Tracking Staphylococcus aureus in the intensive care unit using whole-genome sequencing.

BACKGROUND: Staphylococcus aureus remains an important bacterial pathogen worldwide. This study utilized known staphylococcal epidemiology to track S. aureus between different ecological reservoirs in one 10-bed intensive care unit (ICU). METHODS: Selected hand-touch surfaces, staff hands and air were screened systematically 10 times during 10 months, with patients screened throughout the study. S. aureus isolates were subjected to spa typing and epidemiological analyses, followed by whole-genome sequencing to provide single nucleotide polymorphism (SNP) data. RESULTS: Multiple transmission pathways between patients and reservoirs were investigated. There were 34 transmission events, of which 29 were highly related (<25 SNPs) and five were possibly related (<50 SNPs). Twenty (59%) transmission events occurred between colonized patients and their own body sites (i.e. autogenous spread); four (12%) were associated with cross-transmission between patients; four (12%) occurred between patients and hand-touch sites (bedrails and intravenous pump); four (12%) linked airborne S. aureus with staff hands and bedrail; and two (6%) linked bed tables, bedrail and cardiac monitor. CONCLUSION: Colonized patients are responsible for repeated introduction of new S. aureus into the ICU, whereupon a proportion spread to hand-touch sites in (or near) the patient zone. This short-term reservoir for S. aureus imposes a colonization/infection risk for subsequent patients. More than half of ICU-acquired S. aureus infection originated from the patients' own flora, while staff hands and air were rarely implicated in onward transmission. Control of staphylococcal infection in the ICU is best served by patient screening, systematic cleaning of hand-touch surfaces and continued emphasis on hand hygiene.

Is there an association between airborne and surface microbes in the critical care environment?

BACKGROUND: There are few data and no accepted standards for air quality in the intensive care unit (ICU). Any relationship between airborne pathogens and hospital-acquired infection (HAI) risk in the ICU remains unknown. AIM: First, to correlate environmental contamination of air and surfaces in the ICU; second, to examine any association between environmental contamination and ICU-acquired staphylococcal infection. METHODS: Patients, air, and surfaces were screened on 10 sampling days in a mechanically ventilated 10-bed ICU for a 10-month period. Near-patient hand-touch sites (N = 500) and air (N = 80) were screened for total colony count and Staphylococcus aureus. Air counts were compared with surface counts according to proposed standards for air and surface bioburden. Patients were monitored for ICU-acquired staphylococcal infection throughout. FINDINGS: Overall, 235 of 500 (47%) surfaces failed the standard for aerobic counts (≤2.5 cfu/cm2). Half of passive air samples (20/40: 50%) failed the 'index of microbial air' contamination (2 cfu/9 cm plate/h), and 15/40 (37.5%) active air samples failed the clean air standard (<10 cfu/m3). Settle plate data were closer to the pass/fail proportion from surfaces and provided the best agreement between air parameters and surfaces when evaluating surface benchmark values of 0-20 cfu/cm2. The surface standard most likely to reflect hygiene pass/fail results compared with air was 5 cfu/cm2. Rates of ICU-acquired staphylococcal infection were associated with surface counts per bed during 72h encompassing sampling days (P = 0.012). CONCLUSION: Passive air sampling provides quantitative data analogous to that obtained from surfaces. Settle plates could serve as a proxy for routine environmental screening to determine the infection risk in ICU.

The influence of aquaculture unit proximity on the pattern of Lepeophtheirus salmonis infection of anadromous Salmo trutta populations on the isle of Skye, Scotland.

A total of 230 anadromous Salmo trutta (brown trout) were sampled in five sheltered coastal fjords (or sea lochs) on the Isle of Skye, Scotland, U.K., in 2016 at varying distances from active Atlantic salmon Salmo salar farms. Statistical models were developed to investigate potential correlations between salmon lice Lepeophtheirus salmonis burdens on S. trutta hosts and their proximity to S. salar farm cages. Significant correlations were found between lice burdens and fish fork length and proximity to the nearest S. salar farm. The probability of the presence of L. salmonis on fish hosts increased with fish host size and with distance from the nearest S. salar farm, but total lice burdens were highest in fish sampled near S. salar farms and decreased with distance. The proportion of different life-cycle stages of L. salmonis were also dependent on S. salar farm proximity, with higher juvenile lice numbers recorded at sites near S. salar farm cages. These results highlight the complexity of the relationship between S. trutta and L. salmonis infections on wild fish and emphasize the requirement of further research to quantify these effects to better inform conservation and management strategies, particularly in areas of active S. salar farm facilities.

