Mental Health

Beliefs and Attitudes About the Dissemination and Implementation of Internet-Based Self-Care Programs in a Large Integrated Healthcare System Abstract Behavioral intervention technologies (BITs) are online programs or mobile applications that deliver behavioral health interventions for self-care. The dissemination and implementation of such programs in U.S. healthcare systems has not been widely undertaken. To better understand these phenomena, we explored perspectives on BIT deployment in the Veterans Health Administration. Interviews from 20 providers, administrators, and policy makers were analyzed using qualitative methods. Eight themes were identified including the use of traditional healthcare delivery models, strategies for technology dissemination and implementation, internet infrastructure, leadership, health system structure, regulations, and strategic priorities. This research suggests policy, funding, and strategy development initiatives to promote the implementation and dissemination of BITs.

Treatment of Veterans with Psychiatric Diagnoses Nationally in the Veterans Health Administration: A Comparison of Service Delivery by Mental Health Specialists and Other Providers Abstract Patients with psychiatric disorders are treated by both mental health specialists and non-specialists. We use national data from the Veterans Health Administration to evaluate changing proportions of patients seen exclusively by non-specialists during the study year (FY 2012) limit as well as differences in socio-demographic, clinical and service use characteristics. There has been a five-fold increase in veterans with mental disorders seen by non-specialists over 20 years from 7 to 38%, findings similar to those in non-VA settings. Veterans treated by mental health specialists were younger, more likely to have been homeless and disabled, and had more severe and more numerous psychiatric diagnoses. There is a need to maintain specialty services and to strengthen non-specialty care through education and research.

Policy Levers to Promote Access to and Utilization of Children's Mental Health Services: A Systematic Review Abstract Policies have potential to help families obtain behavioral healthcare for their children, but little is known about evidence for specific policy approaches. We reviewed evaluations of select policy levers to promote accessibility, affordability, acceptability, availability, or utilization of children's mental and behavioral health services. Twenty articles met inclusion criteria. Location-based policy levers (school-based services and integrated care models) were associated with higher utilization and acceptability, with mixed evidence on accessibility. Studies of insurance-based levers (mental health parity and public insurance) provided some evidence for affordability outcomes. We found no eligible studies of workforce development or telehealth policy levers, or of availability outcomes.

Policy Impacts of the Australian National Perinatal Depression Initiative: Psychiatric Admission in the First Postnatal Year Abstract This paper helps to quantify the impact of the Australian National Perinatal Depression Initiative (NPDI) on postnatal inpatient psychiatric hospitalisation. Based on individual hospital admissions data from New South Wales and Western Australia, we found that the NPDI reduced inpatient psychiatric hospital admission by up to 50% [0.9% point reduction (95% CI 0.70–1.22)] in the first postnatal year. The greatest reduction was observed for adjustment disorders. The NPDI appears to be associated with fewer post-birth psychiatric disorders hospital admissions; this suggests earlier detection of psychiatric disorders resulting in early care of women at risk during their perinatal period.

Effectiveness of Health and Social Service Networks for Severely Mentally Ill Patients' Outcomes: A Case–Control Study Abstract Mental health and social care services networks aim to provide patients with continuity of care and support their recovery. There is, however, no conclusive evidence of their effectiveness. Since 2011, Belgium has been implementing a nation-wide reform of mental health care by commissioning service networks. Using a case–control design, we assessed the reform's effectiveness for continuity of care, social integration, quality of life, and re-hospitalization for 1407 patients from 23 networks. Greater reform exposure was associated with a slight improvement in continuity of care, but not with other outcomes. We concluded that service networks alone do not affect patient-level outcomes.

Work Stress and Satisfaction with Leadership Among Nurses Encountering Patient Aggression in Psychiatric Care: A Cross-Sectional Survey Study Abstract We examined the associations between work stress (job strain, effort-reward imbalance), perceived job insecurity, workplace social capital, satisfaction with leadership and working hours in relation to the likelihood of encountering patient aggression (overall exposure, assaults on ward property, mental abuse, physical assaults). We conducted a cross-sectional survey for nurses (N = 923) in 84 psychiatric units. Both work stress indicators were associated higher odds for different types of patient aggression. Poorer satisfaction with leadership was associated with higher odds for overall exposure to patient aggression. These findings were robust to adjustment for several nurse and work characteristics, and unit size.

"We're All in this Together": Peer-specialist Contributions to a Healthy Lifestyle Intervention for People with Serious Mental Illness Abstract This qualitative study explored peer specialists' contributions to a healthy lifestyle intervention for obese/overweight individuals with serious mental illness (SMI) living in supportive housing. Intervention participants, peer specialists, and supervisors were interviewed and a grounded model emerged from the data identifying essential interpersonal attributes of the peer specialist-participant relationship. Peer specialists' disclosure of their own experiences making health behaviors changes was critical for building participants' motivation and ability to try lifestyle changes. Findings can inform peer specialist training and practice standards and facilitate the expansion of peer-delivered interventions to improve the physical health of people with SMI.

Implementing Evidence Based Practices for Children's Mental Health: A Case Study in Implementing Modular Treatments in Community Mental Health Abstract There is strong enthusiasm for utilizing implementation science in the implementation of evidence-based programs in children's community mental health, but there remains work to be done to improve the process. Despite the proliferation of implementation frameworks, there is limited literature providing case examples of overcoming implementation barriers. This article examines whether the use of three implementations strategies, a structured training and coaching program, the use of professional development portfolios for coaching, and a progress monitoring data system, help to overcome barriers to implementation by facilitating four implementation drivers at a community mental health agency. Results suggest that implementation is a process of recognizing and adapting to both predictable and unpredictable barriers. Furthermore, the use of these implementation strategies is important in improving implementation outcomes.

Developing a Strategy to Embed Peer Support into Mental Health Systems Abstract Globally, health care systems stakeholders have encouraged health systems change that reflects recovery oriented practice. The implementation and integration of Peer Support Workers is one such strategy. Yet, what factors should be considered in the implementation of these roles? How can services be integrated effectively? Recent literature will be reviewed to explore current knowledge about peer support, and offer considerations for effective implementation of peer supports into current health care systems.

Help-Seeking by Parental Caregivers of Individuals with Intellectual Disabilities and Dual Diagnosis Abstract This study examined the roles of stigma and of enabling factors in help-seeking by parental caregivers of individuals with intellectual disabilities and dual diagnosis. Questionnaires were completed by 195 family caregivers. Lower family stigma was related to higher personal enabling factors (e.g. knowledge about services and previous experience in seeking help), which in turn was related to higher help-seeking behaviors. Higher professional enabling factors (e.g. attitude of the professional, services in the vicinity) were related to higher intentions to seek help, which were related to higher help-seeking behaviors. Professionals can help families achieve a greater sense of self-efficacy in their own help-seeking process by providing them with knowledge about services and facilitating a more positive experience in the process.

Microbiology

PmrAB and PhoPQ Variants in Colistin-Resistant Enterobacter spp. Isolates in Korea Abstract In this study, we investigated the amino acid variations and mRNA expression of PhoPQ and PmrAB two-component regulatory systems in colistin-resistant Enterobacter cloacae isolates from Korea. We determined the nucleotide sequences of phoP, phoQ, pmrA, and pmrB in 51 colistin-resistant, 5 colistin-susceptible, and 8 skip-well isolates and consequently, the corresponding amino acid sequences as well. PhoPQ and PmrAB sequences showed large variations among the isolates (14, 67, 20, and 68 sites, respectively). Although there was some discrepancy between the genes, the colistin-resistant E. cloacae isolates were grouped into four clades and the susceptible isolates were grouped into two clades. We did not find any distinct amino acid substitutions associated with colistin resistance. Furthermore, mRNA expression of phoQ and pmrB was not significantly higher in the colistin-resistant isolates. Our data suggests that the colistin resistance mechanisms might be different in E. cloacae when compared to other gram-negative bacteria.

