Epidemiology of candidemia in Finland

Candida species are an important cause of nosocomial bloodstream infections in hospitalized patients worldwide, with associated high mortality, excess length of stay and costs. Main contributors to candidemias is profound immunosuppression due to serious underlying condition or intensive treatments leading to an increasing number of susceptible patients. The rank order of causative Candida species varies over time and in different geographic locations. The aim of this study was to obtain information on epidemiology of candidemia in Finland, to identify trends in incidence, causative species, and patient populations at risk. In order to reveal possible outbreaks and assess the value of one molecular typing method, restriction enzyme analysis (REA), in epidemiological study, we analyzed C. albicans bloodstream isolates in Uusimaa region in Southern Finland during eight years. The data from the National Infectious Disease Register were used to assess the incidence and epidemiological features of candidemia cases. In Helsinki University Central Hospital (HUCH) all patients with blood culture yielding any Candida spp. were identified from laboratory log-books and from Finnish Hospital Infection Program. All the patients with a stored blood culture isolate of C. albicans were identified through microbiology laboratory logbooks, and stored isolates were genotyped with REA in the National Institute for Health and Welfare (former KTL). The incidence of candidemia in Finland is globally relatively low, but increased between between 1990s and 2000s. The incidence was highest in males >65 years of age, but incidence rates for patients <1-15 years were lower during 2000s than during 1990s. In HUCH the incidence of candidemia remained low and constant during our 18 years of observation, but a significant shift in patient-populations at risk was observed, associated with patients treated in intensive care units, such as premature neonates and surgical patients. The predominating causative species in Finland and in HUCH is C. albicans, but the proportion of C. glabrata increased considerably. The crude one-month case fatality was constantly high between 28-33%. REA differentiated efficiently between C. albicans blood culture isolates and no clusters were observed in the hospitals involved, despite of abundant transfer of patients among them. Candida spp. are an important cause of nosocomial blood stream infections in Finland, and continued surveillance is necessary to determine the overall trends and patient groups at risk, and reduce the impact of these infections in the future. Molecular methods provide an efficient tool for investigation of suspected outbreak and should be available in the future in Finland, also.

We Are All Georgians: The Neoconservative Narrative on the Russia-Georgia War

In this thesis I examine the U.S. foreign policy discussion that followed the war between Russia and Georgia in August 2008. In the politically charged setting that preceded the presidential elections, the subject of the debate was not only Washington's response to the crisis in the Caucasus but, more generally, the direction of U.S. foreign policy after the presidency of George W. Bush. As of November 2010, the reasons for and consequences of the Russia-Georgia war continue to be contested. My thesis demonstrates that there were already a number of different stories about the conflict immediately after the outbreak of hostilities. I want to argue that among these stories one can discern a “neoconservative narrative” that described the war as a confrontation between the East and the West and considered it as a test for Washington’s global leadership. I draw on the theory of securitization, particularly on a framework introduced by Holger Stritzel. Accordingly, I consider statements about the conflict as “threat texts” and analyze these based on the existing discursive context, the performative force of the threat texts and the positional power of the actors presenting them. My thesis suggests that a notion of narrativity can complement Stritzel’s securitization framework and take it further. Threat texts are established as narratives by attaching causal connections, meaning and actorship to the discourse. By focusing on this process I want to shed light on the relationship between the text and the context, capture the time dimension of a speech act articulation and help to explain how some interpretations of the conflict are privileged and others marginalized. I develop the theoretical discussion through an empirical analysis of the neoconservative narrative. Drawing on Stritzel’s framework, I argue that the internal logic of the narrative which was presented as self-evident can be analyzed in its historicity. Asking what was perceived to be at stake in the conflict, how the narrative was formed and what purposes it served also reveals the possibility for alternative explanations. My main source material consists of transcripts of think tank seminars organized in Washington, D.C. in August 2008. In addition, I resort to the foreign policy discussion in the mainstream media.

