Mutation Analysis in Regulator DNA-Binding Regions for Antimicrobial Efflux Pumps in 17,000 Pseudomonas aeruginosa Genomes

Mutations leading to upregulation of efflux pumps can produce multiple drug resistance in the pathogen Pseudomonas aeruginosa. Changes in their DNA binding regions, i.e., palindromic operators, can compromise pump depression and subsequently enhance resistance against several antibacterials and biocides. Here, we have identified (pseudo)palindromic repeats close to promoters of genes encoding 13 core drug-efflux pumps of P. aeruginosa. This framework was applied to detect mutations in these repeats in 17,292 genomes. Eighty-nine percent of isolates carried at least one mutation. Eight binary genetic properties potentially related to expression were calculated for mutations. These included palindromicity reduction, mutation type, positioning within the repeat and DNA-bending shift. High-risk ST298, ST308 and ST357 clones commonly carried four conserved mutations while ST175 and the cystic fibrosis-linked ST649 clones showed none. Remarkably, a T-to-C transition in the fourth position of the upstream repeat for mexEF-oprN was nearly exclusive of the high-risk ST111 clone. Other mutations were associated with high-risk sublineages using sample geotemporal metadata. Moreover, 1.5% of isolates carried five or more mutations suggesting they undergo an alternative program for regulation of their effluxome. Overall, P. aeruginosa shows a wide range of operator mutations with a potential effect on efflux pump expression and antibiotic resistance.

multiple operators for chronic total occlusion percutaneous coronary interventions: From the PROGRESS-CTO Registry

BACKGROUND

There is limited data on the impact of a second attending operator on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) outcomes.

METHODS

We analyzed the association between multiple operators (MOs) (>1 attending operator) and procedural outcomes of 9296 CTO PCIs performed between 2012 and 2021 at 37 centers.

RESULTS

CTO PCI was performed by a single operator (SO) in 85% of the cases and by MOs in 15%. Mean patient age was 64.4 ± 10 years and 81% were men. SO cases were more complex with higher Japan-CTO (2.38 ± 1.29 vs. 2.28 ± 1.20, p = 0.005) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention scores (1.13 ± 1.01 vs. 0.97 ± 0.93, p < 0.001) compared with MO cases. Procedural time (131 [87, 181] vs. 112 [72, 167] min, p < 0.001), fluoroscopy time (49 [31, 76] vs. 42 [25, 68] min, p < 0.001), air kerma radiation dose (2.32 vs. 2.10, p < 0.001), and contrast volume (230 vs. 210, p < 0.001) were higher in MO cases. Cases performed by MOs and SO had similar technical (86% vs. 86%, p = 0.9) and procedural success rates (84% vs. 85%, p = 0.7), as well as major adverse complication event rates (MACE 2.17% vs. 2.42%, p = 0.6). On multivariable analyses, MOs were not associated with higher technical success or lower MACE rates.

CONCLUSION

In a contemporary, multicenter registry, 15% of CTO PCI cases were performed by multiple operators. Despite being more complex, SO cases had lower procedural and fluoroscopy times, and similar technical and procedural success and risk of complications compared with MO cases.

Effect of Scanned Area and Operator on the Accuracy of Dentate Arch Scans with a Single Implant

Studies have shown the effect of the operator and scanned areas on the accuracy of single implant scans. However, the knowledge on the scan accuracy of the remaining dental arch during single implant scans, which may affect the occlusion, is limited. The aim of this study was to investigate the effect of scanned areas and the operator on the scan accuracy of a dentate arch while scanning a single implant. A dentate model with an anterior implant was digitized with a laboratory scanner (reference scan). Three operators with similar experience performed 10 complete- and 10 partial-arch scans (left 2nd molar to right canine) with an intraoral scanner (TRIOS 3), and these scans were superimposed over the reference. The accuracy was analyzed at 22 points in complete-arch and at 16 points in partial-arch scans on 2nd molars and incisors. Data were evaluated with 2-way ANOVA and Tukey HSD tests (α = 0.05). The trueness of the total scanned area was higher in partial- than in complete-arch scans (p < 0.001). The trueness and precision of the scans were higher in the anterior site compared with the posterior in complete- (trueness: p ≤ 0.022, precision: p ≤ 0.003) and partial-arch (trueness: p ≤ 0.016, precision: p ≤ 0.016) scans of each operator and when the operator scan data were pooled. The complete-arch scan’s precision was not influenced by the operator (p ≥ 0.029), whereas the partial-arch scans of operator 1 and 2 were significantly different (p = 0.036). Trueness was higher in partial- compared with complete-arch scans, but their precision was similar. Accuracy was higher in the anterior site regardless of the scan being a partial- or a complete-arch. The operator’s effect on the accuracy of partial- and complete-arch scans was small.

