Molecular Epidemiology of Blastomyces gilchristii Clusters, Minnesota, USA

We characterized 2 clusters of blastomycosis cases in Minnesota, USA, using whole-genome sequencing and single-nucleotide polymorphism analyses. Blastomyces gilchristii was confirmed as the cause of infection. Genomic analyses corresponded with epidemiologic findings for cases of B. gilchristii infections, demonstrating the utility of genomic methods for future blastomycosis outbreak investigations.

Sustainable micropollutant bioremediation via stormwater biofiltration system

Waters contaminated with micropollutants are of environmental and public health concern globally. Stormwater is a significant source of anthropogenic micropollutants to receiving waters. Hence, sustainable stormwater remediation is needed to reduce contamination of waterways. Yet designing sustainable bioremediation solutions, including those targeted to remove micropollutants, is a major scientific challenge. This study aimed to adapt the design of stormwater biofiltration systems, to improve the removal of micropollutants and understand the role of the micropollutant-degrading bacteria in this bioremediation process. We investigated the atrazine removal performance of a prototype biofiltration system, in which the filter media was supplemented with Granulated Activated Carbon (GAC). The prototype biofiltration system completely removed atrazine to below detectable limits, significantly exceeding the GAC's adsorption capacity alone, suggesting other biological processes were present. We showed that atrazine degradation capacity, measured by the kinetics of the trzN gene abundance, was accelerated in the prototype system compared to the standard system (which had no added GAC; 0.8 vs. 0.37 week-1, respectively). Notably, this high level of atrazine removal did not come at the expense of the removal performance of other typical stormwater macropollutants (e.g., nutrients, suspended solids). The prototype biofiltration system showed a proof-of-concept of sustaining microbial remediation of a model micropollutant alongside stormwater macropollutants, which could be used to reduce impacts on receiving waterways and protect our ecosystems and human health.

Molecular Characterization of Carbapenem-Resistant Enterobacterales Collected in the United States

Carbapenem-resistant Enterobacterales (CRE) are a growing public health concern due to resistance to multiple antibiotics and potential to cause health care-associated infections with high mortality. Carbapenemase-producing CRE are of particular concern given that carbapenemase-encoding genes often are located on mobile genetic elements that may spread between different organisms and species. In this study, we performed phenotypic and genotypic characterization of CRE collected at eight U.S. sites participating in active population- and laboratory-based surveillance of carbapenem-resistant organisms. Among 421 CRE tested, the majority were isolated from urine (n = 349, 83%). Klebsiella pneumoniae was the most common organism (n = 265, 63%), followed by Enterobacter cloacae complex (n = 77, 18%) and Escherichia coli (n = 50, 12%). Of 419 isolates analyzed by whole genome sequencing, 307 (73%) harbored a carbapenemase gene; variants of bla_KPC predominated (n = 299, 97%). The occurrence of carbapenemase-producing K. pneumoniae, E. cloacae complex, and E. coli varied by region; the predominant sequence type within each genus was ST258, ST171, and ST131, respectively. None of the carbapenemase-producing CRE isolates displayed resistance to all antimicrobials tested; susceptibility to amikacin and tigecycline was generally retained.

Long term study of motivational and cognitive effects of low-intensity focused ultrasound neuromodulation in the dorsal striatum of nonhuman primates

Noninvasive brain stimulation using transcranial focused ultrasound (FUS) has many potential applications as a research and clinical tool, including incorporation into neural prosthetics for cognitive rehabilitation. To develop this technology, it is necessary to evaluate the safety and efficacy of FUS neuromodulation for specific brain targets and cognitive functions. It is also important to test whether repeated long-term application of FUS to deep brain targets improves or degrades behavioral and cognitive function. To this end, we investigated the effects of FUS in the dorsal striatum of nonhuman primates (NHP) performing a visual-motor decision-making task for small or large rewards. Over the course of 2 years, we performed 129 and 147 FUS applications, respectively, in two NHP. FUS (0.5 MHz @ 0.2-0.8 MPa) was applied to the putamen and caudate in both hemispheres to evaluate the effects on movement accuracy, motivation, decision accuracy, and response time. Sonicating the caudate or the putamen unilaterally resulted in modest but statistically significant improvements in motivation and decision accuracy, but at the cost of slower reaction times. The effects were dose (i.e., FUS pressure) and reward dependent. There was no effect on reaching accuracy, nor was there long-term behavioral impairment or neurological trauma evident on T1-weighted, T2-weighted, or susceptibility-weighted MRI scans. Sonication also resulted in significant changes in resting state functional connectivity between the caudate and multiple cortical regions. The results indicate that applying FUS to the dorsal striatum can positively impact the motivational and cognitive aspects of decision making. The capability of FUS to improve motivation and cognition in NHPs points to its therapeutic potential in treating a wide variety of human neural diseases, and warrants further development as a novel technique for non-invasive deep brain stimulation.