Oral Nickel Changes of Intestinal Microflora in Mice Abstract Nickel, a silver-colored metal found in nature, is a common cause of allergic contact dermatitis. Nevertheless, the existence of inflammatory reaction to oral nickel exposure remains controversial. The following study investigates whether oral nickel can change the intestinal microflora in mice. A total of 20 female ICR mice were randomly divided into two groups: the oral nickel group (Group O) and the control group (Group C). Group O received water containing 400 µM NiSO4·6H2O, while group C was given pure water for 21 days. The content of nickel in the kidneys was determined by atomic absorption spectrophotometry, while the composition of bacterial community in the cecum was detected by 16S rDNA sequencing. The results were subsequently validated by real-time quantitative PCR with genus and species specific primers. Compared to Group C, significantly higher nickel levels were observed in Group O (P = 0.016); however, our data suggested that oral administration of 400 µM NiSO4·6H2O was nontoxic to the animals. (No statistical difference in body animal weight was found between Group O and Group C, before and after oral administration of nickel.) At the genus level, significantly higher relative abundance of Bacteroides (P = 0.016) and Intestinimonas (P = 0.018), and significantly lower relative abundance of Lachnospiraceae_NK4A136_group (P = 0.002) and Lachnospiraceae_UCG-001_group (P = 0.042) were observed in the oral nickel group compared to the control group. In addition, Group O had significantly lower ratio of Firmicutes/Bacteroides (P = 0.008). The results of real-time quantitative PCR further confirmed that the amplicon mass of Bacteroides and B. fragilis in the Group O was significantly higher compared to C group (P = 0.034 and P = 0.02). Oral nickel could change the intestinal microflora in mice, thus suggesting that oral nickel alters the interaction between the host and the intestinal flora.

Functional Replacement of the BioC and BioH Proteins of Escherichia coli Biotin Precursor Biosynthesis by Ehrlichia chaffeensis Novel Proteins Abstract The biosynthesis of the pimelate moiety of biotin in Escherichia coli requires two specialized proteins, BioC and BioH. However, the enzymes that have BioC- or BioH-like activities show remarkable sequence diversity among biotin-producing bacteria. Here, we report that the intracellular rickettsial pathogen Ehrlichia chaffeensis encodes two novel proteins, BioT and BioU, which functionally replace the E. coli BioC and BioH proteins, respectively. The desthiobiotin assays demonstrated that these two proteins make pimeloyl-acyl carrier protein (ACP) from the substrate malonyl-ACP with the aid of the FAS II pathway, through the expected pimeloyl-ACP methyl ester intermediate. BioT and BioU homologues seem restricted to the species of Ehrlichia and its close relative, Anaplasma. Taken together, the synthesis of the biotin precursor in E. chaffeensis appears to be catalyzed by two novel BioC- and BioH-like proteins.

Association of Listeria monocytogenes LIPI-1 and LIPI-3 marker llsX with invasiveness Abstract Listeria monocytogenes is an opportunistic pathogen that is widely distributed in the environment. The evolution of its genome has exhibited differences in virulence among strains of the same species. Listeria monocytogenes LIPI-3 (Listeria Pathogenicity Island 3) and LIPI-1 (Listeria Pathogenicity Island 1) are considered responsible for the increased virulence in some strains. The aim of this study was to detect LIPI-1 genes and the llsX gene belonging to LIPI-3 in invasive strains of L. monocytogenes and to establish whether there is a relationship among the invasiveness, presence of the llsX and LIPI-1 genes, and the source of the strains. The results showed that 70% of the strains were invasive, and all these strains except one possessed LIPI-1, which suggests that although there is a correlation between LIPI-1 and invasiveness, the independent mechanisms of LIPI-1 may contribute to invasiveness. In contrast, 35% of the total strains were positive for llsX and were invasive; thus, the results revealed that there is a strong association between llsX and the invasiveness of L. monocytogenes in HEp-2 cells (HeLa contaminant/epithelial in origin). In addition, there is no other association with any other variable in this study. Moreover, the authors found that LIPI-1 and llsX are more frequently found in fresh than in frozen vegetables. Together, the findings provide an approximation for the better understanding of Listeriolysin S (LLS) and its role in the pathogenesis of L. monocytogenes, and a possible relation between virulence factors and food-storage temperature.

Insights into the Draft Genome Sequence of the Kiwifruit-Associated Pathogenic Isolate Pseudomonas fluorescens AHK-1 Abstract Pseudomonas fluorescens is a physiologically diverse species of bacteria present in many habitats, which possesses multifunctional traits that provide it with the capability to exhibit biological control activities, promote plant health or cause plant disease. Here, we present the draft genome sequence of the kiwifruit-associated pathogenic isolate AHK-1 of P. fluorescens, which was isolated from the diseased leaves of kiwifruit plants. The genome size of AHK-1 was found to be 7,035,786 bp, with a G + C content of 60.88%. It is predicted to contain a total of 6327 genes, of which 3998 were homologous to genes in the other two sequenced P. fluorescensisolates (SBW25 and GcM5-1A) and 946 were unique to AHK-1 based on comparative genomic analysis. Furthermore, we identified several candidate virulence factors in the genome of AHK-1, including the fliA gene encoding flagellar biosynthetic protein for biosynthesis, and the genes for components of type VI, III, and IV secretion systems. This genomic resource will serve as a reference for better understanding the genetics of pathogenic and non-pathogenic strains, and will help to elucidate the pathogenic mechanisms of P. fluorescens associated with plant disease.

Selection of Optimized Reference Genes for qRT-PCR Normalization in Xanthomonas campestris pv. campestris Cultured in Different Media Abstract Black rot is a cruciferous disease caused by Xanthomonas campestris pv. campestris (Xcc) and results in significant economic losses worldwide; therefore, elucidation of the mechanism of Xcc pathogenesis is urgently required. In this study, we aimed to select optimized reference genes to verify the relative quantification of virulent genes in Xcc. Xcc strains were cultured in three different media [basic medium (MMX), hrp-inducing medium (MMXC) and rich medium (NYG)] and the expression stability of five candidate genes [thymidylate synthase (thyA), DNA gyrase subunit B (gyrB), DNA-directed RNA polymerase subunit beta, glyceraldehyde-3-phosphate dehydrogenase and 16S ribosomal RNA (16S rRNA)] was evaluated using BestKeeper, GeNorm, and NormFinder software programs. Quantitative real-time PCR (qRT-PCR) analysis confirmed that two Xcc effector genes were hrpX/hrpG-regulated in MMXC using selected genes as controls. Finally, gyrB and thyA were validated as the optimized reference genes of Xcc cultured in MMXC, and qRT-PCR analysis was demonstrated to be an efficient alternative to Gus-activity detection for the analysis of Xcc expression. This information will be useful in the future studies of Xcc, especially those seeking new functional genes.

Identification and Characterization of an Autophagy-Related Gene Acatg12 in Acremonium chrysogenum Abstract Autophagy is a highly conserved mechanism to overcome various stresses and recycle cytoplasmic components and organelles. Ubiquitin-like (UBL) protein Atg12 is a key protein involved in autophagosome formation through stimulation of Atg8 conjugation to phosphatidylethanolamine. Here, we describe the identification of the autophagy-related gene Acatg12, encoding an Atg12 homologous protein in the cephalosporin C producing fungus Acremonium chrysogenum. Disruption of Acatg12 impaired the delivery and degradation of eGFP-Atg8, indicating that the autophagic process was blocked. Meanwhile, conidiation was dramatically reduced in the Acatg12 disruption mutant (∆Acatg12). In contrast, cephalosporin C production was increased twofold in ∆Acatg12, but fungal growth was reduced after 6 days fermentation. Consistent with these results, the transcriptional level of the cephalosporin biosynthetic genes was increased in ∆Acatg12. The results extend our understanding of autophagy in filamentous fungi.

