Assessing injury risk in male and female Royal Navy recruits: does the Functional Movement Screen provide understanding to inform effective injury mitigation?

INTRODUCTION

Musculoskeletal injuries (MSKIs) are common during military and other occupational physical training programmes, and employers have a duty of care to mitigate this injury risk. MSKIs account for a high number of working days lost during initial military training, contribute to training attrition and impact training costs. Poorer movement quality may be associated with increased MSKI risk.

METHODS

The present study evaluated the relationship between the Functional Movement Screen (FMS) Score, as a measure of movement quality, and injury risk in Royal Navy (RN) recruits. A cohort of 957 recruits was assessed using the FMS prior to the 10-week phase I training programme. Injury occurrence, time, type and severity were recorded prospectively during the training period.

RESULTS

Total FMS Score was associated with injury risk (p≤0.001), where recruits scoring ≥13 were 2.6 times more likely to sustain an injury during training. However, FMS Score accounted for only 10% of the variance in injury risk (R2=0.1). Sex was the only additional variable to significantly affect the regression model. Mean FMS Scores for men (14.6±2.3) and women (14.4±2.4) were similar, but injury occurrence in women was 1.7 times greater than in men. Examining the influence of individual FMS movement tests on injury prediction did not improve the model, where those movements that significantly contributed to injury prediction only accounted for a small amount of the variance (R2=0.01).

CONCLUSION

There was a weak relationship between FMS and injury risk in RN recruits. Evidence is provided that FMS score alone would not be appropriate to use as an injury prediction tool in military recruits.

Fellowships and defence engagement: from clinical niches to strategic impact

Medical fellowships have traditionally developed the individual rather than furthering military or national strategic objectives. This paper describes a medical fellowship with the British Antarctic Survey to illustrate the benefits to the individual, to the military and to wider international defence engagement efforts.By rebranding such fellowships as Defence Healthcare Engagement and by treating international organisations on a par with partner nations, the humble fellowship can facilitate enduring, mutually beneficial healthcare engagement at low cost and with minimal additional resources.

Musculoskeletal injury in military specialists: a 2-year retrospective study

BACKGROUND

Military specialists are elite personnel who are trained to work across diverse operational environments where a high level of physical conditioning is a prerequisite for their role. Anecdotally, personnel are acknowledged to be at high risk of developing musculoskeletal injuries (MSKIs). However, there are presently no published data on this UK military population to support this view. This is the first (2-year) retrospective epidemiological study to identify the MSKI sustained by this military population.

METHODS

All MSKI reported over a 2-year period (January 2018-December 2019) were recorded to identify the incidence, frequency, nature, onset, cause, location and reporting times. Injuries were described using injury count and relative frequency (percentage). Time at risk for each personnel day was calculated as 365 days.

RESULTS

A total of 199 personnel reported 229 injuries over the reporting periods. The injury incidence rates were 26.8 personnel per 100 person years (2018) and 27.7 personnel per 100 person years (2019), respectively. Military training accounted for the highest number of injuries (32%), followed by 'other injuries' (28%), personal training (28%) and sport (12%). The leading activity associated with injury was weight training (15%), followed by running (11%) and military exercise (10%). Lower extremity injuries accounted for the highest number of injuries (40%), followed by trunk (36%) and upper extremity (24%) injuries.

CONCLUSION

This study identifies the MSKI profile of a military specialist population over a 2-year period. Areas where modifiable risk factors may be identified to reduce risk of injury are highlighted. Recommendations for further research include investigating injury burden and the impact of injury on operational readiness.

Are late hernia mesh complications linked to Staphylococci biofilms?

Purpose

The purpose of this study was to investigate the link between bacterial biofilms and negative outcomes of hernia repair surgery. As biofilms are known to play a role in mesh-related infections, we investigated the presence of biofilms on hernia meshes, which had to be explanted due to mesh failure without showing signs of bacterial infection.

Methods

In this retrospective observational study, 20 paraffin-embedded tissue sections from explanted groin hernia meshes were analysed. Meshes have been removed due to chronic pain, hernia recurrence or mesh shrinkage. The presence and bacterial composition of biofilms were determined. First, specimens were stained with fluorescence in situ hybridisation (FISH) probes, specific for Staphylococcus aureus and coagulase-negative staphylococci, and visualised by confocal laser scanning microscopy. Second, DNA was extracted from tissue and identified by S. aureus and S. epidermidis specific PCR.

