Hydrocarbon-degrading bacteria in deep-water subarctic sediments (Faroe-Shetland Channel).

AIMS: The aim of this study was the baseline description of oil-degrading sediment bacteria along a depth transect in the Faroe-Shetland Channel (FSC) and the identification of biomarker taxa for the detection of oil contamination in FSC sediments. METHODS AND RESULTS: Oil-degrading sediment bacteria from 135, 500 and 1000 m were enriched in cultures with crude oil as the sole carbon source (at 12, 5 and 0°C respectively). The enriched communities were studied using culture-dependent and culture-independent (clone libraries) techniques. Isolated bacterial strains were tested for hydrocarbon degradation capability. Bacterial isolates included well-known oil-degrading taxa and several that are reported in that capacity for the first time (Sulfitobacter, Ahrensia, Belliella, Chryseobacterium). The orders Oceanospirillales and Alteromonadales dominated clone libraries in all stations but significant differences occurred at genus level particularly between the shallow and the deep, cold-water stations. Alcanivorax constituted 64% of clones at FSC135 but was absent at deeper stations. Pseudoalteromonas and Oleispira dominated the bacterial community at 500 and 1000 m. CONCLUSIONS: The genus Oleispira emerged as a major player in the early stages of crude oil degradation in deep-sea sediments of the FSC particularly at subzero temperatures. This finding is offering a direction for future research into biomonitoring tools for the detection of low levels of crude oil contamination in the deep FSC, and possibly high latitude cold waters in general. SIGNIFICANCE AND IMPACT OF THE STUDY: Oil and gas exploration in the FSC occurs at depths >1000 m but baseline environmental data necessary for the assessment of ecosystem recovery to prespill conditions in the event of an oil spill are lacking. This study will contribute to our ability to assess the impact of oil release in the FSC and guide the direction of bioremediation strategies tailored to the area.

Deprivation and ethnicity impact on diabetes control and use of treatment regimen.

AIMS: Deprivation and/or ethnicity impact on care delivery. We have assessed how these factors influence diabetes care in a paediatric clinic. METHODS: We related access to care [type of insulin treatment regimen-twice daily, multiple daily injections and insulin pump therapy (continuous subcutaneous insulin infusion)], measures of care process (HbA(1c)) and an approximate measure of satisfaction with the service (clinic attendance rate) in 325 (170 male) children and young people with Type 1 diabetes (mean age 10.6 years, mean duration of diabetes of 4.5 years), with indices of deprivation and ethnicity. RESULTS: Of the 325 children and young people, 2.7% received twice-daily insulin, 48.4% multiple daily injections and 48.9% continuous subcutaneous insulin infusion. Median clinic HbA(1c) was 62 mmol/mol (7.8%) and those receiving the insulin pump therapy had the lowest HbA(1c). Four ethnic groups were represented; White British 81.6%, Asian non-Indian 6.5%, African 8.1% and Asian Indian 3.8%. Mean deprivation score was 21.06. White British and Asian Indian groups were more likely to receive insulin pump therapy (χ(2) = 50.3; P < 0.001). Attendance rates were 94.1% and did not differ across ethnic groups. Deprivation was related to ethnicity and HbA(1c) (R(2) = 0.02; P = 0.02). There was no relationship between clinic attendance and deprivation. Insulin regimen and ethnicity were associated with HbA(1c) (R(2) = 0.096; P < 0.001). Similar findings were obtained when analysis was confined to the White British population. CONCLUSIONS: These data suggest that deprivation and ethnicity influence diabetes control and how intensive insulin therapy is utilized. A better consideration of the needs of different ethnic groups is required to ensure equitable care delivery in paediatric diabetes.

Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial.

