A Pneumocystis jirovecii pneumonia outbreak in a single kidney-transplant center: role of cytomegalovirus co-infection.

Pneumocystis jirovecii pneumonia (PCP) and cytomegalovirus (CMV) infection represent possible complications of medical immunosuppression. Between 2005 and 2010, non-human immunodeficiency virus (HIV) PCP patients admitted to a nephrology unit were analyzed for outcome, CMV comorbidity, and patient-to-patient contacts prior to PCP. In contrast to 2002-2004 (no cases) and 2008-2010 (10 cases), a PCP outbreak of 29 kidney-transplant recipients and one patient with anti-glomerular basement membrane disease occurred between 2005 and 2007. None of the patients were on PCP chemoprophylaxis. In four PCP patients, the genotyping data of bronchoalveolar lavage specimen showed an identical Pneumocystis strain. PCP cases had a higher incidence of CMV infection (12 of 30 PCP patients) and CMV disease (four patients) when compared to matched PCP-free controls (p < 0.05). Cotrimoxazole and, if applicable, ganciclovir were started 2.0 ± 4.0 days following admission, and immunosuppressive medication was reduced. In-hospital mortality was 10% and the three-year mortality was 20%. CMV co-infection did not affect mortality. CMV co-infection more frequently occurred during a cluster outbreak of non-HIV PCP in comparison to PCP-free controls. Here, CMV awareness and specific therapy of both CMV infection and PCP led to a comparatively favorable patient outcome. The role of patient isolation should be further investigated in incident non-HIV PCP.

Binding of low concentration of peptide to H-2Kd produced in insect cells requires mouse beta 2-microglobulin co-expression.

A recombinant baculovirus expressing the murine class I MHC heavy chain H-2Kd cDNA under the transcriptional control of Autografa californica nuclear polyhedrosis virus (AcNPV) polyhedrin promoter has been isolated and used to infect Sf9 lepidopteran cells either alone or in association with a previously isolated virus expressing mouse beta 2-microglobulina (beta 2-ma). When infected with the heavy chain-encoding virus alone, H-2Kd was produced in a beta 2-m-free conformation detected on the surface of infected cells by conformation-independent antibodies. When Sf9 cells were co-infected with both viruses, approximately 10% of the heavy chain pool was engaged in the formation of native heterodimeric MHC class I molecules, which were glycosylated and transported to the cell surface as demonstrated by radio-binding experiments and flow cytometry. The assembly of the recombinant class I molecule was dependent on peptide, since heterodimer formation was brought about by H-2Kd-specific peptide ligands both in vivo, upon incubation with dually infected cells, and in vitro, in cell-free detergent extracts. In addition, a change in heavy chain conformation was brought about upon incubation with high concentrations (100 microM) of an H-2Kd-restricted octapeptide epitope from Plasmodium berghei. Furthermore, using low concentrations (3 nM) of a photoaffinity label derivative of this peptide, we show direct binding to cells co-expressing class I heavy chain and mouse beta 2-m but not to cells expressing free heavy chain only.

Biogeochemical evolution of a marine shore tailings deposit during bioremediation

