Draft Genome Sequence of anEnterobacterSpecies Associated with Illnesses and Powdered Infant Formula

This is the first report of the draft genome sequence of an Enterobacter species that may have been transmitted from powdered infant formula (PIF) to infants, resulting in illness. Enterobacter spp. are currently permitted in PIF, but the transmission of this strain indicates that the microbiological criteria for PIF may need revision

Comparative study of Cronobacter identification according to phenotyping methods

Background: Microbiological criteria applied to powdered infant formula (PIF) require the absence of all Cronobacter spp. Consequently, misidentification of isolates from finished products can lead to significant financial losses for manufacturers and could increase the risk of neonatal infection. Biochemical identification of suspect isolates using commercially available test panels is recommended for use by PIF manufacturers by both the US FDA and ISO standard methods for Cronobacter species; however, phenotyping can be unreliable, particularly for a genus such as Cronobacter where the taxonomy has been subject to frequent changes. This study compared the predicted identification by commonly used phenotyping kits (API20E and ID32E) for over 240 strains of Cronobacter from diverse sources, which had been identified using DNA sequence analysis. In 2015, the databases associated with the API20E and ID32E biochemical test panels were updated, including the recognition of the Cronobacter genus. Thus, the identifications from multiple versions the databases were compared to each other and toidentifications based on DNA sequencing methods. Results: Using previous versions of the API20E database, 90.0% of strains (216/240) resulted in a match for the species identification; however, version 5.0 produced matches for only 82.3% of strains (237/288). Similarly, the update to version 4.0 in the ID32E database caused the percentage of matches to drop from 88.9% (240/270) to 43.2% (139/322). A smaller study showed that the Vitek GN system identified all 14 strains, belonging all seven Cronobacter species, as members of the 'C. sakazakii group', but also attributed three strains of Franconibacter helveticus and F. pulveris to this group. In silco analysis of a PCR-based method targeting ompA predicted that amplification would only occur with Cronobacter species and this method may be a feasible alternative to biochemical phenotyping. Conclusions: These results indicate that commercially available biochemical test panels are not sufficiently reliable for speciation of Cronobacter isolates. Although DNA-sequence based methods would be the more reliable approach; however, this is not currently feasible for many food microbiology laboratories. Instead, a previously published PCR-based method targeting ompA is suggested as an alternative for identification of Cronobacter species based on in silico analysis

Techniques for the identification and differentiation of Cronobactor species

The Cronobacter genus currently consists of seven species: C. condimenti, C. dublinensis, C. malonaticus, C. muytjensii, C. sakazakii, C. turicensis, and C. universalis. The work presented here was undertaken to examine different methods for detection, identification, and characterization of the members of this genus. First, traditional cultural, biochemical, and molecular detection and identification methods were examined with regard to taxonomic changes that occurred within the genus in 2013. This work showed that these methods may not be sufficient for accurate and specific detection and identification of all Cronobacter spp. Next, the DNA sequence-based method of multilocus sequence typing (MLST) was used to identify and characterize a collection of Cronobacter strains and these results were used in a variety of applications. These sequences were used to identify a novel species, characterize outbreak strains, and resolve discrepancies in species identification. It was also shown that MLST does not necessarily correlate to observable phenotypes. This led to the final portion of work which used whole genome sequences to guide laboratory experiments and data analysis. First, the mutS-rpoS genomic region of Cronobacter spp. was examined. Though this region is highly variable in other related species, all seven Cronobacter spp. contained the same genes in this region, in the same order, indicating that these genes are not likely to be related differences in virulence observed between the species. Finally, production of cellulose as a component of the bacterial capsule was examined. An attempt was made to link colony morphologies on infant formula agar and Congo red agar to the genotypes as determined from whole genome sequence analysis. While some results could be explained by the differences identified in the cellulose gene cluster, it was not possible to predict the phenotype based only on these gene sequences. This is likely due to the presence of four additional components in the capsule of Cronobacter spp. Future work developing a capsular typing scheme and linking these capsular profiles to observable phenotypes is also discussed

Impact of Viral Status on Survival in Patients Receiving Sorafenib for Advanced Hepatocellular Cancer: A Meta-Analysis of Randomized Phase III Trials

Purpose: Following the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP) trial, sorafenib has become the standard of care for patients with advanced unresectable hepatocellular carcinoma, but the relation between survival advantage and disease etiology remains unclear. To address this, we undertook an individual patient data meta-analysis of three large prospective randomized trials in which sorafenib was the control arm. Methods: Of a total of 3,256 patients, 1,643 (50%) who received sorafenib were available. The primary end point was overall survival (OS). A Bayesian hierarchical approach for individual patient data meta-analyses was applied using a piecewise exponential model. Results are presented in terms of hazard ratios comparing sorafenib with alternative therapies according to hepatitis C virus (HCV) or hepatitis B virus (HBV) status. Results: Hazard ratios show improved OS for sorafenib in patients who are both HBV negative and HCV positive (log [hazard ratio], −0.27; 95% CI, −0.46 to −0.06). Median unadjusted survival is 12.6 (11.15 to 13.8) months for sorafenib and 10.2 (8.88 to 12.2) months for “other” treatments in this subgroup. There was no evidence of improvement in OS for any other patient subgroups defined by HBV and HCV. Results were consistent across all trials with heterogeneity assessed using Cochran’s Q statistic. Conclusion: There is consistent evidence that the effect of sorafenib on OS is dependent on patients’ hepatitis status. There is an improved OS for patients negative for HBV and positive for HCV when treated with sorafenib. There was no evidence of any improvement in OS attributable to sorafenib for patients positive for HBV and negative for HCV

