Genomic characterisation of an endometrial pathogenic <i>Escherichia coli</i> strain reveals the acquisition of genetic elements associated with extra-intestinal pathogenicity

&lt;b&gt;Background&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Strains of &lt;i&gt;Escherichia coli&lt;/i&gt; cause a wide variety of intestinal and extra-intestinal diseases in both humans and animals, and are also often found in healthy individuals or the environment. Broadly, a strong phylogenetic relationship exists that distinguishes most &lt;i&gt;E. Coli&lt;/i&gt; causing intestinal disease from those that cause extra-intestinal disease, however, isolates within a recently described subclass of Extra-Intestinal Pathogenic &lt;i&gt;E. Coli&lt;/i&gt; (ExPEC), termed endometrial pathogenic &lt;i&gt;E. Coli&lt;/i&gt;, tend to be phylogenetically distant from the vast majority of characterised ExPECs, and more closely related to human intestinal pathogens. In this work, we investigate the genetic basis for ExPEC infection in the prototypic endometrial pathogenic &lt;i&gt;E. Coli&lt;/i&gt; strain MS499.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt;&lt;p&gt;&lt;/p&gt; By investigating the genome of MS499 in comparison with a range of other E. coli sequences, we have discovered that this bacterium has acquired substantial lengths of DNA which encode factors more usually associated with ExPECs and less frequently found in the phylogroup relatives of MS499. Many of these acquired factors, including several iron acquisition systems and a virulence plasmid similar to that found in several ExPECs such as APEC O1 and the neonatal meningitis &lt;i&gt;E. Coli&lt;/i&gt; S88, play characterised roles in a variety of typical ExPEC infections and appear to have been acquired recently by the evolutionary lineage leading to MS499.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Taking advantage of the phylogenetic relationship we describe between MS499 and several other closely related &lt;i&gt;E. Coli&lt;/i&gt; isolates from across the globe, we propose a step-wise evolution of a novel clade of sequence type 453 ExPECs within phylogroup B1, involving the recruitment of ExPEC virulence factors into the genome of an ancestrally non-extraintestinal &lt;i&gt;E. Coli&lt;/i&gt;, which has repurposed this lineage with the capacity to cause extraintestinal disease. These data reveal the genetic components which may be involved in this phenotype switching, and argue that horizontal gene exchange may be a key factor in the emergence of novel lineages of ExPECs.&lt;p&gt;&lt;/p&gt

Does \u27Free-Sampling\u27 Enhance the Value of Public Goods?

This study investigates whether a \u27free sampling\u27 marketing strategy induces an enduring WTP premium effect for public goods. Using data from a unique field experiment involving curbside recycling, we find that the premium effect associated with providing non-participating households a brief opportunity to participate in a curbside recycling program for free is relatively small and not enduring. It may therefore not be cost effective to offer a free-sampling participation incentive for this type (or similar types) of local public good(s)

The Miseducation of Welfare Reform: Denying the Promise of Postsecondary Education

When Congress enacted “welfare reform” in 1996, decades of progress in assisting low-income mothers obtain a college education in order to escape poverty was nearly eradicated. The federal welfare reform law strongly discouraged states from incorporating postsecondary education into their welfare reform programs and focused instead on “work-first” policies. As a direct result, hundreds of thousands of low-income mothers across the country were forced to drop out of college and find jobs in order to comply with strict “work-first” welfare rules. Despite the pressure imposed by the federal law, the State of Maine persevered in its effort to make college a reality for low-income mothers. Advocates in Maine were adamant that welfare reform policies focus on raising families out of poverty and endeavor to change the position of women in the labor market in order to relieve poverty for low-income single mothers. These farsighted views, embodied in the Maine Parents as Scholars program, have paid off for welfare recipients and for the state, with dividends. As the welfare reform law expires, Congress has the opportunity to reverse course and support states in providing access to postsecondary education for welfare recipients. In this paper, we will reveal how “work-first” ideology pushed the merits of postsecondary education for low-income women to the background despite the well-known, intimate relationship between higher education and women\u27s earnings, employment, and well-being. We will highlight the innovative approach taken in Maine to overcome the pressures of the federal welfare reform law and report on positive outcomes for Maine welfare recipients who were able to access higher education despite federal restrictions. Finally, we will explore the current Congressional proposals for renewing the welfare reform law in a manner more conducive to allowing low-income mothers access to education

Operative versus nonoperative treatment of acute Achilles tendon ruptures: A pilot economic decision analysis

Background: The operative treatment of Achilles tendon ruptures has been associated with lower rerupture rates and better function but also a risk of surgery-related complications compared with nonoperative treatment, which may provide improved outcomes with accelerated rehabilitation protocols. However, economic decision analyses integrating the updated costs of both treatment options are limited in the literature. Purpose: To compare the cost-effectiveness of operative and nonoperative treatment of acute Achilles tendon tears. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: An economic decision model was built to assess the cost-utility ratio (CUR) of open primary repair versus nonoperative treatment for acute Achilles tendon ruptures, based on direct costs from the practices of sports medicine and foot and ankle surgeons at a single tertiary academic center, with published outcome probabilities and patient utility data. Multiway sensitivity analyses were performed to reflect the range of data. Results: Nonoperative treatment was more cost-effective in the average scenario (nonoperative CUR, US$520; operative CUR, US$1995), but crossover occurred during the sensitivity analysis (nonoperative CUR range, US$224-US$2079; operative CUR range, US$789-US$8380). Operative treatment cost an extra average marginal CUR of US$1475 compared with nonoperative treatment, assuming uneventful healing in both treatment arms. The sensitivity analysis demonstrated a decreased marginal CUR of operative treatment when the outcome utility was maximized, and rerupture rates were minimized compared with nonoperative treatment. Conclusion: Nonoperative treatment was more cost-effective in average scenarios. Crossover indicated that open primary repair would be favorable for maximized outcome utility, such as that for young athletes or heavy laborers. The treatment decision for acute Achilles tendon ruptures should be individualized. These pilot results provide inferences for further longitudinal analyses incorporating future clinical evidence

