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Endophytes are microorganisms that colonise the internal compartments of host plants without harming the host. In many cases, endophytic bacteria have been shown to provide several beneficial effects to their host plant, including growth-promoting activity, modulation of plant metabolism and phytohormone signalling that leads to adaptation to environmental abiotic or biotic stresses. Endophytic bacterial community structure is influenced by plant genotype, soil type, abiotic and biotic factors, such as environmental conditions and microbe–microbe/plant–microbe interactions. In addition, agricultural management practices, such as soil tillage, crop rotation, and fertiliser and pesticide applications have a major effect on the function and structure of the soil, rhizosphere and endophytic bacterial communities. Oilseed rape (Brassica napus L.) is an important break crop in cereal crop rotation and can significantly reduce the rate of ‘take-all’ fungal disease (Gaeumannomyces graminis var. tritici) and, as a result, improves the yield of subsequent cereal crops. Additionally, oilseed rape is the world’s third largest source of vegetable oil used for human nutrition and as a source of oil for biodiesel production. Therefore, the promotion of agricultural practices that maintain the natural diversity of B. napus endophytic bacteria is receiving attention as an important element for a sustainable agricultural system that ensures crop productivity and quality while reducing inputs. This chapter reviews the existing literature on the role of endophytic bacteria in oilseed rape crop production, agricultural factors influencing oilseed rape bacterial diversity and discusses how meta-omics is enhancing our understanding of the endophytic bacteria and their function.
Background: Spinal Muscular Atrophy (SMA) is an autosomal recessive neurodegenerative disease. In June 2017, Health Canada approved Nusinersen, currently the only available drug for SMA. Since 2016, patients in Ontario have been treated clinically with Nusinersen through different access programs. Methods: Retrospective case series of patients with SMA treated clinically with Nusinersen in Ontario, describing clinical characteristics and logistics of intrathecal Nusinersen administration. Results: Twenty patients have been treated across four centres. To date, we have reviewed 8 cases at one centre (seven SMA Type I, one SMA Type II). Age at first dose ranged from 3-156 months and disease duration 9-166 months. Patients had received 4-7 doses at last evaluation. Three patients with scoliosis (2 with spinal rods) required fluoroscopy-guided radiologist administration, and 4 required general anesthesia. No complications/adverse events were reported. At last follow up, 5/8 families reported improved daily activities. Of 5 patients with baseline and follow up motor function testing, 3 demonstrated improved scores. One patient died due to respiratory decline at age 9 months, despite improved motor outcome scores. Conclusions: We describe the first Canadian post-marketing experience with Nusinersen. Timely dissemination of this information is needed to guide clinicians, hospital administrators, and policy-makers.
Introduction: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common presentation to the emergency department (ED) accounting for significant morbidity, mortality and health care resource usage. In Alberta, a provincial care pathway was recently developed to provide an evidence informed approach to managing patients with an UGIBs in the ED. Pantoprazole infusions are a commonly used treatment despite evidence that suggests they are generally not indicated prior to endoscopy in the ED. The goal of this project was to optimize management of patients with a NVUGIB, in particular reduce pre-endoscopy pantoprazole infusions. Methods: In July 2016, we implemented a multi-faceted intervention to optimize management of ED patients with NVUGIB including 1. de-emphasizing IV pantoprazole infusions in the ED, 2. clinical decision support (CDS) embedded (for endoscopy, disposition and transfusions) within the order set and 3. educating clinicians about the care pathway. We used a pre/post-order set design, analyzing 391 days pre and 189 days post-order set changes. Data was extracted from our fully integrated electronic health records system. The primary outcome was the % of patients receiving IV pantoprazole infusion ordered by an emergency physician (EP) among all patients with NVUGIB. Secondary outcomes included % transfused with hgb >70g/L and whether using the GIB order set impacted management of NVUGIB patients. Results: In the 391 days pre-order set changes, there were 2165 patients included and in the 189 days post-order set changes, there were 901 patients. For baseline characteristics, patients in the post-order set change group were significantly older (64.4 yrs vs 60.9 yrs p-value=0.0016) and had a lower hgb (115 vs 118, p-value=0.049) but otherwise for gender, measures of severity of illness (systolic blood pressure, heart rate, CTAS, % admitted) there were no significantly differences. For the primary outcome, in the pre-order set phase, 47.1% received a pantoprazole infusion ordered by an EP, compared to 31.5% in the post-order phase, for an absolute reduction of 15.6% (p-value= <0.001). For the secondary outcomes, transfusion rates were similar pre/post (22.08% vs 22.75%). Significant inter-site variability exists with respect to the reduction in pantoprazole infusion rates across the four sites (-23.3% to +6.12%). Conclusion: Our interventions resulted in a significant overall reduction in pantoprazole infusions in ED patients with NVUGIB. Reductions in pantoprazole infusions varied significantly across the different sites, future work in our department will explore and address this variability. Keys to the success of this project included engaging clinicians as well as leveraging the SCM order sets as well as the provincial care pathway. Although there were no changes in transfusion rates, it in unclear if this a function of the CDS not being effective or whether these transfusions were clinically indicated.
