A Multiplex Real-Time PCR with High Resolution Melting Analysis for the Characterization of Antimicrobial Resistance in Neisseria gonorrhoeae.

Resistance to antibiotics used against Neisseria gonorrhoeae infections is a major public health concern. Antimicrobial resistance (AMR) testing relies on time-consuming culture-based methods. Development of rapid molecular tests for detecting AMR determinants could provide valuable tools for surveillance, epidemiological studies and to inform individual case management. We developed a fast (<1.5 hrs) SYBR-green based real-time PCR method with high resolution melting (HRM) analysis. One triplex and three duplex reactions included two sequences for N. gonorrhoeae identification and seven determinants of resistance to extended-spectrum cephalosporins (ESCs), azithromycin, ciprofloxacin, and spectinomycin. The method was validated by testing 39 previously fully-characterized N. gonorrhoeae strains, 19 commensal Neisseria spp., and an additional panel of 193 gonococcal isolates. Results were compared with culture-based AMR determination. The assay correctly identified N. gonorrhoeae and the presence or absence of the seven AMR determinants. There was some cross-reactivity with non-gonococcal Neisseria species and the detection limit was 10(3)-10(4) gDNA copies/reaction. Overall, the platform accurately detected resistance to ciprofloxacin (sensitivity and specificity, 100%), ceftriaxone (sensitivity 100%, specificity 90%), cefixime (sensitivity 92%, specificity 94%), azithromycin and spectinomycin (both sensitivity and specificity, 100%). In conclusion, our methodology accurately detects mutations generating resistance to antibiotics used to treat gonorrhea. Low assay sensitivity prevents direct diagnostic testing of clinical specimens but this method can be used to screen collections of gonococcal isolates for AMR more quickly than with current culture-based AMR testing.

Host and Environmental Correlates of Multi-Drug Resistance in Kenyan Children with Acute Bacterial Diarrhea

Thesis (Master's)--University of Washington, 2016-06

Elicitors of induced disease resistance in postharvest horticultural crops: a brief review

Increasing loss of conventional fungicides due to pathogen resistance and general unacceptability in terms of public and environmental risk have favoured the introduction of integrated pest management (IPM) programmes. Induction of natural disease resistance (NDR) in harvested horticultural crops using physical, biological and/or chemical elicitors has received increasing attention over recent years, it being considered a preferred strategy for disease management. This article reviews the enhancement of constitutive and inducible antifungal compounds and suppression of postharvest diseases through using elicitors. The effect of timing of pre- and/or postharvest elicitor treatment and environment on the degree of elicitation and the potential for inducing local acquired resistance, systemic acquired resistance and/or induced systemic resistance to reduce postharvest disease is discussed. The review highlights that more applied and basic research is required to understand the role that induced NDR can play in achieving practical suppression of postharvest diseases as part of an IPM approach. (C) 2003 Elsevier B.V. All rights reserved.

Factors that influence the prevalence of acaricide resistance and tick-borne diseases