An operator-based expression toolkit for Bacillus subtilis enables fine-tuning of gene expression and biosynthetic pathway regulation

A gene regulatory system is an important tool for the engineering of biosynthetic pathways of organisms. Here, we report the development of an inducible-ON/OFF regulatory system using a malO operator as a key element. We identified and modulated sequence, position, numbers, and spacing distance of malO operators, generating a series of activating or repressive promoters with tunable strength. The stringency and robustness are both guaranteed in this system, a maximal induction factor of 790-fold was achieved, and nine proteins from different organisms were expressed with high yields. This system can be utilized as a gene switch, promoter enhancer, or metabolic valve in synthetic biology applications. This operator-based engineering strategy can be employed for developing similar regulatory systems in different microorganisms.

Genetic elements are key components of metabolic engineering and synthetic biological applications, allowing the development of organisms as biosensors and for manufacturing valuable chemicals and protein products. In contrast to the gram-negative model bacterium Escherichia coli, the gram-positive model bacterium Bacillus subtilis lacks such elements with precise and flexible characteristics, which is a great barrier to employing B. subtilis for laboratory studies and industrial applications. Here, we report the development of a malO-based genetic toolbox that is derived from the operator box in the malA promoter, enabling gene regulation via compatible “ON” and “OFF” switches. This engineered toolbox combines promoter-based mutagenesis and host-specific metabolic engineering of transactivation components upon maltose induction to achieve stringent, robust, and homogeneous gene regulation in B. subtilis. We further demonstrate the synthetic biological applications of the toolbox by utilizing these genetic elements as a gene switch, a promoter enhancer, and an ON-OFF dual-control device in biosynthetic pathway optimization. Collectively, this regulatory system provides a comprehensive genetic toolbox for controlling the expression of genes in biosynthetic pathways and regulatory networks to optimize the production of valuable chemicals and proteins in B. subtilis.

Guidance on the assessment of exposure of operators, workers, residents and bystanders in risk assessment of plant protection products

This guidance is designed to assist risk assessors and applicants when quantifying potential non-dietary, systemic exposures as part of regulatory risk assessment for plant protection products (PPPs). It is based on the Scientific Opinion on 'Preparation of a Guidance Document on Pesticide Exposure Assessment for Workers, Operators, Residents and Bystanders' developed by the EFSA Panel on Plant Protection Products and their Residue (PPR) in 2010. Highlighting some inconsistencies between the approaches adopted by regulatory authorities, the PPR Panel proposed a number of changes to the practices in use (i.e. use of deterministic methods for individual PPPs; need to perform an acute risk assessment for PPPs that are acutely toxic; use of appropriate percentile for acute or longer term risk assessments). In the first version of the guidance, issued in 2014, several scenarios for outdoor uses were included, with an annexed calculator, as well as recommendations for further research. The guidance has been updated in 2021 with the inclusion of additional scenarios and revision of default values, on the basis of the evaluation of additional evidence. To support users in performing the assessment of exposure and risk, an online calculator, reflecting the guidance content, has been further developed.

Monitoring and Protection against Radiation Dose to Eyes of Operators Performing Neuroendovascular Procedures: A Nationwide Study in Japan

OBJECTIVE

To meet the new standard of the annual dose limit for the eye lens recommended by the International Commission on Radiation Protection, radiation doses of neuroendovascular procedures in Japanese institutions were investigated.

METHODS

Radiation doses to operators involved in 304 neuroendovascular procedures at 30 Japanese institutions were prospectively surveyed. The institutions recruited at an annual meeting of the Japanese Society for Neuroendovascular Therapy participated voluntarily. A maximum of 10 wireless dosimeters were attached to the radiation protection (RP) goggles, the ceiling-mounted RP shielding screen, and the operators' forehead and neck over the protective clothing. Doses recorded inside the goggles were defined as eye lens doses for operators who wore RP goggles, while doses to the forehead were defined as eye lens doses for those who did not. The shielding effect rates of the protection devices were calculated, and statistical analysis was performed for the comparison of radiation doses.

RESULTS

From 296 analyzed cases, mean eye lens radiation doses per procedure were 0.088 mGy for the left eye and 0.041 mGy for the right eye. For the left eye, that dose without RP equipment was 0.176 mGy and that with RP goggles plus an RP shielding screen was 0.034 mGy. Four parameters, including left eye dose, air kerma at the patient entrance reference point, fluoroscopic time, and the total number of frames, were assessed for five types of neurovascular procedures. Of them, transarterial embolization for dural arteriovenous fistula was associated with the highest eye lens dose at 0.138 mGy. The shielding effect rates of protection goggles were 60% for the left and 55% for the right RP goggle. The mean doses to the inner and outer surfaces of the RP shielding screen were 0.831 mGy and 0.040 mGy, respectively, amounting to a shielding effect rate of 95%.

