Diagnostic criteria to aid the differential diagnosis of patients presenting with transient loss of consciousness: A systematic review

BACKGROUND: Transient loss of consciousness (TLOC) is a common presentation in primary care. Over 90% of these are due to epileptic seizures (ES), syncope, or psychogenic non-epileptic seizures (PNES). Misdiagnosis rates are as high as 30%. METHODS: Systematic review of inter-ictal clinical criteria to aid differential diagnosis of TLOC. We searched Medline, EMBASE, CINAHL and PsycInfo databases, as well as relevant grey literature depositories and citations of relevant reviews and guidelines for studies giving sensitivity and specificity of inter-ictal clinical characteristics used to differentiate between causes of TLOC. Two independent reviewers selected studies for inclusion and performed critical appraisal of included articles. We performed a narrative synthesis of included studies. RESULTS: Of 1023 results, 16 papers were included. Two compared syncope, ES, and PNES; all others compared ES and PNES. All were at significant risk of bias in at least one domain. 6 studied patient symptoms, 6 medical and social history, 3 witness reports and 1 examination findings. No individual criterion differentiated between diagnoses with high sensitivity and specificity. CONCLUSIONS: There is a lack of validated diagnostic criteria to help clinicians assessing patients in primary or emergency care settings to discriminate between common causes of TLOC. Performance may be improved by combining sets of criteria in a clinical decision rule, but no such rule has been validated prospectively against gold-standard diagnostic criteria

Inference of Convergent Gene Acquisition Among Pseudomonas syringae Strains Isolated From Watermelon, Cantaloupe, and Squash

Pseudomonas syringae sensu strict , (phylogroup 2; referred to as P. syringae) consists of an environmentally ubiquitous bacterial population associated with diseases of numerous plant species. Recent studies using multilocus sequence analysis have indicated the clonal expansion of several P. syringae lineages, located in phylogroups 2a and 2b, in association with outbreaks of bacterial spot disease of watermelon, cantaloupe, and squash in the United States. To investigate the evolutionary processes that led to the emergence of these epidemic lineages, we sequenced the genomes of six P. syringae strains that were isolated from cucurbits grown in the United States, Europe, and China over a period of more than a decade, as well as eight strains that were isolated from watermelon and squash grown in six different Florida counties during the 2013 and 2014 seasons. These data were subjected to comparative analyses along with 42 previously sequenced genomes of P. syringae stains collected from diverse plant species and environments available from GenBank. Maximum likelihood reconstruction of the P. syringae core genome revealed the presence of a hybrid phylogenetic group, comprised of cucurbit strains collected in Florida, Italy, Serbia, and France, which emerged through genome-wide homologous recombination between phylogroups 2a and 2b. Functional analysis of the recombinant core genome showed that pathways involved in the ATP-dependent transport and metabolism of amino acids, bacterial motility, and secretion systems were enriched for recombination. A survey of described virulence factors indicated the convergent acquisition of several accessory type 3 secreted effectors (T3SEs) among phylogenetically distinct lineages through integrative and conjugative element and plasmid loci. Finally, pathogenicity assays on watermelon and squash showed qualitative differences in virulence between strains of the same clonal lineage, which correlated with T3SEs acquired through various mechanisms of horizontal gene transfer (HGT). This study provides novel insights into the interplay of homologous recombination and HGT toward pathogen emergence and highlights the dynamic nature of P. syringae sensu lato genomes

Characteristics of long-duration inhibitory postsynaptic potentials in rat neocortical neurons in vitro

1. The characteristics of long-duration inhibitory postsynaptic potentials (l-IPSPs) which are evoked in rat frontal neocortical neurons by local electrical stimulation were investigated with intracellular recordings from anin vitro slice preparation. 2. Stimulation with suprathreshold intensities evoked l-IPSPs with typical durations of 600–900 msec at resting membrane potential. Conductance increases of 15–60% were measured at the peak amplitude of l-IPSPs (150–250 msec poststimulus). 3. The duration of the conductance increases during l-IPSPs displayed a significant voltage dependence, decreasing as the membrance potential was depolarized and increasing with hyperpolarization. 4. The reversal potential of l-IPSPs is significantly altered by reductions in the extracellular potassium concentration. Therefore it is concluded that l-IPSPs in rat neocortical neurons are generated by the activation of a potassium conductance. 5. l-IPSPs exhibit stimulation fatigue. Stimulation with a frequency of 1 Hz produces a complete fatigue of the conductance increases during l-IPSPs after approximately 20 consecutive stimuli. Recovery from this fatigue requires minutes. 6. l-IPSPs are not blocked by bicuculline but are blocked by baclofen

Career motivation of 1st year nursing and midwifery students: A cross-sectional study

