Dating the Cryptococcus gattii Dispersal to the North American Pacific Northwest.

The emergence of Cryptococcus gattii, previously regarded as a predominantly tropical pathogen, in the temperate climate of the North American Pacific Northwest (PNW) in 1999 prompted several questions. The most prevalent among these was the timing of the introduction of this pathogen to this novel environment. Here, we infer tip-dated timing estimates for the three clonal C. gattii populations observed in the PNW, VGIIa, VGIIb, and VGIIc, based on whole-genome sequencing of 134 C. gattii isolates and using Bayesian evolutionary analysis by sampling trees (BEAST). We estimated the nucleotide substitution rate for each lineage (1.59 × 10-8, 1.59 × 10-8, and 2.70 × 10-8, respectively) to be an order of magnitude higher than common neutral fungal mutation rates (2.0 × 10-9), indicating a microevolutionary rate (e.g., successive clonal generations in a laboratory) in comparison to a species' slower, macroevolutionary rate (e.g., when using fossil records). The clonal nature of the PNW C. gattii emergence over a narrow number of years would therefore possibly explain our higher mutation rates. Our results suggest that the mean time to most recent common ancestor for all three sublineages occurred within the last 60 to 100 years. While the cause of C. gattii dispersal to the PNW is still unclear, our research estimates that the arrival is neither ancient nor very recent (i.e., <25 years ago), making a strong case for an anthropogenic introduction. IMPORTANCE The recent emergence of the pathogenic fungus Cryptococcus gattii in the Pacific Northwest (PNW) resulted in numerous investigations into the epidemiological and enzootic impacts, as well as multiple genomic explorations of the three primary molecular subtypes of the fungus that were discovered. These studies lead to the general conclusion that the subtypes identified likely emerged out of Brazil. Here, we conducted genomic dating analyses to determine the ages of the various lineages seen in the PNW and propose hypothetical causes for the dispersal events. Bayesian evolutionary analysis strongly suggests that these independent fungal populations in the PNW are all 60 to 100 years old, providing a timing that is subsequent to the opening of the Panama Canal, which allowed for more direct shipping between Brazil and the western North American coastline, a possible driving event for these fungal translocation events

Radiographers' involvement in research activities and opinions on radiography research: A Nordic survey

Introduction: Radiographers' engagement in research is important for the development of evidence-based practice in radiography; however, radiographers' interest in research has rarely been reported. This study sought to ascertain radiographers' opinions about radiography research and investigate their involvement in research activities in four Nordic countries.Methods: This study was conducted in Denmark, Finland, Norway and Sweden. A study-specific questionnaire was developed in English and adapted to each language of the study sample, and the content and face validity of the adaptations were evaluated. An online tool was used to collect the study data. The questionnaire link was distributed in September 2019 to radiographers working in clinical settings in four Nordic countries (n = 4572).Results: The overall response rate was 14% (n = 662/4572). Research involvement was reported by 33% of the respondents; data collection was the main type of contribution. Radiographers who contributed to research were more likely to be male, have longer work experience, hold a master's or doctoral degree, work as managers and be employed in university hospitals. Nearly all agreed that radiography research is needed to promote the radiography profession and provide the evidence base for radiographic practice. However, only 14% were aware of the current research evidence regarding their professional field of specialisation, and 19% indicated that they developed current practices based on research evidence.Conclusion: The findings indicate that, although radiographers had positive attitudes towards radiography research, their involvement in research and utilisation of research evidence in practice is low.</p

Pathology and Viral Antigen Distribution of Lethal Pneumonia in Domestic Cats Due to Pandemic (H1N1) 2009 Influenza A Virus

A novel swine-origin H1N1 influenza A virus has been identified as the cause of the 2009 influenza pandemic in humans. Since then, infections with the pandemic (H1N1) 2009 influenza virus have been documented in a number of animal species. The first known cases of lethal respiratory disease associated with pandemic (H1N1) 2009 influenza virus infection in house pets occurred in domestic cats in Oregon. A 10-year-old, neutered male and an 8-year-old, spayed female domestic short hair cat died shortly after developing severe respiratory disease. Grossly, lung lobes of both cats were diffusely firm and incompletely collapsed. Histologically, moderate to severe, necrotizing to pyonecrotizing bronchointerstitial pneumonia was accompanied by serofibrinous exudation and hyaline membranes in the alveolar spaces. Influenza A virus was isolated from nasal secretions of the male and from lung homogenate of the female cat. Both isolates were confirmed as pandemic (H1N1) 2009 influenza virus by real-time reverse transcriptase PCR (rRT-PCR). Using immunohistochemistry, influenza A viral antigen was demonstrated in bronchiolar epithelial cells, pneumocytes and alveolar macrophages in pneumonic areas. The most likely sources of infection were people in the household with influenza-like illness or confirmed pandemic (H1N1) 2009 influenza. The two cases reported here provide, to the best of the authors’ knowledge, the first description of the pathology and viral antigen distribution of lethal respiratory disease in domestic cats after natural pandemic (H1N1) 2009 influenza virus infection, probably transmitted from humans.This is an author's peer-reviewed final manuscript, as accepted by the publisher. The article is published by Sage Publications on behalf of the American College of Veterinary Pathologists, European College of Veterinary Pathologists, and the Japanese College of Veterinary. The published article can be found at: http://vet.sagepub.com/.Keywords: influenza, pneumonia, pandemic, pH1N1, lung, immunohistochemistry, ca

Rapid, Active Surveillance for Medically Attended Acute Gastroenteritis and Norovirus Infection in a Managed Care Environment