Results

Confocal microscopy showed evidence of bacterial biofilms on meshes in 15/20 (75.0%) samples, of which 3 were positive for S. aureus, 3 for coagulase-negative staphylococci and 9 for both species. PCR analysis identified biofilms in 17/20 (85.0%) samples, of which 4 were positive for S. aureus, 4 for S. epidermidis and 9 for both species. Combined results from FISH/microscopy and PCR identified staphylococci biofilms in 19/20 (95.0%) mesh samples. Only 1 (5.0%) mesh sample was negative for bacterial biofilm by both techniques.

Conclusion

Results suggest that staphylococci biofilms may be associated with hernia repair failure. A silent, undetected biofilm infection could contribute to mesh complications, chronic pain and exacerbation of disease.

Metric mechanics with nontrivial topology: Actuating irises, cylinders, and evertors

Liquid crystal elastomers contract along their director on heating and recover on cooling, offering great potential as actuators and artificial muscles. If a flat sheet is programed with a spatially varying director pattern, then it will actuate into a curved surface, allowing the material to act as a strong machine such as a grabber or lifter. Here we study the actuation of programed annular sheets which, owing to their central hole, can sidestep constraints on area and orientation. We systematically catalog the set of developable surfaces encodable via axisymmetric director patterns and uncover several qualitatively new modes of actuation, including cylinders, irises, and everted surfaces in which the inner boundary becomes the outer boundary after actuation. We confirm our designs with a combination of experiments and numerics. Many of our actuators can reattain their initial inner or outer radius upon completing actuation, making them particularly promising, as they can avoid potentially problematic stresses in their activated state even when fixed onto a frame or pipe.

Real-world outcomes of unrestricted direct-acting antiviral treatment for hepatitis C in Australia: The South Australian statewide experience

In March 2016, the Australian government offered unrestricted access to direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) to the entire population. This included prescription by any medical practitioner in consultation with specialists until sufficient experience was attained. We sought to determine the outcomes and experience over the first twelve months for the entire state of South Australia. We performed a prospective, observational study following outcomes of all treatments associated with the state's four main tertiary centres. A total of 1909 subjects initiating DAA therapy were included, representing an estimated 90% of all treatments in the state. Overall, SVR12 was 80.4% in all subjects intended for treatment and 95.7% in those completing treatment and follow-up. 14.2% were lost to follow-up (LTFU) and did not complete SVR12 testing. LTFU was independently associated with community treatment via remote consultation (OR 1.50, 95% CI 1.04-2.18, P = .03), prison-based treatment (OR 2.02, 95% CI 1.08-3.79, P = .03) and younger age (OR 0.98, 95% CI 0.97-0.99, P = .05). Of the 1534 subjects completing treatment and follow-up, decreased likelihood of SVR12 was associated with genotype 2 (OR 0.23, 95% CI 0.07-0.74, P = .01) and genotype 3 (OR 0.23, 95% CI 0.12-0.43, P ≤ .01). A significant decrease in treatment initiation was observed over the twelve-month period in conjunction with a shift from hospital to community-based treatment. Our findings support the high responses observed in clinical trials; however, a significant gap exists in SVR12 in our real-world cohort due to LTFU. A declining treatment initiation rate and shift to community-based treatment highlight the need to explore additional strategies to identify, treat and follow-up remaining patients in order to achieve elimination targets.

Curvature by design and on demand in liquid crystal elastomers

The shape of liquid crystalline elastomers (LCEs) with spatial variation in the director orientation can be transformed by exposure to a stimulus. Here, informed by previously reported analytical treatments, we prepare complex spiral patterns imprinted into LCEs and quantify the resulting shape transformation. Quantification of the stimuli-induced shapes reveals good agreement between predicted and experimentally observed curvatures. We conclude this communication by reporting a design strategy to allow LCE films to be anchored at their external boundaries onto rigid substrates without incurring internal, mechanical-mismatch stresses upon actuation, a critical advance to the realization of shape transformation of LCEs in practical device applications.

Effects of posture and anatomical location on inter-recti distance measured using ultrasound imaging in parous women

STUDY DESIGN

Cross-sectional repeated measures.

OBJECTIVES

To quantify the effects of posture and measurement site on the inter-recti distance (IRD) and investigate the reliability of IRD measurement using ultrasound imaging in different postures.

BACKGROUND

The linea alba connects the rectus abdominis muscles anteriorly and the width is known as the IRD. The IRD is usually measured in crook-lying and is the primary outcome measure to assess for a divarication of recti abdominis (DRA). The effects of posture and measurement site on the IRD have not been investigated.

