Vitamin D3 inhibits p38 MAPK and senescence-associated inflammatory mediator secretion by senescent fibroblasts that impacts immune responses during ageing

Vitamin D3 replacement in older insufficient adults significantly improves their antigen-specific varicella zoster virus (VZV) cutaneous immunity. However, the mechanisms involved in this enhancement of cutaneous immunity are not known. Here, we show for the first time that vitamin D3 blocks the senescence-associated secretory phenotype (SASP) production by senescent fibroblasts by partially inhibiting the p38 MAPK pathway. Furthermore, transcriptomic analysis of skin biopsies from older subjects after vitamin D3 supplementation shows that vitamin D3 inhibits the same inflammatory pathways in response to saline as the specific p38 inhibitor, losmapimod, which also enhances immunity in the skin of older subjects. Vitamin D3 supplementation therefore may enhance immunity during ageing in part by blocking p38 MAPK signalling and in turn inhibit SASP production from senescent cells in vivo.

Speech markers to predict and prevent recurrent episodes of psychosis: A narrative overview and emerging opportunities

Preventing relapse in schizophrenia improves long-term health outcomes. Repeated episodes of psychotic symptoms shape the trajectory of this illness and can be a detriment to functional recovery. Despite early intervention programs, high relapse rates persist, calling for alternative approaches in relapse prevention. Predicting imminent relapse at an individual level is critical for effective intervention. While clinical profiles are often used to foresee relapse, they lack the specificity and sensitivity needed for timely prediction. Here, we review the use of speech through Natural Language Processing (NLP) to predict a recurrent psychotic episode. Recent advancements in NLP of speech have shown the ability to detect linguistic markers related to thought disorder and other language disruptions within 2-4 weeks preceding a relapse. This approach has shown to be able to capture individual speech patterns, showing promise in its use as a prediction tool. We outline current developments in remote monitoring for psychotic relapses, discuss the challenges and limitations and present the speech-NLP based approach as an alternative to detect relapses with sufficient accuracy, construct validity and lead time to generate clinical actions towards prevention.

The impact of electronic pathways and digital systems on neck of femur fracture outcomes globally: a systematic review

INTRODUCTION

Electronic pathways (e-pathways) and digital systems are novel interventions with several uses in healthcare, ranging from clinical decision support systems to checklists for care delivery. Their application in the management of neck of femur (NOF) fractures is evolving and they may play a key role in facilitating improvements in care delivery. The primary aim of this review was to outline the impact of e-pathways/digital systems on NOF fracture outcomes.

METHODS

A systematic literature search was performed using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A total of 698 citations were evaluated, of which 38 passed the inclusion/exclusion criteria. Six studies were then finalised following full-text review. Heterogenous data meant a narrative synthesis was undertaken. Risk of bias for each paper was assessed using the Downs and Black scale.

RESULTS

A statistically significant improvement was demonstrated for time to theatre (3/6 studies), length of hospital stay (2/6 studies) and secondary fracture prevention (2/6 studies). Although postoperative delirium and mortality improved with the introduction of e-pathways/digital systems, statistical significance was not achieved. No outcome measures were adversely affected.

CONCLUSIONS

This systematic review of the literature demonstrates that e-pathways and digital systems are promising novel interventions, displaying a significant positive impact on several NOF fracture outcomes. Owing to the novel nature of e-pathways and digital systems in orthopaedics, a limited number of studies were identified for review, each with variable study design. More high quality homogenous prospective cohort studies with a standardised primary outcome measure are required for more definitive conclusions of efficacy to be drawn.

Optimization of biogas potential using kinetic models, response surface methodology, and instrumental evidence for biodegradation of tannery fleshings during anaerobic digestion

The optimization of the batch size experiment was run for a hydraulic retention time of 45 days using proteolytic enzyme pretreatment. The highest amounts of biogas were produced in comparison to conventional BDS (25:75), which is not processed with enzymes, and there was an increase in the biogas generation of 13.9 and 18.57%. The kinetic models show the goodness of fit between 0.993 and 0.998 and the correlation coefficient's value domain was [-1, 1] from a statistical perspective. The Box-Behnken design was carried out using the response surface methodology at different levels of independent parameters to optimize the process. Different instruments were evaluated to determine the chemical structure change and the contamination of the different treatments and the raw sample of tannery fleshings was determined. Thermogravimetric analysis was conducted to determine the loss of weight on thermal degradation. The Fourier transform infrared spectrometry was carried out to determine the different functional groups, such as -OH, -CH, -NH, and C-O, present in the samples of tannery fleshings. Scanning electron microscopy and energy dispersive X-ray analysis were carried out to determine the morphological alterations in the substrate, digestate, enzyme-pretreated fleshings, and the chemical composition of samples.

