Identifying avoidable switchboard delays in England's NHS hospitals: phase one of the national SWITCH project.

BACKGROUND: Inter-hospital communication frequently requires mediation via a switchboard. Identifying and eliminating switchboard inefficiencies may improve patient care. METHODS: All 175 acute hospital switchboards in England were contacted six times. Call contents and duration were recorded. No clinician calls or bleeps were connected. RESULTS: The mean delay before contacting a switchboard operative was 55±46 seconds. 115 hospitals (66%) used automated switchboards; 34 of these (30%) had infection control messages. Robot operators introduced an additional 40 second delay versus humans (mean 70.3±28 versus 29.8±23 seconds, p<0.0001). Multivariate analysis identified robot operators (HR 5.1, p<0.0001) and infection control messages (HR 2.9, p=0.003) as predictors of delays over 60 seconds. CONCLUSIONS: There are significant avoidable delays in contacting switchboard operatives across England. Quality improvement is underway.

First Report of Bacterial Stalk and Head Rot Disease Caused by Pectobacterium atrosepticum on Sunflower in Turkey.

Bacterial stalk and head rot on sunflower (Helianthus annuus) was investigated in Konya Province of Turkey in 2008. Disease incidence was estimated as 30%. Bacteria appeared as droplets and ooze and symptoms were dark and water-soaked necrotic areas on stems and heads. Twenty-four strains were isolated from lesions on stalks and heads of sunflower cv. TR3080 from a 25-ha field and identified as Pectobacterium atrosepticum (formerly Erwinia caratovora subsp. atroseptica) (2) on the basis of biochemical, physiological (3), and molecular tests (1). Bacteria were gram negative, rod shaped, fermentative, nonfluorescent on King's B medium; positive for gelatin liquefaction, CVP test, catalase, and pectolytic activity, growth on 5% NaCl, reducing substances from sucrose, acid-production from lactose and α-methyl glucoside; and negative for growth at 37°C, acid production from sorbitol and maltose, phosphatase activity, tests for egg yolk (lecithin), sensitivity to erythromycin, and pigmentation on yeast dextrose calcium carbonate agar medium. To distinguish between P. atrosepticum and P. carotovorum, particular attention was paid to the growth at 37°C, reducing substances from sucrose and the utilization of α-methyl glucoside. Mesophyll cells of tobacco plants (Nicotiana tobaccum cv. White Burley) were infiltrated with bacterial suspensions (108 cells/ml) or water (control). Brown, collapsed areas of tissues (hypersensitive response) were observed at the injection sites after incubation for 48 h at 28°C and 80% relative humidity. A P. atrosepticum-specific primer set, Y45/Y46 (3), was used in PCR reactions to generate a 439-bp DNA fragment. Reference strains, Eca17 from Aegean University, Department of Plant Protection (Izmir, Turkey) and NCPPB 1277 from Selcuk University, Department of Plant Protection, Konya, Turkey, were employed in all biochemical, physiological, and molecular tests as positive controls and similar results were obtained. Koch's postulates were carried out to establish a causal relationship between the bacteria and the disease. A bacterial suspension (108 CFU/ml) was injected into sunflower shoot tips and inoculated plants were incubated for 2 weeks at 28°C and 80% relative humidity. All bacterial strains obtained from the stalks and heads produced the rot symptoms and ooze following inoculation to the susceptible sunflower cv. TR 3080. No symptoms were observed on controls that were inoculated with sterile water. The bacteria were isolated from the lesions on stalks and heads and their identities confirmed by the biochemical, physiological, and molecular tests. All tests were performed three times on three plants per strain. To our knowledge, this is the first report of P. atrosepticum on sunflower in Turkey. Further research is needed to determine how far the disease is spread in Turkey since other provinces also grow sunflowers. References: (1) L. Gardan et al. Int. J. Syst. Evol. Microbiol. 53:381, 2003. (2) L. Hauben et al. Syst. Appl. Microbiol. 21:384, 1998. (3) A. Darrasse et al. Appl. Environ. Microbiol. 60:298, 1994.

Characterization of Agrobacterium vitis Strains Isolated from Turkish Grape Cultivars in the Central Anatolia Region.

Crown gall was detected in several vineyards in the Central Anatolia region of Turkey. Vineyards were planted to cultivars of grape that originated in Turkey and that were not grafted. The predominant species isolated from galls consisted of tumorigenic strains of Agrobacterium vitis. They were identified based on reactions to standard biochemical and physiological tests, by polymerase chain reaction amplification of specific Ti plasmid and chromosomal sequences, and by reaction to a species-specific monoclonal antibody. All strains utilized octopine, suggesting that they may carry similar types of Ti plasmids. Some of the strains exhibited a differential host range compared with others and were less virulent based on the numbers of galls that they induced on grape. When grapevines were treated with nontumorigenic A. vitis strain F2/5 prior to inoculation with the Turkish A. vitis strains, crown gall was effectively controlled. The genetic diversity of strains was evaluated by comparing DNA fingerprints that were generated by restriction enzyme digestion of the intergenic spacer region that lies between 16S and 23S rRNA genes. They segregated into two main groups, one that is similar to previously identified A. vitis strains carrying octopine type Ti plasmids and one that was more similar to strains carrying nopaline and vitopine Ti plasmids. The strains of A. vitis from Turkey may represent ancestral forms of the pathogen that will provide insight into the evolution of the bacterium.