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The influence of dietary habits on health/disease is well-established. Accurate dietary assessment is essential to understand metabolic pathways/processes involved in this relationship. In recent years, biomarker discovery has become a major area of interest for improving dietary assessment. Well-established nutrient intake biomarkers exist; however, there is growing interest in identifying and using biomarkers for more accurate and objective measurements of food intake. Metabolomics has emerged as a key tool used for biomarker discovery, employing techniques such as NMR spectroscopy, or MS. To date, a number of putatively identified biomarkers were discovered for foods including meat, cruciferous vegetables and legumes. However, many of the results are associations only and lack the desired validation including dose–response studies. Food intake biomarkers can be employed to classify individuals into consumers/non-consumers of specific foods, or into dietary patterns. Food intake biomarkers can also play a role in correcting self-reported measurement error, thus improving dietary intake estimates. Quantification of food intake was previously performed for citrus (proline betaine), chicken (guanidoacetate) and grape (tartaric acid) intake. However, this area still requires more investigation and expansion to a range of foods. The present review will assess the current literature of identified specific food intake biomarkers, their validation and the variety of biomarker uses. Addressing the utility of biomarkers and highlighting gaps in this area is important to advance the field in the context of nutrition research.
Recent literature suggests that over 70% of cases of antibody-mediated encephalitis present to psychiatry services with features of psychosis predominantly.
To investigate the seroprevalence of N-Methyl-D-Aspartate receptor antibodies (NMDAr-Ab) in patients with first episode psychosis (FEP)
Following ethical approval, all cases meeting entry criteria were invited to participate. Participants were interviewed with SCID to obtain a DSM diagnosis. NMDAr-Ab were identified in serum by cell based assay using co-transfected Human Embryonic Kidney (HEK)cells. Positive cases were reviewed by clinical neurology. Decision to treat with immunotherapy was made on a case by case basis.
85/115 (72%) of patients with FEP entered the study. 49 (58%) participants were male, mean age (SD) 37 (15.7) years. 42 (52%) were outpatients at the time of assessment. Four cases (5%) were serum NMDAr-Ab positive. 3 of these cases were male, age 48 (16.3) years. All four were admitted as inpatients with normal brain MRI imaging. One case (female, 55) was confirmed as NMDAr-Ab encephalitis based on case presentation, EEG demonstrating bilateral cerebral dysfunction and NMDAr-Ab in CSF. Immunotherapy treatment lead to clinical improvement. In remaining cases, EEG was normal and CSF negative. All 3 of these cases showed clinical improvement following psychiatric treatment as usual.
Our findings support the current estimates as to NMDAr-Ab prevalence in FEP. Increased awareness has lead to rapid treatment of florid cases of NMDAr-Ab encephalitis in our service. Additional seropositive cases are being followed with neuro-cognitive testing for any evidence of decline.
A person's dietary intake consists of multiple foods eaten as part of a meal as opposed to any one single food/nutrient. Therefore, it is important to understand the interactions between foods and how they affect diet-disease associations. As a result, dietary patterns have emerged as important tools in nutrition research. The objective of the current study is to assess the reproducibility and stability of dietary patterns across four different time-points. Anthropometric measurements were taken from a subset of participants of a free-living cohort study (n = 94), followed by the administration of a 24-hour dietary recall once a month, for four months. The dietary data was entered into dietary analysis software, Nutritics, by two researchers independently, and cross-checked. Foods were assigned to one of 33 predefined food groups, which were further collapsed to 18 food groups based on previous research. Statistical analysis was then performed on the final dataset. Intra-class correlation coefficients were derived to assess the reproducibility of each food group across the four time-points. Variables were standardized using z-scores and dietary patterns were derived using K-means cluster analysis. Stability was assessed by coding participants into one of six groups based on their dietary pattern transition between visit one and four. Analysis of this sub cohort revealed that the intake of food groups (% energy contribution) was reproducible across the time-points. The majority had good to very good agreement, with vegetables and vegetable dishes having the strongest agreement (ICC = 0.831) followed by milk and yogurts (ICC = 0.773), fruit and fruit dishes (ICC = 0.729), and breakfast cereals (ICC = 0.680). Two distinct dietary patterns were identified at each time-point; a ‘Healthy’ and an ‘Unhealthy’ dietary pattern. The ‘Healthy’ dietary pattern was characterized by a significantly higher energy contribution (p < 0.05) from the following food groups – vegetables and vegetable dishes; fruit and fruit dishes; milk and yogurts; breakfast cereals; butter, spreading fats and oils. The analysis on stability demonstrated 42% of participants remained in the same dietary pattern, while 58% transitioned from one dietary pattern to the other. Our results to date demonstrate that two distinct dietary patterns can be derived across multiple time-points using cluster analysis and the food group composition of these dietary patterns can be considered reproducible. Future work will explore these dietary patterns further incorporating the entire cohort and linking stability to health parameters.
