bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cyclic Rhamnosylated Elongation Factor P Establishes Antibiotic Resistance in Pseudomonas aeruginosa
Authors: Rajkovic Andrei , Erickson Sarah , Witzky Anne , Branson Owen E. , Seo Jin , Gafken Philip R. , Frietas Michael A. , Whitelegge Julian P. , Faull Kym F. , Navarre William , Darwin Andrew J. , Ibba Michael 
Published: June 2015

ABSTRACT

Elongation factor P (EF-P) is a ubiquitous bacterial protein that is required for the synthesis of poly-proline motifs during translation. In
Escherichia coli
and
Salmonella enterica
, the posttranslational β-lysylation of Lys34 by the PoxA protein is critical for EF-P activity. PoxA is absent from many bacterial species such as
Pseudomonas aeruginosa
, prompting a search for alternative EF-P posttranslation modification pathways. Structural analyses of
P. aeruginosa
EF-P revealed the attachment of a single cyclic rhamnose moiety to an Arg residue at a position equivalent to that at which β-Lys is attached to
E. coli
EF-P. Analysis of the genomes of organisms that both lack
poxA
and encode an Arg32-containing EF-P revealed a highly conserved glycosyltransferase (EarP) encoded at a position adjacent to
efp
. EF-P proteins isolated from
P. aeruginosa
Δ
earP
, or from a Δ
rmlC
::
acc1
strain deficient in dTDP-
l
-rhamnose biosynthesis, were unmodified.
In vitro
assays confirmed the ability of EarP to use dTDP-
l
-rhamnose as a substrate for the posttranslational glycosylation of EF-P. The role of rhamnosylated EF-P in translational control was investigated in
P. aeruginosa
using a Pro
4
-green fluorescent protein (Pro
4
GFP)
in vivo
reporter assay, and the fluorescence was significantly reduced in Δ
efp
, Δ
earP
, and Δ
rmlC
::
acc1
strains. Δ
rmlC
::
acc1
, Δ
earP
, and Δ
efp
strains also displayed significant increases in their sensitivities to a range of antibiotics, including ertapenem, polymyxin B, cefotaxim, and piperacillin. Taken together, our findings indicate that posttranslational rhamnosylation of EF-P plays a key role in
P. aeruginosa
gene expression and survival.

IMPORTANCE
Infections with pathogenic
Salmonella
,
E. coli
, and
Pseudomonas
isolates can all lead to infectious disease with potentially fatal sequelae. EF-P proteins contribute to the pathogenicity of the causative agents of these and other diseases by controlling the translation of proteins critical for modulating antibiotic resistance, motility, and other traits that play key roles in establishing virulence. In
Salmonella
spp. and
E. coli
, the attachment of β-Lys is required for EF-P activity, but the proteins required for this posttranslational modification pathway are absent from many organisms. Instead, bacteria such as
P. aeruginosa
activate EF-P by posttranslational modification with rhamnose, revealing a new role for protein glycosylation that may also prove useful as a target for the development of novel antibiotics.
Comparative test of radiological exposure between femoral and radial techniques, development of a protective device and clinical trial design
Authors: Bienert Igor R C , Andrade Pedro B , Rinaldi Fabio S , Vilela Fernanda D T , Silva Paulo A , Braga Joao C S , Waib Paulo H , Rodrigues Alexandre , Filho Fábio V G , Okoshi Katashi 
Published: June 2015

BackgroundInterventional procedures via radial technique have progressively increased due to improved patient comfort, lower complication rates and reduced mortality in some scenarios. One area of interest is radiation exposure and ways of minimising it. Most studies focus on patient radiation risk with conflicting results, but there is reasonable consensus for increased operator exposure from the radial technique. The aim of this study was to evaluate radiological exposure under controlled radial and femoral access simulation tests, mapping radiation paths and developing a radiological protection device for the transradial technique.Methods and resultsRadiation exposure was simulated under controlled conditions for femoral and radial techniques using a pressurised ionisation chamber and water phantom. Different measurement points were defined according to standard positions to simulate radiation received by the operator in the gonads, thyroid and eyes at different angles during real procedures. The radial technique increased total exposure by 33% over the femoral technique. A protective device was developed and tested after radiation mapping. The protective device reduced cumulative radiation by 52% against the radial and 36% against the femoral technique.ConclusionsIn our study, operator exposure to cumulative ionising radiation was higher from the radial technique and the protective device reduced radiation exposure levels in the radial and femoral techniques. These results provided the basis for a clinical trial design to better define the impact of the protection device and radiation exposure during real world practice using different interventional techniques.Trial registration numberhttp://www.clinicaltrials.gov. Unique identifier:NCT02200783.
Benzodiazepine prescribing in children under 15 years of age receiving free medical care on the General Medical Services scheme in Ireland
Authors: O'Sullivan K , Reulbach U , Boland F , Motterlini N , Kelly D , Bennett K , Fahey T 
Published: June 2015