Microbial Bioleaching of Ag, Au and Cu from Printed Circuit Boards of Mobile Phones Abstract Electronic waste (E-Waste) is consumed at high speed in the world. These residues contain metals that increase their price each year, generating new research on the ability of microorganisms to recover the metals from these wastes. Therefore, this work evaluated the biologic lixiviation of Cu, Ag and Au from printed circuit boards (PCB) of mobile phones by three strains of Aspergillus niger, Candida orthopsilosis, Sphingomonas sp. and their respective consortia, in addition to leaching with citric acid. The microorganisms were cultured in mineral media with 0.5 g of PCB, and the treatments with 1M citric acid were added the same amount of PCB. All treatments were incubated for 35 days at room temperature. The results showed that Sphingomonas sp. MXB8 and the consortium of C. orthopsilosis MXL20 and A. niger MXPE6 can increase their dry biomass by 147% and 126%, respectively, in the presence of PCB. In the bioleaching of metals, the inoculation of A. niger MXPE6, the consortium of Sphingomonas sp. MXB8/C. orthopsilosis MXL20 and Sphingomonas sp. MXB8 leached 54%, 44.2% and 35.8% of Ag. The consortium of A. niger MX5 and A. niger MXPE6 showed a leaching of 0.53% of Au. A. niger MX5 leaching 2.8% Cu. Citric acid increased Cu leaching by 280% compared to treatments inoculated with microorganisms. Although further research is required, A. niger MXPE6 and the consortium of Sphingomonas sp. MXB8/C. orthopsilosis MXL20 could be an alternative to recover Ag from PCB of mobile phones.

Phylogenetic Studies on the Prodigiosin Biosynthetic Operon Abstract Prodigiosin and undecylprodigiosin are tripyrrolic red pigmented antibiotics produced by certain bacteria. Many strains of Serratia and certain other Gammaproteobacteria produce prodigiosin and undecylprodigiosin is produced by certain strains of Streptomyces. This is a multistage process which involves the synthesis of a bipyrrolic compound from L-proline and its subsequent condensation with a mono pyrrole synthesized from 2-octenal in the case of prodigiosin and malonyl-CoA in the case of undecylprodigiosin respectively. We have carried out sequence analysis of the genes involved in the pathway and identified the distribution of the prodigiosin producing genes amongst the various bacteria which have been fully sequenced. The presence of the operon was clearly seen in certain clustered branches suggesting inheritance from a common ancestor. This was further confirmed by the absence of traits observed in horizontally acquired genes like, GC content variation, codon bias or the presence of mobile elements. Multiple sequence alignment of the promoter of the prodigiosin operon in seven fully sequenced Serratia marcescens strains showed excellent homology. Putative regulatory elements in this region were identified by sequence analysis studies and many of them have been found to influence pigment production. The undecylprodigiosin gene cluster on the other hand, shows homology to other gene clusters involved in the production of other pyrrole-containing antibiotics of the genus Streptomyces. This coupled with the presence of ORFs with three different promoters could indicate lateral gene transfer. Hence the evolution of undecylprodigiosin operon could be an example of convergent evolution.

Volatile Compounds Produced by Cyanobacteria Isolated from Mangrove Environment Abstract Cyanobacterial communities from the Brazilian Atlantic coast have been recently sampled through cultured and non-cultured approaches. The maintenance of cyanobacterial strains in laboratory cultures is an important source of material for biological and chemical evaluation as well as biotechnological investigations. In this way, this work aimed to identify, for the first time, by means of GC–MS analyses, the nonpolar chemical profiles of four morphologically distinct cyanobacterial strains: Cyanobium sp. CENA178, Cyanobium sp. CENA181, Oxynema sp. CENA135 and Nostoc sp. CENA175, which were previously isolated from Brazilian mangroves. Six distinct classes of volatile compounds were identified: acids, alcohols, fatty aldehydes, esters, ketones and aliphatic hydrocarbons, from which 12 compounds were detected. The predominant compounds were 1-octadecyne and tetradecanoic acid, obtained from Oxynema sp. CENA135 and; the last one being also observed in Cyanobium sp. CENA181. In addition, the aliphatic hydrocarbon heptadecane was produced by these cyanobacterial strains as well as by Nostoc sp. CENA175. The compounds produced by the studied cyanobacteria have already been reported as possessing pharmaceutical properties such as antioxidant, cytotoxic and antimicrobial activities, besides industrial importance as source of intermediates for biofuel production. It is also important to mention that, considering the number of non-identified compounds, which were not compatible with the searched databases, these strains are promising sources of new compounds, denoting the need for more studies. Accordingly, since these strains were isolated from saline or brackish waters, it is also expected that they might be cultivated in waters not used for human consumption, enabling a low-cost approach for biomass and metabolites production.

Maternal and Child Health

Correction to: Understanding the Family Impact of Autism Spectrum Disorder in a Racially and Ethnically Diverse Sample: Findings from the National Survey of Children with Special Health Care Needs The original version of this article unfortunately contained a mistake. The copyright permission below in Table 2 was inadvertently not published in the article.

Next Steps for Measures of Physical Activity During Pregnancy

Correction to: Do Insurance Mandates Affect Racial Disparities in Outcomes for Children with Autism? The original version of this article unfortunately contained a mistake in the analysis of the Tables 4 and 5.

Response Letter to: "Next Steps for Measures of Physical Activity in Pregnancy"

Associations of Socio-demographic, Family, and Neighborhood Factors with Physical Activity-Related Parenting Practices Among Hong Kong Preschoolers' Parents Abstract Objectives Regular engagement in physical activity (PA) has numerous health benefits in young children. Young children's parents can influence their children's PA behavior through different PA-related parenting practices. This cross-sectional study examined the independent contributions of socio-demographic, family/home and parent-perceived neighborhood environmental characteristics explaining PA-related parenting practices encouraging or discouraging PA among Hong Kong preschool-aged children (3–5 years-old). Methods Hong Kong Chinese preschoolers' parents were recruited from pre-selected kindergartens and Maternal and Child Health Centers located in areas stratified by residential density and socio-economic status. They self-completed socio-demographic, family/home and perceived neighborhood characteristics and PA-related parenting practices questionnaires. Generalized linear models were used to examine associations of socio-demographic, family/home and neighborhood variables with PA-related parenting practices. Results Socio-demographic and family/home characteristics were significantly correlated with parenting practices encouraging and discouraging PA. Parent-perceived neighborhood characteristics were significantly correlated with parenting practices discouraging PA only. Conclusions for Practice This study identified correlates of PA-related parenting practices among parents of Hong Kong Chinese preschoolers. The findings suggest future PA-promoting interventions among Chinese preschoolers via the promotion of parenting practices encouraging children's PA should consider multiple factors, including family relationships and childcare sharing, promotion of PA and its benefits among parents, and neighborhood social cohesion, traffic safety and safety from crime.