This manuscript provides a summary of the results presented at a symposium organized to accumulate information on factors that influence the prevalence of acaricide resistance and tick-borne diseases. This symposium was part of the 19th International Conference of the World Association for the Advancement of Veterinary Parasitology (WAAVP), held in New Orleans, LA, USA, during August 10-14, 2003. Populations of southern cattle ticks, Boophilus microplus, from Mexico have developed resistance to many classes of acaricide including chlorinated hydrocarbons (DDT), pyrethroids, organ ophosphates, and formamidines (amitraz). Target site mutations are the most common resistance mechanism observed, but there are examples of metabolic mechanisms. In many pyrethroid resistant strains, a single target site mutation on the Na+ channel confers very high resistance (resistance ratios: >1000x) to both DDT and all pyrethroid acaricides. Acetylcholine esterase affinity for OPs is changed in resistant tick populations. A second mechanism of OP resistance is linked to cytochrome P450 monooxygenase activity. A PCR-based assay to detect a specific sodium channel gene mutation that is associated with resistance to permethrin has been developed. This assay can be performed on individual ticks at any life stage with results available in a few hours. A number of Mexican strains of B. microplus with varying profiles of pesticide resistance have been genotyped using this test. Additionally, a specific metabolic esterase with permethrin-hydrolyzing activity, CzEst9, has been purified and its gene coding region cloned. This esterase has been associated with high resistance to permethrin in one Mexican tick population. Work is continuing to clone specific acetylcholinesterase (AChE) and carboxylesterase genes that appear to be involved in resistance to organophosphates. Our ultimate goal is the design of a battery of DNA- or ELISA-based assays capable of rapidly genotyping individual ticks to obtain a comprehensive profile of their susceptibility to various pesticides. More outbreaks of clinical bovine babesisois and anaplasmosis have been associated with the presence of synthetic pyrethroid (SP) resistance when compared to OP and amidine resistance. This may be the result of differences in the temporal and geographic patterns of resistance development to the different acaricides. If acaricide resistance develops slowly, herd immunity may not be affected. The use of pesticides for the control of pests of cattle other than ticks can affect the incidence of tick resistance and tick-borne diseases. Simple analytical models of tick- and tsetse-bome diseases suggest that reducing the abundance of ticks, by treating cattle with pyrethroids for example, can have a variety of effects on tick-bome diseases. In the worst-case scenario, the models suggest that treating cattle might not only have no impact on trypanosomosis but could increase the incidence of tick-bome disease. In the best-case, treatment could reduce the incidence of both trypanosomosis and tick-bome diseases Surveys of beef and dairy properties in Queensland for which tick resistance to amitraz was known were intended to provide a clear understanding of the economic and management consequences resistance had on their properties. Farmers continued to use amitraz as the major acaricide for tick control after the diagnosis of resistance, although it was supplemented with moxidectin (dairy farms) or fluazuron, macrocyclic lactones or cypermethrin/ chlorfenvinphos. (C) 2004 Published by Elsevier B.V.

Antibiotic resistance in the intensive care unit: A primer in bacteriology

The clinical use of potent, well-tolerated, broad-spectrum antibiotics has been paralleled by the development of resistance in bacteria, and the prevalence of highly resistant bacteria in some intensive care units is despairingly commonplace. The intensive care community faces the realistic prospect of untreatable nosocomial infections and should be searching for new approaches to diagnose and manage resistant bacteria. In this review, we discuss some of the relevant underlying biology, with a particular focus on genetic transfer vehicles and the relationship of selection pressure to their movements. It is an attempt to demystify the relevant language and concepts for the anaesthetist and intensivist, to explain some of the reasons for the emergence of resistance in bacteria, and to provide a contextual basis for discussion of management approaches such as selective decontamination and antibiotic cycling.

Feline obesity: causes, consequences and management

Regulation of food intake and body weight involves a complex balance between long-term control of fat mass involving insulin, adrenal steroids and leptin signals to the CNS and short-term, meal-related signals. Cats will normally limit their food intake to their energy requirements. However, in some instances cats appear unable to regulate energy balance. Our research has demonstrated that despite elevated circulating leptin levels in obese cats associated with increased fat mass, they continue to overeat and gain weight. This paradox of increased leptin concentrations in obesity has been observed in other species and is hypothesized to be a consequence of 'leptin resistance'.

Source of legitimacy in M-government initiatives in Turkey:concerns human vs. technical resource management

Emerging markets have recently been experiencing a dramatic increased in the number of mobile phone per capita. M-government has, hence, been heralded as an opportunity to leap-frog the technology cycle and provide cheaper and more inclusive and services to all. This chapter explores, within an emerging market context, the legitimacy and resistance facing civil servants’ at the engagement stage with m-government activities and the direct implication for resource management. Thirty in depth interview, in Turkey, are drawn-upon with key ICT civil servant in local organizations. The findings show that three types of resources are perceived as central namely: (i) diffusion of information management, (ii) operating system resource management and (iii) human resource management. The main evidence suggests that legitimacy for each resource management, at local level, is an ongoing struggle where all groups deploy multiples forms of resistance. Overall, greater attention in the resource management strategy for m-government application needs to be devoted to enablers such as civil servants rather than the final consumers or citizens.

