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Shunt infections are a common complication when treating hydrocephalus by cerebrospinal fluid (CSF) shunt placement. The source of infecting pathogens is not well understood. One hypothesis, which we explored here, is that microorganisms persist chronically in the host long before a symptomatic infection occurs and may be detectable in surgical events preceding infection. A cohort of 13 patients was selected, for which CSF samples were available from an infection episode and from a previous surgery event, which was either an initial shunt placement or a revision. Microbiota were analyzed both directly from CSF and from isolates cultured from CSF on aerobic and anaerobic media. The detection and identification of bacteria was done with high throughput DNA sequencing methods and mass spectrometry. The presence of bacteria was confirmed in 4 infection samples, of which 2 were after initial placement and 2 after revision surgery. Taxonomic identification was consistent with clinical microbiology laboratory results. Bacteria were not detected in any of the CSF samples collected at the time of the previous surgical events. While our findings do not provide direct evidence for long-term persistence of pathogens, they suggest the need for consideration of additional source material, such as biofilm and environmental swabs, and/or the use of more sensitive and specific analytical methods. [ABSTRACT FROM AUTHOR]

Universities in the EFL context aim to foster graduates who can use English in the workplace. Regardless, university students' insufficient amount of out-of-class study time is a major issue. This problem may stem from learners' lack of learning skills, low levels of learning motivation, and high levels of academic procrastination. Self-coaching skills have the potential to tackle this problem. In this study, we introduce how self-coaching skills training can be applied in the EFL classroom while drawing on relevant literature in ELT. Respecting the diverse characteristics of learners, we grouped participants into different trajectories based on levels of intrinsic motivation, self-regulated learning skills, and academic procrastination tendencies at four different data collection points throughout a required 15-week EFL course. Quantitative data revealed five trajectories in which we examined how self-coaching skills training through self-questioning influenced out-of-class study time in two representative trajectories. Quantitative data also pointed out positive associations between increases in self-coaching skills and out-of-class study time for both trajectories. Our qualitative data analysis results suggested a necessity of providing students with opportunities for gaining deeper understandings of the psychological aspects of language learning to better learning experiences and learning outcomes for the different types of learners.

Most infants with cystic fibrosis (CF) have pancreatic exocrine insufficiency that results in nutrient malabsorption and requires oral pancreatic enzyme replacement. Newborn screening for CF has enabled earlier diagnosis, nutritional intervention and enzyme replacement for these infants, allowing most infants with CF to achieve their weight goals by 12 months of age.sup.1. Nevertheless, most infants with CF continue to have poor linear growth during their first year of life.sup.1. Although this early linear growth failure is associated with worse long-term respiratory function and survival.sup.2,3, the determinants of body length in infants with CF have not been defined. Several characteristics of the CF gastrointestinal (GI) tract, including inflammation, maldigestion and malabsorption, may promote intestinal dysbiosis.sup.4,5. As GI microbiome activities are known to affect endocrine functions.sup.6,7, the intestinal microbiome of infants with CF may also impact growth. We identified an early, progressive fecal dysbiosis that distinguished infants with CF and low length from infants with CF and normal length. This dysbiosis included altered abundances of taxa that perform functions that are important for GI health, nutrient harvest and growth hormone signaling, including decreased abundance of Bacteroidetes and increased abundance of Proteobacteria. Thus, the GI microbiota represent a potential therapeutic target for the correction of low linear growth in infants with CF. Most infants with cystic fibrosis have poor early linear growth in their first year despite nutritional supplementation and treatment. Intestinal dysbiosis in these infants is associated with low length, suggesting a path for intervention., Author(s): Hillary S. Hayden [sup.1] , Alexander Eng [sup.2] , Christopher E. Pope [sup.3] , Mitchell J. Brittnacher [sup.1] , Anh T. Vo [sup.1] , Eli J. Weiss [sup.1] , [...]

