Genetic diversity of Bursaphelenchus cocophilus in South America

Molecular characterisation of Bursaphelenchus cocophilus, the causal agent of ‘red ring disease’, is imperative for efficient identification procedures in Brazil and Colombia, because quarantine species such as B. xylophilus and B. mucronatus are already listed in both countries. ITS-1/2 region and D2-D3 segment of LSU rDNA were used to characterise isolates of B. cocophilus obtained from coconut plantations in Brazil and Colombia. Results from ITS-1/2 and LSU rDNA regions showed that all isolates of B. cocophilus from Brazil and Colombia formed a monophyletic group. The LSU rDNA region indicated that all isolates formed a single monophyletic group with high Bayesian posterior probability (100%). This is the first study on ITS-1/2 for the characterisation of B. cocophilus populations. A species-specific primer was designed for identification of B. cocophilus

Jefferson scale of physician lifelong learning: translation and adaptation for the portuguese medical population

The competence and professionalism of doctors depend on the process of Lifelong Learning (LLL). In the Portuguese settings, in which the re-certification of physicians' skills or knowledge is currently not required, the exercise of LLL is left to personal motivation and initiative. The importance of LLL has been highlighted in numerous international recommendations and has already led, in the United States, to the development and validation of a scale for measuring physician LLL - the Jefferson Scale of Physician Life Long Learning (JSPLL). The lack of valid instruments to measure LLL adapted to the Portuguese contexts was the basis for this work, which presents the translation and adaptation of JSPLL, and the subsequent validation of the translated version to the Portuguese medical community. The translation and validation of the English version of JSPLL (JSPLL-VP) was conducted with physicians of Health Care institutions in the District of Braga, Portugal, in 2007. Methods of both qualitative (translation, assessment of the translation, retro translation) and quantitative nature (internal consistency analysis, factor analysis and analysis of response frequencies) resulted in a factor analysis that replicated, with the exception of three items, the distribution of the original scale by four factors: professional learning beliefs and motivation, scholarly activities, attention to learning opportunities and technical skills in seeking information. The results show that the JSPLL-VP is a valid Scale fit for purpose. Cronbach's alpha coefficients for the whole scale (.89) and for each factor, confirmed the internal consistency of the Scale. Additionally, differences were found between mean and standard deviations for different Scale factors. In summary, this work provides a new validated tool to monitor physician's LLL in Portugal. The transversal characterization of LLL of specific medical professionals - by specialty or by type of institution - or longitudinal studies in relation with profiles of medical training can contribute to the quality of Medical Education at the pre- or post-graduate levels.Concluída a formação universitária, a competência e o profissionalismo médicos dependem do processo de Aprendizagem ao Longo da Vida (ALV) que estes desenvolvam durante a sua actividade profissional. Em contextos que não promovam a re-certificação de competências ou de conhecimentos ao longo da carreira médica, a ALV depende da motivação e da iniciativa pessoais. A importância da ALV tem sido sublinhada em numerosas recomendações internacionais e já conduziu, nos EUA, ao desenvolvimento e validação de uma escala de medição específica para a ALV de médicos – a Jefferson Scale of Physician Life Long Learning (JSPLL). A inexistência de instrumentos válidos de medida adaptados ao contexto Português conduziu a este trabalho, que apresenta a tradução e adaptação da JSPLL, e a subsequente validação da versão traduzida para a população médica Portuguesa. A tradução e validação da versão portuguesa da JSPLL (JSPLL-VP) foi realizada com uma amostra representativa de médicos de instituições prestadoras de cuidados de saúde do distrito de Braga, no ano de 2007. Aplicados os devidos procedimentos de natureza qualitativa (tradução, avaliação da tradução, retro tradução) e quantitativa (análise da consistência interna, análise factorial e cálculo de frequências de resposta), verificou-se que a análise factorial replicou, à excepção de três itens, a distribuição da escala original por quatro factores: profissionalismo, motivação e crenças relacionadas com a aprendizagem, actividades académicas, atenção a oportunidades de aprendizagem e competências técnicas de procura de informação. As evidências resultantes da análise efectuada permitem afirmar que a JSPLL-VP é uma escala válida para os fins a que se propõe. A consistência interna foi confirmada através dos coeficientes alpha de Cronbach para cada factor e para a escala global (.89). Adicionalmente, foram encontradas diferenças entre médias e desvios padrão nos resultados dos diferentes factores da Escala. Por conseguinte, este trabalho disponibiliza um novo instrumento validado, que poderá fornecer elementos interessantes para a monitorização ou o desenvolvimento da ALV da população médica portuguesa. A caracterização da ALV em estudos transversais com diferentes grupos de profissionais médicos – por especialidade ou por tipo de instituição – ou longitudinais com o estudo da sua relação com perfis de formação médica, poderá contribuir para a qualidade da Educação Médica aos níveis pré ou pós-graduado