Afrikkalaisen sikaruton mahdollisia maahantuloreittejä

Afrikkalainen sikarutto on lakisääteisesti vastustettava helposti leviävä sikojen ja villisikojen virustauti, jolla on myös vakavia sosioekonomisia vaikutuksia. Akuutissa tautimuodossa eläimillä esiintyy syömättömyyttä, korkeaa kuumetta, verenpurkaumia iholla, veristä ulostetta sekä mahdollisesti ripulia. Kuolleisuus on lähes 100 % ja tauti johtaa kuolemaan 7-10 vrk tartunnan jälkeen. Tauti ei tartu ihmisiin. Tautia esiintyy sekä kesy- että villisioissa suurimmassa osassa Saharan eteläpuolista Afrikkaa ja Sardiniassa. Vuodesta 2007 lähtien tautia on esiintynyt Kaukasuksen alueella ja vuonna 2011 lähellä Suomen rajaa: Leningradin alueella ja Kuolan niemimaalla. Tässä riskiprofiilissa kartoitetaan reitit ja tapahtumasarjat, jotka voivat johtaa siihen, että afrikkalainen sikarutto tulee Suomeen ensimmäisen kerran. Näistä oleellisimmat ovat: maahantulo infektioalueella matkustaneiden ihmisten mukana, infektoituneen lihan tai lihatuotteen mukana, elävien kesysikojen ja sperman mukana, kontaminoituneiden eläinkuljetusajoneuvojen mukana, kansainvälisen liikenteen ruokajätteen mukana ja Suomeen vaeltavan infektoituneen villisian mukana. Tilatason tautisuojaus sekä tehokas ja kohdennettu tiedottaminen taudin vaaroista ovat avainasemassa, kun halutaan suojata Suomen sikaelinkeinoa afrikkalaiselta sikarutolta.

Ketoprofeenin biologinen käytettävyys ja farmakokinetiikka sioilla eri antotavoilla ja ketoprofeeniyliannoksen farmakokinetiikka ja vaikutus munuaisiin lampailla

Ketoprofeeni on yleisesti käytetty ei-steroidinen tulehduskipulääke (NSAID) lampaiden ja sikojen kivunlievityksessä. Tietoa ketoprofeenin oikeista annosmääristä eri eläinlajeilla on saatavilla rajallisesti. Oikeaa lääkeainemäärää ei voida luotettavasti ekstrapoloida toisten eläinlajien tai ihmisten perusteella. Epäillyissä tulehduskipulääkemyrkytyksissä ongelmana on tietää, oliko eläimen saama lääkeannos toksinen. Lampailla tehdyn tutkimuksen tavoitteena oli selvittää, muuttuuko ketoprofeenin kinetiikka kymmenkertaisella yliannoksella, tutkia yliannoksen vaikutusta munuaisiin ja löytää yksinkertainen tapa diagnosoida yliannos virtsasta. Sioilla tehdyn tutkimuksen tavoitteena oli selvittää ketoprofeenin biologista käytettävyyttä ja ketoprofeenin farmakokinetiikkaa sioilla intravaskulaarisella, intramuskulaarisella ja peroraalisella annolla. Keskeiset tutkimuksessa määritettävät muuttujat olivat AUC0-_, Cmax ja tmax. Hyötyosuus laskettiin i.v. -annon perusteella. Kuudelle lampaalle annettiin 30 mg/kg i.v. -ketoprofeenia. Ketoprofeenin pitoisuuksia seurattiin 24 tunnin ajan plasmanäytteillä, joiden perusteella määritettiin farmakokineettiset parametrit. Veri- ja virtsanäytteistä tutkittiin muun muassa mahdollisesta munuaisvauriosta kertovia entsyymejä. 24 tunnin kuluttua lääkkeenannosta lampaat lopetettiin ja munuaiset tutkittiin histologisesti. Tutkittaville kahdeksalle sialle annosteltiin 3 mg/kg intravaskulaarista, intramuskulaarista ja oraalista ketoprofeenia sekä 6 mg/kg oraalista ketoprofeenia. Tutkimus suoritettiin satunnaistettuna vaihtovuorotutkimuksena. Ketoprofeenin pitoisuuksia seurattiin plasmanäytteillä 48 tunnin ajan lääkkeenannosta ja kaikille antotavoille laskettiin farmakokineettiset parametrit. Lisäksi tutkittiin valmisteiden biologinen samanarvoisuus. Molempien tutkimusten in vivo -kokeet suoritettiin Eläinlääketieteellisessä tiedekunnassa. Samoin munuaisten histologinen tutkimus ja virtsasta ja verestä tehdyt määritykset, lukuun ottamatta ketoprofeeninpitoisuuden analysointia. Plasman ketoprofeenipitoisuus analysoitiin korkean erotuskyvyn nestekromatografialla (HPLC). Ketoprofeenimääritykset ja farmakokineettinen analyysi suoritettiin Farmasian tiedekunnassa. Lampaiden kymmenkertainen ketoprofeeniyliannos oli toksinen. Seerumin urea- ja kreatiniinipitoisuus nousivat ja histologisissa näytteissä näkyi akuutti munuaistiehyen vaurio. Useiden entsyymien pitoisuus nousi virtsassa. Selvimmin ja nopeimmin nousi virtsan laktaattidehydrogenaasipitoisuus, jonka määrittäminen vaikuttaa potentiaaliselta tavalta diagnosoida ketoprofeenin toksinen annos. Ketoprofeenin eliminaation puoliintumisaika toksisella annoksella oli samaa suuruusluokkaa kuin aiemmissa tutkimuksissa terapeuttisella annoksella, joten yliannos ei muuttanut ketoprofeenin kinetiikkaa. AUC- ja Cmax -arvot olivat suhteessa suurempia kuin terapeuttisella annoksella, joten tutkimuksen perusteella kyseiset arvot eivät nousseet lineaarisesti annoksen noustessa toksiseksi. Sioille annetut ketoprofeenivalmisteet eivät olleet biologisesti samanarvoisia keskenään. Hyötyosuus oli erittäin hyvä kaikilla antotavoilla. tmax oli kaikilla antotavoilla hieman yli tunnin kuluttua lääkkeenannosta. Oraalisen 3 mg/kg -annoksen Cmax oli 5,1 mg/l ja AUC 32 mg l-1 h ja intramuskulaarisen vastaavat arvot olivat 7,6 mg/l ja 37 mg l-1 h. Oraalisen ketoprofeenin annostasojen AUC- ja Cmax -arvot korreloivat keskenään, joten ketoprofeenin kinetiikka oli lineaarista. Intravaskulaarisen ja oraalisen annon puoliintumisajoissa oli tilastollisesti merkitsevä ero. Ketoprofeenin jakautumistilavuudessa ja puhdistumassa ei ollut tilastollisesti merkitsevää eroa eri antotapojen välillä.

