Nontuberculous mycobacteria in gastrostomy fed patients with cystic fibrosis

Multi-drug resistant Mycobacterium abscessus complex (MABSC) is a form of Nontuberculous mycobacteria (NTM) of special, international concern in Cystic Fibrosis (CF). We hypothesised that gastric juice and percutaneous endoscopic gastrostomy (PEG) feeding devices might yield MABSC isolates. Gastric juice and sputa from sixteen adult PEG fed CF patients and five replaced PEG tubes were studied. Bacterial and fungal isolates were cultured. Mycobacterium were identified by rpoB, sodA and hsp65 gene sequencing and strain typed using variable number tandem repeat. Bacteria and/or fungi grew from all gastric juice, sputa and PEG samples. MABSC were detected in 7 patients. Five had MABSC in their sputum. Two had an identical MABSC strain in their sputum and gastric juice and one had the same strain isolated from their PEG tube and sputum. Two patients who were sputum sample negative had MABSC isolated in their gastric juice or PEG tube. MABSC were therefore identified for the first time from a gastric sample in a minority of patients. We conclude that gastric juice and PEG-tubes may be a potential source of MABSC isolates in CF patients, and these findings warrant further study.

Inclusion of cottonseed meal into loose mineral mix supplements increases the voluntary intake of the supplement by grazing heifers

Loose mineral mix (LMM) supplements based on ingredients such as salt, urea and minerals offered ad libitum are widely used to provide additional nutrients to grazing cattle, but it is often difficult to achieve target intakes. An experiment with heifers grazing mature tropical pasture examined the effects of substituting 80, 160 or 320 g/kg of the salt in a LMM supplement with cottonseed meal on the voluntary intake of the LMM supplements by paddock groups of heifers over 10 weeks. Average voluntary intake of a LMM containing (g/kg) 640 salt, 300 urea and 60 ammonium sulfate (40.2 g DM and 6.14 g total nitrogen/day) was increased linearly (P < 0.001) to 50.8 g DM and 8.88 g total nitrogen/day when up to 320 g/kg cottonseed meal was substituted for salt in the LMM. This increase in intake of nitrogen in LMM was due to the increase in voluntary intake of the supplement rather than the increased nitrogen concentration of supplement. The distribution of daily intake of supplement within paddock groups of heifers was estimated during Weeks 5 and 10 using supplements labelled with lithium sulfate. Neither the coefficient of variation within paddock groups of heifers in supplement intake (mean 96%), nor the proportion of non-consumers of supplement (mean 17%), was changed (P > 0.05) by substitution of salt with cottonseed meal. In conclusion, the inclusion of a palatable protein meal into LMM increased the voluntary intake of this type of supplement.

Computer-Assisted versus Teacher-Directed Teaching of Community Living Skills in People with a Mild Learning Disability

An experiment was carried out in which adults with a learning disability of the mild type undertook either computer-assisted or teacher-implemented instruction in community living skills, with a third group acting as a control group. All groups were pre-tested on a standardised psychometric measure of community living skills (the HANC 2 subscale of the Hampshire Assessment for Living with Others test), after which the experimental groups received one half-day per week training in such skills as money handling and budgeting for 3 months, when all groups were reassessed. It was found that both the teacher-led and computer-assisted instruction groups appeared to gain more than the control group, but only the teacher-led group differed significantly from the control group. The computer-assisted group improved in their scores by an intermediate amount, with their gains being non-significantly different from either the control or the teacher-led groups. The strengths and weaknesses of the software used in the study are discussed.

Sustaining complex interventions in long-term care: a qualitative study of direct care staff and managers

Background

Little is known about the sustainability of behavioral change interventions in long-term care (LTC). Following a cluster randomized trial of an intervention to improve staff communication (CONNECT), we conducted focus groups of direct care staff and managers to elicit their perceptions of factors that enhance or reduce sustainability in the LTC setting. The overall aim was to generate hypotheses about how to sustain complex interventions in LTC.

Methods

In eight facilities, we conducted 15 focus groups with 83 staff who had participated in at least one intervention session. Where possible, separate groups were conducted with direct care staff and managers. An interview guide probed for staff perceptions of intervention salience and sustainability. Framework analysis of coded transcripts was used to distill insights about sustainability related to intervention features, organizational context, and external supports.

