Adolescents accept digital mental health support in schools: A co-design and feasibility study of a school-based app for UK adolescents

Schools in the UK are required to provide frontline mental health promotion and prevention to adolescents, but with few resources. School-hosted mHealth is one option which could meet needs. This study co-designed and feasibility tested a self-help, school hosted, digital intervention for adolescents showing early symptoms of deteriorating mental health. Via extensive co-design, we produced a youth-targeted web-app (MindMate2) and a low-intensity parent component (Partner2U). Feasibility was tested in four UK high schools with n = 31 young people (15-17y). We specified rules for progression to an effectiveness trial, tested candidate primary outcome measures and conducted an exploratory cost-effectiveness analysis. Co-design produced MindMate2U to be a six-week, self-help, smartphone-delivered program targeting risk and protective factors for adolescent mental health. Young people's MindMate2U account was set up by school after which they progressed independently through six topics of their choosing. User ratings (n = 19) and post- intervention interviews (n = 6) showed resource acceptability. We met our recruitment, retention and pre-post measure completion targets and identified the Strengths and Difficulties Questionnaire as the most sensitive outcome measure. This study established the feasibility of a co-designed, mental health app as a low-burden, school-hosted resource for symptomatic young people and opens up new possibilities for the integration of mHealth in schools. Support via schools to parents of symptomatic young people may need to be universal rather than targeted. Following some refinements of MindMate2U, a phase 2 randomised controlled trial is warranted to test its effectiveness

Fluoromycobacteriophages for rapid, specific, and sensitive antibiotic susceptibility testing of Mycobacterium tuberculosis

Rapid antibiotic susceptibility testing of Mycobacterium tuberculosis is of paramount importance as multiple- and extensively- drug resistant strains of M. tuberculosis emerge and spread. We describe here a virus-based assay in which fluoromycobacteriophages are used to deliver a GFP or ZsYellow fluorescent marker gene to M. tuberculosis, which can then be monitored by fluorescent detection approaches including fluorescent microscopy and flow cytometry. Pre-clinical evaluations show that addition of either Rifampicin or Streptomycin at the time of phage addition obliterates fluorescence in susceptible cells but not in isogenic resistant bacteria enabling drug sensitivity determination in less than 24 hours. Detection requires no substrate addition, fewer than 100 cells can be identified, and resistant bacteria can be detected within mixed populations. Fluorescence withstands fixation by paraformaldehyde providing enhanced biosafety for testing MDR-TB and XDR-TB infections. © 2009 Piuri et al

Phylogenetic Codivergence Supports Coevolution of Mimetic Heliconius Butterflies

The unpalatable and warning-patterned butterflies _Heliconius erato_ and _Heliconius melpomene_ provide the best studied example of mutualistic Müllerian mimicry, thought – but rarely demonstrated – to promote coevolution. Some of the strongest available evidence for coevolution comes from phylogenetic codivergence, the parallel divergence of ecologically associated lineages. Early evolutionary reconstructions suggested codivergence between mimetic populations of _H. erato_ and _H. melpomene_, and this was initially hailed as the most striking known case of coevolution. However, subsequent molecular phylogenetic analyses found discrepancies in phylogenetic branching patterns and timing (topological and temporal incongruence) that argued against codivergence. We present the first explicit cophylogenetic test of codivergence between mimetic populations of _H. erato_ and _H. melpomene_, and re-examine the timing of these radiations. We find statistically significant topological congruence between multilocus coalescent population phylogenies of _H. erato_ and _H. melpomene_, supporting repeated codivergence of mimetic populations. Divergence time estimates, based on a Bayesian coalescent model, suggest that the evolutionary radiations of _H. erato_ and _H. melpomene_ occurred over the same time period, and are compatible with a series of temporally congruent codivergence events. This evidence supports a history of reciprocal coevolution between Müllerian co-mimics characterised by phylogenetic codivergence and parallel phenotypic change

A prospective surveillance study to determine the prevalence of 16S rRNA methyltransferase-producing Gram-negative bacteria in the UK

