Surveillance and Elimination of Bacteriophage Contamination in an Industrial Fermentation Process

Commercial fermentation processes are often vulnerable to bacteriophage due to the lack of genetic diversity and use of high cell density cultures. Bacteriophage infections in these fermentations can have adverse impacts on operability of the production facility and product quality and prevent recovery of valuable bioproducts in the downstream process. Prevention strategies have been developed and optimized through feedback from bacteriophage diagnostic tests, which inform improvements to process design for elimination of entry points, as well as modification of the biocatalyst to reduce or eliminate bacteriophage virulence. In this chapter, we provide case studies for successful elimination of bacteriophage virulence via host modifications, including bacteriophage binding-site modifications on the outer membrane of an Escherichia coli production host, used for commercial manufacture of 1,3-propanediol, as well as application of CRISPR-associated protein 9 (Cas9) for bacteriophage immunity. Finally, we report application of bacteriophage diagnostic methods to fully characterize and eliminate bacteriophage entry points in a commercial fermentation process

Harnessing the Power of Information to Protect Our Public Natural Resource Legacy

In practice, our laws have proven unequal to the lofty objectives of preserving a legacy of public natural resources for our children or achieving sustainable use of these resources. There are many factors that contribute to this shortfall, but inherent inadequacies in the design of these statutes cannot be overlooked as an important determinant. Despite the statutes\u27 broadly stated aspirations toward sustainability and protection of the interests of future generations, only a handful of these statutes include strong and enforceable mandates for sustainable resource use. Many of these statutes accord natural resource-management agencies broad discretion to balance and permit a long list of competing uses of a given resource, including degrading and depleting uses. They lack any clear mandate that the agency protect any particular quantity or quality of a given resource for today, much less for future generations. Thus our laws often promise far more than they can deliver. It should therefore come as no surprise that in practice, many of our public natural resources are declining in quantity and quality. Without an effective legal mechanism to check the decline, this pattern of incremental resource depletion and degradation will likely continue. This article considers the possibility that we need, and should consider enacting, a law that provides an effective check on the degradation and depletion of public natural resources across the board. This article considers whether the National Environmental Policy Act (NEPA), reinforced with a substantive standard of protection, would be the best tool for defining and protecting a public natural resource legacy

Harnessing the Power of Information to Protect Our Public Natural Resource Legacy

In practice, our laws have proven unequal to the lofty objectives of preserving a legacy of public natural resources for our children or achieving sustainable use of these resources. There are many factors that contribute to this shortfall, but inherent inadequacies in the design of these statutes cannot be overlooked as an important determinant. Despite the statutes\u27 broadly stated aspirations toward sustainability and protection of the interests of future generations, only a handful of these statutes include strong and enforceable mandates for sustainable resource use. Many of these statutes accord natural resource-management agencies broad discretion to balance and permit a long list of competing uses of a given resource, including degrading and depleting uses. They lack any clear mandate that the agency protect any particular quantity or quality of a given resource for today, much less for future generations. Thus our laws often promise far more than they can deliver. It should therefore come as no surprise that in practice, many of our public natural resources are declining in quantity and quality. Without an effective legal mechanism to check the decline, this pattern of incremental resource depletion and degradation will likely continue. This article considers the possibility that we need, and should consider enacting, a law that provides an effective check on the degradation and depletion of public natural resources across the board. This article considers whether the National Environmental Policy Act (NEPA), reinforced with a substantive standard of protection, would be the best tool for defining and protecting a public natural resource legacy

Geriatrics Attitudes and Knowledge Among Surgical and Medical Subspecialty House Officers

To examine geriatrics knowledge and attitudes of non-primary care house officers (HOs) before and after a multidisciplinary faculty development program. DESIGN : Serial cross-sectional surveys. PARTICIPANTS : HOs. SETTING : A large midwestern academic medical center. INTERVENTION : Faculty from seven surgical and six medical subspecialties participated in weekly seminars for 9 months and implemented geriatrics curricula in their HO programs. MEASUREMENTS : HO geriatrics attitudes and knowledge were measured using the University of California at Los Angeles Geriatrics Attitudes Scale (GAS; 14 items), two scales of the Maxwell Sullivan test (Therapeutic Potential and Time/Energy; six items each; lower scores denote more-favorable attitudes), and the Geriatrics Clinical Knowledge Assessment (20 multiple choice items; range 0–100%). Repeat surveys were administered in seven disciplines after geriatrics curriculum implementation. RESULTS : Baseline (n=175) geriatrics attitudes were favorable (e.g., 3.7 for GAS; 2.1 for Time/Energy), with more-favorable attitudes among medical subspecialty than surgical HOs (e.g., mean GAS 3.8 and 3.6, respectively; P =.001), and with advanced training. Mean baseline knowledge scores were 65.1% among all HOs. No differences in attitudes or knowledge were observed between the first (n=100) and second (n=90) cohorts in the seven disciplines that administered subsequent tests. CONCLUSION : Geriatrics attitudes of non-primary care HOs are positive, and knowledge is moderate, suggesting need for and potential effect of geriatrics curricula. Demonstrating effects on learner outcomes of faculty development programs may require more than one faculty member per discipline and measures that are curriculum-specific and detailed rather than general and brief.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66180/1/j.1532-5415.2007.01475.x.pd

Interpreting the seasonal cycles of atmospheric oxygen and carbon dioxide concentrations at American Samoa Observatory

We present seven years of atmospheric O2/N2 ratio and CO2 concentration data measured from flask samples collected at American Samoa. These data are unusual, exhibiting higher short-term variability, and seasonal cycles not in phase with other sampling stations. The unique nature of atmospheric data from Samoa has been noted previously from measurements of CO2, methyl chloroform, and ozone. With our O2 data, we observe greater magnitude in the short-term variability, but, in contrast, no clear seasonal pattern to this variability. This we attribute to significant regional sources and sinks existing for O2 in both hemispheres, and a dependence on both the latitudinal and altitudinal origins of air masses. We also hypothesize that some samples exhibit a component of "older" air, demonstrating recirculation of air within the tropics. Our findings could be used to help constrain atmospheric transport models which are not well characterized in tropical regions

What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study.

