Internal quality assurance in diagnostic microbiology: A simple approach for insightful data.

Given the importance of microbiology results on patient care, high quality standards are expected. Internal quality assurance (IQA) could mitigate the limitations of internal quality control, competency assessment and external quality assurance, adding a longitudinal insight, including pre- and post-analytical steps. Here, we implemented an IQA program in our clinical microbiology facilities with blind resubmission of routine samples during 22 months. One-hundred-and-twenty-one out of 123 (98.4%) serological analyses and 112 out of 122 (91.8%) molecular analyses were concordant. Among the discordances in molecular biology analyses, 6 results were low positive samples that turned out negative, likely due to stochastic repartition of nucleic acids. Moreover, one identified retranscription error led us to implement automated results transmission from the Applied Biosystems instruments to the laboratory information system (LIS). Regarding Gram stain microscopy, 560 out of 745 (75.2%) of compared parameters were concordant. As many as 67 out of 84 (79.8%) pairs of culture results were similar, including 16 sterile pairs, 27 having identical identification or description and semi-quantification and 24 only showing variations in semi-quantification with identical description or identification of colonies. Seventeen pairs had diverging identification or description of colonies. Culture was twice only done for one member of the pairs. Regarding antibiotic susceptibility testing, a major discrepancy was observed in 5 out of 48 results (10.4%). In conclusion, serological tests were highly reproducible. Molecular diagnosis also revealed to be robust except when the amounts of nucleic acids present in the sample were close to the limits of detection. Conventional microbiology was less robust with major discrepancies reaching 39.5% of the samples for microscopy. Similarly, culture and antibiotic susceptibility testing were prone to discrepancies. This work was ground for reconsidering multiples aspects of our practices and demonstrates the importance of IQA to complete the other quality management procedures

Distinct roles in autophagy and importance in infectivity of the two ATG4 cysteine peptidases of leishmania major

Macroautophagy in Leishmania, which is important for the cellular remodeling required during differentiation, relies upon the hydrolytic activity of two ATG4 cysteine peptidases (ATG4.1 and ATG4.2). We have investigated the individual contributions of each ATG4 to Leishmania major by generating individual gene deletion mutants (Δatg4.1 and Δatg4.2); double mutants could not be generated, indicating that ATG4 activity is required for parasite viability. Both mutants were viable as promastigotes and infected macrophages in vitro and mice, but Δatg4.2 survived poorly irrespective of infection with promastigotes or amastigotes, whereas this was the case only when promastigotes of Δatg4.1 were used. Promastigotes of Δatg4.2 but not Δatg4.1 were more susceptible than wild type promastigotes to starvation and oxidative stresses, which correlated with increased reactive oxygen species levels and oxidatively damaged proteins in the cells as well as impaired mitochondrial function. The antioxidant N-acetylcysteine reversed this phenotype, reducing both basal and induced autophagy and restoring mitochondrial function, indicating a relationship between reactive oxygen species levels and autophagy. Deletion of ATG4.2 had a more dramatic effect upon autophagy than did deletion of ATG4.1. This phenotype is consistent with a reduced efficiency in the autophagic process in Δatg4.2, possibly due to ATG4.2 having a key role in removal of ATG8 from mature autophagosomes and thus facilitating delivery to the lysosomal network. These findings show that there is a level of functional redundancy between the two ATG4s, and that ATG4.2 appears to be the more important. Moreover, the low infectivity of Δatg4.2 demonstrates that autophagy is important for the virulence of the parasite

Endoscopic Treatment of Vesicoureteral Reflux with Dextranomer/Hyaluronic Acid in Children

Purpose. The goal of this review is to present current indications, injectable agents, techniques, success rates, complications, and potential future applications of endoscopic treatment for vesicoureteral reflux (VUR) in children. Materials and Methods. The endoscopic method currently achieving one of the highest success rates is the double hydrodistention-implantation technique (HIT). This method employs dextranomer/hyaluronic acid copolymer, which has been used in pediatric urology for over 10 years and may be at present the first choice injectable agent due to its safety and efficacy. Results. While most contemporary series report cure rates of greater than 85% for primary VUR, success rates of complicated cases of VUR may be, depending on the case, significantly lower. Endoscopic treatment offers major advantages to patients while avoiding potentially complicated open surgery. As the HIT method continues to be applied to complex cases of VUR and more outcome data become available, the indication for endoscopic treatment may exceed the scope of primary VUR. Conclusions. Endoscopic injection is emerging as the treatment of choice for VUR in children

