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Bread wheat (Triticum aestivum) is one of the most important food crops in the world. Its physiological and morphological traits are closely related to yield. Therefore, it is generally important to discover the genomic region associated with these traits. In this research, associations between 21 simple sequence repeat (SSR) markers and 10 inter-simple sequence repeat (ISSR) markers with some traits related to root structure at the embryonic and seedling stages and also some agromorphological traits at the whole plant stage were evaluated on a set of 102 wheat genotypes. A highly significant coefficient of variation among different genotypes was observed in all measured traits. A high level of polymorphism with SSR and ISSR markers was obtained. Genetic structure analysis revealed two distinct subpopulations. Significant correlations were found between genomic markers and evaluated traits. A total of nine markers, including four SSR markers in 1A, 3A, 5A and 2B chromosomal regions and five different ISSR markers were related to the studied traits. Several molecular markers were significantly associated with more than one phenotypic trait, suggesting the possible presence of pleiotropic or indirect effects. The phenotypic variation justified by these alleles ranged from 4 to 15%. Obtained genetic information can be targeted for further validation and genetic analysis in the relevant populations or other breeding sets.
Advanced practice providers (APPs) are being employed at increasing rates in order to meet new in-hospital care demands. Utilising the Paediatric Acute Care Cardiology Collaborative (PAC3) hospital survey, we evaluated variations in staffing models regarding first-line providers and assessed associations with programme volume, acuity of care, and post-operative length of stay (LOS).
The PAC3 hospital survey defined staffing models and resource availability across member institutions. A resource acuity score was derived for each participating acute care cardiology unit. Surgical volume was obtained from The Society of Thoracic Surgeons database. Pearson’s correlation coefficients were used to evaluate the relationship between staffing models and centre volume as well as unit acuity. A previously developed case-mix adjustment model for total post-operative LOS was utilised in a multinomial regression model to evaluate the association of APP patient coverage with observed-to-expected post-operative LOS.
Surveys were completed by 31 (91%) PAC3 centres in 2017. Nearly all centres (94%) employ APPs, with a mean of 1.7 (range 0–5) APPs present on weekday rounds. The number of APPs present has a positive correlation with surgical volume (r = 0.49, p < 0.01) and increased acuity (r = 0.39, p = 0.03). In the multivariate model, as coverage by APPs increased from low to moderate or high, there was greater likelihood of having a shorter-than-expected post-operative LOS (p < 0.001).
The incorporation of paediatric acute care cardiology APPs is associated with reduced post-operative LOS. Future studies are necessary to understand how APPs impact these patient-specific outcomes.
Background: In April 2019, Nebraska Public Health Laboratory identified an NDM-producing Enterobacter cloacae from a urine sample from a rehabilitation inpatient who had recently received care in a specialized unit (unit A) of an acute-care hospital (ACH-A). After additional infections occurred at ACH-A, we conducted a public health investigation to contain spread. Methods: A case was defined as isolation of NDM-producing carbapenem-resistant Enterobacteriaceae (CRE) from a patient with history of admission to ACH-A in 2019. We conducted clinical culture surveillance, and we offered colonization screening for carbapenemase-producing organisms to all patients admitted to unit A since February 2019. We assessed healthcare facility infection control practices in ACH-A and epidemiologically linked facilities by visits from the ICAP (Infection Control Assessment and Promotion) Program. The recent medical histories of case patients were reviewed. Isolates were evaluated by whole-genome sequencing (WGS). Results: Through June 2019, 7 cases were identified from 6 case patients: 4 from clinical cultures and 3 from 258 colonization screens including 1 prior unit A patient detected as an outpatient (Fig. 1). Organisms isolated were Klebsiella pneumoniae (n = 5), E. cloacae (n = 1), and Citrobacter freundii (n = 1); 1 patient had both NDM-producing K. pneumoniae and C. freundii. Also, 5 case patients had overlapping stays in unit A during February–May 2019 (Fig. 2); common exposures in unit A included rooms in close proximity, inhabiting the same room at different times and shared caregivers. One case-patient was not admitted to unit A but shared caregivers, equipment, and devices (including a colonoscope) with other case patients while admitted to other ACH-A units. No case patients reported travel outside the United States. Screening at epidemiologically linked facilities and clinical culture surveillance showed no evidence of transmission beyond ACH-A. Infection control assessments at ACH-A revealed deficiencies in hand hygiene, contact precautions adherence, and incomplete cleaning of shared equipment within and used to transport to/from a treatment room in unit A. Following implementation of recommended infection control interventions, no further cases were identified. Finally, 5 K. pneumoniae of ST-273 were related by WGS including carriage of NDM-5 and IncX3 plasmid supporting transmission of this strain. Further analysis is required to relate IncX3 plasmid carriage and potential transmission to other organisms and sequence types identified in this study. Conclusions: We identified a multiorganism outbreak of NDM-5–producing CRE in an ACH specialty care unit. Transmission was controlled through improved infection control practices and extensive colonization screening to identify asymptomatic case-patients. Multiple species with NDM-5 were identified, highlighting the potential role of genotype-based surveillance.
