Calcium supplementation for the prevention of hypertension: a synthesis of existing evidence and implications for practise.

Hypertension (also known as high blood pressure), is a medical condition characterized as a persistently raised blood pressure of the pulmonary artery. Effective interventions to treat hypertension typically involve two approaches: lifestyle modifications and pharmacotherapy. One specific lifestyle intervention which aims to increase calcium uptake through dietary supplementation, has recently gained popularity because of its potential to be low-cost and population based. Research suggests that this intervention may be effective given that calcium has been found to have an inverse relationship with blood pressure and hypertension. That said, studies have shown that there may be potential risks to patient health through adverse events such as kidney stone formation and increased cardiovascular events. Association between calcium supplementation and adverse events could have an impact on population health and prevent widespread adoption of the intervention. Because of the need to establish the effectiveness of this intervention assessed against any possible harms, it is now necessary to review the current evidence and evaluate its implications for clinical practise.

Health and social care: The link between social care deficiencies and health care pressures.

In the United Kingdom, demand on the social care sector is rising coupled with a significant reduction in funding making it difficult to meet these needs. The aim of this two-part commentary is to provide a critical evaluation of the evidence base in relation to solutions to tackle the growing demands on health and social care. Part 1 focuses on the evidence from a systematic review around the association between the availability and supply of social care and healthcare on utilisation for older adults in high income countries. Part 1 Health and social care The link between social care deficiencies and health care pressures: An evidence summary based on the following systematic review:Spiers G, Matthews FE, Moffatt S, Barker RO, Jarvis H, Stow D, Kingston A, Hanratty B (2019) Impact of social care supply on healthcare utilisation by older adults: a systematic review and meta-analysis. Age and Ageing 48(1):57-66. https://doi.org/10.1093/ageing/afy147.

The effectiveness and safety of heat/cold therapy in adults with lymphoedema: systematic review.

PURPOSE: The aim of this review is to assess the efficacy and safety of using heat and cold therapy for adults with lymphoedema. METHODS: A multi-database search was undertaken. Only studies which included adults with lymphoedema who were treated with heat or cold therapy reporting any outcome were included. Screening, data extraction, and assessment of bias were undertaken by a single reviewer and verified by a second. Due to the substantial heterogeneity, a descriptive synthesis was undertaken. RESULTS: Eighteen studies were included. All nine studies which assessed the effects of heat-therapy on changes in limb circumference reported a point estimate indicating some reduction from baseline to end of study. Similarly, the five studies evaluating the use of heat-therapy on limb volume demonstrated a reduction in limb volume from baseline to end-of-study. Only four studies reported adverse events of which all were deemed to be minor. Only two studies explored the effects of cold therapy on lymphoedema. CONCLUSIONS: Tentative evidence suggests heat-therapy may have some benefit in treating lymphoedema with minimal side effects. However, further high-quality randomised controlled trials are required, with a particular focus on moderating factors and assessment of adverse events.Implications for rehabilitationThis review highlights the potential benefit that heat therapy may have on reducing limb circumference and volume for adults with lymphoedema.There was no evidence that controlled localised heat therapy was unsafe.The current evidence-base is at a point where no specific clinical recommendations can be made.The use of heat therapy should only be applied as part of a methodologically robust study to treat lymphoedema.

Diagnostic accuracy of early warning system scores in the prehospital setting.

The utilisation of pre-hospital early warning scores in ambulance services is widely endorsed to promptly identify patients at risk of clinical deterioration. Early warning scores enable clinicians to estimate risk based on clinical observations and vital signs, with higher scores indicating an elevated risk of adverse outcomes. Local healthcare systems establish threshold values for these scores to guide clinical decision-making, triage, and response, necessitating a careful balance between identifying critically unwell patients and managing the challenge of prioritisation. Given the limited evidence for optimal early warning scores in emergency department and pre-hospital care settings, a systematic review by Guan et al. (2022) was undertaken to assess the diagnostic accuracy of early warning scores for predicting in-hospital deterioration when applied in the emergency department or pre-hospital setting. This commentary aims to critically appraise the methods used within the review Guan et al (2022) and expand upon the findings in the context of clinical practice.

