bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mutations in the Borrelia burgdorferi Flagellar Type III Secretion System Genes
fliH
and
fliI
Profoundly Affect Spirochete Flagellar Assembly, Morphology, Motility, Structure, and Cell Division
Authors: Lin Tao , Gao Lihui , Zhao Xiaowei , Liu Jun , Norris Steven J. 
Published: May 2015

ABSTRACT

The Lyme disease spirochete
Borrelia burgdorferi
migrates to distant sites in the tick vectors and mammalian hosts through robust motility and chemotaxis activities. FliH and FliI are two cytoplasmic proteins that play important roles in the type III secretion system (T3SS)-mediated export and assembly of flagellar structural proteins. However, detailed analyses of the roles of FliH and FliI in
B. burgdorferi
have not been reported. In this study,
fliH
and
fliI
transposon mutants were utilized to dissect the mechanism of the
Borrelia
type III secretion system. The
fliH
and
fliI
mutants exhibited rod-shaped or string-like morphology, greatly reduced motility, division defects (resulting in elongated organisms with incomplete division points), and noninfectivity in mice by needle inoculation. Mutants in
fliH
and
fliI
were incapable of translational motion in 1% methylcellulose or soft agar. Inactivation of either
fliH
or
fliI
resulted in the loss of the FliH-FliI complex from otherwise intact flagellar motors, as determined by cryo-electron tomography (cryo-ET). Flagellar assemblies were still present in the mutant cells, albeit in lower numbers than in wild-type cells and with truncated flagella. Genetic complementation of
fliH
and
fliI
mutants in
trans
restored their wild-type morphology, motility, and flagellar motor structure; however, full-length flagella and infectivity were not recovered in these complemented mutants. Based on these results, disruption of either
fliH
or
fliI
in
B. burgdorferi
results in a severe defect in flagellar structure and function and cell division but does not completely block the export and assembly of flagellar hook and filament proteins.

IMPORTANCE
Many bacteria are able to rapidly transport themselves through their surroundings using specialized organelles called flagella. In spiral-shaped organisms called spirochetes, flagella act like inboard motors and give the bacteria the ability to bore their way through dense materials (such as human tissue) in a corkscrew manner. In this article, we studied how two proteins, called FliH and FliI, are important for the production of full-length flagella in the Lyme disease spirochete
Borrelia burgdorferi
. Mutants with defective production of FliH and FliI have reduced flagellar length and motility; this deficiency in turn affects many aspects of
B. burgdorferi
's biology, including the ability to undergo cell division and cause disease in mammals. Using a microscopic computed tomography (CT) scan approach called cryo-electron tomography, the structure that contains FliH and FliI was defined in the context of the flagellar motor, providing clues regarding how this amazing nanomachine is assembled and functions.
Spontaneous Electrical Activities at Myofascial Trigger Points at Different Stages of Recovery from Injury in a Rat Model
Authors: Huang Qiang-Min , Lv Jiao-Jiao , Ruanshi Qiong-Mei , Liu Lin 
Published: May 2015

Background Spontaneous electrical activity (SEA) is a feature of myofascial trigger points (MTrPs), which can either be latent or active. However, SEA at different stages of recovery from MTrPs remains unclear. Objective To investigate the temporal changes in the nature of SEA after generation of MTrPs in a rat model. Methods 32 rats were divided into four groups: 24 rats were assigned to experimental groups (EGs), which underwent the MTrP modelling intervention and 8 were allocated to a control group (CG). All EG rats received a blunt strike to the left vastus medialis combined with eccentric exercise for 8 weeks. After modelling, the EG rats were subdivided into three groups with total recovery times of 4, 8 and 12 weeks (EG-4w, EG-8w and EG-12w, respectively). Taut bands (TBs) with and without the presence of active MTrPs were identified in the left hind limb muscles of all rats, verified by SEA and further examined with electromyography recordings. Myoelectrical signals were also categorised into one of five types. Results CG rats had fewer TBs than EG rats and EGs showed variable frequencies of SEA. SEA frequencies were higher in EG-4w than in EG-8w and EG-12w groups (240.57±72.9 vs 168.14±64.5 and 151.63±65.4, respectively, p<0.05) and were significantly greater in all EGs than in the CG (55.75±21.9). Relative to CG rats, amplitudes and durations of electrical potentials in the EG were only increased in the EG-8w and EG-12w groups. Types IV and V myoelectrical signals were never seen in latent MTrPs and type V signals did not occur in EG-4w rats. Conclusions Increasing recovery periods following a MTrP modelling intervention in rats are characterised by different frequencies and amplitudes of SEA from TBs. Trial Registration Number 2014012.
Statistical analysis and handling of missing data in cluster randomised trials: protocol for a systematic review
Authors: Fiero Mallorie , Huang Shuang , Bell Melanie L 
Published: May 2015