Disclosures: Muhammad Salman Ashraf reports that he is the principal investigator for a study funded by an investigator-initiated research grant.
Background: Using alternatives to indwelling urinary catheters plays a vital role in reducing catheter-associated urinary tract infections (CAUTIs). We assessed the impact of introducing female external catheters on urinary catheter utilization and CAUTIs. Methods: In a 500-bed academic medical center, female external catheters were implemented on October 1, 2017, with use encouraged for eligible females with urinary incontinence but not meeting other standard indications for urinary catheters. Nurses were educated and trained on female external catheter application and maintenance, and infection prevention staff performed surveillance case reviews with nursing and medical staff. We determined the number of catheter days for both devices based on nursing documentation of device insertion or application, maintenance, and removal. We used the CAUTI and DUR (device utilization ratio) definitions from the CDC NHSN. Our primary outcomes were changes in DUR for both devices 21 months before and 24 months after the intervention in both intensive care units (ICUs) and non-ICU wards. We used a generalized least-squares model to account for temporal autocorrelation and compare the trends before and after the intervention. Our secondary outcome was a reduction in CAUTIs, comparing females to males. Results: In total, there were 346,213 patient days in 35 months. The mean rate of patient days per month increased from 7,436.4 to 7,601.9 after the implementation of female external catheters, with higher catheter days for both urinary catheters (18,040 vs 19,625) and female external catheters (22 vs 12,675). After the intervention, the DUR for female external catheters increased (0 vs 0.07; P < .001) and for urinary catheters the DUR decreased (0.12 vs 0.10; P < .001) (Fig. 1). A reduction in urinary catheter DUR was observed in ICUs (0.29 vs 0.27; P < .001) but not wards (0.08 vs 0.08; P = NS) (Fig. 2). Of the 39 CAUTIs, there was no significant overall change in the rate per 1,000 catheter days (1.22 vs 0.87; P = .27). In females (n = 20 CAUTI), there was a 61% reduction in the CAUTI rate per 1,000 catheter days (0.78 vs 0.31; P = .02), but no significant change in the rate in males (0.44 vs 0.56; P = .64). The CAUTI rate per 1,000 catheter days among females decreased in the ICUs (1.14 vs 0.31; P = .04) but not in wards (0.6 vs 0.33; P = .96). Conclusions: In a setting with a baseline low UC DUR, successful implementation of female external catheters further modestly reduced UC DUR and was associated with a 61% decrease in CAUTI among females in the ICU but not in wards. Further interventions to better identify appropriate patients for female external catheters may improve patient safety and prevent patient harm.
