A text message intervention to support women's physical and mental health after breast cancer treatments (EMPOWER-SMS): a randomised controlled trial protocol.

BACKGROUND: Breast cancer is the most common cancer diagnosed in women worldwide. In developed countries, 80-90% of women will survive five years after diagnosis but the transition from hospital-based care to health self-management and self-efficacy can be difficult. Text messaging programs offer a simple and proven way to provide support to people with chronic diseases. This study aims to test the effectiveness of a text message support program at improving women's health self-efficacy, and physical and mental health outcomes after breast cancer treatments compared to usual care at 6-months and to understand the barriers and enablers to widespread implementation. METHODS: Single-blind randomised control trial (RCT; N = 160) comparing a text message support intervention to usual care in women with breast cancer (recruited from a large tertiary referral hospital in Sydney, Australia). The intervention group will receive a six-month text message support program, which consists of semi-personalised, supportive, lifestyle-focused text messages (4 messages/week) in addition to usual care. The control group will receive usual care without the text message program. Outcomes will be assessed at 6-months. The primary outcome is change in self-efficacy for managing chronic disease. Secondary outcomes include change in clinical outcomes (body mass index), lifestyle outcomes (physical activity levels, dietary behaviours), mood (depression and anxiety scales), quality of life, satisfaction with, and usefulness of the intervention. Analyses will be performed on the principle of intention-to-treat to examine differences between intervention and control groups. DISCUSSION: This study will test if a scalable and cost-effective text-messaging intervention is effective at improving women's health self-efficacy, as well as physical and mental health outcomes. Moreover, this study will provide essential preliminary data to bolster a large multicentre RCT to helpsupport breast cancer survivors throughout recovery and beyond. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12618002020268 , 17 December 2018.

Complete sequence of pSAM7, an IncX4 plasmid carrying a novel blaCTX-M-14b transposition unit isolated from Escherichia coli and Enterobacter cloacae from cattle.

The same plasmid carrying blaCTX-M-14b was identified from an Escherichia coli isolate and an Enterobacter cloacae isolate collected from cattle in the United Kingdom by complete plasmid sequencing. This 35,341-bp plasmid, pSAM7, had an IncX4 backbone that is 99% identical to that of pJIE143 from a human isolate in Australia. PCR screening identified pSAM7-like plasmids in three other E. coli isolates of different multilocus sequence types isolated from cattle on different farms in the United Kingdom.

Effectiveness of lifestyle interventions for preventing harmful weight gain among young adults from lower socioeconomic status and ethnically diverse backgrounds: a systematic review.

The incidence of overweight and obesity are increasing with each successive generation of young adults. Associated co-morbidities will emerge at an earlier age unless weight gain is prevented. Evidence has demonstrated young adults (aged 18-35 years) from low socioeconomic and ethnically diverse backgrounds are at greater risk of overweight or obesity, yet it is unclear how to effectively intervene in this population. This systematic review aimed to assess the effectiveness of lifestyle interventions conducted in this population. Thirty studies reporting on lifestyle interventions for prevention of weight gain were identified from eight electronic databases searched. Six interventions included subgroup analyses to determine if ethnicity moderated weight change, and two included subgroup analyses to determine if socioeconomic status had an effect on change in weight. Five of these six studies were effective in preventing weight gain, and subgroup analyses showed no differences in effect by ethnicity. Of these five studies, two included a subgroup analysis that showed socioeconomic status to have no effect on weight outcome. Despite the promising results from these five lifestyle interventions utilizing online and mobile components to effectively reach and prevent weight gain in this priority population, the evidence base of high quality trials is limited.

The barriers and enablers of healthy eating among young adults: a missing piece of the obesity puzzle: A scoping review.