ObjectiveTo examine the prevalence and secular trends in benzodiazepine (BZD) prescribing in the Irish paediatric population. In addition, we examine coprescribing of antiepileptic, antipsychotic, antidepressant and psychostimulants in children receiving BZD drugs and compare BZD prescribing in Ireland to that in other European countries.SettingData were obtained from the Irish General Medical Services (GMS) scheme pharmacy claims database from the Health Service Executive (HSE)—Primary Care Reimbursement Services (PCRS).ParticipantsChildren aged 0–15 years, on the HSE-PCRS database between January 2002 and December 2011, were included.Primary and secondary outcome measuresPrescribing rates were reported over time (2002–2011) and duration (≤ or >90 days). Age (0–4, 5–11, 12–15) and gender trends were established. Rates of concomitant prescriptions for antiepileptic, antipsychotics, antidepressants and psychostimulants were reported. European prescribing data were retrieved from the literature.ResultsRates decreased from 2002 (8.56/1000 GMS population: 95% CI 8.20 to 8.92) to 2011 (5.33/1000 GMS population: 95% CI 5.10 to 5.55). Of those children currently receiving a BZD prescription, 6% were prescribed BZD for >90 days. Rates were higher for boys in the 0–4 and 5–11 age ranges, whereas for girls they were higher in the 12–15 age groups. A substantial proportion of children receiving BZD drugs are also prescribed antiepileptic (27%), antidepressant (11%), antipsychotic (5%) and psychostimulant (2%) medicines. Prescribing rates follow a similar pattern to that in other European countries.ConclusionsWhile BZD prescribing trends have decreased in recent years, this study shows that a significant proportion of the GMS children population are being prescribed BZD in the long term. This study highlights the need for guidelines for BZD prescribing in children in terms of clinical indication and responsibility, coprescribing, dosage and duration of treatment.
Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: systematic review
Authors: Martin-Misener Ruth , Harbman Patricia , Donald Faith , Reid Kim , Kilpatrick Kelley , Carter Nancy , Bryant-Lukosius Denise , Kaasalainen Sharon , Marshall Deborah A , Charbonneau-Smith Renee , DiCenso Alba 
Published: June 2015

ObjectiveTo determine the cost-effectiveness of nurse practitioners delivering primary and specialised ambulatory care.DesignA systematic review of randomised controlled trials reported since 1980.Data sources10 electronic bibliographic databases, handsearches, contact with authors, bibliographies and websites.Included studiesRandomised controlled trials that evaluated nurse practitioners in alternative and complementary ambulatory care roles and reported health system outcomes.Results11 trials were included. In four trials ofalternative provider ambulatory primary care roles, nurse practitioners were equivalent to physicians in all but seven patient outcomes favouring nurse practitioner care and in all but four health system outcomes, one favouring nurse practitioner care and three favouring physician care. In a meta-analysis of two studies (2689 patients) with minimal heterogeneity and high-quality evidence, nurse practitioner care resulted in lower mean health services costs per consultation (mean difference: −€6.41; 95% CI −€9.28 to −€3.55; p<0.0001) (2006 euros). In two trials ofalternative provider specialised ambulatory care roles, nurse practitioners were equivalent to physicians in all but three patient outcomes and one health system outcome favouring nurse practitioner care. In five trials ofcomplementary provider specialised ambulatory care roles, 16 patient/provider outcomes favouring nurse practitioner plus usual care, and 16 were equivalent. Two health system outcomes favoured nurse practitioner plus usual care, four favoured usual care and 14 were equivalent. Four studies of complementary specialised ambulatory care compared costs, but only one assessed costs and outcomes jointly.ConclusionsNurse practitioners in alternative provider ambulatory primary care roles have equivalent or better patient outcomes than comparators and are potentially cost-saving. Evidence for their cost-effectiveness in alternative provider specialised ambulatory care roles is promising, but limited by the few studies. While some evidence indicates nurse practitioners in complementary specialised ambulatory care roles improve patient outcomes, their cost-effectiveness requires further study.
Are family, neighbourhood and school social capital associated with higher self-rated health among Croatian high school students? A population-based study
Authors: Novak Dario , Suzuki Etsuji , Kawachi Ichiro 
Published: June 2015

