Initial therapy received by <i>Cryptococcus gattii</i> patients.

<p>Initial therapy received by <i>Cryptococcus gattii</i> patients.</p

Three-month mortality among patients by site of infection and by initial therapy received^*.

<p>*Mortality measured from date of diagnosis; 4 patients died prior to diagnosis and receipt of antifungal therapy and are not included in this table.</p

Characteristics of patients with invasive <i>Cryptococcus gattii</i> infection in United States Pacific Northwest who survived to diagnosis (N = 70).

a<p>VGII molecular type isolates include isolates from the three outbreak genotypes, VGIIa, VGIIb, and VGIIc.</p>b<p>n = 69.</p>c<p>Categories not mutually exclusive.</p

The EU Strategy for the Baltic Sea Region and the Presence of Russia

The aim of this paper is to reveal how the European – Russian political cooperation in the common Baltic Sea Region developed over the last twenty years, ending up at the recently adopted European Union Strategy for the Baltic Sea Region, which excludes Russian participation. This single case study is divided into two well-defined historical periods: starting from the fall of the Berlin Wall until the Eastern Bloc European enlargement and from 2004 to the adoption of the European Union Strategy for the Baltic Sea region in 2009; where comparison and process-tracing methods are applied to connect different variables that matter for clarifying the current state of relations. Furthermore, the analysis is conducted with the help of Constructivist and Neo-Realist theories for two purposes – to achieve stronger scientific explanation and to avoid too loose interpretation of the events. The results show that the Strategy for the Baltic Sea Region is often seen and understood differently by the various political actors, but consequently this leads to a situation in which the role of Russia in the common region remains unclear. When it comes to defining the Russian position today, the Baltic Sea Region provides a good climate for collaboration but so far, the European Union has failed to recognize that the Russian Federation although with a limited access to the sea, remains an actor that should not be ignored. Russia, as well appears confused about its overall foreign policy towards the European Union. Nevertheless, another significant outcome reveals that the levels of regional cooperation have been continuously increasing over the last twenty years, which is an indicator that the Russian presence did not diminish. Finally, the study suggests the European Union Strategy for the Baltic Sea Region is perhaps the beginning of a new tendency towards macro-regional policy development, which will play a future important role in the international relations

<i>Cryptococcus</i><i> gattii</i> in the United States: Genotypic Diversity of Human and Veterinary Isolates

<div><p>Background</p><p><i>Cryptococcus</i><i>gattii</i> infections are being reported in the United States (US) with increasing frequency. Initially, US reports were primarily associated with an ongoing <i>C</i><i>. gattii</i> outbreak in the Pacific Northwest (PNW) states of Washington and Oregon, starting in 2004. However, reports of <i>C</i><i>. gattii</i> infections in patients from other US states have been increasing since 2009. Whether this is due to increasing frequency of disease, greater recognition within the clinical community, or both is currently unknown.</p> <p>Methodology/Principal Findings</p><p>During 2005–2013, a total of 273 <i>C</i><i>. gattii</i> isolates from human and veterinary sources in 16 US states were collected. Of these, 214 (78%) were from the Pacific Northwest (PNW) and comprised primarily the clonal <i>C</i><i>. gattii</i> genotypes VGIIa (64%), VGIIc (21%) and VGIIb (9%). The 59 isolates from outside the PNW were predominantly molecular types VGIII (44%) and VGI (41%). Genotyping using multilocus sequence typing revealed small clusters, including a cluster of VGI isolates from the southeastern US, and an unrelated cluster of VGI isolates and a large cluster of VGIII isolates from California. Most of the isolates were mating type MATα, including all of the VGII isolates, but one VGI and three VGIII isolates were mating type MAT<b>a</b>.</p> <p>Conclusions/Significance</p><p>We provide the most comprehensive report to date of genotypic diversity of US <i>C</i><i>. gattii</i> isolates both inside and outside of the PNW. <i>C</i><i>. gattii</i> may have multiple endemic regions in the US, including a previously-unrecognized endemic region in the southeast. Regional clusters exist both in California and the Southeastern US. VGII strains associated with the PNW outbreak do not appear to have spread substantially beyond the PNW.</p> </div

US map showing <i>C</i><i>. gattii</i> distribution.

<p>The map shows the distribution of <i>C</i><i>. gattii</i> molecular types by the state of origin. Because complete travel histories are not known for all patients contributing isolates, it is possible that some infections were acquired in states other than the ones in which they were recognized.</p

Phylogenetic analysis of VGIII isolates.

<p>The neighbor-joining tree was constructed using the maximum-likelihood model and reveals two well supported clades. Bootstrap values (1000 replicates) are shown next to the branches. CA isolates are blue, Pacific Northwest isolates are red and Southeast US isolates are green.</p

Leftover Chicken Products Collected from Case-Patient Homes, Multistate Outbreak of Multidrug-Resistant <i>Salmonella</i> Heidelberg Infections Linked to a Single Poultry Company, 2013–2014.

<p>Leftover Chicken Products Collected from Case-Patient Homes, Multistate Outbreak of Multidrug-Resistant <i>Salmonella</i> Heidelberg Infections Linked to a Single Poultry Company, 2013–2014.</p

Persons Infected with the Outbreak Strains of <i>Salmonella</i> Heidelberg by State, n = 634, 2013–2014.

<p>Persons Infected with the Outbreak Strains of <i>Salmonella</i> Heidelberg by State, n = 634, 2013–2014.</p

Persons Infected with the Outbreak Strains of <i>Salmonella</i> Heidelberg, by Week of Illness Onset, March 2013-July 2014.

<p>Persons Infected with the Outbreak Strains of <i>Salmonella</i> Heidelberg, by Week of Illness Onset, March 2013-July 2014.</p