Novel heterococcolithophores, holococcolithophores and life cycle combinations from the families Syracosphaeraceae and Papposphaeraceae and the genus Florisphaera

Abstract. Coccolithophores are a diverse group of calcifying phytoplankton, which are responsible for a large part of the modern oceanic carbonate production. Here, we describe novel or poorly known coccolithophores and novel life cycle combination coccospheres detected in samples collected either in the Gulf of Aqaba in the northern Red Sea or in the Gulf of Naples in the western Mediterranean. These include Syracosphaera winteri, for which detached coccoliths have previously been recorded but both a formal description and taxonomic affiliation were lacking, and five undescribed sets of combination cells linking HET and HOL forms for S. pulchra, S. mediterranea, S. azureaplaneta, S. lamina and S. orbicula. We also propose the replacement name S. kareniae for the fossil species Deutschlandia gaarderae. We describe a new species of the genus Ophiaster, O. macrospinus, displaying a unique morphological and ecological distribution as well as putative combination cells of two variants of the deep-dwelling Florisphaera profunda, which provide new insights on the affiliation of this genus within the Calcihaptophycideae. Additionally, in the family Papposphaeraceae we detected a new species, Pappomonas vexillata, and combination cells of Picarola margalefi and of a species resembling Papposphaera arctica. Finally, we detected three novel, unpaired holococcolithophore forms (Calyptrosphaera lluisae, Calicasphaera bipora and one form designated as Holococcolithophore A). Overall, this set of novel observations and ensuing discussions provide further insights into the diversity, evolution and life cycle complexity of coccolithophores in the oceans

A Survey Assessing Kansas Physician Assistants' Attitudes/Beliefs and Current Practices Regarding Implementation of Fall Prevention Strategies in Older Adults

Background. Falls are the leading cause of injury death, nursing home placement, and hospital trauma admissions in older adults. Although guidelines to reduce falls have been available for over a decade, routine implementation by healthcare providers is less than optimal. The purpose of this study was to evaluate the attitudes/beliefs and current practices of Kansas physician assistants (PAs) regarding fall assessment/prevention strategies in older adults and barriers to implementing strategies into daily practice. Methods. A 67-item survey was mailed to all 760 Kansas PAs in 2009; 152 responded. Logistic regressions were performed on current fall prevention practices (exercise, home safety, medications, and vision) to determine attitudes, beliefs, and barriers associated with implementation. Results. Most PAs believe falls are preventable (87%) and implementation of various prevention strategies are their professional responsibility (88% - 96%); yet, less than 50% routinely implement them. Barriers included lack of time (27%), lack of staff (26%), and feeling ill-prepared (18%). Multiple logistic regressions revealed correlations among implementing the medication review strategy and lack of time as well as practicing the exercise strategy and lack of time and awareness of local exercise programs. Conclusions. PAs are aware of the importance of fall prevention, believe falls are preventable, and believe it is their professional responsibility to implement fall prevention strategies with their older adult patients. However, most do not implement strategies in their practice due to a variety of internal and logistical barriers. Fall prevention materials/tools that are practical, simple, inexpensive, and require little implementation time may overcome barriers

Evaluating the organisational climate in Italian public healthcare institutions by means of a questionnaire

<p>Abstract</p> <p>Background</p> <p>By means of the ICONAS project, the Healthcare Agency of an Italian Region developed, and used a standardised questionnaire to quantify the organisational climate. The aims of the project were (a) to investigate whether the healthcare institutions were interested in measuring climate, (b) to estimate the range of applicability and reliability of the instrument, (c) to analyse the dimensions of climate among healthcare personnel, (d) to assess the differences among employees with different contractual positions.</p> <p>Methods</p> <p>The anonymous questionnaire containing 50 items, each with a scale from 1 to 10, was offered to the healthcare organisations, to be compiled during ad hoc meetings. The data were sent to the central project coordinator. The differences between highly specialised staff (mostly physicians) and other employees were assessed after descriptive statistical analysis of the single items. Both Principal Component Analysis and Factor Analysis were used.</p> <p>Results</p> <p>Ten healthcare organisations agreed to partecipate. The questionnaire was completed by 8691 employees out of 13202. The mean value of organisational climate was 4.79 (range 1–10). There were significant differences among single items and between the 2 groups of employees. Multivariate methods showed: (a) one principal component explained > 40% of the variance, (b) 7 factors summarised the data.</p> <p>Conclusion</p> <p>Italian healthcare institutions are interested in assessing organisational phenomena, especially after the reforms of the nineties. The instrument was found to be applicable and suitable for measuring organisational climate. Administration of the questionnaire leads to an acceptable response rate. Climate can be discribed by means of 7 underlying dimensions.</p

