Tetracycline resistance in Listeria monocytogenes and L. innocua from wild black bears (Ursus americanus) in the United States is mediated by novel transposable elements.

IMPORTANCE: Listeria monocytogenes causes severe foodborne illness and is the only human pathogen in the genus Listeria. Previous surveys of AMR in Listeria focused on clinical sources and food or food processing environments, with AMR in strains from wildlife and other natural ecosystems remaining under-explored. We analyzed 185 sequenced strains from wild black bears (Ursus americanus) from the United States, including 158 and 27 L. monocytogenes and L. innocua, respectively. Tetracycline resistance was the most prevalent resistance trait. In L. monocytogenes, it was encountered exclusively in serotype 4b strains with the novel Tn916-like element Tn916.1039. In contrast, three distinct, novel tetracycline resistance elements (Tn5801.UAM, Tn5801.551, and Tn6000.205) were identified in L. innocua. Interestingly, Tn5801.551 was identical to elements in L. monocytogenes from a major foodborne outbreak in the United States in 2011. The findings suggest the importance of wildlife and non-pathogenic Listeria species as reservoir for resistance elements in Listeria.

Comparison of Enhanced Noise Model Performance Based on Analysis of Civilian GPS Data.

We recorded the time series of location data from stationary, single-frequency (L1) GPS positioning systems at a variety of geographic locations. The empirical autocorrelation function of these data shows significant temporal correlations. The Gaussian white noise model, widely used in sensor-fusion algorithms, does not account for the observed autocorrelations and has an artificially large variance. Noise-model analysis-using Akaike's Information Criterion-favours alternative models, such as an Ornstein-Uhlenbeck or an autoregressive process. We suggest that incorporating a suitable enhanced noise model into applications (e.g., Kalman Filters) that rely on GPS position estimates will improve performance. This provides an alternative to explicitly modelling possible sources of correlation (e.g., multipath, shadowing, or other second-order physical phenomena).

Improving Real-Time Position Estimation Using Correlated Noise Models.

We provide algorithms for inferring GPS (Global Positioning System) location and for quantifying the uncertainty of this estimate in real time. The algorithms are tested on GPS data from locations in the Southern Hemisphere at four significantly different latitudes. In order to rank the algorithms, we use the so-called log-score rule. The best algorithm uses an Ornstein-Uhlenbeck (OU) noise model and is built on an enhanced Kalman Filter (KF). The noise model is capable of capturing the observed autocorrelated process noise in the altitude, latitude and longitude recordings. This model outperforms a KF that assumes a Gaussian noise model, which under-reports the position uncertainties. We also found that the dilution-of-precision parameters, automatically reported by the GPS receiver at no additional cost, do not help significantly in the uncertainty quantification of the GPS positioning. A non-learning method using the actual position measurements and employing a constant uncertainty does not even converge to the correct position. Inference with the enhanced noise model is suitable for embedded computing and capable of achieving real-time position inference, can quantify uncertainty and be extended to incorporate complementary sensor recordings, e.g., from an accelerometer or from a magnetometer, in order to improve accuracy. The algorithm corresponding to the augmented-state unscented KF method suggests a computational cost of O(dx2dt), where dx is the dimension of the augmented state-vector and dt is an adjustable, design-dependent parameter corresponding to the length of "past values" one wishes to keep for re-evaluation of the model from time to time. The provided algorithm assumes dt=1. Hence, the algorithm is likely to be suitable for sensor fusion applications.

Trends in coronary revascularization procedures among Medicare beneficiaries between 2008 and 2012.