Summary : Mining activities produce enormous amounts of waste material known as tailings which are composed of fine to medium size particles. These tailings often contain sulfides, which oxidation can lead to acid and metal contamination of water; therefore they need to be remediated. In this work a tailings bioremediation approach was investigated by an interdisciplinary study including geochemistry, mineralogy and microbiology. The aim of the work was to study the effect of the implementation of wetland above oxidizing tailings on the hydrogeology and the biogeochemical element cycles, and to assess the system evolution over time. To reach these goals, biogeochemical processes occurring in a marine shore tailings deposit were investigated. The studied tailings deposit is located at the Bahìa de Ite, Pacific Ocean, southern Peru, where between 1940 and 1996 the tailings were discharged from the two porphyry copper mines Cuajone and Toquepala. After the end of deposition, a remediation approach was initiated in 1997 with a wetland implementation above the oxidizing tailings. Around 90% of the tailings deposits (total 16 km2) were thus remediated, except the central delta area and some areas close to the shoreline. The multi-stable isotope study showed that the tailings were saturated with fresh water in spite of the marine setting, due to the high hydraulic gradient resulting from the wetland implementation. Submarine groundwater discharge (SGD) was the major source of SO4 2-, C1-, Na+, Fe2+, and Mn2+ input into the tailings at the original shelf-seawater interface. The geochemical study (aquatic geochemistry and X-Ray diffraction (XRD) and sequential extractions from the solid fraction) showed that iron and sulfur oxidation were the main processes in the non-remediated tailings, which showed a top a low-pH oxidation zone with strong accumulation of efflorescent salts at the surface due to capillary upward transport of heavy metals (Fe, Cu, Zn, Mn, Cd, Co, and Ni) in the arid climate. The study showed also that the implementation of the wetland resulted in very low concentrations of heavy metals in solution (mainly under the detection limit) due to the near neutral pH and more reducing conditions (100-150 mV). The heavy metals, which were taken from solution, precipitated as hydroxides and sulfides or were bound to organic matter. The bacterial community composition analysis by Terminal Restriction Fragment Length Polymorphism (T-RFLP) and cloning and sequencing of 16S rRNA genes combined with a detailed statistical analysis revealed a high correlation between the bacterial distribution and the geochemical variables. Acidophilic autotrophic oxidizing bacteria were dominating the oxidizing tailings, whereas neutrophilic and heterotrophic reducing bacteria were driving the biogeochemical processes in the remediated tailings below the wetland. At the subsurface of the remediated tailings, an iron cycling was highlighted with oxidation and reduction processes due to micro-aerophilic niches provided by the plant rhizosphere in this overall reducing environment. The in situ bioremediation experiment showed that the main parameter to take into account for the effectiveness was the water table and chemistry which controls the system. The constructed remediation cells were more efficient and rapid in metal removal when saturation conditions were available. This study showed that the bioremediation by wetland implementation could be an effective and rapid treatment for some sulfidic mine tailings deposits. However, the water saturation of the tailings has to be managed on a long-term basis in order to guarantee stability. Résumé : L'activité minière produit d'énormes quantités de déchets géologiques connus sous le nom de « tailings » composées de particules de taille fine à moyenne. Ces déchets contiennent souvent des sulfures dont l'oxydation conduit à la formation d'effluents acides contaminés en métaux, d'où la nécessité d'effectuer une remédiation des sites de stockage concernés. Le but de ce travail est dans un premier temps d'étudier l'effet de la bio-remédiation d'un dépôt de tailings oxydés sur l'hydrogéologie du système et les cycles biogéochimiques des éléments et en second lieu, d'évaluer l'évolution du processus de remédiation dans le temps. Le site étudié dans ce travail est situé dans la Bahía de Ite, au sud du Pérou, au bord de l'Océan Pacifique. Les déchets miniers en question sont déposés dans un environnement marin. De 1940 à 1996, les déchets de deux mines de porphyre cuprifère - Cuajone et Toquepala - ont été acheminés sur le site via la rivière Locumba. En 1997, une première remédiation a été initiée avec la construction d'une zone humide sur les tailings. Depuis, environ 90% de la surface du dépôt (16 km2) a été traité, les parties restantes étant la zone centrale du delta du Locumba et certaines zones proches de la plage. Malgré la proximité de l'océan, les études isotopiques menées dans le cadre de ce travail ont montré que les tailings étaient saturés en eau douce. Cette saturation est due à la pression hydraulique résultant de la mise en place des zones humides. Un écoulement d'eau souterrain sous-marin a été à détecté à l'interface entre les résidus et l'ancien fond marin. En raison de la géologie locale, il constitue une source d'entrée de SO4 2-, Cl-, Na+, FeZ+, et Mn2+ dans le système. L'analyse de la géochimie aquatique, la Diffraction aux Rayons X (XRD) et l'extraction séquentielle ont montré que l'oxydation du fer et .des sulfures est le principal processus se produisant dans les déchets non remédiés. Ceci a entraîné le développement d'une zone d'oxydation à pH bas induisant une forte accumulation des sels efflorescents, conséquence de la migration capillaire des métaux lourds (Fe, Cu, Zn, Mn, Cd, Co et Ni) de la solution vers la surface dans ce climat aride. Cette étude a montré également que la construction de la zone humide a eu comme résultats une précipitation des métaux dans des phases minérales en raison du pH neutre et des conditions réductrices (100-150mV). Les métaux lourds ont précipité sous la forme d'hydroxydes et de sulfures ou sont adsorbés à la matière organique. L'analyse de la composition de la communauté bactérienne à l'aide la technique T-RFLP (Terminal Restriction Fragment Length Polymorphism) et par le clonage/séquençage des gènes de l'ARNr 16S a été combinée à une statistique détaillée. Cette dernière a révélé une forte corrélation entre la distribution de bactéries spécifiques et la géochimie : Les bactéries autotrophes acidophiles dominent dans les déchets oxydés non remédiés, tandis que des bactéries hétérotrophes neutrophiles ont mené les processus microbiens dans les déchets remédiés sous la zone humide. Sous la surface de la zone humide, nos analyses ont également mis en évidence un cycle du fer par des processus d'oxydoréduction rendus possibles par la présence de niches micro-aérées par la rhizosphère dans cet environnement réducteur. L'expérience de bio-remédiation in situ a montré que les paramètres clés qui contrôlent l'efficacité du traitement sont le niveau de la nappe aquifère et la chimie de l'eau. Les cellules de remédiation se sont montrées plus efficaces et plus rapides lorsque le système a pu être saturé en eau. Finalement, cette étude a montré que la bio-remédiation de déchets miniers par la construction de zones humides est un moyen de traitement efficace, rapide et peu coûteux. Cependant, la saturation en eau du système doit être gérée sur le long terme afin de garantir la stabilité de l'ensemble du système.