Results

Staff described important factors for intervention sustainability that are particularly challenging in LTC. Because of the tremendous diversity in staff roles and education level, interventions should balance complexity and simplicity, use a variety of delivery methods and venues (e.g., group and individual sessions, role-play/storytelling), and be inclusive of many work positions. Intervention customizability and flexibility was particularly prized in this unpredictable and resource-strapped environment. Contextual features noted to be important include addressing the frequent lack of trust between direct care staff and managers and ensuring that direct care staff directly observe manager participation and support for the program. External supports suggested to be useful for sustainability include formalization of changes into facility routines, using “train the trainer” approaches and refresher sessions. High staff turnover is common in LTC, and providing materials for new staff orientation was reported to be important for sustainability.

Conclusions

When designing or implementing complex behavior change interventions in LTC, consideration of these particularly salient intervention features, contextual factors, and external supports identified by staff may enhance sustainability.

Trial registration

ClinicalTrial.gov, NCT00636675

Racial, Ethnic, and Age Differences in the Incidence and Survival of Childhood Cancer in Oklahoma, 1997-2012

While cancer is relatively rare in children under 20, it is the leading cause of disease-related death among children aged 5 to 14 years. We aimed to describe the incidence and survival of childhood cancer in Oklahoma from 1997-2012. We calculated age-adjusted incidence rates and five-year observed survival by cancer type using Oklahoma Central Cancer Registry and Surveillance, Epidemiology, and End Results program data among children diagnosed with cancer under the age of 20 from 1997-2012. The average annual age-adjusted incidence rate of childhood cancer was 168.9 per million for the US and 171.7 per million for Oklahoma. Overall, Oklahoma had lower survival from childhood cancer compared to the US (77.0% v. 80.6%). In recent years, research has been conducted on the epidemiology of childhood cancer. Little research has been done, however, on the incidence or survival of childhood cancer at state levels and none focused exclusively on Oklahoma.

Five-Year Cancer Survival Rates in Oklahoma from 1997 to 2008

INTRODUCTION

This study evaluated the five-year observed survival rates of American Indians/Alaskan Native, African American, and white cancer patients among various demographic characteristics in Oklahoma focusing on lung and bronchus, colon and rectum, female breast, and prostate for the cancer patients diagnosed between 1997 and 2008.

METHODS

The five-year observed survival rates were calculated for overall cancer and specific cancer sites, using Kaplan-Meier method with data from the Oklahoma Central Cancer Registry.

RESULTS

Overall, 51.5% patients diagnosed with cancer survived for five years. For specific sites we found: 79.2% for female breast cancer survived; 77.5% for prostate cancer; 12.9% for lung and bronchus cancer; and 49.9% for colorectal cancer.

CONCLUSIONS

The five-year observed survival rates in Oklahoma were consistent with national trends. Overall, cancer survival seems to be improving over time, but there remains disparity with the AA and AI/AN populations in contrast to whites in Oklahoma.

Reduced response of human meniscal cells to Osteogenic Protein 1 during osteoarthritis and pro-inflammatory stimulation

OBJECTIVE

Many cell types lose responsiveness to anabolic factors during inflammation and disease. Osteogenic Protein 1 (OP1/BMP7) was evaluated for the ability to enhance extracellular matrix synthesis in healthy and OA meniscus cells. Mechanisms of cell response to OP1 were explored.

DESIGN

Meniscus and cartilage tissues from healthy tissue donors and osteoarthritis (OA) patients undergoing total knee arthroplasties were acquired. Primary cell cultures were stimulated with OP1 and/or inflammatory factors (IL1α, IL1β, or fibronectin fragments (FnF)) and cellular responses were analyzed by RT-qPCR and immunoblots. Frozen section immunohistochemistry (IHC) was conducted to assess OP1 and receptor proteins in normal and OA meniscus.