Advances in emergency medicine research can be slow to make their way into clinical care, and implementing a new evidence-based intervention can be challenging in the emergency department. The Canadian Association of Emergency Physicians (CAEP) Knowledge Translation Symposium working group set out to produce recommendations for best practice in the implementation of a new science in Canadian emergency departments.
A systematic review of implementation strategies to change health care provider behaviour in the emergency department was conducted simultaneously with a national survey of emergency physician experience. We summarized our findings into a list of draft recommendations that were presented at the national CAEP Conference 2017 and further refined based on feedback through social media strategies.
We produced 10 recommendations for implementing new evidence-based interventions in the emergency department, which cover identifying a practice gap, evaluating the evidence, planning the intervention strategy, monitoring, providing feedback during implementation, and desired qualities of future implementation research.
We present recommendations to guide future emergency department implementation initiatives. There is a need for robust and well-designed implementation research to guide future emergency department implementation initiatives.
The current study was aiming to report the prevalence of suboptimal vitamin D status among schoolchildren in Greece and investigate the role of sex, urbanisation and seasonality on vitamin D status. A sample of 2386 schoolchildren (9–13 years old) from four distinct prefectures was examined. The prevalence of 25-hydroxyvitamin D (25(OH)D) concentration <30 and <50 nmol/l (vitamin D deficiency and insufficiency respectively) was 5·2 and 52·5 %, respectively. Girls had a higher prevalence of 25(OH)D<30 (7·2 v. 3·2 %) and 50 nmol/l (57·0 v. 48·0 %) than boys (P<0·001). The highest prevalence rates of 25(OH)D<30 and 50 nmol/l (9·1 and 73·1 %, respectively) were observed during spring (April to June), whereas the lowest (1·5 and 31·9 %, respectively) during autumn (October to December). The prevalence of 25(OH)D<50 nmol/l was higher in urban/semi-urban than rural regions, particularly during spring months (74·6 v. 47·2 %; P<0·001). Female sex, urban/semi-urban region of residence and spring months were found to increase the likelihood of vitamin D deficiency and insufficiency, with the highest OR observed for spring months (7·47; 95 % CI 3·23, 17·3 and 5·14; 95 % CI 3·84, 6·89 for 25(OH)D<30 and 50 nmol/l respectively). In conclusion, despite the southerly latitude, the prevalence of low vitamin D status among primary schoolchildren in Greece is comparable to or exceeds the prevalence reported among children and adolescents on a European level. Sub-populations at highest risk are girls in urban/semi-urban areas during spring months, thus indicating the need for effective initiatives to support adequate vitamin D status in these population groups.
An ice surface map of central Marie Byrd Land has been compiled from aero-altimetric data taken on 14,000 km. of flight lines during the Antarctic summer of 1960–61 using standard aircraft equipment. A large depression sloping down towards the Filchner Ice Shelf was determined and earlier known features in the area are shown in greater detail.
Introduction: In the Emergency Department (ED), increasing time pressures and acuity require physicians to have access to quick and reliable data to guide patient care decisions. Blood gases (BGs) allow quick access to key information, and are used frequently in the ED. Our objective was to review the literature on reliability and accuracy of electrolyte measurements obtained from BGs in high acuity settings. Methods: A comprehensive literature review was conducted in September of 2015. The search strategy, done in conjunction with a medical librarian, identified studies that assessed the accuracy of BGs when compared to traditional laboratory serum measurements. Prior to the review we determined sodium and potassium would be the area of focus. Eligibility parameters for the studies included samples from acute care areas - the ED and ICU - and a comparison of BG and serum values taken simultaneously from the patient. Results: Our review included 12 studies, 9 in adult and 3 in pediatrics. There were approximately 1,135 patients included, consisting of 851 adult and 284 pediatric cases. The results were mixed; 9 studies agreed that sodium and potassium readings from BGs were accurate enough to guide acute care decisions, 5 did not. Furthermore, important questions were raised regarding the varying accuracy of BGs depending on what physiological level the electrolytes were at during the time of collection, i.e. at critical vs non-critical levels. Conclusion: This is the first literature review to examine the existing evidence on the accuracy of BGs in acute care environments. Given the variability in the results, a larger study needs to be done to determine the validity and reliability of blood gases for electrolytes in acute care settings. Only by ensuring the accuracy of data collected via point-of-care BGs can the most informed decisions be made surrounding patient care in acute care settings.
