Rationale, aims and objectives The Scottish Stroke Care Bundle (SSCB) aims to significantly improve patient outcomes and the consistency with which stroke patients are managed. The identification of key enablers and barriers to implementation will allow a future focus on the development of appropriate interventions to promote reliability of implementation. The aim of this study was to explore and describe the reasons why doctors and nurses in one Health Board area in Scotland feel that the SSCB is not being applied in a consistent and reliable way. The research objective was ‘to explore and describe the factors associated with compliance and non-compliance with the Scottish stroke care bundle’. Method A qualitative approach was used to understand the perspectives of medical and nursing staff involved in implementing the SSCB. Eight semi-structured interviews were undertaken across two sites. Cane et al’s Theoretical Domains Framework (TDF) guided data collection and analysis providing context-based explanations as to why reliable implementation of the SSCB is not being achieved.1 Results Three significant factors were identified that significantly influence the likelihood of patients receiving the SSCB: knowledge; resources; and organisational culture. The interrelationships between these factors revealed key enablers and barriers to the consistent application of the SSCB in this Health Board area. Conclusions Many of the findings are commonly identified as being crucial to the implementation of care bundles and potentially have national implications for SSCB implementation. Multifaceted quality improvement interventions, based on these findings, would improve the consistency of SSCB implementation in this Health Board area.
The aim of the study was to examine the in vitro effects of the slow-releasing H2S donor GYY4137 on immune cells involved in the pathogenesis of the central nervous system (CNS) autoimmune disease, multiple sclerosis (MS). GYY4137 specifically potentiated TGF-beta expression and production in dendritic cells and significantly reduced IFN-γ and IL-17 production in the lymph node and spinal cord T cells obtained from mice immunized with CNS antigens. Both the proportion of FoxP3+ regulatory CD4+ T cells in the lymph node cells, and the percentage of IL-17+ CD4+ T cells in the spinal cord cells were reduced upon culturing with GYY4137. Interestingly, peripheral blood mononuclear cells obtained from MS patients had lower expression of the H2S-producing enzyme, 3-mercaptopyruvate-sulfurtransferase (MPST), in comparison to those obtained from healthy donors. A significant inverse correlation between the expression of MPST and several pro-inflammatory factors was also observed. Further studies on the relevance of the observed results for the pathogenesis and therapy of MS are warranted.
On 11/3/2020, the World Health Organization declared that COVID-19 is a pandemic emergency. In this scenario, cancer patients are to be considered at higher risk, being fragile and often with disease-related or treatment-induced immunodepression. Furthermore, this health emergency generates a harmful psychological impact on these patients, who fear a lot about losing the continuity of cancer therapy. This fact must be carefully considered by health personnel, especially in countries where heavy risk containment and social distancing measures, the only epidemiological strategies currently considered adequate, are in force. In short, this is a very delicate challenge for health professionals engaged in oncology. Here, we report some insights and challenges that healthcare professionals face daily in caring for cancer patients.
Vitamin D has long been known to be a major regulator for both the endocrine and the immune system. With the advent of COVID-19 pandemic, there has been a growing interest in looking at the feasibility of using vitamin D as a preventative and therapeutic option in the management of the disease. A low serum level of vitamin D is linked to higher incidence of respiratory tract infection and disease progression. Vitamin D supplementation has proven to be effective in enhancing the immune system, strengthen lung epithelial barrier, and prevention of unchecked inflammatory response. Previous studies on the roles of vitamin D in managing influenza and other enveloped virus infection could shed light on the possible roles of vitamin D in the current pandemic. More randomised controlled trials are needed to explore the effects of vitamin D supplementation on COVID-19 infection.
A special class of conjugated hydrocarbons known as phenylenes, which is composed of a special arrangement of six- and four-membered rings. In particular, any two six-membered rings (hexagons) are not adjacent, and every four-membered ring(square) is adjacent to a pair of nonadjacent hexagons. If each hexagon of phenylene is adjacent only to two squares, then the obtained chain is called the phenylene chain. The main object of this paper is to determine the expected values of the sum-connectivity, harmonic, and symmetric division indices of this class of conjugated hydrocarbons. The comparisons between the expected values of these indices with respect to the random phenylene chains have been determined explicitly. The graphical illustrations have been given in terms of the differences between the expected values of these indices.