Challenging market conventions:supermarket diversification and consumer resistance in children's apparel purchases

Purpose – In the UK, while fashion apparel purchasing is available to the majority of consumers, the main supermarkets seem – rather against the odds and market conventions – to have created a new, socially-acceptable and legitimate, apparel market offer for young children. This study aims to explore parental purchasing decisions on apparel for young children (below ten years old) focusing on supermarket diversification into apparel and consumer resistance against other traditional brands. Design/methodology/approach – Data collection adopted a qualitative research mode: using semi-structured interviews in two locations (Cornwall Please correct and check againand Glasgow), each with a Tesco and ASDA located outside towns. A total of 59 parents participated in the study. Interviews took place in the stores, with parents seen buying children fashion apparel. Findings – The findings suggest that decisions are based not only on functionality (e.g. convenience, value for money, refund policy), but also on intuitive factors (e.g. style, image, quality) as well as broader processes of consumption from parental boundary setting (e.g. curbing premature adultness). Positive consumer resistance is leading to a re-drawing of the cultural boundaries of fashion. In some cases, concerns are expressed regarding items that seem too adult-like or otherwise not as children's apparel should be. Practical implications – The paper highlights the increasing importance of browsing as a modern choice practice (e.g. planned impulse buying, sanctuary of social activity). Particular attention is given to explaining why consumers positively resist buying from traditional label providers and voluntarily choose supermarket clothing ranges without any concerns over their children wearing such garments. Originality/value – The paper shows that supermarket shopping for children's apparel is now firmly part of UK consumption habits and choice. The findings provide theoretical insights into the significance of challenging market conventions, parental cultural boundary setting and positive resistance behaviour.

Paths of the least resistance:understanding how motives form in international retail joint venturing

Developing the premise that strategies are forged through an ongoing mutual process of developing motives and responses to multiple degrees of resistance, this paper examines the motives underpinning the adoption of joint venture strategies using empirical details from four British retail firms. The findings point to multiple motives forming from multiple paths of resistance in the foreign market, but also among individuals within the firm as well as across the whole international programme. Moreover, this study reveals a paradoxical tension between management's operational impatience to immediately ground the retail format and an overall wariness or gloomy perceptions associated with adopting an international retail joint venture. The paper therefore concludes that the motives and barriers are manifestations of the struggles involved in internationalising retail operations.

Institutional contradiction and management control innovation:a field study of total quality management practices in a privatised telecommunications company

The purpose of this paper is to theorise the changes surrounding the introduction of a management control innovation, total quality management (TQM) techniques, within Telecom Fiji Limited. Using institutional theory and drawing on empirical evidence from multiple sources including interviews, discussions and documents, the paper explicates the institutionalization of these TQM practices. The focus of the paper is the micro-processes and practice changes around TQM implementation, rather than the influence of the macro-level structures that are often linked with institutional theory. The change agents used Quality Action Teams and the National Quality Council to introduce new TQM routines. The present study extends the scope of institutional analysis by explaining how institutional contradictions impact to create and make space for institutional entrepreneurs, who in turn, modify existing routines or introduce new routines in fluid organizational environments which also exhibit evidence of resistance.

Innovative biomarkers for predicting type 2 diabetes mellitus:relevance to dietary management of frailty in older adults

Type 2 diabetes mellitus (T2DM) increases in prevalence in the elderly. There is evidence for significant muscle loss and accelerated cognitive impairment in older adults with T2DM; these comorbidities are critical features of frailty. In the early stages of T2DM, insulin sensitivity can be improved by a “healthy” diet. Management of insulin resistance by diet in people over 65 years of age should be carefully re-evaluated because of the risk for falling due to hypoglycaemia. To date, an optimal dietary programme for older adults with insulin resistance and T2DM has not been described. The use of biomarkers to identify those at risk for T2DM will enable clinicians to offer early dietary advice that will delay onset of disease and of frailty. Here we have used an in silico literature search for putative novel biomarkers of T2DM risk and frailty. We suggest that plasma bilirubin, plasma, urinary DPP4-positive microparticles and plasma pigment epithelium-derived factor merit further investigation as predictive biomarkers for T2DM and frailty risk in older adults. Bilirubin is screened routinely in clinical practice. Measurement of specific microparticle frequency in urine is less invasive than a blood sample so is a good choice for biomonitoring. Future studies should investigate whether early dietary changes, such as increased intake of whey protein and micronutrients that improve muscle function and insulin sensitivity, affect biomarkers and can reduce the longer term complication of frailty in people at risk for T2DM.