Young adults in Western countries are gaining weight faster than their parents and are more likely to gain weight than any other age cohort. Despite this, investigation into the complex young adults' food choice motives, which enable and prevent healthy eating, has not been widely investigated. A scoping review was conducted involving an extensive literature search of four major electronic databases: Medline, Embase, PsychInfo and CINAHL. Data were collected from 34 articles: study descriptions numerically analysed and key findings thematically analysed. The key barriers found included: male apathy towards diet; unhealthy diet of friends and family; expected consumption of unhealthy foods in certain situations; relative low cost of unhealthy foods; lack of time to plan, shop, prepare and cook healthy foods; lack of facilities to prepare, cook and store healthy foods; widespread presence of unhealthy foods; lack of knowledge and skills to plan, shop, prepare and cook healthy foods; lack of motivation to eat healthily (including risk-taking behaviour). The key enablers found included: female interest in a healthy diet; healthy diet of friends and family; support/encouragement of friends and family to eat healthy; desire for improved health; desire for weight management; desire for improved self-esteem; desire for attractiveness to potential partners and others; possessing autonomous motivation to eat healthy and existence and use of self-regulatory skills. This research provides evidence that can be used to tailor interventions for healthy eating and overweight and obesity in this population. However, government intervention in addressing food access, affordability, marketing and taxation remains essential to any significant change.

Strategies for successful recruitment of young adults to healthy lifestyle programmes for the prevention of weight gain: a systematic review.

Recruiting healthy young adults, aged 18-35, to lifestyle programmes for prevention of weight gain is challenging but important given their increasing rates of obesity. This review aimed to examine the success of different recruitment strategies. A systematic literature search identified 26 separate studies using 10 electronic databases. Participant characteristics and efficacy of interventions were well reported in all studies, but reporting of recruitment procedures, costs, times and effectiveness was minimal. Of those reporting recruitment, both active (e.g. face-to-face) and passive (e.g. print-media and mass-mailings) approaches were identified with the latter most frequently employed. Novel strategies such as social media and marketing approaches were identified. Television and radio have potentially high reach but low efficiency with high cost compared with mass-mailings which yield high numbers of participants. Marketing campaigns appeared to be a promising approach. Incentives demonstrated enhanced recruitment. The use of formative research to guide recruitment strategies for interventions is recommended. Reporting of success, cost and timelines for recruitment should be included in reporting of future trials. This first synthesis of recruitment information can be used to inform recruitment frameworks for lifestyle programmes seeking to attract young adults.

Poor quality of external validity reporting limits generalizability of overweight and/or obesity lifestyle prevention interventions in young adults: a systematic review.

Young adulthood is a high-risk life stage for weight gain. Evidence is needed to translate behavioural approaches into community practice to prevent weight gain in young adults. This systematic review assessed the effectiveness and reporting of external validity components in prevention interventions. The search was limited to randomized controlled trial (RCT) lifestyle interventions for the prevention of weight gain in young adults (18-35 years). Mean body weight and/or body mass index (BMI) change were the primary outcomes. External validity, quality assessment and risk of bias tools were applied to all studies. Twenty-one RCTs were identified through 14 major electronic databases. Over half of the studies were effective in the short term for significantly reducing body weight and/or BMI; however, few showed long-term maintenance. All studies lacked full reporting on external validity components. Description of the intervention components and participant attrition rates were reported by most studies. However, few studies reported the representativeness of participants, effectiveness of recruitment methods, process evaluation detail or costs. It is unclear from the information reported how to implement the interventions into community practice. Integrated reporting of intervention effectiveness and enhanced reporting of external validity components are needed for the translation and potential upscale of prevention strategies.

Conservation of the 168 divIB gene in Bacillus subtilis W23 and B. licheniformis, and evidence for homology to ftsQ of Escherichia coli.