820. Optimal Specimen Source(s) for Carbapenemase-Producing Acinetobacter Colonization Screening

Background

Infection prevention (IP) strategies are implemented to limit the transmission of healthcare-associated infections (HAIs), which are estimated to occur in 1 out of 31 hospitalized patients per day in the United States. Carbapenem-resistant Acinetobacter (CRA) cause HAIs classified as an urgent threat by CDC. When carbapenemase-producing CRA (CP-CRA) are identified, containment strategies are implemented, including screening patients at high risk for colonization with CP-CRA. Point prevalence surveys (PPS) are conducted to assist with HAI outbreak investigations and identify colonized patients.

Methods

Herein, we describe results from culture-based CP-CRA colonization testing of multiple specimen sources (rectal, skin [axilla/groin or groin], respiratory, and/or wound). A total of 744 PPS specimens from 356 patients, across six states, were obtained from February 2019 to May 2021 for CP-CRA colonization screening including 30% (224/744) rectal, 52% (390/744) skin, 10% (73/744) respiratory, and 8% (57/744) wound sources. The specimens were plated onto both non-selective (blood agar) and selective media (MacConkey, ESBL CHROMagar, Acinetobacter CHROMagar), and RT-PCR was performed for detection of the Acinetobacter-specific carbapenemase genes blaOXA-23, blaOXA-24, and blaOXA-58.

Results

Twelve percent (90/744) of specimens, representing 17% (62/356) of patients, were positive for detection of blaOXA-23 and/or blaOXA-24 CP-CRA. The majority (96%) of CP-CRA harbored blaOXA-24. Of the 62 colonized patients, 52% (32/62) had more than one collection source and 47% (15/32) of those had more than one source positive for CP-CRA. There was no consensus regarding a single source type across positive specimens. However, rectal or skin swab collection alone would potentially miss 2% (4/163) or 8% (14/186) of positive specimens, respectively.

Conclusion

These data suggest that rectal or skin source collection alone could be sufficient for detection of CP-CRA. Overall, multiple factors should be considered to guide the source(s) for CP-CRA specimen collection, such as infection type, regional prevalence, patient factors, and/or IP gap(s) within a facility.

Disclosures

All Authors: No reported disclosures

Rapid Assessment and Containment of Candida auris Transmission in Postacute Care Settings-Orange County, California, 2019

BACKGROUND

Candida auris, a multidrug-resistant yeast, can spread rapidly in ventilator-capable skilled-nursing facilities (vSNFs) and long-term acute care hospitals (LTACHs). In 2018, a laboratory serving LTACHs in southern California began identifying species of Candida that were detected in urine specimens to enhance surveillance of C auris, and C auris was identified in February 2019 in a patient in an Orange County (OC), California, LTACH. Further investigation identified C auris at 3 associated facilities.

OBJECTIVE

To assess the prevalence of C auris and infection prevention and control (IPC) practices in LTACHs and vSNFs in OC.

DESIGN

Point prevalence surveys (PPSs), postdischarge testing for C auris detection, and assessments of IPC were done from March to October 2019.

SETTING

All LTACHs (n = 3) and vSNFs (n = 14) serving adult patients in OC.

PARTICIPANTS

Current or recent patients in LTACHs and vSNFs in OC.

INTERVENTION

In facilities where C auris was detected, PPSs were repeated every 2 weeks. Ongoing IPC support was provided.

MEASUREMENTS

Antifungal susceptibility testing and whole-genome sequencing to assess isolate relatedness.

RESULTS

Initial PPSs at 17 facilities identified 44 additional patients with C auris in 3 (100%) LTACHs and 6 (43%) vSNFs, with the first bloodstream infection reported in May 2019. By October 2019, a total of 182 patients with C auris were identified by serial PPSs and discharge testing. Of 81 isolates that were sequenced, all were clade III and highly related. Assessments of IPC identified gaps in hand hygiene, transmission-based precautions, and environmental cleaning. The outbreak was contained to 2 facilities by October 2019.