METHODS

Ultrasound imaging was used to measure IRD in 41 women ≥8 weeks postpartum. The IRD was measured at three sites (superior-umbilicus, umbilicus and inferior-umbilicus), in three postures (crook-lying, sitting and standing), and repeated one-week later. The effects of posture and site were investigated using one-way ANOVAs. Reliability was analysed using Intraclass correlation coefficients (ICCs), Bland Altman analyses, standard error of measurement and minimal detectable change.

RESULTS

The IRD was wider when standing vs. lying at both the superior-umbilicus and umbilicus by 0.30 cm (95% CI 0.21 to 0.39) and 0.20 cm (0.11-0.30) respectively (p < 0.001). Measurements at the inferior-umbilicus were, on average, 1.6 and 2.1 cm narrower than superior-umbilicus and umbilicus sites, respectively (p < 0.001). There was high intra-rater reliability within-session (ICC_3.3) and between-session (ICC_3.1) at all sites measured.

CONCLUSION

The IRD can be measured reliably at all sites and postures. The IRD is wider at superior-umbilicus and umbilicus when upright compared with lying. There is a difference in IRD between all sites measured.

Registered Replication Report: Rand, Greene, and Nowak (2012)

In an anonymous 4-person economic game, participants contributed more money to a common project (i.e., cooperated) when required to decide quickly than when forced to delay their decision (Rand, Greene & Nowak, 2012), a pattern consistent with the social heuristics hypothesis proposed by Rand and colleagues. The results of studies using time pressure have been mixed, with some replication attempts observing similar patterns (e.g., Rand et al., 2014) and others observing null effects (e.g., Tinghög et al., 2013; Verkoeijen & Bouwmeester, 2014). This Registered Replication Report (RRR) assessed the size and variability of the effect of time pressure on cooperative decisions by combining 21 separate, preregistered replications of the critical conditions from Study 7 of the original article (Rand et al., 2012). The primary planned analysis used data from all participants who were randomly assigned to conditions and who met the protocol inclusion criteria (an intent-to-treat approach that included the 65.9% of participants in the time-pressure condition and 7.5% in the forced-delay condition who did not adhere to the time constraints), and we observed a difference in contributions of -0.37 percentage points compared with an 8.6 percentage point difference calculated from the original data. Analyzing the data as the original article did, including data only for participants who complied with the time constraints, the RRR observed a 10.37 percentage point difference in contributions compared with a 15.31 percentage point difference in the original study. In combination, the results of the intent-to-treat analysis and the compliant-only analysis are consistent with the presence of selection biases and the absence of a causal effect of time pressure on cooperation.

An assessment of dioxin exposure across gestation and lactation using a PBPK model and new data from Seveso

On July 10, 1976, an explosion at a chemical plant in Seveso, Italy, released up to 30kg of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-the most potent dioxin congener. Twenty years later, the Seveso Women's Health Study (SWHS) initiated a follow-up assessment of a cohort of female Seveso residents. Researchers collected serial blood, measured for TCDD levels, and recorded information about the women's medical history after the explosion. The study's aims were to: 1) modify the human PBPK model for TCDD (Emond et al. 2004; Emond et al. 2005; NCEA-USEPA, 2010) to include repetitive gestation and lactation; 2) simulate TCDD blood concentrations during different life stages including pregnancy and lactation, under different exposure scenarios; and 3) use this PBPK model to compare the influence of gestation and lactation on elimination of TCDD. After optimization of the model, it was assessed using data from the SWHS cohort. The 23 women in Subcohort A, were 4-39years old and in Subcohort B, the 18 women were 3-17years old when the explosion occurred. The model accurately predicted the blood concentrations during the 20years post-exposure, including periods of pregnancy and lactation. The model was also used to analyze the contribution of gestation and lactation to the mother's elimination of TCDD. The results suggest that gestation and lactation do not significantly impact TCDD blood elimination. Future efforts will focus on using additional data to evaluate the PBPK model and improving the mathematical descriptions of lactation and multiple gestations.

Generic and disease-specific quality of life among youth and young men with Hemophilia in Canada

Background

This study was undertaken to explore the longitudinal patterns of health-related quality of life (HRQoL) among youth and young adults with Hemophilia A (HA) over a 3-year period. This report presents the baseline characteristics of the study cohort.

Methods

Males, 14 to 29 years of age, with predominantly severe HA were recruited from six treatment centres in Canada. Subjects completed a comprehensive survey. HRQoL was measured using: the CHO-KLAT_2.0 (youth), Haemo-QoL-A (young adults) and the SF-36v2 (all).