From monomer to micelle: a facile approach to the multi-step synthesis of block copolymers via inline purification

A one-pass continuous flow strategy to form block copolymer nanoaggregates directly from monomers is presented. A key development towards such a sophisticated continuous flow setup is a significant improvement in continuous flow dialysis. Often impurities or solvent residues from polymerizations must be removed before block extensions or nanoaggregate formation can be carried out, typically disrupting the workflow. Hence, inline purification systems are required for fully continuous operation and eventual high throughput operation. An inline dialysis purification system is developed and exemplified for amphiphilic block copolymer synthesis from thermal and photoiniferter reversible addition fragmentation chain transfer (RAFT) polymerization. The inline dialysis system is found to be significantly faster than conventional batch dialysis and the kinetics are found to be very predictable with a diffusion velocity coefficient of 4.1 × 10-4 s-1. This is at least 4-5 times faster than conventional dialysis. Moreover, the newly developed setup uses only 57 mL of solvent for purification per gram of polymer, again reducing the required amount by almost an order of magnitude compared to conventional methods. Methyl methacrylate (MMA) or butyl acrylate (BA) was polymerized in a traditional flow reactor as the first block via RAFT polymerization, followed by a 'dialysis loop', which contains a custom-built inline dialysis device. Clearance of residual monomers is monitored via in-line NMR. The purified reaction mixture can then be chain extended in a second reactor stage to obtain block copolymers using poly(ethylene glycol) methyl ether acrylate (PEGMEA) as the second monomer. In the last step, nano-objects are created, again from flow processes. The process is highly tuneable, showing for the chosen model system a variation in nanoaggregate size from 34 nm to 188 nm.

More than words: Speech production in first-episode psychosis predicts later social and vocational functioning

Background

Several disturbances in speech are present in psychosis; however, the relationship between these disturbances during the first-episode of psychosis (FEP) and later vocational functioning is unclear. Demonstrating this relationship is critical if we expect speech and communication deficits to emerge as targets for early intervention.

Method

We analyzed three 1-min speech samples using automated speech analysis and Bayes networks in an antipsychotic-naive sample of 39 FEP patients and followed them longitudinally to determine their vocational status (engaged or not engaged in employment education or training-EET vs. NEET) after 6-12 months of treatment. Five baseline linguistic variables with prior evidence of clinical relevance (total and acausal connectives use, pronoun use, analytic thinking, and total words uttered in a limited period) were included in a Bayes network along with follow-up NEET status and Social and Occupational Functioning Assessment Scale (SOFAS) scores to determine dependencies among these variables. We also included clinical (Positive and Negative Syndrome Scale 8-item version (PANSS-8)), social (parental socioeconomic status), and cognitive features (processing speed) at the time of presentation as covariates.

Results

The Bayes network revealed that only total words spoken at the baseline assessment were directly associated with later NEET status and had an indirect association with SOFAS, with a second set of dependencies emerging among the remaining linguistic variables. The primary (speech-only) model outperformed models including parental socioeconomic status, processing speed or both as latent variables.

Conclusion

Impoverished speech, even at subclinical levels, may hold prognostic value for functional outcomes and warrant consideration when providing measurement based care for first-episode psychosis.

Synthesis of carbon molecular sieves from agricultural residues: Status, challenges and prospects

Adsorption is the most promising technology used in the gas separation and purification process. The key success of this technology relies on the selection of an adsorbent. Activated carbon and zeolites are the most commonly used adsorbents in the separation of particular gas from gaseous mixtures. Activated carbon deriving from fossil and biomass-based resources has wide pore size distribution and thereby results in lower selectivity. Whereas, zeolites synthesized from natural minerals are expensive which increases the cost of the purification process. Taking this into concern, the quest for synthesizing low-cost and effective adsorbents has gained greater attention in recent years. Carbon Molecular Sieves (CMSs), are considered as an attractive alternative to replace the conventional adsorbents. Furthermore, CMSs exhibit higher selectivity and adsorption capacity, due to their narrow micropore size distribution (0.3-0.5 nm). CMSs are synthesized from any organic carbonaceous precursor with low inorganic content. Since most of the agricultural residues fall under this category, they can be used as a feedstock for CMSs production. The synthesis of CMSs involves three stages: carbonization, activation, and pore modification. In this review, physicochemical characteristics of various agricultural residues, the effects of carbonization process parameters, activation methods, and pore modification techniques adopted for producing CMSs are comprehensively discussed. The effect of deposition temperature, time, and flow rate of depositing agent on pore characteristics of CMSs is briefed. The prospects and challenges in CMSs production are also studied. The insights in this review provide guidelines for synthesizing CMSs from agro-residues.