CONCLUSION

To meet the new standard, both RP goggles and RP shielding screens are strongly recommended to be used effectively. Without proper use of radiological protection devices, the number of neuroendovascular procedures that one operator performs per year will be limited under the new guideline.

Optimal Staffing for Vessel Traffic Service Operators: A Case Study of Yeosu VTS

Vessel traffic volume and vessel traffic service (VTS) operator workloads are increasing with the expansion of global maritime trade, contributing to marine accidents by causing difficulties in providing timely services. Therefore, it is essential to have sufficient VTS operators considering the vessel traffic volume and near-miss cases. However, no quantitative method for determining the optimal number of workstations, which is necessary for calculating the VTS operator staffing level, has yet been proposed. This paper proposes a new, microscopic approach for calculating the number of workstations from vessel trajectories and voice recording communication data between VTS operators and navigators. The vessel trajectory data are preprocessed to interpolate different intervals. The proposed method consists of three modules: Information services, navigational assistance services, and traffic organization service. The developed model was applied to the Yeosu VTS in Korea. Another workstation should be added to the current workstation based on the proposed method. The results showed that even without annual statistical data, a reasonable VTS operator staffing level could be calculated. The proposed approach helps prevent vessel accidents by providing timely services even if the vessel traffic is congested if VTS operators are deployed to a sufficient number of workstations.

Site-Specific N- and O-Glycosylation Analysis of Human Plasma Fibronectin

Human plasma fibronectin is an adhesive protein that plays a crucial role in wound healing. Many studies had indicated that glycans might mediate the expression and functions of fibronectin, yet a comprehensive understanding of its glycosylation is still missing. Here, we performed a comprehensive N- and O-glycosylation mapping of human plasma fibronectin and quantified the occurrence of each glycoform in a site-specific manner. Intact N-glycopeptides were enriched by zwitterionic hydrophilic interaction chromatography, and N-glycosite sites were localized by the ¹⁸O-labeling method. O-glycopeptide enrichment and O-glycosite identification were achieved by an enzyme-assisted site-specific extraction method. An RP–LC–MS/MS system functionalized with collision-induced dissociation and stepped normalized collision energy (sNCE)-HCD tandem mass was applied to analyze the glycoforms of fibronectin. A total of 6 N-glycosites and 53 O-glycosites were identified, which were occupied by 38 N-glycoforms and 16 O-glycoforms, respectively. Furthermore, 77.31% of N-glycans were sialylated, and O-glycosylation was dominated by the sialyl-T antigen. These site-specific glycosylation patterns on human fibronectin can facilitate functional analyses of fibronectin and therapeutics development.

An Interactive Haptic Guidance System for Intuitive Programming CNC Machine Tool

The human-machine interfaces in modern CNC machine tools are not very intuitive and still based on archaic input systems, i.e., switches, handwheels, and buttons. This type of solution has two major drawbacks. The pushed button activates the movement only in one direction and is insensitive to the amount of the force exerted by the operator, which makes it difficult to move the machine axes at variable speeds. The paper proposes a novel and intuitive system of manual programming of a CNC machine tool based on a control lever with strain-gauge sensors. The presented idea of manual programming is aimed at eliminating the need to create a machining program and at making it possible to move the machine intuitively, eliminating mistakes in selecting directions and speeds. The article describes the concept of the system and the principle of operation of the control levers with force sensors. The final part of the work presents the experimental validation of the proposed system and a functionality comparison with the traditional CNC control.

The human factor: does the operator performing the embryo transfer significantly impact the cycle outcome?

STUDY QUESTION

Is Ongoing Pregnancy Rate (OPR) operator-dependent, and can experience improve embryo transfer efficiency?

SUMMARY ANSWER

OPR is influenced by the operators who perform the embryo transfer (ET), and experience does not assure proficiency for everyone.

WHAT IS KNOWN ALREADY

ET remains the critical step in assisted reproduction. Although many other factors such as embryo quality and uterine receptivity impact embryo implantation, the proper ET technique is clearly an operator-dependent variable and as such it should be objectively standardized.

STUDY DESIGN, SIZE, DURATION

Retrospective comparative analysis including all fresh ETs performed between January 1996 and December 2016 at the Humanitas Fertility Center after IVF—ICSI cycles.

