303 research outputs found
Emergence and clonal spread of CTX-M-65-Producing Escherichia coli from retail meat in Portugal
Research Areas: MicrobiologyThe emergence and dissemination of resistance to third- and fourth-generation
cephalosporins among Enterobacteriaceae from different sources impose a global
public health threat. Here, we characterized by whole-genome sequencing four
Escherichia coli strains harboring the blaCTXâMâ65 gene identified among 49 isolates
from beef and pork collected at retail. The genomic content was determined using
the Center for Genomic Epidemiology web tools. Additionally, the prediction and
reconstruction of plasmids were conducted, the genetic platform of the blaCTXâMâ65
genes was investigated, and phylogenetic analysis was carried out using 17 other
genomes with the same sequence type and harboring the blaCTXâMâ65 gene. All strains
harbored blaCTXâMâ65, blaOXAâ1, and blaTEMâ1B, and one also carried the blaSHVâ12
gene. Other resistance genes, namely, qnrS2, aac(60
)-Ib-c, dfrA14, sul2, tetA, and
mphA, were present in all the genomes; the mcr-1.1 gene was identified in the colistinresistant strains. They belong to sequence type 2179, phylogenetic group B1, and
serotype O9:H9 and carried plasmids IncI, IncFIC(FII), and IncFIB. All strains share an
identical genetic environment with IS903 and ISEcp1 flanking the blaCTXâMâ65 gene. It
seems likely that the blaCTXâMâ65 gene is located in the chromosome in all isolates
based on deep in silico analysis. Our findings showed that the strains are clonally
related and belong to two sub-lineages. This study reports the emergence of CTX-M-65-
producing E. coli in Portugal in food products of animal origin. The chromosomal location
of the blaCTXâMâ65 gene may ensure a stable spread of resistance in the absence of
selective pressure.info:eu-repo/semantics/publishedVersio
Global public policy, transnational policy communities, and their networks
Public policy has been a prisoner of the word "state." Yet, the state is reconfigured by globalization. Through "global publicâprivate partnerships" and "transnational executive networks," new forms of authority are emerging through global and regional policy processes that coexist alongside nation-state policy processes. Accordingly, this article asks what is "global public policy"? The first part of the article identifies new public spaces where global policies occur. These spaces are multiple in character and variety and will be collectively referred to as the "global agora." The second section adapts the conventional policy cycle heuristic by conceptually stretching it to the global and regional levels to reveal the higher degree of pluralization of actors and multiple-authority structures than is the case at national levels. The third section asks: who is involved in the delivery of global public policy? The focus is on transnational policy communities. The global agora is a public space of policymaking and administration, although it is one where authority is more diffuse, decision making is dispersed and sovereignty muddled. Trapped by methodological nationalism and an intellectual agoraphobia of globalization, public policy scholars have yet to examine fully global policy processes and new managerial modes of transnational public administration
Multiplex PCR for detection of plasmid-mediated colistin resistance determinants, mcr-1, mcr-2, mcr-3, mcr-4 and mcr-5 for surveillance purposes
International audiencePlasmid-mediated colistin resistance mechanisms have been identified worldwide in the past years. A multiplex polymerase chain reaction (PCR) protocol for detection of all currently known transferable colistin resistance genes (mcr-1 to mcr-5, and variants) in Enterobacteriaceae was developed for surveillance or research purposes. Methods: We designed four new primer pairs to amplify mcr-1, mcr-2, mcr-3 and mcr-4 gene products and used the originally described primers for mcr-5 to obtain a stepwise separation of ca 200 bp between amplicons. The primer pairs and amplification conditions allow for single or multiple detection of all currently described mcr genes and their variants present in Enterobacteriaceae. The protocol was validated testing 49 European Escherichia coli and Salmonella isolates of animal origin. Results: Multiplex PCR results in bovine and porcine isolates from Spain, Germany, France and Italy showed full concordance with whole genome sequence data. The method was able to detect mcr-1, mcr-3 and mcr-4 as singletons or in different combinations as they were present in the test isolates. One new mcr-4 variant, mcr-4.3, was also identified. Conclusions: This method allows rapid identification of mcr-positive bacteria and overcomes the challenges of phenotypic detection of colistin resistance. The multiplex PCR should be particularly interesting in settings or laboratories with limited resources for performing genetic analysis as it provides information on the mechanism of colistin resistance without requiring genome sequencing
Rethinking rehabilitation after percutaneous coronary intervention: a protocol of a multicentre cohort study on continuity of care, health literacy, adherence and costs at all care levels (the CONCARD PCI )
Introduction: Percutaneous coronary intervention (PCI) aims to provide instant relief of symptoms, and improve functional capacity and prognosis in patients with coronary artery disease. Although patients may experience a quick recovery, continuity of care from hospital to home can be challenging. Within a short time span, patients must adjust their lifestyle, incorporate medications and acquire new support. Thus, CONCARDPCI will identify bottlenecks in the patient journey from a patient perspective to lay the groundwork for integrated, coherent pathways with innovative modes of healthcare delivery. The main objective of the CONCARDPCI is to investigate (1) continuity of care, (2) health literacy and self-management, (3) adherence to treatment, and (4) healthcare utilisation and costs, and to determine associations with future short and long-term health outcomes in patients after PCI. Methods and analysis: This prospective multicentre cohort study organised in four thematic projects plans to include 3000 patients. All patients undergoing PCI at seven large PCI centres based in two Nordic countries are prospectively screened for eligibility and included in a cohort with a 1-year follow-up period including data collection of patient-reported outcomes (PRO) and a further 10-year follow-up for adverse events. In addition to PROs, data are collected from patient medical records and national compulsory registries. Ethics and dissemination: Approval has been granted by the Norwegian Regional Committee for Ethics in Medical Research in Western Norway (REK 2015/57), and the Data Protection Agency in the Zealand region (REG-145-2017). Findings will be disseminated widely through peer-reviewed publications and to patients through patient organisations. Trial registration number: NCT03810612
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