Shuffling of mobile genetic elements (MGEs) in successful healthcare-associated MRSA (HA-MRSA).

Methicillin-resistant Staphylococcus aureus (MRSA) CC22 SCCmecIV is a successful hospital-associated (HA-) MRSA, widespread throughout the world, and now the dominant clone in UK hospitals. We have recently shown that MRSA CC22 is a particularly fit clone, and it rose to dominance in a UK hospital at the same time as it began acquiring an increased range of antibiotic resistances. These resistances were not accumulated by individual CC22 isolates, but appear to shuffle frequently between isolates of the MRSA CC22 population. Resistances are often encoded on mobile genetic elements (MGEs) that include plasmids, transposons, bacteriophage and S. aureus pathogenicity islands (SaPIs). Using multi-strain whole genome microarrays, we show that there is enormous diversity of MGE carried within a MRSA CC22 SCCmecIV population, even among isolates from the same hospital and time period. MGE profiles were so variable that they could be used to track the spread of variant isolates within the hospital. We exploited this to show that the majority of patients colonised with MRSA at hospital admission that subsequently became infected were infected with their own colonising isolate. Our studies reveal MGE spread, stability, selection and clonal adaptation to the healthcare setting may be key to the success of HA-MRSA clones, presumably by allowing rapid adaptation to antibiotic exposure and new hosts

Implications of eocene-age philippine sea and forearc basalts for initiation and early history of the izu-bonin-mariana arc

Whole-rock isotope ratio (Hf, Nd, Pb, Sr) and trace element data for basement rocks at ocean drilling Sites U1438, 1201 and 447 immediately west of the KPR (Kyushu-Palau Ridge) are compared to those of FAB (forearc basalts) previously interpreted to be the initial products of IBM subduction volcanism. West-of-KPR basement basalts (drill sites U1438, 1201, 447) and FAB occupy the same Hf-Nd and Pb-Pb isotopic space and share distinctive source characteristics with εHf mostly >16.5 and up to εHf =19.8, which is more radiogenic than most Indian mid-ocean ridge basalts (MORB). Lead isotopic ratios are depleted, with ²⁰⁶Pb/²⁰⁴Pb = 17.8-18.8 accompanying relatively high ²⁰⁸Pb/²⁰⁴Pb, indicating an Indian-MORB source unlike that of West Philippine Basin plume basalts. Some Sr isotopes show affects of seawater alteration, but samples with ⁸⁷Sr/⁸⁶Sr8.0 appear to preserve magmatic compositions and also indicate a common source for west-of-KPR basement and FAB. Trace element ratios resistant to seawater alteration (La/Yb, Lu/Hf, Zr/Nb, Sm/Nd) in west-of-KPR basement are generally more depleted than normal MORB and so also appear similar to FAB. At Site U1438, only andesite sills intruding sedimentary rocks overlying the basement have subduction-influenced geochemical characteristics (εNd ∼6.6, εHf ∼13.8, La/Yb > 2.5, Nd/Hf ∼9). The key characteristic that unites drill site basement rocks west of KPR and FAB is the nature of their source, which is more depleted in lithophile trace elements than average MORB but with Hf, Nd, and Pb isotope ratios that are common in MORB. The lithophile element-depleted nature of FAB has been linked to initiation of IBM subduction in the Eocene, but Sm-Nd model ages and errorchron relationships in Site U1438 basement indicate that the depleted character of the rocks is a regional characteristic that was produced well prior to the time of subduction initiation and persists today in the source of modern IBM arc volcanic rocks with Sm/Nd>0.34 and εNd ∼9.0

A current perspective on cancer immune therapy: Step‑by‑step approach to constructing the magic bullet

Immunotherapy is the new trend in cancer treatment due to the selectivity, long lasting effects, and demonstrated improved overall survival and tolerance, when compared to patients treated with conventional chemotherapy. Despite these positive results, immunotherapy is still far from becoming the perfect magic bullet to fight cancer, largely due to the facts that immunotherapy is not effective in all patients nor in all cancer types. How and when will immunotherapy overcome these hurdles? In this review we take a step back to walk side by side with the pioneers of immunotherapy in order to understand what steps need to be taken today to make immunotherapy effective across all cancers. While early scientists, such as Coley, elicited an unselective but effective response against cancer, the search for selectivity pushed immunotherapy to the side in favor of drugs focused on targeting cancer cells. Fortunately, the modern era would revive the importance of the immune system in battling cancer by releasing the brakes or checkpoints (anti-CTLA-4 and anti-PD-1/PD-L1) that have been holding the immune system at bay. However, there are still many hurdles to overcome before immunotherapy becomes a universal cancer therapy. For example, we discuss how the redundant and complex nature of the immune system can impede tumor elimination by teeter tottering between different polarization states: one eliciting anti-cancer effects while the other promoting cancer growth and invasion. In addition, we highlight the incapacity of the immune system to choose between a fight or repair action with respect to tumor growth. Finally we combine these concepts to present a new way to think about the immune system and immune tolerance, by introducing two new metaphors, the “push the accelerator” and “repair the car” metaphors, to explain the current limitations associated with cancer immunotherapyThis work was supported by NIH R00 CA154605 and Louisiana Board of Regents LEQSF(2016-17)-RD-C-14 (H.L.M.), a Rámon y Cajal Merit Award from the Ministerio de Economía y Competitividad, Spain (B.S.Jr) and a Clinic and Laboratory Integration Program (CLIP) grant from the Cancer Research Institute, NY (B.S.Jr)

