Three phylogenetic groups have driven the recent population expansion of Cryptococcus neoformans.

Cryptococcus neoformans (C. neoformans var. grubii) is an environmentally acquired pathogen causing 181,000 HIV-associated deaths each year. We sequenced 699 isolates, primarily C. neoformans from HIV-infected patients, from 5 countries in Asia and Africa. The phylogeny of C. neoformans reveals a recent exponential population expansion, consistent with the increase in the number of susceptible hosts. In our study population, this expansion has been driven by three sub-clades of the C. neoformans VNIa lineage; VNIa-4, VNIa-5 and VNIa-93. These three sub-clades account for 91% of clinical isolates sequenced in our study. Combining the genome data with clinical information, we find that the VNIa-93 sub-clade, the most common sub-clade in Uganda and Malawi, was associated with better outcomes than VNIa-4 and VNIa-5, which predominate in Southeast Asia. This study lays the foundation for further work investigating the dominance of VNIa-4, VNIa-5 and VNIa-93 and the association between lineage and clinical phenotype.

Special delivery: scavengers direct seed dispersal towards ungulate carcasses.

Cadaver decomposition islands around animal carcasses can facilitate establishment of various plant life. Facultative scavengers have great potential for endozoochory, and often aggregate around carcasses. Hence, they may disperse plant seeds that they ingest across the landscape towards cadaver decomposition islands. Here, we demonstrate this novel mechanism along a gradient of wild tundra reindeer carcasses. First, we show that the spatial distribution of scavenger faeces (birds and foxes) was concentrated around carcasses. Second, faeces of the predominant scavengers (corvids) commonly contained viable seeds of crowberry, a keystone species of the alpine tundra with predominantly vegetative reproduction. We suggest that cadaver decomposition islands function as endpoints for directed endozoochory by scavengers. Such a mechanism could be especially beneficial for species that rely on small-scale disturbances in soil and vegetation, such as several Nordic berry-producing species with cryptic generative reproduction.

Ferromagnetic Resonance Spin Pumping and Electrical Spin Injection in Silicon-Based Metal-Oxide-Semiconductor Heterostructures.

We present the measurement of ferromagnetic resonance (FMR-)driven spin pumping and three-terminal electrical spin injection within the same silicon-based device. Both effects manifest in a dc spin accumulation voltage V_{s} that is suppressed as an applied field is rotated to the out-of-plane direction, i.e., the oblique Hanle geometry. Comparison of V_{s} between these two spin injection mechanisms reveals an anomalously strong suppression of FMR-driven spin pumping with increasing out-of-plane field H_{app}^{z}. We propose that the presence of the large ac component to the spin current generated by the spin pumping approach, expected to exceed the dc value by 2 orders of magnitude, is the origin of this discrepancy through its influence on the spin dynamics at the oxide-silicon interface. This convolution, wherein the dynamics of both the injector and the interface play a significant role in the spin accumulation, represents a new regime for spin injection that is not well described by existing models of either FMR-driven spin pumping or electrical spin injection.

Estimating the burden of fungal disease in Vietnam.

Data regarding the prevalence of fungal infections in Vietnam are limited yet they are likely to occur more frequently as increasingly sophisticated healthcare creates more iatrogenic risk factors. In this study, we sought to estimate baseline incidence and prevalence of selected serious fungal infections for the year 2012. We made estimates with a previously described actuarial method, using reports on the incidence and prevalence of various established risk factors for fungal infections from Vietnam, or similar environments, supplemented by personal communications. Global data were used if local data were unavailable. We estimated 2,352,748 episodes of serious fungal infection occurred in Vietnam in 2012. Frequent conditions included recurrent vaginal candidiasis (3893/100,000 women annually), tinea capitis (457/100,000 annually) and chronic pulmonary aspergillosis (61/100,000/5 year period). We estimated 140 cases of cryptococcal meningitis, 206 of penicilliosis and 608 of Pneumocystis jirovecii pneumonia. This is the first summary of Vietnamese fungal infections. The majority of severe disease is due to Aspergillus species, driven by the high prevalence of pulmonary tuberculosis. The AIDS epidemic highlights opportunistic infections, such as penicilliosis and cryptococcosis, which may complicate immunosuppressive treatments. These estimates provide a useful indication of disease prevalence to inform future research and resource allocation but should be verified by further epidemiological approaches.