Forced symmetry breaking as a mechanism for rogue bursts in a dissipative nonlinear dynamical lattice

We propose an alternative to the standard mechanisms for the formation of rogue waves in a nonconservative, nonlinear lattice dynamical system. We consider an ordinary differential equation (ODE) system that features regular periodic bursting arising from forced symmetry breaking. We then connect such potentially exploding units via a diffusive lattice coupling and investigate the resulting spatiotemporal dynamics for different types of initial conditions (localized or extended). We find that in both cases, particular oscillators undergo extremely fast and large amplitude excursions, resembling a rogue wave burst. Furthermore, the probability distribution of different amplitudes exhibits bimodality, with peaks at both vanishing and very large amplitude. While this phenomenology arises over a range of coupling strengths, for large values thereof the system eventually synchronizes and the above phenomenology is suppressed. We use both distributed (such as a synchronization order parameter) and individual oscillator diagnostics to monitor the dynamics and identify potential precursors to large amplitude excursions. We also examine similar behavior with amplitude-dependent diffusive coupling.

Biogenesis of Zirconium Oxide Nanoparticles by Momordica charantia (Bitter Gourd) Leaf Extract: Characterization and their Antimicrobial Activities

Aims: To determine the antimicrobial activity of zirconium oxide nanoparticles (ZrO2 NPs) synthesized by Justicia Adhatoda leaf extract. Study Design: Synthesis, characterization and antibacterial activity determination of ZrO2 NPs. Place and Duration of Study: PG and Research Department of Chemistry, V.O.Chidambaram College, Tuticorin, Tamilnadu, India, between April 2020 and April 2021. Methodology: Justicia adhatoda leaf extract was used to synthesize ZrO2 NPs. UV-Visible spectroscopy was used to characterize ZrO2 NPs. Using Fourier transform infrared spectroscopy, the function of biomolecules in plant extract in the synthesis of ZrO2 NPs was identified. XRD was used to determine the particle size of nanparticles. ZrO2 NPs were evaluated for antimicrobial activity. Results: The synthesis of ZrO2 NPs was clearly visible in an absorbance band at 321 nm in the UV–visible spectrum. The absorption peak of ZrO2 NPs in the FTIR was 880 cm-1, confirming the Zr–O vibrational mode in ZrO2 NPs. As evidenced by XRD measurements, the average crystallite size of ZrO2 NPs was found to be 40 nm. The biosynthesized ZrO2 NPs were found to have potent antibacterial action against Escherichia coli bacteria and Staphylococcus aureus bacteria. Conclusion: ZrO2 NPs mediated by Justicia adhatoda leaf extract have demonstrated substantial antibacterial activity

Antibacterial Activity of CuO Nanoparticles Synthesized by Justicia adhatoda Leaf Extract

Aims: To determine the antibacterial activity of CuO nanoparticles (CuO NPs) synthesized by Justicia adhatoda leaf extract. Study Design:  Synthesis, characterization and antibacterial activity determination of CuO NPs. Place and Duration of Study: PG and Research Department of Chemistry, V.O.Chidambaram College, Tuticorin, Tamilnadu, India, between April 2019 and April 2020. Methodology: CuO NPs were synthesised using Justicia adhatoda leaf extract. UV-Visible spectroscopy was used to characterize CuO NPs. The role of biomolecules in plant extract in the formation of the CuO NPs was identified using Fourier transform infrared spectroscopy. The particle size and lattice properties of CuO NPs were determined using XRD. The surface morphology of CuO NPs was studied using SEM. The presence of Cu and O in CuO NPs was confirmed using EDAX analysis. Bacterial antimicrobial activity was investigated. Results: An absorbance band at 285 nm in the UV–visible spectrum clearly revealed the formation of CuO NPs. In the FTIR, CuO NPs had a distinct absorption peak at 608 cm-1, confirming metal–oxygen stretching in Cu-O nanostructures. The presence of crystalline CuO NPs was confirmed by XRD patterns, and they were found to be spherical in shape with a size range of 23.21–37.57 nm, as evidenced by FESEM. The biosynthesized CuO NPs exhibited a strong antibacterial activity against Staphylococcus epidermidis and Bacillus cereus bacteria. Conclusion: Justicia adhatoda leaf extract mediated CuO NPs have shown significant antibacterial activity and they are considered potent antibacterial agents.