LIMITATION

Acute care hospitals were not assessed, and IPC improvements over time could not be rigorously evaluated.

CONCLUSION

Enhanced laboratory surveillance and prompt investigation with IPC support enabled swift identification and containment of C auris.

PRIMARY FUNDING SOURCE

Centers for Disease Control and Prevention.

Carbapenemase production among less-common Enterobacterales genera: 10 US sites, 2018

Background

Historically, United States’ carbapenem-resistant Enterobacterales (CRE) surveillance and mechanism testing focused on three genera: Escherichia, Klebsiella, and Enterobacter (EsKE); however, other genera can harbour mobile carbapenemases associated with CRE spread.

Objectives

From January through May 2018, we conducted a 10 state evaluation to assess the contribution of less common genera (LCG) to carbapenemase-producing (CP) CRE.

Methods

State public health laboratories (SPHLs) requested participating clinical laboratories submit all Enterobacterales from all specimen sources during the surveillance period that were resistant to any carbapenem (Morganellaceae required resistance to doripenem, ertapenem, or meropenem) or were CP based on phenotypic or genotypic testing at the clinical laboratory. SPHLs performed species identification, phenotypic carbapenemase production testing, and molecular testing for carbapenemases to identify CP-CRE. Isolates were categorized as CP if they demonstrated phenotypic carbapenemase production and ≥1 carbapenemase gene (bla_KPC, bla_NDM, bla_VIM, bla_IMP, or bla_OXA-48-like) was detected.

Results

SPHLs tested 868 CRE isolates, 127 (14.6%) were from eight LCG. Overall, 195 (26.3%) EsKE isolates were CP-CRE, compared with 24 (18.9%) LCG isolates. LCG accounted for 24 (11.0%) of 219 CP-CRE identified. Citrobacter spp. was the most common CP-LCG; the proportion of Citrobacter that were CP (11/42, 26.2%) was similar to the proportion of EsKE that were CP (195/741, 26.3%). Five of 24 (20.8%) CP-LCG had a carbapenemase gene other than bla_KPC.

Conclusions

Participating sites would have missed approximately 1 in 10 CP-CRE if isolate submission had been limited to EsKE genera. Expanding mechanism testing to additional genera could improve detection and prevention efforts.

Decreased Susceptibility to Azithromycin in Clinical Shigella Isolates Associated with HIV and Sexually Transmitted Bacterial Diseases, Minnesota, USA, 2012-2015

Shigellosis outbreaks caused by Shigella with decreased susceptibility to azithromycin (DSA-Shigella) among men who have sex with men (MSM) have been reported worldwide. We describe sexual health indicators and antimicrobial drug resistance for shigellosis cases in Minnesota, USA. We analyzed a sample of isolates received during 2012-2015 and cross-referenced cases with the Minnesota Department of Health Sexually Transmitted Disease Database to ascertain patients' HIV status and recent chlamydia, gonorrhea, and syphilis infections. Of 691 Shigella isolates, 46 (7%) were DSA-Shigella; 91% of DSA-Shigella patients were men, of whom 60% were living with HIV. Among men, those with DSA-Shigella infection had greater odds of living with HIV, identifying as MSM, or having a recent diagnosis of a sexually transmitted disease. DSA-Shigella was associated with MSM, HIV infection, and recent sexually transmitted disease. To decrease spread of DSA-Shigella, interventions targeted at communities at high risk are needed.

Simulations of the Water Food Energy Nexus for policy driven intervention

Water-Food-Energy (WFE) resources exert mutual influences upon each other and thus cannot be managed separately. Information on household WFE expenditures addresses knowledge that distinguishes between geospatial districts' social welfare. Social welfare and investment in districts' WFE resources are interconnected. District (node) product of WFE normalized expenditures (Volume) is considered as a representative WFE Nexus holistic quantity. This Volume is assumed to be a function of residents' knowledge of welfare level across districts. We prove that the Volume rate conforms to Boltzmann entropy, and this is the premise of our hypothesis for directed information from high to low welfare between network nodes. Welfare mass (WM) represents the district's Volume combined with its income and population density. This WM is used as input into a model balancing between all domain nodes that allows policymakers to simulate the effects of potential quantifiable policy decisions targeted to individual districts at a domain level while also considering influences between districts. Based on existing historic data, the established tool exemplifies its potential by providing outcomes for Israel districts showing the influence of imposing different temporal allocation/deallocation actions as managerial regulations to prescribed districts. It is found that districts with a high WM do not suffer when a defund is applied, but districts that have a low WM gain from subsidies.

