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Maturation of intracellular Escherichia coli communities requires SurA.

Escherichia coli is the most common cause of community-acquired urinary tract infection (UTI). During murine cystitis, uropathogenic E. coli (UPEC) utilizes type 1 pili to bind and invade superficial bladder epithelial cells. UPEC then replicates within to form intracellular bacterial communities (IBCs), a process whose genetic determinants are as yet undefined. In this study, we investigated the role of SurA in the UPEC pathogenic cascade. SurA is a periplasmic prolyl isomerase/chaperone that facilitates outer membrane protein biogenesis and pilus assembly in E. coli. Invasion into bladder epithelial cells was disproportionately reduced when surA was genetically disrupted in the UPEC strain UTI89, demonstrating that binding alone is not sufficient for invasion. In a murine cystitis model, UTI89 surA::kan was unable to persist in the urinary tract. Complementation of UTI89 surA::kan with a plasmid (pDH15) containing surA under the control of an arabinose-inducible promoter restored in vivo binding and invasion events. However, the absence of arabinose within the mouse bladder resulted in depletion of SurA after invasion of the bacteria into the superficial epithelial cells. Under these conditions, invasion by UTI89/pDH15 surA::kan was normal, but in contrast to UTI89, UTI89/pDH15 surA::kan formed intracellular collections that contained fewer bacteria, were loosely organized, and lacked the normal transition to a densely packed, coccoid morphology. Our data argue that SurA is required within bladder epithelial cells for UPEC to undergo the morphological changes that underlie IBC maturation and completion of the UTI pathogenic cascade.

Adhesins, Escherichia coli↗

Additional Essential Criteria for Quality Systems of Medical Laboratories. European Community Confederation of Clinical Chemistry (EC4) Working Group on Harmonisation of Quality Systems and Accreditation.

Essential Criteria for Quality Systems of Medical Laboratories have been published recently by the European Community Confederation of Clinical Chemistry (EC4) Working Group on Harmonisation of Quality Systems and Accreditation. The Essential Criteria address the majority of critical aspects of quality management in the medical laboratory. They have been accepted by the EC4 General Assembly and are endorsed by the Forum of European Societies for Clinical Chemistry (FESCC). However, a supplement to the Essential Criteria was necessary, addressing two aspects, which are only partly covered by the Essential Criteria: the management of resources and point of care testing. Thus, the EC4 Working Group on Harmonisation of Quality Systems and Accreditation has decided to formulate Additional Essential Criteria for Quality Systems of Medical Laboratories, directed at the issues of management of resources and point of care testing. Criteria on management of resources address financial aspects, information logistics and acceptance by clients. Criteria on point of care testing address responsibilities, education of non-laboratory staff and operational aspects. The Additional Criteria are supplementary to the previously published Essential Criteria and should be read as an integral part of these.

Accreditation↗

Annual report awards issue. Six hospitals capture annual report competition honors.

The best of the annual reports entered in this year's annual Healthcare Annual Report Contest are included in this issue on pages four through 32. Every entry in this year's competition had something to commend. They were reflective of the talent that assembled them. The editors and panel judges thank you for submitting your entries. The winners are New York Methodist Hospital, Brooklyn, first overall; Children's Hospital of Orange County, Calif., second overall; Woman's Hospital, Baton Rouge, La., first community health; Hackensack University Medical Center, Hackensack, N.J., first year in review; Chesapeake General Hospital, Chesapeake, Va., first community relations; and Osteopathic Health System of Texas, second community relations. The editors thank all the entrants for participating. Remember, the deadline for 1999 entries is July 1, 2000.

Annual Reports as Topic↗

[Active aging promotion and education for health].

Some years ago, the phenomenon of demographic aging started an intense debate about its supposed negatives effects on the economic progress of a population. Health advances and improved living conditions have gradually increased the health level the elderly have, embellishing the initial perspectives; the elderly live more years but, moreover, they have a better quality of life. For the WHO, to favor an active aging process presents a challenge, avoiding incapacities and dependencies, the real causes of the increase in social-health costs. Following the guidelines established by the II World Assembly on Aging, last year our country passed the Action Plan for Elderly People 2003-2007; this plan contemplates as one of its objectives "Promote the autonomy and the full and active participation by the elderly people in the community" and points out that the strategy to achieve this objective consists in "pushing the measures which Promote Health".

Aged↗

The art and science of integrating Undoing Racism with CBPR: challenges of pursuing NIH funding to investigate cancer care and racial equity.