Kinetic and thermodynamic study of finger millet straw pyrolysis through thermogravimetric analysis

Pyrolysis kinetics of finger millet straw (FMS) was studied using a thermogravimetric analyzer under N₂ environment. Physico-chemical characteristics of FMS were comparable with the established pyrolysis feedstocks. FMS thermally decomposed in three stages: drying, active pyrolysis, and char formation resulting in 70.37% overall weight loss. Average activation energy determined by Friedman and Starink methods was 177.80 and 172.18 kJ mol^-1, respectively. Frequency factor was found to be in the range of 10⁸ to 10²⁹. Reaction pathway followed diffusion, nucleation, and order-based mechanisms. The pyrolysis of FMS was characterized by empirical modeling and predicted well with model adequacy of 97.55%. Thermodynamic parameters (ΔG and ΔH) revealed the non-spontaneous and endothermic nature of FMS pyrolysis. The biochar obtained at multiple heating rates were characterized for its physicochemical, functional, and morphological characteristics. The kinetic and thermodynamic analyses illustrate the feasibility of exploiting finger millet straw as a pyrolysis feedstock to derive biofuels.

Density Distribution in Soft Matter Crystals and Quasicrystals

The density distribution in solids is often represented as a sum of Gaussian peaks (or similar functions) centered on lattice sites or via a Fourier sum. Here, we argue that representing instead the logarithm of the density distribution via a Fourier sum is better. We show that truncating such a representation after only a few terms can be highly accurate for soft matter crystals. For quasicrystals, this sum does not truncate so easily, nonetheless, representing the density profile in this way is still of great use, enabling us to calculate the phase diagram for a three-dimensional quasicrystal-forming system using an accurate nonlocal density functional theory.

Resuming elective hip and knee arthroplasty in the COVID-19 era: a unique insight into patient risk aversion and sentiment

INTRODUCTION

There has been guidance from the government and orthopaedic community on how best to ensure the safety of our patients and colleagues as we recommence elective surgery in the UK. The primary aim was to determine what proportion of patients feel they should proceed with their elective hip and knee arthroplasty surgery during the COVID-19 climate. The secondary aim was to investigate what variables affected this decision.

METHODS

Patient information from a single surgeon's waiting list in a district general hospital were recorded. A standardised telephone discussion was had with all the patients noting the severity of pain and the potential reasons for not wanting to proceed with surgery.

RESULTS

A total of 70.6% (96/136) of patients wished to proceed with surgery; 29.4% (40/136) did not wish to proceed. The decision to proceed with surgery was not correlated with sex, American Society of Anesthesiologists grade or COVID-19 risk. Those who wished to proceed with surgery had a mean age of 68.5 years while those who did not had a mean age of 72.4 years (P = 0.03). Within the matched subgroups, patients under the age of 70 years were more willing to proceed with primary hip arthroplasty surgery (87.9%) compared with primary knee arthroplasty surgery (57.1%; P = 0.007); 75% of the patients who did not wish to proceed with surgery expressed concerns about perioperative COVID-19 infection.

CONCLUSION

There is a significant proportion of arthroplasty patients on waiting lists who would be willing to accept the increased risks associated with COVID-19 to undergo surgery on an urgent basis. The subgroup of younger patients awaiting hip arthroplasty is more willing than those awaiting knee arthroplasty to proceed with surgery.