Losartan attenuates progression of osteoarthritis in the synovial temporomandibular and knee joints of a chondrodysplasia mouse model through inhibition of TGF-β1 signaling pathway

OBJECTIVE

Transforming growth factor beta 1 (TGF-β1) is implicated in osteoarthritis (OA). The purpose of this study was to explore the ability of Losartan to inhibit the inflammatory signaling pathway of TGF-β1 observed during osteoarthritic progression in the temporomandibular joint (TMJ) and knee joint using a genetic mouse model.

METHODS

A murine OA model displaying the heterozygous chondrodysplasia gene (cho/+), a col11a1 mutation, was used to test this hypothesis. Following a 7-month treatment period with Losartan, the synovial joints were analyzed for histopathological improvement comparing two experimental groups. Tissues were fixed in paraformaldehyde, processed to paraffin section, and stained with Safranin O and Fast Green to visualize proteoglycans and collagen proteins in cartilage. Using the Modified Mankin scoring system, the degree of staining and OA progression were evaluated.

RESULTS

Results show heterozygous animals receiving Losartan having diminished degeneration of TMJ condylar and knee joint articular cartilage. This was confirmed in the TMJ and knee by a statistically significant decrease in the Mankin histopathology score. Decreased expression of HtrA1, a key regulator to the TGF-β1 signaling pathway, was demonstrated in vitro as well as in vivo, via Losartan inhibition.

CONCLUSION

Using a genetic mouse model of OA, this study demonstrated the utility of Losartan to improve treatment of human OA in the TMJ and knee joint through inhibition of the TGF-β1 signaling cascade. We further demonstrated inhibition of HtrA1, the lowering of Mankin scores to wild type control levels, and the limiting of OA progressive damage with treatment of Losartan.

A flexible control system designed for lab-scale simulations and optimization of composting processes

Understanding and optimization of composting processes can benefit from the use of controlled simulators of various scales. The Agricultural Research Organization Composting Simulator (ARO-CS) was recently built and it is flexibly automated by means of a programmable logic controller (PLC). Temperature, carbon dioxide, oxygen and airflow are monitored and controlled in seven 9-l reactors that are mounted into separate 80-l water baths. The PLC program includes three basic heating modes (pre-determined temperature profile, temperature-feedback ("self-heating"), and carbon dioxide-dependent temperature), three basic aeration modes (airflow dependence on temperature, carbon dioxide, or oxygen) and enables all possible combinations among them. This unique high flexibility provides a robust and valuable research tool to explore a wide range of research questions related to the science and engineering of composting. In this article the logic and flexibility of the control system is presented and demonstrated and its potential applications are discussed.

AN ANALYSIS OF TWO COMMON REFERENCE POINTS FOR EEGS

Clinical electroencephalographic (EEG) data varies significantly depending on a number of operational conditions (e.g., the type and placement of electrodes, the type of electrical grounding used). This investigation explores the statistical differences present in two different referential montages: Linked Ear (LE) and Averaged Reference (AR). Each of these accounts for approximately 45% of the data in the TUH EEG Corpus. In this study, we explore the impact this variability has on machine learning performance. We compare the statistical properties of features generated using these two montages, and explore the impact of performance on our standard Hidden Markov Model (HMM) based classification system. We show that a system trained on LE data significantly outperforms one trained only on AR data (77.2% vs. 61.4%). We also demonstrate that performance of a system trained on both data sets is somewhat compromised (71.4% vs. 77.2%). A statistical analysis of the data suggests that mean, variance and channel normalization should be considered. However, cepstral mean subtraction failed to produce an improvement in performance, suggesting that the impact of these statistical differences is subtler.