The human gastrointestinal tract consists of a dense and diverse microbial community, the composition of which is intimately linked to health. Extrinsic factors such as diet and host immunity are insufficient to explain the constituents of this community, and direct interactions between co-resident microorganisms have been implicated as important drivers of microbiome composition. The genomes of bacteria derived from the gut microbiome contain several pathways that mediate contact-dependent interbacterial antagonism.sup.1-3. Many members of the Gram-negative order Bacteroidales encode the type VI secretion system (T6SS), which facilitates the delivery of toxic effector proteins into adjacent cells.sup.4,5. Here we report the occurrence of acquired interbacterial defence (AID) gene clusters in Bacteroidales species that reside within the human gut microbiome. These clusters encode arrays of immunity genes that protect against T6SS-mediated intra- and inter-species bacterial antagonism. Moreover, the clusters reside on mobile elements, and we show that their transfer is sufficient to confer resistance to toxins in vitro and in gnotobiotic mice. Finally, we identify and validate the protective capability of a recombinase-associated AID subtype (rAID-1) that is present broadly in Bacteroidales genomes. These rAID-1 gene clusters have a structure suggestive of active gene acquisition and include predicted immunity factors of toxins derived from diverse organisms. Our data suggest that neutralization of contact-dependent interbacterial antagonism by AID systems helps to shape human gut microbiome ecology. An interbacterial defence strategy, involving clusters of immunity genes against toxins released by the type VI secretion system of the same or different species, is widespread among Bacteroides species, and transfer of these gene clusters confers resistance to toxins in vitro and in the mammalian gut., Author(s): Benjamin D. Ross [sup.1] , Adrian J. Verster [sup.2] , Matthew C. Radey [sup.1] , Danica T. Schmidtke [sup.1] , Christopher E. Pope [sup.3] , Lucas R. Hoffman [sup.1] [...]

This paper reports on a combined experimental and modeling investigation of NOx formation in nitrogen-diluted laminar methane diffusion flames seeded with ammonia. The methane-ammonia mixture is a surrogate for biomass fuels which contain significant fuel-bound nitrogen. The experiments use flue-gas sampling to measure the concentration of stable species in the exhaust gas, including NO, O2, CO, and CO2. The computations evolve a two-dimensional low Mach number model using a solution-adaptive projection algorithm to capture fine-scale features of the flame. The model includes detailed thermodynamics and chemical kinetics, differential diffusion, buoyancy, and radiative losses. The model shows good agreement with the measurements over the full range of experimental NH3 seeding amounts. As more NH3 is added, a greater percentage is converted to N2 rather than to NO. The simulation results are further analyzed to trace the changes in NO formation mechanisms with increasing amounts of ammonia in the fuel.

Objective: To characterize the microbiota of the cerebrospinal fluid (CSF) from children with hydrocephalus at the time of initial surgical intervention. Study design: CSF was obtained at initial surgical intervention. One aliquot was stored in skim milk-tryptone-glucose-glycerol (STGG) medium and the second was unprocessed; both were then stored at –70°C. Bacterial growth for CSF samples stored in STGG were subsequently characterized using aerobic and anaerobic culture on blood agar and MALDI-TOF sequencing. All unprocessed CSF samples underwent 16S quantitative polymerase chain reaction (qPCR) sequencing, and a subset underwent standard clinical microbiological culture. CSF with culture growth (either after storage in STGG or standard clinical) were further analyzed using whole-genome amplification sequencing (WGAS). Results: 11/66 (17%) samples stored in STGG and 1/36 (3%) that underwent standard clinical microbiological culture demonstrated bacterial growth. Of the organisms present, 8 were common skin flora and 4 were potential pathogens; only 1 was also qPCR positive. WGAS findings and STGG culture findings were concordant for only 1 sample, identifying Staphylococcus epidermidis. No significant difference in time to second surgical intervention was observed between the STGG culture-positive and negative groups. Conclusion(s): Using high sensitivity methods, we detected the presence of bacteria in a subset of CSF samples at the time of first surgery. Therefore, the true presence of bacteria in CSF of children with hydrocephalus cannot be ruled out, though our findings may suggest these bacteria are contaminants or false positives of the detection methods. Regardless of origin, the detection of microbiota in the CSF of these children may not have any clinical significance. [ABSTRACT FROM AUTHOR]