Buckling instabilities and spatio-temporal dynamics of active elastic filaments

Biological filaments driven by molecular motors tend to experience tangential propulsive forces also known as active follower forces. When such a filament encounters an obstacle, it deforms, which reorients its follower forces and alters its entire motion. If the filament pushes a cargo, the friction on the cargo can be enough to deform the filament, thus affecting the transport properties of the cargo. Motivated by cytoskeletal filament motility assays, we study the dynamic buckling instabilities of a two-dimensional slender elastic filament driven through a dissipative medium by tangential propulsive forces in the presence of obstacles or cargo. We observe two distinct instabilities. When the filament's head is pinned or experiences significant translational but little rotational drag from its cargo, it buckles into a steadily rotating coiled state. When it is clamped or experiences both significant translational and rotational drag from its cargo, it buckles into a periodically beating, overall translating state. Using minimal analytically tractable models, linear stability theory and fully nonlinear computations, we study the onset of each buckling instability, characterize each buckled state, and map out the phase diagram of the system. Finally, we use particle-based Brownian dynamics simulations to show our main results are robust to moderate noise and steric repulsion. Overall, our results provide a unified framework to understand the dynamics of tangentially propelled filaments and filament-cargo assemblies.

Which Wave Numbers Determine the Thermodynamic Stability of Soft Matter Quasicrystals?

For soft matter to form quasicrystals an important ingredient is to have two characteristic length scales in the interparticle interactions. To be more precise, for stable quasicrystals, periodic modulations of the local density distribution with two particular wave numbers should be favored, and the ratio of these wave numbers should be close to certain special values. So, for simple models, the answer to the title question is that only these two ingredients are needed. However, for more realistic models, where in principle all wave numbers can be involved, other wave numbers are also important, specifically those of the second and higher reciprocal lattice vectors. We identify features in the particle pair interaction potentials that can suppress or encourage density modes with wave numbers associated with one of the regular crystalline orderings that compete with quasicrystals, enabling either the enhancement or suppression of quasicrystals in a generic class of systems.

Deriving phase field crystal theory from dynamical density functional theory: Consequences of the approximations

Phase field crystal (PFC) theory is extensively used for modeling the phase behavior, structure, thermodynamics, and other related properties of solids. PFC theory can be derived from dynamical density functional theory (DDFT) via a sequence of approximations. Here, we carefully identify all of these approximations and explain the consequences of each. One approximation that is made in standard derivations is to neglect a term of form ∇·[n∇Ln], where n is the scaled density profile and L is a linear operator. We show that this term makes a significant contribution to the stability of the crystal, and that dropping this term from the theory forces another approximation, that of replacing the logarithmic term from the ideal gas contribution to the free energy with its truncated Taylor expansion, to yield a polynomial in n. However, the consequences of doing this are (i) the presence of an additional spinodal in the phase diagram, so the liquid is predicted first to freeze and then to melt again as the density is increased; and (ii) other periodic structures, such as stripes, are erroneously predicted to be thermodynamic equilibrium structures. In general, L consists of a nonlocal convolution involving the pair direct correlation function. A second approximation sometimes made in deriving PFC theory is to replace L with a gradient expansion involving derivatives. We show that this leads to the possibility of the density going to zero, with its logarithm going to -∞ while being balanced by the fourth derivative of the density going to +∞. This subtle singularity leads to solutions failing to exist above a certain value of the average density. We illustrate all of these conclusions with results for a particularly simple model two-dimensional fluid, the generalized exponential model of index 4 (GEM-4), chosen because a DDFT is known to be accurate for this model. The consequences of the subsequent PFC approximations can then be examined. These include the phase diagram being both qualitatively incorrect, in that it has a stripe phase, and quantitatively incorrect (by orders of magnitude) regarding the properties of the crystal phase. Thus, although PFC models are very successful as phenomenological models of crystallization, we find it impossible to derive the PFC as a theory for the (scaled) density distribution when starting from an accurate DDFT, without introducing spurious artifacts. However, we find that making a simple one-mode approximation for the logarithm of the density distribution lnρ(x) rather than for ρ(x) is surprisingly accurate. This approach gives a tantalizing hint that accurate PFC-type theories may instead be derived as theories for the field lnρ(x), rather than for the density profile itself.

Senescent cells evade immune clearance via HLA-E-mediated NK and CD8+ T cell inhibition

Senescent cells accumulate in human tissues during ageing and contribute to age-related pathologies. The mechanisms responsible for their accumulation are unclear. Here we show that senescent dermal fibroblasts express the non-classical MHC molecule HLA-E, which interacts with the inhibitory receptor NKG2A expressed by NK and highly differentiated CD8+ T cells to inhibit immune responses against senescent cells. HLA-E expression is induced by senescence-associated secretary phenotype-related pro-inflammatory cytokines, and is regulated by p38 MAP kinase signalling in vitro. Consistently, HLA-E expression is increased on senescent cells in human skin sections from old individuals, when compared with those from young, and in human melanocytic nevi relative to normal skin. Lastly, blocking the interaction between HLA-E and NKG2A boosts immune responses against senescent cells in vitro. We thus propose that increased HLA-E expression contributes to persistence of senescent cells in tissues, thereby suggesting a new strategy for eliminating senescent cells during ageing.