Status and Potential of Single-cell Transcriptomics for Understanding Plant Development and Functional Biology

Funding Information University of Western Australia Acknowledgments The authors would like to extend sincere thanks to Robert Salomon for inspiring to write this manuscript. Resources were provided by The University of Western Australia.Peer reviewedPostprin

Identifying the interplay of design artifacts and decisions in practice: A Case Study

Interaction design is a complex and challenging process. It encompasses skills and knowledge from design in general as well as from HCI and software design in particular. In order to find better ways to support interaction design and propose methods and tools to further the research in this area we must first better understand the nature of interaction design in practice. In this paper we present two small case studies which attempt to analyse design and decision-making through the lens of one particular theoretical framework. The framework seeks to focus design activities via its artifacts and the design spaces that exist in order to support reasoning about the process and the evolution of the artifacts. Our case studies show that we can use such a framework to consider real-world design projects, and also that there are further considerations that might usefully be included in such a framework

Exploring the uncertainties of early detection results: model-based interpretation of mayo lung project

Background: The Mayo Lung Project (MLP), a randomized controlled clinical trial of lung cancer screening conducted between 1971 and 1986 among male smokers aged 45 or above, demonstrated an increase in lung cancer survival since the time of diagnosis, but no reduction in lung cancer mortality. Whether this result necessarily indicates a lack of mortality benefit for screening remains controversial. A number of hypotheses have been proposed to explain the observed outcome, including over-diagnosis, screening sensitivity, and population heterogeneity (initial difference in lung cancer risks between the two trial arms). This study is intended to provide model-based testing for some of these important arguments.Method: Using a micro-simulation model, the MISCAN-lung model, we explore the possible influence of screening sensitivity, systematic error, over-diagnosis and population heterogeneity.Results: Calibrating screening sensitivity, systematic error, or over-diagnosis does not noticeably improve the fit of the model, whereas calibrating population heterogeneity helps the model predict lung cancer incidence better.Conclusions: Our conclusion is that the hypothesized imperfection in screening sensitivity, systematic error, and over-diagnosis do not in themselves explain the observed trial results. Model fit improvement achieved by accounting for population heterogeneity suggests a higher risk of cancer incidence in the intervention group as compared with the control group

Needle stick injuries among dental students: risk factors and recommendations for prevention

Aim: To evaluate the risk factors of needle stick injuries (NSIs) sustained by undergraduate dental students and nurse students at the King's College London (KCL) Dental Institute. Materials and methods: A retrospective study evaluated the incident reports relating to NSIs reported over a period of 2 years. Factors including the dental department, study year, and when the injury took place during administration of local anaesthesia (LA) and recapping conventional syringe or clearing work surface or during disposal. Results: This report showed that students are at the highest risk of NSIs at the fourth year of their 5-year BDS course. About one-third of injuries were reported among this group of students followed by year 5 students (25%). Oral surgery clinics were the major source of incident reporting when compared with other specialised dental clinics within the institute. The left hands of the students were the most frequently affected by such injuries and then the right hands of student dental nurses. The attempt of needle recapping of conventional syringes was the least reported mechanism of injuries and constituted only 15% of the total injuries and mainly occurred in third year students. The most frequent injuries among student nurses were during disposal of the needle. Conclusion: Less NSIs occur when using safety syringes. A non-recapping policy with immediate disposal of either the conventional or safety syringe systems after injection would prevent all clearance-related NSIs sustained by nurses. To avoid NSIs, education plays a vital role particularly with effective implementation of the change to safety syringes with appropriate training

Percentile reference values for anthropometric body composition indices in European children from the IDEFICS study

INTRODUCTION: To characterise the nutritional status in children with obesity or wasting conditions, European anthropometric reference values for body composition measures beyond the body mass index (BMI) are needed. Differentiated assessment of body composition in children has long been hampered by the lack of appropriate references. OBJECTIVES: The aim of our study is to provide percentiles for body composition indices in normal weight European children, based on the IDEFICS cohort (Identification and prevention of Dietary-and lifestyle-induced health Effects in Children and infantS). METHODS: Overall 18 745 2.0-10.9-year-old children from eight countries participated in the study. Children classified as overweight/obese or underweight according to IOTF (N = 5915) were excluded from the analysis. Anthropometric measurements (BMI (N = 12 830); triceps, subscapular, fat mass and fat mass index (N = 11 845-11 901); biceps, suprailiac skinfolds, sum of skinfolds calculated from skinfold thicknesses (N = 8129-8205), neck circumference (N = 12 241); waist circumference and waist-to-height ratio (N = 12 381)) were analysed stratified by sex and smoothed 1st, 3rd, 10th, 25th, 50th, 75th, 90th, 97th and 99th percentile curves were calculated using GAMLSS. RESULTS: Percentile values of the most important anthropometric measures related to the degree of adiposity are depicted for European girls and boys. Age-and sex-specific differences were investigated for all measures. As an example, the 50th and 99th percentile values of waist circumference ranged from 50.7-59.2 cm and from 51.3-58.7 cm in 4.5-to < 5.0-year-old girls and boys, respectively, to 60.6-74.5 cm in girls and to 59.9-76.7 cm in boys at the age of 10.5-10.9 years. CONCLUSION: The presented percentile curves may aid a differentiated assessment of total and abdominal adiposity in European children