In this nation, the unequal burden of disease among People of Color has been well documented. One starting point to eliminating health disparities is recognizing the existence of inequities in health care delivery and identifying the complexities of how institutional racism may operate within the health care system. In this paper, we explore the integration of community-based participatory research (CBPR) principles with an Undoing Racism process to conceptualize, design, apply for, and secure National Institutes of Health (NIH) funding to investigate the complexities of racial equity in the system of breast cancer care. Additionally, we describe the sequence of activities and "necessary conflicts" managed by our Health Disparities Collaborative to design and submit an application for NIH funding. This process of integrating CBPR principles with anti-racist community organizing presented unique challenges that were negotiated only by creating a strong foundation of trusting relationships that viewed conflict as being necessary. The process of developing a successful NIH grant proposal illustrated a variety of important lessons associated with the concepts of cultural humility and cultural safety. For successfully conducting CBPR, major challenges have included: assembling and mobilizing a partnership; the difficulty of establishing a shared vision and purpose for the group; the problem of maintaining trust; and the willingness to address differences in institutional cultures. Expectation, acceptance and negotiation of conflict were essential in the process of developing, preparing and submitting our NIH application. Central to negotiating these and other challenges has been the utilization of a CBPR approach.

Breast Neoplasms↗

The relationship of problems in biomedical MRI to the study of porous media.

The NMR methods that are used to characterize inanimate porous media measure relaxation times and related phenomena and material transport, fluid displacement and flow. Biological tissues are comprised of multiple small, fluid-filled compartments, such as cells, that restrict the movement of the bulk solvent water and whose constituents influence water proton relaxation times via numerous interactions with macromolecular surfaces. Several of the methods and concepts that have been developed in one field of application are also of great value in the other, and it may be expected that technical developments that have been spurred by biomedical applications of MR imaging will be used in the continuing study of porous media. Some recent specific studies from our laboratory include the development of multiple quantum coherence methods for studies of ordered water in anisotropic macromolecular assemblies, studies of the degree of restriction of water diffusion in cellular systems, multiple selective inversion imaging to depict the ratios of proton pool sizes and rates of magnetization transfer between proton populations, and diffusion tensor imaging to depict tissue anisotropies. These illustrate how approaches to obtain structural information from biological media are also relevant to porous media. For example, the recent development of oscillating gradient spin echo techniques (OGSE), an approach that extends our ability to resolve apparent diffusion changes over different time scales in tissues, has also been used to compute surface to volume measurements in assemblies of pores. Each of the new methods can be adapted to provide spatially resolved quantitative measurements of properties of interest, and these can be efficiently acquired with good accuracy using fast imaging methods such as echo planar imaging. The community of NMR scientists focused on applications to porous media should remain in close communication with those who use MRI to study problems in biomedicine, to their mutual benefits.

Animals↗

[A faunistic approach to the classification of an animal population (exemplified by small terrestrial mammals of the Kopet-Dag)].

A floristic method of vegetation classification (after Braun-Blanquet) is applied for classification of animal communities. The latter, by analogy with vegetation, can be dividend into classificatory units differing mutually by their composition. Diagnostic species are used as a basis for such classification. Their names are used in producing syntaxonomic nomenclature of the animal population. Assembly is suggested as a principal classificatory unit within this approach. It is defined as multispecies assemblage of animals from various trophic levels, which form stable population combinations and are similar in their geographic and habitat distributions. The assembly can be further divided into subunits called subassembly and population variant. Five assemblies are identified and described for population of insectivores, rodents and lagomorphs in Kopet-Dag Mts (S. Turkmenistan).

Altitude↗

The Elements of Life, Photosynthesis and Genomics.

I am a Professor of Biochemistry, Biophysics and Structural Biology and Plant and Microbial Biology at the University of California in Berkeley. I was born and raised in India, emigrated to the United States to attend university, earning a B.S. in Molecular Biology and a Ph.D. in Biochemistry at the University of Wisconsin in Madison. Following post-doctoral studies with Lawrence Bogorad at Harvard University where I became interested in genetic control of trace element quotas, I joined the department of Chemistry and Biochemistry at UCLA. One of the first to appreciate essential trace metals as potential regulators of gene expression, I articulated the details of the nutritional Cu regulon in Chlamydomonas. In parallel, I used genetic approaches to discover the genes governing missing steps in tetrapyrrole metabolism, including the attachment of heme to apocytochromes in the thylakoid lumen and the factors catalyzing the formation of ring V in chlorophyll. After biochemistry and classical genetics, I embraced genomics, taking a leadership role on the Joint Genome Institute's efforts on the Chlamydomonas genome and more recently, contributing to high quality assemblies of several genomes in the green algal radiation, and large transcriptomic and proteomic datasets - focusing on the diel metabolic cycle in synchronized cultures and acclimation to key environmental and nutritional stressors - that are well-used and appreciated by the community. A new venture in Berkeley is the promotion of Auxenochlorella protothecoides as the true "green yeast" and as a platform for engineering algae to produce useful bioproducts.