BACKGROUND: This study reports on the trends in the volume and outcomes of coronary revascularization procedures performed on Medicare beneficiaries between 2008 and 2012. METHODS AND RESULTS: This retrospective study identifies all Medicare beneficiaries undergoing a coronary revascularization procedure: coronary artery bypass graft surgery or percutaneous coronary intervention (PCI) performed in either the nonadmission or inpatient setting. International Classification of Diseases, 9th Revision, Clinical Modification procedure codes (inpatient setting) and Current Procedural Terminology and Ambulatory Payment Classification codes (nonadmission) were used to identify revascularizations. The study population consists of 2,768,007 records. This study finds that the rapid growth in nonadmission PCIs performed on Medicare beneficiaries (60,405-106,495) has been more than offset by the decrease in PCI admissions (363,384-295,434) during the study period. There also were >18,000 fewer coronary artery bypass graft admissions in 2012 than in 2008. This study finds lower observed mortality rates (3.7%-3.2%) among Medicare beneficiaries undergoing any coronary artery bypass graft surgery and higher observed mortality rates (1.7%-1.9%) for Medicare beneficiaries undergoing any PCI encounter. This study also finds a growth in the number of facilities performing revascularization procedures during the study period: 268 (20.2%) more sites were performing nonadmission PCIs; 136 (8.2%) more sites were performing inpatient PCIs; and 19 (1.6%) more sites were performing coronary artery bypass graft surgery. CONCLUSIONS: The total number of revascularization procedures performed on Medicare beneficiaries peaked in 2010 and declined by >4% per year in 2011 and 2012. Observed mortality rates among all Medicare beneficiaries undergoing any coronary revascularization remained between 2.1% and 2.2% annually during the study period.

Structural Characterisation of Non-Deamidated Acidic Variants of Erwinia chrysanthemi L-asparaginase Using Small-Angle X-ray Scattering and Ion-Mobility Mass Spectrometry.

PURPOSE: Erwinia chrysanthemi L-asparaginase (ErA) is an enzyme commonly used in the treatment regimen for Acute Lymphoblastic Leukaemia (ALL). Biopharmaceutical products such as ErA must be monitored for modifications such as deamidation, typically using ion-exchange chromatography (IEX). Analysis of clinical-grade ErA using native IEX resolves a number of enzymatically-active, acidic variants that were poorly characterised. METHODS: ErA IEX variants were isolated and fully characterised using capillary electrophoresis (cIEF), LC-MS and LC-MS/MS of proteolytic digests, and structural techniques including circular dichroism, small-angle X-ray scattering (SAXS) and ion-mobility mass spectrometry (IM-MS). RESULTS: LC-MS, MS/MS and cIEF demonstrated that all ErA isolates consist mainly of enzyme lacking primary-sequence modifications (such as deamidation). Both SAXS and IM-MS revealed a different conformational state in the most prominent acidic IEX peak. However, SAXS data also suggested conformational differences between the main peak and major acidic variant were minor, based on comparisons with crystal structures. CONCLUSIONS: IEX data for biopharmaceuticals such as ErA should be thoroughly characterised, as the most common modifications, such as deamidation, may be absent.

Draft genome sequences of two wide-host-range phages of Listeria monocytogenes from food processing environments in the United States.

Listeria monocytogenes is notorious for persistence in food facilities. Phages can significantly impact the ecology of Listeria, but there is a dearth of genome sequence data for Listeria phages from food processing ecosystems. We report the genome sequences of two Listeria phages from turkey processing facilities in the USA.

Draft genome sequences of Listeria monocytogenes strains from human listeriosis in Sweden harboring premature stop codons in the virulence determinant inlA.

Premature stop codons in the internalin virulence determinant inlA are common in serotype 1/2a Listeria monocytogenes from food/food processing environments but rare among human clinical isolates. Here, we report the genome sequences of serotype 1/2a (STs 121 and 3258) human listeriosis isolates from Sweden harboring such mutations in inlA.

Self, career and nationhood: the contrasting aspirations of British and French elite graduates.

There is increasing interest in the emergence of a 'global middle class' in which high achieving young graduates increasingly look to develop careers that transcend national boundaries. This paper explores this issue through comparing and contrasting the aspirations and orientations of two 'elite' cohorts of graduates. Interviews with students at the University of Oxford, England, and Sciences-Po, France, reveal very different ambitions and allegiances. Our Oxford respondents portray their futures as projects of self-fulfilment as they build portfolio careers by moving from job to job and from country to country with limited social allegiances - epitomizing the nomadic worker of the transnational elite. Our Parisian respondents, on the other hand, display strong allegiances to the nation, state and civic duty. Their projects of the self involve reconciling their personal aspirations with strong allegiances to France. The paper concludes by discussing the significance of these differences. It argues that the enduring role of education in the formation of national identities should not be overlooked and that more detailed research is needed on the contextual specifity of transnationalism and the (re)production of elites.

