Oral health awareness and care preferences in patients with diabetes : a qualitative study

Background People with type 2 diabetes have an increased risk of oral health problems; however, oral health is currently not included in structured diabetes reviews and education in the UK. Aim and Objectives This study explores the patient experience related to oral health and diabetes, especially in relation to: • Awareness of the link between oral health and diabetes and oral self care needs • Interaction with health professionals in dental and general practice • Preferences for receiving oral health information and education Methods This nested qualitative study involved semi-structured telephone interviews with a purposive sample of 20 participants from a questionnaire study on oral health awareness in patients with diabetes. Interview transcripts were analysed using a thematic framework approach. Results Participants were mostly unaware of the link between oral health and diabetes. Those that had been made aware by a health professional were not given concrete self care advice. Interactions with dental professionals were often limited to informing the dental practice of their diagnosis and current medication. Most participants were in favour of dentists screening for diabetes, but as their general practice was the hub for diabetes care, they felt GPs or nurses should provide oral health information and discuss oral health with patients. Conclusions Written information regarding diabetes and its possible effects on oral health needs to be more readily available to people with diabetes, especially at diagnosis. There may be a place for introducing a structured oral health question in routine diabetes reviews

Forecasting Tourism Travel on Rural Roads

The tourism sector is heavily reliant on the rural road system and it is not uncommon for the road and tourism authorities to receive submissions documenting perceived shortcomings of particular roads. This paper considers tourism demand in NSW and the development and application of analytical procedures for estimating the likely impact of future development scenarios on road-based tourism in NSW. A large number of demographic, socioeconomic and transport variables have influenced domestic and international tourism in NSW over recent decades. These include: population growth, household size and structure, vehicle ownership and operating costs and macro-economic decisions, such as tariff reductions. While future tourism demand is likely to be influenced by a range of variables, it is possible to specify several long term development scenarios which are likely to influence road-based tourism demand. These scenarios are defined by: population growth and distribution; road transport network development and private travel cost; and the attractiveness of tourist destinations. A spreadsheet-based analysis procedure has been developed and applied to estimate the impacts of each of the development scenarios. This has indicated that the long-term road-based tourism growth rate in NSW will be of the order of 2%, with the geographic distribution being influenced by the population and tourist facility development

Comparative genomics of fungal allergens and epitopes shows widespread distribution of closely related allergen and epitope orthologues

BACKGROUND: Allergy is a common debilitating and occasionally life threatening condition. The fungal kingdom contains a number of species that produce a wide range of well defined protein allergens although the vast majority of fungal species have unknown allergenic potential. The recent genome sequencing of a variety of fungi provides the opportunity to assess the occurrence of allergen orthologues across the fungal kingdom. Here we use comparative genomics to survey the occurrence of allergen orthologues in fungi. RESULTS: A database of 82 allergen sequences was compiled and used to search 22 fungal genomes. Additionally we were able to model allergen structure for representative members of several highly homologous allergen orthologue classes. We found that some allergen orthologue classes that had predicted structural congruence to allergens and allergen epitopes were ubiquitous in all fungi. Other allergen orthologues classes were less well conserved and may not possess conserved allergen epitope orthologues in all fungi. A final group of allergen orthologues, including the major allergens Asp f 1 and Alt a 1, appear to be present in only a limited number of species. CONCLUSION: These results imply that most fungi may possess proteins that have potential to be allergens or to cross react with allergens. This, together with the observation that important allergens such as Asp f 1 are limited to genera or species, has significant implications for understating fungal sensitization, and interpreting diagnosis and management of fungal allergy

Genetic susceptibility to allergic bronchopulmonary aspergillosis in asthma: a genetic association study

Background: In patients with asthma, the fungus Aspergillus fumigatus can cause allergic bronchopulmonary aspergillosis (ABPA). Familial ABPA is reported, and some genetic factors have been associated with the disease, however, these are small studies (n ≤ 38) and do not explain all cases of ABPA.Methods: We analysed SNPs in 95 ABPA patients, comparing frequencies to 152 atopic asthmatic and 279 healthy controls. Twenty two genes were selected from literature, and 195 tagging SNPs were analysed for genetic association with ABPA using logistic regression corrected for multiple testing. We also analysed monocyte-derived macrophage gene expression before and during co-culture with A. fumigatus.Results: Seventeen ABPA-associated SNPs (ABPA v Atopic asthma) were identified. Three remained significant after correction for multiple testing; IL13 rs20541, IL4R rs3024656, TLR3 rs1879026. We also identified minor differences in macrophage gene expression responses in the ABPA group compared to the control groups.Conclusions: Multiple SNPs are now associated with ABPA. Some are novel associations. These associations implicate cytokine pathways and receptors in the aberrant response to A. fumigatus and susceptibility to ABPA, providing insights into the pathogenesis of ABPA and/or its complications. We hope these results will lead to increased understanding and improved treatment and diagnostics for ABPA

Persistent Candida albicans colonization and molecular mechanisms of azole resistance in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) patients