PARTICIPANTS/MATERIALS, SETTING, METHODS

IVF/ICSI fresh ETs performed by 32 operators, 19 824 cycles in all, were analyzed. All transfers consisting of freehand insertion of a preloaded soft catheter into the uterine cavity under transabdominal ultrasound guidance were considered. Two different statistical analyses were performed. First, a logistic regression model with a random intercept for the operator was used to estimate the heterogeneity of the rate of success among operators, accounting for woman age, FSH, number of oocytes retrieved, fertilization rate, year of the procedure, number and stage of transferred embryos and operator’s experience. Second, the relationship between experience and pregnancy rate was estimated separately for each operator by logistic regression, and operator-specific results were combined and compared in a random-effects meta-analysis. In both analyses, the operator’s experience at time t was measured in terms of number of embryo transfers performed before t.

MAIN RESULTS AND THE ROLE OF CHANCE

The heterogeneity among operators was highly significant (P value <0.001) and explained 44.5% of the total variability. The odds ratio of success of the worst operator in respect to the mean was equal to 0.84. For the best operator, the odds ratio of success was equal to 1.13 in respect to the mean. Based on the meta-analysis of the relationship between operator’s experience and success rate, it resulted that, on average, the operators’ performance did not improve with additional transfers.

LIMITATIONS, REASONS FOR CAUTION

At our center, operators become independent for ET’s after performing between 30 and 50 transfers under supervision. It is also possible that other relevant factors, such as embryologists on duty for the ET, have not been included in the present analysis and this may represent a potential bias. Among these, it should be mentioned that the embryologists on duty for the ET were not taken into consideration.

WIDER IMPLICATIONS OF THE FINDINGS

Continued performance analysis and the use of a digital simulator could help operators to test their expertise over time and either correct poor performance or avoid doing transfers.

STUDY FUNDING/COMPETING INTEREST(S)

None.

TRIAL REGISTRATION NUMBER

NCT03561129.

Technical note: Repeatability and reproducibility of curd yield and composition in a miniaturized coagulation model

Miniaturized coagulation (MC) models have been proposed for the evaluation of curd yield (CY) in individual milk samples of different dairy species and breeds, and for the analysis of cheese microstructure and texture. It is still unclear if MC using less than 50 mL of milk is suitable to evaluate CY and chemical composition, and if preservative added to raw milk may interfere with MC process. Therefore, this study aimed at evaluating repeatability and reproducibility of CY, curd moisture, and fat and protein content on curd dry matter (DM) from MC trials using 40 g of milk. Miniaturized coagulations were performed by 3 different operators on 3 consecutive days, using raw milk (RM) and raw milk added with preservative (RMP). Repeatability of CY, calculated as relative standard deviation on 6 miniaturized curds obtained within a day by the same operator, was below 5% for MC carried out with both RM and RMP. The Horwitz ratio, which is the ratio between measured and expected reproducibility, highlighted good reproducibility for CY from RM and fair reproducibility for CY from RMP. The same ratio highlighted lower accuracies for curd moisture and fat and protein content on curd DM, especially for MC trials carried out with RMP. The z-test was performed to evaluate the similarity between curds manufactured with RM and RMP in terms of average yield and chemical composition; z-scores did not highlight significant differences between values obtained from MC carried out with RM and RMP. It can be concluded that preservative had negligible effects on MC, giving the opportunity to extend milk physical and chemical stability, to schedule laboratory trials on longer time span, and to broaden the sample size within a batch of analyses.

Rules of Expansion: an Updated Consensus Operator Site for the CopR-CopY Family of Bacterial Copper Exporter System Repressors

Many Gram-positive bacteria respond to copper stress by upregulating a copper export system controlled by a copper-sensitive repressor, CopR-CopY. The previous operator sequence for this family of proteins had been identified as TACANNTGTA. Here, using several recombinant proteins and mutations in various DNA fragments, we define those 10 bases as necessary but not sufficient for binding and in doing so, refine the cop operon operator to the 16-base sequence RNYKACANNTGTMRNY. Due to the sheer number of repressors that have been said to bind to the original 10 bases, including many antibiotic resistance repressors such as BlaI and MecI, we feel that this study highlights the need to reexamine many of these sites of the past and use added stringency for verifying operators in the future.

Copper is broadly toxic to bacteria. As such, bacteria have evolved specialized copper export systems (cop operons) often consisting of a DNA-binding/copper-responsive regulator (which can be a repressor or activator), a copper chaperone, and a copper exporter. For those bacteria using DNA-binding copper repressors, few studies have examined the regulation of this operon regarding the operator DNA sequence needed for repressor binding. In Streptococcus pneumoniae (the pneumococcus), CopY is the copper repressor for the cop operon. Previously, homologs of pneumococcal CopY have been characterized to bind a 10-base consensus sequence T/GACANNTGTA known as the cop box. Using this motif, we sought to determine whether genes outside the cop operon are also regulated by the CopY repressor, which was previously shown in Lactococcus lactis. We found that S. pneumoniae CopY did not bind to cop operators upstream of these candidate genes in vitro. During this process, we found that the cop box sequence is necessary but not sufficient for CopY binding. Here, we propose an updated operator sequence for the S. pneumoniaecop operon to be ATTGACAAATGTAGAT binding CopY with a dissociation constant (K_d) of ∼28 nM. We demonstrate strong cross-species interaction between some CopY proteins and CopY operators, suggesting strong evolutionary conservation. Taken together with our binding studies and bioinformatics data, we propose the consensus operator RNYKACANNYGTMRNY for the bacterial CopR-CopY copper repressor homologs.