Draft Genome Sequences of Closely Related Listeria monocytogenes Lineage III Strains Isolated from a Food Processing Environment and a Case of Human Listeriosis.

Listeria monocytogenes lineage III is genetically highly diverse, and closely related lineage III strains from food facilities and human listeriosis have not been reported. Here, we report the genome sequences of three closely related lineage III strains from Hawaii, namely, one isolated from a human case and two isolated from a produce storage facility.

Draft genome sequences of a historical collection of Listeria monocytogenes from humans and other sources, 1926-1964.

Listeria monocytogenes can persistently contaminate food processing environments and tolerate sanitizers. Most sequenced strains are from clinical and environmental sources in the contemporary era, with relatively few prior to extensive food processing and sanitizer use. We report the genome sequences of a diverse panel of 83 strains from 1926 to 1964.

Horizontal Gene Transfer and Loss of Serotype-Specific Genes in Listeria monocytogenes Can Lead to Incorrect Serotype Designations with a Commonly-Employed Molecular Serotyping Scheme.

Listeria monocytogenes is a Gram-positive, facultative intracellular foodborne pathogen capable of causing severe, invasive illness (listeriosis). Three serotypes, 1/2a, 1/2b, and 4b, are leading contributors to human listeriosis, with 4b including the major hypervirulent clones. The multiplex PCR scheme developed by Doumith and collaborators employs primers targeting specific lineages (e.g., lineage II-specific lmo0737, lineage I-specific LMOf2365_2059) or serotypes (e.g., serotype 4b-specific LMOf2365_1900). The Doumith scheme (DS) is extensively employed for molecular serotyping of L. monocytogenes due to its high accuracy, relative ease, and affordability. However, for certain strains, the DS serotype designations are in conflict with those relying on antibody-based schemes or whole-genome sequence (WGS) analysis. In the current study, all 27 tested serotype 4b strains with sequence type 782 (ST782) within the hypervirulent clonal complex 2 (CC2) were designated 1/2b/3b using the DS. These strains lacked the serotype 4b-specific gene LMOf2365_1900, while retaining LMOf2365_2059, which, together with prs, yields the DS 1/2b/3b profile. Furthermore, 15 serotype 1/2a strains of four STs, mostly from water, were designated 1/2b/3b using the DS. These strains lacked the lmo0737 cassette but harbored genomic islands with LMOf2365_2059, thus yielding the DS 1/2b/3b profile. Lastly, we investigated a novel, dual 1/2a-1/2b profile obtained using the DS with 21 serotype 1/2a strains of four STs harboring both the lmo0737 cassette and genomic islands with LMOf2365_2059. The findings suggest that for certain strains and clones of L. monocytogenes the DS designations should be viewed with caution and complemented with alternative tools, e.g., traditional serotyping or WGS analysis. IMPORTANCE Listeria monocytogenes is a foodborne pathogen responsible for severe illness (listeriosis), especially in pregnant women and their fetuses, immunocompromised individuals, and the elderly. Three serotypes, 1/2a, 1/2b, and 4b, account for most human listeriosis, with certain serotype 4b clonal complexes (CCs) overrepresented in human disease. Serotyping remains extensively employed in Listeria epidemiologic investigations, and a multiplex PCR-based serotyping scheme is widely used. However, the PCR gene targets can be lost or gained via horizontal gene transfer, leading to novel PCR profiles without known serotype designations or to incorrect serotype assignments. Thus, an entire serotype 4b clone of the hypervirulent CC2 would be misidentified as serotype 1/2b, and several strains of serotype 1/2a would be identified as serotype 1/2b. Such challenges are especially common in novel clones from underexplored habitats, e.g., wildlife and surface water. The findings suggest caution in application of molecular serotyping, while highlighting Listeria's diversity and potential for horizontal gene transfer.

Investigation of a Listeria monocytogenes Chromosomal Immigration Control Region Reveals Diverse Restriction Modification Systems with Complete Sequence Type Conservation.