Borna disease virus (BoDV) can cause neurological disease in several vertebrate species, especially in horses and sheep. The recent cases of fatal encephalitis caused by BoDV in humans have raised concern regarding the zoonotic character of this virus. BoDV infection in horses is endemic in Central Europe, whereas in Spain the disease is regarded as an exotic disease in horses and serological investigations in these animals have never been performed. The aim of this study was to investigate the exposure to BoDV in breeding and sport horses in Spain and to determine risk factors for the transmission of the virus. Serum samples from 495 horses (260 sport horses and 235 Spanish Purebred breeding horses) were tested by an Indirect Fluorescence Antibody Test (IFAT). From the SP breeding horses we examined factors putatively associated with seropositivity to BoDV. A total of 164 horses (33.1%; 95% CI 29.0-37.3) showed antibodies against BoDV. Factors associated with BoDV seropositivity in the SP breeding horses were climate, age and the time of the year when the horses were sampled. This is the first report on the presence of BoDV antibodies in apparently asymptomatic breeding and sport horses in Spain. Our results demonstrate the need for BoDV surveillance in horses and possible reservoir hosts in this country, and suggests that BoDV should be included in the differential diagnosis of equine and human cases of encephalitis.
Lupoid cutaneous leishmaniasis is identified by a broad range of clinical presentation with brown to red, yellowish-brown, apple-jelly papules. These papules enlarge to plaques, develop into granulomatous, crusted ulcers, which are as similar as cutaneous lesions of lupus vulgaris. Herein, we report a patient with lupoid CL mimicking lupus vulgaris
Sutureless/rapid deployment valves provide surgeons with a new tool for aortic valve replacement (AVR) therapy, which can simplify the procedure. A main concern being the development of a paravalvular leak. We retrospectively reviewed our Aortic Valve Replacement database, were able to identify 25 rapid deployment aortic valves (INTUITY Valve System, Edwards Life Sciences LLC, Irvine, Calif) that had documented intraoperative Transesophageal Echocardiographic Annular measurements. All valves were implanted in the Aortic position. In this cohort, only patients that had their native aortic valve replaced either isolated or as part of any additional procedure were included. Patients that underwent Intuity valve implantation for Redo Aortic valve replacement were excluded from this study. After review of 25 patients who underwent rapid deployment valve implantation in the aortic position, 36% of patients had the same size valve as the measured aortic annulus, 48% of patients had a valve implanted that was 1 mm different, and 16% of patients had 2 mm difference. The mean annular size based on intraoperative TEE was 22.4 mm (range: 21-28 mm). The mean valve size that we implanted was 23.3 mm (range: 21-27 mm). No statistically significant difference between the mean annular measurement and the valve size selected (0.9 mm , p = 0.8) were found. TEE is perhaps remains as one of our most important tool to further enhance valve sizing and appropriately guide one through a proper and safe deployment.
Bacillus subtilis is an attractive host for directed evolution of the enzymes whose substrates cannot be transported across the cell membrane. However, generation of mutant library in B. subtilis still suffers problems of small library size, plasmid instability and heterozygosity. Here, large library of random mutant was created through inserting error-prone PCR (epPCR) product to the chromosome of B. subtilis. Specifically, epPCR product was fused with flanking regions and antibiotic resistant marker using a PCR-based multimerization method, generating insertion construct. epPCR product was integrated into chromosome via homologous recombination after insertion construct was transformed into the supercompetent cells of B. subtilis strain SCK6. The transformation efficiency of insertion construct was improved though increasing the number of competent cell and the length of flanking regions. A library containing 3.5×105 random mutant was construction using per μg insertion construct, which is sufficient for directed evolution. Moreover, the library generation process could be accomplished within one day. The effectiveness of this method was confirmed by improving the activity of Methyl Parathion Hydrolase (MPH) toward chlorpyrifos and to enhance the secretion level of MPH in B. subtilis. Taken together, present work provides a fast and efficient method to integrate epPCR product into the chromosome of B. subtilis, facilitating directed evolution and expression optimization of target protein.