The CDC recommends that consultant pharmacists support antimicrobial stewardship programs (ASPs) in long-term care facilities (LTCFs). We studied CDC-recommended ASP core elements implementation and antibiotic use in LTCFs before and after training consultant pharmacists. Methods: Between August 2017 and October 2017, consultant pharmacists from a regional long-term care pharmacy attended 5 didactic sessions preparing them to assist LTCFs in implementation of CDC-recommended ASP core elements. Training also included creating a process for evaluating appropriateness of all systemic antibiotics and providing prescriber feedback during their monthly mandatory drug-regimen reviews. Once monthly “meet-the-expert” sessions were held with consultant pharmacists throughout the project (November 2017 to December 2018). LTCF enrollment began in November 2017 and >90% of facilities joined by January 2018. After enrollment, consultant pharmacists initiated ASP interventions including antibiotic reviews and feedback using standard templates. They also held regular meetings with infection preventionists to discuss Core Elements implementation and provided various ASP resources to LTCFs (eg, antibiotic policy template, guidance documents and standard assessment and communication tools). Data collection included ASP Core Elements, antibiotic starts, days of therapy (DOT), and resident days (RD). The McNemar test, the Wilcoxon signed-rank test, generalized estimating equation model, and the classic repeated measures approach were used to compare the presence of all 7 core elements and antibiotic use during the baseline (2017) and intervention (2018) year.Results: In total, 9 trained consultant pharmacists assisted 32 LTCFs with ASP implementation. When evaluating 27 LTCFs that provided complete data, a significant increase in presence of all 7 Core Elements after the intervention was noted compared to baseline (67% vs 0; median Core Elements, 7 vs 2; range, 6–7 vs 1–6; P < .001). Median monthly antibiotic starts per 1,000 RD and DOT per 1,000 RD decreased in 2018 compared to 2017: 8.93 versus 9.91 (P < .01) and 106.47 versus 141.59 (P < .001), respectively. However, variations in antibiotic use were detected among facilities (Table 1). When comparing trends, antibiotic starts and DOT were already trending downward during 2017 (Fig. 1A and 1B). On average, antibiotic starts decreased by 0.27 per 1,000 RD (P < .001) and DOT by 1.92 per 1,000 RD (P < .001) each month during 2017. Although antibiotic starts remained mostly stable in 2018, DOT continued to decline further (average monthly decline, 2.60 per 1,000 RD; P < .001). When analyzing aggregated mean, antibiotic use across all sites per month by year, DOT were consistently lower throughout 2018 and antibiotic starts were lower for the first 9 months (Fig. 1C and 1D). Conclusions: Consultant pharmacists can play an important role in strengthening ASPs and in decreasing antibiotic use in LTCFs. Educational programs should be developed nationally to train long-term care consultant pharmacists in ASP implementation.
Funding: Merck & Co., Inc, provided funding for this study.
Disclosures: Muhammad Salman Ashraf and Scott Bergman report receipt of a research grant from Merck.
We determined the effects of a combination of C18 unsaturated fatty acids (C18-UFAs) consisting of oleic, linoleic, and linolenic acids on milk lipogenesis in bovine mammary epithelial cells (BMECs). By orthogonal experiments to determine cellular triacylglycerol (TAG) accumulation, a combination of 200 μmol/l C18 : 1, 50 μmol/l C18 : 2, and 2 μmol/l C18 : 3 was selected as C18-UFAs combination treatment, and culture in medium containing fatty acid-free bovine serum albumin was used as the control. The expression of genes related to milk lipid synthesis and intracellular FA composition was measured. The results showed that cytosolic TAG formation was higher under C18-UFAs treatment than under control treatment. The mRNA expression of acetyl-CoA carboxylase-α (ACACA), fatty acid synthase (FASN), and peroxisome proliferator-activated receptor gamma (PPARG) did not differ between treatments. The abundance of stearoyl-CoA desaturase (SCD) and acyl-CoA synthetase long-chain family member 1 (ACSL1) was higher, whereas that of sterol regulatory element binding transcription factor 1 (SREBF-1) was lower after C18-UFAs treatment compared to control treatment. The C16 : 0 and SFA content was decreased following C18-UFAs treatment compared to control treatment, while the cis-9 C18 : 1 and UFA content was increased. In conclusion, C18-UFAs could stimulate triglyceride accumulation, increase the cellular UFA concentration, and regulate lipogenic genes in BMECs.
