An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia: Impact of multidrug resistance

Introduction: Pseudomonas aeruginosa nosocomial pneumonia (Pa-NP) is associated with considerable morbidity, prolonged hospitalization, increased costs, and mortality. Methods: We conducted a retrospective cohort study of adult patients with Pa-NP to determine 1) risk factors for multidrug-resistant (MDR) strains and 2) whether MDR increases the risk for hospital death. Twelve hospitals in 5 countries (United States, n = 3; France, n = 2; Germany, n = 2; Italy, n = 2; and Spain, n = 3) participated. We compared characteristics of patients who had MDR strains to those who did not and derived regression models to identify predictors of MDR and hospital mortality. Results: Of 740 patients with Pa-NP, 226 patients (30.5%) were infected with MDR strains. In multivariable analyses, independent predictors of multidrug-resistance included decreasing age (adjusted odds ratio [AOR] 0.91, 95% confidence interval [CI] 0.96-0.98), diabetes mellitus (AOR 1.90, 95% CI 1.21-3.00) and ICU admission (AOR 1.73, 95% CI 1.06-2.81). Multidrug-resistance, heart failure, increasing age, mechanical ventilation, and bacteremia were independently associated with in-hospital mortality in the Cox Proportional Hazards Model analysis. Conclusions: Among patients with Pa-NP the presence of infection with a MDR strain is associated with increased in-hospital mortality. Identification of patients at risk of MDR Pa-NP could facilitate appropriate empiric antibiotic decisions that in turn could lead to improved hospital survival

Impacts of climate change on plant diseases – opinions and trends

There has been a remarkable scientific output on the topic of how climate change is likely to affect plant diseases in the coming decades. This review addresses the need for review of this burgeoning literature by summarizing opinions of previous reviews and trends in recent studies on the impacts of climate change on plant health. Sudden Oak Death is used as an introductory case study: Californian forests could become even more susceptible to this emerging plant disease, if spring precipitations will be accompanied by warmer temperatures, although climate shifts may also affect the current synchronicity between host cambium activity and pathogen colonization rate. A summary of observed and predicted climate changes, as well as of direct effects of climate change on pathosystems, is provided. Prediction and management of climate change effects on plant health are complicated by indirect effects and the interactions with global change drivers. Uncertainty in models of plant disease development under climate change calls for a diversity of management strategies, from more participatory approaches to interdisciplinary science. Involvement of stakeholders and scientists from outside plant pathology shows the importance of trade-offs, for example in the land-sharing vs. sparing debate. Further research is needed on climate change and plant health in mountain, boreal, Mediterranean and tropical regions, with multiple climate change factors and scenarios (including our responses to it, e.g. the assisted migration of plants), in relation to endophytes, viruses and mycorrhiza, using long-term and large-scale datasets and considering various plant disease control methods

“I would rather be told than not know” - A qualitative study exploring parental views on identifying the future risk of childhood overweight and obesity during infancy

BACKGROUND: Risk assessment tools provide an opportunity to prevent childhood overweight and obesity through early identification and intervention to influence infant feeding practices. Engaging parents of infants is paramount for success however; the literature suggests there is uncertainty surrounding the use of such tools with concerns about stigmatisation, labelling and expressions of parental guilt. This study explores parents' views on identifying future risk of childhood overweight and obesity during infancy and communicating risk to parents. METHODS: Semi-structured qualitative interviews were conducted with 23 parents and inductive, interpretive and thematic analysis performed. RESULTS: Three main themes emerged from the data: 1) Identification of infant overweight and obesity risk. Parents were hesitant about health professionals identifying infant overweight as believed they would recognise this for themselves, in addition parents feared judgement from health professionals. Identification of future obesity risk during infancy was viewed positively however the use of a non-judgemental communication style was viewed as imperative. 2) Consequences of infant overweight. Parents expressed immediate anxieties about the impact of excess weight on infant ability to start walking. Parents were aware of the progressive nature of childhood obesity however, did not view overweight as a significant problem until the infant could walk as viewed this as a point when any excess weight would be lost due to increased energy expenditure. 3) Parental attributions of causality, responsibility, and control. Parents articulated a high level of personal responsibility for preventing and controlling overweight during infancy, which translated into self-blame. Parents attributed infant overweight to overfeeding however articulated a reluctance to modify infant feeding practices prior to weaning. CONCLUSION: This is the first study to explore the use of obesity risk tools in clinical practice, the findings suggest that identification, and communication of future overweight and obesity risk is acceptable to parents of infants. Despite this positive response, findings suggest that parents' acceptance to identification of risk and implementation of behaviour change is time specific. The apparent level of parental responsibility, fear of judgement and self-blame also highlights the importance of health professionals approach to personalised risk communication so feelings of self-blame are negated and stigmatisation avoided