Dietary assessment methods including FFQ and food diaries are associated with many measurement errors including energy under-reporting and incorrect estimation of portion sizes. Such errors can lead to inconsistent results especially when investigating the relationship between food intake and disease causation. To improve the classification of a person's dietary intake and therefore clarify proposed links between diet and disease, reliable and accurate dietary assessment methods are essential. Dietary biomarkers have emerged as a complementary approach to the traditional methods, and in recent years, metabolomics has developed as a key technology for the identification of new dietary biomarkers. The objective of this review is to give an overview of the approaches used for the identification of biomarkers and potential use of the biomarkers. Over the years, a number of strategies have emerged for the discovery of dietary biomarkers including acute and medium term interventions and cross-sectional/cohort study approaches. Examples of the different approaches will be presented. Concomitant with the focus on single biomarkers of specific foods, there is an interest in the development of biomarker signatures for the identification of dietary patterns. In the present review, we present an overview of the techniques used in food intake biomarker discover, including the experimental approaches used and challenges faced in the field. While significant progress has been achieved in the field of dietary biomarkers in recent years, a number of challenges remain. Addressing these challenges will be key to ensure success in implementing use of dietary biomarkers.
Candida auris (CA) is an emerging multidrug-resistant pathogen associated with increased mortality. The environment may play a role, but transmission dynamics remain poorly understood. We sought to limit environmental and patient CA contamination following a sustained unsuspected exposure.
A 528-bed teaching hospital.
The index case patient and 17 collocated ward mates.
Immediately after confirmation of CA in the bloodstream and urine of a patient admitted 6 days previously, active surveillance, enhanced transmission-based precautions, environmental cleaning with peracetic acid-hydrogen peroxide and ultraviolet light, and patient relocation were undertaken. Pre-existing agreements and foundational relationships among internal multidisciplinary teams and external partners were leveraged to bolster detection and mitigation efforts and to provide genomic epidemiology.
Candida auris was isolated from 3 of 132 surface samples on days 8, 9, and 15 of ward occupancy, and from no patient samples (0 of 48). Environmental and patient isolates were genetically identical (4–8 single-nucleotide polymorphisms [SNPs]) and most closely related to the 2013 India CA-6684 strain (~200 SNPs), supporting the epidemiological hypothesis that the source of environmental contamination was the index case patient, who probably acquired the South Asian strain from another New York hospital. All isolates contained a mutation associated with azole resistance (K163R) found in the India 2105 VPCI strain but not in CA-6684. The index patient remained colonized until death. No surfaces were CA-positive 1 month later.
Compared to previous descriptions, CA dissemination was minimal. Immediate access to rapid CA diagnostics facilitates early containment strategies and outbreak investigations.
The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that US Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non–VA nursing homes.
VA and non-VA nursing homes participating in the AHRQ Safety Program for Long-Term Care collaborative.
Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention via a needs assessment questionnaire.
A total of 353 of 494 nursing homes from 41 states (71%; 47 VA and 306 non-VA facilities) responded. VA nursing homes reported more hours per week devoted to infection prevention-related activities (31 vs 12 hours; P<.001) and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs 66%; P<.001), sharing CAUTI data with leadership (94% vs 70%; P=.014) and with nursing personnel (85% vs 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs 81%; P=.004) and catheter insertion (83% vs 94%; P=.004).
Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems.