IMPORTANCE Many Gram-positive bacteria respond to copper stress by upregulating a copper export system controlled by a copper-sensitive repressor, CopR-CopY. The previous operator sequence for this family of proteins had been identified as TACANNTGTA. Here, using several recombinant proteins and mutations in various DNA fragments, we define those 10 bases as necessary but not sufficient for binding and in doing so, refine the cop operon operator to the 16-base sequence RNYKACANNTGTMRNY. Due to the sheer number of repressors that have been said to bind to the original 10 bases, including many antibiotic resistance repressors such as BlaI and MecI, we feel that this study highlights the need to reexamine many of these sites of the past and use added stringency for verifying operators in the future.

Inter-operator Reliability for Measuring Pulse Wave Velocity and Augmentation Index

Background: Arterial stiffness is a reversible precursor to hypertension. However, research is needed to determine the minimum amount of training required before acceptable arterial stiffness measurements are collected by novice operators. Objective: To compare novice vs. experienced operator measurements over a 2-week training period to assess when expert-like measures are achieved by the novice operator. Method: Forty-one participants (18 males, 23 females, age: 46.6 ± 14.9 years; BMI: 25.2 ± 3.8; systolic blood pressure: 122.8 ± 14.7 mmHg) received alternating novice and experienced operator arterial stiffness assessments. Measurements included: pulse wave velocity (PWV; using the automatic-capture time-periods of 5-, 10-, and 20-s) and augmentation index (AIx75) measurements using the SphygmoCor XCEL System v1 (AtCor Medical Pty Ltd., Sydney, Australia). Data were chronologically arranged into quintiles. Results: The intraclass correlation coefficient for PWV substantially improved from quintile 1 (r < 0.8) to quintile 2 and beyond (typically r > 0.8) while AIx75 improved consistently (r = 0.7 in quintile 1 and r = 0.97 in quintile 5). The coefficient of variation was lowest in quintile 4 (PWV: 4.7-6% across the three measurement time-periods; and 15% for AIx75) but increased in quintile 5 (PWV: 6.2-10.5%; and 25% for AIx75). All measurements demonstrated acceptable to excellent reliability after quintile 2. Conclusion: To achieve expert-like PWV measurements in this study, the novice operator underwent a familiarization session including guided practice measurements on 5 different people, for 10-15 min per person on two occasions (~2.5 h). The novice operator then required ≥14 practice measurements, with accuracy continuing to improve up to 30 participants. At least 30 training measurements are recommended for novices to take acceptable AIx75 measurements after a familiarization training.

Implementation of an Algorithm to Prevent Chatter Vibration in a CNC System

Machining of shafts characterized by a high compliance is difficult due to the occurrence of self-excited chatter vibrations. It is possible to limit their occurrence through the appropriate selection of technological parameters. For a proper selection of these parameters it is necessary to know the dynamic properties of the machine-tool-workpiece. This study proposes an approach through which these properties can be determined as a result of the synthesis of the dynamic properties of the system, using the receptance coupling method. Knowledge of these properties allows us to select the technological parameters of the lathe using the assistance system integrated into the CNC (Computerized Numerical Control). The final section of this work presents the experimental validation of the assistant and proposed procedures.

[Measurement of Head and Neck Exposure in CT Guided IVR]

In April 2011, the International Radiological Protection Committee recommended that "The equivalent dose of the crystalline lens should not exceed 20 mSv/year, averaged over defined periods of 5 years, with no single year exceeding 50 mSv". Based on this recommendation, it is predicted that the equivalent dose limit of our crystalline lens can be lowered in the near future. Therefore, it is important to grasp the current situation of radiation exposure. The purpose of this study is to measure the crystalline lens of surgeons by focusing on the CT-fluoroscopy guided interventional radiology's (IVRs). We also examined whether the exposure dose of the crystalline lens can be correctly evaluated by measuring the unequal exposure dose of the neck, which is usually used for the unequal exposure measurement. Results of the analysis of 200 CT-fluoroscopy guided IVR procedures showed that the unequal exposure dose of the neck was significantly correlated with the exposure dose of the crystalline lens which was measured near the left eye ball (R=0.83). However, the exposure dose of the crystalline was 33% lower than those of the neck. Therefore, although the individual dosimeter worn on the neck can be used as the useful index of the exposure dose of the crystalline lens, the results can be overestimated.