Water and sodium intake habits and status of ultra-endurance runners during a multi-stage ultra-marathon conducted in a hot ambient environment: an observational field based study

<p>Abstract</p> <p>Background</p> <p>Anecdotal evidence suggests ultra-runners may not be consuming sufficient water through foods and fluids to maintenance euhydration, and present sub-optimal sodium intakes, throughout multi-stage ultra-marathon (MSUM) competitions in the heat. Subsequently, the aims were primarily to assess water and sodium intake habits of recreational ultra-runners during a five stage 225 km semi self-sufficient MSUM conducted in a hot ambient environment (T_max range: 32°C to 40°C); simultaneously to monitor serum sodium concentration, and hydration status using multiple hydration assessment techniques.</p> <p>Methods</p> <p>Total daily, pre-stage, during running, and post-stage water and sodium ingestion of ultra-endurance runners (UER, <it>n</it> = 74) and control (CON, <it>n</it> = 12) through foods and fluids were recorded on Stages 1 to 4 by trained dietetic researchers using dietary recall interview technique, and analysed through dietary analysis software. Body mass (BM), hydration status, and serum sodium concentration were determined pre- and post-Stages 1 to 5.</p> <p>Results</p> <p>Water (overall mean (SD): total daily 7.7 (1.5) L/day, during running 732 (183) ml/h) and sodium (total daily 3.9 (1.3) g/day, during running 270 (151) mg/L) ingestion did not differ between stages in UER (<it>p</it> < 0.001 <it>vs</it>. CON). Exercise-induced BM loss was 2.4 (1.2)% (<it>p</it> < 0.001). Pre- to post-stage BM gains were observed in 26% of UER along competition. Pre- and post-stage plasma osmolality remained within normal clinical reference range (280 to 303 mOsmol/kg) in the majority of UER (<it>p</it> > 0.05 <it>vs</it>. CON pre-stage). Asymptomatic hyponatraemia (<135 mmol/L) was evident pre- and post-stage in <it>n</it> = 8 UER, corresponding to 42% of sampled participants. Pre- and post-stage urine colour, urine osmolality and urine/plasma osmolality ratio increased (<it>p</it> < 0.001) as competition progressed in UER, with no change in CON. Plasma volume and extra-cellular water increased (<it>p</it> < 0.001) 22.8% and 9.2%, respectively, from pre-Stage 1 to 5 in UER, with no change in CON.</p> <p>Conclusion</p> <p>Water intake habits of ultra-runners during MSUM conducted in hot ambient conditions appear to be sufficient to maintain baseline euhydration levels. However, fluid over-consumption behaviours were evident along competition, irrespective of running speed and gender. Normonatraemia was observed in the majority of ultra-runners throughout MSUM, despite sodium ingestion under benchmark recommendations.</p

Sozialstaatliche Kürzungspolitik in Deutschland: Nur eine Mär? Eine quantitative Gesetzgebungsanalyse 1974–2014