Results

13 youth (mean age = 15.7, range = 12.9-17.9 years) and 33 young adults (mean age = 23.6; range = 18.4 -28.7 years) with moderate (7 %) and severe (93 %) HA were enrolled. All were on a prophylactic regimen with antihemophilic factor (Helixate FS®) during the study. The youth had minimal joint damage (mean HJHS = 5.2) compared to young adults (mean HJHS = 13.3). The mean HRQoL scores for youth were: 79.2 (SD = 11.9) for the CHO-KLAT, and 53.0 (5.5) and 52.3 (6.8) for the SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores respectively. The mean HRQoL scores for young adults were: 85.8 (9.5) for the Haemo-Qol-A, and 50.8 (6.4) and 50.9 (8.8) for PCS and MCS respectively. PCS and MCS scores were comparable to published Canadian norms, however significant differences were found for the domains of Physical Functioning and Bodily Pain. The disease-specific HRQoL scores were weakly correlated with the PCS for youth (CHO-KLAT vs. PCS r = 0.28, p = 0.35); and moderately correlated for the MCS (r = 0.39, p = 0.19). Haemo-QoL-A scores for young adults were strongly correlated with the PCS (r = 0.53, p = 0.001); and weakly correlated with the MCS (r = 0.26, p = 0.13). Joint status as assessed by HJHS was correlated with PCS scores. A history of lifelong prophylaxis resulted in better PCS but worse MCS scores.

Conclusion

Despite having hemophilia, the youth in this cohort have minimal joint disease and good HRQoL. The young adults demonstrated more joint disease and slightly worse HRQoL in the domains of physical functioning and pain. The data presented here provide new information to inform the selection of Health Related Quality of Life (HRQoL) instruments for use in future clinical trials involving persons with hemophilia.

Trial registration

ClinicalTrials.gov : NCT01034904. Study funded by CSL Behring Canada.

Electronic supplementary material

The online version of this article (doi:10.1186/s12878-016-0052-x) contains supplementary material, which is available to authorized users.

Liver X receptor β is essential for the differentiation of radial glial cells to oligodendrocytes in the dorsal cortex

Several psychiatric disorders are associated with aberrant white matter development, suggesting oligodendrocyte and myelin dysfunction in these diseases. There are indications that radial glial cells (RGCs) are involved in initiating myelination, and may contribute to the production of oligodendrocyte progenitor cells (OPCs) in the dorsal cortex. Liver X receptors (LXRs) are involved in maintaining normal myelin in the central nervous system (CNS), however, their function in oligodendrogenesis and myelination is not well understood. Here, we demonstrate that loss of LXRβ function leads to abnormality in locomotor activity and exploratory behavior, signs of anxiety and hypomyelination in the corpus callosum and optic nerve, providing in vivo evidence that LXRβ deletion delays both oligodendrocyte differentiation and maturation. Remarkably, along the germinal ventricular zone-subventricular zone and corpus callosum there is reduced OPC production from RGCs in LXRβ(-/-) mice. Conversely, in cultured RGC an LXR agonist led to increased differentiation into OPCs. Collectively, these results suggest that LXRβ, by driving RGCs to become OPCs in the dorsal cortex, is critical for white matter development and CNS myelination, and point to the involvement of LXRβ in psychiatric disorders.

Subnanometre resolution in three-dimensional magnetic resonance imaging of individual dark spins

Magnetic resonance imaging (MRI) has revolutionized biomedical science by providing non-invasive, three-dimensional biological imaging. However, spatial resolution in conventional MRI systems is limited to tens of micrometres, which is insufficient for imaging on molecular scales. Here, we demonstrate an MRI technique that provides subnanometre spatial resolution in three dimensions, with single electron-spin sensitivity. Our imaging method works under ambient conditions and can measure ubiquitous 'dark' spins, which constitute nearly all spin targets of interest. In this technique, the magnetic quantum-projection noise of dark spins is measured using a single nitrogen-vacancy (NV) magnetometer located near the surface of a diamond chip. The distribution of spins surrounding the NV magnetometer is imaged with a scanning magnetic-field gradient. To evaluate the performance of the NV-MRI technique, we image the three-dimensional landscape of electronic spins at the diamond surface and achieve an unprecedented combination of resolution (0.8 nm laterally and 1.5 nm vertically) and single-spin sensitivity. Our measurements uncover electronic spins on the diamond surface that can potentially be used as resources for improved magnetic imaging. This NV-MRI technique is immediately applicable to diverse systems including imaging spin chains, readout of spin-based quantum bits, and determining the location of spin labels in biological systems.