The social brain has a nerve: insights from attachment and autistic phenotypes

Research in the mid-20th century raised the probability that unloving and neglectful care hinders healthy infant development. More recent observations of atypical neurodevelopment among post-institutionalised and pre-term infants illustrate the relative benefits of nurturing physical care. In short, early touch exposure correlates with subsequent adult behaviour. This paper focuses on recent novel research linking a lack of early nurturing touch, both by necessity (i.e. in the case of NICU infants), and in the case of avoidant individuals who withdraw from social touch, with the subsequent development of colloquially defined ‘autism-like’ phenotypes. Here we propose that avoidant attachment, together with early touch deprivation, plays a central role in the adverse experience of affective touch, as mediated by C-tactile afferents. This manifests as withdrawal motivation, a behaviour commonly observed in Autism Spectrum Condition. Here, this hypothesis, together with evidence of other underlying biological mechanisms are discussed

Psychological health and wellbeing of primary healthcare workers during COVID-19 pandemic in Malaysia:a longitudinal qualitative study

BACKGROUND: Primary healthcare workers (PHCWs) are at the frontline of dealing with viral pandemics. They may experience significant psychological stresses, which have hitherto not been examined in depth. We aimed to explore the impact of the COVID-19 pandemic on the psychological health and wellbeing of frontline PHCWs in Malaysia. METHOD: We purposively recruited PHCWs with diverse backgrounds in Klang Valley, Malaysia. Using longitudinal qualitative methods, we conducted two sequential semi-structured telephone interviews, 3 to 4 weeks apart, to capture different stages of the pandemic. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. RESULT: Twenty-one PHCWs participated yielding a total of forty-two interviews. Themes clustered around stressors associated with work, home, and leisure activities, emotional changes, and modifying factors. In the first interviews, COVID-19 had just started in Malaysia. Participants expressed fear about the actual and perceived personal risk of COVID-19 infection. Most were worried about transmitting COVID-19 to their family members. Some felt stigmatized because of this perceived risk of infection. By the second interviews, participants felt safer, but instead focused on the need to keep other people safe. Participants’ emotions were influenced by their perceived risk of contracting COVID-19 infection. Internal factors such as religion enabled them to manage their concerns and develop personal coping strategies. Support from family members, colleagues, and employers promoted wellbeing during the pandemic. Training sessions, daily roll calls, and psychological support services were important in maintaining their psychological health and wellbeing. Many participants were hopeful and believed normalcy would return by the end of 2020. CONCLUSION: PHCW’s psychological health and wellbeing evolved throughout the early stages of the pandemic and were influenced by their perceived risk of contracting the disease and personal belief structures. Clear updates on the disease and strategies for keeping safe at work and socially are essential to maintaining PHCWs’ psychological health and wellbeing. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-022-01870-0

Speaking Up for Fundamental Care: the ILC Aalborg Statement.

OBJECTIVE: The International Learning Collaborative (ILC) is an organisation dedicated to understanding why fundamental care, the care required by all patients regardless of clinical condition, fails to be provided in healthcare systems globally. At its 11th annual meeting in 2019, nursing leaders from 11 countries, together with patient representatives, confirmed that patients' fundamental care needs are still being ignored and nurses are still afraid to 'speak up' when these care failures occur. While the ILC's efforts over the past decade have led to increased recognition of the importance of fundamental care, it is not enough. To generate practical, sustainable solutions, we need to substantially rethink fundamental care and its contribution to patient outcomes and experiences, staff well-being, safety and quality, and the economic viability of healthcare systems. KEY ARGUMENTS: We present five propositions for radically transforming fundamental care delivery:Value: fundamental care must be foundational to all caring activities, systems and institutionsTalk: fundamental care must be explicitly articulated in all caring activities, systems and institutions.Do: fundamental care must be explicitly actioned and evaluated in all caring activities, systems and institutions.Own: fundamental care must be owned by each individual who delivers care, works in a system that is responsible for care or works in an institution whose mission is to deliver care. RESEARCH: fundamental care must undergo systematic and high-quality investigations to generate the evidence needed to inform care practices and shape health systems and education curricula. CONCLUSION: For radical transformation within health systems globally, we must move beyond nursing and ensure all members of the healthcare team-educators, students, consumers, clinicians, leaders, researchers, policy-makers and politicians-value, talk, do, own and research fundamental care. It is only through coordinated, collaborative effort that we will, and must, achieve real change