Background/Aims: Norovirus is the leading cause of acute gastroenteritis in the United States and is the leading cause of medically attended acute gastroenteritis (MAAGE) among children younger than five years of age. Our primary goal is to describe the community incidence of MAAGE and the proportion of MAAGE encounters due to norovirus within the membership population of Kaiser Permanente Northwest (KPNW). Our secondary goal is to describe transmission of norovirus within households. Methods: We are conducting a 12-month active surveillance project in which we identify all KPNW members with MAAGE-associated health care encounters through daily electronic abstraction of the electronic health record system. We are recruiting a sample of this population daily, along with their symptomatic household members, to complete a recruitment survey and collect a stool sample for norovirus testing. Results: During the four months of our surveillance period, we identified 6,156 members presenting for MAAGE (annualized incidence of 413/100,000). We attempted to reach 1,782 (30%) potential participants, 525 (29%) of whom were ineligible. Of those remaining, 708 (56%) refused and 549 (44%) agreed to participate. Of those agreeing to participate, 453 (83%) provided a sample from which we obtained viral testing results. Among samples tested, we identified 52 (11%) positive for norovirus. Norovirus positivity was highest among those 0–4 years of age (20%) and lowest among those 65 years or older (6%). Thus far, we have recruited 48 household members, 8 (15%) of whom tested positive for norovirus; 7 (88%) had the same laboratory results as their MAAGE-associated household member. Discussion: Our observed incidence of MAAGE and proportion of MAAGE encounters due to norovirus infection in the KPNW member population over the first four months of our surveillance period are consistent with results obtained from other studies using varying methodologies and reinforce the high burden of MAAGE and norovirus infection within the community. Our results further support the high transmission of norovirus infection within households. Importantly, our project –– with 44% agreeing to participate and 83% collecting and returning a stool sample –– demonstrates a model for conducting other community-based studies of acute infectious diseases within a managed care system

Facilitators for and barriers to radiography research in public healthcare in Nordic countries

Introduction:It has been suggested that the future of diagnostic imaging relies on engagement inresearch and evidence-based practice. This implies a role transition from a clinical radiographer to aclinical radiographer-researcher. Clinical radiographers’stimuli for engaging in research in Nordiccountries are unknown. This study aimed to address this gap.Methods:Cross-sectional data collection via an online questionnaire on facilitators for and barriers toparticipation in radiography research was carried out among 507 clinical radiographers in publichealthcare in the Nordic countries: Denmark, Finland, Norway and Sweden.Results:Support from colleagues (odds ratio [OR] 2.62) and other professionals (OR 2.74), and self-esteem in research skills (OR2.21), were facilitators for radiography research. Lack of knowledgeand skills to conduct research (OR 2.48) was revealed to hinder radiographers’participation in research.The absence of a radiography research culture in the workplace explained non-participation in research(OR 1.75).Conclusion:This study revealed significant factors for clinical radiographers’participation in research.Implications for practice:A strategy for establishing a radiography research culture in healthcare isproposed that is novel for the context. Management support for knowledge development and activityleading to inter-professional research projects across knowledgefields, provision of a radiographyresearch lead and acknowledgement of radiography research among colleagues signify the establishmentof the culture. These prerequisites might provide a paradigm change towards not only the symbiosis of aclinical radiographer and an autonomous researcher but also a partner who adds radiography research toevidence-based practice in diagnostic imaging

Radiographers' involvement in research activities and opinions on radiography research : A Nordic survey

INTRODUCTION: Radiographers' engagement in research is important for the development of evidence-based practice in radiography; however, radiographers' interest in research has rarely been reported. This study sought to ascertain radiographers' opinions about radiography research and investigate their involvement in research activities in four Nordic countries.METHODS: This study was conducted in Denmark, Finland, Norway and Sweden. A study-specific questionnaire was developed in English and adapted to each language of the study sample, and the content and face validity of the adaptations were evaluated. An online tool was used to collect the study data. The questionnaire link was distributed in September 2019 to radiographers working in clinical settings in four Nordic countries (n = 4572).RESULTS: The overall response rate was 14% (n = 662/4572). Research involvement was reported by 33% of the respondents; data collection was the main type of contribution. Radiographers who contributed to research were more likely to be male, have longer work experience, hold a master's or doctoral degree, work as managers and be employed in university hospitals. Nearly all agreed that radiography research is needed to promote the radiography profession and provide the evidence base for radiographic practice. However, only 14% were aware of the current research evidence regarding their professional field of specialisation, and 19% indicated that they developed current practices based on research evidence.CONCLUSION: The findings indicate that, although radiographers had positive attitudes towards radiography research, their involvement in research and utilisation of research evidence in practice is low.IMPLICATIONS FOR PRACTICE: Strategies should be developed to improve knowledge and skills related to evidence-based practice and stimulate radiographers' engagement in research

Correlation of Genotype and In Vitro Susceptibilities of Cryptococcus gattii Strains from the Pacific Northwest of the United States▿

Cryptococcus gattii emerged in North America in 1999 as a human and veterinary pathogen on Vancouver Island, British Columbia. The emergent subtype, VGIIa, and the closely related subtype VGIIb can now be found in the United States in Washington, Oregon, and California. We performed multilocus sequence typing and antifungal susceptibility testing on 43 isolates of C. gattii from human patients in Oregon, Washington, California, and Idaho. In contrast to Vancouver Island, VGIIa was the most frequent but not the predominant subtype in the northwest United States. Antifungal susceptibility testing showed statistically significant differences in MICs between the subtypes. This is the first study to apply antifungal susceptibility testing to C. gattii isolates from the Pacific Northwest and the first to make direct comparisons between subtypes