Listeria monocytogenes is a Gram-positive pathogen responsible for the severe foodborne disease listeriosis. A chromosomal hotspot between lmo0301 and lmo0305 has been noted to harbor diverse restriction modification (RM) systems. Here, we analyzed 872 L. monocytogenes genomes to better understand the prevalence and types of RM systems in this region, designated the immigration control region (ICR). Type I, II, III and IV RM systems were found in 86.1% of strains inside the ICR and in 22.5% of strains flanking the ICR. ICR content was completely conserved within the same multilocus sequence typing-based sequence type (ST), but the same RM system could be identified in diverse STs. The intra-ST conservation of ICR content suggests that this region may drive the emergence of new STs and promote clone stability. Sau3AI-like, LmoJ2 and LmoJ3 type II RM systems as well as type I EcoKI-like, and type IV AspBHI-like and mcrB-like systems accounted for all RM systems in the ICR. A Sau3AI-like type II RM system with specificity for GATC was harbored in the ICR of many STs, including all strains of the ancient, ubiquitous ST1. The extreme paucity of GATC recognition sites in lytic phages may reflect ancient adaptation of these phages to preempt resistance associated with the widely distributed Sau3AI-like systems. These findings indicate that the ICR has a high propensity for RM systems which are intraclonaly conserved and may impact bacteriophage susceptibility as well as ST emergence and stability.

Draft Genome Sequences of Heavy Metal-Resistant Listeria monocytogenes Strains of Sequence Type 14 (Clonal Complex 14) from Human Listeriosis Cases in Sweden.

Listeria monocytogenes of clonal complex 14 (CC14) is a potentially hypervirulent clone of serotype 1/2a but remains poorly characterized. We report the genome sequences of five sequence type 14 (ST14) (CC14) strains from human listeriosis cases in Sweden, which harbor a chromosomal heavy metal resistance island that is generally uncommon in serotype 1/2a.

Draft Genome Sequences of 158 Listeria monocytogenes Strains Isolated from Black Bears (Ursus americanus) in the United States.

Listeria monocytogenes is responsible for severe foodborne disease and major economic losses, but its potential reservoirs in natural ecosystems remain poorly understood. Here, we report the draft genome sequences of 158 L. monocytogenes strains isolated from black bears (Ursus americanus) in the southeastern United States between 2014 and 2017.

Virtual Reality as a Pain Distraction Modality for Experimentally Induced Pain in a Chronic Pain Population: An Exploratory Study.

Virtual reality (VR) has shown promising results as an adjunct therapy for pain management. Recent literature exploring the use of VR for pain management among a chronic pain (CP) population has produced encouraging results, although little has been done to explore what about a VR intervention is the provider of the analgesic response. Furthermore, as has been suggested in the literature previously, little has been said of the association between pain tolerance and presence. This study primarily aimed to investigate pain tolerance differentiation between VR-head-mounted display (HMD) active and control interventions. Secondarily, this study looked to report on whether presence correlates to pain tolerance, among a CP population. A repeated-measures study design was used. Twelve participants received two 5-minute interventions while being subjected to experimentally induced pain. The interventions were as follows: (a) "active intervention," an immersive and interactive experience (b) "control intervention," and a nonimmersive controlled experience with no interaction. Tolerance to pain was assessed via the total time the participant continued the intervention. Presence was assessed via the Witmer and Singer's presence questionnaire. Participants also completed the Simulator Sickness Questionnaire, the Presence Questionnaire, and the Brief Pain Inventory. Pain tolerance was significantly higher in the active intervention compared with the control intervention (p = 0.005). There was a positive correlation between pain tolerance and presence during the active VR intervention. The media as opposed to the medium was determined to be responsible for greater tolerance to pain, as well as greater sense of presence, which was positively correlated to an increase in pain tolerance.

The Tabula Sapiens: A multiple-organ, single-cell transcriptomic atlas of humans.

Molecular characterization of cell types using single-cell transcriptome sequencing is revolutionizing cell biology and enabling new insights into the physiology of human organs. We created a human reference atlas comprising nearly 500,000 cells from 24 different tissues and organs, many from the same donor. This atlas enabled molecular characterization of more than 400 cell types, their distribution across tissues, and tissue-specific variation in gene expression. Using multiple tissues from a single donor enabled identification of the clonal distribution of T cells between tissues, identification of the tissue-specific mutation rate in B cells, and analysis of the cell cycle state and proliferative potential of shared cell types across tissues. Cell type-specific RNA splicing was discovered and analyzed across tissues within an individual.