BACKGROUND: Trial findings show cognitive behaviour therapy (CBT) and graded exercise therapy (GET) can be effective treatments for chronic fatigue syndrome, but patients' organisations have reported that these treatments can be harmful and favour pacing and specialist health care. We aimed to assess effectiveness and safety of all four treatments. METHODS: In our parallel-group randomised trial, patients meeting Oxford criteria for chronic fatigue syndrome were recruited from six secondary-care clinics in the UK and randomly allocated by computer-generated sequence to receive specialist medical care (SMC) alone or with adaptive pacing therapy (APT), CBT, or GET. Primary outcomes were fatigue (measured by Chalder fatigue questionnaire score) and physical function (measured by short form-36 subscale score) up to 52 weeks after randomisation, and safety was assessed primarily by recording all serious adverse events, including serious adverse reactions to trial treatments. Primary outcomes were rated by participants, who were necessarily unmasked to treatment assignment; the statistician was masked to treatment assignment for the analysis of primary outcomes. We used longitudinal regression models to compare SMC alone with other treatments, APT with CBT, and APT with GET. The final analysis included all participants for whom we had data for primary outcomes. This trial is registered at http://isrctn.org, number ISRCTN54285094. FINDINGS: We recruited 641 eligible patients, of whom 160 were assigned to the APT group, 161 to the CBT group, 160 to the GET group, and 160 to the SMC-alone group. Compared with SMC alone, mean fatigue scores at 52 weeks were 3·4 (95% CI 1·8 to 5·0) points lower for CBT (p = 0·0001) and 3·2 (1·7 to 4·8) points lower for GET (p = 0·0003), but did not differ for APT (0·7 [-0·9 to 2·3] points lower; p = 0·38). Compared with SMC alone, mean physical function scores were 7·1 (2·0 to 12·1) points higher for CBT (p = 0·0068) and 9·4 (4·4 to 14·4) points higher for GET (p = 0·0005), but did not differ for APT (3·4 [-1·6 to 8·4] points lower; p=0·18). Compared with APT, CBT and GET were associated with less fatigue (CBT p = 0·0027; GET p = 0·0059) and better physical function (CBT p=0·0002; GET p<0·0001). Subgroup analysis of 427 participants meeting international criteria for chronic fatigue syndrome and 329 participants meeting London criteria for myalgic encephalomyelitis yielded equivalent results. Serious adverse reactions were recorded in two (1%) of 159 participants in the APT group, three (2%) of 161 in the CBT group, two (1%) of 160 in the GET group, and two (1%) of 160 in the SMC-alone group. INTERPRETATION: CBT and GET can safely be added to SMC to moderately improve outcomes for chronic fatigue syndrome, but APT is not an effective addition. FUNDING: UK Medical Research Council, Department of Health for England, Scottish Chief Scientist Office, Department for Work and Pensions.

Improvement for most, but not all: changes in newspaper coverage of mental illness from 2008 to 2019 in England.

AIMS: Time to Change, an anti-stigma programme in England, has worked to reduce stigma relating to mental illness in many facets of life. Newspaper reports are an important factor in shaping public attitudes towards mental illnesses, as well as working as a barometer reflecting public opinion. This study aims to assess the way that coverage of mental health topics and different mental illnesses has changed since 2008. METHOD: Articles covering mental health in 18 different newspapers were retrieved using keyword searches on two randomly chosen days of each month in 2008, 2009, 2010, 2011, 2013, 2014, 2016 and 2019. A content analysis approach using a structured coding framework was used to extract information from the articles. Logistic regression models were used to estimate the change in odds of each hypothesised stigmatising or anti-stigmatising element occurring in 2019 compared to 2008 and 2016 with a Wald test to assess the overall significance of year as a predictor in the model. Further logistic regression models were used to assess the association between the diagnosis that an article was about and the odds that it was stigmatising, and whether this relationship is moderated by year of publication. RESULTS: A total of 6731 articles were analysed, and there was a significant increase in anti-stigmatising articles in 2019 compared to 2008 (OR 3.16 (2.60-3.84), p < 0.001) and 2016 (OR 1.40 (1.16-1.69), p < 0.001). Of the 5142 articles that specified a diagnosis, articles about schizophrenia were 6.37 times more likely to be stigmatising than articles about other diagnoses (OR 6.37 (3.05-13.29) p < 0.001), and there was evidence that the strength of this relationship significantly interacted with the year an article was published (p = 0.010). Articles about depression were significantly less likely to be stigmatising (OR 0.59 (0.69-0.85) p = 0.018) than those about other diagnoses, while there was no difference in coverage of eating disorders v. other diagnoses (OR 1.37 (0.67-2.80) p = 0.386); neither of these relationships showed an interaction with the year of publication. CONCLUSION: Anti-stigma programmes should continue to work with newspapers to improve coverage of mental illness. However, interventions should consider providing specific guidance and promote awareness of rarer mental illnesses, such as schizophrenia, and evaluation should examine whether reductions in stigma extend to people with all mental illness diagnoses.