Preliminary age-based life history characteristics of the dogtooth tuna, Gymnosarda unicolor (Ruppell, 1838), in the southwest Pacific Ocean

Dogtooth tuna, Gymnosarda unicolor were sampled off the east coast of Australia (southwest Pacific Ocean) from 2007 to 2012. Ages were determined by examining thin transverse sections of their sagittal otoliths and were based on counts of alternating opaque and translucent zones (annual growth increments). Growth was rapid during the first year of life, after which growth in length was much reduced. Parameters of the constrained von Bertalanffy growth function (fork length-at-age) were L∞ = 1164.77 (mm, FL) and K = 0.44 year−1. Preliminary estimates of longevity indicate a maximum observed age of at least 20 years. There was a high degree of variation in the observed length and age of sexual maturity for G. unicolor. Despite this variation, the size at 50% maturity for female G. unicolor estimated in this study was 713 mm FL (<2 years of age). The diet of G. unicolor is very broad and covers a range of fish species. The life history characteristics of G. unicolor overall, indicate that this species may be somewhat resilient to fishing. However, reports of localised depletions, in association with heavy targeting by sports fishers, low effective population sizes and patchy recruitment indicate that this species is particularly vulnerable to overfishing

Salt Links Dominate Affinity of Antibody HyHEL-5 for Lysozyme through Enthalpic Contributions*

The binding of murine monoclonal antibody HyHEL-5 to lysozyme has been the subject of extensive crystallographic, computational, and experimental investigations. The complex of HyHEL-5 with hen egg lysozyme (HEL) features salt bridges between Fab heavy chain residue Glu50, and Arg45 and Arg68 of HEL. This interaction has been predicted to play a dominant role in the association on the basis of molecular electrostatics calculations. The association of aspartic acid and glutamine mutants at position 50H of the cloned HyHEL-5 Fab with HEL and bobwhite quail lysozyme (BQL), an avian variant bearing an Arg68 ? Lys substitution in the epitope, was characterized by isothermal titration calorimetry and sedimentation equilibrium. Affinities for HEL were reduced by 400-fold (E50HD) and 40,000-fold (E50HQ) (??G� estimated at 4.0 and 6.4 kcal mol?1, respectively). The same mutations reduce affinity for BQL by only 7- and 55-fold, respectively, indicating a reduced specificity for HEL. The loss of affinity upon mutation is in each case primarily due to an unfavorable change in the enthalpy of the interaction; the entropic contribution is virtually unchanged. An enthalpy-entropy compensation exists for each interaction; ?H� decreases, while ?S� increases with temperature. The ?Cp for each mutant interaction is less negative than the wild-type. Mutant-cycle analysis suggests the mutations present in the HyHEL-5 Fab mutants are linked to those present in the BQL with coupling energies between 3 and 4 kcal mol?1

Exploring the impact of an Aboriginal Health Worker on hospitalised Aboriginal experiences: lessons from cardiology.

To enhance Aboriginal inpatient care and improve outpatient cardiac rehabilitation utilisation, a tertiary hospital in Western Australia recruited an Aboriginal Health Worker (AHW). Interviews were undertaken with the cardiology AHW, other hospital staff including another AHW, and recent Aboriginal cardiac patients to assess the impact of this position. The impact of the AHW included facilitating culturally appropriate care, bridging communication divides, reducing discharges against medical advice, providing cultural education, increasing inpatient contact time, improving follow-up practices and enhancing patient referral linkages. Challenges included poor job role definition, clinical restrictions and limitations in AHW training for hospital settings. This study demonstrates that AHWs can have significant impacts on Aboriginal cardiac inpatient experiences and outpatient care. Although this study was undertaken in cardiology, the lessons are transferable across the hospital setting

A new concept in cancer care: The supportive care program

This article describes the findings of a pilot program designed to enter advanced prostate cancer patients into the hospice benefit while they are still being actively treated, but in situations where treatment is known to be primarily palliative in nature. The supportive care program (SCP) combines the medical model’s goal to prolong life with the goal of hospice to palliate symptoms and improve quality of life (QOL). The concept of a SCP was developed to create a team approach where advanced prostate cancer patients who are starting investigational chemotherapy are concurrently enrolled into a hospice program. The objectives were to identify whether SCP improved QOL and continuity of care while remaining cost-effective. Data were collected on patient quality of life, performance status, use of health care resources, and costs for the 36 enrolled patients. A comparison was made to a matched set of 23 control patients. Our findings indicate that the SCP contributes to continuity of care while being cost-effective.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66626/2/10.1177_104990919901600608.pd