Objectives Patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED, APS-I) suffer from chronic candidosis caused mainly by Candida albicans, and repeated courses of azole antifungals have led to the development of resistance in the APECED patient population in Finland. The aim of our study was to address whether the patients are persistently colonized with the same or genetically closely related strains, whether epidemic strains are present and which molecular mechanisms account for azole resistance. Methods Sets of C. albicans (n = 19) isolates from nine APECED patients reported with decreased susceptibility to fluconazole isolated up to 9years apart were included. The strains were typed by multilocus sequence typing. CDR1/2, MDR1 and ERG11 mRNA expression was analysed by northern blotting and Cdr1, Cdr2 and Mdr1 protein expression by western blotting, and TAC1 and ERG11 genes were sequenced. Results All seven patients with multiple C. albicans isolates analysed were persistently colonized with the same or a genetically closely related strain for a mean of 5 years. All patients were colonized with different strains and no epidemic strains were found. The major molecular mechanisms behind the azole resistance were mutations in TAC1 contributing to overexpression of CDR1 and CDR2. Six new TAC1 mutations were found, one of which (N740S) is likely to be a gain-of-function mutation. Most isolates were found to have gained multiple TAC1 and ERG11 point mutations. Conclusions Despite clinically successful treatment leading to relief of symptoms, colonization by C. albicans strains is persistent within APECED patients. Microevolution and point mutations occur within strains, leading to the development of azole-resistant isolate

Aspergillus fumigatus allergen expression is coordinately regulated in response to hydrogen peroxide and cyclic AMP

<p>Abstract</p> <p>Background</p> <p><it>A. fumigatus </it>has been associated with a wide spectrum of allergic disorders such as ABPA or SAFS. It is poorly understood what allergens in particular are being expressed during fungal invasion and which are responsible for stimulation of immune responses. Study of the dynamics of allergen production by fungi may lead to insights into how allergens are presented to the immune system.</p> <p>Methods</p> <p>Expression of 17 <it>A. fumigatus </it>allergen genes was examined in response to various culture conditions and stimuli as well as in the presence of macrophages in order to mimic conditions encountered in the lung.</p> <p>Results</p> <p>Expression of 14/17 allergen genes was strongly induced by oxidative stress caused by hydrogen peroxide (Asp f 1, -2, -4, -5, -6, -7, -8, -10, -13, -17 and -18, all >10-fold and Asp f 11, -12, and -22, 5-10-fold) and 16/17 allergen genes were repressed in the presence of cAMP. The 4 protease allergen genes (Asp f -5, -10, -13 and -18) were expressed at very low levels compared to the comparator (<it>β</it>-tubulin) under all other conditions examined. Mild heat shock, anoxia, lipid and presence of macrophages did not result in coordinated changes in allergen gene expression. Growth on lipid as sole carbon source contributed to the moderate induction of most of the allergen genes. Heat shock (37°C > 42°C) caused moderate repression in 11/17 genes (Asp f 1, -2, -4, -5, -6, -9, -10, -13, -17, -18 and -23) (2- to 9-fold), which was mostly evident for Asp f 1 and -9 (~9-fold). Anaerobic stress led to moderate induction of 13/17 genes (1.1 to 4-fold) with one, Asp f 8 induced over 10-fold when grown under mineral oil. Complex changes were seen in gene expression during co-culture of <it>A. fumigatus </it>with macrophages.</p> <p>Conclusions</p> <p>Remarkable coordination of allergen gene expression in response to a specific condition (oxidative stress or the presence of cAMP) has been observed, implying that a single biological stimulus may play a role in allergen gene regulation. Interdiction of a putative allergen expression induction signalling pathway might provide a novel therapy for treatment of fungal allergy.</p

Bradyzoite pseudokinase 1 is crucial for efficient oral infectivity of the Toxoplasma gondii tissue cyst.

The tissue cyst formed by the bradyzoite stage of Toxoplasma gondii is essential for persistent infection of the host and oral transmission. Bradyzoite pseudokinase 1 (BPK1) is a component of the cyst wall, but nothing has previously been known about its function. Here, we show that immunoprecipitation of BPK1 from in vitro bradyzoite cultures, 4 days postinfection, identifies at least four associating proteins: MAG1, MCP4, GRA8, and GRA9. To determine the role of BPK1, a strain of Toxoplasma was generated with the bpk1 locus deleted. This BPK1 knockout strain (Δbpk1) was investigated in vitro and in vivo. No defect was found in terms of in vitro cyst formation and no difference in pathogenesis or cyst burden 4 weeks postinfection (wpi) was detected after intraperitoneal (i.p.) infection with Δbpk1 tachyzoites, although the Δbpk1 cysts were significantly smaller than parental or BPK1-complemented strains at 8 wpi. Pepsin-acid treatment of 4 wpi in vivo cysts revealed that Δbpk1 parasites are significantly more sensitive to this treatment than the parental and complemented strains. Consistent with this, 4 wpi Δbpk1 cysts showed reduced ability to cause oral infection compared to the parental and complemented strains. Together, these data reveal that BPK1 plays a crucial role in the in vivo development and infectivity of Toxoplasma cysts