ObjectivesWe investigated the associations between self-rated health and social capital among Croatian high school students.DesignA cross-sectional survey among high school students was carried out in the 2013–2014 school year.SettingHigh schools in Croatia.ParticipantsSubjects were 3427 high school students (1688 males and 1739 females), aged 17–18 years.Main outcome measureSelf-rated health was assessed by the single item: “How do you perceive your health?”. Possible responses were arranged along a five-item Likert-type scale: 1 very poor, 2 poor, 3 fair, 4 good, 5 excellent. The outcome was binarised as ‘good health’ (excellent, good or fair) versus ‘poor health’ (poor or very poor).MethodsWe calculated ORs and 95% CIs for good self-rated health associated with family, neighbourhood and school social capital, while adjusting for gender, self-perceived socioeconomic status, psychological distress, physical activity and body mass index. We used generalised estimating equations using an exchangeable correlation matrix with robust SEs.ResultsGood self-rated health was significantly associated with higher family social capital (OR 2.43; 95% CI 1.55 to 3.80), higher neighbourhood trust (OR 2.02; 95% CI 1.48 to 2.76) and higher norms of reciprocity at school (OR 1.79; 95% CI 1.13 to 2.84). When all of the social capital variables were entered simultaneously, good self-rated health remained significantly associated with higher family social capital (OR 1.98; 95% CI 1.19 to 3.30), neighbourhood trust (OR 1.77; 95% CI 1.25 to 2.51) and reciprocity at school (OR 1.71; 95% CI 1.08 to 2.73).ConclusionsHigher levels of social capital were independently associated with higher self-rated health among youth. Intervention and policies that leverage community social capital might serve as an avenue for health promotion in youth.
Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study
Authors: O'Leary Helen , Smart Keith M , Moloney Niamh A , Blake Catherine , Doody Catherine M 
Published: June 2015

IntroductionPain is the dominant symptom of knee osteoarthritis (OA), and recent evidence suggests factors outside of local joint pathology, such as pain sensitisation, can contribute significantly to the pain experience. It is unknown how pain sensitisation influences outcomes from commonly employed interventions such as physiotherapy. The aims of this study are, first, to provide a comprehensive description of the somatosensory characteristics of people with pain associated with knee OA. Second, we will investigate if indicators of pain sensitisation in patients with knee osteoarthritis are predictive of non-response to physiotherapy.Methods and analysisThis is a multicentre prospective cohort study with 140 participants. Eligible patients with moderate to severe symptomatic knee osteoarthritis will be identified at outpatient orthopaedic and rheumatology clinics. A baseline assessment will provide a comprehensive description of the somatosensory characteristics of each participant by means of clinical examination, quantitative sensory testing, and validated questionnaires measuring pain and functional capacity. Participants will then undergo physiotherapy treatment. The primary outcome will be non-response to physiotherapy on completion of the physiotherapy treatment programme as defined by the Osteoarthritis Research Society International treatment responder criteria. A principal component analysis will identify measures related to pain sensitisation to include in the predictive model. Regression analyses will explore the relationship between responder status and pain sensitisation while accounting for confounders.Ethics and disseminationThis study has been approved by St James’ Hospital/AMNCH Research Ethics Committee and by the St Vincent's Healthcare Group Ethics and Medical Research Committee. The results will be presented at international conferences and published in a peer review journal.Trial registration numberNCT02310945.
Temporal trends in out-of-hospital cardiac arrest survival outcomes between two metropolitan communities: Seoul-Osaka resuscitation study
Authors: Ro Young Sun , Shin Sang Do , Kitamura Tetsuhisa , Lee Eui Jung , Kajino Kentaro , Song Kyoung Jun , Nishiyama Chika , Kong So Yeon , Sakai Tomohiko , Nishiuchi Tatsuya , Hayashi Yasuyuki , Iwami Taku ,   for Seoul-Osaka Resuscitation Study (SORS) Group
Published: June 2015

