The Contribution of Social Networks to the Health and Self-Management of Patients with Long-Term Conditions: A Longitudinal Study

Evidence for the effectiveness of patient education programmes in changing individual self-management behaviour is equivocal. More distal elements of personal social relationships and the availability of social capital at the community level may be key to the mobilisation of resources needed for long-term condition self-management to be effective. Aim: To determine how the social networks of people with long-term conditions (diabetes and heart disease) are associated with health-related outcomes and changes in outcomes over time. Methods: Patients with chronic heart disease (CHD) or diabetes (n = 300) randomly selected from the disease registers of 19 GP practices in the North West of England. Data on personal social networks collected using a postal questionnaire, alongside face-to-face interviewing. Follow-up at 12 months via postal questionnaire using a self-report grid for network members identified at baseline. Analysis: Multiple regression analysis of relationships between health status, self-management and health economics outcomes, and characteristics of patients’ social networks. Results: Findings indicated that: (1) social involvement with a wider variety of people and groups supports personal self-management and physical and mental well-being; (2) support work undertaken by personal networks expands in accordance with health needs helping people to cope with their condition; (3) network support substitutes for formal care and can produce substantial saving in traditional health service utilisation costs. Health service costs were significantly (p0.01) reduced for patients receiving greater levels of illness work through their networks. Conclusions: Support for self-management which achieves desirable policy outcomes should be construed less as an individualised set of actions and behaviour and more as a social network phenomenon. This study shows the need for a greater focus on harnessing and sustaining the capacity of networks and the importance of social involvement with community groups and resources for producing a more desirable and cost-effective way of supporting long term illness management

Recycler: an algorithm for detecting plasmids from <i>de novo</i> assembly graphs

Abstract Motivation Plasmids and other mobile elements are central contributors to microbial evolution and genome innovation. Recently, they have been found to have important roles in antibiotic resistance and in affecting production of metabolites used in industrial and agricultural applications. However, their characterization through deep sequencing remains challenging, in spite of rapid drops in cost and throughput increases for sequencing. Here, we attempt to ameliorate this situation by introducing a new circular element assembly algorithm, leveraging assembly graphs provided by a conventional de novo assembler and alignments of paired-end reads to assemble cyclic sequences likely to be plasmids, phages and other circular elements. Results We introduce Recycler, the first tool that can extract complete circular contigs from sequence data of isolate microbial genomes, plasmidome and metagenome sequence data. We show that Recycler greatly increases the number of true plasmids recovered relative to other approaches while remaining highly accurate. We demonstrate this trend via simulations of plasmidomes, comparisons of predictions with reference data for isolate samples, and assessments of annotation accuracy on metagenome data. In addition, we provide validation by DNA amplification of 77 plasmids predicted by Recycler from the different sequenced samples in which Recycler showed mean accuracy of 89% across all data types—isolate, microbiome and plasmidome. Availability and Implementation Recycler is available at http://github.com/Shamir-Lab/Recycler Supplementary information Supplementary data are available at Bioinformatics online. </jats:sec

Recycler: an algorithm for detecting plasmids from <i>de novo</i> assembly graphs

AbstractPlasmids are central contributors to microbial evolution and genome innovation. Recently, they have been found to have important roles in antibiotic resistance and in affecting production of metabolites used in industrial and agricultural applications. However, their characterization through deep sequencing remains challenging, in spite of rapid drops in cost and throughput increases for sequencing. Here, we attempt to ameliorate this situation by introducing a new plasmid-specific assembly algorithm, leveraging assembly graphs provided by a conventional de novo assembler and alignments of paired- end reads to assembled graph nodes. We introduce the first tool for this task, called Recycler, and demonstrate its merits in comparison with extant approaches. We show that Recycler greatly increases the number of true plasmids recovered while remaining highly accurate. On simulated plasmidomes, Recycler recovered 5-14% more true plasmids compared to the best extant method with overall precision of about 90%. We validated these results in silico on real data, as well as in vitro by PCR validation performed on a subset of Recycler’s predictions on different data types. All 12 of Recycler’s outputs on isolate samples matched known plasmids or phages, and had alignments having at least 97% identity over at least 99% of the reported reference sequence lengths. For the two E. Coli strains examined, most known plasmid sequences were recovered, while in both cases additional plasmids only known to be present in different hosts were found. Recycler also generated plasmids in high agreement with known annotation on real plasmidome data. Moreover, in PCR validations performed on 77 sequences, Recycler showed mean accuracy of 89% across all data types – isolate, microbiome, and plasmidome. Recycler is available at http://github.com/Shamir-Lab/Recycler</jats:p