Simultaneous whole-animal 3D-imaging of neuronal activity using light field microscopy

3D functional imaging of neuronal activity in entire organisms at single cell level and physiologically relevant time scales faces major obstacles due to trade-offs between the size of the imaged volumes, and spatial and temporal resolution. Here, using light-field microscopy in combination with 3D deconvolution, we demonstrate intrinsically simultaneous volumetric functional imaging of neuronal population activity at single neuron resolution for an entire organism, the nematode Caenorhabditis elegans. The simplicity of our technique and possibility of the integration into epi-fluoresence microscopes makes it an attractive tool for high-speed volumetric calcium imaging.Comment: 25 pages, 7 figures, incl. supplementary informatio

Viral Hepatitis and Rapid Diagnostic Test Based Screening for HBsAg in HIV-infected Patients in Rural Tanzania.

\ud \ud Co-infection with hepatitis B virus (HBV) is highly prevalent in people living with HIV in Sub-Saharan Africa. Screening for HBV surface antigen (HBsAg) before initiation of combination antiretroviral therapy (cART) is recommended. However, it is not part of diagnostic routines in HIV programs in many resource-limited countries although patients could benefit from optimized antiretroviral therapy covering both infections. Screening could be facilitated by rapid diagnostic tests for HBsAg. Operating experience with these point of care devices in HIV-positive patients in Sub-Saharan Africa is largely lacking. We determined the prevalence of HBV and Hepatitis C virus (HCV) infection as well as the diagnostic accuracy of the rapid test device Determine HBsAg in an HIV cohort in rural Tanzania. Prospectively collected blood samples from adult, HIV-1 positive and antiretroviral treatment-naïve patients in the Kilombero and Ulanga antiretroviral cohort (KIULARCO) in rural Tanzania were analyzed at the point of care with Determine HBsAg, a reference HBsAg EIA and an anti-HCV EIA. Samples of 272 patients were included. Median age was 38 years (interquartile range [IQR] 32-47), 169/272 (63%) subjects were females and median CD4+ count was 250 cells/µL (IQR 97-439). HBsAg was detected in 25/272 (9.2%, 95% confidence interval [CI] 6.2-13.0%) subjects. Of these, 7/25 (28%) were positive for HBeAg. Sensitivity of Determine HBsAg was rated at 96% (95% CI 82.8-99.6%) and specificity at 100% (95% CI, 98.9-100%). Antibodies to HCV (anti-HCV) were found in 10/272 (3.7%, 95% CI 2.0-6.4%) of patients. This study reports a high prevalence of HBV in HIV-positive patients in a rural Tanzanian setting. The rapid diagnostic test Determine HBsAg is an accurate assay for screening for HBsAg in HIV-1 infected patients at the point of care and may further help to guide cART in Sub-Saharan Africa

Training health providers to address unhealthy alcohol use in primary care: a cross-sectional, multicenter study.

Background: Health professionals’ training is a key element to address unhealthy alcohol use in Primary Care (PC). Education about alcohol use can be effective in improving PC provider’s knowledge and skills addressing alcoholrelated problems. The aim of the study was to evaluate the training of health professionals to address unhealthy alcohol use in PC. Methods: An observational, descriptive, cross-sectional, multicenter study was performed. Location: PC centres of the Spanish National Health System (SNHS). Participants: Family physicians, residents and nurses completed an online questionnaire that inquired about their training (none, basic, medium or advanced), knowledge and preventive practices aimed at reducing unhealthy alcohol use. The study population was recruited via random sampling, stratified by the regions of the SNHS’s PC centre, and by email invitation to members of two Spanish scientific societies of Family Medicine. Results: A total of 1760 professionals participated in the study. Sixty-seven percent (95% CI: 67.5–71.8) reported not having received specific training to address unhealthy alcohol use, 30% (95% CI: 27.4–31.7) reported having received basic training, and 3% (95% CI: 2.3–4.0) medium/advanced training. The training received was greater in younger providers (p < 0.001) who participated in the PAPPS (Preventive Activities and Health Promotion Programme) (p < 0.001). Higher percentages of providers with intermediate or advanced training reported performing screening for unhealthy alcohol use (p < 0.001), clinical assessment of alcohol consumption (p < 0.001), counselling of patients to reduce their alcohol intake (p < 0.001) or to abstain, in the cases of pregnant women and drivers (p < 0.001). Conclusion: Our study reveals a low level of training among Spanish PC providers to address unhealthy alcohol use. A higher percentage of screening, clinical assessment and counselling interventions aimed at reducing unhealthy alcohol use was reported by health professionals with an intermediate or advanced level of training.post-print565 K