An Incentive-Based and Community Health Worker Package Intervention to Improve Early Utilization of Antenatal Care: Evidence from a Pilot Randomised Controlled Trial Abstract Objectives One of the factors linked to South Africa's relatively high maternal mortality ratio is late utilization of antenatal care (ANC). Early utilization is especially important in South Africa due to the high HIV prevalence amongst pregnant women. This study examined the impact of a package intervention, consisting of an incentive called the Thula Baba Box (TBB) and a community health worker (CHW) programme, on early utilization of ANC. Methods A pilot randomised controlled trial consisting of 72 women aged 18 and older was conducted in an urban area in South Africa to evaluate the impact of the package intervention. Women were recruited and randomised into either intervention (n = 39) or control group (n = 33). The intervention group received both the TBB and monthly CHW visits, while the control group followed standard clinical practice. Both groups were interviewed at recruitment and once again after giving birth. The outcomes measured are the timing of first ANC visit and whether they attended more than four times. It is anticipated that the box will also have a beneficial impact on infant health outcomes, but these fall out of the scope of this study. Results Women in the intervention groups sought care on average 1.35 months earlier than the control group. They were also significantly more likely to attend at least four antenatal clinic visits. Conclusions for practice Given the South African context and the importance of early care-seeking behaviour to improve health outcomes of HIV-positive pregnant women, the intervention can help to improve maternal and neonatal health outcomes. Further research is needed to investigate the impact of the two interventions separately, and to see if these findings hold in other communities.

Coordinating Outpatient Care for Pregnant and Postpartum Women with Opioid Use Disorder: Implications from the COACHH Program Abstract Purpose With the rise of opioid use disorder (OUD) among women of childbearing age, effective care models must address the complex needs of pregnant and postpartum women with OUD. This paper describes promising practices and implementation challenges from the Collaborative Outreach and Adaptable Care at Hallmark Health (COACHH) program, which utilizes a collaborative care team to coordinate outpatient care for pregnant and postpartum women with OUD. Description Semi-structured interviews were conducted with members of the COACHH team to discuss program logistics and takeaways. Interviews were coded to analyze themes. Assessment The COACHH team identified the need for specialized, time-intensive care coordination to address the unique needs of pregnant and postpartum women with OUD. First, the team prioritizes forming trusting relationships with patients to holistically understand patients' needs, improve patient engagement, and connect patients with resources. Second, the wide range of patient needs necessitates a team with diverse professional skills, whose members share an understanding of addiction and pregnancy. Third, finding the right quantitative outcome measurements is difficult; instead, success is measured in qualitative terms, stressing relationships and engagement as signals of change. Finally, the team encounters challenges with low referral rates, lack of provider awareness, and fragmented services. Conclusion We identified care delivery and program design considerations that may inform others who wish to coordinate care for pregnant and postpartum women with OUD. The program continues to face challenges enrolling patients and measuring outcomes, reflecting the need for tailored approaches and metrics for this population.

Ultra-processed Food Consumption by Pregnant Women: The Effect of an Educational Intervention with Health Professionals Abstract Objectives Nutrition during pregnancy is related with many maternal and child outcomes. To investigate the consumption of ultra-processed foods is one of the newest methods to evaluate food consumption, but these studies in pregnant women are rare. Methods We conducted a non-randomized controlled educational intervention on healthy eating and physical activity during pregnancy in primary health care units of Botucatu, São Paulo, Brazil. The sample comprised two groups of pregnant women with low obstetric risk, an intervention group (n = 181) and a control group (n = 172). The health professionals that assisted the pregnant women from the intervention group were trained to promote five healthy food practices during the prenatal care appointments: consumption of three fruits; two portions of vegetables; two portions of beans, at least 5 days per week; and restriction of soft drinks and industrially processed cookies. All pregnant women answered two 24-h dietary recalls per trimester, one face-to-face, another by telephone. The foods consumed by pregnant women were classified according Nova. The impact of the intervention on the ultra-processed food consumption was evaluated by multilevel linear regression analysis. Results A quarter of the energy consumed by the pregnant women provided from ultra-processed foods. The intervention reduced these percentage of energy between the first and second trimester of pregnancy by 4.6 points (p = 0.015). This effect was not observed in the third trimester of pregnancy. Conclusions for Practice Training health care professionals to promote healthy food practices is a viable and sustainable alternative to reduce ultra-processed foods during pregnancy.

Patterns of Health Insurance Discontinuity and Children's Access to Health Care Abstract Objectives This study classified patterns of discontinuous health insurance coverage, including change in coverage type and gaps in coverage, and described their associations with children's access to health care. Methods Using the 2011–2013 National Health Interview Survey data, we determined children's insurance coverage over the past year, and whether children had a usual source of care, had to delay getting care, or had unmet health care needs. Using multivariable logistic regression, we compared measures of access to care across insurance coverage patterns, classified as continuous private coverage; continuous public coverage; continuous lack of coverage; change in coverage type (public versus private) without gaps in coverage; and any gap in coverage. A subgroup analysis repeated this comparison for children with a caregiver-reported chronic physical illness. Results The analysis included 34,105 children, of whom 7% had a gap in coverage and 1% had a change in coverage type. On multivariable analysis, gaps in coverage were associated with increased likelihood of unmet health care needs, compared to continuous private (OR 6.9; 95% CI 5.9, 8.0) or continuous public coverage (OR 5.1; 95% CI 4.4, 6.0). Seamless changes in coverage were also associated with greater likelihood of unmet health care needs [OR vs. private: 3.8 (95% CI 2.3, 6.1); OR vs. public: 2.8 (95% CI 1.8, 4.6); all p < 0.001]. Results were similar for other study outcomes, and among children with chronic physical illness. Conclusions for Practice Both gaps in coverage and seamless changes between coverage types were associated with limited health care access for children.

Applying Organizational Health Literacy to Maternal and Child Health Abstract Purpose Describe the development of an innovative teaching activity that applies organizational health literacy to maternal and child health (MCH). Description Health literacy is a strong predictor of health behavior and outcomes. While the study of health literacy has traditionally been confined to skills and capacities of individuals, the significant role of the social and physical environmental contexts in facilitating or hindering one's ability to obtain, understand, and make informed decision about their health has been recognized. MCH organizations play a critical role in influencing health literacy across system levels. This teaching activity aims to equip students with knowledge and skills needed to foster organizational health literacy. Assessment The teaching activity is assembled within a toolkit which includes the following: (1) instructor lesson plan; (2) interactive PowerPoint presentation with instructor notes; (3) field assignment description; (4) health literacy attribute assessment worksheets; and (5) grading rubric. The teaching tool was pilot tested by a student research team member to assess the educational value and assignment logistics, resulting in minor edits (i.e., addition of interviewer probes, and option of a group project-format to permit triangulation of multiple organizational interviews). Conclusion The field of MCH is expanding in complexity, and the demands of health systems on women, children, and families must be mediated by conscious efforts within organizations. Through teaching the importance and function of organizational health literacy to students in MCH, educators can prepare an emerging workforce to improve health literacy, and ultimately the quality of healthcare for women, children, and families.

Cardiovascular

Cardiovascular clinical implications of heart rate variability Mahmoud Hassan Abdelnabi International Journal of the Cardiovascular Academy 2019 5(2):37-41 Heart rate variability (HRV) is one of the promising emerging noninvasive modalities that are extensively used nowadays in research and risk stratification of several diseases. Reduced HRV has been linked to several cardiovascular risk factors such as hypertension (HTN) and diabetes mellitus (DM) also; it has been linked and used for years now in the risk stratification of congestive heart failure, coronary artery disease (CAD), and acute myocardial infarction (AMI). Controversial data are present about the effect of coronary artery bypass graft (CABG) on HRV and the use of HRV for risk stratification in post-CABG patients while percutaneous coronary intervention was linked to a dramatic improvement in HRV and improved survival of CAD patients. Although experimental data are present correlating reduced HRV with increased risk for cardiovascular morbidity and mortality, extensive research is required for further implementation in daily clinical use. In this review, we will discuss the current cardiovascular clinical implications and highlight the limitations of usage and future perspective of HRV.

