Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department

Objectives Early identification of patients with blood stream infection (BSI), especially bacteraemia, is important as prompt treatment improves outcome. The initial stages of severe infection may be characterised by increased numbers of neutrophils in the peripheral blood and depression of the lymphocyte count (LC). The neutrophil to LC ratio (NLCR) has previously been compared with conventional tests, such as C-reactive protein (CRP) and white cell count (WCC), and has been proposed as a useful marker in the timely diagnosis of bacteraemia. Methods Data on consecutive adult patients presenting to the emergency department with pyrexial illness during the study period, November 2009 to October 2010, were analysed. The main outcome measure was positive blood cultures (bacteraemia). Sensitivity, specificity, positive and negative predictive values and likelihood ratios were determined for NLCR, CRP, WCC, neutrophil count and LC. Results 1954 patients met the inclusion criteria. Blood cultures were positive in 270 patients, hence the prevalence of bacteraemia was 13.8%. With the exception of WCC, there were significant differences in the mean value for each marker between bacteraemic and non-bacteraemic patients (p<0.001). The area under the receiver operating characteristic curve was highest for NLCR (0.72; 95% CI 0.69 to 0.75) and LC (0.71; 0.68 to 0.74) and lowest for WCC (0.54; 0.40 to 0.57). The sensitivity and specificity of NLCR for predicting bacteraemia were 70% (64% to 75%) and 57% (55% to 60%), respectively. Positive and negative predictive values for NLCR were 0.20 (0.18 to 0.23) and 0.92 (0.91 to 0.94), respectively. The positive likelihood ratio was 1.63 (1.48 to 1.79) and the negative likelihood ratio was 0.53 (0.44 to 0.64). Conclusions Although NLCR outperforms conventional markers of infection, it is insufficient in itself to guide clinical management of patients with suspected BSI, and it offers no advantage over LC. However, it may offer some diagnostic utility when taken into account as part of the overall assessment

Želatinski film s mikrokapsulama antocijana izoliranih iz plavog graška (Clitoria ternatea) kao prehrambena ambalaža s učinkom suzbijanja patogenih mikroorganizama