Molecular methods for the epidemiological analysis of methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pneumoniae

Methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pneumoniae are major health problems worldwide, both found in symptomless carriage but also causing even life-threatening infections. The aim of this thesis was to characterise MRSA and S. pneumoniae in detail by using several molecular typing methods for various epidemiological purposes: clonality analysis, epidemiological surveillance, outbreak investigation, and virulence factor analysis. The characteristics of MRSA isolates from the strain collection of the Finnish National Infectious Disease Register (NIDR) and pneumococcal isolates collected from military recruits and children with acute otitis media (AOM) were analysed using various typing techniques. Antimicrobial susceptibility testing, pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), spa typing, staphylococcal cassette chromosome mec (SCCmec) typing, and the detection of Panton-Valentine leukocidin (PVL) genes were performed for MRSA isolates. Pneumococcal isolates were analysed using antimicrobial susceptibility testing, serotyping, MLST, and by detecting pilus islet 1 (PI-1) and 2 (PI-2) genes. Several international community- and hospital-associated MRSA clones were recognised in Finland. The genetic diversity among MRSA FIN-4 isolates and among FIN-16 isolates was low. Overall, MRSA blood isolates from 1997 to 2006 were genetically diverse. spa typing was found to be a highly discriminatory, rapid and accurate typing method and it also qualifies as the primary typing method in countries with a long history of PFGE-based MRSA strain nomenclature. However, additional typing by another method, e.g. PFGE, is needed in certain situations to be able to provide adequate discrimination for epidemiological surveillance and outbreak investigation. An outbreak of pneumonia was associated with one pneumococcal strain among military recruits, previously healthy young men living in a crowded setting. The pneumococcal carriage rate after the outbreak was found to be exceptionally high. PI-1 genes were detected at a rather low prevalence among pneumococcal isolates from children with AOM. However, the study demonstrated that PI-1 has existed among pneumococcal isolates prior to pneumococcal conjugate vaccine and the increased antimicrobial resistance era. Moreover, PI-1 was found to associate with the serotype rather than the genotype. This study adds to our understanding of the molecular epidemiology of MRSA strains in Finland and the importance of an appropriate genotyping method to be able to perform high-level laboratory-based surveillance of MRSA. Epidemiological and molecular analyses of S. pneumoniae add to our knowledge of the characteristics of pneumococcal strains in Finland.