RESULTS

OP1 treatment of normal meniscus cells resulted in significant, dose-dependent increases in ACAN (aggrecan) and COL2A1, and decreased MMP13 gene transcription, while only ACAN was upregulated (P < 0.01) at the highest dose of OP1 in OA meniscus cells. OP1 induced significantly more ACAN gene transcription in normal meniscus than normal articular cartilage (P = 0.05), and no differences between normal and OA cartilage were detected. Receptor expression and kinetics of canonical signaling activation were similar between normal and OA specimens. Normal meniscus cells treated with inflammatory factors were refractory to OP1 stimulation. Smad1 phosphorylation at an inhibitory site was induced (P = 0.01 for both normal and OA meniscus) by inflammatory cytokine treatment.

CONCLUSIONS

The meniscus demonstrates resistance to OP1 stimulation in OA and in the presence of inflammatory mediators. MAPK-mediated Smad1 linker phosphorylation is a possible mediator of the loss of anabolic extracellular matrix production in the inflammatory cytokine affected meniscus.

Microbiological profiles of sputum and gastric juice aspirates in Cystic Fibrosis patients

Gastro-Oesophageal Reflux (GOR) is a key problem in Cystic Fibrosis (CF), but the relationship between lung and gastric microbiomes is not well understood. We hypothesised that CF gastric and lung microbiomes are related. Gastric and sputum cultures were obtained from fifteen CF patients receiving percutaneous endoscopic gastrostomy feeding. Non-CF gastric juice data was obtained through endoscopy from 14 patients without lung disease. Bacterial and fungal isolates were identified by culture. Molecular bacterial profiling used next generation sequencing (NGS) of the 16S rRNA gene. Cultures grew bacteria and/or fungi in all CF gastric juice and sputa and in 9/14 non-CF gastric juices. Pseudomonas aeruginosa(Pa) was present in CF sputum in 11 patients, 4 had identical Pa strains in the stomach. NGS data from non-CF gastric juice samples were significantly more diverse compared to CF samples. NGS showed CF gastric juice had markedly lower abundance of normal gut bacteria; Bacteroides and Faecalibacterium, but increased Pseudomonas compared with non-CF. Multivariate partial least squares discriminant analysis demonstrated similar bacterial profiles of CF sputum and gastric juice samples, which were distinct from non-CF gastric juice. We provide novel evidence suggesting the existence of an aerodigestive microbiome in CF, which may have clinical relevance.

Scanning electron microscopy-energy dispersive X-ray spectrometry (SEM-EDX) and aerosol time-of-flight mass spectrometry (ATOFMS) single particle analysis of metallurgy plant emissions

The chemical composition of single particles deposited on industrial filters located in three different chimneys of an iron-manganese (Fe-Mn) alloy manufacturing plant have been compared using aerosol time-of-flight mass spectrometry (ATOFMS) and scanning electron microscopy-energy dispersive X-ray spectrometry (SEM-EDX). Very similar types of particles were observed using both analytical techniques. Calcium-containing particles dominated in the firing area of the sintering unit, Mn and/or Al-bearing particles were observed at the cooling area of the sintering unit, while Mn-containing particles were dominant at the smelting unit. SEM-EDX analysis of particles collected downstream of the industrial filters showed that the composition of the particles emitted from the chimneys is very similar to those collected on the filters. ATOFMS analysis of ore samples was also performed to identify particulate emissions that could be generated by wind erosion and manual activities. Specific particle types have been identified for each emission source (chimneys and ore piles) and can be used as tracers for source apportionment of ambient PM measured in the vicinity of the industrial site.

Towards Canine Rabies Elimination in South-Eastern Tanzania: Assessment of Health Economic Data

An estimated 59 000 people die annually from rabies, keeping this zoonosis on the forefront of neglected diseases, especially in the developing world. Most deaths occur after being bitten by a rabid dog. Those exposed to a suspect rabid animal should receive appropriate post-exposure prophylaxis (PEP) or risk death. However, vaccination of dogs to control and eliminate canine rabies at the source has been implemented in many places around the world. Here, we analysed the vaccination and cost data for one such campaign in the area surrounding and including Dar es Salaam, Tanzania and estimated the cost per dog vaccinated. We also estimated the cost of human PEP. We found that the cost per dog vaccinated ranged from $2.50 to $22.49 across districts and phases, with the phase average ranging from $7.30 to $11.27. These figures were influenced by over purchase of vaccine in the early phases of the programme and the significant costs associated with purchasing equipment for a programme starting from scratch. The cost per human PEP course administered was approximately $24.41, with the average patient receiving 2.5 of the recommended four vaccine doses per suspect bite. This study provides valuable financial insights into programme managers and policymakers working towards rabies elimination.