Propiedades psicométricas del “cuestionario de cinco facetas de la conciencia plena” (five facet mindfulness questionnaire, FFMQ-M) en México

Este trabajo pretende analizar las propiedades psicométricas del “Cuestionario de cinco facetas de la conciencia plena” (FFMQ-M) en México respondiendo a limitaciones metodológicas previas. Participaron 1210 estudiantes mexicanos y se realizaron análisis factoriales confirmatorios multigrupos. El análisis factorial en la muestra de calibración (n1= 620) mostró como mejor modelo cuatro factores de primer orden (Ausencia de reacción, Ausencia de juicio, Actuación consciente y Descripción), sin la dimensión de Observación, agrupados en un factor de segundo orden (conciencia plena) con un total de 19 ítems. El análisis factorial con la muestra de validación (n2= 590) replicó el buen ajuste de este modelo y el análisis de invarianza indicó invarianza estricta. Finalmente, se analizó la validez concurrente de la conciencia plena con medidas de autoinforme de calidad y satisfacción con la vida, afecto positivo y depresivo y la percepción de situaciones/estímulos estresantes académicos. Estos resultados informan sobre los componentes de la conciencia plena en personas no meditadoras y su relación con diferentes indicadores de salud y bienestar.The aim of the present study was to analyze the psychometric properties of the Five Facets Mindfulness Questionnaire in Mexico (FFMQ-M) solving previous methodological limitations. A transversal study was carried out with 1210 Mexican students and a multigroup confirmatory factor analysis was performed in Mplus 7.0. A confirmatory factor analysis in the calibration sample (n1= 620) indicated as best model a total of 19 items structured into four first order factors (Nonreacting against internal experiences, Nonjudging internal experiences, Acting with awareness, Describing own experiences), without Observing dimension, loading in a second order factor (mindfulness). This model also exhibited good model fit in a second confirmatory factor analysis in the validation sample (n2= 590). The invariance test indicated the existence of strict invariance. Finally, the concurrent validity between the indicators of mindfulness and the self-reported measures of life quality, life satisfaction, positive and depressive affect and the perception academic stressors was analyzed. These results provide information about the components of mindfulness and their relationship with health

Prevalence of hazardous alcohol use among Spanish primary care providers

Background: Alcohol use by health care professionals is one of the potential factors that may affect the prevention of hazardous drinking in Primary Care (PC). The objective of the study was to estimate the prevalence of hazardous alcohol use by PC professionals and assess the existing relationship between socio-demographic and occupational variables of PC professionals and their alcohol use. Methods: A descriptive, cross-sectional, observational, multicenter study was performed. Location: PC sites of the Spanish National Health Care System (NHS). Participants: Physicians and nurses, who completed an online questionnaire intended to identify the pattern of hazardous alcohol use through the AUDIT-C test. The study population was recruited through random sampling stratified by regions of the PC sites in the NHS. The primary measurements: Frequency of alcohol use, number of drinks containing alcohol on a typical day, frequency of six or more drinks on one occasion. Results: One thousand seven hundred sixty professionals completed the questionnaire. Hazardous alcohol use was detected in 27.80% (95% CI: 25.5–29.7) of PC providers. The prevalence of hazardous alcohol use was higher in males (34.2%) [95% CI: 30.4–37.6] and professionals aged 56 years or over (34.2%) [95% CI: 28.2–40.2]. The multiple logistic regression analysis revealed a higher hazardous use in males (OR = 1.52; 95% CI: 1.22–1.90), PC physicians (OR = 1.42; 95% CI: 1.01–2.02) and professionals with more time worked (OR = 1.03; 95% CI: 1.01–1.05). Conclusion: Our study shows the current prevalence of hazardous alcohol use among Spanish PC providers, revealing a higher percentage of hazardous alcohol use in healthcare professionals compared to the Spanish general population. Further interventions are required to increase the awareness of negative consequences derived from alcohol use among PC professionals and its impact on the clinical settingThe study has been financed by the Spanish Society of Family and Community Medicine (semFYC, Sociedad Española de Medicina Familiar y Comunitaria) through the Francesc Borrell Scholarship in the year 2018 and has been awarded with the 1st Prize for the best Research Project in Primary Care by the Spanish Society of Primary Care Physicians (SEMERGEN, Sociedad Española de Médicos de Atención Primaria) in the year 2018. Also, this publication has been financed by one of the PhD scholarships, SEMERGEN, 2018