Previous reports have identified risk factors associated with development of post-Fontan protein-losing enteropathy. Less is known about the economic impact and resource utilisation required for post-Fontan protein-losing enteropathy in the current era. We conducted a single-centre retrospective study to assess the impact of post-Fontan protein-losing enteropathy on transplant-free survival. We also described resource utilisation and treatment variations among post-Fontan protein-losing enteropathy patients. Children who received care at our centre between 2009 and 2017 after the Fontan surgery were eligible. Initial admissions for the Fontan operative procedure were excluded. Demographics, hospital admissions, resource utilisation, medications and charges were reviewed. Patients were divided into two groups based on the presence of post-Fontan protein-losing enteropathy. Of the 343 patients screened, 147 met the eligibility criteria. Of these, 28 (19%) developed protein-losing enteropathy. After adjusting for follow-up duration, the protein-losing enteropathy group had higher number of encounters (2.15 ± 2.16 versus 1.47 ± 2.56, p 0.002), hospital length of stay (days) (25 ± 51.3 versus 11.4 ± 41.7, p < 0.0001) and total charges (2018US$) (388,489 ± 759,859 versus 202,725 ± 1,076,625, p < 0.0001). Encounters for patients with protein-losing enteropathy utilised more therapies. Among those with protein-losing enteropathy, use of digoxin was associated with slightly decreased odds for mortality and/or transplant (0.95, confidence interval 0.90–0.99, p 0.021). The 10-year transplant-free survival for patients with/without protein-losing enteropathy was 65.7/97.3% (p 0.002), respectively. Post-Fontan protein-losing enteropathy is associated with reduced 10-year transplant-free survival, higher resource utilisation, charges and medication use compared with the non-protein-losing enteropathy group. Practice variation among post-Fontan protein-losing-enteropathy patients is common. Further larger studies are needed to assess the impact of standardisation on the well-being of children with post-Fontan protein-losing enteropathy.
This study investigated relationships among spirituality, hope, and overall quality of life in Muslim women with breast cancer in Malaysia.
A cross-sectional descriptive design with a convenience sample of 145 Malay patients was used. The mediating role of hope in the relationship between spirituality and quality of life as well as the moderating effect of education level on the spirituality hope link were examined.
Participants with higher self-reported spirituality reported more hope (b = 6.345, p < 0.001) and higher levels of quality of life (b = 1.065, p < 0.001). Higher educational attainment weakened relationships between spirituality and hope (b = −1.460, p < 0.001).
Significance of results
The role of advanced education in contributing to lessened hope in relation to spirituality emphasizes the importance of skilled and personalized spiritual counseling in the respective socio-cultural religious context.
Since April 2004, Government policy in England upholds that clinicians should send copies of their clinical letters to their patients. However, some argue that patients already have the right to access their records under the Data Protection Act, 1998. Others suggest it wiser not to provide a letter in certain circumstances. Little evidence is available examining the factors that impact on and underlie patients’ views in relation to this.
To inform professionals about patients’ views on receiving clinical letters.
To establish the proportion and characteristics of patients who would like to receive clinical letters and to elicit underlying reasons for decisions.
Subjects were randomly sampled from an outpatient clinic and data collected using an 11-item questionnaire, between October 2010 and July 2013.
The majority (60%) of patients wished to receive their clinical letter. Most (62%) favoured wanting to know about treatment primarily. Of those who did not wish to have a copy, greatest concerns were of loss in the post and ‘unnecessary paperwork’ (each 11%). This group of patients were characteristically male, aged 61-80, of asian ethnicity, unmarried and unemployed. Patients with a diagnosis of adult personality and behaviour (ICD-10 F60-69) were most likely to opt to receive their clinical letter.