The Accuracy of iPhone Applications to Monitor Environmental Noise Levels.

OBJECTIVE: The Control of Noise at Work Regulations came into force in Great Britain in 2005, requiring all work environments to be monitored for potentially harmful noise exposure levels. This study evaluated the effectiveness of a number of iPhone phone applications (apps) (Apple, Cupertino, CA) to accurately measure noise exposure, which may prove effective when a specialist-calibrated sound level meter is not readily available. METHODS: Suitable apps were identified using the search terms noise and decibel through the App Store (Apple). Apps that were free to download and had at least one rating were included. Apps were evaluated using a calibrated pure tone sound field and a soundproof testing booth. A 3-frequency audiogram (1000 Hz, 2000 Hz, and 4000 Hz) was used at 25 dB, 40 dB, 55 dB, 70 dB, and 85 dB. Linear regression was carried out to assess accuracy. RESULTS: Nine apps were tested in total, with four out of nine providing a goodness-of-fit coefficient (R2 value) over 0.9. The most effective app was found to be the NIOSH (National Institute for Occupational Safety and Health) Sound Level Meter (EA LAB, Slovenia) with an R2 of 0.97. The least effective app was the Decibel Meter With Recorder (Jianhua Ming, China) with an R2 of 0.62. CONCLUSION: This study has shown significant variation in the ability of iPhone apps (Apple) to accurately predict environmental dB levels. However, if the correct app is used, an iPhone represents a relatively reliable means of measuring noise exposure levels when a specialist calibrated sound level meter is not readily available. LEVEL OF EVIDENCE: NA Laryngoscope, 131:E59-E62, 2021.

Use of Bacteriophage Amended with CRISPR-Cas Systems to Combat Antimicrobial Resistance in the Bacterial Foodborne Pathogen Listeria monocytogenes.

Listeria monocytogenes is a bacterial foodborne pathogen and the causative agent of the disease listeriosis, which though uncommon can result in severe symptoms such as meningitis, septicemia, stillbirths, and abortions and has a high case fatality rate. This pathogen can infect humans and other animals, resulting in massive health and economic impacts in the United States and globally. Listeriosis is treated with antimicrobials, typically a combination of a beta-lactam and an aminoglycoside, and L. monocytogenes has remained largely susceptible to the drugs of choice. However, there are several reports of antimicrobial resistance (AMR) in both L. monocytogenes and other Listeria species. Given the dire health outcomes associated with listeriosis, the prospect of antimicrobial-resistant L. monocytogenes is highly problematic for human and animal health. Developing effective tools for the control and elimination of L. monocytogenes, including strains with antimicrobial resistance, is of the utmost importance to prevent further dissemination of AMR in this pathogen. One tool that has shown great promise in combating antibiotic-resistant pathogens is the use of bacteriophages (phages), which are natural bacterial predators and horizontal gene transfer agents. Although native phages can be effective at killing antibiotic-resistant pathogens, limited host ranges and evolved resistance to phages can compromise their use in the efforts to mitigate the global AMR challenge. However, recent advances can allow the use of CRISPR-Cas (clustered regularly interspaced short palindromic repeats-CRISPR-associated proteins) to selectively target pathogens and their AMR determinants. Employment of CRISPR-Cas systems for phage amendment can overcome previous limitations in using phages as biocontrol and allow for the effective control of L. monocytogenes and its AMR determinants.

UK Dental Medicines Advisory Service: questions asked by dentists - part 4: prescribing of high-strength fluoride toothpastes and use of fluoride varnishes in dental practice.

The UK Dental Medicines Advisory Service (UKDMAS) provides advice to dentists and other dental healthcare professionals concerning the use of medicines and medical devices in dental prescribing, administering, or dispensing. The commonly asked questions posed to the UKDMAS concerning the prescribing of high-strength fluoride toothpastes and use of fluoride varnishes in dental practice are discussed with answers, supplemented by relevant information from clinicians. These include: the prescribing of high-strength fluoride toothpastes and application of fluoride varnish in particular patient groups; issues concerning the amounts of fluoride toothpaste that can be prescribed; regulations related to the supply of fluoride toothpastes by dental hygienists and therapists; and the constituents and selection of fluoride varnishes.