Dos contextos da prática à (co)construção do modelo de cuidados de enfermagem de família

Face aos desafios que se colocam aos enfermeiros, no desenvolvimento de cuidados centrados na família como contexto e unidade de intervenção, realizamos uma pesquisa direcionada para a intervenção familiar, no contexto dos Cuidados de Saúde Primários. De natureza qualitativa, adotamos a metodologia de investigação-ação, numa trajetória de cinco etapas, integradas num ciclo de estudos. Dos resultados do diagnóstico, através da análise comparativa dos modelos conceituais com as práticas de cuidados à família, emergiu a necessidade da mudança iniciada com um processo formativo. Tendo como referenciais o Modelo Sistêmico, o Modelo Calgary de Avaliação da Família e o Modelo Calgary de Intervenção na Família, reconstruiu-se o modelo de cuidados de enfermagem à família, operacionalizando-o através da definição das áreas de atenção e intervenção. A co-construção do modelo a partir das necessidades identificadas pelos enfermeiros, legitimado pelas tomadas de decisão dos mesmos, constitui-se como base de discussão no contexto da enfermagem de família.

Co-morbidade fadiga e depressão em pacientes com câncer colo-retal

O estudo teve como objetivos caracterizar e identificar a comorbidade entre fadiga e depressão em pacientes com câncer colorretal. A amostra não-probabilística foi de 154 pacientes ambulatoriais (53% homens; idade média 49,6±11,7 anos; escolaridade média 8,9±5,4 anos). A fadiga foi avaliada pela Escala de Fadiga de Piper Revisada e o humor pelo Inventário de Depressão de Beck. A Fadiga foi relatada por 76 (49,4%) pacientes e foi intensa (escore total > 6) para 19,7% deles. Escores que sugerem depressão (IDB>20) foram encontrados em 11 (7,1%) pacientes. Fadiga e depressão estavam correlacionadas (r=0,395; p 0,001). A co-morbidade fadiga moderada/intensa e disforia/depressão ocorreu em 12,3%. A Fadiga estava presente na totalidade dos doentes deprimidos (100%), e a depressão ocorreu em 18% dos doentes fatigados. Fadiga e depressão são fenômenos relacionados, a sua comorbidade pode ser muito deletéria ao doente; a depressão foi mais importante para a ocorrência de fadiga do que a fadiga para a depressão.

BAFF production by antigen-presenting cells provides T cell co-stimulation.

The B cell-activating factor from the tumor necrosis factor family (BAFF) is an important regulator of B cell immunity. Recently, we demonstrated that recombinant BAFF also provides a co-stimulatory signal to T cells. Here, we studied expression of BAFF in peripheral blood leukocytes and correlated this expression with BAFF T cell co-stimulatory function. BAFF is produced by antigen-presenting cells (APC). Blood dendritic cells (DC) as well as DC differentiated in vitro from monocytes or CD34+ stem cells express BAFF mRNA. Exposure to bacterial products further up-regulates BAFF production in these cells. A low level of BAFF transcription, up-regulated upon TCR stimulation, was also detected in T cells. Functionally, blockade of endogenous BAFF produced by APC and, to a lesser extent, by T cells inhibits T cell activation. Altogether, this indicates that BAFF may regulate T cell immunity during APC-T cell interactions and as an autocrine factor once T cells have detached from the APC.

Genome-wide association study of co-occurring anxiety in major depression.