Prevalence, severity and preventability of prehospital patient safety incidents.

The provision of safe and effective healthcare is a mainstay for all services and clinicians associated with the delivery of pre-hospital care, however little is empirically known about the prevalence and impact of harm caused in the pre-hospital phase. This commentary critically appraises a recent systematic review which sought to identify the frequency of patient safety incidents and the harm associated with them in prehospital care.

Mortality of a large wide-ranging mammal largely caused by anthropogenic activities.

With efforts to restore large mammal populations following extirpations, it is vital to quantify how they are impacted by human activities and gain insights into population dynamics in relation to conservation goals. Our objective was to characterize cause-specific mortality of black bears (Ursus americanus) throughout their range. We first quantified cause-specific mortality for 247 black bears in one harvested and two non-harvested populations. We then simulated a small recolonizing population with and without anthropogenic mortality. Lastly, we conducted a meta-analysis of all published black bear mortality studies throughout North America (31 studies of 2630 bears). We found anthropogenic mortality was greater than natural mortality, non-harvest anthropogenic mortality (e.g. poaching, defense of property, etc.) was greater in non-harvested populations, and harvesting was one of the major causes of mortality for bears throughout their range. Our simulation indicated that removing anthropogenic mortality increased population size by an average of 23% in 15 years. We demonstrated that bears are exposed to high levels of anthropogenic mortality, and the potential for human activities to slow population growth in expanding populations. Management and conservation of wide-ranging mammals will depend on holistic strategies that integrate ecological factors with socio-economic issues to achieve successful conservation and coexistence.

Different and diverse anaerobic microbiota were seen in women living with HIV with unsuppressed HIV viral load and in women with recurrent bacterial vaginosis: a cohort study.

OBJECTIVE: To compare the vaginal microbiota of women living with HIV (WLWH) with the vaginal microbiota of women with recurrent bacterial vaginosis (BV) and healthy women without HIV to determine if there are differences in the vaginal microbiome, what factors influence these differences, and to characterise HIV clinical parameters including viral load and CD4 count in relation to the vaginal microbiome. DESIGN: Observational cohort study. SETTING: Canada. POPULATION: Women aged 18-49 years who were premenopausal and not pregnant were recruited into three cohorts: healthy women, WLWH and women with recurrent BV. METHODS: Demographic and clinical data were collected via interviews and medical chart reviews. Vaginal swabs were collected for Gram-stain assessment and microbiome profiling using the cpn60 barcode sequence. MAIN OUTCOME MEASURES: To compare overall community composition differences, we used compositional data analysis methods, hierarchical clustering and Kruskal-Wallis tests where appropriate. RESULTS: Clinical markers such as odour and abnormal discharge, but not irritation, were associated with higher microbial diversity. WLWH with unsuppressed HIV viral loads were more likely than other groups to have non-Gardnerella-dominated microbiomes. HIV was associated with higher vaginal microbial diversity and this was related to HIV viral load, with unsuppressed women demonstrating significantly higher relative abundance of Megasphaera genomosp. 1, Atopobium vaginae and Clostridiales sp. (all P < 0.05) compared with all other groups. CONCLUSIONS: In WLWH, unsuppressed HIV viral loads were associated with a distinct dysbiotic profile consisting of very low levels of Lactobacillus and high levels of anaerobes. TWEETABLE ABSTRACT: Vaginal microbiomes in WLWH with viral load >50 copies/ml have distinct dysbiotic profiles with high levels of anaerobes.

Expanding the Klebsiella pneumoniae volatile metabolome using advanced analytical instrumentation for the detection of novel metabolites.