Research background. Microbial contamination of food products is one of the significant causes of food spoilage and foodborne illnesses. The use of active packaging films incorporated with antimicrobial agents can be a measure to improve food quality and extend shelf life. Nevertheless, antimicrobial agents such as silver, copper, titanium and zinc in the packaging films have raised concerns among consumers due to toxicity issues. Experimental approach. The current study aims to develop biodegradable gelatine-based edible films incorporated with microcapsules of Clitoria ternatea-derived anthocyanins as a natural antimicrobial agent. The impact of incorporation of microcapsules with anthocyanins on the morphology, thermal, mechanical, water vapour barrier and physicochemical properties of the gelatine films was evaluated in this study. The effectiveness of the developed films against foodborne pathogens and their application for perishable food protection were also investigated. Results and conclusions. The results show that incorporating anthocyanin microcapsules enhances the gelatine film physical and mechanical properties by increasing the thickness, tensile strength, Young\u27s modulus and elongation at break of the films. Scanning electronic microscopy analysis revealed that the film surface morphology with anthocyanin microcapsules had a homogeneous and smooth surface texture compared to the control. The thermogravimetric analysis also showed a slight improvement in the thermal properties of the developed films. Agar well diffusion assay revealed that the developed films exhibit significant inhibition against a broad-spectrum of bacteria. Furthermore, the films composed of gelatine with anthocyanin microcapsules significantly reduced the total viable count of microorganisms in the bean curd during storage for 12 days compared with the control films. Novelty and scientific contribution.Increasing global awareness of healthy and safe food with minimal synthetic ingredients as preservatives has sparked the search for the use of antimicrobial agents of natural origins in active food packaging material. In this study, a safe and effective active packaging film was developed using an environmentally friendly biopolymer, gelatine film incorporated with microcapsules of Clitoria ternatea-derived anthocyanins as a natural antimicrobial agent. This study demonstrated that such a method is not only able to improve the film physical properties but can also significantly prolong the shelf life of food products by protecting them from microbial spoilage.Pozadina istraživanja. Mikrobna kontaminacija je jedan od važnijih uzroka kvarenja hrane i pojave bolesti koje se prenose hranom. Primjenom aktivnih filmova za pakiranje hrane obogaćenih antimikrobnim agensima može se poboljšati kakvoća hrane i produljiti njezina valjanost. No, potrošači su sve više zabrinuti zbog moguće toksičnosti mnogih antimikrobnih agensa koji se primjenjuju u tim filmovima, kao što su srebro, bakar, titan i cink. Eksperimentalni pristup. Svrha je ovoga rada bila izraditi biorazgradive jestive filmove od želatine obogaćene mikrokapsulama antocijana izoliranih iz plavog graška (Clitoria ternatea) kao prirodnih antimikrobnih agensa. Ispitan je utjecaj mikrokapsula s antocijanima na morfologiju, toplinska, mehanička i fizikalno-kemijska svojstva filmova, te njihovu propusnost vodene pare. Također je ispitan učinak dobivenih filmova na patogene mikroorganizme u hrani i zaštitu lako pokvarljivih proizvoda. Rezultati i zaključci. Rezultati pokazuju da su se fizikalna i mehanička svojstva filmova poboljšala s dodatkom mikrokapsula antocijana, koje su povećale gustoću, vlačnu čvrstoću, Youngov modul elastičnosti i istezljivost filma. Ispitivanjem morfoloških značajki pretražnom elektronskom mikroskopijom utvrđeno je da film obogaćen antocijanima imao homogenu i glatku površinu, za razliku od kontrolnog uzorka. Termogravimetrijskom je analizom potvrđeno blago poboljšanje toplinskih svojstava filmova. Difuzijom u jažicama agara otkriveno je da dobiveni filmovi imaju znatan inhibicijski učinak na širok spektar bakterija. Osim toga, filmovi od želatine s dodatkom mikrokapsula antocijana smanjili su ukupni broj živih stanica mikroorganizama u tofuu tijekom 12 dana skladištenja, u usporedbi s kontrolnim uzorcima. Novina i znanstveni doprinos. Veća svijest ljudi o važnosti zdrave i sigurne prehrane sa što manjim udjelom sintetičkih konzervansa potakla je potragu za antimikrobnim agensima iz prirodnih izvora koji se mogu upotrijebiti u materijalima za aktivno pakiranje hrane. U ovom je radu razvijen siguran i učinkovit aktivni ambalažni film s dodatkom ekološki prihvatljivog biopolimera, želatinskog filma obogaćenog mikrokapsulama antocijana izoliranih iz plavog graška (Clitoria ternatea) kao prirodnih antimikrobnih agensa. Istraživanje je pokazalo da se ovom metodom mogu poboljšati fizikalna svojstva filma, ali i bitno produljiti vrijeme skladištenja hrane, jer ih dobiveni film štiti od mikrobnog kvarenja

PhoR/PhoP two component regulatory system affects biocontrol capability of Bacillus subtilis NCD-2

The Bacillus subtilis strain NCD-2 is an important biocontrol agent against cotton verticillium wilt and cotton sore shin in the field, which are caused by Verticillium dahliae Kleb and Rhizoctonia solani Kuhn, respectively. A mutant of strain NCD-2, designated M216, with decreased antagonism to V. dahliae and R. solani, was selected by mini-Tn10 mutagenesis and in vitro virulence screening. The inserted gene in the mutant was cloned and identified as the phoR gene, which encodes a sensor kinase in the PhoP/PhoR two-component system. Compared to the wild-type strain, the APase activities of the mutant was decreased significantly when cultured in low phosphate medium, but no obvious difference was observed when cultured in high phosphate medium. The mutant also grew more slowly on organic phosphate agar and lost its phosphatidylcholine-solubilizing ability. The suppression of cotton seedling damping-off in vivo and colonization of the rhizosphere of cotton also decreased in the mutant strain when compared with the wild type strain. All of these characteristics could be partially restored by complementation of the phoR gene in the M216 mutant