OBJECTIVES: Co-morbidity between depression and anxiety disorders is common. In this study we define a quantitative measure of anxiety by summating four anxiety items from the SCAN interview in a large collection of major depression (MDD) cases to identify genes contributing to this complex phenotype. METHODS: A total of 1522 MDD cases dichotomised according to those with at least one anxiety item scored (n = 1080) and those without anxiety (n = 442) were analysed, and also compared to 1588 healthy controls at a genome-wide level, to identify genes that may contribute to anxiety in MDD. RESULTS: For the quantitative trait, suggestive evidence of association was detected for two SNPs, and for the dichotomous anxiety present/absent ratings for three SNPs at genome-wide level. In the genome-wide analysis of MDD cases with co-morbid anxiety and healthy controls, two SNPs attained P values of < 5 × 10⁻⁶. Analysing candidate genes, P values ≤ 0.0005 were found with three SNPs for the quantitative trait and three SNPs for the dichotomous trait. CONCLUSIONS: This study provides an initial genome-wide assessment of possible genetic contribution to anxiety in MDD. Although suggestive evidence of association was found for several SNPs, our findings suggest that there are no common variants strongly associated with anxious depression.

Designation of Co-benefits and Its Implication for Policy: Water Quality versus Carbon Sequestration in Agricultural Soils, March 2005

Designation of Co-benefits and Its Implication for Policy: Water Quality versus Carbon Sequestration in Agricultural Soils, The

Fusion of the human gene for the polyubiquitination co-effector UEV-1 with Kua, a newly identified gene

UEV proteins are enzymatically inactive variants of the E2 ubiquitin-conjugating enzymes that regulate noncanonical elongation of ubiquitin chains. In Saccharomyces cerevisiae, UEV is part of the RAD6-mediated error-free DNA repair pathway. In mammalian cells, UEV proteins can modulate c-FOS transcription and the G2-M transition of the cell cycle. Here we show that the UEV genes from phylogenetically distant organisms present a remarkable conservation in their exon–intron structure. We also show that the human UEV1 gene is fused with the previously unknown gene Kua. In Caenorhabditis elegans and Drosophila melanogaster, Kua and UEV are in separated loci, and are expressed as independent transcripts and proteins. In humans, Kua and UEV1 are adjacent genes, expressed either as separate transcripts encoding independent Kua and UEV1 proteins, or as a hybrid Kua–UEV transcript, encoding a two-domain protein. Kua proteins represent a novel class of conserved proteins with juxtamembrane histidine-rich motifs. Experiments with epitope-tagged proteins show that UEV1A is a nuclear protein, whereas both Kua and Kua–UEV localize to cytoplasmic structures, indicating that the Kua domain determines the cytoplasmic localization of Kua–UEV. Therefore, the addition of a Kua domain to UEV in the fused Kua–UEV protein confers new biological properties to this regulator of variant polyubiquitination.[Kua cDNAs isolated by RT-PCR and described in this paper have been deposited in the GenBank data library under accession nos. AF1155120 (H. sapiens) and AF152361 (D. melanogaster). Genomic clones containing UEV genes: S. cerevisiae, YGL087c (accession no. Z72609); S. pombe, c338 (accession no. AL023781); P. falciparum, MAL3P2 (accession no. AL034558); A. thaliana, F26F24 (accession no. AC005292); C. elegans, F39B2 (accession no. Z92834); D. melanogaster, AC014908; and H. sapiens, 1185N5 (accession no. AL034423). Accession numbers for Kua cDNAs in GenBank dbEST: M. musculus, AA7853; T. cruzi, AI612534. Other Kua-containing sequences: A. thaliana genomic clones F10M23 (accession no. AL035440), F19K23 (accession no. AC000375), and T20K9 (accession no. AC004786).

Abandono do tratamento de tuberculose em co-infectados TB/HIV

Este estudo objetivou analisar os motivos que levam os pacientes coinfectados TB/HIV a abandonar o tratamento da TB e conhecer a conduta da equipe de saúde frente a esse abandono. A abordagem foi qualitativa. Utilizou-se a entrevista semiestruturada, aplicada a quarenta e cinco profissionais que atuam em uma Unidade de Referência no Pará. Após análise temática, foram construídas duas unidades: fatores relacionados aos doentes que dificultam adesão ao tratamento da TB; e fatores relacionados ao serviço que contribuem para o abandono. Mostrou-se, com relação aos pacientes, que a baixa condição socioeconômica foi o fator mais frequente que propicia o abandono. Também efeitos adversos dos medicamentos, uso de drogas lícitas, e pouca motivação pessoal facilitam esse desfecho. Quanto ao Serviço, as questões relacionadas à estrutura física, organização do processo de trabalho e acesso mostraram-se relevantes para não adesão. Os resultados apontam para a necessidade de alterar as práticas desenvolvidas nos Serviços.