Although the majority preferred to receive clinical letters, reasons for preferences varied widely. With an increasing drive towards greater transparency in the health service, approaches to enhancing patient involvement will need to be flexible to the individual to enable truly meaningful patient participation.
Opening of C.E.P.P.D (Center for Emotional, Personal and Professional Development). Almost every child in the world joins school and as per policy and procedures school staff/teachers develop their educational level but emotional health is not in focus at all; therefore child raised up with many severe negative and self-defeating behaviors; they understand others but others not understand them and that's the beginning all problems start from here…. The Center will provide state of the art guidelines/guidance (one stop solutions) supporting facilities starting from schooling onward throughout entire life for people belongs to all walks of life. In these centers anyone can go and will come out with clear head and in hand solutions, team of professionals shall provide guidance and support to everyone for healthy and balanced life by all means and will also develop alumni networking for permanent intact and fund raising on continuous basis from all over the world. C.E.P.P.D will play central and synergizing role between all sectors (for instance, schools, colleges, universities, counseling, vocational, community, hospitals, NGOs, mental and emotional health centers, child up-bringing, parenting, career counseling, soft skills training's; likewise list is on.... along with financial assistance from Govt. and semi-government sectors, will share implementation details as needed/at the time of symposium/brain storming sessions. These centers will become surely The turning point center in city than progress in next cities; likewise in country than at global level and yes together positively we can set landmark by mainly utilizing the medium of education and guidance.
Disclosure of interest
The author has not supplied his declaration of competing interest.
In the first part, the scattering characteristics of an isolated dielectric coated conducting rod have been investigated. The types of considered coatings for the scattering analysis are realistic materials including barium strontium titanate, magnetodielectric, gallium arsenide, and silicon carbide. It is found that the gallium arsenide coating can be used to significantly reduce the scattering from a thin perfectly electric conducting cylindrical rod at specific observation angles. In the second part, the effective permittivity and permeability of metamaterials composed of two dimensional periodic arrangements of these dielectric coated conducting cylindrical rods have been studied. An increase in the double negative (DNG) bandwidth of a metamaterial composed of barium strontium titanate coated conducting rods has been observed in contrast to the corresponding bandwidth of a metamaterial composed of only barium strontium titanate material rods. Also an additional plasmonic epsilon negative (ENG) bandwidth has been found in case of a metamaterial composed of barium strontium titanate coated conducting rods. It is further studied that the widest ENG, mu negative, and DNG bandwidths exist for a metamaterial composed of gallium arsenide rods.
Mastitis is among the most common and challenging diseases of dairy animals. It is an inflammation of udder tissues due to physical damage, chemical irritation, or infection caused by certain pathogens. Bovine mastitis has been known for ages, but its complex etiology and multi-factorial nature make it difficult to control. Mastitis may have a negative impact on human health by inducing antibiotic-resistant pathogens that may spread, which is threatening. Researchers are continuously struggling to devise suitable methods for mastitis control. Management strategies are mainly focused on disease prevention by farm management which includes proper hygiene, trained staff to monitor minor changes in the udder or milk, and better diagnostic and treatment methods. New technologies which have the potential to unravel this complicated disease include improved diagnostic tools, based on advanced genomics or proteomics, prevention, based on vaccines and immune modulators, and metabolic products of probiotics such as bacteriocins and gene therapy.
Accurately diagnosing urinary tract infections (UTIs) in hospitalized patients remains challenging, requiring correlation of frequently nonspecific symptoms and laboratory findings. Urine cultures (UCs) are often ordered indiscriminately, especially in patients with urinary catheters, despite the Infectious Diseases Society of America guidelines recommending against routine screening for asymptomatic bacteriuria (ASB).1,2 Positive UCs can be difficult for providers to ignore, leading to unnecessary antibiotic treatment of ASB.2,3 Using diagnostic stewardship to limit UCs to situations with a positive urinalysis (UA) can reduce inappropriate UCs since the absence of pyuria suggests the absence of infection.4–6 We assessed the impact of the implementation of a UA with reflex to UC algorithm (“reflex intervention”) on UC ordering practices, diagnostic efficiency, and UTIs using a quasi-experimental design.
