Integration of the cytogenetic and physical maps of chicken chromosome 17

The chicken genome, like those of most avian species, contains numerous microchromosomes that cannot be distinguished by size alone. Unique properties attributed to the microchromosomes include high GC content and gene density, and an enhanced recombination rate. Previously, microchromosome GGA 17 was shown to align with the consensus genetic linkage group E41W17, and bacterial artificial chromosome (BAC) clones containing E41W17 markers were isolated and assigned on the physical BAC map as well as the recently assembled draft chicken genome sequence. For this study, these same BACS were utilized as probes for fluorescence in-situ hybridization (FISH) to develop the GGA 17 cytogenetic map. Here we detail the chromosome order of ten BAC DNAs, thereby deriving a cytogenetic map of GGA 17 that is simultaneously integrated with both the linkage map and genome sequence. The location of the FISH probes together with the morphological appearance of the chromosome suggested that GGA 17 is an acrocentric chromosome whose cytogenetic map orientation is reversed from that currently indicated by the linkage map and draft genome sequence. The reversed orientation and the centromere location of GGA 17 were confirmed experimentally by dual-colour FISH hybridization using terminal BACs and the centromere-specific CNM oligonucleotide as probes. An advantage of this cyto-genomic approach is the improved alignment of the sequence and linkage maps with cytogenetic features such as the centromere, telomeres, p and q arms, and staining patterns indicating GC versus AT content.     

Screening for Candida auris in patients admitted to eight intensive care units in England, 2017 to 2018

Background Candida auris is an emerging multidrug-resistant fungal pathogen associated with bloodstream, wound and other infections, especially in critically ill patients. C. auris carriage is persistent and is difficult to eradicate from the hospital environment.AimWe aimed to pilot admission screening for C. auris in intensive care units (ICUs) in England to estimate prevalence in the ICU population and to inform public health guidance.MethodsBetween May 2017 and April 2018, we screened admissions to eight adult ICUs in hospitals with no previous cases of C. auris, in three major cities. Swabs were taken from the nose, throat, axilla, groin, perineum, rectum and catheter urine, then cultured and identified using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). Patient records were linked to routine ICU data to describe and compare the demographic and health indicators of the screened cohort with a national cohort of ICU patients admitted between 2016 and 2017.ResultsAll C. auris screens for 921 adults from 998 admissions were negative. The upper confidence limit of the pooled prevalence across all sites was 0.4%. Comparison of the screened cohort with the national cohort showed it was broadly similar to the national cohort with respect to demographics and co-morbidities.ConclusionThese findings imply that C. auris colonisation among patients admitted to ICUs in England is currently rare. We would not currently recommend widespread screening for C. auris in ICUs in England. Hospitals should continue to screen high-risk individuals based on local risk assessment.     

Marek's disease virus up-regulates major histocompatibility complex class II cell surface expression in infected cells

Many herpesviruses modulate major histocompatibility complex (MHC) expression on the cell surface as an immune evasion mechanism. We report here that Marek's disease virus (MDV), a lymphotrophic avian alphaherpesvirus, up-regulates MHC class II cell surface expression in infected cells, contrary to all other herpesviruses examined to date. This MDV-induced class II up-regulation was detected both in vitro and in vivo. This effect was not solely an indirect effect of interferon, which is a highly potent natural inducer of MHC class II expression, since MHC class II up-regulation in cultured primary fibroblast cells was confined to the infected cells only. MHC class II up-regulation was also observed in infected cells of the bursa of Fabricius during the lytic phase of MDV infection in birds and upon reactivation of MDV from latency in an MDV-transformed cell line. As MDV is a strictly cell-associated virus and requires activated T cells for its life cycle, this up-regulation of MHC class II in infected cells may contribute to virus spread within the infected host by increasing the chance of contact between productively infected cells and susceptible activated T cells.     