Verotoxigenic Escherichia coli (VTEC) are significant for their low infectious dose, their potential clinical severity and the frequency with which they generate outbreaks. To describe the relative importance of different outbreak transmission routes for VTEC infection in Ireland, we reviewed outbreak notification data for the period 2004–2012, describing the burden and characteristics of foodborne, waterborne, animal contact and person-to-person outbreaks. Outbreaks where person-to-person spread was reported as the sole transmission route accounted for more than half of all outbreaks and outbreaks cases, most notably in childcare facilities. The next most significant transmission route was waterborne spread from untreated or poorly treated private water supplies. The focus for reducing incidence of VTEC should be on reducing waterborne and person-to-person transmission, by publicizing Health Service Executive materials developed for consumers on private well management, and for childcare facility managers and public health professionals on prevention of person-to-person spread.
To characterize the epidemiology of multidrug-resistant (MDR) Acinetobacter baumannii colonization in high-risk nursing home (NH) residents.
Nested case-control study within a multicenter prospective intervention trial.
Four NHs in Southeast Michigan.
Case patients and control subjects were NH residents with an indwelling device (urinary catheter and/or feeding tube) selected from the control arm of the Targeted Infection Prevention study. Cases were residents colonized with MDR (resistant to ≥3 classes of antibiotics) A. baumannii; controls were never colonized with MDR A. baumannii.
For active surveillance cultures, specimens from the nares, oropharynx, groin, perianal area, wounds, and device insertion site(s) were collected upon study enrollment, day 14, and monthly thereafter. A. baumannii strains and their susceptibilities were identified using standard microbiologic methods.
Of 168 NH residents, 25 (15%) were colonized with MDR A. baumannii. Compared with the 143 controls, cases were more functionally disabled (Physical Self-Maintenance Score >24; odds ratio, 5.1 [95% CI, 1.8–14.9]; P<.004), colonized with Proteus mirabilis (5.8 [1.9–17.9]; P<.003), and diabetic (3.4 [1.2–9.9]; P<.03). Most cases (22 [88%]) were colonized with multiple antibiotic-resistant organisms and 16 (64%) exhibited co-colonization with at least one other resistant gram-negative bacteria.
Functional disability, P. mirabilis colonization, and diabetes mellitus are important risk factors for colonization with MDR A. baumannii in high-risk NH residents. A. baumannii exhibits widespread antibiotic resistance and a preference to colonize with other antibiotic-resistant organisms, meriting enhanced attention and improved infection control practices in these residents.
Infect Control Hosp Epidemiol 2015;36(10):1155–1162
Characterize the clinical and molecular epidemiology of new methicillin-resistant Staphylococcus aureus (MRSA) acquisitions at nasal and extranasal sites among high-risk nursing home (NH) residents.
Multicenter prospective observational study.
Six NHs in southeast Michigan.
A total of 120 NH residents with an indwelling device (feeding tube and/or urinary catheter).
Active surveillance cultures from the nares, oropharynx, groin, perianal area, wounds (if present), and device insertion site(s) were collected upon enrollment, at day 14, and monthly thereafter. Pulsed-field gel electrophoresis and polymerase chain reaction for SCCmec, agr, and Panton-Valentine leukocidin were performed.
Of 120 participants observed for 16,290 device-days, 50 acquired MRSA (78% transiently, 22% persistently). New MRSA acquisitions were common in extranasal sites, particularly at device insertion, groin, and perianal areas (27%, 23%, and 17.6% of all acquisitions, respectively). Screening extranasal sites greatly increases the detection of MRSA colonization (100% of persistent carriers and 97.4% of transient carriers detected with nares, groin, perianal, and device site sampling vs 54.5% and 25.6%, respectively, for nares samples alone). Colonization at suprapubic urinary catheter sites generally persisted. Healthcare-associated MRSA (USA100 and USA100 variants) were the dominant strains (79.3% of all new acquisition isolates). Strain diversity was more common in transient carriers, including acquisition of USA500 and USA300 strains.
Indwelling device insertion sites as well as the groin and perianal area are important sites of new MRSA acquisitions in NH residents and play a role in the persistency of MRSA carriage. Clonal types differ among persistent and transient colonizers.