Knowledge regarding the signs, symptoms, and risk factors associated with stroke in medical and nonmedical personnel Veresa Chintya, Raymond Pranata, Ian Huang International Journal of the Cardiovascular Academy 2019 5(2):42-46 Introduction: Stroke was the second-leading global cause of death accounting for 11.8% of total deaths worldwide and a leading cause of disability. Stroke was the leading cause of death in Indonesia accounting for 21.1% of them. Knowledge is essential for the prevention of stroke and minimizing delay in receiving proper treatment. Methods: This was a cross-sectional observational study using a questionnaire consisting of questions about signs, symptoms, and risk factors for stroke in the Indonesian Language with a minimal amount of technical jargon. There were 113 respondents, 49 has a medical background (11 was medical doctors) and 64 was from a nonmedical background. Results: Majority of the nonmedical personnel knew that hemiparesis is a symptom of stroke, but only a third knew that hemihypesthesia is one of the symptoms. Approximately half knew that dysarthria and uneven face is a symptom of stroke. Only a few knew that sudden loss of vision is a symptom of stroke. Hypertension and hypercholesterolemia were the two most popular risk factors among nonmedical personnel, other risk factors were only known to <40% of the respondents. After comparing the results between medical and nonmedical personnel, medical personnel was more confident about their knowledge (P < 0.001). The difference was also statistically significant in hemihypesthesia (P = 0.029) and sudden loss of vision (P = 0.032). The difference was statistically significant when assessing several risk factors such as arrhythmia (P = 0.004), smoking (P = 0.004), hypertension (P = 0.001), diabetes (P < 0.001), and atrial fibrillation (P < 0.001). Disappointingly, both groups performed poorly in recognizing menopause as a risk factor. Conclusion: The knowledge about the symptoms and signs of stroke other than hemiparesis was poor in nonmedical personnel. Medical personnel was only slightly better than nonmedical personnel. This is a wake-up call to emphasize the importance of stroke, its prevention and early recognition.

The relationship between epicardial fat tissue thickness and red blood cell distribution width in patients with Type 2 diabetes mellitus Abdulmelik Yildiz, Cennet Yildiz, Ahmet Karakurt International Journal of the Cardiovascular Academy 2019 5(2):47-51 Aim: Red blood cell distribution width (RDW) and epicardial fat tissue (EFT) are considered as a novel risk factor for cardiovascular disease. However, their relationship in patients with type II diabetes mellitus (DM) has never investigated before. Materials and Methods: Our study was a single-center prospective study which included 159 diabetic patients and 153 healthy controls. Two-dimensional and M-mode echocardiographic examination was performed using standard apical, parasternal, and subcostal views in all the study participants. Results: EFT thickness and RDW were found to be significantly higher in diabetic patients compared to controls (4.3 ± 1.1 mm vs. 3.7 ± 1.0 mm P = 0.001 and 13.5 ± 0.7 vs. 13.2 ± 0.9 P = 0.044, respectively). EFT thickness and RDW were positively correlated. RDW value of 13.55 predicted EFT thickness >5 mm with a sensitivity of 61.7% and specificity of 58.8% (area under the curve [AUC]: 0.649 and P = 0.001). HgA1C value of >7 predicted EFT thickness ≥4.15 mm with a sensitivity of 60.7% and specificity of 60.4% (AUC: 0.651 and P < 0.001). No correlation found between RDW and HgA1C (AUC: 0.554 and P: 0.169). Conclusion: EFT thickness increased in diabetic patients, independent of age, gender, waist circumference, body mass index, and it was correlated with RDW and HgA1C.

Initial T wave morphology in the chest leads in patients presenting with anterior ST-segment elevation myocardial infarction and its correlation with spontaneous reperfusion of the left anterior descending coronary artery Dalia Azab, Mohamed Elsayed Zahran, Ahmed Elmahmoudy International Journal of the Cardiovascular Academy 2019 5(2):52-57 Background: T wave inversion in leads with ST-segment elevation after reperfusion therapy is considered a sign of reperfusion. However, the significance of T wave inversion on presentation before the initiation of reperfusion therapy is unclear. Aim of the Work: The current study aimed to assess whether the initial T wave morphology in the electrocardiographic (ECG) at presentation can predict patency of the left anterior descending artery (LAD) in patients with acute anterior ST segment elevation myocardial infarction (STEMI) before undergoing primary percutaneous coronary interventions (PCIs). Methods: This study included ninety patients who presented to the emergency department with acute anterior ST-elevation MI. We excluded patients with bundle branch block, postcoronary artery bypass grafting patients, patients with paced rhythm, and patients who received thrombolytic therapy. The T wave morphology in the 2 leads with maximal ST-segment elevation on the presenting ECG was identified as one of the three morphologies, positive T waves (T+; initial positive deflection ≥0.5 mm above the isoelectric line), biphasic T waves (T+/−; where the T wave initially showed a positive deflection above the ST segment afterward followed by a negative deflection ≥0.5 mm below the isoelectric line), and negative T waves (T−; where the T wave initially showed a negative deflection ≥0.5 mm below the isoelectric line without showing any initial positive deflection). Then, according to the results of the initial angiography, patients were classified into spontaneous reperfusion (SR) (those with thrombolysis in MI [TIMI] II or TIMI III flow in the infarct-related artery [IRA] prior to intervention) or non-SR (those with TIMI 0 or TIMI I flow in the IRA prior to intervention). Results: Ninety consecutive patients (77 males and 13 females) presented by STEMI and treated by primary PCI at cath lab of Ainshams University Hospitals (a 24/7 tertiary referral center for primary PCI) between January 2015 and March 2016 were included in this study, of which 40 patients (44.4%) had positive T waves (T+), 34 patients (37.8%) had negative T waves (T−), and 16 patients (17.8%) had biphasic T waves (T+/−). Initial angiogram showed that 18 patients had SR and 72 patients had no SR. With regard to T wave morphology, negative T waves were significantly present in SR group (66.7% vs. 30.6%, P = 0.004), whereas positive T waves were predominantly present in non-SR (50% vs. 22.2%, P = 0.033). Conclusions: For SR of LAD in anterior STEMI patients, prior to primary PCI, T wave inversion had a good sensitivity of 66.7%, a specificity of 69.4%, and a good negative predictive value of 89.29%.

Differences in atrial fibrillation management strategies among physicians: A survey based study Sara Cetin Sanlialp, Ugur Onsel Turk, Kaan Okyay, Ozcan Basaran, Ugur Canpolat, Mehdi Zoghi International Journal of the Cardiovascular Academy 2019 5(2):58-65 Aim: Previous data reflected confusions about classification and management of atrial fibrillation (AF) among physicians. Although relatively clear suggestions of dedicated guidelines, poor adaptation of them to routine clinical practice may result with suboptimal prevention and treatment measures. As a main stakeholder of management, physicians' perceptions about the disease have major role. The study aimed to assess confusions and concordances of physicians about the definition and management of the disease. Methods and Results: We developed a web-based survey about AF consisting of 27 questions regarding valvular or non-valvular AF perception, using thromboembolic and bleeding risk scores, antithrombotic management and rate/rhythm control strategies. Two hundred and thirty two physicians participated and 224(97%) of them completed the survey. Although only cardiologists were invited to the survey, 27 physicians from different specialties also responded the survey. Half of the physicians reported that ≥40% of their patients had valvular AF. Dramatically, the survey responses revealed that nearly one-third of physicians classified the AF patients with mitral regurgitation as valvular AF. Most of the physicians denoted that they were using bleeding and stroke risk scores before deciding oral anticoagulation therapy and also preferring long term rhythm-control strategy in AF patients with systolic heart failure. However, results exposed evident disparities among physicians at specific aspects of the disease management. Conclusion: The survey-based study demonstrated a great heterogeneity in classification and management of AF among physicians because of guideline confusions/failures, inadequate evidence about some specific conditions and not being able to dominate the guidelines by physicians.

