Categorizing stroke prognosis using different stroke scales

<p><b>Background and Purpose</b>: Stroke severity and dependency are often categorized to allow stratification for randomization or analysis. However, there is uncertainty whether the categorizations used for different stroke scales are equivalent. We investigated the amount of information retained by categorizing severity and dependency, and whether the currently used cut-offs are equivalent across different stroke scales.</p> <p><b>Methods</b>: Stroke severity and dependency have been categorized as mild, moderate, or severe. We studied 2 acute stroke unit cohorts, measuring Scandinavian Stroke Scale (SSS), modified Rankin Scale (mRS), Barthel Index (BI), and modified National Institutes of Health Stroke Scale (mNIHSS). Receiver operating characteristic (ROC) curves were examined to determine the ability of full and categorized scales to predict death and dependency. A weighted kappa analysis assessed agreement between the categorized scales.</p> <p><b>Results</b>: When scales are categorized, the area under the ROC curve is significantly reduced; however, the differences are small and may not be practically important. BI, mRS, and SSS all have excellent agreement with each other when categorized, whereas mNIHSS has substantial agreement with mRS and BI.</p> <p><b>Conclusions</b>: Little predictive information is lost when stroke scales are categorized. There is substantial to almost perfect agreement among categorized scales. Therefore the use and categorization of a variety of stroke severity or dependency scales is acceptable in analyses.</p&gt

EXAMINING THE RELATIONSHIP BETWEEN SPIRITUALITY AND PERSISTENCE OF COMMUNITY COLLEGE GRADUATES WHO MATRICULATE TO THE BACCALAUREATE DEGREE GRANTING INSTITUTION

Community college students, more often than not, face challenges not typical to those of traditional-aged students. They are more likely to attend part-time, tend to be the least academically prepared, more financially challenged, often working, and have a greater likelihood of being single parents. What drives these students to not only graduate from the community college, but go on to continue at four-year institutions? Also, how do these students define, or come to “make meaning” of the force that drives their persistence in higher education? The purpose of this study examines the relationship between spirituality and persistence of Illinois community college students who matriculate to the baccalaureate degree granting institution. The research questions ask the following: (1) How is spirituality defined by community college students who persist?, (2) For community college students who persist, how do they come to “make meaning” of their educational journey?, and (3) What is the relationship between spirituality and community college student persistence? The study utilized qualitative case study methodology employing three separate phases: (1) Survey Questionnaire, (2) Guided Focus Group Discussion, and (3), Face-to-Face Interviews. Responses from the survey questionnaire were coded, further segmented and used to determine those survey participants who would receive invitations for the guided focus group discussion. The guided focus group discussion was recorded and conversation transcribed so that the researcher might establish recurring patterns and emerging themes. From those focus group discussion participants, three participants were selected to take part in the face-to-face interview portion of the study. Through the course of these three phases of data collection, the researcher was able to establish valid conclusions about the relationship between spirituality and community college student persistence

Peptide Fragments of a β-Defensin Derivative with Potent Bactericidal Activity

β-Defensins are known to be both antimicrobial and able to chemoattract various immune cells. Although the sequences of paralogous genes are not highly conserved, the core defensin structure is retained. Defb14-1C(V) has bactericidal activity similar to that of its parent peptide (murine β-defensin Defb14) despite all but one of the canonical six cysteines being replaced with alanines. The 23-amino-acid N-terminal half of Defb14-1C(V) is a potent antimicrobial while the C-terminal half is not. Here, we use a library of peptide derivatives to demonstrate that the antimicrobial activity can be localized to a particular region. Overlapping fragments of the N-terminal region were tested for their ability to kill Gram-positive and Gram-negative bacteria. We demonstrate that the most N-terminal fragments (amino acids 1 to 10 and 6 to 17) are potent antimicrobials against Gram-negative bacteria whereas fragments based on sequence more C terminal than amino acid 13 have very poor activity against both Gram-positive and -negative types. We further test a series of N-terminal deletion peptides in both their monomeric and dimeric forms. We find that bactericidal activity is lost against both Gram types as the deletion region increases, with the point at which this occurs varying between bacterial strains. The dimeric form of the peptides is more resistant to the peptide deletions, but this is not due just to increased charge. Our results indicate that the primary sequence, together with structure, is essential in the bactericidal action of this β-defensin derivative peptide and importantly identifies a short fragment from the peptide that is a potent bactericide

Different associations between body composition and alcohol when assessed by exposure frequency or by quantitative estimates of consumption

Background: Alcohol intake is widely assumed to contribute to excess body fatness, especially among young men; however, the evidence is inconsistent. We have addressed this research question by investigating associations between reported alcohol consumption and body composition from large representative national surveys in a high alcohol‐consuming country with a high obesity prevalence. Methods: The present study comprised a secondary analysis of combined cross‐sectional nationally representative Scottish Health Surveys (1995–2010). Reported alcohol‐drinking frequency was divided into five groups: from ‘nonfrequent drinking’ (reference) to daily/‘almost every day’ among 35 837 representative adults [mean (SD) age: 42.7 (12.7) years (range 18–64 years)]. Quantitative alcohol consumption was categorised into seven groups: from ‘1–7 to ≥50 10 g units per week’. Regression models against measured body mass index (BMI) and waist circumference (WC) were adjusted for age, physical activity, income, smoking, deprivation category and economic status. Results: Among alcohol‐consuming men, heavier drinking (21–28 units per week) was associated with a higher BMI by +1.4 kg m–2 [95% confidence interval (CI) = 1.38–1.43] and higher WC by +3.4 cm (95% CI = 3.2–3.6) than drinking 1–7 units per week. However, those who reported daily drinking frequency were associated with a lower BMI by −2.45 kg m–2 (95% CI = −2.4 to −2.5) and lower WC by −3.7 cm (95% CI = −3.3 to −4.0) than those who reported less‐frequent drinking. Similar associations were found for women. Most of these associations were restricted to subjects aged >30 years. Unexplained variances in BMI and WC are large. Conclusions: Quantitative alcohol consumption and frequency of consumption were positively and inversely associated, respectively, with both BMI and WC among alcohol‐consuming adults. Surveys are needed that evaluate both the quantity and frequency of consumption. The lowest BMI and WC were associated with a ‘Mediterranean’ drinking style (i.e. relatively little, but more frequently)