The chromosomal regions of Bacillus subtilis (Bs) W23 and Bacillus licheniformis (Bl), which span the sequence encoding the homolog of the division initiation gene, divIB, of Bs168 were cloned and sequenced. The high level of conservation of the amino acid (aa) sequence of the DivIB protein (99 and 68% identity for BsW23 and Bl, respectively) was consistent with a significant role for this protein in the cell cycle of the two species. The hydropathy profile for DivIB of Bl was almost identical to that of Bs168 and consistent with a membrane location, as previously established for the latter. The higher than average level of identity (87%) of the 31-aa N-terminal cytoplasmic domain of DivIB between Bs168 and Bl raised the possibility of a special role for this domain. Database analyses using the Bl DivIB sequence and similarity analyses also strongly suggested that DivIB, of Bl and Bs, is a homolog of FtsQ of Escherichia coli. The flanking sequences extending into the unidentified orfs both upstream and downstream from divIB were highly conserved between Bs168 and Bl at both the nucleotide and aa levels. It was confirmed that orf4 of Bs168 is dispensable.

Mobile gene cassettes and integrons in evolution.

Integrons and the site-specific recombination systems encoded by them provide a simple mechanism for the addition of new genes to bacterial chromosomes. Although there is substantial divergence among the four known integron-encoded integrases, they all recognize the recombination sites, known as 59-base elements, that are associated with genes that are packaged in gene cassettes. In contrast, the integron-associated recombination sites, attl sites, are preferentially recognized by the cognate integrase.

Does weight loss in overweight or obese women improve fertility treatment outcomes? A systematic review.

This systematic review assessed the effect of weight loss in overweight and/or obese women undergoing assisted reproductive technology (ART) on their subsequent pregnancy outcome. Weight losses achieved by diet and lifestyle changes, very-low-energy diets, non-surgical medical interventions and bariatric surgery translated into significantly increased pregnancy rates and/or live birth in overweight and/or obese women undergoing ART in 8 of the 11 studies reviewed. In addition, regularization of the menstrual pattern, a decrease in cancellation rates, an increase in the number of embryos available for transfer, a reduction in the number of ART cycles required to achieve pregnancy and a decrease in miscarriage rates were reported. There were also a number of natural conceptions in five of the six studies that reported this outcome. Non-surgical medical weight loss procedures and bariatric surgery induced the greatest weight losses, but their use, as well as that of very-low-energy diets, for weight loss prior to ART requires careful consideration. While the overall quality of the studies included in this review was poor, these results support the clinical recommendation of advising overweight and/or obese women to lose weight prior to ART. Prospective randomized controlled trials are required to establish efficacious evidence-based guidelines for weight loss interventions in overweight and/or obese women prior to ART treatment.

The importance of morphological events and intercellular interactions in the regulation of prespore-specific gene expression during sporulation in Bacillus subtilis.

We have established a time course for the early morphological events of sporulation in Bacillus subtilis and related this to changes in gene expression, particularly those occurring in the prespore compartment. We have also systematically studied the effects of mutations in various regulatory (spo) genes on prespore-specific gene expression. On the basis of these results, and those of other laboratories, at least four distinct temporal classes of prespore-specific gene expression can now be distinguished. The first class begins within 15 min of the formation of the spore septum, and requires the sigma F form of RNA polymerase. The second class, also directed by RNA polymerase containing sigma F, begins soon after the completion of prespore engulfment, and depends on an intercellular signal from the mother cell. This transcription results in synthesis of sigma G. However, sigma G activity, directing the third class of gene expression, appears only about 30 min later and is dependent on the completion of prespore engulfment and on further interactions with the mother cell. The fourth class of gene expression has been described. The results demonstrate that the prespore programme of gene expression incorporates a series of control points modulated by information from the mother cell and on progress through the morphogenetic process.

FtsZ and nucleoid segregation during outgrowth of Bacillus subtilis spores.

Spores of a strain of Bacillus subtilis in which ftsZ was under the control of the spac promoter were allowed to germinate and grow out in the presence of increasing concentrations of isopropyl-beta-D-thiogalactopyranoside (IPTG). Over the IPTG concentration range of 0 to 10(-3) M, the level of FtsZ from the time when the first nucleoid segregations were occurring, measured in Western blot (immunoblot) transfer experiments, varied between 15 and 100% of that in the wild type. Septation was completely blocked (for at least several hours) when the amount of FtsZ was < 30% of the wild-type level. At all levels of ftsZ induction, the timing and rate of segregation of nucleoids following the first round of replication were unaltered. It is concluded that FtsZ has no direct role in nucleoid segregation in this situation.