ObjectivesThe objective of this study was to compare the temporal trends in survival after out-of-hospital cardiac arrest (OHCA) between two large metropolitan communities in Asia and evaluate the factors affecting survival after OHCA.DesignA population-based prospective observational study.SettingThe Cardiovascular Disease Surveillance (CAVAS) project in Seoul and the Utstein Osaka Project in Osaka.ParticipantsA total of 36 292 resuscitation-attempted OHCAs with cardiac aetiology from 2006 to 2011 in Seoul and Osaka (11 082 in Seoul and 25 210 in Osaka).Primary outcome measuresThe primary outcome was neurologically favourable survival. Trend analysis and multivariable Poisson regression models were conducted to evaluate the temporal trends in survival of two communities.ResultsDuring the study period, the overall neurologically favourable survival was 2.6% in Seoul and 4.6% in Osaka (p<0.01). In both communities, bystander cardiopulmonary resuscitation (CPR) rates increased significantly from 2006 to 2011 (from 0.1% to 13.1% in Seoul and from 33.3% to 41.7% in Osaka). OHCAs that occurred in public places increased in Seoul (12.5% to 20.1%, p for trend <0.01) and decreased in Osaka (13.5% to 10.5%, p for trend <0.01). The proportion of OHCAs defibrillated by emergency medical service (EMS) providers was only 0.4% in 2006 but increased to 17.5% in 2011 in Seoul, whereas the proportion in Osaka decreased from 17.7% to 13.7% (both p for trend <0.01). Age-adjusted and gender-adjusted rates of neurologically favourable survival increased significantly in Seoul from 1.4% in 2006 to 4.3% in 2011 (adjusted rate ratio per year, 1.17; p for trend <0.01), whereas no significant improvement was observed in Osaka (3.6% in 2006 and 5.1% in 2011; adjusted rate ratio per year, 1.03; p for trend=0.08).ConclusionsSurvivals after OHCA were increased in Seoul while remained constant in Osaka, which may have been affected by the differences and improvements of patient, community, and EMS system factors.
Reducing hospital acquired pressure ulcers in intensive care
Authors: Cullen Gill Emma 
Published: June 2015

AbstractPressure ulcers are a definite problem in our health care system and are growing in numbers. Unfortunately, it is usually the most weak and vulnerable of our culture that faces these complications, causing the patient and their families discomfort, anguish, and economic hardship due to their expensive treatment.Data collected by the tissue viability department showed high incidence of hospital acquire pressure ulcers in the intensive care unit in March 2013. An action plan was initiated and implemented by the tissue viability team, senior nursing management, pressure ulcer prevention (PUP) team and respiratory therapists (RT’s) within the ICU. Our objective was to reduce hospital acquired pressure ulcers in the intensive care unit using the plan, do, check, act quality improvement process.
Reducing Door to- Balloon- Time for Acute ST Elevation Myocardial Infarction In Primary Percutaneous Intervention: Transformation using Robust Performance Improvement
Authors: Ellahham, MD Samer , Aljabbari Samir , Harold Mananghaya Tristan , J. Raji Salama , Al Zubaidi Abdulmajeed 
Published: June 2015

AbstractCardiovascular diseases (CVDs) are the leading causes of death in the UAE. Prompt reperfusion access is essential for patients who have Myocardial Infarction (MI) with ST-segment elevation as they are at a relatively high risk of death.This risk may be reduced by primary percutaneous coronary intervention (PCI), but only if it is performed in a timely manner. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon (D2B) time) during primary PCI should be 90 minutes or less. The earlier therapy is initiated, the better the outcome. Our aim was to decrease the door-to-balloon time for patients with ST segment elevation myocardial infarction (STEMI) who come through the emergency department (ED) in Sheikh Khalifa Medical City,a tertiary hospital in UAE, to meet the standard of less than 90 minutes. A multidisciplinary team was formed including interventional cardiologists, catheterization laboratory personnel, emergency department caregivers and quality staff. The project utilized the Lean Six Sigma Methodology which provided a powerful approach to quality improvement. The process minimized waste and variation, and a decreased median door-to-balloon time from 75.9 minutes to 60.1 minutes was noted. The percentage of patients who underwent PCI within 90 minutes increased from 73% to 96%. In conclusion, implementing the Lean Six Sigma methodology resulted in having processes that are leaner, more efficient and minimally variable. While recent publication failed to provide evidence of better outcome, the lessons learned were extrapolated to other primary percutaneous coronary intervention centers in our system.This would have marked impact on patient safety, quality of care and patient experience.
Quality improvement in resident education: a pilot project to mitigate metabolic side effects from atypical antipsychotic medications in youth
Authors: Jeffrey Jessica 
Published: June 2015

