Rapid Identification of Hospitalized Patients at High Risk for MRSA Carriage

Patients who are asymptomatic carriers of methicillin-resistant Staphylococcus aureus (MRSA) are major reservoirs for transmission of MRSA to other patients. Medical personnel are usually not aware when these high-risk patients are hospitalized. We developed and tested an enterprise-wide electronic surveillance system to identify patients at high risk for MRSA carriage at hospital admission and during hospitalization. During a two-month study, nasal swabs from 153 high-risk patients were tested for MRSA carriage using polymerase chain reaction (PCR) of which 31 (20.3%) were positive compared to 12 of 293 (4.1%, p < 0.001) low-risk patients. The mean interval from admission to availability of PCR test results was 19.2 hours. Computer alerts for patients at high-risk of MRSA carriage were found to be reliable, timely and offer the potential to replace testing all patients. Previous MRSA colonization was the best predictor but other risk factors were needed to increase the sensitivity of the algorith

Combining CBT and sertraline does not enhance outcomes for anxious youth: a double-blind randomised controlled trial

Background Anxiety disorders are the most prevalent mental disorder in children and young people. Developing effective therapy for these children is critical to reduce mental disorders across the lifespan. The study aimed to evaluate the efficacy of combining cognitive behavioural therapy (CBT) and sertraline (SERT) in the treatment of anxiety in youth, using a double-blind randomised control trial design. Methods Ninety-nine youth (ages 7-15 years) with an anxiety disorder were randomly allocated to either individual (CBT) and SERT or individual CBT and pill placebo and assessed again immediately and 6 months after treatment. Results There were no significant differences between conditions in remission of primary anxiety disorder or all anxiety disorders. Furthermore, there were no significant differences in rates of change in diagnostic severity, parent-reported anxiety symptoms, child-reported anxiety symptoms or life interference due to anxiety. Conclusions The efficacy of CBT for children and adolescents with anxiety disorders is not significantly enhanced by combination with a short-term course of anti-depressants over and above the combined effects of pill placebo

Low intensity treatment for clinically anxious youth: a randomised controlled comparison against face-to-face intervention

Methods to deliver empirically validated treatments for anxious youth that require fewer therapist resources (low intensity) are beginning to emerge. However, the relative efficacy of low-intensity treatment for youth anxiety against standard face-to-face delivery has not been comprehensively evaluated. Young people aged 6–16 years with a primary anxiety disorder (N = 281) were randomly allocated to treatment delivered either face-to-face or in a low-intensity format. Face-to-face treatment comprised ten, 60-min sessions delivered by a qualified therapist. Low intensity comprised information delivered in either printed (to parents of children under 13) or electronic (to adolescents aged 13 +) format and was supported by up to four telephone sessions with a minimally qualified therapist. Youth receiving face-to-face treatment were significantly more likely to remit from all anxiety disorders (66%) than youth receiving low intensity (49%). This difference was reflected in parents’ (but not child) reports of child’s anxiety symptoms and life interference. No significant moderators were identified. Low intensity delivery utilised significantly less total therapist time (175 min) than face-to-face delivery (897 min) and this was reflected in a large mean difference in therapy costs ($A735). Standard, face-to-face treatment for anxious youth is associated with significantly better outcomes than delivery of similar content using low-intensity methods. However, the size of this difference was relatively small. In contrast, low-intensity delivery requires markedly less time from therapists and subsequently lower treatment cost. Data provide valuable information for youth anxiety services. Clinical trial registration information: A randomised controlled trial of standard care versus stepped care for children and adolescents with anxiety disorders; https://anzctr.org.au/; ACTRN12612000351819