High nitrogen contribution by Gunnera magellanica

Chronosequences at the forefront of retreating glaciers provide information about colonization rates of bare surfaces. In the northern hemisphere, forest development can take centuries, with rates often limited by low nutrient availability. By contrast, in front of the retreating Pia Glacier (Tierra del Fuego, Chile), a Nothofagus forest is in place after only 34 yr of development, while total soil nitrogen (N) increased from near zero to 1.5%, suggesting a strong input of this nutrient. We measured N-fixation rates, carbon fluxes, leaf N and phosphorus contents and leaf δ15N in the dominant plants, including the herb Gunnera magellanica, which is endosymbiotically associated with a cyanobacterium, in order to investigate the role of N-fixing and mycorrhizal symbionts in N-budgets during successional transition. G. magellanica presented some of the highest nitrogenase activities yet reported (potential maximal contribution of 300 kg N ha−1 yr−1). Foliar δ15N results support the framework of a highly efficient N-uptake and transfer system based on mycorrhizas, with c. 80% of N taken up by the mycorrhizas potentially transferred to the host plant. Our results suggest the symbiosis of G. magellanica with cyanobacteria, and trees and shrubs with mycorrhizas, to be the key processes driving this rapid successioncyanobacteriaMinisterio de Economía y Competitividad (España)Depto. de Farmacología, Farmacognosia y BotánicaFac. de FarmaciaTRUEpu

Single-balloon enteroscopy: results from an initial experience at a U.S. tertiary-care center

BACKGROUND: Single Balloon Enteroscopy (SBE) is a novel deep enteroscopy modality for diagnosis and treatment of disorders of the small bowel. OBJECTIVE: The aim of the study was to examine the performance, yield and safety of SBE in the initial experience at a tertiary care center. DESIGN: Retrospective analysis of all SBEs during a 10 month period in 2008. Data was extracted from electronic clinical and endoscopy records. SETTING: U.S. tertiary care center. PATIENTS: All patients referred for SBE were included in the current analysis. INTERVENTION: SBE. MAIN OUTCOME MEASUREMENTS: Anterograde SBE procedure time, diagnostic yield, and complications. RESULTS: Thirty-eight anterograde SBEs were performed. The mean age was 62 (42% female). Patients (97%) were referred for gastrointestinal bleeding, Crohn's disease, suspected polyps or neoplasia, and abnormal capsule endoscopy. The mean procedure time was 49 ± 19 minutes. The estimated depth of insertion: proximal jejunum (34%), mid-jejunum (45%), distal jejunum (21%). The SBE diagnostic yield was 47%, with significant findings in 18 patients. Findings included: angiectasias, bleeding, abnormal mucosa, ulceration, polyps, and foreign body. The therapeutic yield was 42%, with lesion ablation performed in 24%. Diagnostic biopsies were performed in 24% of subjects, and tattooing in 52%. There were no significant complications. LIMITATIONS: Single center retrospective study. CONCLUSIONS: Single balloon enteroscopy appears to be a safe and efficient method for examination of the mid-small bowel. The significant therapeutic yield (42%) suggests comparative studies with double balloon and spiral enteroscopy are warranted