultsHigh initial plaque (mean=2.1 (SD 0.45)) and gingival (mean=2.0 (SD 0.54)) scores were recorded for 21 patients. A significant reduction compared with initial plaque index occurred using both toothbrushes (mean change=−1.26, 95% CI −1.57 to −0.95; p<0.001) and foam swabs (mean change=−1.28, 95% CI −1.54 to −1.01; p<0.001). There was significant reduction in gingival index over time using toothbrushes (mean change=−0.92; 95% CI −1.19 to −0.64; p<0.001) and foam swabs (mean change=−0.85; 95% CI −1.10 to −0.61; p<0.001). Differences between cleaning methods were not statistically significant (p=0.12 for change in gingival index; p=0.24 for change in plaque index). There was no significant change in bacterial dental plaque counts between toothbrushing (mean change 3.7×104colony-forming units (CFUs); minimum to maximum (−2.5×1010CFUs, 8.7×107CFUs)) and foam swabs (mean change 9×104CFUs; minimum to maximum (−3.1×1010CFUs, 3.0×107CFUs)).ConclusionsPatients admitted to adult intensive care had poor oral health, which improved after brushing with a toothbrush or foam swab. Both interventions were equally effective at removing plaque and reducing gingival inflammation.Trial registration numberNCT01154257; Pre-results.