Land use modification causes slow, but predictable, change in soil microbial community composition and functional potential.

BACKGROUND: Bacterial communities are critical to ecosystem functioning and sensitive to their surrounding physiochemical environment. However, the impact of land use change on microbial communities remains understudied. We used 16S rRNA gene amplicon sequencing and shotgun metagenomics to assess soil microbial communities' taxonomic and functional responses to land use change. We compared data from long-term grassland, exotic forest and horticulture reference sites to data from sites that transitioned from (i) Grassland to exotic forest or horticulture and from (ii) Exotic forest to grassland. RESULTS: Community taxonomic and functional profiles of the transitional sites significantly differed from those within reference sites representing both their historic and current land uses (P < 0.001). The bacterial communities in sites that transitioned more recently were compositionally more similar to those representing their historic land uses. In contrast, the composition of communities from sites exposed to older conversion events had shifted towards the compositions at reference sites representing their current land use. CONCLUSIONS: Our study indicates that microbial communities respond in a somewhat predictable way after a land use conversion event by shifting from communities reflecting their former land use towards those reflecting their current land use. Our findings help us to better understand the legacy effects of land use change on soil microbial communities and implications for their role in soil health and ecosystem functioning. Understanding the responsiveness of microbial communities to environmental disturbances will aid us in incorporating biotic variables into soil health monitoring techniques in the future.

A bioavailable strontium (87Sr/86Sr) isoscape for Aotearoa New Zealand: Implications for food forensics and biosecurity.

As people, animals and materials are transported across increasingly large distances in a globalized world, threats to our biosecurity and food security are rising. Aotearoa New Zealand is an island nation with many endemic species, a strong local agricultural industry, and a need to protect these from pest threats, as well as the economy from fraudulent commodities. Mitigation of such threats is much more effective if their origins and pathways for entry are understood. We propose that this may be addressed in Aotearoa using strontium isotope analysis of both pests and products. Bioavailable radiogenic isotopes of strontium are ubiquitous markers of provenance that are increasingly used to trace the origin of animals and plants as well as products, but currently a baseline map across Aotearoa is lacking, preventing use of this technique. Here, we have improved an existing methodology to develop a regional bioavailable strontium isoscape using the best available geospatial datasets for Aotearoa. The isoscape explains 53% of the variation (R2 = 0.53 and RMSE = 0.00098) across the region, for which the primary drivers are the underlying geology, soil pH, and aerosol deposition (dust and sea salt). We tested the potential of this model to determine the origin of cow milk produced across Aotearoa. Predictions for cow milk (n = 33) highlighted all potential origin locations that share similar 87Sr/86Sr values, with the closest predictions averaging 7.05 km away from their true place of origin. These results demonstrate that this bioavailable strontium isoscape is effective for tracing locally produced agricultural products in Aotearoa. Accordingly, it could be used to certify the origin of Aotearoa's products, while also helping to determine if new pest detections were of locally breeding populations or not, or to raise awareness of imported illegal agricultural products.

Anti-biofouling efficacy of three home and personal care product preservatives: Pseudomonas aeruginosa biofilm inhibition and prevention.

Due to increasing water scarcity, it is essential to determine cost-effective and efficient methods of producing potable water, especially ones that utilize non-traditional sources. Although reverse osmosis (RO) shows promise as a key-player in mitigating water scarcity, it is limited by biofouling. It is therefore integral to identify effective antifoulants that also do not damage the membrane, cause resistance, or negatively impact human health and the environment. Potential antifoulants include preservatives used in home and personal care products. It is hypothesized that safer preservatives can be applied to RO systems to remove or prevent biofouling. Three preservatives including methylisothiazolinone (MIT), phenoxyethanol (PE), and sodium benzoate (SB) were tested via antimicrobial susceptibility tests against P. aeruginosa biofilms grown in 96-well plates to investigate both biofilm prevention and biofilm removal. Data were collected in the form of minimum biofilm inhibitory concentration (MBIC) and minimum biofilm eradication concentration (MBEC), respectively. MIT was the most effective of the three preservatives but also poses the highest hazard to human health and the environment. Due to efficacy and safety concerns, MIT, PE, and SB are not the final solution; however, a process was demonstrated for determining the efficacy of novel, safer antifoulants. Ultimately, further investigations into safer antifoulants, paired with a greater understanding of biofilm removal and prevention doses will help make RO a better solution for water scarcity.

Covalent functionalization of polypropylene filters with diazirine-photosensitizer conjugates producing visible light driven virus inactivating materials.