IntroductionCluster randomised trials (CRTs) randomise participants in groups, rather than as individuals, and are key tools used to assess interventions in health research where treatment contamination is likely or if individual randomisation is not feasible. Missing outcome data can reduce power in trials, including in CRTs, and is a potential source of bias. The current review focuses on evaluating methods used in statistical analysis and handling of missing data with respect to the primary outcome in CRTs.Methods and analysisWe will search for CRTs published between August 2013 and July 2014 using PubMed, Web of Science and PsycINFO. We will identify relevant studies by screening titles and abstracts, and examining full-text articles based on our predefined study inclusion criteria. 86 studies will be randomly chosen to be included in our review. Two independent reviewers will collect data from each study using a standardised, prepiloted data extraction template. Our findings will be summarised and presented using descriptive statistics.Ethics and disseminationThis methodological systematic review does not need ethical approval because there are no data used in our study that are linked to individual patient data. After completion of this systematic review, data will be immediately analysed, and findings will be disseminated through a peer-reviewed publication and conference presentation.
Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study
Authors: Hernan Andrea L , Giles Sally J , Fuller Jeffrey , Johnson Julie K , Walker Christine , Dunbar James A 
Published: May 2015

BackgroundPatients can have an important role in reducing harm in primary-care settings. Learning from patient experience and feedback could improve patient safety. Evidence that captures patients’ views of the various contributory factors to creating safe primary care is largely absent. The aim of this study was to address this evidence gap.MethodsFour focus groups and eight semistructured interviews were conducted with 34 patients and carers from south-east Australia. Participants were asked to describe their experiences of primary care. Audio recordings were transcribed verbatim and specific factors that contribute to safety incidents were identified in the analysis using the Yorkshire Contributory Factors Framework (YCFF). Other factors emerging from the data were also ascertained and added to the analytical framework.ResultsThirteen factors that contribute to safety incidents in primary care were ascertained. Five unique factors for the primary-care setting were discovered in conjunction with eight factors present in the YCFF from hospital settings. The five unique primary care contributing factors to safety incidents represented a range of levels within the primary-care system from local working conditions to the upstream organisational level and the external policy context. The 13 factors included communication, access, patient factors, external policy context, dignity and respect, primary–secondary interface, continuity of care, task performance, task characteristics, time in the consultation, safety culture, team factors and the physical environment.DiscussionPatient and carer feedback of this type could help primary-care professionals better understand and identify potential safety concerns and make appropriate service improvements. The comprehensive range of factors identified provides the groundwork for developing tools that systematically capture the multiple contributory factors to patient safety.
Quantification of opportunities for early-stage paramedicine students to practice clinical skills during clinical placements compared with an equal dose of simulation-based workshops
Authors: Mills Brennen W , Carter Owen B J , Rudd Cobie J , Mills Jodie K , Ross Nathan P , Ruck Joanne D 
Published: May 2015