Understanding the chain fountain

If a chain is initially at rest in a beaker at a height h 1 above the ground, and the end of the chain is pulled over the rim of the beaker and down towards the ground and then released, the chain will spontaneously ‘flow’ out of the beaker under gravity. Furthermore, the beads do not simply drag over the edge of the beaker but form a fountain reaching a height h 2 above it. We show that the formation of a fountain requires that the beads come into motion not only by being pulled upwards by the part of the chain immediately above the pile, but also by being pushed upwards by an anomalous reaction force from the pile of stationary chain. We propose possible origins for this force, argue that its magnitude will be proportional to the square of the chain velocity and predict and verify experimentally that h 2 ∝ h 1 .

Involvement of estrogen receptor β in maintenance of serotonergic neurons of the dorsal raphe

The serotonergic neurons of the dorsal raphe (DR) nucleus in the CNS are involved in fear, anxiety and depression. Depression and anxiety occur quite frequently in postmenopausal women, but estrogen replacement to correct these CNS disorders is at present not favored because estrogen carries with it an increased risk for breast cancer. Serotonin synthesis, release and reuptake in the DR are targets of pharmaceuticals in the treatment of depression. In the present study we have examined by immunohistochemistry, the expression of two nuclear receptors, that is, the estrogen receptors ERα and ERβ. We found that ERβ but not ERα is strongly expressed in the DR and there is no sex difference and no change with ageing in the number of tryptophan hydroxylase (TPH)-positive neurons in the DR of wild-type (WT) mice. However, in ovariectomized (OVX) WT and in ERβ(-/-) mice, there was a marked reduction in the number of TPH-positive normal-looking neurons and a marked increase in TPH-positive spindle-shaped cells. These neuronal changes were prevented in mice 1-3 weeks (but not 10 weeks) after OVX by the selective ERβ agonist, LY3201, given as continuous release pellets for 3 days. The ERβ agonist had no effects on glucose homeostasis. Thus, the onset of action of the ERβ agonist is rapid but there is a limited window in time after estrogen loss when the drug is useful. We conclude that, rather than estradiol, ERβ agonists could be useful pharmaceuticals in maintaining functional DR neurons to treat postmenopausal depression.

Angular deficits in flat space: remotely controllable apertures in nematic solid sheets

Recent attention has been given to the realization of angular deficits and surpluses in the local ground-state geometry of thin sheets of nematic solids as out-of-plane deformations. Such systems exhibit conical or anti-conical curvature sites, or possibly arrays of such polyhedral corners, in order to satisfy the material's spontaneous strain-generated metric requirements. Here, we turn the angular deficit requirement on its head, and show theoretically and experimentally that by appropriately altering the topology of the initially flat sheet—for example, by cutting it in carefully chosen regions—the same angular deficits and surpluses may manifest simply in-plane by changing the geometry of the cut region. Such a mechanism offers a route to apertures or arrays of apertures that may be reversibly opened and closed by applying spontaneous strain with heat, light or chemical potential.

Mechanical frustration and spontaneous polygonal folding in active nematic sheets

We analyze the bending response to light or heat of a solid nematic disk with a director twisted from being radial on the upper surface to be azimuthal on the lower. We find a number of curl lobes determined purely by the geometry of the mechanical frustration that arises during the response.

Neurotransmitters in the CNS of the vitamin D deficient, hypocalcemic rat

Sprague-Dawley rats were made chronically vitamin D deficient (VDD) and hypocalcemic, or VDD and normocalcemic. Rickets, severely reduced body weight, hair shedding, lethargy, muscular paralysis and a high mortality rate are characteristic features of the male VDD/hypocalcemic animals. An assessment was made of the neurotransmitter status of the VDD-hypocalcemic and VDD/normocalcemic animals. In nine out of eleven regions of the CNS studied, the increase in GABA induced by the GABA-T inhibitor ethanolamine sulphate (EOS) was significantly higher (P < 0.05 or P < 0.01) in the VDD/hypocalcemic group vs the normal controls. However, the EOS-mediated increase in GABA was similar in the VDD/normocalcemic and normal control groups suggesting that hypocalcemia is the likely cause of the increased GABA turnover in the VDD/hypocalcemic rats. Glutamate, dopamine, dihydroxyphenylacetic acid, homovanillic acid and norepinephrine, were also analysed in representative regions of the CNS. Their concentrations were not affected in any consistent way in either the VDD/hypocalcemic group or VDD/normocalcemic groups vs the normal controls. Therefore, despite the chronic, severe pathology induced by vitamin D deficiency and hypocalcemia, the neurotransmitters studied appeared to be normal in the CNS of these animals.