Introduction: The Ottawa Ankle Rules (OAR) are a clinical decision tool used to minimize unnecessary radiographs in ankle and foot injuries. The OAR has been shown to be a reliable rule to exclude fractures in children over 5 years of age. However, there is limited data to support its use by other health care workers in children. Our objective was to determine the sensitivity and specificity of the OAR, to detect clinically significant fractures, when applied by allied health providers (AHPs). Methods: Children aged 5 to 17 years presenting with an acute ankle or foot injury were enrolled. Patients assessed by a physician prior to an AHP, presenting for reassessment or >24 hours after the injury, having open, penetrating or neurovascular injury, or multiple injuries were excluded. Patients with metabolic bone disease, a previous x-ray, or the inability to communicate or ambulate before the injury were also excluded. Baseline data on x-ray use was collected in a convenience sample of 100 patients. AHPs then completed an OAR learning module. Then in phase 2, AHPs applied the OAR to a convenience sample of 186 patients. Both AHPs and physicians performed inter-observer assessments. Results: When AHP’s applied the ankle portion of the OAR, the sensitivity was 88% (95% CI 46.7-99.3) and the specificity was 32.5% (95% CI 24.5-41.6) for clinically significant fractures. When AHP’s applied the foot portion of the OAR, the sensitivity was 87.5% (95% CI 46.7-99.3) and the specificity was 15.6% (95% CI 7.0-30.1) for clinically significant fractures. In total, 2 clinically significant fractures (1 foot fracture and 1 ankle fracture) were missed by AHP’s. Inter-observer agreement was κ=0.24 for the ankle rule and κ=0.32 for the foot rule. The missed ankle fracture had a positive OAR when performed by a physician as an inter-observer assessment. The missed foot fracture was a distal metatarsal fracture that was outside of the “foot zone” as defined by the OAR. Conclusion: The sensitivity of the OAR when applied by AHP’s was very good. Both clinically significant fractures that were missed by AHP’s would likely have been picked up by a physician assessment. More training and practice using the OAR would likely improve AHP’s inter-observer reliability. Our data suggest the OAR may be a useful tool for AHP’s to apply as a screening tool prior to physician assessment.
Physical health and, in particular, frailty may be associated with psychological factors among older adults. We aimed to investigate the relationships between aspects of psychological distress and progression of frailty over time among older adults.
We used a longitudinal observational study design with 624 participants aged over 60 years (mean age=72.75, s.d.=7.21, 68% female) completing a baseline comprehensive biopsychosocial geriatric assessment, and 447 returning for a follow-up assessment 2 years later. Aspects of psychological distress, physical health, and frailty were analysed for the purposes of this study. We employed a series of logistic regression analyses to determine psychological predictors of changing states of aspects of frailty over time.
With individual components of frailty, neuroticism and age predicted negative transitions of exhaustion and grip strength, respectively, whereas age alone was a predictor of transitions in overall frailty scores based on four components.
We conclude that neuroticism and age may impact upon physical frailty and its progression over time in an ageing population. These findings may reflect the tendency for those with high levels of neuroticism to endorse negative symptoms, or alternatively, neuroticism may result in exhaustion via worry in an older population. Further research is required to further elucidate this relationship.
