Sequence and Structural Differences between Enzyme and Nonenzyme Homologs

AbstractTo improve our understanding of the evolution of novel functions, we performed a sequence, structural, and functional analysis of homologous enzymes and nonenzymes of known three-dimensional structure. In most examples identified, the nonenzyme is derived from an ancestral catalytic precursor (as opposed to the reverse evolutionary scenario, nonenzyme to enzyme), and the active site pocket has been disrupted in some way, owing to the substitution of critical catalytic residues and/or steric interactions that impede substrate binding and catalysis. Pairwise sequence identity is typically insignificant, and almost one-half of the enzyme and nonenzyme pairs do not share any similarity in function. Heterooligomeric enzymes comprising homologous subunits in which one chain is catalytically inactive and enzyme polypeptides that contain internal catalytic and noncatalytic duplications of an ancient enzyme domain are also discussed

Breast Milk Stem Cells: Current Science and Implications for Preterm Infants

Background: The benefits of breast milk are well described, yet the mechanistic details related to how breast milk protects against acute and chronic diseases and optimizes neurodevelopment remain largely unknown. Recently, breast milk was found to contain stem cells that are thought to be involved in infant development. Purpose: The purpose of this review was to synthesize all available research involving the characterization of breast milk stem cells to provide a basis of understanding for what is known and what still needs further exploration. Methods/Search Strategy: The literature search was conducted between August and October 2015 using the CINAHL, PubMed, and reference list searching. Nine studies addressed characterization of human breast milk stem cells. Findings/Results: Five research teams in 4 countries have published studies on breast milk stem cells. Current research has focused on characterizing stem cells in full-term breast milk. The amount, phenotype, and expression of breast milk stem cells are known to vary between mothers, and they have been able to differentiate into all 3 germ layers (expressing pluripotent characteristics). Implications for Practice: There is much to learn about breast milk stem cells. Given the potential impact of this research, healthcare professionals should be aware of their presence and ongoing research to determine benefits for infants. Implications for Research: Extensive research is needed to further characterize stem cells in breast milk (full-term and preterm), throughout the stages of lactation, and most importantly, their role in the health of infants, and potential for use in regenerative therapies

Employment benefits and job retention: evidence among patients with colorectal cancer

A “health shock,” that is, a large, unanticipated adverse health event, can have long‐term financial implications for patients and their families. Colorectal cancer is the third most commonly diagnosed cancer among men and women and is an example of a specific health shock. We examined whether specific benefits (employer‐based health insurance, paid sick leave, extended sick leave, unpaid time off, disability benefits) are associated with job retention after diagnosis and treatment of colorectal cancer. In 2011–14, we surveyed patients with Stage III colorectal cancer from two representative SEER registries. The final sample was 1301 patients (68% survey response rate). For this study, we excluded 735 respondents who were not employed and 20 with unknown employment status. The final analytic sample included 546 respondents. Job retention in the year following diagnosis was assessed, and multivariable logistic regression was used to evaluate associations between job retention and access to specific employment benefits. Employer‐based health insurance (OR = 2.97; 95% CI = 1.56–6.01; P = 0.003) and paid sick leave (OR = 2.93; 95% CI = 1.23–6.98; P = 0.015) were significantly associated with job retention, after adjusting for sociodemographic, clinical, geographic, and job characteristics.A “health shock,” that is, a large, unanticipated adverse health event, can have long‐term financial implications for patients and their families. We examined whether specific benefits (employer‐based health insurance, paid sick leave, extended sick leave, unpaid time off, disability benefits) are associated with job retention after diagnosis and treatment of colorectal cancer, an example of a specific health shock. Employer‐based health insurance and paid sick leave were associated with job retention.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142914/1/cam41371_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142914/2/cam41371.pd

Woman-centred maternity care: what do women say? Protocol for a survey of women receiving maternity care in NSW

