Quantitative microbial faecal source tracking with sampling guided by hydrological catchment dynamics

The impairment of water quality by faecal pollution is a global public health concern. Microbial source tracking methods help to identify faecal sources but the few recent quantitative microbial source tracking applications disregarded catchment hydrology and pollution dynamics. This quantitative microbial source tracking study, conducted in a large karstic spring catchment potentially influenced by humans and ruminant animals, was based on a tiered sampling approach: a 31-month water quality monitoring (Monitoring) covering seasonal hydrological dynamics and an investigation of flood events (Events) as periods of the strongest pollution. The detection of a ruminant-specific and a human-specific faecal Bacteroidetes marker by quantitative real-time PCR was complemented by standard microbiological and on-line hydrological parameters. Both quantitative microbial source tracking markers were detected in spring water during Monitoring and Events, with preponderance of the ruminant-specific marker. Applying multiparametric analysis of all data allowed linking the ruminant-specific marker to general faecal pollution indicators, especially during Events. Up to 80% of the variation of faecal indicator levels during Events could be explained by ruminant-specific marker levels proving the dominance of ruminant faecal sources in the catchment. Furthermore, soil was ruled out as a source of quantitative microbial source tracking markers. This study demonstrates the applicability of quantitative microbial source tracking methods and highlights the prerequisite of considering hydrological catchment dynamics in source tracking study design.

The effects of buprenorphine on behaviour in the ACI and BN rat inbred strains

Summary

Buprenorphine is a partial μ, κ agonist that has been shown to influence spontaneous behaviour in animals. Previously, we have demonstrated significant differences in the analgesic response to buprenorphine between the August Copenhagen Irish (ACI)/SegHsd and the Brown Norway (BN)/RijHsd inbred rat strains. The purpose of this study was to determine whether these strains also differed in their behavioural response to buprenorphine in order to provide an additional parameter for the genetic analysis and localization of genes involved in this response. Male and female rats of both strains were used ( n = 6/strain/sex) for this study. Each rat was subjected, respectively, to three treatment regimens at 15:00 h: (A) unchallenged; (B) intravenous saline; (C) intravenous buprenorphine (0.05 mg/kg) according to a crossover design. The relative duration (s/h) of locomotion, grooming, drinking and eating behaviour was subsequently determined from 15:30 to 07:00 h using the automatic registration system, Laboratory Animal Behaviour Registration and Analysis System™. Significant strain differences were observed in unchallenged behaviour between the ACI and the BN rats. ACI rats, but not BN rats, responded to buprenorphine treatment with decreased levels of locomotion, drinking and eating behaviour. The same treatment resulted in an increased grooming behaviour in both strains. Slight but significant sex differences were observed for locomotion and eating in the analysis of variance procedure, but did not reach the level of statistical significance in the multiple comparison procedure. The results of this study emphasize the possibility that strain-specific effects must be taken into account when using behavioural parameters for the assessment of the analgesic effects of buprenorphine in rats.

Microbiological monitoring and automated event sampling at karst springs using LEO-satellites

Data communication via Low-Earth-Orbit (LEO) Satellites between portable hydrometeorological measuring stations is the backbone of our system. This networking allows automated event sampling with short time increments also for E. coli field analysis. All activities of the course of the event-sampling can be observed on an internet platform based on a Linux-Server. Conventionally taken samples compared with the auto-sampling procedure revealed corresponding results and were in agreement with the ISO 9308-1 reference method. E. coli concentrations were individually corrected by event specific inactivation coefficients (0.10-0.14 day(-1)), compensating losses due to sample storage at spring temperature in the auto sampler.Two large summer events in 2005/2006 at an important alpine karst spring (LKAS2) were monitored including detailed analysis of E. coli dynamics (n = 271) together with comprehensive hydrological characterisations. High-resolution time series demonstrated a sudden increase of E. coli concentrations in spring water (approximately 2 log10 units) with a specific time delay after the beginning of the event. Statistical analysis suggested the spectral absorption coefficient measured at 254 nm (SAC254) as an early warning surrogate for real time monitoring of faecal input. Together with the LEO-satellite based system it is a helpful tool for early-warning systems in the field of drinking water protection.