Tracing the Sources of Atmospheric Phosphorus Deposition to a Tropical Rain Forest in Panama Using Stable Oxygen Isotopes

Atmospheric dust deposition can be a significant source of phosphorus (P) in some tropical forests, so information on the origins and solubility of atmospheric P is needed to understand and predict patterns of forest productivity under future climate scenarios. We characterized atmospheric dust P across a seasonal cycle in a tropical lowland rain forest on Barro Colorado Nature Monument (BCNM), Republic of Panama. We traced P sources by combining remote sensing imagery with the first measurements of stable oxygen isotopes in soluble inorganic phosphate (δ(18)OP) in dust. In addition, we measured soluble inorganic and organic P concentrations in fine (<1 μm) and coarse (>1 μm) aerosol fractions and used this data to estimate the contribution of P inputs from dust deposition to the forest P budget. Aerosol dry mass was greater in the dry season (December to April, 5.6-15.7 μg m(-3)) than the wet season (May to November, 3.1-7.1 μg m(-3)). In contrast, soluble P concentrations in the aerosols were lower in the dry season (980-1880 μg P g(-1)) than the wet season (1170-3380 μg P g(-1)). The δ(18)OP of dry-season aerosols resembled that of nearby forest soils (∼19.5‰), suggesting a local origin. In the wet season, when the Trans-Atlantic Saharan dust belt moves north close to Panama, the δ(18)OP of aerosols was considerably lower (∼15.5‰), suggesting a significant contribution of long-distance dust P transport. Using satellite retrieved aerosol optical depth (AOD) and the P concentrations in aerosols we sampled in periods when Saharan dust was evident we estimate that the monthly P input from long distance dust transport during the period with highest Saharan dust deposition is 88 ± 31 g P ha(-1) month(-1), equivalent to between 10 and 29% of the P in monthly litter fall in nearby forests. These findings have important implications for our understanding of modern nutrient budgets and the productivity of tropical forests in the region under future climate scenarios.

The long-lasting antidepressant effects of rapastinel (GLYX-13) are associated with a metaplasticity process in the medial prefrontal cortex and hippocampus

Rapastinel (GLYX-13) is an N-methyl-d-aspartate receptor (NMDAR) modulator that has characteristics of a glycine site partial agonist. Rapastinel is a robust cognitive enhancer and facilitates hippocampal long-term potentiation (LTP) of synaptic transmission in slices. In human clinical trials, rapastinel has been shown to produce marked antidepressant properties that last for at least one week following a single dose. The long-lasting antidepressant effect of a single dose of rapastinel (3mg/kg IV) was assessed in rats using the Porsolt, open field and ultrasonic vocalization assays. Cognitive enhancement was examined using the Morris water maze, positive emotional learning, and contextual fear extinction tests. LTP was assessed in hippocampal slices. Dendritic spine morphology was measured in the dentate gyrus and the medial prefrontal cortex. Significant antidepressant-like or cognitive enhancing effects were observed that lasted for at least one week in each model. Rapastinel facilitated LTP 1day-2weeks but not 4weeks post-dosing. Biweekly dosing with rapastinel sustained this effect for at least 8weeks. A single dose of rapastinel increased the proportion of whole-cell NMDAR current contributed by NR2B-containing NMDARs in the hippocampus 1week post-dosing, that returned to baseline by 4weeks post-dosing. The NMDAR antagonist 3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid (CPP) blocked the antidepressant-like effect of rapastinel 1week post dosing. A single injection of rapastinel also increased mature spine density in both brain regions 24h post-dosing. These data demonstrate that rapastinel produces its long-lasting antidepressant effects via triggering NMDAR-dependent processes that lead to increased sensitivity to LTP that persist for up to two weeks. These data also suggest that these processes led to the alterations in dendritic spine morphologies associated with the maintenance of long-term changes in synaptic plasticity associated with learning and memory.

The challenge of pelvic discontinuity

The use of ilioischial cage reconstruction for pelvic discontinuity has been replaced by the Trabecular Metal (Zimmer, Warsaw, Indiana) cup-cage technique in our institution, due to the unsatisfactory outcome of using a cage alone in this situation. We report the outcome of 26 pelvic discontinuities in 24 patients (20 women and four men, mean age 65 years (44 to 84)) treated by the cup-cage technique at a mean follow-up of 82 months (12 to 113) and compared them with a series of 19 pelvic discontinuities in 19 patients (18 women and one man, mean age 70 years (42 to 86)) treated with a cage at a mean follow-up of 69 months (1 to 170). The clinical and radiological outcomes as well as the survivorship of the groups were compared. In all, four of the cup-cage group (15%) and 13 (68%) of the cage group failed due to septic or aseptic loosening. The seven-year survivorship was 87.2% (95% confidence interval (CI) 71 to 103) for the cup-cage group and 49.9% (95% CI 15 to 84) for the cage-alone group (p = 0.009). There were four major complications in the cup-cage group and nine in the cage group. Radiological union of the discontinuity was found in all successful cases in the cup-cage group and three of the successful cage cases. Three hips in the cup-cage group developed early radiological migration of the components, which stabilised with a successful outcome.