Diagnostic ability of a smart phone app (injured tooth) in diagnosing traumatic injuries to the teeth - a multicentre analysis

BACKGROUND

Dental trauma is not uncommon. The initial management provided at the time of injury is critical in predicting prognosis. However, initial management depends on correct diagnosis. Recently an App named 'Injured Tooth' was made available to diagnose traumatic injuries to the teeth and supporting structures.

AIM

To test the diagnostic ability of the Injured Tooth App compared with the conventional method of diagnosing traumatic injuries to the teeth.

DESIGN

A cross-sectional study was conducted at three different centres with 176 patients aged 0-15 years, having 201 injured teeth. Diagnosis of the injured teeth in these children at every centre was done independently by one experienced faculty using the traditional method and by a student using the Injured Tooth App.

RESULTS

Injured Tooth App gave a correct diagnosis for 197 teeth included in the study. Statistical analysis showed that there was good agreement (Kappa = 0.973) between the diagnosis given by the App and the experienced faculty.

CONCLUSIONS

The study found that the diagnosis given by the Injured Tooth App was in good agreement with the diagnosis given by an experienced faculty. Hence, the App can be successfully used by dental students to arrive at diagnosis.

Stability of outcomes after 5 years of treatment in an early intervention programme

AIM

It has been hypothesized that the first 5 years are critical in determining long-term recovery from psychotic disorders. We examine stability in recovery indices after 5 years for 56 patients treated in an early intervention programme for psychosis.

METHODS

Assessments of symptom remission and functional recovery were carried out 5 and 10 years after initiation of treatment.

RESULTS

Although overall rates of recovery were comparable at both times, there were significant changes for individuals reflecting both improvement and deterioration.

CONCLUSIONS

Evidence concerning the critical period hypothesis should examine stability in individuals rather than relying on cumulative indices.

Structural crossover in a model fluid exhibiting two length scales: Repercussions for quasicrystal formation

We investigate the liquid state structure of the two-dimensional model introduced by Barkan et al. [Phys. Rev. Lett. 113, 098304 (2014)10.1103/PhysRevLett.113.098304], which exhibits quasicrystalline and other unusual solid phases, focusing on the radial distribution function g(r) and its asymptotic decay r→∞. For this particular model system, we find that as the density is increased there is a structural crossover from damped oscillatory asymptotic decay with one wavelength to damped oscillatory asymptotic decay with another distinct wavelength. The ratio of these wavelengths is ≈1.932. Following the locus in the phase diagram of this structural crossover leads directly to the region where quasicrystals are found. We argue that identifying and following such a crossover line in the phase diagram towards higher densities where the solid phase(s) occur is a good strategy for finding quasicrystals in a wide variety of systems. We also show how the pole analysis of the asymptotic decay of equilibrium fluid correlations is intimately connected with the nonequilibrium growth or decay of small-amplitude density fluctuations in a bulk fluid.

Factors associated with nurses' perceptions about quality of end-of-life care

AIM

To examine the factors associated with nurses' perceptions of the quality of end-of-life care.

BACKGROUND

With increasing demand for hospitals to provide end-of-life care, the low quality of palliative care provided in hospital settings is an issue of growing concern in developing countries. Most dying patients receive their care from general nurses, irrespective of the nurses' specialty or level of training.

METHOD

A structured cross-sectional questionnaire survey was conducted of 553 nurses working at a teaching hospital in Malaysia.

RESULTS

The mean scores for nurses' knowledge about end-of-life care, their attitudes towards end-of-life care and the perceived quality of end-of-life care were low. The factors identified as significantly associated with the quality of end-of-life care were nurses' levels of knowledge and their attitudes towards end-of-life care.

DISCUSSION

Factors that contributed to the low quality of end-of-life care were inadequate knowledge and negative attitudes. These findings may reflect that end-of-life care education is not well integrated into nursing education.

CONCLUSION

The findings of this study suggest that there is a need to increase the nurses' level of knowledge and improve their attitude towards end-of-life care in order to enhance the quality of care provided to dying patients.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nurse managers and hospital policymakers should develop strategies to enhance nurses' level of knowledge, as well as providing adequate emotional support for nurses who care for dying patients and their families. Nurses should be proactive in increasing their knowledge and adopting more positive attitudes towards end-of-life care.