Comparative genomics of isolates of a pseudomonas aeruginosa epidemic strain associated with chronic lung infections of cystic fibrosis patients

Pseudomonas aeruginosa is the main cause of fatal chronic lung infections among individuals suffering from cystic fibrosis (CF). During the past 15 years, particularly aggressive strains transmitted among CF patients have been identified, initially in Europe and more recently in Canada. The aim of this study was to generate high-quality genome sequences for 7 isolates of the Liverpool epidemic strain (LES) from the United Kingdom and Canada representing different virulence characteristics in order to: (1) associate comparative genomics results with virulence factor variability and (2) identify genomic and/or phenotypic divergence between the two geographical locations. We performed phenotypic characterization of pyoverdine, pyocyanin, motility, biofilm formation, and proteolytic activity. We also assessed the degree of virulence using the Dictyostelium discoideum amoeba model. Comparative genomics analysis revealed at least one large deletion (40-50 kb) in 6 out of the 7 isolates compared to the reference genome of LESB58. These deletions correspond to prophages, which are known to increase the competitiveness of LESB58 in chronic lung infection. We also identified 308 non-synonymous polymorphisms, of which 28 were associated with virulence determinants and 52 with regulatory proteins. At the phenotypic level, isolates showed extensive variability in production of pyocyanin, pyoverdine, proteases and biofilm as well as in swimming motility, while being predominantly avirulent in the amoeba model. Isolates from the two continents were phylogenetically and phenotypically undistinguishable. Most regulatory mutations were isolate-specific and 29% of them were predicted to have high functional impact. Therefore, polymorphism in regulatory genes is likely to be an important basis for phenotypic diversity among LES isolates, which in turn might contribute to this strain's adaptability to varying conditions in the CF lung

Just plain Wronga?: a multimodal critical analysis of online payday loan discourse

Payday loans constitute one of the most rapidly expanding and controversial forms of consumer lending today. Payday lending – the selling of high-interest, short-term credit – has thrived in the wake of the decline of the traditional high street banking system and the reluctance on the part of many mainstream credit services, following the 2007/8 Global Financial Crisis, to lend to low income earners. This study critically examines the website of the industry leader in the UK, Wonga, a payday lender which recently rebranded and relaunched itself (in 2015) after being embroiled in a series of financial scandals. Our analysis centres on the new Wonga website, the gateway to its financial services, and identifies three inter-related discursive strategies through which the lender, in the wake of its financial misconduct, seeks to present itself as a reputable financial service provider, namely by (1) constructing the empowered and responsible borrower, (2) de-stigmatising both its service provision and its prospective customers, the payday borrower, and (3) minimising the consequences and risks associated with payday borrowing. We argue that, collectively, these strategies constitute an artful response by Wonga to the changing legislative and socio-economic contexts in which it and other payday lenders are now required to operate, permitting it to continue marketing and selling its high-interest rate financial services

Filling the intervention gap: service evaluation of an intensive nonsurgical weight management programme for severe and complex obesity

Background: Weight management including formula total diet replacement (TDR) is emerging as an effective intervention for severe and complex obesity, particularly with respect to type 2 diabetes (T2DM). However, no prospective audit and service evaluation of such programmes have been reported. Methods: Following initial feasibility piloting, the Counterweight‐Plus programme was commissioned across a variety of healthcare providers. The programme includes: Screening, TDR (formula low energy diet), food reintroduction and weight loss maintenance, all delivered by staff with 8 h of training, in‐service mentoring, ongoing specialist support and access to medical consultant expertise. Anonymised data are returned centrally for clinical evaluation. Results: Up to December 2016, 288 patients commenced the programme. Mean (SD) baseline characteristics were: age 47.5 (12.7) years, weight 128.0 (32.0) kg, body mass index 45.7 (10.1) kg m−2, n = 76 (26.5%) were male and n = 99 (34.5%) had T2DM. On an intention‐to‐treat (ITT) basis, a loss of ≥15 kg at 12 months was achieved by 48 patients, representing 22.1% of all who started and 40% of those who maintained engagement. For complete cases, mean (95% confidence interval) weight loss was 13.3 (12.1–14.4) kg at 3 months, 16.0 (14.4–17.6) kg at 6 months and 14.2 (12.1–16.3) kg at 12 months (all P < 0.001), with losses to follow‐up of 10.8%, 29.3% and 44.2%, respectively. Mean loss at 12 months by ITT analyses was: single imputation –10.5 (9.5) kg, last observation carried forward –10.9 (11.6) kg and baseline observation carried forward –7.9 (11.1) kg. The presence of diabetes had no significant impact on weight change outcomes. Conclusions: This nonsurgical approach is effective for many individuals with severe and complex obesity, representing an option before considering surgery. The results are equally effective in terms of weight loss for people with T2DM