Photosynthesis↗

A developmental and psychoeducational approach to reducing conflict and abuse in little league and youth sports. The sport psychiatrist's role.

To stress a point made earlier, whether backyard or Little League, the tone of the youth sports experience is greatly influenced by the player and team selection process. All possible steps should therefore be taken to ensure that the draft is held on high moral ground, and that the adult participants, even on the Major Little League level, behave cooperatively rather than competitively. If it is the community's hope that Little League will "build character, and not characters," it must embrace Shields and Bredemeier's work and flood the Draft Room with the four virtues of compassion, fairness, sportspersonship, and integrity. In one attempt to achieve fairness and balance, some leagues enter player evaluations into a data base and allow a properly programmed computer to project equal teams. It might be best, however, to borrow a page from backyard baseball, and make team selection a more cooperative venture. Wolff has proposed such a draft model. He recommends that each child's name be placed on a big blackboard at the beginning of the draft. All assembled give their assessment of each child's baseball ability, and a consensus skill-level number (one through five) is entered next to each player's name. If there are 72 names, and the league wishes to form six teams of 12 players each, dividing up the rated players so that the skill levels balance would assure everyone (coaches, parents, the league, and by extension, the community) that the teams were of relatively equal strength. No coach at this point would know to which team he or she was being assigned, so there would be no motive for "stacking" a given team. Each team would be designated by a letter of the alphabet, and the six letters would be thrown into a hat. The six coaches would then blindly pick a team from the hat. If a coach desired that his or her child play on his or her team, fair adjustments (trades) could be made subject to majority agreement. The three draft models can be summarized as follows: Draft Model 1 Public tryouts Previous year rating Coach makes selections Can be very competitive, lacking in "character" Can result in very unequal teams Draft Model 2 Player evaluations placed into a data base Properly programmed computer projects equal teams Draft Model 3 All names placed on a blackboard Relative merits of players discussed Equal team drawn up and placed into a hat Adjustments can be made for coach's child If practical, this author suggests that coaches not pick a name for the team until the first team meeting or practice, when that task can be given to the children. In a symbolic way, this returns some of the sport to them while encouraging social interaction among new teammates, and helping the coach detect who the leaders are. Names of professional teams in the major sports, especially baseball, are to be avoided, as they fuel longstanding unconscious associations and fantasies, and may subtly tilt all participants toward the professional "win at all costs" mentality. No one draft model is perfect for every town, and even the most ethical attempt to achieve balance among teams can be severely tested by parents who request that their athlete be placed on the same team as another child for social or car pool reasons. Such requests are not inviolate, however. For example, they do not usually dictate placement in school classes, and car pools are frequently disrupted when children, in individual sports such as Tae Kwan Do, reach different ability levels, and so attend practices at different times. Baseball is no longer the national pasttime and, as we approach the millennium, American children have too many other attractive, competing interests and time demands to spontaneously organize a pick-up game. One coach shared with the author that his saddest moment in CAP League came when he arrived at 6 PM at a field that had been "reserved" for his team, and found a group of boys who were playing a pick-up game. The coach's impulse was to set his boys fre

Baseball↗

Blood mercury levels among Ontario anglers and sport-fish eaters.

We conducted two surveys of Ontario (Canada) fishers: a stratified sample of licensed anglers in two Lake Ontario communities (anglers, n=232) and a shore and community-based sample in five Great Lakes' Areas of Concern (AOC eaters, n=86). Among the 176 anglers consuming their catch, the median number of sport-fish meals/year was 34.2 meals and 10.9, respectively, in two communities, with a mean blood total mercury level among these sport-fish consumers of 2.8 microg/L. The vast majority of fish eaten by AOC eaters was from Ontario waters (74%). For AOC eaters, two broad country-of-origin groups were assembled: Euro-Canadians (EC) and Asian-Canadians (AC). EC consumed a median of 174 total fish meals/year and had a geometric mean total mercury level of 2.0 microg/L. Corresponding AC figures were 325 total fish meals/year and 7.9 microg/L. Overall, mercury levels among AOC eaters were higher than in many other Great Lakes populations but lower than in populations frequently consuming seafood. In multivariate models, mercury levels were significantly associated with levels of fish consumption among both anglers and EC AOC eaters. Given the nutritional and social benefits of fish consumption, prudent species and location choices should continue.

