Laboratory surveillance of communicable diseases : enteric pathogens

Laboratories represent a crucial link in the surveillance chain. Since only a small proportion of cases of enteric infections are asked to submit a stool sample, one needs to assess the practices for testing for enteric pathogens and their notification practices. Five local laboratories participated in this study. This included a description of the laboratory practices; capacity for stool sample analysis; awareness of the notification system and the factors which could improve the system at laboratory level.peer-reviewe

Infectious intestinal disease : do we know it all?

Infectious intestinal disease (IID), with associated high morbidity and considerable mortality worldwide, causes a wide spectrum of illness. This ranges from mild discomfort to illness with severe complications. The economic burden from direct and indirect costs may be high. It is acquired by oral ingestion of micro-organisms which are transmitted from person to person; via food or water or through contact with animals or contaminated objects. Viruses are the commonest cause in developed countries. In Malta, medical practitioners and laboratories are the main source of data on IID. However, under-reporting is a problem. In order to fill in the lacunae in information on the disease burden, population-based-studies are required. Along with other countries, Malta has embarked on a number of studies to describe and quantify under-reporting of IID. This may assist in strengthening the surveillance system which, in combination with other measures, should result in an improvement of the control of IID.peer-reviewe

Scaling up antiretroviral therapy in Malawi-implications for managing other chronic diseases in resource-limited countries.

The national scale-up of antiretroviral therapy (ART) in Malawi is based on the public health approach, with principles and practices borrowed from the successful DOTS (directly observed treatment, short course) tuberculosis control framework. The key principles include political commitment, free care, and standardized systems for case finding, treatment, recording and reporting, and drug procurement. Scale-up of ART started in June 2004, and by December 2008, 223,437 patients were registered for treatment within a health system that is severely underresourced. The Malawi model for delivering lifelong ART can be adapted and used for managing patients with chronic noncommunicable diseases, the burden of which is already high and continues to grow in low-income and middle-income countries. This article discusses how the principles behind the successful Malawi model of ART delivery can be applied to the management of other chronic diseases in resource-limited settings and how this paradigm can be used for health systems strengthening

Genome-wide association mapping of zinc and iron concentration in barley landraces from Ethiopia and Eritrea

Mamo, B.E., Barber, B., Steffenson, B.J., 2014. Genome- wide association mapping of zinc and iron concentration in barley landraces from Ethiopia and Eritrea. J. Cereal Sci. XX, XX-XX.Barley is one of the oldest cultivated crop plants and is a major part of a staple diet in some developing countries. The objectives of this study were to characterize genetic variation in grain zinc and iron concentration and kernel weight, and identify quantitative trait loci (QTL) associated with these traits in barley landraces from Ethiopia/Eritrea using a genome-wide association study (GWAS). Barley landraces were grown under greenhouse and field conditions, characterized for micronutrient concentration and kernel weight, and then genotyped with 7842 single nucleotide polymorphism (SNP) markers. The germplasm exhibited a wide range of variation for these traits with some accessions having high levels of zinc and iron. Heritability values of 0.65 and 0.59, respectively, were obtained for zinc and iron concentrations in grain samples harvested from field trials. One QTL associated with grain zinc concentration was identified in a unique genomic location on the long arm of chromosome 6H. For kernel weight, a known QTL region on the long arm of chromosome 2H was detected. This study demonstrates the existence of high genetic variation for grain zinc and iron concentration in Ethiopian/Eritrean barley landraces and also the utility of GWAS for identifying and mapping QTL underlying micronutrient accumulation

Using engineering design tools in multidisciplinary distributed student teams

Collaborative design practice in distributed student teams is becoming more popular as technology makes it easier to communicate ideas with others that are geographically distant. However, a challenge for students is to use design tools which they are not familiar with. These design tools usually differ from each other and engineers may find it much more difficult to share their ideas. This could make the whole design process longer and less successful. Each year the University of Malta, City University London and University of Strathclyde organise a joint collaborative design project, involving engineering students with different disciplines and cultural backgrounds. In this paper, the patterns of use of design tools by students to collaborate with each other are investigated. Based on survey results of students, this paper proposes an approach which can be utilised by engineering students to enhance collaboration in multidisciplinary distributed design teams