Fungal vaccines and immunotherapeutics: current concepts and future challenges

Purpose of review The remarkable advances in modern medicine have paradoxically resulted in a rapidly expanding population of immunocompromised patients displaying extreme susceptibility to life-threatening fungal infections. There are currently no licensed vaccines, and the prophylaxis and therapy of fungal infections in at-risk individuals remains challenging, contributing to undesirable mortality and morbidity rates. The design of successful antifungal preventive approaches has been hampered by an insufficient understanding of the dynamics of the host-fungus interaction and the mechanisms that underlie heterogenous immune responses to vaccines and immunotherapy. Recent findings Recent advances in proteomics and glycomics have contributed to the identification of candidate antigens for use in subunit vaccines, novel adjuvants, and delivery systems to boost the efficacy of protective vaccination responses that are becoming available, and several targets are being exploited in immunotherapeutic approaches. Summary We review some of the emerging concepts as well as the inherent challenges to the development of fungal vaccines and immunotherapies to protect at-risk individuals.ThisworkwassupportedbytheNorthernPortugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER) (NORTE-01-0145-FEDER-000013), and the Fundação para a Ciência e Tecnologia (FCT) (contracts IF/00735/ 2014 to A.C., and SFRH/BPD/96176/2013 to C.C).info:eu-repo/semantics/publishedVersio

Optimising the acceptability and feasibility of acceptance and commitment therapy for treatment-resistant generalised anxiety disorder in older adults

BACKGROUND:generalised anxiety disorder (GAD) is common in later life with a prevalence of 3-12%. Many only partially respond to cognitive behavioural therapy or pharmacotherapy and can be classified as treatment resistant. These patients experience poor quality of life, and are at increased risk of comorbid depression, falls and loneliness. Acceptance and commitment therapy (ACT) is an emerging therapy, which may be particularly suited to this population, but has not been tailored to their needs. OBJECTIVES:to optimise the acceptability and feasibility of ACT for older adults with treatment-resistant GAD. DESIGN:a person-based approach to ground the adapted ACT intervention in the perspectives and lives of those who will use it. METHODS:first, we conducted qualitative interviews with 15 older adults with GAD and 36 healthcare professionals to develop guiding principles to inform the intervention. Second, we consulted service users and clinical experts and interviewed the same 15 older adults using 'think aloud' techniques to enhance its acceptability and feasibility. RESULTS:in Stage 1, older adults' concerns and needs were categorised in four themes: 'Expert in one's own condition', 'Deep seated coping strategies', 'Expert in therapy' and 'Support with implementation'. In Stage 2, implications for therapy were identified that included an early focus on values and ACT as a collaborative partnership, examining beliefs around 'self as worrier' and the role of avoidance, validating and accommodating individuals' knowledge and experience and compensating for age-related cognitive changes. DISCUSSION:Our systematic approach combined rigour and transparency to develop a therapeutic intervention tailored to the specific needs of older adults with treatment-resistant GAD

Additive manufacturing of inorganic scintillator-based particle detectors

Inorganic scintillators are widely used for scientific, industrial and medical applications. The development of 3D printing with inorganic scintillators would allow fast creation of detector prototypes for registration of ionizing radiation, such as alpha and beta, gamma particles in thin layers of active material and soft X-ray radiation. This article reports on the technical work and scientific achievements that aimed at developing a new inorganic scintillation filament to be used for the 3D printing of composite scintillator materials: study and definition of the scintillator composition; development of the methods for the inorganic scintillator filament production and further implementation in the available 3D printing technologies; study of impact of the different 3D printing modes on the material scintillation characteristics. Also, 3D printed scintillators can be used for creation of combined detectors for high-energy physics.Comment: 14 pages, 16 figure

Validation of edge turbulence codes against the TCV-X21 diverted L-mode reference case