The SARS-CoV-2 pandemic has highlighted the weaknesses of relying on single-use mask and respirator personal protective equipment (PPE) and the global supply chain that supports this market. There have been no major innovations in filter technology for PPE in the past two decades. Non-woven textiles used for filtering PPE are single-use products in the healthcare environment; use and protection is focused on preventing infection from airborne or aerosolized pathogens such as Influenza A virus or SARS-CoV-2. Recently, C-H bond activation under mild and controllable conditions was reported for crosslinking commodity aliphatic polymers such as polyethylene and polypropylene. Significantly, these are the same types of polymers used in PPE filtration systems. In this report, we take advantage of this C-H insertion method to covalently attach a photosensitizing zinc-porphyrin to the surface of a melt-blow non-woven textile filter material. With the photosensitizer covalently attached to the surface of the textile, illumination with visible light was expected to produce oxidizing 1O2/ROS at the surface of the material that would result in pathogen inactivation. The filter was tested for its ability to inactivate Influenza A virus, an enveloped RNA virus similar to SARS-CoV-2, over a period of four hours with illumination of high intensity visible light. The photosensitizer-functionalized polypropylene filter inactivated our model virus by 99.99% in comparison to a control.

Trial of remote continuous versus intermittent NEWS monitoring after major surgery (TRaCINg): a feasibility randomised controlled trial.

BACKGROUND: Despite medical advances, major surgery remains high risk with up to 44% of patients experiencing postoperative complications. Early recognition of postoperative complications is crucial in reducing morbidity and preventing long-term disability. The current standard of care is intermittent manual vital signs monitoring, but new wearable remote monitors offer the benefits of continuous vital signs monitoring without limiting the patient's mobility. The aim of this study was to evaluate the feasibility, acceptability and clinical outcomes of continuous remote monitoring after major surgery. METHODS: The study was a randomised, controlled, unblinded, parallel group, feasibility trial. Adult patients undergoing elective major surgery were randomly assigned to receive continuous remote monitoring and normal National Early Warning Score (NEWS) monitoring (intervention group) or normal NEWS monitoring alone (control group). Continuous remote monitoring was achieved using the SensiumVitals® wireless patch which is worn on the patient's chest and monitors heart rate, respiratory rate and temperature continuously, and alerts the nurse when there is deviation from pre-set physiological norms. Feasibility was assessed by evaluating recruitment rate, adherence to protocol and randomisation and the amount of missing data. Clinical outcomes included time to antibiotics in cases of sepsis, length of hospital stay, number of critical care admissions and rate of hospital readmission within 30 days of discharge. RESULTS: One hundred and thirty-six patients were randomised between October 2018 and April 2019: 67 to the control group and 69 to the intervention group. Recruitment was completed prior to the 12 month target with a high rate of eligibility and consent. Missing data was limited only to questionnaire responses; no participants were lost to follow-up and only one participant was withdrawn due to loss of capacity. The number of patients classed as 'drop-out' due to design (8.1%) were less than anticipated, and there were no participants who crossed over into the alternative trial allocation group. Seventeen participants in the intervention group (28%) did not adhere to the monitoring protocol. No formal comparisons between arms was undertaken; however, participants had fewer unplanned critical care admissions (1 versus 5) and had a shorter average length of hospital stay (11.6 days (95% confidence interval 9.5-13.7 days) versus 16.2 days (95% confidence interval 11.3-21.2 days)) in the continuous vital signs monitoring group. The time taken to receive antibiotics in cases of sepsis was similar in both arms. A cost-utility analysis indicated that the remote monitoring system was cost-saving when compared to standard NEWS monitoring alone. CONCLUSIONS: It is feasible to perform a large-scale randomised controlled trial of continuous remote monitoring after major surgery. Progression to a definitive multicentre randomised controlled trial would be appropriate, taking consideration of factors, such as patient adherence, that might mask the potential benefit of additional monitoring. TRIAL REGISTRATION: ISRCTN registry with study ID ISRCTN16601772 . Registered 30 August 2017.

'TB or not TB': the conundrum of pre-European contact tuberculosis in the Pacific.

Tuberculosis (TB) is a major global health threat, infecting one-third of the world's population. Despite this prominence, the age, origin and spread of the disease have been topics of contentious debate. Molecular studies suggest that Mycobacterium tuberculosis 'sensu stricto', the most common strain of TB infecting humans today, originated in Africa and from there spread into Europe and Asia. The M. tuberculosis strains most commonly found across the Pacific and the Americas today are most closely related to European strains, supporting a hypothesis that the disease only reached these regions relatively recently via European sailors or settlers. However, this hypothesis is inconsistent with palaeopathological evidence of TB-like lesions in human remains from across the Pacific that predate European contact. Similarly, genetic evidence from pre-European South American mummies challenges the notion of a European introduction of the disease into the Pacific. Here, we review the complex evidence for the age and origin of TB in the Pacific, and discuss key gaps in our knowledge and how these may be addressed. This article is part of the theme issue 'Insights into health and disease from ancient biomolecules'.