Comparison of damage to live v. euthanized Atlantic salmon Salmo salar smolts from passage through an Archimedean screw turbine.

This study assessed the usefulness of passing euthanized Atlantic salmon Salmo salar smolts through an Archimedean screw turbine to test for external damage, as compared with live, actively swimming smolts. Scale loss was the only observed effect. Severe scale loss was 5·9 times more prevalent in euthanized turbine-passed fish (45%) than the live fish (7·6%). Additionally, distinctive patterns of scale loss, consistent with grinding between the turbine helices and housing trough, were observed in 35% of euthanized turbine-passed smolts. This distinctive pattern of scale loss was not seen in live turbine-passed smolts, nor in control groups (live and euthanized smolts released downstream of the turbine), which suggests that the altered behaviour of dead fish in turbine flows generates biased injury outcomes.

The effect of foraging and ontogeny on the prevalence and intensity of the invasive parasite Anguillicola crassus in the European eel Anguilla anguilla.

Infection patterns of the invasive Anguillicola crassus nematode were investigated in a population of the European eel Anguilla anguilla where parasite invasion is very recent, Loch Lomond, Scotland. Intensity levels of the parasite were associated with differences in fish ontogeny and trophic ecology. Although eels foraged on both fish and invertebrates, individuals which were smaller and fed on invertebrates (>70% contribution to diet) were found to contain a greater number of swim bladder parasites compared to larger eel with a predominance of fish (>60% contribution) in their diet. Within affected fish, a significant negative relationship was found between fish length and parasite intensity, with smaller individuals having higher parasite intensity than larger individuals. This study indicates that food intake and infection risk are linked in this recently infected host-parasite system. From a management perspective increasing our understanding of how infection intensity and repeated exposure is linked to resource use in an ecosystem is important for the future management of this endangered species in Europe.

Examining the association between surface bioburden and frequently touched sites in intensive care.

BACKGROUND: Critical care patients are at increased risk of infection. Near-patient surfaces act as reservoirs of microbial soil, which may contain pathogens. AIM: To correlate soil levels with hand-touch frequency of near-patient sites in an intensive care unit (ICU). METHODS: Five sites around each bed in a 10-bed ICU were screened for total microbial soil (cfu/cm2) and Staphylococcus aureus every month for 10 months. Selected sites were infusion pump and cardiac monitor, left and right bedrails, and bed table. Ten 1 h covert audits of hand-touch frequency of these sites were performed in order to provide an average hand-touch count, which was modelled against soil levels obtained from microbiological screening. FINDINGS: Seven of 10 staphylococci were found in conjunction with gross contamination of a specific site (P=0.005) and the same proportion from three most frequently touched sites (bedrails and bed table). There was a linear association between four sites demonstrating gross microbial contamination (>12 cfu/cm2) and mean number of hand-touch counts (P=0.08). The bed table was handled most but was not the most contaminated site. We suspected that customary placement of alcohol gel containers on bed tables may have reduced microbiological yield. Removing the gel container from one table confirmed its inhibitory effect on microbial contamination after rescreening (19% vs 50% >12 cfu/cm2: P=0.007). CONCLUSION: Surface bioburden at near-patient sites in ICU is associated with hand-contact frequencies by staff and visitors. This supports the need for targeted hygienic cleaning in a high-risk healthcare environment.

Does size matter? A test of size-specific mortality in Atlantic salmon Salmo salar smolts tagged with acoustic transmitters.