Impact of physical processes on the chlorophyll distribution in the Bay of Bengal

Satellite-derived chlorophyll a concentration (chl a) maps show three regions with high chl a in the Bay of Bengal. First among these is close to the coast, particularly off river mouths, with high values coinciding with the season of peak discharge; second is in the southwestern bay during the northeast monsoon, which is forced by local Ekman pumping; and the third is to the east of Sri Lanka in response to the summer monsoon winds. Chlorophyll-rich water from the mouths of rivers flows either along the coast or in an offshore direction, up to several hundred kilometers, depending on the prevailing ocean current pattern. The Irrawady River plume flows toward offshore and then turns northwestward during October–December, but it flows along the coast into the Andaman Sea for the rest of the year. From the Ganga-Brahmaputra river mouth, chl a–rich water flows directly southward into the open bay during spring but along the Indian coast during summer and winter. Along the Indian coast, the flow of chl a–rich water is determined by the East India Coastal Current (EICC). Whenever the EICC meanders off the Indian coast, it leads to an offshore outbreak of chl a–rich water from the coastal region into open ocean. The EICC as well as open ocean circulation in the bay is made up of several eddies, and these eddies show relatively higher chl a. Eddies near the coast, however, can often have higher chl a because of advection from the coastal region rather than generation within the eddy itself. The bay experiences several cyclones in a year, most of them occurring during October–November. These cyclones cause a drop in the sea surface temperature, a dip in the sea level, and a local increase in chl a. The impact of a cyclone is weaker in the northern part of the bay because of stronger stratification compared to the southern parts.

Stochastic analysis of epidemics on adaptive time varying networks

Many studies investigating the effect of human social connectivity structures (networks) and human behavioral adaptations on the spread of infectious diseases have assumed either a static connectivity structure or a network which adapts itself in response to the epidemic (adaptive networks). However, human social connections are inherently dynamic or time varying. Furthermore, the spread of many infectious diseases occur on a time scale comparable to the time scale of the evolving network structure. Here we aim to quantify the effect of human behavioral adaptations on the spread of asymptomatic infectious diseases on time varying networks. We perform a full stochastic analysis using a continuous time Markov chain approach for calculating the outbreak probability, mean epidemic duration, epidemic reemergence probability, etc. Additionally, we use mean-field theory for calculating epidemic thresholds. Theoretical predictions are verified using extensive simulations. Our studies have uncovered the existence of an ``adaptive threshold,'' i.e., when the ratio of susceptibility (or infectivity) rate to recovery rate is below the threshold value, adaptive behavior can prevent the epidemic. However, if it is above the threshold, no amount of behavioral adaptations can prevent the epidemic. Our analyses suggest that the interaction patterns of the infected population play a major role in sustaining the epidemic. Our results have implications on epidemic containment policies, as awareness campaigns and human behavioral responses can be effective only if the interaction levels of the infected populace are kept in check.

Humanized antibody neutralizing 2009 pandemic H1N1 virus

The 2009 pandemic H1N1 S-OIV (swine origin influenza A virus) caused noticeable morbidity and mortality worldwide. In addition to vaccine and antiviral drug therapy, the use of influenza virus neutralizing monoclonal antibodies (MAbs) for treatment purposes is a viable alternative. We previously reported the isolation of a high affinity, potently neutralizing murine MAb MA2077 against 2009 pandemic H1N1 virus. We describe here the humanization of MA2077 and its expression in a mammalian cell line. Six complementarity-determining regions (CDRs) of MA2077 were grafted onto the human germline variable regions; along with six and eight back mutations in the framework of heavy and light chains, respectively, pertaining to the vernier zone and interchain packing residues to promote favorable CDR conformation and facilitate antigen binding. The full length humanized antibody, 2077Hu2, expressed in CHO-K1 cells, showed high affinity to hemagglutinin protein (K-D = 0.75 +/- 0.32 nM) and potent neutralization of pandemic H1N1 virus (IC50 = 0.17 mu g/mL), with marginally higher IC50 as compared to MA2077 (0.08 mu g/mL). In addition, 2077Hu2 also retained the epitope specificity for the ``Sa'' antigenic site on pandemic HA. To the best of our knowledge, this is the first report of a humanized neutralizing antibody against pandemic H1N1 virus.

