Membership and behavior of ultra-low-diversity pathogen communities present in the gut of humans during prolonged critical illness.

UnlabelledWe analyzed the 16S rRNA amplicon composition in fecal samples of selected patients during their prolonged stay in an intensive care unit (ICU) and observed the emergence of ultra-low-diversity communities (1 to 4 bacterial taxa) in 30% of the patients. Bacteria associated with the genera Enterococcus and Staphylococcus and the family Enterobacteriaceae comprised the majority of these communities. The composition of cultured species from stool samples correlated to the 16S rRNA analysis and additionally revealed the emergence of Candida albicans and Candida glabrata in ~75% of cases. Four of 14 ICU patients harbored 2-member pathogen communities consisting of one Candida taxon and one bacterial taxon. Bacterial members displayed a high degree of resistance to multiple antibiotics. The virulence potential of the 2-member communities was examined in C. elegans during nutrient deprivation and exposure to opioids in order to mimic local conditions in the gut during critical illness. Under conditions of nutrient deprivation, the bacterial members attenuated the virulence of fungal members, leading to a "commensal lifestyle." However, exposure to opioids led to a breakdown in this commensalism in 2 of the ultra-low-diversity communities. Application of a novel antivirulence agent (phosphate-polyethylene glycol [Pi-PEG]) that creates local phosphate abundance prevented opioid-induced virulence among these pathogen communities, thus rescuing the commensal lifestyle. To conclude, the gut microflora in critically ill patients can consist of ultra-low-diversity communities of multidrug-resistant pathogenic microbes. Local environmental conditions in gut may direct pathogen communities to adapt to either a commensal style or a pathogenic style.ImportanceDuring critical illness, the normal gut microbiota becomes disrupted in response to host physiologic stress and antibiotic treatment. Here we demonstrate that the community structure of the gut microbiota during prolonged critical illness is dramatically changed such that in many cases only two-member pathogen communities remain. Most of these ultra-low-membership communities display low virulence when grouped together (i.e., a commensal lifestyle); individually, however, they can express highly harmful behaviors (i.e., a pathogenic lifestyle). The commensal lifestyle of the whole community can be shifted to a pathogenic one in response to host factors such as opioids that are released during physiologic stress and critical illness. This shift can be prevented by using compounds such as Pi-PEG15-20 that interrupt bacterial virulence expression. Taking the data together, this report characterizes the plasticity seen with respect to the choice between a commensal lifestyle and a pathogenic lifestyle among ultra-low-diversity pathogen communities that predominate in the gut during critical illness and offers novel strategies for prevention of sepsis

The impact of internal service quality on job satisfaction in the hotel industry

Service quality is a key factor for success in any hotel. Many researchers have conducted studies on service quality, but only a few studies have been conducted on internal service quality (ISQ) in general, and in the hotel industry in particular. Since there is no general agreement among researchers on the measurement of ISQ, many studies have used SERVQUAL instrument to measure the employees’ perceptions of ISQ. The purpose of this study is to explore the influence of ISQ on employee’s job satisfaction in five-star hotels in Jordan. The current study was carried out by measuring the data gathered through a seven-point Likert scale. The quantitative survey method was applied, and therefore the SERVQUAL instrument was used to measure ISQ, and the Job Satisfaction Survey (JSS) was used to measure job satisfaction. Data obtained from a sample of 238 respondents drawn from 14 five-star hotels in Jordan were analysed with the SPSS software based on descriptive statistics. The study’s findings indicated that the ISQ of five-star hotels in Jordan has a significantly positive influence on an employee’s job satisfaction. These findings support the hypothesis that there is a positive relationship between ISQ in the hotel industry and industry employees’ job satisfaction.Keywords: hotels, internal service quality, job satisfactio

MEDIATING ROLE OF EMPOWERMENT BETWEEN TOTAL QUALITY MANAGEMENT (TQM) AND SERVICE RECOVERY PERFORMANCE IN THE HOTEL INDUSTRY

The purpose of this research was to examine the mediating effect of empowerment on the linkage between Total Quality Management (TQM) and service recovery performance in the hotel industry. Although much has been written about TQM, empowerment and service recovery performance, but the role of empowerment as a mediator in the relationship between TQM and service recovery performance has remained a relatively unexplored research area. A 93-item questionnaire is designed to measure TQM, empowerment and service recovery amongst employees in five-star hotels in Jordan, and 254 usable questionnaires were used in this study. Principal components analysis determined the factor structure and regression analysis determined the relationships between the study’s variables. The results revealed that the TQM implementations have positive effects on empowerment and service recovery performance. Moreover, the study found the full mediating effect of empowerment in the relationship between TQM and service recovery performance. Implications, limitations and future research are discussed at the end. This study proposes model of influence of TQM in service recovery performance, whereby empowerment fully mediates this relationship

Fecal microbiota transplant rescues mice from human pathogen mediated sepsis by restoring systemic immunity.