Discrepancies not only in physicians, but also in atrial fibrillation guidelines Gonenc Kocabay International Journal of the Cardiovascular Academy 2019 5(2):66-67

Persistent atrial fibrillation ablation in a case of persistent left superior vena cava with absence of the right superior vena cava Tolga Aksu, Tumer Erdem Guler, Serdar Bozyel, Kivanc Yalin International Journal of the Cardiovascular Academy 2019 5(2):68-70 The great majority of atrial fibrillation cases originate from pulmonary vein (PV) triggers; however, non-PV triggers may be the drivers of the arrhythmia, especially in the patients with a persistent left superior vena cava (PLSVC). The presence of a PLSVC may be suggested with a dilated coronary sinus on transesophageal echocardiography during the procedure and may be confirmed with an atrial angiogram, if not known beforehand. Detection and elimination of true trigger site are the most important step for clinical success in such cases.

Large thrombus on a prosthetic aortic valve diagnosed on the 1st postpartum day Sinan Varol, Sevgi Özcan, Gökmen Kum, İrfan Şahin, Ertuğrul Okuyan International Journal of the Cardiovascular Academy 2019 5(2):71-73 40 years old female with prosthesis aortic valve had developed shortness of breath and consulted to our clinic on the first postpartum day. Her dyspnea was worsened at the last week. She had a history of Bentall operation before 16 years ago, and had a bi-leaflet mechanical prosthetic valve. After detection of pregnancy, her warfarin treatment had switched to enoxaparine 6000 IU subcutaneously for twice a day, continued throughout the pregnancy. Her weight was 62 kg. She did not have any blood test for factor Xa. On physical examination, she has orthopnea, tachypnea (24/min), tachycardia (128 bpm) and hypotension (85/55 mmHg). Electrocardiogram was uneventful with sinus tachycardia of 128 bpm with normal axis. Echocardiography revealed normal left ventricle size with left ventricle hypertrophy, ejection fraction of 60%, reduced motion of prosthetic-valve leaflets and an obstructing mass between the struts. Doppler ultrasonography showed that prosthetic aortic valve has a pressure gradient of 104/59 mmHg. These findings were consistent with prosthetic thrombosis. Moderate aortic regurgitation into the left ventricle was also detected. Transesophageal echocardiography showed 1.4 × 2.3 cm thrombotic material located over leaflets and adjacent to the posterior aortic wall. It was restricting the valve motion. The patient underwent emergency operation immediately. The thrombotic material over mechanical valve was extracted and there was no pathology seen on mechanical valve, graft repaired primarily. Postoperative recovery was fine. No bacteria were detected both direct microscopy and culture.

Skeletal Radiology

Painful right elbow mass

Perspective from a pediatric orthopedic deformity surgeon

Alkaptonuria—an atypical case: multi-modality imaging review Abstract Alkaptonuria is a rare inborn metabolic disorder due to a mutation in the homogentisic acid oxidase enzyme (HGO) gene on chromosome 3q. As HGO is deficient in alkaptonuria patients, there is an accumulation of homogentisic acid in the blood and urine. Homogentisic acid gets deposited in the soft tissues, tendons, cartilages, large joints and intervertebral discs. Ochronosis usually affects the dorsolumbar spine and typically spares the cervical spine and sacroiliac joints. However, in this case of isolated ochronosis, we report co-existent extensive cervical spine degenerative changes and cervical vertebral fusion, which has not been described in the literature so far.

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Bone metastases with multiple fluid-fluid levels from gastric cancer: a case report and review of literature Abstract We report the case of a 54-year-old man with 6 months of progressive sacral pain. Computed tomography showed a large osteolytic mass in the sacrum with multiple osteolytic foci in the ilium and lumbar spine. Magnetic resonance imaging revealed multiple fluid-fluid levels in the sacral lesion as well as in the lumbar foci. The multiple bone lesions were initially diagnosed as a primary sacral malignancy with multiple bone metastases. A biopsy of the sacral lesion under the guidance of computed tomography was performed and a metastatic adenocarcinoma from the stomach or lung was found pathologically. Finally, a gastric tubular adenocarcinoma was detected by endoscopic biopsy and the diagnosis of the patient was gastric cancer with uncommon multiple bone metastases.

Painful right elbow mass

Surface-type chondromyxoid fibroma in an elderly patient: a case report and literature review Abstract Chondromyxoid fibroma (CMF) is a rare benign bone neoplasm that typically occurs in young adults. Juxtacortical or surface-type CMF are rarer still and we present the case of a surface-type CMF in a 78-year-old woman, with only one other case described in a patient of a similar age previously. This patient was an otherwise healthy woman who presented for evaluation of a palpable lump in the anterior proximal tibia. Initial radiographs obtained demonstrated a focal soft tissue fullness immediately anterior to the anterior cortex of the proximal tibia, which contained faint chondroid-like matrix internally. There was associated scalloping of the anterior tibial cortex. MRI confirmed the presence of a juxtacortical, enhancing lesion. Subsequent excisional biopsy was performed and histopathology demonstrated features, which was consistent with surface-type CMF. At a 6-month follow-up the patient remained free of recurrence. In a patient of this age, paraosteal chondrosarcoma should be excluded. Surface-type CMF, although rare, has been described in older patients and while it is unlikely to feature in a list of differential considerations on initial imaging, awareness of the entity is important.

Subacromial impingement anatomy and its association with rotator cuff pathology in women: radiograph and MRI correlation, a retrospective evaluation Abstract Objective To evaluate the relationships between acromial anatomy and developmental alterations with rotator cuff tears in female patients and compare these parameters on radiographs and corresponding MRIs along with inter-reader performance. Materials and methods Patient demographics, symptoms, and acromial characteristics on radiograph (acromial index, lateral acromion angle, subacromial space on AP and Y- views, acromial anterior and lateral downsloping) and MRI (shape, slope, spur, osteoarthrosis, os acromiale) were recorded. Radiographic and MRI findings were compared and correlated with rotator cuff pathology on MRI. Inter-reader analysis was performed. Results A total of 140 MRIs from 137 female patients were included. No significant correlation (p > 0.05) existed between acromial parameters and rotator cuff tears, except for a smaller subacromial space on the Y view and spurs correlated with subscapularis tendon tear (p = 0.02, p = 0.04). The presence of lateral downsloping on MRI correlated with a smaller lateral acromion angle (p = 0.0002) and the presence of lateral downsloping on radiography (p = 0.0015). Inter-reader agreements were good to excellent (ICC: 0.65–0.89). Conclusion Subacromial impingement anatomy characteristics have no significant associations with supraspinatus or infraspinatus tears in symptomatic women. Among different measures, supine MRI can be reliably used to identify lateral downsloping of the acromion.