IntroductionA reported advantage of simulation-based learning environments (SLE) over clinical placements (CPs) is that the former can provide a greater number and breadth of opportunities to practice level-appropriate clinical skills compared with the random patient presentations provided during the latter. Although logical and widely accepted as fact, we find no published evidence to demonstrate the magnitude, nor indeed veracity, of this assumption. We therefore sought to quantify the clinical skills practiced by entry-level paramedicine students attending a well-selected CP compared with an equal dosage of SLE.MethodsN=37 first-year paramedicine students completed activity diaries during 3 days of CP and 3 days of SLE. Opportunities to practice clinical skills were quantified and coded as either: level-appropriate, beyond-level or of non-discipline relevance.ResultsDuring SLE, the average student was exposed 226 times to 11 level-appropriate clinical procedures. During CP the average student was exposed 48 times to 24 clinical procedures, the majority relevant to paramedicine (63%), but a minority level-appropriate (38%). Students’ opportunities for supervised, ‘hands on’ practice represented only 10% of exposures in either SLE or CP but in terms of raw numbers of level-appropriate opportunities, SLE provided more than CP (n=23 vs 2).DiscussionOur results confirm that SLE provides substantially more opportunities than CP for students to practice level-appropriate skills and is therefore more appropriate for repetitive practice. However, CP is likely to remain useful to students for practicing interpersonal skills and contextualisation of knowledge within the broader health system. Educators should therefore carefully articulate learning objectives before choosing between SLE and CP.
AIRWAY MANAGEMENT SIMULATION TRAINING FOR NOVICE NURSING STUDENTS: AN OBSERVATIONAL STUDY
Authors: Kaur Baljit 
Published: May 2015

Background/PurposeAirway Management is one of the crucial skills to increase the survival chance of a critical patient. Nurses act as one of the team member during airway management. Nurses carry-out basic airway management and as an assistant in advanced airway management. Simulation had been commonly used to teach the skills of airway management in medical education. Hence, it can also‖be used in nursing education. This study aims to provide airway management simulation training to novice nursing students to improve their skills in performing the skill.MethodologyThis is an observational study. Year three undergraduate nursing students were voluntarily recruited in a bachelor of nursing programme. They are equipped with basic skills of taking patients and are ready to take care of critical patient. Students will be divided into twenty groups (n=20) with three students in each group. They are provided with theoretical knowledge of airway management, demonstration, and hands-on practice on simulation. The same training was implemented twelve weeks later to assess the retention of knowledge.ResultsOnly 35% (n=7) were able to complete basic airway management in the first training and all of the students were able to complete it in the second training (n=20). None of the group were able to complete the airway management skills in the first trial and the completion rate in the second training increased to 65% (n=13). Students were having difficulty in manipulating and assemble the equipment. They were not able to identify their role and responsibilities as well.Conclusion and RecommendationsSimulation training in airway management is effective in helping novice nursing students in gaining the experience, knowledge and performance of the skill. Simulation training gives a real life experience of learning and hands-on skill practice is an important aspect in promoting learning and teaching.
National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: a retrospective observational study
Authors: Keep JW , Messmer AS , Sladden R , Burrell N , Pinate R , Tunnicliff M , Glucksman E 
Published: May 2015

IntroductionSevere sepsis and septic shock (SS) are time-critical medical emergencies that affect millions of people in the world. Earlier administration of antibiotics has been shown to reduce mortality from SS; however, the initiation of early resuscitation requires recognition that a patient may have sepsis. Early warning scores (EWS) are broadly used to detect patient deterioration, but to date have not been evaluated to detect patients at risk for SS. The purpose of our study was to look at the relationship between the initial national EWS (NEWS) in the emergency department (ED) and the diagnosis of SS.MethodsWe performed a retrospective, single-centre, observational study in the ED of an urban university hospital with an annual attendance of 140 000 patients. We aimed to include 500 consecutive non-trauma adult patients presenting to the ED with Manchester Triage System (MTS) category 1–3. The final diagnosis was taken from either the ED medical records or the hospital discharge summary. For all NEWS, the sensitivity and specificity to detect patients with SS was calculated.ResultsA total of 500 patients were included, 27 patients (5.4%) met the criteria for SS. The area under the curve (AUC) for NEWS to identify patient at risk for SS is 0.89 (95% CI 0.84 to 0.94). A NEWS of 3 or more at ED triage has a sensitivity of 92.6% (95% CI 74.2% to 98.7%) and a specificity of 77% (95% CI 72.8% to 80.6%) to detect patients at risk for SS at ED triage.ConclusionsA NEWS of 3 or more at ED triage may be the trigger to systematically screen the patient for SS, which may ultimately lead to early recognition and treatment.
Use of MALDI Biotyper plus ClinProTools mass spectra analysis for correct identification ofStreptococcus pneumoniaeandStreptococcus mitis/oralis
Authors: Chen Jonathan H K , She Kevin K K , Wong Oi-Ying , Teng Jade L L , Yam Wing-Cheong , Lau Susanna K P , Woo Patrick C Y , Cheng Vincent C C , Yuen Kwok-Yung 
Published: May 2015