In this chapter, you will learn about the unique challenges of learning game design, the necessary multidisciplinary makeup of learning game design teams, and ways to improve team efficiency and effectiveness through communication. Learning games combine content and context to create a meaningful interaction between players’ experience and learning. They often employ an experiential learning strategy and have been called “designed experiences” (Squire, 2006). When learning games are viewed in this light, designing them becomes quite a challenge for several reasons: 1) many variables must be manipulated to achieve the right kind of learning experience at the right time; 2) learning game design has characteristics of ill-structured problem solving; 3) as an ill-structured problem, it requires learning game designers with a high level of expertise; and 4) the solution will require input from multiple disciplines. Having a highly skilled multidisciplinary design team raises another set of challenges including the development of a shared mental model. Research has shown that when team members think similarly, they are more likely to work effectively together (Cannon-Bowers & Salas, 1998; Guzzo & Salas, 1995; Hackman, 1990). When team members understand their differences and take measures to leverage them, learning game design teams are strengthened, leading to a more efficient and effective design process. Research indicates that multidisciplinary learning game design team members think differently about: 1) design goals; 2) authenticity requirements; 3) feedback design; 4) the integration of fun within the learning experience; 5) term definition; and 6) documentation contents. Current design models do not include steps to mitigate these differences and to build a team’s shared mental model. Therefore, we provide specific actions that should be integrated into a learning game design model to support the critical and necessary communications among learning game design team members.
This chapter shares details about the design and development of the Virtual Dental Implant Trainer (VDIT) learning game created for the Medical College of Georgia. The design and development team introduces the program by sharing the instructional goals of the learning game, basic design concepts, and development constraints. The chapter then highlights successes and discusses issues the team encountered during the design and development of the VDIT learning game. The emphasis is on sharing our experiences to help future organizations interested in creating or procuring learning game products learn from our example. Despite the issues, the team was able to minimize their impact and happily report that the game has been successfully created, tested, and delivered to the Medical College of Georgia for use in the affiliated dental school programs. The chapter closes with actionable recommendations for learning game design teams to help ensure delivery of successful game products.
The purpose of the Virtual Dental Implant Trainer (VDIT) project was to create a game-based simulation training tool to allow students to practice dental implant decision making during their free time. Nobel Biocare, a globally recognized maker of dental implant tools and hardware, through its partnership with the Medical College of Georgia (MCG), commissioned our team to design VDIT as a downloadable or CD-driven software package that could be distributed to medical students through its network of accredited schools and businesses.
We describe two cases of infant botulism due to Clostridium butyricum producing botulinum type E neurotoxin (BoNT/E) and a previously unreported environmental source. The infants presented at age 11 days with poor feeding and lethargy, hypotonia, dilated pupils and absent reflexes. Faecal samples were positive for C. butyricum BoNT/E. The infants recovered after treatment including botulism immune globulin intravenous (BIG-IV). C. butyricum BoNT/E was isolated from water from tanks housing pet ‘yellow-bellied’ terrapins (Trachemys scripta scripta): in case A the terrapins were in the infant's home; in case B a relative fed the terrapin prior to holding and feeding the infant when both visited another relative. C. butyricum isolates from the infants and the respective terrapin tank waters were indistinguishable by molecular typing. Review of a case of C. butyricum BoNT/E botulism in the UK found that there was a pet terrapin where the infant was living. It is concluded that the C. butyricum-producing BoNT type E in these cases of infant botulism most likely originated from pet terrapins. These findings reinforce public health advice that reptiles, including terrapins, are not suitable pets for children aged <5 years, and highlight the importance of hand washing after handling these pets.
Feedback provided by relativistic jets may be effective in shaping the galaxy luminosity function. The quenching mode (quasar mode) at redshifts ~2-3 potentially disperses gas in star-forming galaxies. The maintenance mode (radio mode) heats the gas in galaxy clusters counteracting cooling flows. A number of authors have examined the effect of relativistic jets in dispersing clouds in the kpc-scale inhomogeneous interstellar medium of evolving galaxies. We have also investigated a particular case of maintenance-mode feedback in our simulation of the iconic radio galaxy / cooling flow cluster Hydra A. Modelling of the knots produced by the jets in the inner 10 kpc provides an estimate of 0.8 – 0.9 c for the velocities of the jets in agreement with other velocity estimates for FR1 jets. The addition of jet precession provides realistic simulations of the morphology of the Hydra A radio source and raises interesting questions as to the role of black hole and disk precession, in general, in galaxy formation.