A universal equation to predict methane production of forage-fed cattle in Australia

The methods for estimating methane emissions from cattle as used in the Australian national inventory are based on older data that have now been superseded by a large amount of more recent data. Recent data suggested that the current inventory emissions estimates can be improved. To address this issue, a total of 1034 individual animal records of daily methane production (MP) was used to reassess the relationship between MP and each of dry matter intake (DMI) and gross energy intake (GEI). Data were restricted to trials conducted in the past 10 years using open-circuit respiration chambers, with cattle fed forage-based diets (forage >70%). Results from diets considered to inhibit methanogenesis were omitted from the dataset. Records were obtained from dairy cattle fed temperate forages (220 records), beef cattle fed temperate forages (680 records) and beef cattle fed tropical forages (133 records). Relationships were very similar for all three production categories and single relationships for MP on a DMI or GEI basis were proposed for national inventory purposes. These relationships were MP (g/day) = 20.7 (±0.28) × DMI (kg/day) (R2 = 0.92, P < 0.001) and MP (MJ/day) = 0.063 (±0.008) × GEI (MJ/day) (R2 = 0.93, P < 0.001). If the revised MP (g/day) approach is used to calculate Australia’s national inventory, it will reduce estimates of emissions of forage-fed cattle by 24%. Assuming a global warming potential of 25 for methane, this represents a 12.6 Mt CO2-e reduction in calculated annual emissions from Australian cattle.

High-throughput determination of structural phase diagram and constituent phases using GRENDEL

Advances in high-throughput materials fabrication and characterization techniques have resulted in faster rates of data collection and rapidly growing volumes of experimental data. To convert this mass of information into actionable knowledge of material process-structure-property relationships requires high-throughput data analysis techniques. This work explores the use of the Graph-based endmember extraction and labeling (GRENDEL) algorithm as a high-throughput method for analyzing structural data from combinatorial libraries, specifically, to determine phase diagrams and constituent phases from both x-ray diffraction and Raman spectral data. The GRENDEL algorithm utilizes a set of physical constraints to optimize results and provides a framework by which additional physics-based constraints can be easily incorporated. GRENDEL also permits the integration of database data as shown by the use of critically evaluated data from the Inorganic Crystal Structure Database in the x-ray diffraction data analysis. Also the Sunburst radial tree map is demonstrated as a tool to visualize material structure-property relationships found through graph based analysis.

Hydration in non-suckling neonatal Brahman-cross calves

OBJECTIVE

To identify measures that most closely relate to hydration in healthy Brahman-cross neonatal calves that experience milk deprivation.

METHODS

In a dry tropical environment, eight neonatal Brahman-cross calves were prevented from suckling for 2-3 days during which measurements were performed twice daily.

RESULTS

Mean body water, as estimated by the mean urea space, was 74±3% of body weight at full hydration. The mean decrease in hydration was 7.3±1.1% per day. The rate of decrease was more than three-fold higher during the day than at night. At an ambient temperature of 39°C, the decrease in hydration averaged 1.1% hourly. Measures that were most useful in predicting the degree of hydration in both simple and multiple-regression prediction models were body weight, hindleg length, girth, ambient and oral temperatures, eyelid tenting, alertness score and plasma sodium. These parameters are different to those recommended for assessing calves with diarrhoea. Single-measure predictions had a standard error of at least 5%, which reduced to 3-4% if multiple measures were used.

CONCLUSION

We conclude that simple assessment of non-suckling Brahman-cross neonatal calves can estimate the severity of dehydration, but the estimates are imprecise. Dehydration in healthy neonatal calves that do not have access to milk can exceed 20% (>15% weight loss) in 1-3 days under tropical conditions and at this point some are unable to recover without clinical intervention.