The role of sigma F in prespore-specific transcription in Bacillus subtilis.

Sporulation in Bacillus subtilis is a simple developmental system in which a single cell undergoes differentiation to two 'sister' cells, namely the prespore and the sporangium. Prespore-specific gene expression is largely dependent on the synthesis of a transcription factor, sigma G. Transcription of spolllG, the gene encoding sigma G, is under precise temporal and spatial control, requiring the products of at least eight genes that are expressed in the pre-divisional cell. Here we show that the product of one of these genes, another sigma factor, sigma F, is by itself sufficient to direct transcription of spolllG in non-sporulating cells. The results indicate that the cell-specificity of prespore gene expression is determined by a mechanism that exerts temporal and spatial control over the activity of sigma F.

Sigma factors, asymmetry, and the determination of cell fate in Bacillus subtilis.

Soon after the initiation of sporulation, Bacillus subtilis divides asymmetrically to produce sister cells that have very different developmental fates. Recently, it has been proposed that the differential gene expression which begins soon after this division is due to cell-specific activation of the transcription factors sigma F and sigma E in the prespore and the mother cell, respectively. We describe the use of a method for the localization of gene expression in individual sporulating cells that lends strong support to the cell-specific localization of sigma F and sigma E activities. The dependence of sigma E activity on integrity of the gene encoding sigma F has led to the suggestion that activation of sigma F in the prespore leads to a directional signal that triggers activation of sigma E only in the mother cell. Here we show that sigma E actually specifies the fate of the mother cell; in the absence of sigma E, two prespore-like cells are made. The appearance of sigma F activity at both poles of a sigma E-deficient mutant supports the idea that sigma F normally remains latent in the mother cell and that its activation depends on some morphological or physiological feature of the prespore. We present a model for the generation of asymmetry and the establishment of cell fate in B. subtilis.

Transposons Tn1696 and Tn21 and their integrons In4 and In2 have independent origins.

The first 13.6 kb of the mercury and multidrug resistance transposon Tn1696, which includes the class 1 integron In4, has been sequenced. In4 is 8.33 kb long and contains the 5'-conserved segment (5'-CS) and 2.24 kb of the 3'-conserved segment (3'-CS) flanking four integrated cassettes. The 3'-CS region is followed by one full copy and an adjacent partial copy of the insertion sequence IS6100 flanked, in inverse orientation, by two short segments (123 and 152 bp) from the outer right-hand end of class 1 integrons. This structure is representative of a distinct group of class 1 integrons that differs from In2, found in Tn21, and other related class 1 integrons. In4 does not include transposition genes but is bounded by characteristic 25-bp inverted repeats and flanked by a direct duplication of 5 bp of the target sequence, indicating that it was inserted by a transpositional mechanism. In4 lies between the resII and resI sites of a backbone mercury resistance transposon which is >99.5% identical to Tn5036. Although Tn21 and Tn1696 are both classified as members of the Tn21 subfamily of the Tn3 transposon family, the backbone mercury resistance transposons are only 79 to 96% identical. Tn21 also contains a region of about 0.7 kb not found in Tn1696. The integrons In2 and In4 carrying the antibiotic resistance genes have been inserted at different locations into distinct ancestral mercury resistance transposons. Thus, Tn21 and Tn1696 have independent histories and origins. Other transposons (Tn1403 and Tn1412) that include a class 1 integron also have independent origins. In all except Tn21, the integron is located within the res region of the backbone transposon.

Family of class 1 integrons related to In4 from Tn1696.