Clinical research without consent in adults in the emergency setting: a review of patient and public views

<p>Abstract</p> <p>Background</p> <p>In emergency research, obtaining informed consent can be problematic. Research to develop and improve treatments for patients admitted to hospital with life-threatening and debilitating conditions is much needed yet the issue of research without consent (RWC) raises concerns about unethical practices and the loss of individual autonomy. Consistent with the policy and practice turn towards greater patient and public involvement in health care decisions, in the US, Canada and EU, guidelines and legislation implemented to protect patients and facilitate acute research with adults who are unable to give consent have been developed with little involvement of the lay public. This paper reviews research examining public opinion regarding RWC for research in emergency situations, and whether the rules and regulations permitting research of this kind are in accordance with the views of those who ultimately may be the most affected.</p> <p>Methods</p> <p>Seven electronic databases were searched: Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews, Philosopher's Index, Age Info, PsychInfo, Sociological Abstracts and Web of Science. Only those articles pertaining to the views of the public in the US, Canada and EU member states were included. Opinion pieces and those not published in English were excluded.</p> <p>Results</p> <p>Considering the wealth of literature on the perspectives of professionals, there was relatively little information about public attitudes. Twelve studies employing a range of research methods were identified. In five of the six questionnaire surveys around half the sample did <it>not </it>agree generally with RWC, though paradoxically, a higher percentage would <it>personally </it>take part in such a study. Unfortunately most of the studies were not designed to investigate individuals' views in any depth. There also appears to be a level of mistrust of medical research and some patients were more likely to accept an experimental treatment 'outside' of a research protocol.</p> <p>Conclusion</p> <p>There are too few data to evaluate whether the rules and regulations permitting RWC protects – or is acceptable to – the public. However, any attempts to engage the public should take place in the context of findings from further basic research to attend to the apparently paradoxical findings of some of the current surveys.</p

Universal Artifacts Affect the Branching of Phylogenetic Trees, Not Universal Scaling Laws

The superficial resemblance of phylogenetic trees to other branching structures allows searching for macroevolutionary patterns. However, such trees are just statistical inferences of particular historical events. Recent meta-analyses report finding regularities in the branching pattern of phylogenetic trees. But is this supported by evidence, or are such regularities just methodological artifacts? If so, is there any signal in a phylogeny?In order to evaluate the impact of polytomies and imbalance on tree shape, the distribution of all binary and polytomic trees of up to 7 taxa was assessed in tree-shape space. The relationship between the proportion of outgroups and the amount of imbalance introduced with them was assessed applying four different tree-building methods to 100 combinations from a set of 10 ingroup and 9 outgroup species, and performing covariance analyses. The relevance of this analysis was explored taking 61 published phylogenies, based on nucleic acid sequences and involving various taxa, taxonomic levels, and tree-building methods.All methods of phylogenetic inference are quite sensitive to the artifacts introduced by outgroups. However, published phylogenies appear to be subject to a rather effective, albeit rather intuitive control against such artifacts. The data and methods used to build phylogenetic trees are varied, so any meta-analysis is subject to pitfalls due to their uneven intrinsic merits, which translate into artifacts in tree shape. The binary branching pattern is an imposition of methods, and seldom reflects true relationships in intraspecific analyses, yielding artifactual polytomies in short trees. Above the species level, the departure of real trees from simplistic random models is caused at least by two natural factors--uneven speciation and extinction rates; and artifacts such as choice of taxa included in the analysis, and imbalance introduced by outgroups and basal paraphyletic taxa. This artifactual imbalance accounts for tree shape convergence of large trees.There is no evidence for any universal scaling in the tree of life. Instead, there is a need for improved methods of tree analysis that can be used to discriminate the noise due to outgroups from the phylogenetic signal within the taxon of interest, and to evaluate realistic models of evolution, correcting the retrospective perspective and explicitly recognizing extinction as a driving force. Artifacts are pervasive, and can only be overcome through understanding the structure and biological meaning of phylogenetic trees. Catalan Abstract in Translation S1

Threatened reef corals of the world

10.1371/journal.pone.0034459PLoS ONE73