Improvement of Flutter-Kick Performance in Novice Surface Combat Swimmers With Increased Hip Strength

PURPOSE

To examine strength, range of motion, anthropometric, and physiological contributions to novice surface-combat-swimming (sCS) performance and establish differences from freestyle-swimming (FS) performance to further understand the transition of FS to sCS performance.

METHODS

A total of 13 competitive swimmers (7 male and 6 female; 27.7 [2.3] y; 176.2 [2.6] cm; 75.4 [3.9] kg) completed 8 testing sessions consisting of the following: physiological land-based measurements for maximal anaerobic and aerobic capacity and upper- and lower-extremity strength and range of motion, an sCS anaerobic capacity swim test measuring peak and mean force and fatigue index, 2 aerobic capacity tests measuring maximal aerobic capacity for both FS and sCS, and four 500-m performance swims for time, 1 FS, and 3 sCS. Separate multiple linear-regression analysis was used to analyze predictors of both sCS and FS performance models.

RESULTS

FS performance was predicted by the final FS maximal oxygen uptake with an R2 of 42.03% (F1,10 = 7.25; P = .0226), whereas sCS performance was predicted by isometric hip-extension peak strength with an R2 of 41.46% (F1,11 = 7.79; P = .0176).

CONCLUSIONS

Results demonstrate that different physiological characteristics predict performance, suggesting that an altered strategy is used for novice sCS than FS. It is suggested that this may be due to the added constraints as mandated by mission requirements including boots, weighted gear, and clandestine requirements with hips lowered beneath the surface. Further research should examine the kinematics of the sCS flutter kick to improve performance by developing training strategies specific for the task.

Stent and Dual Antiplatelet Therapy Duration Comparisons in the Setting of a Multicenter Randomized Controlled Trial: Can the Operator Experience Affect the Study Results?

Background

Operator experience influences outcomes after percutaneous coronary intervention, but this association in the controlled setting of a randomized, clinical trial is unclear.

Methods and Results

We investigated operator‐related outcomes (30‐day and 2‐year efficacy and safety end points) among patients undergoing percutaneous coronary intervention and randomized to different dual antiplatelet therapy durations and stent types. A total of 2003 patients were analyzed, and 7 operator groups were compared. The majority of preprocedural and postprocedural characteristics were imbalanced. The primary end point of the study, the composite of death, myocardial infarction, or cerebrovascular accidents, did not differ among operators at 30 days or 2 years. There were no significant differences also for all other individual and composite end points analyzed at 30 days and 2 years, except for 2‐year stent thrombosis (P=0.048) and bleeding events (P=0.022 for Bleeding Academic Research Consortium type 2, 3, or 5). Adjusted comparisons for the main end points showed slight differences among operators at 30 days, but not at 2 years. There was no interaction of operator with dual antiplatelet therapy duration (P=0.112) or stent type (P=0.300). Results remained entirely consistent when operators were stratified by their experience.

Conclusions

There was a weak signal of heterogeneity across study operators for the 30‐day, but not the 2‐year, main study outcomes. No clear effect of operator or operator experience was observed for the comparative efficacy and safety profile of the randomized stent types or dual antiplatelet therapy duration regimens.

Clinical Trial Registration

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00611286.

On a more accurate Hardy-Mulholland-type inequality

By using the way of weight coefficients, the technique of real analysis, and Hermite-Hadamard's inequality, a more accurate Hardy-Mulholland-type inequality with multi-parameters and a best possible constant factor is given. The equivalent forms, the reverses, the operator expressions and some particular cases are considered.

A more accurate half-discrete Hardy-Hilbert-type inequality with the logarithmic function

By means of the weight functions, the technique of real analysis and Hermite-Hadamard's inequality, a more accurate half-discrete Hardy-Hilbert-type inequality related to the kernel of logarithmic function and a best possible constant factor is given. Moreover, the equivalent forms, the operator expressions, the reverses and some particular cases are also considered.

On Hardy-type integral inequalities with the gamma function

By means of real analysis and weight functions, we obtain a few equivalent conditions of two kinds of Hardy-type integral inequalities with the non-homogeneous kernel and parameters. The constant factors related to the gamma function are proved to be the best possible. We also consider the operator expressions and some cases of homogeneous kernel.

An extension of a multidimensional Hilbert-type inequality

In this paper, by the use of weight coefficients, the transfer formula and the technique of real analysis, a new multidimensional Hilbert-type inequality with multi-parameters and a best possible constant factor is given, which is an extension of some published results. Moreover, the equivalent forms, the operator expressions and a few particular inequalities are considered.