Real-time in vivo dosimetry in high dose rate prostate brachytherapy

Background and purpose: Single fraction treatments of 15 Gy or 19 Gy are common in HDR prostate brachytherapy. In vivo dosimetry (IVD) is therefore important to ensure patient safety. This study assesses clinical IVD and investigates error detection thresholds for real-time treatment monitoring. Materials and methods: IVD was performed for 40 treatments planned using intra-operative trans-rectal ultrasound (TRUS) with a MOSFET inserted into an additional needle. Post-treatment TRUS images were acquired for 20 patients to assess needle movement. Monte Carlo simulations of treatment plans were performed for 10 patients to assess impact of heterogeneities. Per-needle and total plan uncertainties were estimated and retrospectively applied to the measured data as error detection thresholds. Results: The mean measured dose was −6.4% compared to prediction (range + 5.1% to −15.2%). Needle movement and heterogeneities accounted for −1.8% and −1.6% of this difference respectively (mean values for the patients analysed). Total plan uncertainty (k = 2) ranged from 11% to 17% and per needle uncertainty (k = 2) ranged from 18% to 110% (mean 31%). One out of 40 plans and 5% of needles were outside k = 2 error detection threshold. Conclusions: IVD showed good agreement with predicted dose within measurement uncertainties, providing reassurance in the accuracy of dose delivery. Thresholds for real-time error detection should be calculated on an individual plan/needle basis

Genetic Characterization of Resistance to Wheat Stem Rust Race TTKSK in Landrace and Wild Barley Accessions Identifies the rpg4/Rpg5 Locus.

Race TTKSK of the wheat stem rust pathogen (Puccinia graminis f. sp. tritici) threatens the production of wheat and barley worldwide because of its broad-spectrum virulence on many widely grown cultivars. Sources of resistance against race TTKSK were recently identified in several barley landraces (Hordeum vulgare subsp. vulgare) and wild barley accessions (H. vulgare subsp. spontaneum). The objectives of this study were to characterize the inheritance of resistance to wheat stem rust race TTKSK in four barley landraces (Hv501, Hv545, Hv602, and Hv612) and two wild barley (WBDC213 and WBDC345) accessions, map the resistance genes, and determine the allelic relationships among the genes in these accessions and the previously described rpg4/Rpg5 locus. Resistant accessions were crossed with the susceptible cv. Steptoe and resulting F3 populations were evaluated for resistance to race TTKSK at the seedling stage. Segregation of F3 families in populations involving the resistance sources of Hv501, Hv545, Hv612, WBDC213, and WBDC345 fit a 1:2:1 ratio for homozygous resistant (HR)/segregating (SEG)/homozygous susceptible (HS) progenies (with χ2=2.27 to 5.87 and P=0.053 to 0.321), indicating that a single gene confers resistance to race TTKSK. Segregation of F3 families in cross Steptoe/Hv602 did not fit a 1:2:1 ratio (HR/SEG/HS of 20:47:43 with χ2=11.95 and P=0.003), indicating that more than one gene is involved in imparting resistance to race TTKSK. Bulked segregant analysis using >1,500 single-nucleotide polymorphism markers positioned a resistance locus in all six populations on chromosome 5HL in very close proximity to the known location of the rpg4/Rpg5 complex locus. Allelism tests were conducted by making crosses among resistant accessions Hv501, Hv545, and Hv612 and also Q21861 with the rpg4/Rpg5 complex. No segregation was observed in F2 families inoculated with race TTKSK, demonstrating that all Hv lines carry the same allele for resistance and that it resides at or very near the rpg4/Rpg5 locus. Phenotype evaluations of the six barley accessions with wheat stem rust race QCCJ revealed resistant infection types (ITs) at a low incubation temperature and susceptible ITs at a high incubation temperature, similar to Q21861, which carries the temperature-sensitive gene rpg4. The accessions also exhibited low ITs against the rye stem rust isolate 92-MN-90, suggesting that they also carry Rpg5. This result was confirmed through molecular analysis, which revealed that all six barley accessions contain the serine threonine protein kinase domain that confers Rpg5 resistance. These results indicate that cultivated barley is extremely vulnerable to African stem rust races such as TTKSK because even these diverse selections of landrace and wild barley accessions carry only one locus for resistance

The intersection of pharmacology, imaging, and genetics in the development of personalized medicine

We currently rely on large randomized controlled trials and meta-analyses to make clinical decisions; this places us at a risk of discarding subgroup or individually specific treatment options owing to their failure to prove efficacious across entire populations. There is a new era emerging in personalized medicine that will focus on individual differences that are not evident phenomenologically. Much research is directed towards identifying genes, endophenotypes, and biomarkers of disease that will facilitate diagnosis and predict treatment outcome. We are at the threshold of being able to predict treatment response, primarily through genetics and neuroimaging. In this review we discuss the most promising markers of treatment response and adverse effects emerging from the areas of pharmacogenetics and neuroimaging in depression and schizophrenia.peer-reviewe