Zukunftstrends im Tourismus

Trotz internationalem Terrorismus, extremen Wetterereignissen und wirtschaftlichen Krisensymptomen ist die Reiselust der Deutschen nicht nachhaltig beeinträchtigt. Das globale System Tourismus scheint sich – auch unter dem Einfluss von Strukturbrüchen und Krisen – flexibel an die Wirklichkeit der Risikogesellschaft zu adaptieren und wird seinem Ruf als Boombranche gerecht. Wie aber sieht die Zukunft des Tourismus aus? Kann er der Vision einer Leitökonomie des 21. Jahrhunderts auch weiterhin gerecht werden? Die Autoren skizzieren in diesem Band mögliche Entwicklungspfade und Zukünfte des Tourismus und erörtern hierauf bezogenen Forschungs- und Handlungsbedarf. Im Mittelpunkt stehen dabei drei thematische Felder von hoher Relevanz: Die Implikationen des soziodemografischen Wandels für den Tourismus; die Einflüsse, die von der EU-Erweiterung auf den Tourismus und die Strategien der Reiseanbieter ausgehen; sowie Fragen der Sicherheit – hier geht es u.a. um die Wahrnehmung und Kommunikation von Risiken mit ihren Auswirkungen für Reiseentscheidungen und um Konzepte der Krisenprävention und des Krisenmanagements auf Seiten der nationalen wie der internationalen Akteure

Partizipative Verfahren der Technikfolgen-Abschätzung und parlamentarische Politikberatung: neue Formen der Kommunikation zwischen Wissenschaft, Politik und Öffentlichkeit

Im vorliegenden Arbeitsbericht wird den Möglichkeiten und Grenzen neuer Formen der Beratung wissenschafts- und technologiepolitischer Fragen in der Zusammenarbeit von Wissenschaft, Politik und Öffentlichkeit nachgegangen. Der Bericht arbeitet die sozialwissenschaftliche Diskussion um eine Neubestimmung der gesellschaftlichen Rolle von Wissenschaft auf, sichtet die vorliegenden Erfahrungen mit neuen Formen der Kooperation von Experten, Bürgern und politischen Entscheidungsträgern und erörtert auf dieser Basis die Möglichkeiten einer stärkeren Berücksichtigung partizipativer Verfahren im Kontext parlamentarischer Beratungsprozesse zu wissenschafts- und technologiepolitischen Fragen. INHALT ZUSAMMENFASSUNG 3 I. EINLEITUNG 9 II. POLITIK, ÖFFENTLICHKEIT UND WISSENSCHAFT IN TECHNIKKONTROVERSEN 13 1. Politische Öffentlichkeit 15 2. Formwandel staatlicher Steuerung 17 3. Gesellschaftlicher Status von Wissenschaft 18 4. Zwei Modi der Legitimation von Entscheidungen 20 III. PARLAMENT, ÖFFENTLICHKEIT UND POLITIKBERATUNG 23 1. Enquete-Kommissionen und Öffentlichkeit 23 2. Parlamentarische TA-Einrichtungen in Europa 30 IV. PARTIZIPATION UND KOOPERATION – NEUE FORMEN DES DIALOGS 35 1. Nachhaltigkeitsforschung 35 2. Partizipative Verfahren der Technikbewertung 41 2.1 Stakeholder-Verfahren 43 2.2 Bürgerberatung 47 2.3 Aktuelle Tendenzen bei partizipativen TA-Verfahren 49 V. BEWERTUNG PARTIZIPATIVER VERFAHREN 53 1. Demokratietheoretische Einordnung 53 2. Verbindlichkeit und politischer Stellenwert der Verfahren 56 3. Fazit 59 VI. NEUE FORMEN DES DIALOGS UND PARLAMENT 61 LITERATUR 67 1. In Auftrag gegebene Gutachten 67 2. Weitere Literatur 67 ANHANG 7