OBJECTIVES: To determine the prevalence of 16S rRNA methyltransferase- (16S RMTase-) producing Gram-negative bacteria in patients in the UK and to identify potential risk factors for their acquisition. METHODS: A 6 month prospective surveillance study was conducted from 1 May to 31 October 2016, wherein 14 hospital laboratories submitted Acinetobacter baumannii, Enterobacterales and Pseudomonas aeruginosa isolates that displayed high-level amikacin resistance according to their testing methods, e.g. no zone of inhibition with amikacin discs. Isolates were linked to patient travel history, medical care abroad, and previous antibiotic exposure using a surveillance questionnaire. In the reference laboratory, isolates confirmed to grow on Mueller-Hinton agar supplemented with 256 mg/L amikacin were screened by PCR for 16S RMTase genes armA, rmtA-rmtH and npmA, and carbapenemase genes (blaKPC, blaNDM, blaOXA-48-like and blaVIM). STs and total antibiotic resistance gene complement were determined via WGS. Prevalence was determined using denominators for each bacterial species provided by participating hospital laboratories. RESULTS: Eighty-four isolates (44.7%), among 188 submitted isolates, exhibited high-level amikacin resistance (MIC >256 mg/L), and 79 (94.0%) of these harboured 16S RMTase genes. armA (54.4%, 43/79) was the most common, followed by rmtB (17.7%, 14/79), rmtF (13.9%, 11/79), rmtC (12.7%, 10/79) and armA + rmtF (1.3%, 1/79). The overall period prevalence of 16S RMTase-producing Gram-negative bacteria was 0.1% (79/71 063). Potential risk factors identified through multivariate statistical analysis included being male and polymyxin use. CONCLUSIONS: The UK prevalence of 16S RMTase-producing Gram-negative bacteria is low, but continued surveillance is needed to monitor their spread and inform intervention strategies

Aspects of the breeding biology of Janaira gracilis Moreira & Pires (Crustacea, Isopoda, Asellota)

The biological aspects of incubating females of Janaira gracilis Mbreira & Pires, are described. The marsupium is formed by 4 pairs of oostegites arising from pereopods I-IV. The oostegites appear for the first time at the post-marsupial stage 7 (preparatory stage 1), growing successively at each moult until stage 9 (brooding stage 1), when they reach fully development. The sizes of the eggs increase with the body size of the females. The number of eggs, per female, is a linear function of the body volume, i.e., the fecundity increases with the female's body size. The number of eggs, embryos and juveniles decrease during the marsupial development. This decrease in brood number is higher between the last two marsupial stages, i.e., from stage C to D, than between the preceding marsupial stages. The average and overall brood mortality rate is of 38.95%.São descritos, no presente trabalho, vários aspectos relacionados à biologia de fêmeas grávidas de Janaira gracilis Moreira & Pires. O marsúpio é formado por 4 pares de oostégitos, que partem dos pereópodos I-IV. Os oostégitos, que surgem pela primeira vez no estádio 7 do desenvolvimento pós-marsupial (estágio preparatório 1), crescem nas sucessivas mudas, atingindo no estágio 9 (estágio reprodutor 1) seu pleno desenvolvimento. O tamanho dos ovos é proporcional ao tamanho das fêmeas. O número de ovos, por fêmeas, e proporcional ao volume das fêmeas, isto é, a fecundidade é mais elevada nos exemplares de maior comprimento. O número de ovos, embriões e jovens decresce com o desenvolvimento marsupial, sendo este decréscimo maior entre os dois últimos estágios marsupials (i.é., entre os estágios C e D) do que entre os estágios precedentes. A taxa média de mortalidade marsupial é de 38.95%

A European multicentre evaluation of detection and typing methods for human enteroviruses and parechoviruses using RNA transcripts