Real-world Effectiveness and Safety of Vedolizumab for the Treatment of Inflammatory Bowel Disease: The Scottish Vedolizumab Cohort.

BACKGROUND & AIMS: Vedolizumab is an anti-a4b7 monoclonal antibody that is licensed for the treatment of moderate to severe Crohn's disease and ulcerative colitis. The aims of this study were to establish the real-world effectiveness and safety of vedolizumab for the treatment of inflammatory bowel disease. METHODS: This was a retrospective study involving seven NHS health boards in Scotland between June 2015 and November 2017. Inclusion criteria included: a diagnosis of ulcerative colitis or Crohn's disease with objective evidence of active inflammation at baseline (Harvey-Bradshaw Index[HBI] ≥5/Partial Mayo ≥2 plus C-reactive protein [CRP] >5 mg/L or faecal calprotectin ≥250 µg/g or inflammation on endoscopy/magnetic resonance imaging [MRI]); completion of induction; and at least one clinical follow-up by 12 months. Kaplan-Meier survival analysis was used to establish 12-month cumulative rates of clinical remission, mucosal healing, and deep remission [clinical remission plus mucosal healing]. Rates of serious adverse events were described quantitatively. RESULTS: Our cohort consisted of 180 patients with ulcerative colitis and 260 with Crohn's disease. Combined median follow-up was 52 weeks (interquartile range [IQR] 26-52 weeks). In ulcerative colitis, 12-month cumulative rates of clinical remission, mucosal healing, and deep remission were 57.4%, 47.3%, and 38.5%, respectively. In Crohn's disease, 12-month cumulative rates of clinical remission, mucosal healing, and deep remission were 58.4%, 38.9%, and 28.3% respectively. The serious adverse event rate was 15.6 per 100 patient-years of follow-up. CONCLUSIONS: Vedolizumab is a safe and effective treatment for achieving both clinical remission and mucosal healing in ulcerative colitis and Crohn's disease.

The lack of therapeutic effect of Saccharomyces boulardii in the prevention of antibiotic-related diarrhoea in elderly patients.

Diarrhoea is a common side effect of antibiotic therapy, especially in the elderly. Saccharomyces boulardii is a non-pathogenic yeast which has been demonstrated to reduce the frequency of diarrhoea in patients due to a variety of causes. We set out to assess its role in preventing antibiotic-related diarrhoea. Consecutive patients over the age of 65 admitted to medical wards, and who were being prescribed antibiotics, were randomized to receive either S. boulardii 113 g twice daily or placebo for as long as they received antibiotics. Bowel habit was monitored using a record of interdefaecatory intervals (IDI) and stool form graded 1-4 (hard to liquid). Stool samples were tested every fourth day for Clostridium difficile toxin. Of the 72 patients randomized, 69 completed the study. There was no difference in sex, age, duration of antibiotic use, length of hospital stay, IDI, stool form, the proportion of patients receiving laxatives, the number of patients experiencing watery stools (seven vs. five), or the presence of C. difficile toxin (five vs. three). No side effects were attributable to S. boulardii. There was no evidence that the concomitant use of S. boulardii with antibiotics alters patients' bowel habits or prevents the appearance of C. difficile toxin in the stool. Thus, S. boulardii cannot be recommended as a 'natural' way to prevent antibiotic-related diarrhoea. This highlights the need for proper evaluation of probiotics before their unrestricted use in medical practice.

Pharmacists as HIV/AIDS information resources: survey of Alabama pharmacists.