Cup-cage reconstruction is a reliable technique for treating pelvic discontinuity in mid-term follow-up and is preferred to ilioischial cage reconstruction. If the continuity of the bone graft at the discontinuity site is not disrupted, early migration of the components does not necessarily result in failure.

Cite this article: Bone Joint J 2014;96-B:195–200.

The importance of perceived helplessness and emotional health in understanding the relationship among pain, function, and satisfaction following revision knee replacement surgery

OBJECTIVE

Little is known about the relationships among pain, function, psychological variables like perceived helplessness and emotional health, and patient satisfaction in people with revision knee replacement surgery. We hypothesized that pain and function would have a direct association with satisfaction as well as an indirect association through patient perceptions of helplessness and emotional health.

DESIGN

This longitudinal study included 145 participants undergoing revision knee replacement surgery. Demographic data and expectation of benefit from surgery were recorded prior to surgery. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Arthritis Helplessness Scale (AHS) and the Mental Component Scale (MCS) of the SF-36 (emotional health) were collected prior to and 2 years post-surgery. Satisfaction was recorded 2 years post-surgery. Regression analyses were conducted to test for mediation effects of helplessness and MCS.

RESULTS

Participants were on average 69 years old and 54% were women. Participants were satisfied with the results of the surgery (mean ± standard deviation (SD) = 70.42 ± 31.46). Less pain and functional disability were associated with increased patient satisfaction and, the effect of pain or function was also mediated through helplessness whereby more pain and disability were associated with perceptions of helplessness and helplessness was associated with lower satisfaction. MCS did not mediate the relationship of pain and function with satisfaction.

CONCLUSION

Helplessness plays an important role in understanding patient satisfaction. Interventions aimed at improving patient outcome should target not only pain and function but also should address strategies to support people in managing following knee revision surgery to maximize satisfaction with outcome.

First result from the Alpha Magnetic Spectrometer on the International Space Station: precision measurement of the positron fraction in primary cosmic rays of 0.5-350 GeV

A precision measurement by the Alpha Magnetic Spectrometer on the International Space Station of the positron fraction in primary cosmic rays in the energy range from 0.5 to 350 GeV based on 6.8 × 10(6) positron and electron events is presented. The very accurate data show that the positron fraction is steadily increasing from 10 to ∼ 250  GeV, but, from 20 to 250 GeV, the slope decreases by an order of magnitude. The positron fraction spectrum shows no fine structure, and the positron to electron ratio shows no observable anisotropy. Together, these features show the existence of new physical phenomena.

Free energy rhythms in Saccharomyces cerevisiae: a dynamic perspective with implications for ribosomal biogenesis

To describe the time course of cellular systems, we integrate ideas from thermodynamics and information theory to discuss the work needed to change the state of the cell. The biological example analyzed is experimental microarray transcription level oscillations of yeast in the different phases as characterized by oxygen consumption. Surprisal analysis was applied to identify groups of transcripts that oscillate in concert and thereby to compute changes in free energy with time. Three dominant transcript groups were identified by surprisal analysis. The groups correspond to the respiratory, early, and late reductive phases. Genes involved in ribosome biogenesis peaked at the respiratory phase. The work to prepare the state is shown to be the sum of the contributions of these groups. We paid particular attention to work requirements during ribosomal building, and the correlation with ATP levels and dissolved oxygen. The suggestion that cells in the respiratory phase likely build ribosomes, an energy intensive process, in preparation for protein production during the S phase of the cell cycle is validated by an experiment. Surprisal analysis thereby provided a useful tool for determining the synchronization of transcription events and energetics in a cell in real time.