Mortality rates of wild Atlantic salmon Salmo salar smolts implanted with acoustic transmitters were assessed to determine if mortality was size dependent. The routinely accepted, but widely debated, '2% transmitter mass: body mass' rule in biotelemetry was tested by extending the transmitter burden up to 12·7% of body mass in small [mean fork length (LF ) 138·3 mm, range 115-168 mm] downstream migrating S. salar smolts. Over the short timescale of emigration (range 11·9-44·5 days) through the lower river and estuary, mortality was not related to S. salar size, nor was a relationship found between mortality probability and transmitter mass: body mass or transmitter length: LF ratios. This study provides further evidence that smolt migration studies can deviate from the '2% rule' of thumb, to more appropriate study-specific measures, which enables the use of fishes representative of the body size in natural populations without undue effects.

Tweeting links to Cochrane Schizophrenia Group reviews: a randomised controlled trial.

OBJECTIVE: To assess the effects of using health social media on web activity. DESIGN: Individually randomised controlled parallel group superiority trial. SETTING: Twitter and Weibo. PARTICIPANTS: 170 Cochrane Schizophrenia Group full reviews with an abstract and plain language summary web page. INTERVENTIONS: Three randomly ordered slightly different 140 character or less messages, each containing a short URL to the freely accessible summary page sent on specific times on one single day. This was compared with no messaging. OUTCOME: The primary outcome was web page visits at 1 week. Secondary outcomes were other metrics of web activity at 1 week. RESULTS: 85 reviews were randomised to each of the intervention and control arms. Google Analytics allowed 100% follow-up within 1 week of completion. Intervention and control reviews received a total of 1162 and 449 visits, respectively (IRR 2.7, 95% CI 2.2 to 3.3). Fewer intervention reviews had single page only visits (16% vs 31%, OR 0.41, 0.19 to 0.88) and users spent more time viewing intervention reviews (geometric mean 76 vs 31 s, ratio 2.5, 1.3 to 4.6). Other secondary metrics of web activity all showed strong evidence in favour of the intervention. CONCLUSIONS: Tweeting in this limited area of healthcare increases 'product placement' of evidence with the potential for that to influence care. TRIAL REGISTRATION NUMBER: ISRCTN84658943.

Lake bathymetry and species occurrence predict the distribution of a lacustrine apex predator.

This study examined the abiotic and biotic characteristics of ecosystems that allow expression of a life history called ferox trout, the colloquial name given to brown trout Salmo trutta adopting a piscivorous life history strategy, an apex predator in post-glacial lakes in northern Europe. One hundred and ninety-two lakes in Scotland show evidence of currently, or historically, supporting ferox S. trutta; their presence was predicted in logistic models by larger and deeper lakes with a large catchment that also support populations of Arctic charr Salvelinus alpinus.

Inter and intra-population phenotypic and genotypic structuring in the European whitefish Coregonus lavaretus, a rare freshwater fish in Scotland.

This study revealed between-lake genetic structuring between Coregonus lavaretus collected from the only two native populations of this species in Scotland, U.K. (Lochs Eck and Lomond) evidenced by the existence of private alleles (12 in Lomond and four in Eck) and significant genetic differentiation (FST = 0·056) across 10 microsatellite markers. Juvenile C. lavaretus originating from eggs collected from the two lakes and reared in a common-garden experiment showed clear phenotypic differences in trophic morphology (i.e. head and body shape) between these populations indicating that these characteristics were, at least partly, inherited. Microsatellite analysis of adults collected from different geographic regions within Loch Lomond revealed detectable and statistically significant but relatively weak genetic structuring (FST = 0·001-0·024) and evidence of private alleles related to the basin structure of the lake. Within-lake genetic divergence patterns suggest three possibilities for this observed pattern: (1) differential selection pressures causing divergence into separate gene pools, (2) a collapse of two formerly divergent gene pools and (3) a stable state maintained by balancing selection forces resulting from spatial variation in selection and lake heterogeneity. Small estimates of effective population sizes for the populations in both lakes suggest that the capacity of both populations to adapt to future environmental change may be limited.

Freshwater and coastal migration patterns in the silver-stage eel Anguilla anguilla.