Quantitative analyses on welfare state dynamics have to cope with the “dependent variable problem”, as studies on social spending reach different conclusions than analyses of replacement rate data. This article suggests a way around this problem by presenting results from a fine-grained analysis of welfare state legislation in Germany between 1974 and 2014. We show that the German welfare state has seen both cuts and expansions occur in all decades. Moreover, we show by means of a regression analysis that partisan politics play a role. Supporting the “Nixon-in-China”-thesis, social democratic governments are associated with a higher probability of cutbacks – especially in times of budgetary pressure – whereas expansions are more likely under Christian democratic governments

Antimicrobial Nanoplexes meet Model Bacterial Membranes: the key role of Cardiolipin

Antimicrobial resistance to traditional antibiotics is a crucial challenge of medical research. Oligonucleotide therapeutics, such as antisense or Transcription Factor Decoys (TFDs), have the potential to circumvent current resistance mechanisms by acting on novel targets. However, their full translation into clinical application requires efficient delivery strategies and fundamental comprehension of their interaction with target bacterial cells. To address these points, we employed a novel cationic bolaamphiphile that binds TFDs with high affinity to form self-assembled complexes (nanoplexes). Confocal microscopy revealed that nanoplexes efficiently transfect bacterial cells, consistently with biological efficacy on animal models. To understand the factors affecting the delivery process, liposomes with varying compositions, taken as model synthetic bilayers, were challenged with nanoplexes and investigated with Scattering and Fluorescence techniques. Thanks to the combination of results on bacteria and synthetic membrane models we demonstrate for the first time that the prokaryotic-enriched anionic lipid Cardiolipin (CL) plays a key-role in the TFDs delivery to bacteria. Moreover, we can hypothesize an overall TFD delivery mechanism, where bacterial membrane reorganization with permeability increase and release of the TFD from the nanoplexes are the main factors. These results will be of great benefit to boost the development of oligonucleotides-based antimicrobials of superior efficacy

A comparision of GHG emissions from UK field crop production under selected arable systems with reference to disease control

Crop disease not only threatens global food security by reducing crop production at a time of growing demand, but also contributes to greenhouse gas (GHG) emissions by reducing efficiency of N fertiliser use and farm operations and by driving land use change. GHG emissions associated with adoption of reduced tillage, organic and integrated systems of field crop production across the UK and selected regions are compared with emissions from conventional arable farming to assess their potential for climate change mitigation. The reduced tillage system demonstrated a modest (<20%) reduction in emissions in all cases, although in practice it may not be suitable for all soils and it is likely to cause problems with control of diseases spread on crop debris. There were substantial increases in GHG emissions associated with the organic and integrated systems at national level, principally due to soil organic carbon losses from land use change. At a regional level the integrated system shows the potential to deliver significant emission reductions. These results indicate that the conventional crop production system, coupled to reduced tillage cultivation where appropriate, is generally the best for producing high yields to minimise greenhouse gas emissions and contribute to global food security, although there may be scope for use of the integrated system on a regional basis. The control of crop disease will continue to have an essential role in both maintaining productivity and decreasing GHG emissions.Peer reviewe

Landslide susceptibility mapping at VAZ watershed (Iran) using an artificial neural network model: a comparison between multilayer perceptron (MLP) and radial basic function (RBF) algorithms

Landslide susceptibility and hazard assessments are the most important steps in landslide risk mapping. The main objective of this study was to investigate and compare the results of two artificial neural network (ANN) algorithms, i.e., multilayer perceptron (MLP) and radial basic function (RBF) for spatial prediction of landslide susceptibility in Vaz Watershed, Iran. At first, landslide locations were identified by aerial photographs and field surveys, and a total of 136 landside locations were constructed from various sources. Then the landslide inventory map was randomly split into a training dataset 70 % (95 landslide locations) for training the ANN model and the remaining 30 % (41 landslides locations) was used for validation purpose. Nine landslide conditioning factors such as slope, slope aspect, altitude, land use, lithology, distance from rivers, distance from roads, distance from faults, and rainfall were constructed in geographical information system. In this study, both MLP and RBF algorithms were used in artificial neural network model. The results showed that MLP with Broyden–Fletcher–Goldfarb–Shanno learning algorithm is more efficient than RBF in landslide susceptibility mapping for the study area. Finally the landslide susceptibility maps were validated using the validation data (i.e., 30 % landslide location data that was not used during the model construction) using area under the curve (AUC) method. The success rate curve showed that the area under the curve for RBF and MLP was 0.9085 (90.85 %) and 0.9193 (91.93 %) accuracy, respectively. Similarly, the validation result showed that the area under the curve for MLP and RBF models were 0.881 (88.1 %) and 0.8724 (87.24 %), respectively. The results of this study showed that landslide susceptibility mapping in the Vaz Watershed of Iran using the ANN approach is viable and can be used for land use planning