The aim of this study was to examine cross-sectionally whether higher cardiorespiratory fitness (CRF) might favorably modify amyloid-β (Aβ)-related decrements in cognition in a cohort of late-middle-aged adults at risk for Alzheimer’s disease (AD). Sixty-nine enrollees in the Wisconsin Registry for Alzheimer’s Prevention participated in this study. They completed a comprehensive neuropsychological exam, underwent 11C Pittsburgh Compound B (PiB)-PET imaging, and performed a graded treadmill exercise test to volitional exhaustion. Peak oxygen consumption (VO2peak) during the exercise test was used as the index of CRF. Forty-five participants also underwent lumbar puncture for collection of cerebrospinal fluid (CSF) samples, from which Aβ42 was immunoassayed. Covariate-adjusted regression analyses were used to test whether the association between Aβ and cognition was modified by CRF. There were significant VO2peak*PiB-PET interactions for Immediate Memory (p=.041) and Verbal Learning & Memory (p=.025). There were also significant VO2peak*CSF Aβ42 interactions for Immediate Memory (p<.001) and Verbal Learning & Memory (p<.001). Specifically, in the context of high Aβ burden, that is, increased PiB-PET binding or reduced CSF Aβ42, individuals with higher CRF exhibited significantly better cognition compared with individuals with lower CRF. In a late-middle-aged, at-risk cohort, higher CRF is associated with a diminution of Aβ-related effects on cognition. These findings suggest that exercise might play an important role in the prevention of AD. (JINS, 2015, 21, 841–850)
Although inquiry into the impact of contextual factors on the governance of multinational enterprises (MNEs) has increased, primary attention has centred on MNEs from developed countries, which operate in other industrialised economies. There has been relatively little research into organisations from developed nations involved in less developed countries (LDCs). As this dearth of inquiry is particularly evident in South Pacific economies, this paper examines the management of Bougainville Copper Limited (BCL), an Australian mining company that operated in Papua New Guinea (PNG) until it was violently expelled by local communities in 1990. While this study supports research claiming that MNE performance depends upon the alignment of firms' internal and external environments, it demonstrates that alignment becomes increasingly difficult as characteristics in the host setting deviate from those in the home country. More importantly, it reveals that MNEs cannot survive under extremely divergent home—host conditions despite management efforts to control environmental variables. It also establishes that MNEs should focus contextual congruency on the host society, not the host country as widely suggested in the literature.
The Standards Committee of the Experimental Research Section of the American Political Science Association has produced reporting guidelines that aim to increase the clarity of experimental research reports. This paper describes the Committee's rationale for the guidelines it developed and includes our Recommended Reporting Standards for Experiments (Laboratory, Field, Survey). It begins with a content analysis of current reporting practices in published experimental research. Although researchers report most important aspects of their experimental designs and data, we find substantial omissions that could undermine the clarity of research practices and the ability of researchers to assess the validity of study conclusions. With the need for reporting guidelines established, the report describes the process the Committee used to develop the guidelines, the feedback received during the comment period, and the rationale for the final version of the guidelines.
Online counselling is a rapidly growing field and, while there is emerging evidence of its comparative effectiveness, there has been little research into what techniques are being applied in practice and which clients will most likely benefit from this medium. Using a focus group methodology, this study examines the experiences of 19 online clinicians employed by a youth mental health service, investigating their perception of online clients, views on their counsellor roles, the approaches and techniques they employ, and the unique aspects of counselling in an online environment. Overall, online clinicians perceived their clients as presenting with highly complex problems and a high level of psychological distress. They noted online clients would most often use the service once or twice, and that some would use online chat as an adjunct to face-to-face counselling. The online clinicians described various roles, including: assessments, gatekeeping, providing emotional support, and therapeutic interventions. According to the online clinicians, they used a variety of techniques online, but favoured person-centred techniques, as these helped keep the clients engaged with the service. Areas of further research and implications for practice are discussed.
Small changes in the availability of liquid water can have profound effects on the water levels, aqueous chemistry and biogeochemical dynamics of the closed-basin, perennially ice-covered lakes of the McMurdo Dry Valleys, Antarctica. We have compiled the published and unpublished data on dissolved gas, tritium and chlorofluorocarbons (CFCs) for Lake Fryxell and Lake Hoare to determine the effects of a high meltwater year (2001–02 summer) on the lakes. The dissolved gas, tritium and CFC data indicate that the pulse of freshwater that flowed onto the surfaces of the lakes did not mix extensively with the upper water column. At the bottom of Lake Hoare, the measurable CFC and lower dissolved gas values suggest that the recent meltwater may have mixed with bottom waters. The probable mechanism for this transportation is weak density currents with c. 0.1–1.5% surface water being transported downwards in Lake Hoare. This deep water input, while not constant, may have a significant effect on the chemistry of the bottom waters in Lake Hoare over time. In Lake Fryxell, the tritium and CFC data indicate that the recent meltwater did not significantly affect the bottom water chemistry; therefore, weak density currents may not be present in Lake Fryxell.