The unimpeded downstream movement patterns and migration success of small female and male Anguilla anguilla through a catchment in north-west Europe were studied using an acoustic hydrophone array along the River Finn and into the Foyle Estuary in Ireland. Twenty silver-stage A. anguilla (total length, LT , range: 332-520 mm) were trapped 152 km upstream from a coastal marine sea-lough outlet and internally tagged with acoustic transmitters of which 19 initiated downstream migration. Migration speed was highly influenced by river flow within the freshwater (FW) compartment. Anguilla anguilla activity patterns were correlated with environmental influences; light, tidal direction and lunar phase all influenced the initiation of migration of tagged individuals. Migration speed varied significantly between upstream and lower river compartments. Individuals migrated at a slower speed in transitional water and sea-lough compartments compared with the FW compartment. While 88·5% survival was recorded during migration through the upper 121 km of the river and estuary, only 26% of A. anguilla which initiated downstream migration were detected at the outermost end of the acoustic array. Telemetry equipment functioned efficiently, including in the sea-lough, so this suggests high levels of mortality during sea-lough migration, or less likely, long-term sea-lough residence by silver A. anguilla emigrants. This has important implications for eel management plans.

Local scale, coastal currents influence recruitment to freshwater populations in the European eel Anguilla anguilla: a case study from the Isle of Man.

This study examines juvenile Anguilla anguilla (<30 cm) abundance in five study catchments on the Isle of Man. Preliminary results suggest that juvenile abundance is negatively correlated with increasing coastal current speed at river mouth entry (P < 0·05). These findings indicate that at least under some circumstances, tidally driven coastal currents may influence recruitment to freshwater habitats; therefore, it is presumed that high coastal current speed at the entry to river mouths may reduce the likelihood of freshwater entry.

Surface feeding and aggressive behaviour of diploid and triploid brown trout Salmo trutta during allopatric pair-wise matchings.

Diploid and triploid brown trout Salmo trutta were acclimated for 6 weeks on two feeding regimes (floating and sinking). Thereafter, aggression and surface feeding response were compared between pairs of all diploid, all triploid and diploid and triploid S. trutta in an experimental stream. In each pair-wise matching, fish of similar size were placed in allopatry and rank was determined by the total number of aggressive interactions recorded. Dominant individuals initiated more aggression than subordinates, spent more time defending a territory and positioned themselves closer to the surface food source (Gammarus pulex), whereas subordinates occupied the peripheries. In cross ploidy trials, diploid S. trutta were more aggressive than triploid, and dominated their sibling when placed in pair-wise matchings. Surface feeding, however, did not differ statistically between ploidy irrespective of feeding regime. Triploids adopted a sneak feeding strategy while diploids expended more time defending a territory. In addition, we also tested whether triploids exhibit a similar social dominance to diploids when placed in allopatry. Although aggression was lower in triploid pairs than in the diploid and triploid pairs, a dominance hierarchy was also observed between individuals of the same ploidy. Dominant triploid fish were more aggressive and consumed more feed items than subordinate individuals. Subordinate fish displayed a darker colour index than dominant fish suggesting increased stress levels. Dominant triploid fish, however, appeared to be more tolerant of subordinate individuals and did not display the same degree of invasive aggression as seen in the diploid and diploid or diploid and triploid matchings. These novel findings suggest that sterile triploid S. trutta feed similarly but are less aggressive than diploid trout. Future studies should determine the habitat choice of triploid S. trutta after release and the interaction between wild fish and triploids during the breeding season prior to utilization of triploids as an alternative management strategy within freshwater fisheries.

Reduced CHRNA7 expression in C3H mice is associated with increases in hippocampal parvalbumin and glutamate decarboxylase-67 (GAD67) as well as altered levels of GABA(A) receptor subunits.