Mechanical and optical bending of nematic elastomer cantilevers

We describe how bend imposed on a nematic elastomer cantilever can be accommodated with little or no internal stress by the director rotating. Thus, for a range of imposed curvatures that we calculate, there is no countertorque. Equally nonclassically, in such beams there is associated transverse curvature (clasticity). When instead bend is induced by illumination which causes spatially dependent contractions, director rotation can also act to vitiate stresses, but then (anti-)clasticity and its suppression has to be resolved, sometimes at the cost of stress creation.

Programming of adipose tissue miR-483-3p and GDF-3 expression by maternal diet in type 2 diabetes

Nutrition during early mammalian development permanently influences health of the adult, including increasing the risk of type 2 diabetes and coronary heart disease. However, the molecular mechanisms underlying such programming are poorly defined. Here we demonstrate that programmed changes in miRNA expression link early-life nutrition to long-term health. Specifically, we show that miR-483-3p is upregulated in adipose tissue from low-birth-weight adult humans and prediabetic adult rats exposed to suboptimal nutrition in early life. We demonstrate that manipulation of miR-483-3p levels in vitro substantially modulates the capacity of adipocytes to differentiate and store lipids. We show that some of these effects are mediated by translational repression of growth/differentiation factor-3, a target of miR-483-3p. We propose that increased miR-483-3p expression in vivo, programmed by early-life nutrition, limits storage of lipids in adipose tissue, causing lipotoxicity and insulin resistance and thus increasing susceptibility to metabolic disease.

Blueprinting nematic glass: systematically constructing and combining active points of curvature for emergent morphology

Much recent progress has been made in the study of nematic solids, both glassy and elastomeric, particularly in the realm of stress-free, defect-driven deformation in thin sheets of material. In this paper we consider a subset of texture domains in nematic glasses that are simple to synthesize, and explore the ways that these simple domains may be compatibly combined to yield analogs of the traditional smooth disclination defect textures seen in standard liquid crystals. We calculate the deformation properties of these constructed textures, and show that, subject to the compatibility constraints of the construction, these textures may be further combined to achieve shape blueprinting of three-dimensional structures from flat sheets.

A sensitive and specific phenotypic assay for detection of metallo-β-lactamases and KPC in Klebsiella pneumoniae with the use of meropenem disks supplemented with aminophenylboronic acid, dipicolinic acid and cloxacillin

Enterobacteriaceae producing carbapenemases, such as KPC or metallo-β-lactamases (MBLs), have emerged on several continents. Phenotypic tests are urgently needed for their rapid and accurate detection. A novel carbapenemase detection test, comprising a meropenem disk, and meropenem disks supplemented with 730 μg of EDTA, 1000 μg of dipicolinic acid (DPA), 600 μg of aminophenylboronic acid (APBA), or 750 μg of cloxacillin, was evaluated against Klebsiella pneumoniae isolates with KPC (n = 34), VIM (n = 21), IMP (n = 4) or OXA-48 (n = 9) carbapenemases, and carbapenem-resistant Enterobacteriaceae with porin loss in combination with an extended-spectrum β-lactamase (ESBL) (n = 9) or AmpC hyperproduction (n = 5). Commercially available diagnostics tablets from Rosco containing meropenem and the same inhibitors as described above (except EDTA) were also evaluated. An increased meropenem inhibition zone was sought in the presence of each added β-lactamase inhibitor. APBA had excellent sensitivity for detecting K. pneumoniae with KPC enzymes. Isolates with combined AmpC hyperproduction and porin loss were also positive in the APBA test but, unlike KPC producers, showed cloxacillin synergy. Both DPA and EDTA had excellent sensitivity for detection of MBL-producing K. pneumoniae. However, EDTA showed poor specificity, with positive results noted for 1/9 ESBL-producing isolates, for 4/34 KPC-producing isolates, and for 4/9 OXA-48-producing isolates, whereas all of these were negative when DPA was used. The in-house test distinguished accurately between several different mechanisms mediating reduced susceptibility to carbapenems in Enterobacteriaceae. The commercial combination tablets from Rosco performed similarly to the in-house test, with the exception of one false-positive MBL result and one false-positive KPC result among the OXA-48 producers.