AIMS: The purpose of this study was to identify the volatile molecules produced by the pathogenic Gram-negative bacterium Klebsiella pneumoniae (ATCC 13883) during in vitro growth using comprehensive two-dimensional gas chromatography coupled to time-of-flight mass spectrometry (GC×GC-TOFMS). METHODS AND RESULTS: Klebsiella pneumoniae ATCC 13883 was incubated in lysogeny broth to mid-exponential and stationary growth phases. Headspace volatile molecules from culture supernatants were concentrated using solid-phase microextraction (SPME) and analysed via GC×GC-TOFMS. Ninety-two K. pneumoniae-associated volatile molecules were detected, of which 78 (85%) were detected at both phases of growth and 14 (15%) were detected at either mid-exponential or stationary growth phases. CONCLUSIONS: This study has increased the total number of reported K. pneumoniae-associated volatile molecules from 77 to 150, demonstrating the sensitivity and resolution achieved by employing GC×GC-TOFMS for the analysis of bacterial headspace volatiles. SIGNIFICANCE AND IMPACT OF THE STUDY: This study represents an early-stage comprehensive volatile metabolomic analysis of an opportunistic bacterial pathogen. Characterizing the volatile molecules produced by K. pneumoniae during in vitro growth could provide us with a better understanding of this organisms' metabolism, an area that has not been extensively studied to date.

Sensitivity of a real-time polymerase chain reaction for Tritrichomonas fetus in direct individual and pooled preputial samples.

The objective of this study was to evaluate the sensitivity of a commercially available real-time polymerase chain reaction (PCR) test for the detection of Tritrichomonas fetus in individual and pooled direct preputial samples. Two samples were collected and processed once a week from nine T. fetus-infected bulls (n = 121) and placed into either an InPouch TF or 2 mL of PBS. Preputial samples were also collected into both media and PBS from 1016 other bulls. All pouches were cultured and evaluated as per manufacturer's instructions. The prepuce samples collected directly into PBS were individually evaluated using real-time PCR by a commercial diagnostic laboratory. Direct preputial samples were then randomly divided for pooling into groups of 5 and 10 samples, ensuring that every pool had one sample from a known infected bull before testing using real-time PCR. Sensitivity was estimated for culture and real-time PCR of the 121 direct and culture-enriched individual samples from nine infected bulls. There were no differences (P = 0.12) among the sensitivity estimates for culture, 95.0% (95% confidence interval [CI]: 89.6%-97.7%); real-time PCR of culture-enriched samples, 95.9% (95% CI: 90.7-98.2); and direct preputial samples, 90.1% (95% CI: 83.5-94.2). There was also no significant difference (P = 0.08) between the sensitivity of real-time PCR for direct preputial samples in 110 pools of 5 (83.6%, 95% CI: 75.6-89.4) or 10 samples (77.3%, 95% CI: 68.6-84.1). The use of three sequential direct samples, collected in PBS at weekly intervals and tested by real-time PCR, increased the sensitivity to 100% for pools of 5 and 96% for pools of 10. In conclusion, direct preputial samples collected in PBS and tested by real-time PCR individually have comparable sensitivity to culture and real-time PCR in enriched samples. The use of pooled direct preputial samples appears to be relatively sensitive. However, this strategy requires repeated sampling to optimize sensitivity. Real-time PCR testing of preputial samples collected directly into PBS with the option of pooling would decrease the cost associated with screening bulls, and increase the feasibility of large epidemiological studies and active surveillance.

Establishment of a European-type strain of Echinococcus multilocularis in Canadian wildlife.

In 2009, a haplotype closely related to European strains of Echinococcus multilocularis was detected in a dog from the Quesnel region of British Columbia, Canada. We now report the establishment of this same haplotype in 7 coyotes (Canis latrans) trapped within 40 km of Quesnel, BC. In addition, 3 coyotes and 1 red fox (Vulpes vulpes) harboured adult cestodes morphologically compatible with that of E. multilocularis (overall prevalence 33% in 33 carnivores). None of 156 potential intermediate hosts, including 131 representatives of two highly suitable rodent species, Peromyscus maniculatus and Microtus pennsylvanicus, trapped from a region 120-210 km south of Quesnel were infected. This report confirms the establishment and local transmission of a European-type strain of E. multilocularis (the causative agent of human alveolar hydatid disease), in wildlife in a forested region of North America where this cestode had not been previously detected, with significance for public and animal health.