Adaptive evolution of a novel avian-origin influenza A/H7N9 virus

In China, the recent outbreak of novel influenza A/H7N9 virus has been assumed to be severe, and it may possibly turn brutal in the near future. In order to develop highly protective vaccines and drugs for the A/H7N9 virus, it is critical to find out the selection pressure of each amino acid site. In the present study, six different statistical methods consisting of four independent codon-based maximum likelihood (CML) methods, one hierarchical Bayesian (HB) method and one branch-site (BS) method, were employed to determine if each amino acid site of A/H7N9 virus is under natural selection pressure. Functions for both positively and negatively selected sites were inferred by annotating these sites with experimentally verified amino acid sites. Comprehensively, the single amino acid site 627 of PB2 protein was inferred as positively selected and it function was identified as a T-cell epitope (TCE). Among the 26 negatively selected amino acid sites of PB2, PB1, PA, HA, NP, NA, M1 and NS2 proteins, only 16 amino acid sites were identified to be involved in TCEs. In addition, 7 amino acid sites including, 608 and 609 of PA, 480 of NP, and 24, 25, 109 and 205 of M1, were identified to be involved in both B-cell epitopes (BCEs) and TCEs. Conversely, the function of positions 62 of PA, and, 43 and 113 of HA was unknown. In conclusion, the seven amino acid sites engaged in both BCEs and TCEs were identified as highly suitable targets, as these sites will be predicted to play a principal role in inducing strong humoral and cellular immune responses against A/H7N9 virus. (C) 2014 Elsevier Inc. All rights reserved.

Stalking influenza by vaccination with pre-fusion headless HA mini-stem

Inaccuracies in prediction of circulating viral strain genotypes and the possibility of novel reassortants causing a pandemic outbreak necessitate the development of an anti-influenza vaccine with increased breadth of protection and potential for rapid production and deployment. The hemagglutinin (HA) stem is a promising target for universal influenza vaccine as stem-specific antibodies have the potential to be broadly cross-reactive towards different HA subtypes. Here, we report the design of a bacterially expressed polypeptide that mimics a H5 HA stem by protein minimization to focus the antibody response towards the HA stem. The HA mini-stem folds as a trimer mimicking the HA prefusion conformation. It is resistant to thermal/chemical stress, and it binds to conformation-specific, HA stem-directed broadly neutralizing antibodies with high affinity. Mice vaccinated with the group 1 HA mini-stems are protected from morbidity and mortality against lethal challenge by both group 1 (H5 and H1) and group 2 (H3) influenza viruses, the first report of cross-group protection. Passive transfer of immune serum demonstrates the protection is mediated by stem-specific antibodies. Furthermore, antibodies indudced by these HA stems have broad HA reactivity, yet they do not have antibody-dependent enhancement activity.

Control dynamics of severe acute respiratory syndrome transmission

Severe acute respiratory syndrome (SARS) is a serious disease with many puzzling features. We present a simple, dynamic model to assess the epidemic potential of SARS and the effectiveness of control measures. With this model, we analysed the SARS epidemic data in Beijing. The data fitting gives the basic case reproduction number of 2.16 leading to the outbreak, and the variation of the effective reproduction number reflecting the control effect. Noticeably, our study shows that the response time and the strength of control measures have significant effects on the scale of the outbreak and the lasting time of the epidemic.