Polymer nanocomposites possess unique sets of properties that make them suitable for different applications, including structural and flame-retardant material, electromagnetic wave reflector, sensors, thin film transistor, flexible display, and many more. The properties of these nanocomposite are dependent on nanofiller dispersion and bonding with polymer matrix (i.e. particle-matrix interaction). Thermography is a non-destructive method that may be used to gain insight into dispersion and particle-matrix interaction. Infrared (IR) radiation emitted from these nanomaterial polymer composite depends on the emissivity of the individual components. In addition, during flash heating and cooling, different thermal conductivity of components in the nanocomposite can influence pixel intensity differently in the IR image or video being captured. We have used an economical mid wavelength IR camera Fluke RSE600 equipped with a close-up macro lens and algorithm based on MATLAB image processing toolbox to analyse dispersion, voids and thermal diffusivity of patented graphene polymer nanocomposite materials (G-PMC) in micro-scale. These G-PMCs can act as a standard material to determine the potential of our IR thermography technique due to their homogeneity and lack of impurity due to unique fabrication process. Thermal diffusivity and dispersion of nanoparticles in our G-PMCs was estimated after irradiation with a xenon flash lamp by spatially mapping transient IR radiations from different G-PMCs using the Fluke RSE600 thermal imager. Results from thermography experiments were compared with scanning electron microscope (SEM) and Raman spectroscopy results. Micro-scale thermography was able to detect millimetre scale thermal diffusivity variation in the injection molded G-PMC samples and relate it to change in dispersion of nanofillers, unlike SEM and Raman, where micro-scale measurements could not determine the reason behind millimetre scale property variation. We believe this low cost, fast, micro-scale, non-destructive technique will provide valuable insight into functional polymer nanocomposite fabrication and corresponding electrical and thermal properties.
To assess the reliability of diffusion-weighted magnetic resonance imaging in differentiating recurrent cholesteatoma from granulation tissue after intact canal wall mastoidectomy.
A prospective study was conducted of 56 consecutive patients with suspected cholesteatoma recurrence after intact canal wall mastoidectomy who underwent diffusion-weighted imaging and delayed contrast magnetic resonance imaging of the temporal bone. The final diagnosis was recurrence in 38 patients and granulation tissue in 18 patients.
Cholesteatoma detection on diffusion-weighted imaging based on two sets of readings had sensitivity of 94.7 and 94.7 per cent, specificity of 94.4 and 88.9 per cent, and accuracy of 94.6 and 92.8 per cent, with good intra-observer agreement (Κ = 0.72, p = 0.001). Cholesteatoma detection on delayed contrast magnetic resonance imaging had sensitivity of 81.6 and 78.9 per cent, specificity of 77.8 and 66.7 per cent, and accuracy of 80.4 and 75.0 per cent, with fair intra-observer agreement (Κ = 0.57, p = 0.001). The mean cholesteatoma diameter on diffusion-weighted imaging was 7.7 ± 1.8 and 7.9 ± 1.8 mm, with excellent intra-observer agreement (Κ = 0.994, p = 0.001).
Diffusion-weighted imaging is a reliable method for differentiating recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy.
Fasting – the voluntary withholding of food – is a common practice in many religions. Depending on the type of fast, weight loss may occur. Participants in a fast may develop negative sodium balance and have high rates of gluconeogenesis with amino acids as the primary substrates. Ketosis develops and ketones replace glucose as the primary energy source in the central nervous system, thereby decreasing the need for gluconeogenesis and sparing protein catabolism. Several hormonal changes occur during fasting, including a fall in insulin and T3 levels and a rise in glucagon and reverse T3 levels . However, the effect of fasting on neurological diseases, direct or indirect (for instance through affecting medication adherence), are not well known. The mass participation in, and clear regulations of, Ramadan fasting make it an ideal opportunity to study these issues.