Clinical Outcome of Exclusively Radiographer-led Delivery of Postoperative Vaginal Vault Brachytherapy for Endometrial Cancer - The Addenbrooke's Experience.

AIMS: Postoperative vaginal vault brachytherapy (VBT) reduces local recurrence in operable endometrial cancer. Radiographer-led delivery of VBT, carried out without image guidance, was implemented at Addenbrooke's in 2010 to maximise skills mix and to improve service delivery. The purpose of this study was to evaluate the safety and effectiveness of this service. MATERIALS AND METHODS: This was a single-centre retrospective study of endometrial cancer patients treated with postoperative high dose rate VBT ± external beam radiotherapy (EBRT) between January 2010 and December 2016. RESULTS: In total, 414 patients were analysed: 307 received adjuvant VBT alone and 107 patients received pelvic EBRT followed by VBT. Thirty-seven per cent of patients receiving VBT alone were high risk according to ESMO-ESGO-ESTRO criteria. After a median follow-up of 59 months (range 2-118), 9/414 (2.2%) patients had isolated vaginal recurrences, 15/414 (3.6%) had locoregional recurrence (vaginal, pelvic node or both), whereas 62/414 (15%) patients had distant recurrence. The 5-year actuarial isolated vaginal recurrence rate was 2.3% (VBT alone 2.1%, EBRT + VBT 3.0%). Grade 3 urinary or bowel toxicity occurred in 2/414 (0.6%) patients treated with EBRT and VBT. None of the patients treated with VBT alone had grade 3 complications. CONCLUSION: Radiographer-led delivery of VBT, without the use of image guidance, is a safe and effective service.

Patients with surgical wounds healing by secondary intention: A prospective, cohort study.

BACKGROUND: Surgical wounds healing by secondary intention can be difficult and costly to manage and are profoundly under researched. This prospective inception, cohort study aimed to derive a better understanding of surgical wounds healing by secondary intention and to facilitate the design of future research investigating effective treatments. OBJECTIVES: To investigate the clinical characteristics of patients with surgical wounds healing by secondary intention and the surgeries that preceded their wounds; to clearly delineate the clinical outcomes of these patients, specifically focusing on time to wound healing and its determinants; to explore the types of treatments for surgical wounds healing by secondary intention; and to assess the impact surgical wounds healing by secondary intention have on patients' quality of life. DESIGN: Prospective, inception cohort study. SETTING: Acute and community settings in eight sites across two large centres in the United Kingdom (Hull and Leeds, UK). METHODS: Patients with a surgical wounds healing by secondary intention (an open wound, <3 weeks' duration, resulting from surgery), were recruited and followed up for at least 12 months. Key outcome events included: time to healing; treatment type; infection; hospital re-admission and further procedures; health-related quality of life and pain. RESULTS: In total, 393 patients were recruited. Common co-morbidities were cardiovascular disease (38%), diabetes (26%) and peripheral vascular disease (14.5%). Baseline median SWHSI area was 6 cm2 (range 0.01-1200). Abdominal (n = 132), foot (n = 59), leg (n = 58) and peri-anal (n = 34) wounds were common. The majority of wounds (236, 60.1%) were intentionally left open following surgery; the remainder were mostly dehisced wounds. Healing was observed in 320 (81.4%) wounds with a median time to healing of 86 days (95% CI: 75-130). Factors associated with delayed healing included wound infection at any point and baseline wound area above the median. Health-related quality of life scores were low at baseline but improved with time and healing. CONCLUSIONS: This is the first inception cohort study in patients with surgical wounds healing by secondary intention. Patient characteristics have been clearly defined, with prolonged healing times and adverse events being common impacting on patient's health-related quality of life. Areas for, and factors crucial to the design of, future research have been identified.

Trial of Remote Continuous versus Intermittent NEWS monitoring after major surgery (TRaCINg): protocol for a feasibility randomised controlled trial.