A comparison of animal abundance and distribution in similar habitats in Rookery Bay, Marco Island and Fakahatchee on the southwest coast of Florida, 1971 - 1972

The three areas in Rookery Bay, near Marco Island and Fakahatchee Bay were sampled from July 1971 through July 1972, and 1,006,640 individual animals were collected, of which the majority (55%) came from the Marco area. The large disparity between the catches at Marco and the remaining study areas was due mainly to the appearance of high numbers of species of polychaetes and echinoderms that were of very minor importance or absent from the catches in Rookery Bay and Fakahatchee Bay. When only the major classes of animals in the catch are considered (i.e., crustaceans, fish and mollusks) the total counts for Fakahatchee (298,830) and Marco (275,075) are quite comparable but both exceed Rookery Bay (119,388) by a considerable margin. The effects of the red tide outbreak in the summer of 1971 were apparently restricted to the Rookery Bay Sanctuary and may account for some of the observed differences. For the purposes of making controlled comparisons between the study areas, three common habitats were selected in each area so that a mud bottom habitat, a sand-shell bottom habitat and a vegetated bottom habitat were located in each of the study areas. Total catches by habitat types for crustaceans, fish and mollusks and certain of the more abundant species show clearly the overwhelming importance of the vegetated bottom as a habitat for animals. By habitat the vegetated areas had the most "indicator species" with five, the mud habitat was next with three and the sand-shell habitat third with two. Thus the vegetated habitat would be the best choice if a single habitat were to be used to detect environmental changes between study areas. (PDF contains 137 pages)

Distribución de "coxiella burnetii" en los rumiantes domésticos y en la fauna silvestre de la Comunidad Atutónoma Vasca. Evaluacióndel efecto del tratamiento antibiótico y de la vacunación en el control de la fiebre Q en rebaños ovinos naturalmente infectados

243 p. : il.

Switch Region for Pathogenic Structural Change in Conformational Disease and Its Prediction

Many diseases are believed to be related to abnormal protein folding. In the first step of such pathogenic structural changes, misfolding occurs in regions important for the stability of the native structure. This destabilizes the normal protein conformation, while exposing the previously hidden aggregation-prone regions, leading to subsequent errors in the folding pathway. Sites involved in this first stage can be deemed switch regions of the protein, and can represent perfect binding targets for drugs to block the abnormal folding pathway and prevent pathogenic conformational changes. In this study, a prediction algorithm for the switch regions responsible for the start of pathogenic structural changes is introduced. With an accuracy of 94%, this algorithm can successfully find short segments covering sites significant in triggering conformational diseases (CDs) and is the first that can predict switch regions for various CDs. To illustrate its effectiveness in dealing with urgent public health problems, the reason of the increased pathogenicity of H5N1 influenza virus is analyzed; the mechanisms of the pandemic swine-origin 2009 A(H1N1) influenza virus in overcoming species barriers and in infecting large number of potential patients are also suggested. It is shown that the algorithm is a potential tool useful in the study of the pathology of CDs because: (1) it can identify the origin of pathogenic structural conversion with high sensitivity and specificity, and (2) it provides an ideal target for clinical treatment.

Legal dimensions of the Chinese experience in Los Angeles, 1860-1880

On October 24, 1871, a massacre of eighteen Chinese in Los Angeles brought the small southern California settlement into the national spotlight. Within a few days, news of this “night of horrors” was reported in newspapers across the country. This massacre has been cited in Asian American narratives as the first documented outbreak of ethnic violence against a Chinese community in the United States. This is ironic because Los Angeles’ small population has generally placed it on the periphery in historical studies of the California anti-Chinese movement. Because the massacre predated Los Angeles’ organized Chinese exclusion movements of the late 1870s, it has often been erroneously dismissed as an aberration in the history of the city.

The violence of 1871 was an outburst highlighting existing community tensions that would become part of public debate by decade’s close. The purpose of this study is to insert the massacre into a broader context of anti-Chinese sentiments, legal discrimination, and dehumanization in nineteenth century Los Angeles. While a second incident of widespread anti-Chinese violence never occurred, brutal attacks directed at Chinese small businessmen and others highlighted continued community conflict. Similarly, economic rivalries and concerns over Chinese prostitution that underlay the 1871 massacre were manifest in later campaigns of economic discrimination and vice suppression that sought to minimize Chinese influence within municipal limits. An analysis of the massacre in terms of anti-Chinese legal, social and economic strategies in nineteenth-century Los Angeles will elucidate these important continuities.