Aim/objective: This paper presents findings from a cross-sectional study into the motivational factors of students who chose nursing and midwifery as a career. Background: 189 students from the University of Bedfordshire (UoB) and 223 students from Canterbury Christ Church University (CCCU) completed a questionnaire at the start of their studies in 2018. The findings were generated from the first stage of the Placement, Impact, Experience and Destination (PIED) study into student belongingness on placement and the influence of practice on the first career destination of newly qualified nurses and midwives. Design: An in-class questionnaire was administered to 1st year pre-registration adult, child and mental health nursing and midwifery students to identify the intrinsic and extrinsic factors that influenced their motivation to choose nursing or midwifery as a career. Methods: A mix methods study design was adopted for the PIED study where participants completed a survey that collected quantitative and qualitative data and administered during the course induction period. Results: Motivation scores were found to be high in both cohorts, with students at both sites endorsing intrinsic motivational factors over extrinsic at statistically significant levels. The strongest intrinsic factors appeared to be a desire to help and care for people and play a useful role in society, whereas the strongest extrinsic factors were career stability and the ability to work in different regions and countries. Conclusions: The study suggests that the influence of family and friends continues to exert a strong intrinsic motivational influence on the career choices of students, particularly those under the age of 25. Identifying the motivational factors of first year nursing and midwifery students presents employers with an opportunity to tailor strategies to recruit apprentices, enable placement partners to enculturate prospective employees into the workforce and understand the relationship between extrinsic factors and practice learning to successfully recruit graduates

Inhibition of chylomicron assembly leads to dissociation of hepatic steatosis from inflammation and fibrosis

Regulating dietary fat absorption may impact progression of nonalcoholic fatty liver disease (NAFLD). Here we asked if inducible inhibition of chylomicron assembly, as observed in intestine-specific microsomal triglyceride transfer protein knockout mice (Mttp-IKO), could retard NAFLD progression and/or reverse established fibrosis in two dietary models. Mttp-IKO mice fed a methionine/choline deficient (MCD) diet exhibited reduced hepatic triglycerides (TG), inflammation and fibrosis, associated with reduced oxidative stress and downstream activation of JNK and NFκB signaling pathways. However, when Mtt

Noodles made from high amylose wheat flour attenuate postprandial glycaemia in healthy adults

Previous research has not considered the effect of high amylose wheat noodles on postprandial glycaemia. The aim of the study is to investigate the effect of consumption of high amylose noodles on postprandial glycaemia over 2-h periods by monitoring changes in blood glucose concentration and calculating the total area under the blood glucose concentration curve. Twelve healthy young adults were recruited to a repeated measure randomised, single-blinded crossover trial to compare the effect of consuming noodles (180 g) containing 15%, 20% and 45% amylose on postprandial glycaemia. Fasting blood glucose concentrations were taken via finger-prick blood samples. Postprandial blood glucose concentrations were taken at 15, 30, 45, 60, 90 and 120 min. Subjects consuming high amylose noodles made with flour containing 45% amylose had significantly lower blood glucose concentration at 15, 30 and 45 min (5.5 ± 0.11, 6.1 ± 0.11 and 5.6 ± 0.11 mmol/L; p = 0.01) compared to subjects consuming low amylose noodles with 15% amylose (5.8 ± 0.12, 6.6 ± 0.12 and 5.9 ± 0.12 mmol/L). The total area under the blood glucose concentration curve after consumption of high amylose noodles with 45% amylose was 640.4 ± 9.49 mmol/L/min, 3.4% lower than consumption of low amylose noodles with 15% amylose (662.9 ± 9.49 mmol/L/min), p = 0.021. Noodles made from high amylose wheat flour attenuate postprandial glycaemia in healthy young adults, as characterised by the significantly lower blood glucose concentration and a 3.4% reduction in glycaemic response

VLT Suzaku observations of the Fermi pulsar PSR J1028-5819

We used optical images taken with the Very Large Telescope (VLT) in the B and V bands to search for the optical counterpart of PSR J1028-5819 or constrain its optical brightness. At the same time, we used an archival Suzaku observation to confirm the preliminary identification of the pulsar's X-ray counterpart obtained by Swift. Due to the large uncertainty on the pulsar's radio position and the presence of a bright (V = 13.2) early F-type star at < 4", we could not detect its counterpart down to flux limits of B~25.4 and V ~25.3, the deepest obtained so far for PSR J1028-5819. From the Suzaku observations, we found that the X-ray spectrum of the pulsar's candidate counterpart is best-fit by a power-law with spectral index 1.7 +/- 0.2 and an absorption column density NH < 10^21 cm-2, which would support the proposed X-ray identification. Moreover, we found possible evidence for the presence of diffuse emission around the pulsar. If real, and associated with a pulsar wind nebula (PWN), its surface brightness and angular extent would be compatible with the expectations for a ~100 kyr old pulsar at the PSR J1028-5819 distance.Comment: 10 pages, 9 figures, submitted to Astronomy and Astrophysic