BACKGROUND: Despite medical advances, major surgery remains high risk. Up to 44% of patients experience postoperative complications, which can have huge impacts for patients and the healthcare system. Early recognition of postoperative complications is crucial in reducing morbidity and preventing long-term disability. The current standard of care is intermittent manual vital signs monitoring, but new wearable remote monitors offer the benefits of continuous vital signs monitoring without limiting the patient's mobility. The aim of this study is to evaluate the feasibility, acceptability and clinical impacts of continuous remote monitoring after major surgery. METHODS: The study is a randomised, controlled, unblinded, parallel group, feasibility trial. Adult patients undergoing elective major surgery will be invited to participate if they have the capacity to provided informed, written consent and do not have a cardiac pacemaker or an allergy to adhesives. Participants will be randomly assigned to receive continuous remote monitoring and normal National Early Warning Score (NEWS) monitoring (intervention group) or normal NEWS monitoring alone (control group). Continuous remote monitoring will be achieved using the SensiumVitals® wireless patch which is worn on the patient's chest and monitors heart rate, respiratory rate and temperature continuously and alerts the nurse when there is deviation from pre-set physiological norms. Participants will be followed up throughout their hospital admission and for 30 days after discharge. Feasibility will be assessed by evaluating recruitment rate, adherence to protocol and randomisation, and the amount of missing data. The acceptability of the patch to nursing staff and patients will be assessed using questionnaires and interviews. Clinical outcomes will include time to antibiotics in cases of sepsis, length of hospital stay, number of critical care admissions and rate of readmission within 30 days of discharge. DISCUSSION: Early detection and treatment of complications minimises the need for critical care, improves patient outcomes, and produces significant cost savings for the healthcare system. Remote continuous monitoring systems have the potential to allow earlier detection of complications, but evidence from the literature is mixed. Demonstrating significant benefit over intermittent monitoring to offset the practical and economic implications of continuous monitoring requires well-controlled studies in high-risk populations to demonstrate significant differences in clinical outcomes; this feasibility trial seeks to provide evidence of how best to conduct such a confirmatory trial. TRIAL REGISTRATION: This study is listed on the ISRCTN registry with study ID ISRCTN16601772.

Pilot feasibility randomized clinical trial of negative-pressure wound therapy versus usual care in patients with surgical wounds healing by secondary intention.

BACKGROUND: Surgical wounds healing by secondary intention (SWHSI) are increasingly being treated with negative-pressure wound therapy (NPWT) despite a lack of high-quality research evidence regarding its clinical and cost-effectiveness. This pilot feasibility RCT aimed to assess the methods for and feasibility of conducting a future definitive RCT of NPWT for the treatment of SWHSI. METHODS: Eligible consenting adult patients receiving care at the study sites (2 acute and 1 community) and with a SWHSI appropriate for NPWT or wound dressing treatment were randomized 1 : 1 centrally to receive NPWT or usual care (no NPWT). Participants were followed up every 1-2 weeks for 3 months. Feasibility (recruitment rate, time to intervention delivery) and clinical (time to wound healing) outcomes were assessed. RESULTS: A total of 248 participants were screened for eligibility; 40 (16·1 per cent) were randomized, 19 to NPWT and 21 to usual care. Twenty-four of the 40 wounds were located on the foot. Participants received NPWT for a median of 18 (range 0-72) days. Two participants in the NPWT group never received the intervention and 14 received NPWT within 48 h of randomization. Five participants in the usual care group received NPWT during the study. Ten of the 40 wounds were deemed to have healed during the study. CONCLUSION: A full-scale RCT to investigate the clinical and cost-effectiveness of NPWT for SWHSI is feasible. This study identified crucial information on recruitment rates and data collection methods to consider during the design of a definitive RCT. Registration number: ISRCTN12761776 (http://www.iscrtn.com).

Oral propranolol in the treatment of proliferating infantile haemangiomas: British Society for Paediatric Dermatology consensus guidelines.

BACKGROUND: Infantile haemangiomas (IH) are the most common vascular tumours of infancy. Despite their frequency and potential complications, there are currently no unified U.K. guidelines for the treatment of IH with propranolol. There are still uncertainties and diverse opinions regarding indications, pretreatment investigations, its use in PHACES (posterior fossa malformations-haemangiomas-arterial anomalies-cardiac defects-eye abnormalities-sternal cleft and supraumbilical raphe) syndrome and cessation of treatment. OBJECTIVES: To provide unified guidelines for the treatment of IH with propranolol. METHODS: This study used a modified Delphi technique, which involved an international treatment survey, a systematic evidence review of the literature, a face-to-face multidisciplinary panel meeting and anonymous voting. RESULTS: The expert panel achieved consensus on 47 statements in eight categories, including indications and contraindications for starting propranolol, pretreatment investigations, starting and target dose, monitoring of adverse effects, the use of propranolol in PHACES syndrome and how to stop treatment. CONCLUSIONS: These consensus guidelines will help to standardize and simplify the treatment of IH with oral propranolol across the U.K. and assist in clinical decision-making.