Microbial communities in low permeability, high pH uranium mine tailings: characterization and potential effects.

AIMS: To describe the diversity and metabolic potential of microbial communities in uranium mine tailings characterized by high pH, high metal concentration and low permeability. METHODS AND RESULTS: To assess microbial diversity and their potential to influence the geochemistry of uranium mine tailings using aerobic and anaerobic culture-based methods, in conjunction with next generation sequencing and clone library sequencing targeting two universal bacterial markers (the 16S rRNA and cpn60 genes). Growth assays revealed that 69% of the 59 distinct culturable isolates evaluated were multiple-metal resistant, with 15% exhibiting dual-metal hypertolerance. There was a moderately positive correlation coefficient (R = 0·43, P < 0·05) between multiple-metal resistance of the isolates and their enzyme expression profile. Of the isolates tested, 17 reduced amorphous iron, 22 reduced molybdate and seven oxidized arsenite. Based on next generation sequencing, tailings depth was shown to influence bacterial community composition, with the difference in the microbial diversity of the upper (0-20 m) and middle (20-40 m) tailings zones being highly significant (P < 0·01) from the lower zone (40-60 m) and the difference in diversity of the upper and middle tailings zone being significant (P < 0·05). Phylotypes closely related to well-known sulfate-reducing and iron-reducing bacteria were identified with low abundance, yet relatively high diversity. CONCLUSIONS: The presence of a population of metabolically-diverse, metal-resistant micro-organisms within the tailings environment, along with their demonstrated capacity for transforming metal elements, suggests that these organisms have the potential to influence the long-term geochemistry of the tailings. SIGNIFICANCE AND IMPACT OF THE STUDY: This study is the first investigation of the diversity and functional potential of micro-organisms present in low permeability, high pH uranium mine tailings.

Identifying the role of flagella in the transport of motile and nonmotile Salmonella enterica serovars.

The influence of bacterial flagella on cell transport has been examined using three Salmonella enterica serovars with different motility phenotypes. Both a packed bed (PB) column and radial stagnation point flow system (RSPF) were employed to investigate bacterial deposition kinetics onto quartz over a range of conditions. The aim of this study was to better understand the role of motility on the deposition behavior of Salmonella, an important food- and waterborne pathogen. In both the PB column and RSPF systems, flagellated strains showed higher deposition, indicating the nonmotile cells can be transported further than the motile. At late-exponential growth phase, the deposition of the functional flagellated motile strain was enhanced, much more so than the dysfunctionally flagellated nonmotile and nonflagellated strains, highlighting the role of flagellar motion in cellular deposition and retention through available pore spaces and irregularities on quartz surfaces.

Diets supplemented with chickpea or its main oligosaccharide component raffinose modify faecal microbial composition in healthy adults.