Gaussian curvature from flat elastica sheets

We discuss methods of reversibly inducing non-developable surfaces from flat sheets of material at the micro-scale all the way to macroscopic objects. We analyse the elastic ground states of a nematic glass in the membrane approximation as a function of temperature for disclination defects of topological charge +1. An aim is to show that by writing an appropriate director field into such a solid, one could create a surface with Gaussian curvature, dynamically switchable from flat sheets while avoiding stretch energy. In addition to the prospect of programmable structures, such surfaces offer actuation via stretch in thin systems since when illumination is subsequently removed, unavoidable stretches return.

Anisotropic response of glassy splay-bend and twist nematic cantilevers to light and heat

A gradient of director through the thickness of a nematic glass cantilever gives a gradient in the large distortions such materials suffer in response to temperature or illumination changes. We first sketch, within isotropic elasticity, how such gradients cause these cantilevers to respond by bending. We then derive the response within the anisotropic elasticity expected for uniaxial solids. Because, in general, spontaneously bending cantilevers have regions of elongation and contraction (with respect to their neutral state), internal stresses are generated, the magnitude of which depends on the anisotropic, fourth rank modulus tensor and in particular on its local alignment arising from the director's spatial distribution. We show that despite elastic complexity, bend is simply linear in the anisotropy of thermo-optical response, with a slope depending on the structure of the modulus tensor, justifying the previous literature on spontaneously bending cantilevers. We also explicitly consider two important director distributions--splay-bend and twist. Splay-bend cantilevers have no anticlastic (double-bend, saddle) response in the isotropic case or for some values of the anisotropic modulus tensor. Twist cantilevers have maximal anticlasticity in the isotropic case which we show to be weakly modified by anisotropy of elastic moduli.

Activity of chequerboard combinations of ceftaroline and NXL104 versus beta-lactamase-producing Enterobacteriaceae

BACKGROUND

Ceftaroline is a novel oxyimino-cephalosporin, strongly active against methicillin-resistant staphylococci and pneumococci. It is active against Enterobacteriaceae too, but is labile to common beta-lactamases, including AmpC and extended-spectrum types. To counteract these enzymes, ceftaroline is also being developed combined with NXL104, a beta-lactamase inhibitor.

METHODS

Chequerboard MIC titrations were performed to determine the NXL104 concentrations needed to protect ceftaroline against beta-lactamase-producing Enterobacteriaceae, most of them with ceftaroline MICs >16 mg/L.

RESULTS

All of 60 extended-spectrum beta-lactamase (ESBL) producers were susceptible to ceftaroline + NXL104, 1 + 1 mg/L, as were 5/5 Klebsiella oxytoca with high-level K1 enzyme. Among 30 Enterobacteriaceae with high-level chromosomal AmpC, 18 were susceptible at 1 + 1 mg/L, 28 at 1 + 4 mg/L and all at 4 + 4 mg/L; among 10 with plasmid AmpC enzymes, nine were susceptible at 1 + 1 mg/L and all at 1 + 4 mg/L. None of 10 isolates with combinations of AmpC or ESBL and impermeability was susceptible at 1 + 1 mg/L, but nine were susceptible at 1 + 4 mg/L and all at 4 + 4 mg/L. Among 12 with KPC carbapenemases, only two were susceptible at 1 + 1 mg/L, compared with 10 at 1 + 4 mg/L and 11 at 4 + 4 mg/L; 8/8 with OXA-48 carbapenemase were susceptible at 1 + 1 mg/L whilst 0/5 with metallo-beta-lactamases were inhibited by ceftaroline + NXL104, even at 8 + 4 mg/L. NXL104 potentiated the activity of ceftaroline against many ESBL- and AmpC-negative isolates for which ceftaroline MICs were 1-4 mg/L but not those for which MICs were < or = 0.5 mg/L, probably reflecting the slight lability of this cephalosporin to classical penicillinases, which were present in the former group but not the latter.

CONCLUSIONS

At concentrations of < or = 4 mg/L, NXL104 protected ceftaroline against all relevant beta-lactamases except metalloenzymes.

Interaction of MnO and ZnO nanomaterials with biomedically important proteins and cells

Zinc and manganese nanomaterials may have potential for biomedical nanotechnology. Here first generation Zn and Mn oxide nanomaterials were prepared as determined by XRD. Transmission electron microscopy confirmed their nanoscale in two dimensions and revealed a rod or belt-like morphology for MnO or ZnO respectively. Association of MnO and ZnO to three model biomedically important proteins (albumin, protamine and thrombin) has been characterized by ultra-violet and dynamic laser light spectroscopy, UVS and DLLS respectively. UVS demonstrated a concentration-dependent loss of protein from the supernatant upon sedimentation of MnO or ZnO. Shifts in the surface charge of the MnO or ZnO by DLLS confirmed the protein's adsorption to the surface. MnO and ZnO were incubated with live human cells in culture (HeLa, A375 or 1321N1). A marked difference was observed for the two nanomaterials behavior in cell culture where the MnO could be discerned associating at the cell surface whereas the ZnO caused the cells to exhibit a rounded up morphology. Trypan blue dye exclusion studies demonstrated cytotoxicity of the ZnO at high concentrations 62.5-31.5 microg/mL whereas surprisingly the MnO demonstrated no cytotoxicity at any of the concentrations tested.