Influence of environmental enrichment and handling on the acute stress response in individually housed mice

In this study we investigated the effect of environmental enrichment and handling on the acute physiological stress response caused by short periods of restraint in individually housed female mice. Heart rate (HR) and body temperature (BT) were measured by radiotelemetry and compared with plasma corticosterone (pCORT) levels. Also, postmortem thymus weight and tyrosine hydroxylase (TH) activity were assessed. The acute stress response was seen in both HR and BT. Enrichment and handling were found to increase rather than decrease this stress response, but pCORT values, measured 90 min after restraint, suggested a lower stress response in the enriched groups. No effect was found with thymus weight or TH as parameters.

Development of a novel amplified fragment length polymorphism (AFLP) typing method for enterococci isolates from cattle faeces and evaluation of the single versus pooled faecal sampling approach

A novel and highly reproducible amplified fragment length polymorphism (AFLP) typing approach was developed for typing of Enterococcus strains from the environment. Pooled and corresponding single faecal sample isolates were analysed to test the efficiency and coverage of dominant isolates for future sampling procedures. AFLP development was based on the selection of appropriate restriction enzymes and the design of adaptors and primers which was supported by in silico optimisation of selective bases using Enterococcus spp. genome data. Three optimal combinations of selective bases at the 3' end of the designed primers (i.e., CC, GG, CG) could be determined. AFLP fragment analysis using a capillary sequencer and intralane standardisation resulted in excellent methodical stability (> or =98% similarity for GG and > or =94% similarity for CC). Furthermore, the developed typing method was evaluated on 16 type trains of the genera Enterococcus and Streptococcus and 398 faecal isolates of cow pats from five alpine pastures in a karstic catchment area. Statistical analysis revealed a discrimination capacity of DI > or =0.95 (Simpson Diversity Index) and a reproducibility level of > or =94% similarity indicating the methods high typing capacity and robustness. Results of the comparative analysis of single and pooled faecal samples indicate that for a "strain to strain" based faecal source tracking, pooled faecal samples rather than single faecal samples are likely to be the most efficient sampling strategy for collecting the abundant corresponding strains.

Analysis of factors that contribute to treatment failure in patients with community-acquired pneumonia

To determine the causes of treatment failure and to evaluate the prognostic factors in patients hospitalized for community-acquired pneumonia, a prospective, observational study of 228 adult patients hospitalized for a community-acquired pneumonia in the University Hospital of Geneva and the La Chaux-de-Fonds Community Hospital, Switzerland, was conducted. The percentage of patients who failed to improve (as defined by guidelines of the Infectious Disease Society of America) and the causes of treatment failure were assessed, and patients who failed to improve under antimicrobial therapy were compared with those who did improve. In the 54 (24%) patients who failed to improve, a mean increase in length of hospitalization of 4 days was observed. Most causes of treatment failure could be attributed to host factors (61%) rather than to the pathogen (16%) or to an inappropriate antibiotic regimen (3%). After adjusting for potentially confounding variables, concomitant neoplasia (OR 3.25; 95%CI 1.11-9.56), neurological disease (OR 2.34; 95%CI 1.07-5.13), and aspiration pneumonia (OR 2.97; 95%CI 29-6.86]) were associated with failure to improve, whereas monocytosis improved prognosis (OR 0.40; 95%CI 0.20-0.80). Almost one out of four patients hospitalized for community-acquired pneumonia failed to respond to empirical antibiotic treatment. Aspiration pneumonia, concomitant neoplasia, and neurological disease were factors positively associated with failure to improve, whereas monocytosis was linked to a better prognosis.

Digitized pathology: theory and experiences in automated tissue-based virtual diagnosis

AIMS

To describe the theory and develop an automated virtual slide screening system. Theoretical considerations. Tissue-based diagnosis separates into (a) sampling procedure to allocate the slide area containing diagnostic information, and (b) evaluation of diagnosis from the selected area. Nyquist's theorem broadly applied in acoustics, serves to presetting the sampling accuracy. Tissue-based diagnosis relies on two different information systems: (a) texture, and (b) object information. Texture information can be derived by recursive formulas without image segmentation. Object information requires image segmentation and feature extraction. Both algorithms complete another to a "self-learning" classification system.

METHODS

Non-overlapping compartments of the original virtual slide (image) are chosen at random with predefined error-rate (Nyquist's theorem). The standardized image compartments are subject for texture and object analysis. The recursive formula of texture analysis computes median gray values and local noise distribution. Object analysis includes automated measurements of immunohistochemically stained slides. The computations performed at different magnifications (x 2, x 4.5, x 10, x 20, x 40) are subject to multivariate statistically analysis and diagnosis classification.