Private sector participation in domestic waste management in informal settlements in Lagos, Nigeria

Lagos is one of the fastest growing cities in Africa, which is grappling with the challenges of poorly managed urbanisation. With an estimated population of about 17.5 million, solid waste management is one of the most pressing environmental challenges currently faced in the city. It is estimated that more than 9071847.4kg of urban waste is generated every day in the city. The city lacks the capacity to deal with such magnitude of waste. Consequently, the city has involved the private sector (private sector participation) in its waste management drive. This article examines the effectiveness of this public-private sector collaboration model in waste management in informal settlements in Lagos using empirical data. Major findings of the article include the irregularity of waste collection owing to a poor road network, an inadequate transport infrastructure and the desire to maximise profit, as well as poor waste handling and disposal methods by the private sector participation operators who are not chosen based on competence and capacity to perform. Another major finding is the lack of cooperation from residents evidenced in non-payment of bills and poor packaging of wastes, resulting in wastes being littered. The article concludes on the need to restructure the scheme through proper sensitisation of residents, selection of operators with demonstrable delivery capacity and provision of a well-maintained road network to facilitate access of operators to settlements.

Ergonomics in the arctic - a study and checklist for heavy machinery in open pit mining

BACKGROUND

Heavy mining vehicle operators at arctic mines have a high risk of discomfort, musculoskeletal disorders and occupational accidents. There is a need for tailored approaches and safety management tools that take into account the specific characteristics of arctic work environments.

OBJECTIVE

The aim of this study was to develop a holistic evaluation tool for heavy mining vehicles and operator well-being in arctic mine environments.

METHODS

Data collection was based on design science principles and included literature review, expert observations and participatory ergonomic sessions.

RESULTS

As a result of this study, a systemic checklist was developed and tested by eight individuals in a 350-employee mining environment.

CONCLUSIONS

The checklist includes sections for evaluating vehicle specific ergonomic and safety aspects from a technological point of view and for checking if the work has been arranged so that it can be performed safely and fluently from an employee's point of view.

Operator dermal exposure and protection provided by personal protective equipment and working coveralls during mixing/loading, application and sprayer cleaning in vineyards

The efficiency of a working coverall combined with personal protective equipment to protect operators against dermal exposure to plant protection products under field conditions was studied. Operators wore a non-certified water-repellent finish polyester/cotton coverall plus a certified gown during the mixing/loading and the cleaning phases. Insecticide foliar application to a vineyard was selected as the exposure scenario. The overall dermal residue levels measured in this study were in the range of data recently collected in Europe. The water-repellent finish working coverall reduced body exposure by a factor of approximately 95%. Wearing a Category III Type 3 partial body gown during mixing/loading and cleaning of the application equipment led to a further protective effect of 98.7%. The combination of a water-repellent finish working coverall and partial body protection during specific tasks provided satisfactory levels of protection and can be considered as suitable protection for the conditions of use studied.

Regulatable and Modulable Background Expression Control in Prokaryotic Synthetic Circuits by Auxiliary Repressor Binding Sites

Expression control in synthetic genetic circuitry, for example, for construction of sensitive biosensors, is hampered by the lack of DNA parts that maintain ultralow background yet achieve high output upon signal integration by the cells. Here, we demonstrate how placement of auxiliary transcription factor binding sites within a regulatable promoter context can yield an important gain in signal-to-noise output ratios from prokaryotic biosensor circuits. As a proof of principle, we use the arsenite-responsive ArsR repressor protein from Escherichia coli and its cognate operator. Additional ArsR operators placed downstream of its target promoter can act as a transcription roadblock in a distance-dependent manner and reduce background expression of downstream-placed reporter genes. We show that the transcription roadblock functions both in cognate and heterologous promoter contexts. Secondary ArsR operators placed upstream of their promoter can also improve signal-to-noise output while maintaining effector dependency. Importantly, background control can be released through the addition of micromolar concentrations of arsenite. The ArsR-operator system thus provides a flexible system for additional gene expression control, which, given the extreme sensitivity to micrograms per liter effector concentrations, could be applicable in more general contexts.

[Prevention of medical device-related adverse events in hospitals: Specifying the recommendations of the German Coalition for Patient Safety (APS) for users and operators of anaesthesia equipment]

BACKGROUND

The use and organisation of medical technology has an important role to play for patient and user safety in anaesthesia.

OBJECTIVES

Specification of the recommendations of the German Coalition for Patient Safety (APS) for users and operators of anaesthesia equipment, explore opportunities and challenges for the safe use and organisation of anaesthesia devices.