BackgroundDifferentiation ofStreptococcus pneumoniaefrom other viridans group streptococci is well known to be challenging in clinical laboratories. Matrix assisted laser desorption ionisation–time of flight mass spectrometry (MALDI-TOF MS) had been reported to be a good alternative forStreptococcusspecies level identification. However, differentiation ofS. pneumoniaefrom otherStreptococcus mitisgroup organisms was found to be problematic using the Bruker MALDI Biotyper system.MethodsThis study used the Bruker MALDI Biotyper system in addition to a mass spectra model analysis generated by 10 reference strains ofS. pneumoniae,8 strains ofS. mitis and2 strains ofS. oralisin the ClinProTools to identify 28 clinical isolates ofS. pneumoniaeand 47 isolates ofS. mitis/oralis. The results were compared with those generated by the MALDI Biotyper system alone.ResultsThe percentages of correct species level identification using the MALDI Biotyper system alone and the direct transfer and extraction method were 66.7% (50/75) and 70.7% (53/75), respectively. With the additional ClinProTools mass spectra analysis, the percentages of correct identification by the direct transfer and extraction method increased to 85.3% (64/75) and 100% (75/75), respectively. This new workflow significantly improved the accuracy ofS. pneumoniaeandS. mitis/oralisidentification.ConclusionsThe additional ClinProTools mass spectra analysis with extraction method after MALDI Biotyper identification significantly improved the accuracy of identification amongS. pneumoniae,S. oralisandS. mitis. The extra 15 min processing time of spectra analysis should be affordable in most clinical laboratories. We suggest that the same approach could be further explored in handling other bacterial species with high similarities.
The Tokar Gap Jet: Regional Circulation, Diurnal Variability, and Moisture Transport Based on Numerical Simulations
Authors: Davis Shannon R. , Pratt Lawrence J. , Jiang Houshuo 
Published: May 2015

Abstract
The structure, variability, and regional connectivity of the Tokar Gap jet (TGJ) are described using WRF Model analyses and supporting atmospheric datasets from the East African–Red Sea–Arabian Peninsula (EARSAP) region during summer 2008. Sources of the TGJ’s unique quasi-diurnal nature and association with atypically high atmospheric moisture transport are traced back to larger-scale atmospheric dynamics influencing its forcing. These include seasonal shifts in the intertropical convergence zone (ITCZ), variability of the monsoon and North African wind regimes, and ties to other orographic flow patterns. Strong modulation of the TGJ by regional processes such as the desert heating cycle, wind convergence at the ITCZ surface front, and the local land–sea breeze cycle are described. Two case studies present the interplay of these influences in detail. The first of these was an “extreme” gap wind event on 12 July, in which horizontal velocities in the Tokar Gap exceeded 26 m s−1 and the flow from the jet extended the full width of the Red Sea basin. This event coincided with development of a large mesoscale convective complex (MCC) and precipitation at the entrance of the Tokar Gap as well as smaller gaps downstream along the Arabian Peninsula. More typical behavior of the TGJ during the 2008 summer is discussed using a second case study on 19 July. Downwind impact of the TGJ is evaluated using Lagrangian model trajectories and analysis of the lateral moisture fluxes (LMFs) during jet events. These results suggest means by which TGJ contributes to large LMFs and has potential bearing upon Sahelian rainfall and MCC development.
Projected Twenty-First-Century Changes in the Length of the Tropical Cyclone Season
Authors: Dwyer John G. , Camargo Suzana J. , Sobel Adam H. , Biasutti Michela , Emanuel Kerry A. , Vecchi Gabriel A. , Zhao Ming , Tippett Michael K. 
Published: May 2015