Alabama pharmacists were surveyed by researchers from the University of Alabama at Birmingham's School of Public Health in collaboration with investigators at the Schools of Pharmacy at Auburn University and Stamford University as part of a statewide pharmacists' demonstration project to mobilize pharmacists and pharmacy locations as information resources for HIV/AIDS education and prevention. The objectives of the survey were to: (1) establish a baseline of knowledge and attitudes among Alabama pharmacists about HIV/AIDS; (2) to assess Alabama pharmacists' willingness to assume the role of HIV/AIDS information resources in their communities; and (3) to identify perceived barriers to assuming the role of information resources. The results of the survey were used in the development of an educational intervention program and will be used subsequently to assess the impact of the implementation of the Alabama demonstration project. Findings from this project will serve as a basis for development of a nationwide project as part of a collaborative agreement between the Centers for Disease Control and Prevention's National Partnership Program and the Foundation of Pharmacists and Corporate America for AIDS Education.

Use of in vitro methods to rank surfactants for irritation potential in support of new product development.

11 surfactant raw materials with potential applications in light-duty liquid cleaning products were evaluated in vitro using a human skin analogue (ATS SKIN(2) Model ZK1100) for predicting cytotoxicity (MTT reduction) and inflammation [prostaglandin E(2) (PGE(2)) release]. Two of the 11 raw materials, both in the same compound family, were selected to be individually combined with each of the other nine in a 90:10 (raw:selected raw) mixture. Selection criteria were based on desired performance characteristics and low irritation potential as suggested from the individual surfactant assay data. To determine whether irritation potential was mitigated, MTT and PGE(2) scores were again determined for each of the 18 combinations with the resulting data being compared with the untreated raw material data. A plot of the data indicated that one of two selected materials may have an 'anti-irritant' effect. For raw materials with intrinsic MTT scores of less than 50 mug/ml and with the original data corrected for possible dilution effects, a statistical comparison between individual raw materials and the two sets of combinations was done using a one-sample analysis. Both cytotoxicity (MTT) and inflammation (PGE(2)) were significantly decreased by the milder of the two selected raw materials. By factoring the data into future new product decisions, this methodology has become a useful and practical tool for Amway product development.

A teaching tool for patients receiving continuous i.v. infusion recombinant interleukin-2 therapy.

PURPOSE/OBJECTIVES: To present a tool developed to facilitate education of patients and families undergoing continuous i.v. therapy with interleukin-2 (IL-2). DATA SOURCES: Published articles, book chapters, authors' clinical experience. DATA SYNTHESIS: Topics covered in the teaching tool include development of IL-2, immune functioning, common side effects, side effect management, and when to contact healthcare providers. CONCLUSIONS: Well-received by patients, families, and healthcare providers who reviewed the material. IMPLICATIONS FOR NURSING PRACTICE: Use of a written patient education tool enables nurses to effectively teach patients with efficient use of nursing time.

A double-blind comparative study of norfloxacin versus placebo in hospitalised elderly patients with asymptomatic bacteriuria.

Patients over the age of 65 years with clear catch specimens of urine containing organisms sensitive to norfloxacin were blindly randomised to receive either norfloxacin in a dose of 400 mg twice daily for 7 days or a placebo for the same period. Urine cultures were repeated immediately prior to treatment, at the end of treatment and at 7 days, 1 month and 3 months after treatment. Physical and mental function were assessed by performing a Crighton Behavioural Rating Scale at the same time intervals. Observations were made on 29 each of subjects on norfloxacin and placebo. The proportions of patients abacteriuric at the end of treatment, 7 days and 3 months post- treatment were 16/24 (66%), 12/24 (50%) and 5/24 (21%) in the norfloxacin group and 10/26 (38%), 8/26 (31%) and 8/25 (32%) in the placebo group. Percentage calculations (and denominators) exclude those patients withdrawn or for whom there were no specimens available at the sampling interval in question. Means and 95% intervals for the Crighton Behaviour Rating Scales initially and at 3 months in subjects on norfloxacin were 18.1 (15.1-20.7) and 19.1 (16.2-21.9) respectively. The same figures for the placebo group were 15.7 (12.6-18.8) and 16.6 (13.7-19.5). It is concluded that a 7 day course of norfloxacin for the treatment of asymptomatic bacteriuria had no effect on the physical and mental function of elderly continuing care patients, and that one explanation for this is that there was a high rate of urinary re-infection.