Cygnus A, the nearest truly powerful radio galaxy, resides at the centre of a massive galaxy cluster. Chandra X-ray observations reveal its cocoon shocks, radio lobe cavities and an X-ray jet, which are discussed here. It is argued that X-ray emission from the outer regions of the cocoon shocks is nonthermal. The X-ray jets are best interpreted as synchrotron emission, suggesting that they, rather than the radio jets, are the path of energy flow from the nucleus to the hotspots. In that case, a model shows that the jet flow is non-relativistic and carries in excess of one solar mass per year.
Influenza causes significant morbidity and mortality in children. This study's objectives were to describe influenza A(H1N1)pdm09 during the pandemic, to compare it with circulating influenza in 2010/2011, and to identify risk factors for severe influenza defined as requiring admission to a paediatric intensive care unit (PICU). Children hospitalized with influenza during the pandemic were older, and more likely to have received antiviral therapy than children hospitalized during the 2010/2011 season. In 2010/2011, only one child admitted to a PICU with underlying medical conditions had been vaccinated. The risk of severe illness in the pandemic was higher in females and those with underlying conditions. In 2010/2011, infection with influenza A(H1N1)pdm09 compared to other influenza viruses was a significant risk factor for severe disease. An incremental relationship was found between the number of underlying conditions and PICU admission. These findings highlight the importance of improving low vaccination uptake and increasing the use of antivirals in vulnerable children.
Epitaxial ZnO layers heavily doped with Ga (GZO) were grown at 400 °C under metaland oxygen-rich conditions in terms of metal-to-reactive oxygen ratio by plasma-assisted molecular beam epitaxy (MBE). Several atomic force microscopy (AFM) techniques were used to characterize the surface morphology and electrical properties of these GZO films in ambient conditions. Local I-V spectra indicate that layers grown under both O-rich and metal-rich conditions are highly resistive until a relatively high voltage sweep (±12 V) is used. After removal of an insulating surface layer, conduction is possible at lower voltages, but eventually the film resistivity increases and it again becomes insulating. In addition to local I-V spectra, local charge injection and subsequent surface potential measurements were used to probe surface charging characteristics. For charge injection experiments, a reverse-bias voltage is applied to the sample while scanning in contact mode with a metallized tip. The resultant change in surface potential due to trapped charge is subsequently observed using scanning Kelvin probe microscopy (SKPM). The layers deposited in a metal-rich environment demonstrate the expected behavior, but the O-rich layers show anomalous negative and positive charging. Finally, surface photovoltage (SPV) measurements using above-bandgap UV illumination were performed. The GZO layers produce SPV values of 0.4 to 0.5 eV, where the films deposited in an O-rich environment have slightly higher SPV values and faster restoration.
A complete molted exoskeleton of the asteropygine phacopid trilobite Greenops widderensis Lieberman and Kloc, 1997 from the Middle Devonian (Givetian) Widder Formation in southwestern Ontario, Canada that has suffered predatory trauma provides insights into the sequence of regeneration of segments. The molt configuration is such that it is possible to interpret the molting technique used by the trilobite. Predatory trauma affected four areas of the exoskeleton. The pygidium shows loss of the spinose margin on one side and damage to a single spine on the other; one genal spine has been broken and partially regrown; and the posterior of the glabella has been removed. It is thought that the first three traumas occurred during life, as these areas affected show signs of exoskeletal regeneration. The fourth trauma probably occurred to the exuvium. Analysis of the degree of regeneration of the pygidial pleurae indicates that there was an anteroposterior polarity to the regeneration. Other examples in the literature suggest that this regeneration polarity pattern may have been widespread in trilobites. It is suggested that, as in modern arthropods and annelids, this sequential regeneration was under the control of segmentation polarity genes.
We have recently found that uranium and plutonium metals will react with nitrogen trifluoride (NF3) at temperatures below 120°C. These are the first reported instances of such low temperature fluorination reactions using NF3 and implicate metal catalyzed dissociation of the NF3 bond. We additionally present preliminary evidences for a surface mediated product distribution. Reaction of uranium metal with NF3 promotes products that are apparently determined by the concentration of the fluorinating reagent between temperatures of 60 to 120°C.