Embedded heat pipes in cofired ceramic substrates for enhanced thermal management of electronics

A novel and new thermal management technology for advanced ceramic microelectronic packages has been developed incorporating miniature heat pipes embedded in the ceramic substrate. The heat pipes use an axially grooved wick structure and water as the working fluid. Prototype substrate/heat pipe systems were fabricated using high temperature co-fired ceramic (alumina). The heat pipes were nominally 81 mm in length, 10 mm in width, and 4 mm in height, and were charged with approximately 50–80 μL of water. Platinum thick film heaters were fabricated on the surface of the substrate to simulate heat dissipating electronic components. Several thermocouples were affixed to the substrate to monitor temperature. One end of the substrate was affixed to a heat sink maintained at constant temperature. The prototypes were tested and shown to successful and reliably operate with thermal loads over 20 Watts, with thermal input from single and multiple sources along the surface of the substrate. Temperature distributions are discussed for the various configurations and the effective thermal resistance of the substrate/heat pipe system is calculated. Finite element analysis was used to support the experimental findings and better understand the sources of the system's thermal resistance. ^

Embedded Heat Pipes in Cofired Ceramic Substrates for Enhanced Thermal Management of Electronics

A novel and new thermal management technology for advanced ceramic microelectronic packages has been developed incorporating miniature heat pipes embedded in the ceramic substrate. The heat pipes use an axially grooved wick structure and water as the working fluid. Prototype substrate/heat pipe systems were fabricated using high temperature co-fired ceramic (alumina). The heat pipes were nominally 81 mm in length, 10 mm in width, and 4 mm in height, and were charged with approximately 50-80 mL of water. Platinum thick film heaters were fabricated on the surface of the substrate to simulate heat dissipating electronic components. Several thermocouples were affixed to the substrate to monitor temperature. One end of the substrate was affixed to a heat sink maintained at constant temperature. The prototypes were tested and shown to successful and reliably operate with thermal loads over 20 Watts, with thermal input from single and multiple sources along the surface of the substrate. Temperature distributions are discussed for the various configurations and the effective thermal resistance of the substrate/heat pipe system is calculated. Finite element analysis was used to support the experimental findings and better understand the sources of the system's thermal resistance.

Advanced thermal analysis of microelectronics using spreading resistance models

Thermal analysis of electronic devices is one of the most important steps for designing of modern devices. Precise thermal analysis is essential for designing an effective thermal management system of modern electronic devices such as batteries, LEDs, microelectronics, ICs, circuit boards, semiconductors and heat spreaders. For having a precise thermal analysis, the temperature profile and thermal spreading resistance of the device should be calculated by considering the geometry, property and boundary conditions. Thermal spreading resistance occurs when heat enters through a portion of a surface and flows by conduction. It is the primary source of thermal resistance when heat flows from a tiny heat source to a thin and wide heat spreader. In this thesis, analytical models for modeling the temperature behavior and thermal resistance in some common geometries of microelectronic devices such as heat channels and heat tubes are investigated. Different boundary conditions for the system are considered. Along the source plane, a combination of discretely specified heat flux, specified temperatures and adiabatic condition are studied. Along the walls of the system, adiabatic or convective cooling boundary conditions are assumed. Along the sink plane, convective cooling with constant or variable heat transfer coefficient are considered. Also, the effect of orthotropic properties is discussed. This thesis contains nine chapters. Chapter one is the introduction and shows the concepts of thermal spreading resistance besides the originality and importance of the work. Chapter two reviews the literatures on the thermal spreading resistance in the past fifty years with a focus on the recent advances. In chapters three and four, thermal resistance of a twodimensional flux channel with non-uniform convection coefficient in the heat sink plane is studied. The non-uniform convection is modeled by using two functions than can simulate a wide variety of different heat sink configurations. In chapter five, a non-symmetrical flux channel with different heat transfer coefficient along the right and left edges and sink plane is analytically modeled. Due to the edge cooling and non-symmetry, the eigenvalues of the system are defined using the heat transfer coefficient on both edges and for satisfying the orthogonality condition, a normalized function is calculated. In chapter six, thermal behavior of two-dimensional rectangular flux channel with arbitrary boundary conditions on the source plane is presented. The boundary condition along the source plane can be a combination of the first kind boundary condition (Dirichlet or prescribed temperature) and the second kind boundary condition (Neumann or prescribed heat flux). The proposed solution can be used for modeling the flux channels with numerous different source plane boundary conditions without any limitations in the number and position of heat sources. In chapter seven, temperature profile of a circular flux tube with discretely specified boundary conditions along the source plane is presented. Also, the effect of orthotropic properties are discussed. In chapter 8, a three-dimensional rectangular flux channel with a non-uniform heat convection along the heat sink plane is analytically modeled. In chapter nine, a summary of the achievements is presented and some systems are proposed for the future studies. It is worth mentioning that all the models and case studies in the thesis are compared with the Finite Element Method (FEM).