Self-consistent full-size turbulent-transport simulations of the divertor and scrape-off-layer (SOL) of existing tokamaks have recently become feasible. This enables the direct comparison of turbulence simulations against experimental measurements. In this work, we perform a series of diverted ohmic L-mode discharges on the tokamak à configuration variable (TCV) tokamak, building a first-of-a-kind dataset for the validation of edge turbulence models. This dataset, referred to as TCV-X21, contains measurements from five diagnostic systems from the outboard midplane (OMP) to the divertor targets - giving a total of 45 one- and two-dimensional comparison observables in two toroidal magnetic field directions. The experimental dataset is used to validate three flux-driven 3D fluid-turbulence models - GBS, GRILLIX and TOKAM3X. With each model, we perform simulations of the TCV-X21 scenario, individually tuning the particle and power source rates to achieve a reasonable match of the upstream separatrix value of density and electron temperature. We find that the simulations match the experimental profiles for most observables at the OMP - both in terms of profile shape and absolute magnitude - while a comparatively poorer agreement is found towards the divertor targets. The match between simulation and experiment is seen to be sensitive to the value of the resistivity, the heat conductivities, the power injection rate and the choice of sheath boundary conditions. Additionally, despite targeting a sheath-limited regime, the discrepancy between simulations and experiment also suggests that the neutral dynamics should be included. The results of this validation show that turbulence models are able to perform simulations of existing devices and achieve reasonable agreement with experimental measurements. Where disagreement is found, the validation helps to identify how the models can be improved. By publicly releasing the experimental dataset and validation analysis, this work should help to guide and accelerate the development of predictive turbulence simulations of the edge and SOL

Formation of a G-quadruplex at the BCL2 major breakpoint region of the t(14;18) translocation in follicular lymphoma

The t(14;18) translocation in follicular lymphoma is one of the most common chromosomal translocations. Most breaks on chromosome 18 are located at the 3′-UTR of the BCL2 gene and are mainly clustered in the major breakpoint region (MBR). Recently, we found that the BCL2 MBR has a non-B DNA character in genomic DNA. Here, we show that single-stranded DNA modeled from the template strand of the BCL2 MBR, forms secondary structures that migrate faster on native PAGE in the presence of potassium, due to the formation of intramolecular G-quadruplexes. Circular dichroism shows evidence for a parallel orientation for G-quadruplex structures in the template strand of the BCL2 MBR. Mutagenesis and the DMS modification assay confirm the presence of three guanine tetrads in the structure. 1H nuclear magnetic resonance studies further confirm the formation of an intramolecular G-quadruplex and a representative model has been built based on all of the experimental evidence. We also provide data consistent with the possible formation of a G-quadruplex structure at the BCL2 MBR within mammalian cells. In summary, these important features could contribute to the single-stranded character at the BCL2 MBR, thereby contributing to chromosomal fragility

Rapid Identification of Fluorochrome Modification Sites in Proteins by LC ESI-Q-TOF Mass Spectrometry

Conjugation of either a fluorescent dye or a drug molecule to the ε-amino groups of lysine residues of proteins has many applications in biology and medicine. However, this type of conjugation produces a heterogeneous population of protein conjugates. Because conjugation of fluorochrome or drug molecule to a protein may have deleterious effects on protein function, the identification of conjugation sites is necessary. Unfortunately, the identification process can be time-consuming and laborious; therefore, there is a need to develop a rapid and reliable way to determine the conjugation sites of the fluorescent label or drug molecule. In this study, the sites of conjugation of fluorescein-5′-isothiocyanate and rhodamine-B-isothiocyanate to free amino groups on the insert-domain (I-domain) protein derived from the α-subunit of lymphocyte function-associated antigen-1 (LFA-1) were determined by electrospray ionization quadrupole time-of-flight mass spectrometry (ESI-Q-TOF MS) along with peptide mapping using trypsin digestion. A reporter fragment of the fluorochrome moiety that is generated in the collision cell of the Q-TOF without explicit MS/MS precursor selection was used to identify the conjugation site. Selected ion plots of the reporter ion readily mark modified peptides in chromatograms of the complex digest. Interrogation of theses spectra reveals a neutral loss/precursor pair that identifies the modified peptide. The results show that one to seven fluorescein molecules or one to four rhodamine molecules were attached to the lysine residue(s) of the I-domain protein. No modifications were found in the metal ion-dependent adhesion site (MIDAS), which is an important binding region of the I-domain