Conceptual and methodologic problems in the evaluation of a new burn treatment modality.

This article describes and analyzes major conceptual and methodologic problems that occurred during the implementation and evaluation of a new home-based burn treatment modality. Problems described include those of conceptualization, measurement, patient sampling, and follow-up, data collection, and analysis. The origins of each specific problem are discussed along with their effects on the implementation of the project and project outcomes. Solutions for each set of problems are suggested.

Classifying patients with burns for hospital reimbursement: diagnosis-related groups and modifications for severity.

This study was designed to evaluate the relative severity and resource consumption of hospitalized patients with burns in a national cross section of hospitals, both with and without burn centers. We investigated to determine whether clinical variables or severity of illness measures not recorded in the Uniform Hospital Discharge Data Set are significant in explaining variation in length of stay, total cost, and mortality for patients with burns. The ability of the six burn diagnosis-related groups (DRGs) to explain variation in patients' length of stay was 20% and their ability to predict total costs was 24%. For the same patient population, the explanatory power of the DRGs improved to 54% for length of stay and 44% for costs when these variables were adjusted by the Severity of Illness Index. We also investigated whether hospitals with burn centers treated a more severely ill population of patients with burns than did hospitals without such centers. Significantly higher levels of severely ill patients with burns (p less than or equal to 0.0001) were found at burn center hospitals. Other patients or treatment variables, combined with a case-mix severity measure, were evaluated for their ability to further increase the explanatory power of DRGs. We also discuss here the use of the study results for reevaluating reimbursement policy.

Differences and intersubject variability of loudness discomfort levels measured in sound pressure level and hearing level for TDH-50P and ER-3A earphones.

Loudness discomfort levels (LDLs) were measured in dB HL and SPL at discrete frequencies between 500 to 4000 Hz on 31 hearing-impaired ears using TDH-50P and ER-3A earphones. The results revealed no significant differences in the measured sound pressure level (SPL) between the two earphones at all test frequencies. However, with dB HL measurements, statistically significant differences were revealed at 1500 and 4000 Hz between earphone conditions. The results also revealed large intersubject differences in the measured LDL (HL and SPL) for both earphones. The results of this study highlight the difficulty in accurately predicting individual performance from averaged group data.

Recognition of speech in noise with hearing aids using dual microphones.

Fifty subjects with mild to moderately severe sensorineural hearing loss and prior experience with amplification were evaluated at two sites (25 subjects at each site). Speech recognition in noise scores were measured using the Hearing in Noise Test (HINT) for each subject while wearing binaural behind-the-ear hearing aids allowing switching between two fitting algorithms ("basic" and "party") and two microphone conditions (single microphone omnidirectional and dual-microphone directional). Results revealed an average improvement in signal-to-noise ration (SNR) of 7.4 to 8.5 dB at the two sites for the directional conditions in comparison to the omnidirectional conditions. No significant improvement in SNR was measured between the two fitting algorithms. In addition, the Profile of Hearing Aid Benefit (PHAB) (Site I) and the Abbreviated Profile of Hearing Aid Benefit (APHAB) (Site II) were administered. Results revealed that the benefit scores for background noise and reduced cues (Site I) and background noise and aversiveness of sounds (Site II) were significantly higher than those reported in the established norms. Finally, 76 percent of the subjects of Site I reported that the experimental hearing aids provided "significantly better" or "better" performance than their current hearing aids.

Intersubject variability of real-ear sound pressure level: conventional and insert earphones.

Measures of the sound pressure level (SPL) near the eardrum were determined at discrete frequencies between 500 and 4000 Hz on 50 ears using TDH-39P and ER-3A earphones with the attenuator of an audiometer fixed at 90 dB HL. Results revealed significant differences in the measured SPL between the two earphones at all test frequencies. Results also revealed large intersubject differences in the SPL measured near the eardrum for both earphones. The results of this study highlight the large intersubject variability associated with measuring the SPL at the eardrum and point out the difficulty in accurately predicting individual performance from averaged group data.

Performance of dual-microphone in-the-ear hearing aids.

