Notes

Common Baclofen Drawback Leading to Overactive Delirium: An incident Document.
cadres of PHC workers to inform cadre-related motivational interventions.
Policy designs and management strategies for improving workforce performance, particularly in resource-constrained settings should create working environments that foster feelings of being valued and supported while enabling workers to apply their knowledge and skills to improve healthcare delivery and promote UHC. Future research can test the explanatory framework generated by this study and explore differences in motivational mechanisms among different cadres of PHC workers to inform cadre-related motivational interventions.Huanglongbing (HLB) is a devastating citrus disease worldwide that is putatively caused by Candidatus Liberibacter asiaticus and transmitted by Diaphorina citri Melatonin is a ubiquitously distributed auxin-like metabolite found in both prokaryotes and eukaryotes. In this study, we used integrative metabolomic and transcriptomic approaches to investigate the potential role of melatonin in citrus response against HLB and to understand the relationships between melatonin and the stress-associated phytohormones at molecular and metabolic levels. Melatonin was detected in the leaves of Valencia sweet orange (Citrus sinensis) after derivatization with N-methyl-N-trimethylsilyltrifluoroacetamide using a targeted gas chromatography-mass spectrometry running in selective ion monitoring mode-based method. Ca. L. asiaticus infection and D. citri infestation significantly increased endogenous melatonin levels in Valencia sweet orange leaves and upregulated the expression of its biosynthetic genes (CsTDC, CsT5H, CsSNAT, CsASMT, and CsCOMT). However, infection with Ca. L. asiaticus had a greater effect than did infestation with D. citri Melatonin induction was positively correlated with salicylic acid content, but not that of trans-jasmonic acid. Moreover, melatonin supplementation enhanced the endogenous contents of the stress-associated phytohormones (salicylates, auxins, trans-jasmonic acid, and abscisic acid) and the transcript levels of their biosynthetic genes. Furthermore, melatonin supplementation diminished the Ca. L. asiaticus titer within the infected leaves, which suggests that melatonin might play an antibacterial role against this bacterium and gram-negative bacteria in general. These findings provide a better understanding of the melatonin-mediated defensive response against HLB via modulation of multiple hormonal pathways. Understanding the role of melatonin in citrus defense to HLB may provide a novel therapeutic strategy to mitigate the disease.Stomata respond to changes in light environment through multiple mechanisms that jointly regulate the tradeoff between carbon assimilation and water loss. The stomatal response to blue light is highly sensitive, rapid, and not driven by photosynthesis. It is present in most vascular plant groups but is believed to have been lost in the ancestor of leptosporangiate ferns. Schizaeales and Salviniales are the only leptosporangiate orders that have not been tested for stomatal responses to a low fluence of blue light. We report that these stomatal responses are absent in Lygodium japonicum (Schizaeales). In contrast, we observed stomatal responses to a low fluence of blue light in Regnellidium diphyllum and Marsilea minuta (Marsileaceae, Salviniales). In R. diphyllum, blue light triggered stomatal oscillations. click here The oscillations were more sensitive to atmospheric carbon dioxide concentration than to humidity, suggesting that the blue light responses of Marsileaceae stomata differ from those of angiosperms. Our findings suggest that Marsileaceae have physiologically diverged from other leptosporangiate ferns, achieving unusually high photosynthetic capacities through amphibious lifestyles and numerous anatomical convergences with angiosperms. Blue light stomatal responses may have contributed to this divergence by enabling high rates of leaf gas exchange in Marsileaceae.Plant pathogens cause widespread yield losses in agriculture. Understanding the drivers of plant-pathogen interactions requires decoding the molecular dialog leading to either resistance or disease. However, progress in deciphering pathogenicity genes has been severely hampered by suitable model systems and incomplete fungal genome assemblies. Here, we report a significant improvement of the assembly and annotation of the genome of the Fusarium oxysporum (Fo) strain Fo5176. Fo comprises a large number of serious plant pathogens on dozens of plant species with largely unresolved pathogenicity factors. The strain Fo5176 infects Arabidopsis thaliana and, hence, constitutes a highly promising model system. We use high-coverage Pacific Biosciences Sequel long-read and Hi-C sequencing data to assemble the genome into 19 chromosomes and a total genome size of 67.98 Mb. The genome has a N50 of 4 Mb and a 99.1% complete BUSCO score. Phylogenomic analyses based on single-copy orthologs clearly place the Fo5176 strain in the Fo f sp. conglutinans clade as expected. We generated RNAseq data from culture medium and plant infections to train gene predictions and identified ∼18,000 genes including ten effector genes known from other Fo clades. We show that Fo5176 is able to infect cabbage and Brussel sprouts of the Brassica oleracea, expanding the usefulness of the Fo5176 model pathosystem. Finally, we performed large-scale comparative genomics analyses comparing the Fo5176 to 103 additional Fo genomes to define core and accessory genomic regions. In conjunction with the molecular tool sets available for A. thaliana, the Fo5176 genome and annotation provides a crucial step toward the establishment of a highly promising pathosystem.The paper offers the concept of reversing the medical humanities In agreement with the call from Kristeva et al to recognise the bidirectionality of the medical humanities, I propose moving beyond debates of attitude and aptitude in the application and engagement (either friendly or critical) of humanities to/in medicine, by considering a reversal of the directions of epistemic movement (a reversal of the flow of knowledge). I situate my proposal within existing articulations of the field found in the medical humanities meta-literature, pointing to a gap in the current terrain. I then develop the proposal by unfolding three reasons why we might gain something from exploring a reversed knowledge flow. First, a reversed knowledge flow seems to be an inherent-but still to be articulated-possibility in medical humanities and thus provides an opportunity for more knowledge. Second, the current unidirectionality of the field is founded on an inconsistency in the depiction of the connection between medicine and humanities, which risks creating the very divide that medical humanities set out to bridge. Practising a reversal may help avoid this divide. And third, a reversal might help rebalance the internal epistemic power, so as to motivate less external scepticism and in turn displace more external epistemic power towards medical humanities. I end the paper with a remark on precursors for a reversal, and ideas for where to go from here.
To investigate the decision-making process of Chinese university students with respect to antibiotic use for upper respiratory tract infections (URTIs).