Reliability of on-site greywater treatment systems in Mediterranean and arid environments - a case study

On-site greywater (GW) treatment and reuse is gaining popularity. However, a main point of concern is that inadequate treatment of such water may lead to negative environmental and health effects. Maintenance of single-family home GW systems is usually performed by home owners with limited professional support. Therefore, unless GW systems are reliable, environmental and public health might be compromised. This study is aimed at investigating the reliability of on-site recirculated vertical flow constructed wetlands (RVFCW) in 20 single-family homes. In order to ensure reliability, the failure-tree approach was adopted during the design and construction of the systems. The performance of the systems was monitored for 1.5 years, by evaluating treated GW flow and quality, and by recording all malfunctions and maintenance work. Only 39 failures occurred during this period, of which four caused irrigation with impaired quality GW, while the rest led to no irrigation. The mean time between failures (MTBF) was 305 days; two out of the 20 systems suffered from seven malfunctions (each), while nine systems did not fail at all. Thus, it can be postulated that if on-site GW treatment systems are designed with the right controls, and if scheduled (basic and relatively infrequent) maintenance is performed, GW reuse can be safe to the environment and human health.

Rejuvenating Bi(d)ology

The BH3-only Bid protein is a critical sentinel of cellular stress in the liver and the hematopoietic system. Bid's initial 'claim to fame' came from its ability-as a caspase-truncated product-to trigger the mitochondrial apoptotic program following death receptor activation. Today we know that Bid can response to multiple types of proteases, which are activated under different conditions such as T-cell activation, ischemical reperfusion injury and lysosomal injury. Activation of the mitochondrial apoptotic program by Bid-via its recently identified receptor mitochondrial carrier homolog 2-involves multiple mechanisms, including release of cytochrome c and second mitochondria-derived activator of caspase (Smac), alteration of mitochondrial cristae organization, generation of reactive oxygen species and engagement of the permeability transition pore. Bid is also emerging-in its full-length form-as a pivotal sentinel of DNA damage in the bone marrow regulated by the ataxia telangiectasia mutated (ATM)/ataxia telangiectasia and Rad3-related (ATR) kinases. The ATM/ATR-Bid pathway is critically involved in preserving the quiescence and survival of hematopoietic stem cells both in the absence and presence of external stress, and a large part of this review will be dedicated to recent advances in this area of research.

[Transurethral en bloc resection of non-muscle invasive bladder cancer. What is the state of the art?]

Bladder cancer of the urothelium is the second most common malignancy among urological tumors. In view of a worldwide aging population and the fact that increased incidence rates are associated with higher age, new socioeconomic challenges will appear. Even nowadays the treatment of bladder cancer bears the highest lifetime treatment costs per patient among all forms of cancer. In conjunction with higher comorbidity rates among older patients urologists are facing new challenges in the treatment and care of patients with bladder cancer. The standard treatment for non-muscle invasive bladder cancer (NMIBC) is monopolar transurethral resection using resection loops (TURB). Based on experience in the surgical treatment of benign prostatic hyperplasia, different concepts of en bloc resection of bladder tumors using alternative energy resources (e.g. holmium laser, thulium laser and the water-jet HybridKnife) have been developed. Goals of new treatment modalities are reduction of perioperative and postoperative comorbidities, better pathological work-up of the specimens and increased recurrence-free survival. Postulated advantages using laser devices are a more precise cutting line as well as better hemostasis. The evidential value of this review is limited due to the lack of randomized, prospective studies. However, there is a tendency towards a limitation of perioperative and postoperative morbidities as well as higher chance of well-preserved tissues for better pathohistological evaluation using en bloc resection methods. More studies with long-term follow-up periods and better randomization are needed to clarify whether en bloc strategies provide better long-term oncological survival.

Theoretical study of the O₂ interaction with a tetrahedral Al₄ cluster

Employing both multireference configuration interaction (MRCI) and density functional theory (DFT) methods, we have studied the interaction of O₂ with a tetrahedral Al₄ cluster in the total spin triplet state. For a parallel to the base approach of O₂ facing an apex of the pyramid, the O₂ adsorption is hindered by a barrier. Both the MRCI and the DFT calculations show that after a small barrier, there are two local energy minima: a shallow one just above the apex atom and another deeper one below the apex atom. The latter corresponds to dissociative O₂ adsorption. We discuss the implications of these findings for the understanding of O₂ adsorption on defect sites of Al surfaces.