Fifty subjects with mild to moderate-severe sensorineural hearing loss and prior experience with binaural amplification were evaluated at two sites (25 subjects at each site). Signal-to-noise ratios (SNRs) were measured using the Hearing in Noise Test (HINT) after each subject wore binaural in-the-ear hearing aids programmed for omnidirectional and dual-microphone performance, for 4 weeks. Both microphone conditions were evaluated under "ideal" (signal at 0 degrees; noise at 180 degrees) and "diffuse" (signal at 0 degrees; correlated noise at 45 , 135 degrees, 225 degrees, and 315 degrees) listening conditions. Results revealed statistically significant mean improvements in SNRs between 3.7 and 3.5 dB at Site I and 3.2 and 2.7 dB at Site II for the ideal and diffuse listening conditions, respectively, for the dual-microphones in comparison to the performance provided by the omnidirectional microphone.

Comparing the performance of the Widex SENSO digital hearing aid with analog hearing aids.

Differences in performance were evaluated between the Widex SENSO and several analog hearing aids currently worn by 50 hearing-impaired subjects. Subjects were initially fit with the SENSO using the manufacturer's recommended procedure. After wearing the hearing aids for 1 week, the adjustable parameters were fine-tuned based on subjective comments. Differences in performance between the SENSO and the subjects' current hearing aids were assessed using the Speech Perception in Noise administered at overall levels of 50, 65, and 80 dB SPL; the Hearing in Noise Test in which the background noise was presented at 50, 65, and 80 dBA; the Abbreviated Profile of Hearing Aid Benefit; and two questionnaires relating to overall preference between the SENSO and the subjects' current hearing aids.

High-frequency thresholds: sound suite versus hospital room.

Benefits of high-frequency audiometry in monitoring hearing sensitivity of patients administered ototoxic medications are well established. Thresholds obtained within a sound suite have been proven reliable. It may, however, often be necessary for the audiologist to evaluate the patient at bedside. The primary purpose of this study was to determine if significant differences are present between high-frequency thresholds measured in a sound suite versus thresholds measured in a hospital room. In addition, the test-retest reliability of high-frequency thresholds was determined when measured in a hospital room. For 25 normal hearing subjects, results revealed that significant differences were not observed between thresholds measured in a sound suite versus those measured in a typical hospital room. In addition, differences between the initial and repeated thresholds obtained in the hospital room were not significant, and the differences were, for the most part, within +/- 10 dB at all test frequencies.

Differences in performance between Oticon MultiFocus Compact and ReSound BT2-E hearing aids.

Differences in performance were evaluated between binaural fittings of the Oticon MultiFocus (MF) and ReSound BT2-E on 25 hearing-impaired subjects across two sites. Subjects were initially fit using each manufacturer's algorithm and adjustments were made at 1 week based on subjects' responses to diary questions. Performance was assessed after a 4- to 6-week trial period with each hearing aid set using the Speech Perception in Noise (SPIN) test administered at 50, 65, and 80 dB SPL, the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, loudness judgments of female connected discourse at 65 and 80 dB SPL, and an overall preference selection. The MF yielded significantly better SPIN scores at 50 and 65 dB SPL, while the BT2-E yielded a significantly better score at 80 dB SPL. No statistically significant differences were found in the APHAB benefit scores between the hearing aid sets, but both sets were significantly better than the subjects' own hearing aids on three of the four subscales. The MF produced slightly higher mean loudness judgments at both input levels than the BT2-E. Finally, 12 subjects preferred the BT2-E, 10 subjects preferred the MF, and three subjects stated no preference. The results are discussed in terms of audiogram effects on preference and effects of differences in signal processing approaches between the devices.

Ogden R. Lindsley and the historical development of precision teaching.

This paper presents the historical developments of precision teaching, a technological offshoot of radical behaviorism and free-operant conditioning. The sequence progresses from the scientific precursors of precision teaching and the beginnings of precision teaching to principal developments since 1965. Information about the persons, events, and accomplishments presented in this chronology was compiled in several ways. Journals, books, and conference presentations provided the essential information. The most important source for this account was Ogden Lindsley himself, because Lindsley and his students established the basic practices that define precision teaching.