BackgroundAlthough asthma morbidity can be prevented through long-term controller medication, most patients with persistent asthma do not take their daily inhaled corticosteroid. The objective of this study was to gather patients’ insights into barriers and facilitators to taking long-term daily inhaled corticosteroids as basis for future knowledge translation interventions.MethodsWe conducted a collective qualitative case study. We interviewed 24 adults, adolescents, or parents of children, with asthma who had received a prescription of long-term inhaled corticosteroids in the previous year. The one-hour face-to-face interviews revolved around patients’ perceptions of asthma, use of asthma medications, current self-management, prior changes in self-management, as well as patient-physician relationship. We sought barriers and facilitators to optimal asthma management. Interviews were transcribed verbatim and transcripts were analyzed using a thematic approach.ResultsPatients were aged 2–76 years old and 58% were female. Nine patients were followed by an asthma specialist (pulmonologist or allergist), 13 patients by family doctors or pediatricians, and two patients had no regular follow-up. Barriers and facilitators to long-term daily inhaled corticosteroids were classified into the following loci of responsibility and its corresponding domains: (1) patient (cognition; motivation, attitudes and preferences; practical implementation; and parental support); (2) patient-physician interaction (communication and patient-physician relationship); and (3) health care system (resources and services). Patients recognized that several barriers and facilitators fell within their own responsibility. They also underlined the crucial impact (positive or negative) on their adherence of the quality of patient-physician interaction and health care system accessibility.ConclusionsWe identified a close relationship between reported barriers and facilitators to adherence to long-term daily controller medication for asthma within three loci of responsibility. As such, patients’ adherence must be approached as a multi-level phenomenon; moreover, interventions targeting the patient, the patient-physician interaction, and the health care system are recommended. The present study offers a potential taxonomy of barriers and facilitators to adherence to long-term daily inhaled corticosteroids therapy that, once validated, may be used for planning a knowledge translation intervention and may be applicable to other chronic conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-015-0044-9) contains supplementary material, which is available to authorized users.

A membrane-associated 3,5-dichlorophenol reductive dehalogenase was isolated from Desulfitobacterium frappieri PCP-1. The highest dehalogenase activity was observed with the biomass cultured at 22°C, compared to 30 and 37°C, where the cell suspensions were 2.2 and 9.6 times less active, respectively. The reductive dehalogenase was purified 12.7-fold to apparent homogeneity. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed a single band with an apparent molecular mass of 57 kDa. Its dechlorinating activity was not inhibited by sulfate and nitrate but was completely inhibited by 2.5 mM sulfite and 10 mM KCN. A mixture of iodopropane and titanium citrate caused a light-reversible inhibition of the dechlorinating activities, suggesting the involvement of a corrinoid cofactor. Several polychlorophenols were dechlorinated at the meta and para positions. The apparent K m for 3,5-dicholorophenol was 49.3 ؎ 3.1 M at a methyl viologen concentration of 2 mM. Six internal tryptic peptides were sequenced by mass spectrometry. One open reading frame (ORF) was found in the Desulfitobacterium hafniense genome containing these peptide sequences. This ORF corresponds to a gene coding for a CprA-type reductive dehalogenase. The corresponding ORF (named cprA5) in D. frappieri PCP-1 was cloned and sequenced. The cprA5 gene codes for a 548-amino-acid protein that contains a twin-arginine-type signal for secretion. The gene product has a cobalamin binding site motif and two iron-sulfur binding motifs and shows 66% identity (76 to 77% similarity) with some tetrachloroethene reductive dehalogenases. This is the first CprA-type reductive dehalogenase that can dechlorinate chlorophenols at the meta and para positions.Several strictly anaerobic bacteria are able to reductively dehalogenate a large variety of chlorinated compounds and use them as terminal electron acceptors (8). Desulfomonile tiedjei DCB-1, Dehalobacter restrictus PER-K23, Sulfurospirillum (formerly Dehalospirillum) multivorans, and many members of the genus Desulfitobacterium have been the most studied for their dechlorinating activity. Three types of reductive dehalogenases have been isolated from dehalorespiring bacteria. The most frequently reported dehalogenases consist of a single polypeptide containing one corrinoid cofactor and two iron-sulfur clusters: tetrachloroethene (PCE) reductive dehalogenases of S. multivorans (18), Desulfitobacterium sp. strain PCE-S (16), and Desulfitobacterium frappieri TCE-1 (27), ortho-chlorophenol reductive dehalogenases of Desulfitobacterium hafniense (5), Desulfitobacterium dehalogenans (28), and Desulfitobacterium chlororespirans (10), and PCE-and trichloroethene (TCE)-reductive dehalogenases of Dehalococcoides ethenogenes (14). Two reductive dehalogenases with one corrinoid cofactor but without an iron-sulfur cluster have also been reported: the ortho-chlorophenol reductive dehalogenase from D. frappieri PCP-1 (3) and the PCE reductive dehalogenase from Clostridium bifermentans DPH-1 (22). These two proteins are d...