Polymerase chain reaction (PCR) detection has become the gold standard for diagnosis and typing of enterovirus (EV) and human parechovirus (HPeV) infections. Its effectiveness depends critically on using the appropriate sample types and high assay sensitivity as viral loads in cerebrospinal fluid samples from meningitis and sepsis clinical presentation can be extremely low. This study evaluated the sensitivity and specificity of currently used commercial and in-house diagnostic and typing assays. Accurately quantified RNA transcript controls were distributed to 27 diagnostic and 12 reference laboratories in 17 European countries for blinded testing. Transcripts represented the four human EV species (EV-A71, echovirus 30, coxsackie A virus 21, and EV-D68), HPeV3, and specificity controls. Reported results from 48 in-house and 15 commercial assays showed 98% detection frequencies of high copy (1000 RNA copies/5 mu L) transcripts. In-house assays showed significantly greater detection frequencies of the low copy (10 copies/5 mu L) EV and HPeV transcripts (81% and 86%, respectively) compared with commercial assays (56%, 50%; P = 7 x 10(-5)). EV-specific PCRs showed low cross-reactivity with human rhinovirus C (3 of 42 tests) and infrequent positivity in the negative control (2 of 63 tests). Most or all high copy EV and HPeV controls were successfully typed (88%, 100%) by reference laboratories, but showed reduced effectiveness for low copy controls (41%, 67%). Stabilized RNA transcripts provide an effective, logistically simple and inexpensive reagent for evaluation of diagnostic assay performance. The study provides reassurance of the performance of the many in-house assay formats used across Europe. However, it identified often substantially reduced sensitivities of commercial assays often used as point-of-care tests.Peer reviewe

Phenotypic and molecular characterization of Staphylococcus aureus isolates expressing low- and high-level mupirocin resistance in Nigeria and South Africa

<p>Abstract</p> <p>Background</p> <p>Mupirocin is a topical antimicrobial agent which is used for the treatment of skin and postoperative wound infections, and the prevention of nasal carriage of methicillin-resistant <it>Staphylococcus aureus </it>(MRSA). However, the prevalence of mupirocin resistance in <it>S. aureus</it>, particularly in MRSA, has increased with the extensive and widespread use of this agent in hospital settings. This study characterized low- and high-level mupirocin-resistant <it>S. aureus </it>isolates obtained from Nigeria and South Africa.</p> <p>Methods</p> <p>A total of 17 mupirocin-resistant <it>S. aureus </it>isolates obtained from two previous studies in Nigeria and South Africa, were characterized by antibiogram, PCR-RFLP of the coagulase gene and PFGE. High-level mupirocin resistant isolates were confirmed by PCR detection of the <it>mupA </it>gene. The genetic location of the resistance determinants was established by curing and transfer experiments.</p> <p>Results</p> <p>All the low-level mupirocin resistant isolates were MRSA and resistant to gentamicin, tetracycline and trimethoprim. PFGE identified a major clone in two health care institutions located in Durban and a health care facility in Pietermaritzburg, Greytown and Empangeni. Curing and transfer experiments indicated that high-level mupirocin resistance was located on a 41.1 kb plasmid in the South African strain (A15). Furthermore, the transfer of high-level mupirocin resistance was demonstrated by the conjugative transfer of the 41.1 kb plasmid alone or with the co-transfer of a plasmid encoding resistance to cadmium. The size of the mupirocin-resistance encoding plasmid in the Nigerian strain (35 IBA) was approximately 35 kb.</p> <p>Conclusion</p> <p>The emergence of mupirocin-resistant <it>S. aureus </it>isolates in Nigeria and South Africa should be of great concern to medical personnel in these countries. It is recommended that methicillin-susceptible <it>S. aureus </it>(MSSA) and MRSA should be routinely tested for mupirocin resistance even in facilities where the agent is not administered. Urgent measures, including judicious use of mupirocin, need to be taken to prevent clonal dissemination of the mupirocin/methicillin resistant <it>S. aureus </it>in KZN, South Africa and the transfer of the conjugative plasmid encoding high-level mupirocin resistance identified in this study.</p