OBJECTIVES: To investigate the deployment of physician associates (PAs); the factors supporting and inhibiting their employment and their contribution and impact on patients' experience and outcomes and the organisation of services. DESIGN: Mixed methods within a case study design, using interviews, observations, work diaries and documentary analysis. SETTING: Six acute care hospitals in three regions of England in 2016-2017. PARTICIPANTS: 43 PAs, 77 other health professionals, 28 managers, 28 patients and relatives. RESULTS: A key influencing factor supporting the employment of PAs in all settings was a shortage of doctors. PAs were found to be acceptable, appropriate and safe members of the medical/surgical teams by the majority of doctors, managers and nurses. They were mainly deployed to undertake inpatient ward work in the medical/surgical team during core weekday hours. They were reported to positively contribute to: continuity within their medical/surgical team, patient experience and flow, inducting new junior doctors, supporting the medical/surgical teams' workload, which released doctors for more complex patients and their training. The lack of regulation and attendant lack of authority to prescribe was seen as a problem in many but not all specialties. The contribution of PAs to productivity and patient outcomes was not quantifiable separately from other members of the team and wider service organisation. Patients and relatives described PAs positively but most did not understand who and what a PA was, often mistaking them for doctors. CONCLUSIONS: This study offers new insights concerning the deployment and contribution of PAs in medical and surgical specialties in English hospitals. PAs provided a flexible addition to the secondary care workforce without drawing from existing professions. Their utility in the hospital setting is unlikely to be completely realised without the appropriate level of regulation and authority to prescribe medicines and order ionising radiation within their scope of practice

Characterization of engraftment dynamics in myelofibrosis after allogeneic hematopoietic cell transplantation including novel conditioning schemes.

INTRODUCTION Myelofibrosis (MF) is a rare hematopoietic stem cell disorder progressing to bone marrow (BM) failure or blast phase. Allogeneic hematopoietic cell transplantation (HCT) represents a potentially curative therapy for a limited subset of patients with advanced MF, who are eligible, but engraftment in MF vs. AML is delayed which promotes complications. As determinants of engraftment in MF are incompletely characterized, we studied engraftment dynamics at our center. METHODS A longitudinal cohort of 71 allogeneic HCT performed 2000-2019 with >50% after 2015 was evaluated. RESULTS Median time to neutrophil engraftment ≥0.5x109/l was +20 days post-transplant and associated with BM fibrosis, splenomegaly and infused CD34+ cell number. Engraftment dynamics were similar in primary vs. secondary MF and were independent of MF driver mutations in JAK2, CALR and MPL. Neutrophil engraftment occurred later upon haploidentical HCT with thiotepa-busulfan-fludarabine conditioning, post-transplant cyclophosphamide and G-CSF (TBF-PTCy/G-CSF) administered to 9.9% and 15.6% of patients in 2000-2019 and after 2015, respectively. Engraftment of platelets was similarly delayed, while reconstitution of reticulocytes was not affected. CONCLUSIONS Since MF is a rare hematologic malignancy, this data from a large number of HCT for MF is essential to substantiate that later neutrophil and platelet engraftment in MF relates both to host and treatment-related factors. Observations from this longitudinal cohort support that novel conditioning schemes administered also to rare entities such as MF, require detailed evaluation in larger, multi-center cohorts to assess also indicators of long-term graft function and overall outcome in patients with this infrequent hematopoietic neoplasm undergoing allogeneic transplantation

Interventions to Reduce Adult Nursing Turnover: A Systematic Review of Systematic Reviews.

Background: Nurse turnover is an issue of concern in health care systems internationally. Understanding which interventions are effective to reduce turnover rates is important to managers and health care organisations. Despite a plethora of reviews of such interventions, strength of evidence is hard to determine. Objective: We aimed to review literature on interventions to reduce turnover in nurses working in the adult health care services in developed economies. Method: We conducted an overview (systematic review of systematic reviews) using the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, Applied Social Sciences Index and Abstracts, CINAHL plus and SCOPUS and forward searching. We included reviews published between 1990 and January 2015 in English. We carried out parallel blinded selection, extraction of data and assessment of bias, using the Assessment of Multiple Systematic Reviews. We carried out a narrative synthesis. Results: Despite the large body of published reviews, only seven reviews met the inclusion criteria. These provide moderate quality review evidence, albeit from poorly controlled primary studies. They provide evidence of effect of a small number of interventions which decrease turnover or increase retention of nurses, these being preceptorship of new graduates and leadership for group cohesion. Conclusion: We highlight that a large body of reviews does not equate with a large body of high quality evidence. Agreement as to the measures and terminology to be used together with well-designed, funded primary research to provide robust evidence for nurse and human resource managers to base their nurse retention strategies on is urgently required