First bioarchaeological evidence of probable scurvy in Southeast Asia: Multifactorial etiologies of vitamin C deficiency in a tropical environment.

This paper presents the first bioarchaeological evidence of probable scurvy in Southeast Asia from a six-year-old child at the historic-era site of Phnom Khnang Peung (15-17th centuries A.D.) in the Cardamom Mountains, Cambodia. Examination of skeletal material shows evidence consistent with scurvy - specifically, abnormal porosity on the greater wings of the sphenoid bone and hard palate, and vascular impressions on the ectocranial surface of the frontal bone and maxillary alveolar bone. In addition, this individual has evidence of cribra orbitalia indicative of anemia. Although a nutritionally linked etiology is the most common cause of scurvy, a number of other factors influencing ascorbic acid levels need to be considered in an environment with sufficient vitamin C potentially available in the diet. Assessing the environmental evidence, the possibility of a number of interrelated factors contributing to the development of scurvy in this individual seems the most plausible explanation. Factors affecting vitamin C levels may have included social aspects of food allocation or choice of food, genetic predisposition, anemia, pathogens, and nutrient malabsorption.

Leprosy and tuberculosis in Iron Age Southeast Asia?

The recent excavation of a sample of 120 human skeletons from an Iron Age site in the valley of the Mun River, a tributary of the Mekong River on the Khorat Plateau in northeast Thailand, has provided the largest sample from this period in the region to date. This paper reviews three individuals from the sample with pathological changes for which the differential diagnosis includes systemic infectious disease. In two of these, both males with lesions of the hands and feet, leprosy and psoriatic arthritis are discussed as differential diagnoses, with leprosy the most probable. In the third, a female with lesions of the spine, the differential diagnosis includes tuberculosis and nonspecific osteomyelitis. Tuberculosis is the most probable diagnosis. Although the focus of this paper is a presentation of the evidence for infectious disease at Noen U-Loke, the significance of probable diagnoses of mycobacterial diseases for the history of the diseases and for prehistory in mainland Southeast Asia is also briefly discussed.

Skeletal pathology in a prehistoric Pacific Island sample: issues in lesion recording, quantification, and interpretation.

This paper presents a profile of evidence of disease in a skeletal sample from Taumako Island, Southeast Solomon Islands, Melanesia, and aims to increase awareness of the prehistoric Pacific Island disease environment. It also addresses issues of lesion recording, quantification, and interpretation. Two methodologies for the determination of lesion prevalence were applied, one based on prevalence in observable individuals and one in skeletal elements. The aim of these methodologies was to provide objective data on skeletal lesions in this sample, with transparency in methods for application in comparative studies. The types of lesions observed were predominantly osteoblastic and affecting multiple bones, particularly in the lower limbs. The individual analysis yielded a prevalence of lesions affecting 56.4% of the postcranial sample from birth to old age. As expected, the skeletal element analysis yielded a lower prevalence, with 15.0% of skeletal elements affected. The skeletal element analysis also revealed a pattern of greater lower limb involvement, with a predilection for the tibia. The pattern of skeletal involvement was similar in both analyses, suggesting the validity of employing either method in paleopathological studies. A differential diagnosis of the lesions included osteomyelitis, treponemal disease, and leprosy. Metabolic disease was also considered for subadult lesions. Based on lesion type, skeletal distribution, and epidemiology of lesions in the sample, an etiology of yaws (Treponema pertenue) was suggested as responsible for nearly half the adult lesions, while multiple causes, including yaws, were suggested for the lesions in subadults.

Isolation of a gene encoding a putative polyamine transporter from Candida albicans, GPT1.

A gene encoding a transport protein from the pathogenic yeast, Candida albicans, has been isolated during a complementation experiment utilizing an ornithine decarboxylase-negative (spe1 Delta) strain of Saccharomyces cerevisiae. This gene restores gamma-aminobutyric acid (GABA) transport to a GABA transport-negative mutant of S. cerevisiae and encodes a protein which putatively allows transport of one or more of the polyamines. We have assigned the name GPT1 (GABA/polyamine transporter) to this gene.

Dental misidentification on the basis of presumed unique features.

Positive identification of skeletal remains by dental comparison depends on the demonstrable concordance between postmortem and antemortem records. However, there is no accepted norm for the number of points of concordance and there are circumstances when a single (or a few) unique features may allow positive identification. We present a recent case in which superficial similarity may have led to misidentification. We argue that misidentification is particularly likely with over-reliance on apparently unique features. The fact that a single inexplicable inconsistency will rule out a positive dental identification is highlighted.