A cross-sectional questionnaire study.

The participants recruited from six universities across all Chinese regions from September to November 2015.

A total of 2834 university students sampled across six Chinese regions who self-reported experiencing symptoms of URTI within the past month completed the survey.

The prevalence of decisions for treatment and antibiotic use for URTIs as well as knowledge about antibiotic use were measured by a self-administrated questionnaire. Using regular and multinomial logistic regression a nd adapted health belief model, we identified and measured a number of variables as potential risk factors for antibiotic misuse behaviours in order to explain and predict people's treatment decisions and antibiotic use including knowledge, perceptions, access to antibiotics and cues to action.

Of the 2834 university students wha prescription-were associated with antibiotic misuse among Chinese university students, which calls for context-appropriate multifaceted interventions in order to effectively reduce antibiotic misuse.
Misconceptions of antibiotic efficacy and easy access to antibiotics-with or without a prescription-were associated with antibiotic misuse among Chinese university students, which calls for context-appropriate multifaceted interventions in order to effectively reduce antibiotic misuse.
To determine the rate of outpatient antimicrobial use and the rationale for antimicrobial prescription.

A prospective, multicentre, cross-sectional study.

Ambulatory care settings at community general hospitals.

A total of 1972 consecutive ambulatory visits by 1952 patients were included from 2 February 2020 to 13 February 2020. Visits resulting in hospital admission and regularly scheduled visits were excluded.

The primary outcome was the proportion of ambulatory visits resulting in antimicrobial drug prescriptions. The secondary outcomes were the reasons for antimicrobial drug prescription and the proportion of unnecessary antimicrobial prescriptions among all antimicrobial drugs used for treatment.

The mean patient age was 53.8 (SD 25.8) years old, and the proportion of women was 52.6%. A total of 162 antimicrobial drugs were prescribed in 153 (7.8%) visits. The most common antimicrobial drugs were penicillins (n=48, 29.6%), followed by third-generation cephalosporins (n=35, 21.6%) and quinolones (n=20, 12.4%). Among all the antimicrobial drugs prescribed, 125 (77.2%), 18 (11.1%) and 11 (6.8%) were used for infection treatment, wound prophylaxis and surgical prophylaxis, respectively. Of the 125 antimicrobial drugs used for infection treatment, 60 (48.0%) were judged to be unnecessary.

One in every 13 ambulatory visits resulted in antimicrobial use in Japan. Three-fourths of the prescribed antimicrobial drugs were used for infection treatment, but approximately half of those drugs may have been unnecessary. Further efforts to reduce unnecessary antimicrobial drug use are needed.

UMIN000039360.
UMIN000039360.
Safety-netting in primary care is the best practice in cancer diagnosis, ensuring that patients are followed up until symptoms are explained or have resolved. Currently, clinicians use haphazard manual solutions. The ubiquitous use of electronic health records provides an opportunity to standardise safety-netting practices.A new electronic safety-netting toolkit has been introduced to provide systematic ways to track and follow up patients. We will evaluate the effectiveness of this toolkit, which is embedded in a major primary care clinical system in EnglandEgerton Medical Information System(EMIS)-Web.

We will conduct a stepped-wedge cluster RCT in 60 general practices within the RCGP Research and Surveillance Centre (RSC) network. Groups of 10 practices will be randomised into the active phase at 2-monthly intervals over 12 months. All practices will be activated for at least 2 months. The primary outcome is the primary care interval measured as days between the first recorded symptom of cancer (within the year prior to diagnosis) and the subsequent referral to secondary care.
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