Adult↗

HAPPY days for the Dictyostelium genome project.

Without the HAPPY map, the collaborators in the genome project would have found assembly to be extremely difficult, and the Dictyostelium genome sequence would perhaps have been left highly incomplete. With the HAPPY Map the YAC clones can be remapped and the original YAC skim strategy followed. In conclusion, this method has already made one community very happy and seems sure to make its mark in many other genome projects.

Animals↗

Implementation of the Bamako Initiative: strategies in Benin and Guinea.

Two West African countries, Benin and Guinea, have been reorganizing their peripheral health systems since 1986, with the goal of improving access to primary health care (PHC). A comprehensive approach evolve, based on improving effectiveness, optimizing efficiency, ensuring financial variability and promoting equity. These strategies were launched as the Bamako Initiative by the World Health Organization's Regional Assembly in 1987. This is the first in a series of five articles on the Bamako Initiative in Benin and Guinea. The strategies implemented in these two countries are discussed. Subsequent articles discuss the improved health indicators, impact on service costs efficiency, and community empowerment through local cost recovery and equity implications. The health center is the basis for a revitalized primary care system. From here, an integrated minimum health care package is readily accessible to meet basic community health needs. Through the Bamako Initiative program, drugs and other essential resources are always available, regular contract between the community health service providers and communities has increased, and the quality of care has improved while also becoming more efficient. Community health resources are managed locally through joint microplanning and monitoring, involving health personnel and village committees. Community ownership, fostered by local budgeting and decision making, is an essential pillar for the success of the system.

Benin↗

Integron content of extended-spectrum-beta-lactamase-producing Escherichia coli strains over 12 years in a single hospital in Madrid, Spain.

The contribution of integrons to the dissemination of extended-spectrum beta-lactamases (ESBL) was analyzed on all ESBL-producing Escherichia coli isolates from 1988 to 2000 at Ramon y Cajal Hospital. We studied 133 E. coli pulsed-field gel electrophoresis types: (i) 52 ESBL-producing clinical strains (C-ESBL) (16 TEM, 9 SHV, 21 CTX-M-9, 1 CTX-M-14, and 5 CTX-M-10); (ii) 43 non-ESBL blood clinical strains (C-nESBL); and (iii) 38 non-ESBL fecal isolates from healthy volunteers (V-nESBL). Class 1 integrons were more common among C-ESBL (67%) than among C-nESBL (40%) or V-nESBL (26%) (P < 0.001) due to the high number of strains with bla(CTX-M-9), which is linked to an In6-like class 1 integron. Without this bias, class 1 integron occurrence would be similar in C-ESBL and C-nESBL groups (47% versus 40%). Occurrence of class 2 integrons was similar among clinical and community isolates (13 to 18%). No isolates contained class 3 integrons. The relatively low rate of class 1 integrons within transferable elements carrying bla(TEM) (23%) or bla(SHV) (33%) and the absence of class 2 integrons in all ESBL transconjugants mirror the assembly of translocative pieces containing bla(TEM) or bla(SHV) on local available transferable elements lacking integrons. The low diversity of class 1 integrons (seven types recovered in all groups) might indicate a wide dissemination of specific genetic elements in which they are located. In our environment, the spread of genetic elements encoding ESBL has no major impact on the dispersion of integrons, nor do integrons have a major impact on the spread of ESBL, except when bla(ESBL) genes are within an integron platform such as bla(CTX-M-9).

Cloning, Molecular↗

Tissues from population-based cancer registries: a novel approach to increasing research potential.