Susceptibility-weighted MR imaging to improve the specificity of erosion detection: a prospective feasibility study in hand arthritis Abstract Objective To evaluate the diagnostic potential of susceptibility-weighted imaging (SWI) for the detection of erosions of the hand, compared to T1-weighted (T1w) magnetic resonance imaging (MRI). Computed tomography (CT) was used as a reference standard. Materials and methods We prospectively investigated 37 patients with suspected arthritic activity of the hand. All patients underwent T1w, SWI, and CT on the same day. Patients were randomized to MRI or CT first. CT, T1w, SWI, and T1w/SWI were scored for erosions according to OMERACT RAMRIS guidelines. Specificity, sensitivity, and diagnostic accuracy were separately calculated for T1w, SWI, and T1w/SWI on a per-patient and per-bone basis using CT as reference. The one-tailed McNemar test was performed to test the number of erosion-positive patients in T1w, SWI, and T1w/SWI for non-inferiority. Measured erosion sizes were compared using Pearson's test. Results CT was positive for erosions in 16 patients and 55 bones. SWI and T1w/SWI had superior diagnostic accuracy (91.2 and 93.8%) compared to T1w (87.8%) driven by a higher specificity (93.8 and 96.5%) compared to T1w (88.8%). On the patient level, SWI and T1w/SWI showed non-inferiority (p = 0.11 and p = 0.38) but not T1w alone (p < 0.0001). The lesion size on CT correlated better with SWI (Pearson's r = 0.92) compared to T1w (r = 0.69). Conclusions Adding SWI to a standard MRI protocol has the potential to improve erosion detection in hands by increasing specificity. SWI depicts bony erosions more accurately compared to standard MRI techniques.

MRI and ultrasound of the hands and wrists in rheumatoid arthritis. I. Imaging findings Abstract The management of patients with rheumatoid arthritis (RA) has rapidly evolved with the development of newer disease-modifying drugs and the recognition that long-term damage can be mitigated by an earlier and more-informed use of these medications. Historically, radiographs were the mainstay of imaging in RA patients, but radiographic joint narrowing and erosions are late and insensitive findings in the disease. MRI (with intravenous contrast agent) and ultrasound (with power Doppler interrogation) of the hands and wrists are able to demonstrate erosions earlier and with greater sensitivity than radiographs. More importantly, these imaging studies also depict synovitis and active soft-tissue inflammation, which represents a precursor to structural damage. Additionally, MRI can show inflammation within the bones (osteitis), which is proving to be the most important prognosticator of an aggressive disease course. Part I of this review discusses the imaging techniques, pitfalls, definitions, and comparative studies of MRI and ultrasound for identifying and quantifying erosions, synovitis, and osteitis. Part II will demonstrate how these imaging findings influence the clinical management of RA patients throughout their disease course, from presentation through clinical remission.

Antonie van Leeuwenhoek

Phoenicibacter congonensis gen. nov., sp. nov., a new genus isolated from the human gut and its description using a taxonogenomic approach Abstract Culturomics has recently allowed the isolation and description of previously uncultured bacteria from the human microbiome at different body sites. As part of a project aiming to describe the human gut microbiota by culturomics, Phoenicibacter congonensis strain Marseille-P3241T was isolated from the gut of a 45 years old Pygmy female. In the present work, we aim to describe this strain via the taxonogenomics approach. The major phenotypic, genomic and biochemical characteristics of this strain were analysed. Strain Marseille-P3241T is an anaerobic, Gram-positive and motile coccobacillus that grows optimally at 37 °C. The genome of strain Marseille-P3241T is 1,447,956 bp long with 43.44% GC content and its 16S rRNA gene sequence exhibited 89% sequence similarity with that of Denitrobacterium detoxificans strain NPOH1T, the phylogenetically closest related species with current standing in nomenclature. After performing a phylogenetic and genomic analysis, we conclude that strain Marseille-P3241T (= CCUG 70681T = CSUR P3241T) represents the type species of a new genus, for which we propose the name Phoenicibacter congonensis gen. nov., sp. nov.

Calcite formation induced by Ensifer adhaerens , Microbacterium testaceum , Paeniglutamicibacter kerguelensis , Pseudomonas protegens and Rheinheimera texasensis Abstract A wide range of bacterial species are able to induce calcium carbonate precipitation. Using our own laboratory-preserved strains, we have newly discovered that Ensifer sp. MY11e, Microbacterium sp. TMd9a1, Paeniglutamicibacter sp. MSa1a, Pseudomonas sp. GTc3, and Rheinheimera sp. ATWe6 can induce the formation of calcite crystals on an agar medium. Type strains of their closely related species (Ensifer adhaerens, Microbacterium testaceum, Paeniglutamicibacter kerguelensis, Pseudomonas protegens, and Rheinheimera texasensis) could also induce calcite formation. Although the initial pH value of the agar medium was 6.1, the pH of the agar media containing calcite, induced by cultivation of the 10 bacterial strains, increased to 8.0–8.4. The ammonification (oxidative deamination) of amino acids may been responsible for this increase in pH. The crystals formed both on and around the bacterial colonies. Furthermore, when these strains (excepting two Microbacterium strains) were cultivated on a cellulose acetate membrane filter (0.20 μm pore size) resting on the surface of the agar medium (i.e., in the membrane filter culture method), the crystals formed on the agar medium separate from the bacterial cells. These results indicate that the bacterial cells did not necessarily become nucleation sites for these crystals. We also investigated whether the studied strains could be applied to the biocementation of sand, and found that only two Ensifer strains were able to form large sand lumps.

Edaphocola aurantiacus gen. nov., sp. nov., a new member of the family Chitinophagaceae isolated from wetland soil in South Korea Abstract A short rod-shaped, yellow–orange pigmented, strictly aerobic bacterium, designated as strain H2T, was isolated from the wetland soil of Halla Mountain, Jeju-island, South Korea. Growth was observed at temperatures of 10–30 °C (optimum at 25–30 °C), pH of 6–8 (optimum at pH 7), and salt concentrations of 0–1% (w/v) NaCl (optimum at 0%). The strain H2T was found to be a catalase and oxidase-positive, non-motile, Gram-negative bacterium. On the basis of 16S rRNA gene sequence similarity and phylogenetic analysis, strain H2T was found to be related to the members of the Chitinophagaceae family, being closely related to Taibaiella chishuiensisAY17T (94.3% sequence similarity). The major polar lipids are phosphatidylethanolamine and glycolipid. Strain H2T contained MK-7 as the only menaquinone as well as iso-C15:0, iso-C15:1 G and iso-C17:0 3-OH as the major fatty acids (> 15%). The DNA G+C content of strain H2T was determined to be 48.3 mol%. Based on the phylogenetic, phenotypic characteristics and chemotaxonomic analysis data, strain H2T (= KCTC 62115T = JCM 32353T) should be classified as representative of a novel species of a novel genus within the family Chitinophagaceae, for which the name Edaphocola aurantiacus gen. nov., sp. nov., is proposed.

Studies in the Stypella vermiformis group (Auriculariales, Basidiomycota) Abstract Stypella vermiformis is a heterobasidiomycete producing minute gelatinous basidiocarps on rotten wood of conifers in the Northern Hemisphere. In the current literature, Stypella papillata, the genus type of Stypella(described from Brazil), is treated as a taxonomic synonym of S. vermiformis. In the present paper, we revise the type material of S. papillata and a number of specimens addressed to S. vermiformis. As a result, the presumed synonymy of S. papillata and S. vermiformis is rejected and the genus Stypella is restricted to the single species S. papillata. Morphological and molecular phylogenetic studies of specimens from the Northern Hemisphere corresponding to the current concept of S. vermiformis uncovered three species from two newly described genera. S. vermiformis s.str. is distributed in temperate Europe and has small-sized basidia and basidiospores, and it is placed in a new genus, Mycostilla. Another genus, Stypellopsis, is created for two other species, the North American Stypellopsis farlowii, comb. nov., and the North European Stypellopsis hyperborea, sp. nov. Basidia and basidiospores of Stypellopsis spp. are larger than in Mycostilla vermiformis but other morphological characters are very similar. In addition, Spiculogloea minuta (Spiculogloeomycetes, Pucciniomycotina) is reported as new to Norway, parasitising basidiocarps of M. vermiformis and Tulasnella spp.