RESULTS

A total of 808 lung cancer cases of diagnoses groups: cohort (1) normal lung (318 cases) - cancer (490 cases); cancer subdivided: cohort (2) small cell lung cancer (10 cases) - non-small cell lung cancer (480 cases); non-small cell lung cancer subdivided: cohort (3) squamous cell carcinoma (318 cases) - adenocarcinoma (194 cases) - large cell carcinoma (70 cases) was analyzed. Cohorts (1) and (2) were classified correctly in 100%, cohort (3) in more than 95%. The selected area can be limited to 10% of the original image without increased error rate. A second approach included 233 breast tissue cases (105 normal, 128 breast carcinomas) and 88 lung tissue cases (58 normal, 38 cancer). Texture analysis revealed a correct classification with only 10 training set cases in >92% for both, breast and lung tissue.

CONCLUSIONS

The developed system is a fast and reliable procedure to fulfill all requirements for an automated "pre-screening" of virtual slides in tissue-based diagnosis.

Beyond the Mediterranean peninsulas: evidence of central European glacial refugia for a temperate forest mammal species, the bank vole (Clethrionomys glareolus)

This study details the phylogeographic pattern of the bank vole, Clethrionomys glareolus, a European rodent species strongly associated with forest habitat. We used sequences of 1011 base pairs of the mitochondrial DNA cytochrome b gene from 207 bank voles collected in 62 localities spread throughout its distribution area. Our results reveal the presence of three Mediterranean (Spanish, Italian and Balkan) and three continental (western, eastern and 'Ural') phylogroups. The endemic Mediterranean phylogroups did not contribute to the post-glacial recolonization of much of the Palaearctic range of species. Instead, the major part of this region was apparently recolonized by bank voles that survived in glacial refugia in central Europe. Moreover, our phylogeographic analyses also reveal differentiated populations of bank voles in the Ural mountains and elsewhere, which carry the mitochondrial DNA of another related vole species, the ruddy vole (Clethrionomys rutilus). In conclusion, this study demonstrates a complex phylogeographic history for a forest species in Europe which is sufficiently adaptable that, facing climate change, survives in relict southern and northern habitats. The high level of genetic diversity characterizing vole populations from parts of central Europe also highlights the importance of such regions as a source of intraspecific genetic biodiversity.

Microbicidal efficacy of an advanced oxidation process using ozone/hydrogen peroxide in water treatment

The combined application of ozone and hydrogen peroxide represents a kind of advanced oxidation for water treatment. The radicals that are generated during the process are used for the degradation of organic pollutants from groundwater and industrial effluents. The aim of our study was to evaluate the possible microbicidal, and particularly virucidal, efficacy of such a process, since no substantial data were available. The investigations were performed at a pilot plant installed for the elimination of perchloroethylene from polluted groundwater (reduction efficacy for perchloroethylene from 26 microg/L to 5 microg/L). To enable a reliable evaluation of the microbicidal effect, a set of alternate test organisms was used. As model viruses we chose bacteriophages MS2 (F+ specific, single-stranded RNA), phiX174 (single-stranded DNA) and PRD-1 (coated, double-stranded DNA). Furthermore, spores of Bacillus subtilis were included as possible surrogates for protozoa and Escherichia coli as representative for traditional indicator bacteria used in water analysis. The microbicidal efficiency was compared to the inactivation by means of ozone under two standard conditions (20 degrees C): (a) 0.4 mg/L residual after 4 min and (b) 0.1 mg/L residual after 10 min. Surprisingly, a good microbicidal effect of the ozone/hydrogen peroxide process was found. This was somewhat unexpected, because we had assumed that the disinfection potential of ozone would have been interfered with by the presence of hydrogen peroxide. Escherichia coli and the three test viruses revealed a reduction of about 6-log. In contrast, spores of Bacillus subtilis showed after the total process a reduction of 0.4-log. These results matched the effect of the ozone treatment (a) with a residual of 0.4 mg/L after 4 min contact time (20 degrees C). The test condition (b) with a residual of 0.1 mg/L ozone after a contact time of 10 min at 20 degrees C gave a higher reduction of the B. subtilis spores (1.5-log). The presented study revealed a satisfying microbicidal efficacy of the ozone/hydrogen peroxide process with respect to vegetative bacteria and viruses (bacteriophages). However, it has to be emphasised that intense mixing and sufficient contact time have to be optimised and tested for each individual installation.