Population-based cancer registries, such as those included in the Surveillance, Epidemiology, and End-Results (SEER) Program, offer tremendous research potential beyond traditional surveillance activities. We describe the expansion of SEER registries to gather formalin-fixed, paraffin-embedded tissue from cancer patients on a population basis. Population-based tissue banks have the advantage of providing an unbiased sampling frame for evaluating the public health impact of genes or protein targets that may be used for therapeutic or diagnostic purposes in defined communities. Such repositories provide a unique resource for testing new molecular classification schemes for cancer, validating new biologic markers of malignancy, prognosis and progression, assessing therapeutic targets, and measuring allele frequencies of cancer-associated genetic polymorphisms or germline mutations in representative samples. The assembly of tissue microarrays will allow for the use of rapid, large-scale protein-expression profiling of tumor samples while limiting depletion of this valuable resource. Access to biologic specimens through SEER registries will provide researchers with demographic, clinical, and risk factor information on cancer patients with assured data quality and completeness. Clinical outcome data, such as disease-free survival, can be correlated with previously validated prognostic markers. Furthermore, the anonymity of the study subject can be protected through rigorous standards of confidentiality. SEER-based tissue resources represent a step forward in true, population-based tissue repositories of tumors from US patients and may serve as a foundation for molecular epidemiology studies of cancer in this country.

Biomarkers, Tumor↗

Educational portfolios in the assessment of general practice trainers: reliability of assessors.

OBJECTIVES: This paper reports a project that assessed a series of portfolios assembled by a cohort of participants attending a course for prospective general practice trainers. DESIGN: The reliability of judgements about individual 'components', together with an overall global judgement about performance were studied. SETTING: NHSE South & West, King Alfred's College, Winchester and Institute of Community Studies, Bournemouth University. SUBJECTS: Eight experienced general practice trainers recruited from around Wessex, which incorporates Hampshire, Dorset, Wiltshire and the Isle of Wight. RESULTS: The reliability of individual assessor's judgements (i.e. their consistency) was moderate, but inter-rater reliability did not reach a level which could support making a safe summative judgement. The levels of reliability reached were similar to other subjective assessments and perhaps reflected individuality of personal agendas of both the assessed and the assessors, and variations in portfolio structure and content. CONCLUSIONS: Suggestions for approaches in future are made.

Education, Medical, Continuing↗

A Graph Contrastive Learning Method for Enhancing Genome Recovery in Complex Microbial Communities.

Accurate genome binning is essential for resolving microbial community structure and functional potential from metagenomic data. However, existing approaches-primarily reliant on tetranucleotide frequency (TNF) and abundance profiles-often perform sub-optimally in the face of complex community compositions, low-abundance taxa, and long-read sequencing datasets. To address these limitations, we present MBGCCA, a novel metagenomic binning framework that synergistically integrates graph neural networks (GNNs), contrastive learning, and information-theoretic regularization to enhance binning accuracy, robustness, and biological coherence. MBGCCA operates in two stages: (1) multimodal information integration, where TNF and abundance profiles are fused via a deep neural network trained using a multi-view contrastive loss, and (2) self-supervised graph representation learning, which leverages assembly graph topology to refine contig embeddings. The contrastive learning objective follows the InfoMax principle by maximizing mutual information across augmented views and modalities, encouraging the model to extract globally consistent and high-information representations. By aligning perturbed graph views while preserving topological structure, MBGCCA effectively captures both global genomic characteristics and local contig relationships. Comprehensive evaluations using both synthetic and real-world datasets-including wastewater and soil microbiomes-demonstrate that MBGCCA consistently outperforms state-of-the-art binning methods, particularly in challenging scenarios marked by sparse data and high community complexity. These results highlight the value of entropy-aware, topology-preserving learning for advancing metagenomic genome reconstruction.

canonical correlation analysis↗

Current thinking on chronic renal allograft rejection: issues, concerns, and recommendations from a 1997 roundtable discussion.

Chronic rejection accounts for most renal allograft losses after the first year posttransplantation. On March 24 and 25, 1997, a roundtable of five transplant surgeons, two nephrologists, and one pathologist assembled in Dallas, Texas, to review critical issues surrounding chronic renal allograft rejection. This article summarizes the presentations and relevant discussions of this meeting regarding the cause of chronic rejection, clinical diagnoses, risk factors, future prospects for intervention strategies, and general recommendations for the transplant community. Growing evidence indicates that chronic rejection is the aggregate sum of irreversible immunologic and nonimmunologic injuries to the renal graft over time. A history of acute rejection episodes and inadequate immunosuppression, likely attributable to inconsistent cyclosporine exposure or poor patient compliance, are among the most recognizable immunologic risk factors for chronic rejection. Donor organ quality, delayed graft function, and other donor and recipient variables leading to reduced nephron mass are nonimmunologic factors that contribute to the progressive deterioration of renal graft function. Clinical management of renal transplant recipients should incorporate both immunologic- and nonimmunologic-based intervention strategies aimed at minimizing risk factors to thwart the progression of chronic rejection and improve long-term allograft and patient survival.

Biopsy↗