The effects of diets supplemented with either chickpea or its main oligosaccharide raffinose on the composition of the faecal microbial community were examined in 12 healthy adults (18-65 years) in a randomised crossover intervention study. Subjects consumed their usual diet supplemented with soups and desserts that were unfortified, or fortified with either 200 g/d of canned chickpeas or 5 g/d of raffinose for 3 week periods. Changes in faecal bacterial populations of subjects were examined using 16S rRNA-based terminal restriction fragment length polymorphisms (T-RFLP) and clone libraries generated from the diet pools. Classification of the clone libraries and T-RFLP analysis revealed that Faecalibacterium prausnitzii, reported to be an efficient butyrate producer and a highly metabolically active bacterium in the human intestinal microbiota, was more abundant in the raffinose diet and the chickpea diet compared to the control diet. However, no significant difference was observed in the faecal total short chain fatty acid concentration or in the levels of the components (butyrate, acetate and propionate) with the chickpea diet or the raffinose diet compared to the control diet. Bifidobacterium species were detected by T-RFLP in all three diet groups and quantitative real-time PCR (qPCR) analysis showed a marginal increase in 16S rRNA gene copies of Bifidobacterium with the raffinose diet compared to control (P>0.05). The number of individuals showing TRFs for the Clostridium histolyticum - Clostridum lituseburense groups, which include pathogenic bacteria species and putrefactive bacteria, were lower in the chickpea diet compared to the other two treatments. Diet appeared to affect colonisation by a high ammonia-producing bacterial isolate which was detected in 83%, 92% and 42% of individuals in the control, raffinose and chickpea groups, respectively. Our results indicate that chickpea and raffinose have the potential to modulate the intestinal microbial composition to promote intestinal health in humans.

Isolation of a novel strain of Bacillus pumilus from penaeid shrimp that is inhibitory against marine pathogens.

A bacterium was isolated from the mid-gut of healthy black tiger shrimp, Penaeus monodon, based on a large zone of inhibition in mixed culture on solid medium. The isolate was a Gram-positive, motile spore former, with an optimum pH range for growth in tryptone soya broth containing 2% NaCl of between pH 6 and 9. The bacterium was highly salt tolerant with concentrations between 0% and 8% having no detrimental effect on growth. The isolate was identified as Bacillus pumilus based on physiological capabilities using the API50CHB and Biolog systems. Amplification and sequencing of the 16S rRNA gene followed by phylogenetic analysis confirmed its identity. The Bacillus pumilus isolate was strongly inhibitory against the marine bacterial pathogens Vibrio alginolyticus, V. mimicus and V. harveyi, and weakly inhibitory against V. parahaemolyticus in cross-streaking assays on solid medium. The organism was marginally self-inhibitory, and inhibited B. licheniformis and B. subtilis. The suitability of the B. pumilus isolate for use as a probiotic in farmed shrimp was further supported by the absence of any of the known B. cereus enterotoxin genes. Based on these in vitro results, in vivo safety and efficacy trials are underway to determine suitability of the novel strain as a commercial probiotic.

Destructive polyarthropathy in aborted bovine fetuses: a possible association with Ureaplasma diversum infection?

Severe destructive polyarthropathy with fibrillation and erosion of articular cartilage, deformation of articular surfaces, and proliferation of periarticular soft tissue was diagnosed in 5 bovine fetuses aborted in the last trimester. There was involvement of a single coxofemoral joint in 2 fetuses, both elbows, and a stifle in 1, both stifles and tarsal joints in another, and, in the most severely affected fetus, both hips, stifles, and shoulders as well as 1 carpus. In affected joints, the articular cartilage was irregularly reduced in thickness and contained fibrovascular tissue and, in some cases, inflammatory cells and fibrin. Four of 5 fetuses had microscopic placentitis; all had mild lymphoplasmacytic conjunctivitis. Ureaplasma spp. was identified in 4 cases by polymerase chain reaction or culture. Fetal arthropathy and Ureaplasma diversum-associated joint pathology have not been previously reported in the veterinary literature; however, other Ureaplasma spp. are known to cause reproductive disease and arthritis in humans.

X-ray flares in early GRB afterglows.

The Swift X-ray Telescope (XRT) has discovered that flares are quite common in early X-ray afterglows of gamma-ray bursts (GRBs), being observed in roughly 50% of afterglows with prompt follow-up observations. The flares range in fluence from a few per cent to approximately 100% of the fluence of the prompt emission (the GRB). Repetitive flares are seen, with more than four successive flares detected by the XRT in some afterglows. The rise and fall times of the flares are typically considerably smaller than the time since the burst. These characteristics suggest that the flares are related to the prompt emission mechanism, but at lower photon energies. We conclude that the most likely cause of these flares is late-time activity of the GRB central engine.