AbstractThis resident physician-led quality improvement project was conducted with aims to improve the health of youth prescribed atypical antipsychotic medications by increasing physician monitoring for metabolic side effects, while simultaneously educating trainees in quality improvement methodology.The plan, do, study, act quality improvement framework was utilized. Baseline metabolic monitoring rates of patients prescribed atypical antipsychotic medications in the two psychiatry resident outpatient clinics were obtained. Rates were stratified based on time on medication (<1 year, ≥1 year) and parameter monitored. Metabolic monitoring rates subsequent to targeted changes were obtained. Problem solving with residents revealed barriers to monitoring, such as limited awareness of specific guideline recommendations and lack of convenient access to medical equipment (calibrated scales). Residents received education about atypical antipsychotic monitoring guidelines and side effect treatment. Residents were provided with calibrated scales. Atypical antipsychotic monitoring templates were introduced. Online surveys using were conducted to determine self-reported baseline-monitoring rates and comfort with guidelines following targeted change.The baseline metabolic monitoring rates of patients prescribed atypical antipsychotic medications was 9% (range: 0 to 17.6%) for youth in their first year taking an atypical antipsychotic medication and 58.9% (range: 29% to 100%) in subsequent years on medication. The results of relatively easy changes resulted in modest improvement in monitoring rates. The metabolic monitoring rate of a patient initiated on an atypical antipsychotic medication was 29% after targeted quality improvement measures were employed. Following quality improvement changes, residents reported increased knowledge about guidelines and increased monitoring for side effects. Use of a standardized data collection instrument to track monitoring of patients increased from 0% to 70% (range: 30% to 90%).Quality improvement projects provide an avenue with which to improve atypical antipsychotic monitoring rates. Through active participation in quality improvement projects, psychiatry residents may be taught to employ quality improvement methodology.
Menstrual cycle could affect Ki67 expression in estrogen receptor-positive breast cancer patients
Authors: Horimoto Yoshiya , Arakawa Atsushi , Tanabe Masahiko , Kuroda Keiji , Matsuoka Joe , Igari Fumie , Himuro Takanori , Yoshida Yuko , Tokuda Emi , Shimizu Hideo , Hino Okio , Saito Mitsue 
Published: June 2015

BackgroundKi67 is a potent prognostic marker for determining systemic treatment of patients with hormone receptor-positive breast cancer. However, evaluation of Ki67 expression can be difficult, due mostly to its heterogeneity. The Ki67 expression level, which indicates that a cell is undergoing division (cell cycle), rises when proliferation activity increases. Thus, Ki67 expression might be affected by hormonal stimuli. We hypothesised that Ki67 expression level might change during the menstrual cycle. We examined pairs of biopsy and surgical specimens from individual patients to evaluate this hypothesis.MethodsFirst, the effects of estradiol on Ki67 expression in breast cancer cell lines were examined employing immunocytochemistry and Western blotting. Next, differences in Ki67 expression between biopsy and surgical specimens from 131 patients with estrogen receptor-positive tumours were retrospectively examined.ResultsIn vitro experiments showed Ki67 expression in estrogen receptor-positive cancer cells to be dependent on estradiol stimulation. Ki67 expression was higher in biopsy samples collected in the luteal phase than in those from other phases. When biopsy and surgical samples were obtained at different times during the menstrual cycle in the same individual, there were differences in Ki67 expression between these samples. Those collected in the luteal phase showed higher Ki67 expression than samples obtained during other phases (p<0.01).ConclusionsKi67 expression varied in the same patients according to menstrual cycle phase. Our results suggest that Ki67 expression in estrogen receptor-positive breast cancer should be carefully assessed bearing in mind the patient's menstrual cycle, since the interpretation of expression could affect treatment decisions.