Angiotensin receptor blockers as anti-hypertensive treatment for patients with diabetes mellitus: meta-analysis of controlled double-blind randomized trials

AIMS

To assess the evidence for possible reduction of all-cause mortality, cardiovascular morbidity and mortality, and end-stage renal disease in diabetic patients treated with angiotensin II type 1 receptor blockers (ARBs) as an anti-hypertensive treatment.

METHODS

Systematic review and meta-analysis of randomized, double-blind controlled trials of at least 1 year's duration. ARBs were used in the intervention group vs. placebo or standard anti-hypertensive treatment in the control group. The main outcome measures were all-cause mortality, cardiovascular morbidity and mortality, and end-stage renal disease.

RESULTS

Three studies fulfilled the inclusion criteria. Separate analyses were conducted for comparisons of ARBs with groups given placebo and those given standard anti-hypertensive treatment. There was no significant difference in mortality between the ARBs and placebo groups, with an estimated odds ratio (OR) of 0.99 [95% confidence interval (CI) 0.81, 1.20]. There was a non-significant difference in patients treated with ARBs compared with standard anti-hypertensive treatment, with an OR of 0.78 (95% CI 0.45, 1.36). No statistically significant difference in cardiovascular morbidity and mortality between the intervention and placebo groups was found, with an OR of 0.91 (95% CI 0.77, 1.08). When ARBs were compared with standard treatment, the OR was estimated at 0.85 (0.54, 1.33). Data on end-stage renal disease were available for two studies comparing ARBs vs. placebo and showed a statistically significant advantage of ARBs, with an OR of 0.73 (95% CI 0.6, 0.89). As only one study compared end-stage renal disease outcome for ARBs vs. standard treatment, a meta-analysis was not possible. This study reported a considerable benefit of ARBs [OR = 0.73 (0.54, 1.01)] compared with the calcium channel blocker amlodipine.

CONCLUSIONS

ARBs failed to show significant reduction in total mortality and cardiovascular morbidity and mortality in diabetic patients. The only statistical benefit was the reduction of end-stage renal disease compared with placebo. Therefore, at this time ARBs have not proved to be superior to standard anti-hypertensive treatment in diabetic patients.

Prospective epidemiologic survey of patients with community-acquired pneumonia requiring hospitalization in Switzerland

BACKGROUND

Community-acquired pneumonia (CAP) is a common problem and the principal infection requiring hospitalization, but its treatment is complicated by the difficulty in microbiological diagnosis and the increasing incidence of antibiotic resistance among respiratory pathogens. The purpose of this paper is to present the main epidemiologic features of patients with CAP requiring hospitalization in our country.

METHODS

We enrolled three hundred and eighteen adult patients with CAP requiring hospitalization in seven large medical centers in Switzerland during two winter periods. The patients' mean age was 70.4 years. This study describes the epidemiology of these patients. Clinical, radiologic and microbiological evaluations were performed at study entry during treatment, and at 4 weeks post-therapy. For microbiological diagnostic purposes, sputum culture, throat swab culture, PCR, blood cultures, Legionella urinary antigen and serologic evaluations were also performed.

RESULTS

Despite the higher mean age, the overall mortality rate was 8%, lower than in other comparable studies. The most common underlying diseases present at study entry were cardiac failure (23%), chronic obstructive pulmonary disease (20%), renal failure (15%), and diabetes (12%); 40% of the patients were smokers. Although dyspnea, cough and positive pulmonary auscultation findings were present in about 90% of patients, fever >38 degrees C was present in only 64%. The most frequently isolated respiratory pathogens were Streptococcus pneumoniae (12.6%), Haemophilus influenzae (6%), Staphylococcus aureus (1.6%), and Moraxella catarrhalis (1.6%). Atypical pathogens were frequently found, with the following distribution: Mycoplasma pneumoniae, 7.5%; Chlamydia pneumoniae, 5.3%; and Legionella pneumophila, 4.4%. The mean duration between onset of symptoms and hospital admission was 4.8 days, and the mean treatment duration was 12.1 days. Two weeks after the start of therapy, although clinical symptoms were absent, radiologic infiltrates were still present in 24% of patients.

CONCLUSIONS

The microbiological diagnosis in CAP can be established in only about 50% of cases with the combination of several diagnostic tools. Epidemiologic surveys of CAP should be performed on a regular basis, regionally, as a way to improve the management of these infections.

