Relationship between nitrate and nitrite stress responses of Desulfovibrio vulgaris Hildenborough and Desulfovibrio alaskensis G20

Many heavy metal-contaminated sites where nuclear weapons have been produced contain high concentrations of nitrate. Nitrate inhibits dissimilatory sulfate-reducing bacteria (SRB), bacteria known to precipitate heavy metals. An understanding of nitrate stress responses in SRB is necessary to predict responses in environmental settings. Desulfovibrio vulgaris Hildenborough and Desulfovibrio alaskensis G20, model SRB, offer the opportunity to identify the physiological and genetic changes that confer nitrate resistance. It is currently thought that nitrite production mediates nitrate inhibition of SRB (He et al., 2010). However, microarray studies have revealed few gene expression changes in common between nitrate- and nitrite-inhibited D. vulgaris cells (He et al., 2010). Since it has been shown that nitrite interacts with the dissimilatory sulfite reductase (Wolfe et al., 1994), it has been assumed that sulfite reduction is the sole target of nitrite inhibition (Haveman et al., 2004). Our results point to inhibition and resistance mechanisms for both nitrate and nitrite that are independent of sulfite reduction

Effectiveness of Quality Incentive Payments in General Practice (EQuIP-GP) cluster randomized trial: impact on patient-reported experience

Background: Relational continuity, ‘a therapeutic relationship between a patient and provider/s that spans health care events’, has been associated with improved patient outcomes.Objectives: To evaluate whether an intervention incorporating patient enrolment and a funding model for higher-risk patients influenced patient-reported experience measures, particularly relational continuity.Methods: Cluster-randomized controlled trial over 12 months (1 August 2018–31 July 2019). Participating patients within intervention practiceswere offered enrolment with a preferred general practitioner, a minimum of 3 longer appointments, and review within 7 days of hospital admission or emergency department attendance. Intervention practices received incentives for longer consultations (dependent on reducing unnecessary prescriptions and tests), early post-hospital follow-up, and hospitalization reductions. The primary outcome was patient-reported relationalcontinuity, measured by the Primary Care Assessment Tool Short Form.Results: A total of 774 patients, aged 18–65 years with a chronic illness or aged over 65 years, from 34 general practices in metropolitan, regional, and rural Australia across 3 states participated. Response rates for questionnaires were >90%. From a maximum of 4.0, mean baselinescores for relational continuity were 3.38 (SE 0.05) and 3.42 (SE 0.05) in control and intervention arms, respectively, with no significant between-group differences in changes pre-post trial. There were no significant changes in other patient-focussed measures.Conclusion: Patient-reported relational continuity was high at baseline and not influenced by the intervention, signalling the need for cautionwith policies incorporating patient enrolment and financial incentives. Further research is required targeting at-risk patient groups with low baseline engagement with primary care