The symbiotic bacteria associated with honeybee gut have likely transformed from a free-living or parasitic lifestyle, through a close evolutionary association with the insect host. However, little is known about the genomic mechanism underlying bacterial transition to exclusive adaptation to the bee gut. Here we compared the genomes of bee gut symbionts Apibacter with their close relatives living in different lifestyles. We found that despite of general reduction in the Apibacter genome, genes involved in amino acid synthesis and monosaccharide detoxification were retained, which was likely beneficial to the host. Interestingly, the microaerobic Apibacter species have specifically preserved the NAR operon encoding for the nitrate respiration pathway which in contrast, is absent from the related non-free-living microaerobic pathogenic relatives. The NAR operon is also conserved in the cohabiting bee microbe Snodgrasella, but with a differed structure. This convergence implies a crucial role of respiration nitrate reduction for microaerophilic microbiomes to colonize bee gut epithelium. Genes involved in lipid, histidine and phenylacetate degradation are partially lost in Apibacter, possibly associated with the loss of pathogenicity. Antibiotic resistance genes were only sporadically distributed among Apibacter species, but condensed in their pathogenic relatives. Collectively, this study advanced our understanding of genomic transition underlying specialization in bee gut symbionts.
Hemodialysis requires repeated, reliable access to the systemic circulation; therefore, a well-functioning vascular access (VA) procedure is crucial for stable hemodialysis. VA infections (VAIs) constitute the most challenging complication and cause considerable morbidity, loss of access, and even death. In this study, we investigated the molecular profiles of different bacterial isolates retrieved from various types of VA grafts. We collected clinical isolates from hemodialysis patients with VAIs in our institution for the period between 2013 and 2018. We identified the bacterial isolates using standard biochemical procedures; we used a polymerase chain reaction for coagulase-negative staphylococcus (CoNS) and Burkholderia cepacia complex (BCC) species identification. The antibiotic resistance and molecular profile were analyzed using the disk diffusion method and multilocus sequence typing, respectively. We studied 150 isolates retrieved from patients with VAI and observed that Staphylococcus aureus was the predominant bacterial species, followed by S. argenteus, BCC, and CoNS. According to multilocus sequence typing data, we identified a wide variety of sequence types (STs) in S. aureus isolates, with ST59, ST45, and ST239 being the predominant types. Burkholderia cepacia with two new ST types, namely ST1723 and ST1724, accounted for most of the BCC infections, along with ST102 B. contaminans, which were mainly isolated from infected tunneled-cuffed catheters. In summary, the increased incidence of S. argenteus and BCC infections provides insights into their potential clinical effects in VAIs. The various STs identified in different bacterial species indicate the high genetic diversity of bacterial species isolated from VAIs in our institution.
Inherent in climate change experiments is the assumption that researchers seek to understand the impacts of contemporary climate change and not the impacts of changes in the abiotic environment that are not predicted to occur. In general, climate warming is expected to be asymmetrical, with a mean increase in temperature that is driven more by warming at night rather than during the day. However, climate warming experiments tend to disproportionately increase daytime temperatures. If day and night warming have different effects on ecosystems, the mismatch in timing may produce misleading inference about the effects of climate change. To better understand how the timing of warming affects species and their interactions, we examined a food chain of lady beetles, aphids and host plants within environmental chambers programmed to simulate four w treatments (ambient, constant warming, day warming, and night warming). Our results show that the timing of warming influences predators and their interactions with prey in several ways. In plant-only treatments, all warming treatments increased plant above-ground biomass. When aphids were added, the positive direct effect of warming on plants disappeared, and night-warming indirectly reduced plant biomass more than the day- and constant-warming treatments. Although our feeding trial experiments found that lady beetles in day-warming treatments consumed the most aphids in a 24 hour period, predators generated a trophic cascade in only the night warming treatment. Our results contributes to mounting evidence predators can mediate the effects of climate warming and that these predators are affected by day and night warming differently.