Desulfitobacterium frappieri PCP-1 has the capacity to dehalogenate several halogenated aromatic compounds by reductive dehalogenation, however, the genes encoding the enzymes involved in such processes have not yet been identified. Using a degenerate oligonucleotide corresponding to a conserved sequence of CprA/PceA reductive dehalogenases, a cprA-like gene fragment was amplified by PCR from this bacterial strain. A Desulfitobacterium frappieri PCP-1 cosmid library was screened with the PCR product, allowing the cloning and sequencing of a 1.9-kb fragment. This fragment contains a nucleic acid sequence identical to one genomic contig of Desulfitobacterium hafniense, a bacterium closely related to Desulfitobacterium frappieri that is also involved in reductive dehalogenation. Other genes related to the Desulfitobacterium dehalogenans cpr locus were identified in this contig. Interestingly, the gene arrangement shows the presence of two copies of cprA-, cprB-, cprC-, cprD-, cprK-, and cprT-related genes, suggesting that gene duplication occurred within this chromosomic region. The screening of Delfitobacterium hafniense genomic contigs with a CprA-deduced amino acid sequence revealed two other cprA-like genes. Microbial genomes available in gene databases were also analyzed for sequences related to CprA/PceA. Two open reading frames encoding other putative reductive dehalogenases in Desulfitobacterium hafniense contigs were detected, along with 17 in the Dehalococcoides ethenogenes genome, a bacterium involved in the reductive dehalogenation of tetrachloroethene to ethene. The fact that several gene encoding putative reductive dehalogenases exist in Delfitobacterium hafniense, probably in other members of the genus Desulfitobacterium, and in Dehalococcoides ethenogenes suggests that these bacteria use distinct but related enzymes to achieve the dehalogenation of several chlorinated compounds [corrected].

<h4></h4> <p>Aggressive behavior is a frequent occurrence in the care of individuals with dementia. In this pilot study, the authors explored the impact of sharing patients&rsquo; life histories with staff on four patients&rsquo; aggression and interviewed nursing staff and families to determine the impact that developing and learning about the life history had on them. There was some evidence of decrease in aggression among the patients who demonstrated frequent aggressive behavior at baseline. Life history information affected some staff members profoundly, leading toward a greater empathy for the patient. This study demonstrates the feasibility and potential value of using life histories with residents who demonstrate aggressive behavior.</p>

Desulfitobacterium hafniense PCP-1 (formerly frappieri PCP-1) has two reductive dehalogenases (RDases) that have been characterized. One is a membrane-associated 2,4,6-trichlorophenol RDase, which is encoded by crdA, and the other is a 3,5-dichlorophenol RDase encoded by cprA5. In this report, we determined the occurrence of these two RDase genes in seven other Desulfitobacterium strains. The presence or absence of these two RDases may explain the differences in the spectrum of halogenated compounds by these Desulfitobacterium strains. crdA gene sequences were found in all of the tested strains. It was expressed in strain PCP-1 regardless of the absence or presence of chlorophenols in the culture medium. crdA was also expressed in D. hafniense strains DCB-2 and TCE-1. cprA5 was detected only in D. hafniense strains PCP-1, TCP-A, and DCB-2. In these strains, cprA5 transcripts were detected only in the presence of chlorophenols. We also examined the expression of putative cprA RDases (cprA2, cprA3, and cprA4) that were shown to exist in the D. hafniense DCB-2 genome. RT-PCR experiments showed that cprA2, cprA3, and cprA4 were expressed in D. hafniense strains PCP-1, DCB-2, and TCP-A in the presence of chlorophenols. However, contrary to cprA5, these three genes were also expressed in the absence of halogenated compounds in the culture medium.