Combining Medical Informatics and Bioinformatics toward Tools for Personalized Medicine

Objectives: Key bioinformatics and medical informatics research areas need to be identified to advance knowledge and understanding of disease risk factors and molecular disease pathology in the 21st century toward new diagnoses, prognoses, and treatments. Methods: Three high-impact informatics areas are identified: predictive medicine (to identify significant correlations within clinical data using statistical and artificial intelligence methods), along with pathway informatics and cellular simulations (that combine biological knowledge with advanced informatics to elucidate molecular disease pathology).

Results: Initial predictive models have been developed for a pilot study in Huntington’s disease. An initial bioinformatics platform has been developed for the reconstruction and analysis of pathways, and work has begun on pathway simulation.

Conclusions: A bioinformatics research program has been established at GE Global Research Center as an important technology toward next generation medical diagnostics. We anticipate that 21st century medical research will be a combination of informatics tools with traditional biology wet lab research, and that this will translate to increased use of informatics techniques in the clinic.

Imaging spectroscopy of solar radio burst fine structures

Solar radio observations provide a unique diagnostic of the outer solar atmosphere. However, the inhomogeneous turbulent corona strongly affects the propagation of the emitted radio waves, so decoupling the intrinsic properties of the emitting source from the effects of radio wave propagation has long been a major challenge in solar physics. Here we report quantitative spatial and frequency characterization of solar radio burst fine structures observed with the Low Frequency Array, an instrument with high-time resolution that also permits imaging at scales much shorter than those corresponding to radio wave propagation in the corona. The observations demonstrate that radio wave propagation effects, and not the properties of the intrinsic emission source, dominate the observed spatial characteristics of radio burst images. These results permit more accurate estimates of source brightness temperatures, and open opportunities for quantitative study of the mechanisms that create the turbulent coronal medium through which the emitted radiation propagates.

Radio observations of the solar atmosphere provide a unique view on the non-thermal processes in the outer atmosphere. Here the authors use LOFAR observations to demonstrate that the observed radio burst characteristics are dominated by propagation effects rather than underlying emission variations.

SYN-004 (ribaxamase), an oral beta-lactamase, mitigates antibiotic-mediated dysbiosis in a porcine gut microbiome model

AIM

To evaluate an antibiotic inactivation strategy to protect the gut microbiome from antibiotic-mediated damage.

METHODS AND RESULTS

SYN-004 (ribaxamase) is an orally delivered beta-lactamase intended to degrade penicillins and cephalosporins within the gastrointestinal tract to protect the microbiome. Pigs (20 kg, n = 10) were treated with ceftriaxone (CRO) (IV, 50 mg kg^-1 , SID) for 7 days and a cohort (n = 5) received ribaxamase (PO, 75 mg, QID) for 9 days beginning the day before antibiotic administration. Ceftriaxone serum levels were not statistically different in the antibiotic-alone and antibiotic + ribaxamase groups, indicating ribaxamase did not alter systemic antibiotic levels. Whole-genome metagenomic analyses of pig faecal DNA revealed that CRO caused significant changes to the gut microbiome and an increased frequency of antibiotic resistance genes. With ribaxamase, the gut microbiomes were not significantly different from pretreatment and antibiotic resistance gene frequency was not increased.

CONCLUSION

Ribaxamase mitigated CRO-mediated gut microbiome dysbiosis and attenuated propagation of the antibiotic resistance genes in pigs.

SIGNIFICANCE AND IMPACT OF THE STUDY

Damage of the microbiome can lead to overgrowth of pathogenic organisms and antibiotic exposure can promote selection for antibiotic-resistant micro-organisms. Ribaxamase has the potential to become the first therapy designed to protect the gut microbiome from antibiotic-mediated dysbiosis and reduce emergence of antibiotic resistance.

Minimally invasive periacetabular osteotomy using a modified Smith-Petersen approach: technique and early outcomes

AIMS

Periacetabular osteotomy is an effective way of treating symptomatic hip dysplasia. We describe a new minimally invasive technique using a modification of the Smith-Peterson approach. We performed a prospective, longitudinal cohort study to assess for any compromise in acetabular correction when using this approach, and to see if the procedure would have a higher complication rate than that quoted in the literature for other approaches. We also assessed for any improvement in functional outcome.