Curvature in nematic elastica responding to light and heat

Nematic elastic bodies can develop a gradient of response to heat, light and other stimuli. They then bend and develop curvature in a complex manner depending on director field distributions, on whether they are monodomain or polydomain structures and on linear or nonlinear light absorptive processes. In each case, we derive the general weak response where bend in each direction is treated independently of that in others. In a subsequent paper, we address the reverse phenomenon, that is of strong spontaneous distortion leading to curvature suppression.

Suppression of curvature in nematic elastica

Nematic elastic bodies can develop a gradient of response to heat, light and other stimuli. They then bend and develop curvature in a complex manner. Using the results for a general weak response derived in the preceding paper, we solve for strong spontaneous distortion where bend in one direction causes stretch in another direction if that too is bending, and vice versa. Since stretch is elastically expensive, it can cause suppression of one of the bends (we determine which), thus eliminating Gaussian curvature. This is the spontaneous distortion equivalent of the classical Lamb calculation of the anti-clastic suppression when large distortions are imposed in classical elastica. In practice, spontaneously deforming nematic solids, e.g. in actuation, are in this strong bend limit.

Supersoft elasticity in polydomain nematic elastomers

We consider the equilibrium stress-strain behavior of polydomain liquid crystal elastomers (PLCEs). We show that there is a fundamental difference between PLCEs cross-linked in the high temperature isotropic and low temperature aligned states. PLCEs cross-linked in the isotropic state then cooled to an aligned state will exhibit extremely soft elasticity (confirmed by recent experiments) and ordered director patterns characteristic of textured deformations. PLCEs cross-linked in the aligned state will be mechanically much harder and characterized by disclination textures.

Mechanical switching of ferroelectric rubber

At the A to C transition, smectic elastomers have recently been observed to undergo approximately 35% spontaneous shear strains. We first explicitly describe how strains of up to twice this value could be mechanically or electrically induced in Sm-C elastomers by rotation of the director on a cone around the layer normal with an elastic cost dependent on constraints. Second, for typical sample geometries, we give the various microstructures in Sm-C akin to those seen in nematic elastomers under distortions with constraints. It is possible to give explicit results for the nature of the textures. Chiral Sm-C elastomers are ferroelectric. We calculate how the polarization could be mechanically reversed by large, hard, or soft strains of the rubber depending upon sample geometry.

Spatiotemporal dynamics of the expression of estrogen receptors in the postnatal mouse brain

This study reports on the spatiotemporal dynamics of the expression of estrogen receptors (ERs) in the mouse central nervous system (CNS) during the early postnatal and the peripubertal period. At postnatal day 7 (P7), neurons with strong nuclear immunostaining for both ERalpha and ERbeta1 were widely distributed throughout the brain. Sucrose density gradient sedimentation followed by western blotting supported the histochemical evidence for high levels of both ERs at P7. Over the following 2 days, there was a rapid downregulation of ERs. At P9, ERalpha expression was visible only in the hypothalamic area. Decline in ERbeta1 expression was slower than that of ERalpha, and ERalpha-negative, ERbeta1-positive cells were observed in the dentate gyrus and walls of third ventricle. Between P14 and P35, ERs were undetectable except for the hypothalamic area. As before P7, the ovary does not produce estrogen but does produce 5alpha-androstane-3beta, 17beta-diol (3betaAdiol), an estrogenic metabolite of dihydrotestosterone, we examined the effects of high levels of 3betaAdiol in the postnatal period. We used CYP7B1 knockout mice which cannot hydroxylate and inactivate 3betaAdiol. The brains of these mice are abnormally large with reduced apoptosis. In the early postnatal period, there was 1-week delay in the timing of the reduction in ER expression in the brain. These data reveal that the time when ERs might be activated in the brain is limited to the first 8 postnatal days. In addition, the importance of aromatase has to be reconsidered as the alternative estrogen, 3betaAdiol, is important in neuronal function in the postnatal brain.