Variability of Insulin Requirements Over 12 Weeks of Closed-Loop Insulin Delivery in Adults With Type 1 Diabetes.

OBJECTIVE: To quantify variability of insulin requirements during closed-loop insulin delivery. RESEARCH DESIGN AND METHODS: We retrospectively analyzed overnight, daytime, and total daily insulin amounts delivered during a multicenter closed-loop trial involving 32 adults with type 1 diabetes. Participants applied hybrid day-and-night closed-loop insulin delivery under free-living home conditions over 12 weeks. The coefficient of variation was adopted to measure variability of insulin requirements in individual subjects. RESULTS: Data were analyzed from 1,918 nights, 1,883 daytime periods and 1,564 total days characterized by closed-loop use over 85% of time. Variability of overnight insulin requirements (mean [SD] coefficient of variation 31% [4]) was nearly twice as high as variability of total daily requirements (17% [3], P < 0.001) and was also higher than variability of daytime insulin requirements (22% [4], P < 0.001). CONCLUSIONS: Overnight insulin requirements were significantly more variable than daytime and total daily amounts. This may explain why some people with type 1 diabetes report frustrating variability in morning glycemia.Seventh Framework Programme of the European Union (ICT FP7- 247138). Additional support for the Artificial Pancreas work by JDRF, National Institute for Health Research Cambridge Biomedical Research Centre and Wellcome Strategic Award (100574/Z/12/Z). Abbott Diabetes Care supplied discounted continuous glucose monitoring devices, sensors, and communication protocol to facilitate real-time connectivity. We acknowledge support by the staff at the Addenbrooke’s Wellcome Trust Clinical Research Facility. Jasdip Mangat and John Lum (Jaeb Center) supported development and validation of the closed-loop system. Josephine Hayes (University of Cambridge) provided administrative support. Karen Whitehead (University of Cambridge) provided laboratory support. We acknowledge support by the staff at Profil Institut; Krisztina Schmitz-Grozs provided support as a research physician, Martina Haase supported the study as an insulin pump expert, and Maren Luebkert, Kirstin Kuschma and Elke Przetak provided administrative, coordinating and documentation support.This is the author accepted manuscript. The final version is available from the American Diabetes Association via http://dx.doi.org/10.2337/dc15-262

Effects of b-lactam antibiotics and fluoroquinolones on human gut microbiota in relation to clostridium difficile associated diarrhea

Clostridium difficile infections are an emerging health problem in the modern hospital environment. Severe alterations of the gut microbiome with loss of resistance to colonization against C. difficile are thought to be the major trigger, but there is no clear concept of how C. difficile infection evolves and which microbiological factors are involved. We sequenced 16S rRNA amplicons generated from DNA and RNA/cDNA of fecal samples from three groups of individuals by FLX technology: (i) healthy controls (no antibiotic therapy); (ii) individuals receiving antibiotic therapy (Ampicillin/Sulbactam, cephalosporins, and fluoroquinolones with subsequent development of C. difficile infection or (iii) individuals receiving antibiotic therapy without C. difficile infection. We compared the effects of the three different antibiotic classes on the intestinal microbiome and the effects of alterations of the gut microbiome on C. difficile infection at the DNA (total microbiota) and rRNA (potentially active) levels. A comparison of antibiotic classes showed significant differences at DNA level, but not at RNA level. Among individuals that developed or did not develop a C. difficile infection under antibiotics we found no significant differences. We identified single species that were up- or down regulated in individuals receiving antibiotics who developed the infection compared to non-infected individuals. We found no significant differences in the global composition of the transcriptionally active gut microbiome associated with C. difficile infections. We suggest that up- and down regulation of specific bacterial species may be involved in colonization resistance against C. difficile providing a potential therapeutic approach through specific manipulation of the intestinal microbiome.This work was supported by the ERANET Project PathoGenoMics program grant number 0315441A.Peer Reviewe