PATIENTS AND METHODS

From 168 consecutive patients (189 hips) who underwent acetabular correction between March 2010 and March 2013 we excluded those who had undergone previous pelvic surgery for DDH and those being treated for acetabular retroversion. The remaining 151 patients (15 men, 136 women) (166 hips) had a mean age of 32 years (15 to 56) and the mean duration of follow-up was 2.8 years (1.2 to 4.5). In all 90% of cases were Tönnis grade 0 or 1. Functional outcomes were assessed using the Non Arthritic Hip Score (NAHS), University of California, Los Angeles (UCLA) and Tegner activity scores.

RESULTS

The mean pre-operative lateral centre-edge angle was 14.2° (-5° to 30°) and the mean acetabular index was 18.4° (4° to 40°). Post-operatively these were 31° (18° to 46°) and 3° (-7° to 29°), respectively, a significant improvement in both (p < 0.001). Allogenic blood transfusion was required in two patients (1.2%). There were no major nerve or vascular complications, and no wound infections. At the time of last follow-up, we noted a significant improvement in functional outcome scores: UCLA improved by 2.31 points, Tegner improved by 1.08 points, and the NAHS improved by 25.4 points (p < 0.001 for each). Hypermobility and longer duration of surgery were significant negative predictors for a good post-operative UCLA score, while residual retroversion was a positive predictor of post-operative UCLA score.

CONCLUSION

We have found this approach to be safe and effective, facilitating early recovery from surgery. Cite this article: Bone Joint J 2017;99-B:22-8.

Perceptions of Healthcare Professionals on the Usage of Percutaneous Endoscopic Gastrostomy in a Teaching Hospital from a Middle-Income South East Asian Country

OBJECTIVE

To explore the perceptions of healthcare professionals' (HCPs) in a South East Asian nation towards percutaneous endoscopic gastrostomy (PEG) feeding.

DESIGN

Semi-structured, qualitative interviews.

SETTINGS

A teaching hospital in Kuala Lumpur, Malaysia.

PARTICIPANTS

A total of 17 healthcare professionals aged 23-43 years, 82% women.

RESULTS

Thematic analysis revealed five themes that represent HCPs' perceptions in relation to the usage of PEG feeding: 1) knowledge of HCPs, 2) communication, 3) understanding among patients, and 4) financial and affordability.

CONCLUSION

The rationale for reluctance towards PEG feeding observed in this regions was explained by lack of education, knowledge, communication, team work, and financial support. Future studies should assess the effects of educational programmes among HCPs and changes in policies to promote affordability on the utilization of PEG feeding in this region.

Transient Weakening of Earth's Magnetic Shield Probed by a Cosmic Ray Burst

The GRAPES-3 tracking muon telescope in Ooty, India measures muon intensity at high cutoff rigidities (15-24 GV) along nine independent directions covering 2.3 sr. The arrival of a coronal mass ejection on 22 June 2015 18:40 UT had triggered a severe G4-class geomagnetic storm (storm). Starting 19:00 UT, the GRAPES-3 muon telescope recorded a 2 h high-energy (∼20  GeV) burst of galactic cosmic rays (GCRs) that was strongly correlated with a 40 nT surge in the interplanetary magnetic field (IMF). Simulations have shown that a large (17×) compression of the IMF to 680 nT, followed by reconnection with the geomagnetic field (GMF) leading to lower cutoff rigidities could generate this burst. Here, 680 nT represents a short-term change in GMF around Earth, averaged over 7 times its volume. The GCRs, due to lowering of cutoff rigidities, were deflected from Earth's day side by ∼210° in longitude, offering a natural explanation of its night-time detection by the GRAPES-3. The simultaneous occurrence of the burst in all nine directions suggests its origin close to Earth. It also indicates a transient weakening of Earth's magnetic shield, and may hold clues for a better understanding of future superstorms that could cripple modern technological infrastructure on Earth, and endanger the lives of the astronauts in space.

Three-Dimensional Icosahedral Phase Field Quasicrystal

We investigate the formation and stability of icosahedral quasicrystalline structures using a dynamic phase field crystal model. Nonlinear interactions between density waves at two length scales stabilize three-dimensional quasicrystals. We determine the phase diagram and parameter values required for the quasicrystal to be the global minimum free energy state. We demonstrate that traits that promote the formation of two-dimensional quasicrystals are extant in three dimensions, and highlight the characteristics required for three-dimensional soft matter quasicrystal formation.