Decreased expression of CHRNA7, the gene encoding the α7(∗) subtype of nicotinic receptor, may contribute to the cognitive dysfunction observed in schizophrenia by disrupting the inhibitory/excitatory balance in the hippocampus. C3H mice with reduced Chrna7 expression have significant reductions in hippocampal α7(∗) receptor density, deficits in hippocampal auditory gating, increased hippocampal activity as well as significant decreases in hippocampal glutamate decarboxylase-65 (GAD65) and γ-aminobutyric acid-A (GABAA) receptor levels. The current study investigated whether altered Chrna7 expression is associated with changes in the levels of parvalbumin, GAD67 and/or GABAA receptor subunits in the hippocampus from male and female C3H Chrna7 wildtype, C3H Chrna7 heterozygous and C3H Chrna7 knockout (KO) mice using quantitative Western immunoblotting. Reduced Chrna7 expression was associated with significant increases in hippocampal parvalbumin and GAD67 and with complex alterations in GABAA receptor subunits. A decrease in α3 subunit protein was seen in both female C3H Chrna7 Het and KO mice while a decrease in α4 subunit protein was also detected in C3H Chrna7 KO mice with no sex difference. In contrast, an increase in δ subunit protein was observed in C3H Chrna7 Het mice while a decrease in this subunit was observed in C3H Chrna7 KO mice, with δ subunit protein levels being greater in males than in females. Finally, an increase in γ2 subunit protein was found in C3H Chrna7 KO mice with the levels of this subunit again being greater in males than in females. The increases in hippocampal parvalbumin and GAD67 observed in C3H Chrna7 mice are contrary to reports of reductions in these proteins in the postmortem hippocampus from schizophrenic individuals. We hypothesize that the disparate results may occur because of the influence of factors other than CHRNA7 that have been found to be abnormal in schizophrenia.

Morphological abnormalities in a population of Lampetra planeri, with a short review of petromyzontid teratologies.

Reported here are several deviations (n = 15; 1·96%) from typical morphology in a large sample (n = 767) of European brook lamprey Lampetra planeri from a single population in the Loch Lomond catchment; this includes one specimen bearing a true anal fin. A brief review of petromyzontid teratology is provided.

Evidence of a recent decline in river lamprey Lampetra fluviatilis parasitism of a nationally rare whitefish Coregonus lavaretus: is there a diamond in the ruffe Gymnocephalus cernuus?

Lamprey-induced scarring of the nationally rare Coregonus lavaretus, a known host of a freshwater-resident population of European river lamprey Lampetra fluviatilis, was found to have declined precipitously since the establishment of several non-native fishes in Loch Lomond. Evidence presented in this study points to the possibility that L. fluviatilis in this lake may have altered its trophic ecology in response to the negative impact that non-native species, in particular ruffe Gymnocephalus cernuus, have had on their favoured host.

Sneak male mating tactics between lampreys (Petromyzontiformes) exhibiting alternative life-history strategies.

Interspecific sneak male mating tactics between paired lamprey species are described for the first time. Although alternative mating tactics among petromyzontids have been described previously, including intraspecific sneak males, the presence of sneak male tactics between parasitic and non-parasitic forms suggests that high levels of gene flow between putative lamprey species could remain high, despite large body size discrepancies.

Androgen receptor phosphorylation at serine 515 by Cdk1 predicts biochemical relapse in prostate cancer patients.

BACKGROUND: Prostate cancer cell growth is dependent upon androgen receptor (AR) activation, which is regulated by specific kinases. The aim of the current study is to establish if AR phosphorylation by Cdk1 or ERK1/2 is of prognostic significance. METHODS: Scansite 2.0 was utilised to predict which AR sites are phosphorylated by Cdk1 and ERK1/2. Immunohistochemistry for these sites was then performed on 90 hormone-naive prostate cancer specimens. The interaction between Cdk1/ERK1/2 and AR phosphorylation was investigated in vitro using LNCaP cells. RESULTS: Phosphorylation of AR at serine 515 (pAR(S515)) and PSA at diagnosis were independently associated with decreased time to biochemical relapse. Cdk1 and pCdk1(161), but not ERK1/2, correlated with pAR(S515). High expression of pAR(S515) in patients with a PSA at diagnosis of ≤20 ng ml(-1) was associated with shorter time to biochemical relapse (P=0.019). This translated into a reduction in disease-specific survival (10-year survival, 38.1% vs 100%, P<0.001). In vitro studies demonstrated that treatment with Roscovitine (a Cdk inhibitor) caused a reduction in pCdk1(161) expression, pAR(S515)expression and cellular proliferation. CONCLUSION: In prostate cancer patients with PSA at diagnosis of ≤20 ng ml(-1), phosphorylation of AR at serine 515 by Cdk1 may be an independent prognostic marker.