Winogradskyella algae sp. nov., a marine bacterium isolated from the brown alga Abstract An aerobic, Gram-negative, yellow-pigmented non-motile rod-shaped bacterium Kr9-9T was isolated from a brown alga specimen collected near the Kuril Islands. Based on the 16S rRNA gene sequence analysis strain Kr9-9T was assigned to the genus Winogradskyella, and its close phylogenetic neighbors were found to be Winogradskyella damuponensis KCTC 23552T, Winogradskyella sediminis LMG 28075T, and Winogradskyella rapidaCCUG 59098T showing high similarities of 98.1%, 97.5%, and 97.1%, respectively. It contained MK-6 as the predominant menaquinone and iso-C15:0, anteiso-C15:0, iso-C16:0 3-OH followed by iso-C15:1 as the major fatty acids. Polar lipids included phosphatidylethanolamine, three unidentified aminolipids and an unidentified lipid. The DNA C+C content was 32.3 mol%. Based on the phylogenetic analysis and distinctive phenotypic characteristics, strain Kr9-9T is concluded to represent a novel species of the genus Winogradskyella, for which the name Winogradskyella algae sp. nov. is proposed. The type strain of the species is strain Kr9-9T (= KMM 8180T = KACC 19709T).

Rhodococcus daqingensis sp. nov., isolated from petroleum-contaminated soil Abstract A novel Gram-stain positive, aerobic, non-motile bacterial strain, designated Z1T, was isolated from a sample of petroleum-contaminated soil collected in Daqing, Heilongjiang province, China and characterised with a series of taxonomic approaches. The morphological and chemotaxonomic properties of the isolate were typical of those of members of the genus Rhodococcus. Phylogenetic analyses based on 16S rRNA gene sequences showed that strain Z1T belongs to the genus Rhodococcus and clustered with Rhodococcus maanshanensis DSM 44675T (99.2%, sequence similarity) and Rhodococcus tukisamuensis JCM 11308T (97.9%), respectively. However, the DNA–DNA hybridizations between strain Z1T and R. maanshanensis DSM 44675T and R. tukisamuensis JCM 11308T were both less than 70%. The optimal growth temperature and pH for strain Z1T were found to be at 28 °C and at pH 7.0. The peptidoglycan was found to contain meso-diaminopimelic acid; arabinose, galactose and glucose were detected as diagnostic sugars. The main polar lipids were identified as diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylinositol, phosphatidylinositol mannoside and an unidentified lipid; MK-8(H2) was found as the major menaquinone. The major fatty acids were identified as C16:0, 10-methyl C18:0 and C18:1ω9c. Mycolic acids were found to be present. The G + C content of the genomic DNA was determined to be 66.7 mol%. Based on a comparative analysis of phenotypic and genotypic characteristics, in combination with DNA–DNA hybridization results, strain Z1T can be distinguished from the type strains of its two close neighbours as a novel species of the genus Rhodococcus, for which the name Rhodococcus daqingensis sp. nov. is proposed. The type strain is Z1T (= CGMCC 1.13630T = DSM 107227T).

Genome sequencing of Aureobasidium pullulans P25 and overexpression of a glucose oxidase gene for hyper-production of Ca 2+ -gluconic acid Abstract Gluconic acid (GA) has many applications such as in the food and pharmaceutical industry. Aureobasidium pullulans P25 strain is able to produce high levels of Ca2+-GA. The genome length, GC content and the gene number of this yeast were found to be 30.97 Mb, 50.28% and 10,922, respectively. The pathways for gluconic acid biosynthesis were annotated. Glucose oxidase (Gox) sequences from different strains of A. pullulans were highly similar but were distinct from those of other fungi. The glucose oxidase had two FAD binding sites and a signal sequence. Deletion of the GOX gene resulted in a strain that showed no Gox activity and that was unable to produce Ca2+-GA. Overexpression of the GOX gene in strain P25 generated strain GA-6 that produced 200.2 ± 2.3 Ca2+-GA g/l and 2480 U/mg of Gox activity. The productivity of Ca2+-GA was 2.78 g/l/h and the yield was 1.1 g/g.

Oceanobacillus timonensis sp. nov. and Oceanobacillus senegalensis sp. nov., two new moderately halophilic, Gram-stain positive bacteria isolated from stools sample of healthy young Senegalese Abstract Oceanobacillus timonensis Marseille-P3532T (CSUR P3532, CCUG 70981) and Oceanobacillus senegalensis Marseille-P3587T (CSUR P3587, CCUG 70613), are the type strains of O. timonensis sp. nov. and O. senegalensis sp. nov., respectively. They are moderately halophilic, aerobic, motile and Gram-stain positive bacteria. The strains P3532T and P3587T were isolated from stools with 3.8% and 2.1% sodium chloride (NaCl) of healthy 10 year old female and male 7-year-old children, respectively and living respectively at Dielmo and N'diop two villages in Senegal (West Africa). This study aimed to describe the genome and phenotypic characteristics of O. timonensis Marseille-P3532T and O. senegalensis Marseille-P3587T. The genomes are 4,485,335 bp long for O. timonensis and 4,300,331 bp for O. senegalensis with 38.78% and 36.92% G+C content, respectively. They contain 4306 and 3979 protein-coding and 87 and 273 RNAs genes, respectively.

Serine-glyoxylate aminotranferases from methanotrophs using different C1-assimilation pathways Abstract The indicator enzyme of the serine pathway of assimilation of reduced C1 compounds, serine-glyoxylate aminotransferase (Sga), has been purified from three methane-oxidizing bacteria, Methylomicrobium alcaliphilum20Z, Methylosinus trichosporium OB3b and Methylococcus capsulatus Bath. The native enzymes were shown to be dimeric (80 kDa, strain 20Z), tetrameric (~ 170 kDa, strain OB3b) or trimeric (~ 120 kDa, strain Bath). Sga from the three methanotrophs catalyse the pyridoxal phosphate-dependent transfer of an amino group from serine to glyoxylate and pyruvate; the enzymes from strains 20Z and Bath also transfer an amino group from serine to α-ketoglutarate and from alanine to glyoxylate. No other significant differences between the Sga from the three methanotrophs were found. The three methanotrophic Sga have their highest catalytic efficiencies in the reaction between glyoxylate and serine, which is in agreement with their function to provide circulation of the serine assimilation pathway.The disruption of the sga gene in Mm. alcaliphilum resulted in retardation of growth rate of the mutant cells and in a prolonged lag-phase after passaging from methane to methanol. In addition, the growth of the mutant strain is accompanied by formaldehyde accumulation in the culture liquid. Hence, Sga is important in the serine cycle of type I methanotrophs and this pathway could be related to the removal of excess formaldehyde and/or energy regulation.

Phyllobacterium phragmitis sp. nov., an endophytic bacterium isolated from Phragmites australis rhizome in Kumtag Desert Abstract A Gram-negative rod, designated strain 1N-3T, was isolated from a rhizome of Phragmites australis grown in Kumtag Desert, China. Phylogenetic analysis showed that the strain is closely related to Phyllobacterium salinisoli LMG 30173T with 99.0% sequence similarity in the 16S rRNA gene and 92.9% in the atpD gene. Growth was observed at salinities of 0–4% (w/v), over a pH range of 5.0–10.0 (optimum 8.0) and at temperatures of 15–40 °C (optimum 30 °C). The predominant cellular fatty acids were identified as summed feature 8 (C18:1ω7c/C18:1ω6c). The G+C content of strain 1N-3T was determined to be 60.1%. Based on phenotypic, chemotaxonomic, phylogenetic properties and genomic comparison, it is concluded that strain 1N-3T represents a novel species of the genus Phyllobacterium, for which the name Phyllobacterium phragmitis sp. nov. is proposed. The type strain is 1N-3T (=KCTC 62183T =ACCC 60071T).