METHODS

We conducted a literature search in Medline/PubMed for studies dealing with the APS recommendations for the prevention of medical device-related risks in the context of anaesthesia. In addition, we performed an internet search for reports and recommendations focusing on the use and organisation of medical devices in anaesthesia. Identified studies were grouped and assigned to the recommendations. The division into users and operators was maintained.

RESULTS

Instruction and training in anaesthesia machines is sometimes of minor importance. Failure to perform functional testing seems to be a common cause of critical incidents in anaesthesia. There is a potential for reporting to the federal authority. Starting points for the safe operation of anaesthetic devices can be identified, in particular, at the interface of staff, organisation, and (anaesthesia) technology.

CONCLUSIONS

The APS recommendations provide valuable information on promoting the safe use of medical devices and organisation in anaesthesia. The focus will be on risks relating to the application as well as on principles and materials for the safe operation of anaesthesia equipment.

Computation of diffusion limited controlled actions for gene regulating repressor particles

Temporal changes in association anddissociation kinetics of the repressor -operator reaction were simulated by a computational approach using MATOLABO on the basis of strict mathematical description. The diffusion equation of a repressor particle has been combinedwith arrival probabilities of therepressor particle. Temporal behaviors of the repressor operator complex have been computed by inverting the Laplace transformed equations. The temporal kinetic data of association anddissociation obtained at differentionic strength and at different DNA length were successfully simulated. Those results could be achieved byregulating diffusion constants inmedium on the DNA, a reaction radius of the repressor and a reaction rate per one repressor on the reaction sphere surface, k value. The reported values of association rate constant ka obtained at different ionic strength were also successfully simulated. Amongthe regulated parameters to get these successful simulations, the reaction rate per one particle on the reaction sphere surface, k value has effectiveinfluences on the association anddissociation kinetics particularly those at varying ionic strength that were induced by high KCl condition. By an electro chemical consideration for thechange of k value in combinationwith the screening effects of counter ions around the repressor particle and the DNA molecule, the most effectivefactor seems to be the Coulombrepulsive forces and or Londondispersion forces. The sliding mechanism for facilitated translocation of a repressor protein ona DNA chain can be described by the present mathematical approach which describes the temporal changes in amounts of the species. To achieve such mechanism in varying ionic strength,the secondary changes in the diffusion constants, the reaction radius and the reaction rate per one particle on thereaction sphere surface k value (anelectro chemical factor) seemed to have important roles.

Multiple regulation of the galactose operon-genetic evidence for a distinct site in the galactose operon that responds to capR gene regulation in Escherichia coli K-12

Previous results demonstrated that the capR (lon) locus, which is not linked to the gal operon, independently controls the synthesis of the gal operon enzymes and gal mRNA, i.e., galO(+)capR9 strains are derepressed 4- to 6-fold as compared to galO(+)capR(+) strains. A mutation has been isolated and localized in the galactose operator region that defines a new and distinct site of control. Mutation in this site, designated galO(capR+), causes a 4-fold increase in the galactose enzymes, galactokinase (EC 2.7.1.6) and UDP-galactose-4-epimerase (EC 5.1.3.2), in a capR(+) background. These mutants exhibit a reduced response to regulation by the unlinked regulator gene capR (lon). However, the galO(capR+) mutants are still subject to control by the galR repressor, since they can be further derepressed by growth in the presence of D-fucose. They also synthesize more galactokinase when grown in glycerol as compared to glucose. Thus there are now at least three, and probably four, sites for control of mRNA synthesis in the operator-promoter regions of the gal operon, making it one of the most complex control systems to date for a single operon in bacteria. The complexity is sufficient to accommodate models for differentiation in higher organisms that require more than one "switch" to control a single group of genes.

The nucleotide sequence of the lactose messenger ribonucleic acid transcribed from the UV5 promoter mutant of Escherichia coli

I have sequenced the first 63 bases of mRNA transcribed in vitro from the UV5 promoter mutant of the E. coli lactose operon. Sonic fragments of DNA, 1000 base pairs long and purified to contain only the lac operator-promoter region, were used as template. The UV5 promoter mutation allows transcription of the lac operon in the absence of catabolite activator protein and cAMP; lac repressor controls the synthesis of this RNA. I find that during synthesis, RNA polymerase pauses at particular sites along the DNA, naturally generating several discrete sizes of RNA that provide overlaps useful for sequencing. The UV5 lac mRNA initiates within the lac operator and copies the operator sequence. The AUG initiator codon for beta-galactosidase occurs at position 39 of the message. The sequence is: pppA-A-U-U-G-U-G-A-G-C-G-G-A-U-A-A-C-A-A-U-U-U- C-A-C-A-C-A-G-G-A-A-A-C-A-G-C-U-A-U-G-A-C-C-A-U- G-A-U-U-A-C-G-G-A-U-U-C-A-C-U-G-G.