Cloning, disruption and characterisation of Aspergillus fumigatus allergen proteases and their effect on airway epithelial cells

Allergen proteases from a number sources including the filamentous fungus A. fumigatus, are thought to be important in the development of severe asthma through protease dependent interactions with the respiratory epithelium. The first aim of the thesis was to determine the effect of a variety of growth substrates on the secretion of proteases from different strains of A. fumigatus. The second aim was to investigate the effects of recombinant allergen proteases Asp f 5 and Asp f 13 expressed in the P. pastoris protein expression system and crude A. fumigatus culture supernatants on airway epithelial cells and determine whether protease induced interleukin 8 (IL-8) release from airway epithelial cells was dependent on the activation of protease activated receptor 2 (PAR-2).Results demonstrated that the AF293 strain of A. fumigatus secreted serine proteases during growth on pig lung homogenate medium and metalloproteases during growth on a casein based medium but suppressed protease secretion in Vogel's minimal medium. Analysis of the secretion and RNA levels of proteases in A. fumigatus showed that the matrix metalloprotease, Asp f 5 and the serine protease, Asp f 13 were up-regulated and secreted during growth in pig lung medium and that the matrix metalloprotease, Lap1 was up-regulated and secreted along with Asp f 5 and Asp f 13 in casein medium. This finding was confirmed using protease inhibitors and by using strains of A. fumigatus in which Asp f 5 and Asp f 13 genes were disrupted. These results suggest that A. fumigatus was able to detect different complex proteins available as substrates in its environment and regulate protease secretion accordingly. Furthermore, in several strains of A. fumigatus, protease activity was not suppressed by growth in Vogel's medium, suggesting differences in the regulation of protease secretion between strains. Both A. fumigatus culture supernatants and recombinant Asp f 5 and Asp f 13 produced in P. pastoris caused epithelial airway cell desquamination, and IL-8 release in a protease and dose-dependent manner. In addition, both recombinant Asp f 5 and Asp f 13 were both shown to cleave PAR-2 at a site that resulted in receptor activation.In conclusion, differences in the secretion of proteases between A. fumigatus strains and during growth of A. fumigatus on different media suggests a requirement for the standardisation of the preparation of A. fumigatus allergen extracts used both in clinical diagnosis of A. fumigatus allergy and in vitro and in vivo research studies. Furthermore, it is proposed that allergen proteases secreted by A. fumigatus may interact with a variety of host proteins including, matrix molecules, enzymes and receptors which may exacerbate allergic airway diseases.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Coma revealed as an extended hard X-rays source by INTEGRAL IBIS/ISGRI

Aims. We report the INTEGRAL/IBIS observations of the Coma Cluster in the hard X-ray/soft-ray domain. Methods. Since the Coma Cluster appears as an extended source, its global intensity and significance cannot be directly extracted with standard coded mask analysis. We used the method of imaging the extended sources with a coded mask telescope developed by Renaud et al. (2006). Results. The imaging capabilities and the sensitivity of the IBIS/ISGRI coded mask instrument allows us to identify for the first time the site of the emission above ~ 15 keV. We have studied the Coma Cluster morphology in the 18-30keV band and found that it follows the prediction based on X-ray observations.We also bring constraints on the non-thermal mechanism contribution at higher energies.Comment: 4 pages, 4 figures, Accepted for publication in A&A Letter

Monte Carlo studies of two-dimensional polymer–solvent systems

<div><p>Allergic bronchopulmonary aspergillosis (ABPA) in asthma is a severe, life-affecting disease that potentially affects over 4.8 million people globally. In the UK, ABPA is predominantly caused by the fungus <i>Aspergillus fumigatus</i>. Phagocytosis is important in clearance of this fungus, and Early Endosome Antigen 1 (<i>EEA1</i>) has been demonstrated to be involved in phagocytosis of fungi. We sought to investigate the role of <i>EEA1</i> mutations and phagocytosis in ABPA. We used exome sequencing to identify variants in <i>EEA1</i> associated with ABPA. We then cultured monocyte-derived macrophages (MDMs) from 17 ABPA subjects with <i>A</i>. <i>fumigatus</i> conidia, and analyzed phagocytosis and phagolysosome acidification in relation to the presence of these variants. We found that variants in <i>EEA1</i> were associated with ABPA and with the rate of phagocytosis of <i>A</i>. <i>fumigatus</i> conidia and the acidification of phagolysosomes. MDMs from ABPA subjects carrying the disease associated genotype showed increased acidification and phagocytosis compared to those from ABPA subjects carrying the non-associated genotypes or healthy controls.The identification of ABPA-associated variants in EEA that have functional effects on MDM phagocytosis and phagolysosome acidification of <i>A</i>. <i>fumigatus</i> conidia revolutionizes our understanding of susceptibility to this disease, which may in future benefit patients by earlier identification or improved treatments. We suggest that the increased phagocytosis and acidification observed demonstrates an over-active MDM profile in these patients, resulting in an exaggerated cellular response to the presence of <i>A</i>. <i>fumigatus</i> in the airways.</p></div