ERBB2 in Cat Mammary Neoplasias Disclosed a Positive Correlation between RNA and Protein Low Expression Levels: A Model for erbB-2 Negative Human Breast Cancer

Human ERBB2 is a proto-oncogene that codes for the erbB-2 epithelial growth factor receptor. In human breast cancer (HBC), erbB-2 protein overexpression has been repeatedly correlated with poor prognosis. In more recent works, underexpression of this gene has been described in HBC. Moreover, it is also recognised that oncogenes that are commonly amplified or deleted encompass point mutations, and some of these are associated with HBC. In cat mammary lesions (CMLs), the overexpression of ERBB2 (27%–59.6%) has also been described, mostly at the protein level and although cat mammary neoplasias are considered to be a natural model of HBC, molecular information is still scarce. In the present work, a cat ERBB2 fragment, comprising exons 10 to 15 (ERBB2_10–15) was achieved for the first time. Allelic variants and genomic haplotype analyses were also performed, and differences between normal and CML populations were observed. Three amino acid changes, corresponding to 3 non-synonymous genomic sequence variants that were only detected in CMLs, were proposed to damage the 3D structure of the protein. We analysed the cat ERBB2 gene at the DNA (copy number determination), mRNA (expression levels assessment) and protein levels (in extra- and intra protein domains) in CML samples and correlated the last two evaluations with clinicopathological features. We found a positive correlation between the expression levels of the ERBB2 RNA and erbB-2 protein, corresponding to the intracellular region. Additionally, we detected a positive correlation between higher mRNA expression and better clinical outcome. Our results suggest that the ERBB2 gene is post-transcriptionally regulated and that proteins with truncations and single point mutations are present in cat mammary neoplastic lesions. We would like to emphasise that the recurrent occurrence of low erbB-2 expression levels in cat mammary tumours, suggests the cat mammary neoplasias as a valuable model for erbB-2 negative HBC.POCI/CVT/62940/2004 and by the PhD grants (SFRH/BD/23406/2005 and SFRH/BD/31754/2006, of the Science and Technology Foundation (FCT) from Portugal

Sudden massive neck swelling due to hemorrhage of a thyroid adenoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Sudden swelling of the neck is an emergency situation that can be life-threatening for the patient. Therefore, an understanding of the possible underlying pathology is of great importance. Sudden massive swelling of the neck because of intralesional bleeding of a thyroid adenoma is seldom encountered but must be considered. Such massive swelling caused by spontaneous bleeding of a thyroid adenoma has not yet been described in the literature.</p> <p>Case presentation</p> <p>We report the case of a 71-year-old Caucasian man with sudden massive neck swelling due to intralesional bleeding of a thyroid adenoma. We present his clinical history, physical examination results, computed tomography (CT) scans, and histological findings after surgery. He presented with sudden massive swelling of the left side of his neck after sneezing while working with his hands over his head. An ear, nose, and throat examination showed a painless swelling of the left side of his neck and a displacement of his larynx to the right. CT scans revealed a mass originating from the left lobe of his thyroid gland and the mass displaced his larynx and trachea. A surgical exploration showed a greatly enlarged left lobe of his thyroid gland. A histopathological examination showed a hemorrhagic infarction of a follicular thyroid adenoma.</p> <p>Conclusions</p> <p>Sudden intralesional bleeding of a thyroid adenoma is a rare condition but one that should be considered in cases of sudden and massive swelling of the neck.</p