Background: Over the past decade or so, recommendations for improvements in maternity care have emphasised the importance of providing woman-centred care. Feedback from women about existing maternity services can help to identify whether services are currently meeting women’s needs. The present study aims to capture women’s expectations of, and experiences with maternity care, and to explore whether maternal and birth characteristics are associated with those experiences. Methods: A survey will be undertaken with a sample of approximately 2,000 women who have given birth over a 3-month period at seven public maternity units in two neighbouring health districts in New South Wales (NSW), Australia. The survey will be mailed out three-four months after birth. The study will also examine two strategies intended to increase survey response rates: use of two types of pre-notification letters, and request for consent from women to link survey responses with health information recorded at the time of birth. Data analysis will examine response rate, evidence of sample bias and effect of pre-notification letters; describe expectations and experiences with maternity care and associations with maternal and/or health characteristics; and where possible, compare results with maternity satisfaction data reported by others. Discussion: This study will provide, for the first time in NSW, comprehensive information about women’s expectations, experiences and satisfaction with maternity services in two local health districts. It will identify aspects of care that are meeting women’s needs, and areas where care and service provision may be improved in line with the aspirations of Towards Normal Birth. The survey tool may also prove to be appropriate for use by other health districts and/or state-wide.NHMR

Woman-centred maternity care: what do women say? Protocol for a survey of women receiving maternity care in NSW

Background: Over the past decade or so, recommendations for improvements in maternity care have emphasised the importance of providing woman-centred care. Feedback from women about existing maternity services can help to identify whether services are currently meeting women’s needs. The present study aims to capture women’s expectations of, and experiences with maternity care, and to explore whether maternal and birth characteristics are associated with those experiences. Methods: A survey will be undertaken with a sample of approximately 2,000 women who have given birth over a 3-month period at seven public maternity units in two neighbouring health districts in New South Wales (NSW), Australia. The survey will be mailed out three-four months after birth. The study will also examine two strategies intended to increase survey response rates: use of two types of pre-notification letters, and request for consent from women to link survey responses with health information recorded at the time of birth. Data analysis will examine response rate, evidence of sample bias and effect of pre-notification letters; describe expectations and experiences with maternity care and associations with maternal and/or health characteristics; and where possible, compare results with maternity satisfaction data reported by others. Discussion: This study will provide, for the first time in NSW, comprehensive information about women’s expectations, experiences and satisfaction with maternity services in two local health districts. It will identify aspects of care that are meeting women’s needs, and areas where care and service provision may be improved in line with the aspirations of Towards Normal Birth. The survey tool may also prove to be appropriate for use by other health districts and/or state-wide.NHMR

Women’s expectations and experiences in maternity care: how do women conceptualise the process of continuity?

Objective: to gain an understanding of how women conceptualise continuity of maternity care. Design: a qualitative study involving in-depth semi-structured interviews and thematic analysis. Setting: a range of urban and rural public hospitals in New South Wales, Australia. Participants: 53 women aged 18-44 years (median age 27 years) receiving maternity care in 2011 - 2012. Findings: responses from women suggested five types of continuity: continuity of staff, continuity of relationship, continuity of information, continuity across pregnancies, and continuity across locations. The types of continuity differed by parity and location. Conclusion and implications for practice: continuity of maternity care has a variety of meanings to women. If healthcare providers are to commit to providing woman-centred maternity care it is important to recognise the diversity of women’s experiences, and ensure that systems of care are flexible and appropriate to women’s circumstances and needs

Women’s expectations and experiences in maternity care: how do women conceptualise the process of continuity?

Objective: to gain an understanding of how women conceptualise continuity of maternity care. Design: a qualitative study involving in-depth semi-structured interviews and thematic analysis. Setting: a range of urban and rural public hospitals in New South Wales, Australia. Participants: 53 women aged 18-44 years (median age 27 years) receiving maternity care in 2011 - 2012. Findings: responses from women suggested five types of continuity: continuity of staff, continuity of relationship, continuity of information, continuity across pregnancies, and continuity across locations. The types of continuity differed by parity and location. Conclusion and implications for practice: continuity of maternity care has a variety of meanings to women. If healthcare providers are to commit to providing woman-centred maternity care it is important to recognise the diversity of women’s experiences, and ensure that systems of care are flexible and appropriate to women’s circumstances and needs