Occurrence and levels of indicator bacteriophages in bathing waters throughout Europe

Somatic coliphages, F-specific RNA bacteriophages, bacteriophages infecting Bacteroides fragilis, Escherichia coli and enterococci were counted in bathing waters in the late spring and summer. We tested fresh and marine bathing waters from North, South, East and West Europe expected to contain between 100 and 500 E. coli per 100 ml, although wider ranges were sometimes found. Bacteriophages were counted after concentration, since a preliminary study proved that this step was necessary to obtain positive counts. During monitoring, a first-line quality control with reference materials for bacteria and bacteriophages was performed by all the laboratories participating in the study. The same microbes were also counted in raw sewage samples from various areas in Europe, where the bacterial indicators and the three groups of bacteriophages were detected in roughly the same numbers. All groups of bacteriophages were detected in both fresh and marine bathing waters throughout Europe. Reliable and complete results from 147 samples showed that for log-transformed values, E. coli and bacteriophages were slightly correlated. However, the slope of the regression line changed according to E. coli concentration and the correlation diminished when this concentration was close to zero per 100 ml. The ratios between E. coli and phages in bathing waters differed significantly from those in sewage. The relative amounts of bacteriophages, mainly somatic coliphages and phages infecting Bact. fragilis RYC2056, increased in bathing waters with low E. coli concentration, especially in seawater samples containing < 100 E. coli per 100 ml. The relationship of bacteriophages with respect to enterococci paralleled that of bacteriophages with respect to E. coli. Somatic coliphages and bacteriophages infecting Bact. fragilis are useful to predict the presence of some pathogens with the same origin as present bacterial indicators but with higher survival rates.

Occurrence of Cryptosporidium sp. oocysts in fecal and water samples in Austria

Oocysts of Cryptosporidium spp. were detected and differentiated by a modular arranged gene amplification procedure in various samples, mostly human stool, feces of herpetotaxa, and water, in different locations of South and Eastern Austria. Cryptosporidium parvum was found in stool samples of immunocompromised persons, in reptile feces, and in water samples. The presence of Cryptosporidium in an area is probably associated with high human population densities since water from protected sources in sparsely inhabited areas is rarely contaminated.

Inactivation of bacteriophages in water by means of non-ionizing (UV-253.7 nm) and ionizing (gamma) radiation: a comparative approach

Thc inactivation behaviour of the bacteriophages PHI X 174 (ssDNA virus). MS2 (ssRNA virus) and B40-8 (dsDNA) toward non-ionizing (UV-253.7 nm) as well as to ionizing radiation (gamma radiation) was studied in order to evaluate their potential as viral indicators for water disinfection by irradiation. Previous findings of the high UV-253.7 nm resistance of MS2 were confirmed whereas an unexpected high sensitivity to gamma radiation compared to the two other phages was found. On the other hand, PHI X 174 revealed an enhanced UV sensitivity but a high resistance to ionizing radiation. B40-8 had an intermediate position between the other two bacteriophages relative to both types of radiation. As expected, the data of E. coli reconfirmed the unreliability of fecal indicator bacteria for the purpose of predicting responses of viruses to water treatment. In UV disinfection the influence of water matrix may be adequately controlled by considering the UV (253.7 nm) absorption of the water whereas so far no such parameter has existed for the influence of the water quality on ionizing irradiation with respect to the scavenger concentration.

[Parenthood and psychiatric hospitalization]

As a topic, parenthood by persons with severe mental disturbances has predominantly been investigated with regard to the effects of the disorder on the children. The present article, in contrast, focuses on the concerns of psychically ill parents. On the one hand, the study aimed to record the portion of treated stationary patients with children under age; on the other hand, the need of these parents for assistance with regard to their parenthood was to be explored. In the course of a five-month period, number and age of children of all patients entering the in-patient clinic (n = 614) were recorded. 101 persons, or 16.5%, were registered as being a parent of at least one minor child. Semi-structured interviews were conducted with 44 parents, addressing the problems caused by the illness, contact with the children during hospitalisation, resources, familiarity and experience with assistance provided, as well as the need for further support. More than 2/3 of the patients expressed a need for help with informing their children of the illness and requested support in the form of parent groups at the clinic. Almost half of the patients were prepared to contact an expert at the clinic on questions relating to parent-child issues. Our findings reveal a great demand for support and that provision of assistance is imperative.