Adesão ao tratamento por indivíduos com a co-infecção HIV/tuberculose: revisão integrativa da literatura

Trata-se de revisão integrativa cujo objetivo foi avaliar as evidências disponíveis na literatura sobre os fatores associados à adesão ao tratamento por pacientes com a co-infecção HIV/TB. Foram levantados artigos publicados no período de 2002 a 2008, nas bases de dados LILACS e MEDLINE. O material foi categorizado de acordo com ano de publicação, periódico, local do estudo e fatores relacionados à adesão. A amostra final foi composta por oito artigos. Os fatores encontrados, associados à adesão ao tratamento da co-infecção HIV/TB, relacionam-se: ao indivíduo e ao estilo de vida (tratamento prévio de TB, receio de estigma e discriminação, uso de substâncias químicas, depressão, suporte social), à doença e aos medicamentos (tipo de regime medicamentoso, uso de outros medicamentos, efeitos colaterais, dificuldade de diagnóstico de TB nestes pacientes), e aos serviços de saúde (problemas operacionais para acompanhar o tratamento, treinamento dos profissionais, supervisão, locais distintos para atendimento de TB e de HIV).

LdShake: learning design solutions sharing and co-edition

Two important challenges that teachers are currently facing are the sharing and the collaborative authoring of their learning design solutions, such as didactical units and learning materials. On the one hand, there are tools that can be used for the creation of design solutions and only some of them facilitate the co-edition. However, they do not incorporate mechanisms that support the sharing of the designs between teachers. On the other hand, there are tools that serve as repositories of educational resources but they do not enable the authoring of the designs. In this paper we present LdShake, a web tool whose novelty is focused on the combined support for the social sharing and co-edition of learning design solutions within communities of teachers. Teachers can create and share learning designs with other teachers using different access rights so that they can read, comment or co-edit the designs. Therefore, each design solution is associated to a group of teachers able to work on its definition, and another group that can only see the design. The tool is generic in that it allows the creation of designs based on any pedagogical approach. However, it can be particularized in instances providing pre-formatted designs structured according to a specific didactic method (such as Problem-Based Learning, PBL). A particularized LdShake instance has been used in the context of Human Biology studies where teams of teachers are required to work together in the design of PBL solutions. A controlled user study, that compares the use of a generic LdShake and a Moodle system, configured to enable the creation and sharing of designs, has been also carried out. The combined results of the real and controlled studies show that the social structure, and the commenting, co-edition and publishing features of LdShake provide a useful, effective and usable approach for facilitating teachers' teamwork.

Outage probability analysis for MRC in η-μ fading channels with co-channel interference

Exact closed-form expressions are obtained for the outage probability of maximal ratio combining in η-μ fadingchannels with antenna correlation and co-channel interference. The scenario considered in this work assumes the joint presence of background white Gaussian noise and independent Rayleigh-faded interferers with arbitrary powers. Outage probability results are obtained through an appropriate generalization of the moment-generating function of theη-μ fading distribution, for which new closed-form expressions are provided.

Stringless Portland Cement Concrete Paving, February 2004

This report describes results from a study evaluating the use of stringless paving using a combination of global positioning and laser technologies. CMI and Geologic Computer Systems developed this technology and successfully implemented it on construction earthmoving and grading projects. Concrete paving is a new area for considering this technology. Fred Carlson Co. agreed to test the stringless paving technology on two challenging concrete paving projects located in Washington County, Iowa. The evaluation was conducted on two paving projects in Washington County, Iowa, during the summer of 2003. The research team from Iowa State University monitored the guidance and elevation conformance to the original design. They employed a combination of physical depth checks, surface location and elevation surveys, concrete yield checks, and physical survey of the control stakes and string line elevations. A final check on profile of the pavement surface was accomplished by the use of the Iowa Department of Transportation Light Weight Surface Analyzer (LISA). Due to the speed of paving and the rapid changes in terrain, the laser technology was abandoned for this project. Total control of the guidance and elevation controls on the slip-form paver were moved from string line to global positioning systems (GPS). The evaluation was a success, and the results indicate that GPS control is feasible and approaching the desired goals of guidance and profile control with the use of three dimensional design models. Further enhancements are needed in the physical features of the slipform paver oil system controls and in the computer program for controlling elevation.