Two New Techniques for Evaluating Connectivity of Septic Fields to Great Lake Watersheds and Embayments

Pictometry Oblique Imagery was successfully used to map septic fields in Oak Orchard watershed. Analysis of the imagery proved to be efficient for finding leach fields, and between 66 to 81% of the septic fields previously mapped by the Genesee Orleans County Department of Health, were identified. The remainder were not identified because of canopy cover, or were either septic systems without leach fields, the septic field postdated the imagery, or were not visible. Consequently under ideal conditions (septic systems with leach fields and no canopy or shadows) the method should be able to identify over 80% of the systems. Imagery taken during the transition from dormant to growing season proved best for identifying leach fields. One example of a plume from a short circuited system was recorded. A total of 1277 septic fields were mapped in the watershed. Spatial distribution was heterogenous, with dense sites of septic fields concentrated along residential road corridors. Approximately 4.2% of the leach fields were located less than 100 feet of a tributary. This is below the minimum separation distance of a leach field to a waterbody that is required by the NYS Department of Health code. The average distance of a leach field to a tributary is 327 meters with 50% of the leach fields occurring within 240 meters of mapped tributaries. Maps of important septic field “hotspots” were developed for watershed stakeholders and include tributaries along Batavia-Elba Townline Rd., Marsh Creek, and tributaries near the intersections of Alleghany and Lockport Rds, Judge Rd and Knowlesville Rd., and Lockport and Albion Rd. Considerable numbers of septic fields occur along Lake Alice in the main stem of the river, however this stretch is probably diluted by water input from the Erie Canal at the Glendale Dam. In a second set of experiments, a new DNA-based groundwater tracer was introduced to two septic systems to see if it could be used to trace individual septic systems. The tracer was not discovered in one site, however, a breakthrough curve was obtained in the second site 31 days after being introduced into the toilet. This tracer passed through at least 200 meters of groundwater flowpath and 1 km of stream. The results of these experiments suggest that frequent, systematic sampling and careful lab protocols to identify the signal to noise threshold of the procedure are critical to the success of the technique. In summary we suggest that Pictometry Oblique Imagery can be used to map septic fields in a watershed and that the DNA Tracer technique may be successful in some septic systems. Further research needs to be conducted to improve the success of the latter

Pathways to a rising caesarean section rate: a population-based cohort study

OBJECTIVES: To determine whether the obstetric pathways leading to caesarean section changed from one decade to another. We also aimed to explore how much of the increase in caesarean rate could be attributed to maternal and pregnancy factors including a shift towards delivery in private hospitals. DESIGN: Population-based record linkage cohort study. SETTING: New South Wales, Australia. PARTICIPANTS: For annual rates, all women giving birth in NSW during 1994 to 2009 were included. To examine changes in obstetric pathways two cohorts were compared: all women with a first-birth during either 1994–1997 (82 988 women) or 2001–2004 (85 859 women) and who had a second (sequential) birth within 5 years of their first-birth. PRIMARY OUTCOME MEASURES: Caesarean section rates, by parity and onset of labour. RESULTS: For first-births, prelabour and intrapartum caesarean rates increased from 1994 to 2009, with intrapartum rates rising from 6.5% to 11.7%. This fed into repeat caesarean rates; from 2003, over 18% of all multiparous births were prelabour repeat caesareans. In the 1994–1997 cohort, 17.7% of women had a caesarean delivery for their first-birth. For their second birth, the vaginal birth after caesarean (VBAC) rate was 28%. In the 2001–2004 cohort, 26.1% of women had a caesarean delivery for their first-birth and the VBAC rate was 16%. Among women with a first-birth, maternal and pregnancy factors and increasing deliveries in private hospitals, only explained 24% of the rise in caesarean rates from 1994 to 2009. CONCLUSIONS: Rising first-birth caesarean rates drove the overall increase. Maternal factors and changes in public/private care could explain only a quarter of the increase. Changes in the perceived risks of vaginal birth versus caesarean delivery may be influencing the pregnancy management decisions of clinicians and/or mothers