Political economy of tobacco control in low-income and middle-income countries: lessons from Thailand and Zimbabwe. Global Analysis Project Team

Crucial to the success of the proposed Framework Convention on Tobacco Control will be an understanding of the political and economic context for tobacco control policies, particularly in low-income and middle-income countries. Policy studies in Thailand and Zimbabwe employed the analytical perspective of political economy and a research strategy that used political mapping, a technique for characterizing and evaluating the political environment surrounding a policy issue, and stakeholder analysis, which seeks to identify key actors and to determine their capacity to shape policy outcomes. These policy studies clearly revealed how tobacco control in low-income and middle-income countries is also being shaped by developments in the global and regional political economy. Hence efforts to strengthen national control policies need to be set within the context of globalization and the international context. Besides the transnational tobacco companies, international tobacco groups and foreign governments, international agencies and nongovernmental organizations are also playing influential roles. It cannot be assumed, therefore, that the tobacco control strategies being implemented in industrialized countries will be just as effective and appropriate when implemented in developing countries. There is an urgent need to expand the number of such tobacco policy studies, particularly in low-income and middle-income countries. Comprehensive guidelines for tobacco policy analysis and research are required to support this process, as is a broader international strategy to coordinate further tobacco policy research studies at country, regional and global levels.     

Comparison of cost and outcome of endovascular and neurosurgical procedures in the treatment of ruptured intracranial aneurysms

Endovascular techniques for the treatment of intracranial aneurysms have gained rapid acceptance in some countries as an alternative to conventional neurosurgical treatment. The International Subarachnoid Aneurysm Trial (ISAT) is the first multicentre prospective randomized trial comparing neurosurgery with endovascular coil (Guglielmi detachable coil) treatment of acute subarachnoid haemorrhage. The cost and outcome of endovascular procedures was compared with neurosurgical procedures in the treatment of ruptured intracranial aneurysms within the context of the ISAT. Two groups of patients (Endovascular group with 10 patients and the Neurosurgical group with 12 patients) were drawn from admissions to Royal Perth Hospital and Sir Charles Gairdner Hospital, Perth, Western Australia, as detailed in the ISAT trial protocol. Data were collected in the following categories: patient, procedure, hospitalization, morbidity and mortality. While the endovascular procedure tended to be the more expensive in terms of the cost of consumables, this expense was more than compensated by savings in staffing costs, and the period and cost of hospitalization. Following an endovascular procedure, patients tended to return to normal activity or paid employment sooner and have a favourable functional outcome compared with patients following a neurosurgical procedure.     

Implications for Burns Unit design following outbreak of multi-resistant Acinetobacter infection in ICU and Burns Unit

We reviewed the emergence of 13 cases of multi-resistant Acinetobacter infection in burns patients over a 12-month period. The outbreak was started in a non-burn patient in the intensive care unit (ICU) that spread to burns patients in ICU and then the Burns Unit. The importance of opportunistic infection, potential risk factors, treatment and clinical outcome of Acinetobacter infection in burns patients from this cluster of cases is described.This paper implicates the movement of burns patients and medical equipment between ICU and the Burns Unit in the spread of this infection. Future design of Burn Units should aim to incorporate features to allow the management of all burns cases in one location with all intensive care, burns and theatre facilities built in close proximity.     

The experiences of Western expatriate nursing educators teaching in Eastern Asia.

PURPOSE: To describe the lived experience of English-speaking Western nurse educators teaching in East Asian countries. DESIGN: The study design was an application of existential phenomenological approach to qualitative data collection and analysis. Eight expatriate nurse educators who had taught more than 2 years in an East Asian country were interviewed about their experiences between January 2004 and November 2005. METHODS: Narrative data were analyzed using a phenomenological approach aimed at distilling the experience of the educators. Each member of the research team analyzed the data, then through group discussions a consensus was reached, paying close attention to developing clear understandings of language nuances and maintaining the participants' voices. FINDINGS: Four themes emerged from the data: (a) differing expectations, (b) the cost of the expatriate experience, (c) bridging pedagogies, and (d) adapting and finding purpose. The tacit meanings of cultural differences affecting participants' experiences are presented. CONCLUSIONS: The ways that a collectivist-oriented culture may affect nurse educators coming from a Western individualist worldview needs to continue to be researched to develop better mutual understandings that will lead to culturally collaborative models of nursing practice, education and research. CLINICAL RELEVANCE: Nurses providing direct care and nurse educators who work with people from cultures other than their own will find the discussion of cross-cultural misunderstandings useful.