Abstract
This study investigates projected changes in the length of the tropical cyclone season due to greenhouse gas increases. Two sets of simulations are analyzed, both of which capture the relevant features of the observed annual cycle of tropical cyclones in the recent historical record. Both sets use output from the general circulation models (GCMs) of either phase 3 or phase 5 of the CMIP suite (CMIP3 and CMIP5, respectively). In one set, downscaling is performed by randomly seeding incipient vortices into the large-scale atmospheric conditions simulated by each GCM and simulating the vortices’ evolution in an axisymmetric dynamical tropical cyclone model; in the other set, the GCMs’ sea surface temperature (SST) is used as the boundary condition for a high-resolution global atmospheric model (HiRAM). The downscaling model projects a longer season (in the late twenty-first century compared to the twentieth century) in most basins when using CMIP5 data but a slightly shorter season using CMIP3. HiRAM with either CMIP3 or CMIP5 SST anomalies projects a shorter tropical cyclone season in most basins. Season length is measured by the number of consecutive days that the mean cyclone count is greater than a fixed threshold, but other metrics give consistent results. The projected season length changes are also consistent with the large-scale changes, as measured by a genesis index of tropical cyclones. The season length changes are mostly explained by an idealized year-round multiplicative change in tropical cyclone frequency, but additional changes in the transition months also contribute.
Recent Rainfall Trends in the Aegean Region of Turkey
Authors: Asikoglu Omer Levend , Ciftlik Dogangun 
Published: May 2015

AbstractThis study is intended to determine potential trends in annual rainfall series with the parametric Student’s t test and the nonparametric Mann–Kendall, Spearman’s rho, and Sneyers tests. The study includes a trend analysis of annual rainfall data from 47 rain gauges, mostly located at rural sites, in the Aegean region of Turkey. The chi-square and Kolmogorov–Smirnov tests showed that the null hypothesis of normality for the majority of the data (45 out of 47 stations) is acceptable. Moreover, the serial independence assumption, based on the lag-1 sample autocorrelations, is rejected in 14 datasets. The parametric Student’s t test detected significant downward trends at 15 rain gauge stations; 14 of them were also confirmed by the three nonparametric tests and by the trend-free version of the Mann–Kendall test. The results of the Sneyers test revealed that the approximate start years of significant downward trends were in the early 1970s and, sometimes, in the early 1980s. Moreover, the testing found that the normalized slopes of linear downward trends were significantly dependent on the station’s longitude, which meant that the farther the station was located from the coast, the smaller the decreasing trend in annual rainfall was. Additional studies carried out on the normalized regional data and on the 5-yr running means showed that a considerable portion of the detected downward trends were mainly due to interactions of the particular start and end times of a large number of stations with interdecadal fluctuations and the dry conditions over the Mediterranean region during the last 25–30 years.
Prevalence and impact of comorbid alcohol use disorder in bipolar disorder: A prospective follow-up study
Authors: Simhandl Christian , Radua Joaquim , König Barbara , Amann Benedikt L 
Published: May 2015

Objective: Alcohol use disorder may very well increase the likelihood of affective episodes in bipolar disorder, but prospective data on survival are inconsistent. Method: The authors examined the prevalence of alcohol use disorders and their impact on the risk of relapse. A total of 284 consecutively admitted International Classification of Diseases-10 bipolar I ( n = 161) and II ( n = 123) patients were followed up naturalistically over a period of 4 years. Results: The prevalence of alcohol use disorders was higher in bipolar II disorder than in bipolar I disorder (26.8% vs 14.9%; χ2 = 5.46, p = 0.019), with a global prevalence of alcohol use disorders of 20.1% in the whole sample. A total of 8.7% of bipolar I patients suffered from alcohol abuse and 6.2% from alcohol dependency, whereas 13% bipolar II patients had alcohol abuse and 13.8% alcohol dependency. Male bipolar subjects had a higher prevalence of alcohol use disorders than female patients (38.3% vs 12.8%; χ2 = 21.84, p-value < 0.001). The presence of alcohol use disorders was associated with an increased risk of depressive relapse in bipolar I patients (Cox regression analysis hazard ratio = 2.7, p = 0.005). The increased risk was not modulated by medication. Conclusion: Our data underline the negative long-term impact of alcohol use disorders on bipolar disorder with more depressive bipolar I episodes and the importance of its detection and treatment.