Death due to sepsis remains a persistent threat to critically ill patients confined to the intensive care unit and is characterized by colonization with multi-drug-resistant healthcare-associated pathogens. Here we report that sepsis in mice caused by a defined four-member pathogen community isolated from a patient with lethal sepsis is associated with the systemic suppression of key elements of the host transcriptome required for pathogen clearance and decreased butyrate expression. More specifically, these pathogens directly suppress interferon regulatory factor 3. Fecal microbiota transplant (FMT) reverses the course of otherwise lethal sepsis by enhancing pathogen clearance via the restoration of host immunity in an interferon regulatory factor 3-dependent manner. This protective effect is linked to the expansion of butyrate-producing Bacteroidetes. Taken together these results suggest that fecal microbiota transplantation may be a treatment option in sepsis associated with immunosuppression

Food Safety Training: A Study of Food Handlers Working in Hotels in the North of Jordan

In spite of decenniums of advancement, a numerous foodborne outbreaks continue to occur each year; these were mostly happening due to malpractices of employees working in foodservices. This study aims to investigate the role of food safety training in improving food handlers' practices through the application of Knowledge, Attitude and Practices (KAP) model. Primary data were collected using a self-completed questionnaires that were collected from 100 Food and Beverage (F&B) employees working in hotels at the north of Jordan. Findings confirmed the role of food safety training in increasing F&B employees’ knowledge which positively correlates with their food handling practices. Furthermore, this study explored work environment elements affecting the transformation of learned knowledge into proper food handling practices; these include management motivation, availability of necessary resources and facilities and reinforcement programs. The study contributed to knowledge by employing the aforementioned variables to produce an adapted version of the KAP model

Fecal microbiota transplant rescues mice from sepsis due to multi-drug resistant healthcare pathogens by restoring systemic immunity

Death due to sepsis remains a persistent threat to critically ill patients confined to the intensive care unit and is characterized by colonization with multi-drug-resistant healthcare-associated pathogens. Here we report that sepsis in mice caused by a defined four-member pathogen community isolated from a patient with lethal sepsis is associated with the systemic suppression of key elements of the host transcriptome required for pathogen clearance and decreased butyrate expression. More specifically, these pathogens directly suppress interferon regulatory factor 3. Fecal microbiota transplant (FMT) reverses the course of otherwise lethal sepsis by enhancing pathogen clearance via the restoration of host immunity in an interferon regulatory factor 3-dependent manner. This protective effect is linked to the expansion of butyrate-producing Bacteroidetes. Taken together these results suggest that fecal microbiota transplantation may be a treatment option in sepsis associated with immunosuppression

A communal catalogue reveals Earth’s multiscale microbial diversity

Our growing awareness of the microbial world’s importance and diversity contrasts starkly with our limited understanding of its fundamental structure. Despite recent advances in DNA sequencing, a lack of standardized protocols and common analytical frameworks impedes comparisons among studies, hindering the development of global inferences about microbial life on Earth. Here we present a meta-analysis of microbial community samples collected by hundreds of researchers for the Earth Microbiome Project. Coordinated protocols and new analytical methods, particularly the use of exact sequences instead of clustered operational taxonomic units, enable bacterial and archaeal ribosomal RNA gene sequences to be followed across multiple studies and allow us to explore patterns of diversity at an unprecedented scale. The result is both a reference database giving global context to DNA sequence data and a framework for incorporating data from future studies, fostering increasingly complete characterization of Earth’s microbial diversity

A communal catalogue reveals Earth's multiscale microbial diversity

Our growing awareness of the microbial world's importance and diversity contrasts starkly with our limited understanding of its fundamental structure. Despite recent advances in DNA sequencing, a lack of standardized protocols and common analytical frameworks impedes comparisons among studies, hindering the development of global inferences about microbial life on Earth. Here we present a meta-analysis of microbial community samples collected by hundreds of researchers for the Earth Microbiome Project. Coordinated protocols and new analytical methods, particularly the use of exact sequences instead of clustered operational taxonomic units, enable bacterial and archaeal ribosomal RNA gene sequences to be followed across multiple studies and allow us to explore patterns of diversity at an unprecedented scale. The result is both a reference database giving global context to DNA sequence data and a framework for incorporating data from future studies, fostering increasingly complete characterization of Earth's microbial diversity.Peer reviewe

The ethics of informed consent and shared decision-making in pediatric surgery

Informed consent is a required feature in the practice of pediatric surgery. Surgeons cannot practice the trade without it and most of us learned to do it as part of our apprenticeship in surgical training. We were bystanders when the senior resident or attending spoke to the patient and family and we were silent witnesses to the signing of the document called a consent. Intentional instruction about informed consent is rudimentary in most residencies. By the time we become surgical fellows, it is assumed that we have the requisite skill set to perform this task so we can get on with what we like to do best; operating. For many, it is viewed as a perfunctory step which, if done properly, will comply with hospital policies, might someday be exhibited during medical litigation, and ultimately it will occupy a tiny bit of memory in the hospital EMR system. However, this thing called the informed consent is much more than an item on a pre-op check list. The re-branding of the term informed consent into shared decision-making underscores the re-evolution that has occurred in thought and practice from the act of obtaining an individual\u27s permission for treatment toward the process leading up to that act. It reflects some of our most important ethical values in healthcare and is still the source of scholarly inquiry and controversy. In this paper, the terms informed consent and shared decision-making will be used interchangeably but the intention is focused on the process of how physicians and their patients make choices together. If you have not thought about this topic recently, I encourage you to take a moment and explore some of the interesting and challenging questions which are still unanswered. Although the ethical principles underlying informed consent are shared by adult and pediatric medicine, there are many aspects which are unique to the medical care of children. This article highlights some of those challenges and controversies illustrated by two case studies and viewed through the lens of bioethics

Ethics and multiculturalism in pediatric surgery

The concept of culture includes many defining characteristics such race, ethnicity, gender, identity, socioeconomic status, beliefs, traditions, and habits. Multiculturalism is a concept that allows for respect, understanding and acknowledgement of a diversity of identities. The cases discussed in this manuscript indicate the importance of multiculturalism in the practice of pediatric surgery