Randomized Trial of Artesunate+Amodiaquine, Sulfadoxine-Pyrimethamine+Amodiaquine, Chlorproguanal-Dapsone and SP for Malaria in Pregnancy in Tanzania

Malaria in pregnancy is serious, and drug resistance in Africa is spreading. Drugs have greater risks in pregnancy and determining the safety and efficacy of drugs in pregnancy is therefore a priority. This study set out to determine the efficacy and safety of several antimalarial drugs and combinations in pregnant women with uncomplicated malaria.Pregnant women with non-severe, slide proven, falciparum malaria were randomised to one of 4 regimes: sulfadoxine-pyrimethamine [SP]; chlorproguanil-dapsone [CD]; SP+amodiaquine [SP+AQ] or amodiaquine+artesunate [AQ+AS]. Randomisation was on a 1ratio2ratio2ratio2 ratio. Women were admitted for treatment, and followed at days 7, 14, 21, 28 after the start of treatment, at delivery and 6 weeks after delivery to determine adverse events, clinical and parasitological outcomes. Primary outcome was parasitological failure by day 28.1433 pregnant women were screened, of whom 272 met entry criteria and were randomised; 28 to SP, 81 to CD, 80 to SP+AQ and 83 to AQ+AS. Follow-up to day 28 post treatment was 251/272 (92%), and to 6 weeks following delivery 91%. By day 28 parasitological failure rates were 4/26 (15%, 95%CI 4-35) in the SP, 18/77 (23%, 95%CI 14-34) in the CD, 1/73 (1% 95%CI 7-0.001) in the SP+AQ and 7/75 (9% 95%CI 4-18) in the AQ+AS arms respectively. After correction by molecular markers for reinfection the parasitological failure rates at day 28 were 18% for CD, 1% for SP+AQ and 4.5% for AQ+AS. There were two maternal deaths during the trial. There was no apparent excess of stillbirths or adverse birth outcomes in any arm. Parasitological responses were strikingly better in pregnant women than in children treated with the same drugs at this site.Failure rates with monotherapy were unacceptably high. The two combinations tested were efficacious and appeared safe. It should not be assumed that efficacy in pregnancy is the same as in children.ClinicalTrials.gov NCT00146731

Interferon-driven alterations of the host’s amino acid metabolism in the pathogenesis of typhoid fever

Enteric fever, caused by Salmonella enterica serovar Typhi, is an important public health problem in resource-limited settings and, despite decades of research, human responses to the infection are poorly understood. In 41 healthy adults experimentally infected with wild-type S. Typhi, we detected significant cytokine responses within 12 h of bacterial ingestion. These early responses did not correlate with subsequent clinical disease outcomes and likely indicate initial host–pathogen interactions in the gut mucosa. In participants developing enteric fever after oral infection, marked transcriptional and cytokine responses during acute disease reflected dominant type I/II interferon signatures, which were significantly associated with bacteremia. Using a murine and macrophage infection model, we validated the pivotal role of this response in the expression of proteins of the host tryptophan metabolism during Salmonella infection. Corresponding alterations in tryptophan catabolites with immunomodulatory properties in serum of participants with typhoid fever confirmed the activity of this pathway, and implicate a central role of host tryptophan metabolism in the pathogenesis of typhoid fever

Intermittent preventive treatment for malaria in pregnancy in Africa: What's new, what's needed?

Falciparum malaria is an important cause of maternal, perinatal and neonatal morbidity in high transmission settings in Sub-Saharan Africa. Intermittent preventive treatment with sulphadoxine-pyrimethamine (SP-IPT) has proven efficacious in reducing the burden of pregnancy-associated malaria but increasing levels of parasite resistance mean that the benefits of national SP-IPT programmes may soon be seriously undermined in much of the region. Hence, there is an urgent need to develop alternative drug regimens for IPT in pregnancy. This paper reviews published safety and efficacy data on various antimalarials and proposes several candidate combination regimens for assessment in phase II/III clinical trials