Rationale, aims and objectives Public health systems are under pressure to meet increasing demand for health care in environments of increasing financial resource constraint. There is therefore a need to maximise health outcomes given limited public healthcare expenditure. This paper aims to establish the extent of literature and approaches to efficiency improvement in public health systems of developed countries. Methods The Rapid Evidence Assessment model was used to address the review question. Two database searches returned a result of 3,526 unique titles, which were individually screened for potential relevance. 144 titles were selected for full review to determine relevance. 73 papers were included in the final review. Results Data on country, study design, key findings and links to efficiency improvement were extracted and synthesized. Synthesis of findings revealed that the literature on this topic is disparate and non-cohesive. A range of isolated approaches were described, and no evidence or consensus on a single best-practice approach to efficiency improvement was identified. Conclusions Combining the factors identified in this review has the potential to inform a framework for supporting efficiency improvement in public health systems. By considering these factors central health system management bodies can support efficiency improvement to deliver both financial and health services benefits.
Populations with higher genetic diversity and larger effective sizes have greater evolutionary capacity (i.e., higher adaptive potential) to respond to ecological stressors. We are interested in how the adaptive potential captured in protein-coding genes persists in small populations and how it fluctuates relative to overall genomic diversity. We analyzed individual whole genome sequences from different populations of Montezuma Quail (Cyrtonyx montezumae), a small ground-dwelling bird that is sustainably harvested in some portions of its range but is of conservation concern elsewhere. Our historical demographic results indicate that overall, Montezuma Quail populations in the U.S. exhibit low levels of genomic diversity due in large part to long-term declines in effective population sizes over nearly a million years. The smaller and more isolated Texas population is significantly more inbred than the large Arizona and the intermediate-sized New Mexico populations. The Texas gene pool has a significantly lower proportion of deleterious alleles than the Arizona gene pool, but also significantly more high-frequency deleterious alleles that, coupled with elevated inbreeding, elevate the realized genetic load in Texas. Our results highlight that although small, isolated populations can maintain adaptive potential (i.e., genic diversity can still be high), they are at higher risk of inbreeding depression as detrimental mutations rise in frequency due to drift and weakened purifying selection. Our study illustrates how population genomics can be used to proactively assess both neutral and adaptive aspects of contemporary genetic diversity in a conservation framework while simultaneously considering deeper demographic histories.
Rational: In March 2020, the World Health Organization (WHO) declared the coronavirus infectious disease as a pandemic referred to as COVID-19. As an essential service, community pharmacists have been enacting a key role in patient counseling and supply of essential medicines and protective equipment. Objectives: To investigate pharmacists’ perspectives of the role of educational institutes and professional pharmacy organizations in supporting them to take on roles during COVID-19 pandemic and to identify barriers to be able to support themselves and their patients. Methods: This descriptive mixed-method study was conducted via a cross-sectional online survey distributed to pharmacists/pharmacy students in Jordan during the COVID-19 outbreak (15-30 March 2020) using an online questionnaire, followed by an online focus group. Questionnaire items related to participants’ perspectives in being prepared for and supported in their roles during the COVID-19 pandemic and items were tested for face validity. Data were descriptively analyzed using the Statistical Package for the Social Sciences and triangulated with focus group findings. Results: Considering that fear and anxiety are a consequence of mass social distancing/quarantine, study participants (n=726, age=26.9 (SD=8.0) years, 71.9% females), reported needing training on mental healthcare to be able to support themselves and people during pandemics (90.2%). Most respondents agreed/strongly agreed (59.7%) with the statement around pharmacy educators/educational institutes having a key role in preparing pharmacists for practice during epidemics/pandemics, and agreed that their faculties should add a course regarding pandemic preparedness in their curriculum (89.9%). Results were similar regarding roles for the pharmaceutical associations. Focus group findings (n=7) mirrored the survey findings to a large extent. Conclusions: Most participants believed that Pharmacy Educators and pharmaceutical associations have a role in preparing them to deal with the COVID-19 pandemic through online educational workshops/webinars. Online education on mental healthcare is specifically needed.