The class 1 integron In28, found in the multidrug resistance transposon Tn1403, was found to be located in the res site of the backbone transposon and is flanked by a 5-bp direct duplication, indicating that it reached this position by transposition. In28 has a backbone structure related to that of In4, but has lost internal sequences, including the sul1 gene, due to an IS6100-mediated deletion. In28 also lacks the partial copy of IS6100 found in In4 and contains different gene cassettes, blaP1, cmlA1, and aadA1. In1, the class 1 integron found in the multidrug resistance plasmid R46, is also located in a putative res site and belongs to the In4 group. In1 has a shorter internal deletion than In28 and has also lost one end. Additional integrons with structures related to In4 were also found in databases, and most of them had also lost either one end or internal regions or both. Tn610 belongs to this group.

DivIB, FtsZ and cell division in Bacillus subtilis.

The Bacillus subtilis cell-division protein DivIB is shown to be present at an approximately 100-fold higher abundance (approximately 5000 molecules per cell) than its Escherichia coli FtsQ homologue. B. subtilis contains much more DivIB (at least 60-fold) than is needed to maintain the normal rate of cell division at moderate temperatures (up to 37 degrees C). However, a high level of DivIB is needed to achieve the normal rate of division at high temperature (47 degrees C). It is proposed that membrane-bound DivIB is involved in stabilizing or promoting the assembly of the division complex (which is intrinsically temperature sensitive) in a manner that requires more of the protein at higher temperatures. The (at least) 60-fold accumulation of DivIB and FtsZ from an undetectable level, following germination and outgrowth of spores up until the stage of the first cell division, was unaffected by blocking of initiation of the first round of replication. It is concluded that there is no major synthesis of either of these 'division initiation' proteins linked to initiation, progression or completion of the first round of replication accompanying spore outgrowth.

Clusterin, a putative complement regulator, binds to the cell surface of Staphylococcus aureus clinical isolates.

The ability of Staphylococcus aureus Cowan I strain and a number of S. aureus clinical isolates to bind to the human blood glycoprotein clusterin was investigated. Binding of clusterin to these strains was tested by both enzyme-linked immunosorbent assay and flow cytometry. All of the S. aureus strains examined appeared to bind clusterin to some extent, while nonpathogenic control strains Bacillus subtilis BR151 and Escherichia coli JM109 did not. Three S. aureus isolates were selected for more detailed study; binding of labeled clusterin was saturable, inhibited in the presence of excess unlabeled clusterin, and prevented by pretreatment of bacteria with proteases. From the saturation binding studies, estimates of the affinity constants for the binding of clusterin to the bacteria ranged from 31 to 57 nM. Addition of clusterin to S. aureus cultures was also found to result in aggregation of the bacterial cells; aggregation was not detected when clusterin was added to B. subtilis BR151 or E. coli JM109 cultures. These results suggest that at least some S. aureus strains possess specific proteinaceous receptors for clusterin. Such receptors may be an important new bacterial virulence determinant for S. aureus, as clusterin has been proposed to have a role in the regulation of complement activity.

Structure and function of the spoIIIJ gene of Bacillus subtilis: a vegetatively expressed gene that is essential for sigma G activity at an intermediate stage of sporulation.

The spo-87 mutation is one of two sporulation mutations originally used to define the spo0J locus of Bacillus subtilis. We now show that it blocks sporulation after completion of prespore engulfment (stage III). Surprisingly, the operon is expressed vegetatively, probably from a sigma A-dependent promoter, and its expression is shut down at the transcriptional level at about the onset of sporulation. DNA sequencing reveals that the locus defined by spo-87, which we now designate spoIIIJ, consists of a bicistronic operon. However, only the first gene is essential for sporulation; the function of the second cistron is cryptic. The predicted SpoIIIJ product has an M(r) of 29,409. It probably forms a lipoprotein and is rich in basic and hydrophobic amino acids. Mutations in spoIIIJ abolish the transcription of prespore-specific genes transcribed by the sigma G form of RNA polymerase but not transcription of the spoIIIG gene encoding sigma G. The SpoIIIJ product could be involved in a signal transduction pathway coupling gene expression in the prespore to events in the mother cell, or it could be necessary for essential metabolic interactions between the two cells.