Circulating Tumor Cells After Neoadjuvant Chemotherapy in Stage I-III Triple-Negative Breast Cancer

BACKGROUND

Triple-negative breast cancer (TNBC) is characterized by a lack of estrogen and progesterone receptor expression and HER-2 gene amplification. Circulating tumor cells (CTCs) can be identified in 25 % of nonmetastatic breast cancer patients, and the identification of ≥1 CTC predicts outcome. This study was designed to determine whether CTCs present after neoadjuvant chemotherapy (NACT) predicted worse outcome in nonmetastatic TNBC patients.

METHODS

CTCs were assessed in 57 TNBC patients with nonmetastatic TNBC after the completion of NACT. CTCs (per 7.5 ml blood) were identified using the Cell Search(®) System (Janssen). Log-rank test and Cox regression analysis were applied to establish the association of CTCs with relapse-free (RFS) and overall survival (OS).

RESULTS

Median follow-up was 30 months, and mean age was 53 years. Fifty-four patients (95 %) had >2-cm tumors, 42 (84 %) were nuclear grade 3, and 42 (74 %) had positive axillary lymph nodes. One or more CTC was identified in 30 % of patients. CTC presence was not associated with primary tumor size, high grade, or lymph node positivity. Multivariate analysis demonstrated that detection of ≥1 CTC predicted decreased RFS (log-rank P = 0.03, HR 5.25, 95 % CI 1.34-20.56) and OS (log-rank P = 0.03, HR 7.04, 95 % CI 1.26-39.35).

CONCLUSIONS

One or more CTCs present after NACT predicted relapse and survival in nonmetastatic TNBC patients. This information would be helpful in future clinical trial design of adjuvant treatments for TNBC patients who are at risk for relapse after completing NACT.

Piloting yoga and assessing outcomes in a residential behavioural health unit

This study examined if adolescents on a residential behavioural health unit would participate in a yoga intervention. Yoga has been used as a mind-body practice for more than 2000 years; however, studies are limited regarding its effects on adolescents with mental illness on an inpatient unit. Yoga was added, twice weekly, to the program schedule. Trait Emotional Intelligence Questionnaire-Adolescent Short Form (TEIQue-ASF) scores were measured over 8 weeks. Additional measures included daily numbers of quiet times, time outs, and point card scores. Twenty-two adolescents completed the study. The TEIQue-ASF assessment was able to detect changes in total scores over 8 weeks. Increased yoga participation was related to higher values of the TEIQue-ASF subdomain of sociability, increase in weekly point card totals, a decrease in behavioural time outs, and a decrease in combined behavioural interventions at various time points throughout the programme. This study was relevant because it was conducted on an adolescent inpatient unit. It provides support that yoga, as part of a residential programme, is a feasible intervention for adolescents with mental illness. Changes in the various measures cannot be directly linked to yoga because of lack of a comparison group. Additional studies with a larger sample, and randomization, are needed to evaluate the potential benefits of yoga and to determine if changes to the TEIQue-ASF can be attributed to yoga or other behavioural-based interventions. Little is known about how yoga will impact behavioural health outcomes for adolescents with mental illness in an inpatient setting. This study examined if adolescents on a residential behavioural health unit would participate in a yoga intervention to address emotional regulation. A single cohort study design was used. Yoga was added to the programme schedule twice weekly. Trait Emotional Intelligence Questionnaire-Adolescent Short Form (TEIQue-ASF) scores and additional behavioural measures were tracked over 8 weeks. Adolescents participated in yoga, with a higher participation rate for girls compared with boys. The TEIQue-ASF assessment detected changes in total score over 8 weeks. Increased yoga participation was related to higher values of the TEIQue-ASF subdomain of sociability, increase in weekly point card totals, and a decrease in combined behavioural interventions at various time points throughout the programme. This study was relevant because it was conducted on an adolescent inpatient unit. Further studies are needed to determine if changes can be attributed to yoga or other behavioural-based interventions. If supported by further studies, yoga has the potential to be a complimentary therapy that can be integrated into the multidisciplinary treatment approach for mental health patients.