Background This study aimed to evaluate whether prompting general practitioners (GPs) to routinely assess and manage anxiety and depression in patients consulting with osteoarthritis (OA) improves pain outcomes. Methods and findings We conducted a cluster randomised controlled trial involving 45 English general practices. In intervention practices, patients aged [greater than or equal to]45 y consulting with OA received point-of-care anxiety and depression screening by the GP, prompted by an automated electronic template comprising five questions (a two-item Patient Health Questionnaire-2 for depression, a two-item Generalized Anxiety Disorder-2 questionnaire for anxiety, and a question about current pain intensity [0-10 numerical rating scale]). The template signposted GPs to follow National Institute for Health and Care Excellence clinical guidelines for anxiety, depression, and OA and was supported by a brief training package. The template in control practices prompted GPs to ask the pain intensity question only. The primary outcome was patient-reported current pain intensity post-consultation and at 3-, 6-, and 12-mo follow-up. Secondary outcomes included pain-related disability, anxiety, depression, and general health. During the trial period, 7,279 patients aged [greater than or equal to]45 y consulted with a relevant OA-related code, and 4,240 patients were deemed potentially eligible by participating GPs. Templates were completed for 2,042 patients (1,339 [31.6%] in the control arm and 703 [23.1%] in the intervention arm). Of these 2,042 patients, 1,412 returned questionnaires (501 [71.3%] from 20 intervention practices, 911 [68.0%] from 24 control practices). Follow-up rates were similar in both arms, totalling 1,093 (77.4%) at 3 mo, 1,064 (75.4%) at 6 mo, and 1,017 (72.0%) at 12 mo. For the primary endpoint, multilevel modelling yielded significantly higher average pain intensity across follow-up to 12 mo in the intervention group than the control group (adjusted mean difference 0.31; 95% CI 0.04, 0.59). Secondary outcomes were consistent with the primary outcome measure in reflecting better outcomes as a whole for the control group than the intervention group. Anxiety and depression scores did not reduce following the intervention. The main limitations of this study are two potential sources of bias: an imbalance in cluster size (mean practice size 7,397 [intervention] versus 5,850 [control]) and a difference in the proportion of patients for whom the GP deactivated the template (33.6% [intervention] versus 27.8% [control]). Conclusions In this study, we observed no beneficial effect on pain outcomes of prompting GPs to routinely screen for and manage comorbid anxiety and depression in patients presenting with symptoms due to OA, with those in the intervention group reporting statistically significantly higher average pain scores over the four follow-up time points than those in the control group. Trial registration ISRCTN registry ISRCTN40721988, Author(s): Christian D. Mallen 1,2,*, Barbara I. Nicholl 3, Martyn Lewis 1, Bernadette Bartlam 1, Daniel Green 1, Sue Jowett 1, Jesse Kigozi 1, John Belcher 1, Kris Clarkson 1, [...]

Comparative studies are carried out on two Campylobacter jejuni strains, T1016 and Pstau, in relation to their prevalence in human infections and on poultry meat in a specific geographical area of New Zealand. The strain comparisons have used an in vitro cell invasion assay, microarray-based comparative genomic hybridization, flagellin A (FlaA) characteristics obtained from amino acid sequences, and competitive-exclusion experiments with chickens.

The push for better English as a Foreign Language (EFL) pedagogy continues in Asia. In Japan, particularly, developing self-regulated learning (SRL) skills is a major objective in the new national curriculum for primary and secondary schools. Research in education suggests the practice of formative assessment (FA) in the classroom fosters SRL skills. The importance of FA in EFL is discussed here, along with an investigation of the relationship between FA and SRL skills of Japanese university students. An examination of 118 participants measured secondary school experiences of FA practices and its connection to the development of participants' SRL skills. Quantitative results showed that participants experienced FA practices in secondary schools, however, qualitative data showed these experiences did not sufficiently lead to the development of SRL skills to the extent of participants' out-of-class study time. In conclusion, we recommend EFL teachers to implement more FA practices and explicit instruction of SRL skills to meet curriculum objectives of fostering the lifelong language learner. [ABSTRACT FROM AUTHOR]