Does the addition of a urine testing kit to use of contact slips increase the partner notification rates for genital chlamydial infection?

This study was designed to determine whether a better partner notification outcome could be achieved by giving female index patients with genital chlamydial infection a home sampling kit instead of contact slips only. Two hundred female patients attending a sexually transmitted infection clinic with a diagnosis of genital chlamydial infection were randomized to either the conventional partner notification arm using contact slips (swab testing arm) or the urine sampling kit for partner notification arm (urine testing arm). There were no differences in the number of partners treated per index case (0.67 in the swab testing group versus 0.62 in the urine testing group, P = 0.46), the median number of traceable partners and the number of index patients with at least one partner treated within 28 days. The addition of a urine testing kit to contact slips for male partners of women with genital chlamydial infection did not increase the partner notification rates for genital chlamydial infection.

Are opportunities for vitamin A supplementation being utilised at primary health-care clinics in the Western Cape Province of South Africa?

OBJECTIVES: To determine missed opportunities and problems relating to implementation of the Vitamin A Supplementation Programme in urban and rural regions of the Western Cape Province of South Africa.MethodA cross-sectional survey was conducted at primary health-care (PHC) clinics in Cape Metropole, an urban region, and West Coast Winelands, a rural region, of the Western Cape. A purposive sample of clinics where more than 30 children were seen per day was drawn from 10 of the 11 districts in the Cape Metropole region and the two districts of the West Coast Winelands region. The number of children selected from each district was weighted in terms of population size for the two regions. At each clinic visited, the first five to 10 children seen on a day, and meeting the inclusion criteria for vitamin A supplementation (VAS) based on the vitamin A provincial policy guidelines, were selected. These included children with low birth weight (LBW), growth faltering, underweight and severe undernutrition, recurrent diarrhoea and lower respiratory tract infection (LRTI), tuberculosis, measles, HIV/AIDS and eye signs of vitamin A deficiency. Clinic records were reviewed following consultation with the PHC nurse to identify if the child required vitamin A, exit interviews were conducted with mothers/caregivers, and Road to Health Charts (RTHCs) were reviewed. At the end of the study, PHC managers were interviewed to determine if problems could be identified with the Programme. RESULTS: Forty-three of 123 (35%) and 13 of 40 (33%) of the fixed PHC clinics in the Cape Metropole and West Coast Winelands regions were visited, and a total of 300 children (234 from Cape Metropole, 66 from West Coast Winelands) with a mean (standard deviation) age of 24.3 (16.3) months and who met the inclusion criteria for VAS were selected. Of the total sample of children, 198 (66%) had multiple (i.e. more than one) indication and 102 (34%) had a single indication for VAS. There were a total of 617 indications for VAS in the two regions; 238 (39%) for growth faltering, 119 (19%) for underweight, 98 (16%) for LBW, 70 (11%) for LRTI, 51 (8%) for diarrhoea, 21 (3%) for HIV/AIDS and 20 (3%) for tuberculosis. A total of 102 (34%) of the children in the two regions received vitamin A supplements (Cape Metropole 29%; West Coast Winelands 52%). A record was made on the RTHC of 79 (77%) of the children who received VAS (Cape Metropole 76%; West Coast Winelands 79%). Twenty-four per cent of the mothers knew why their child had been given vitamin A (Cape Metropole 29%; West Coast Winelands 12%). Eleven per cent of the mothers had previously heard about the Vitamin A Supplementation Programme (Cape Metropole 12%; West Coast Winelands 6%). More than 81% of PHC managers indicated that health staff had been trained to implement the Vitamin A Supplementation Programme. The main problems identified by health staff in the two regions were lack of vitamin A capsules, inadequate training and difficulties in implementing the Programme. CONCLUSIONS: Opportunities to administer vitamin A were underutilised in both regions. Recommendations such as improving mothers' awareness of the benefits of vitamin A and training of PHC nurses were made to the provincial Department of Health and are being implemented to improve the effectiveness of the Programme.

Education to undermine a taboo. Understanding herpes simplex virus.

Although the physical symptoms of herpes can be well-managed, the psychological effects can be severe and distressing. Nurses can help alleviate sufferers' fear and anxiety by educating them on how they can control symptoms and prevent the virus from spreading.

Evaluation of GonoGen coagglutination test for serodiagnosis of Neisseria gonorrhoeae: identification of problem isolates by auxotyping, serotyping, and with a fluorescent antibody reagent.

GonoGen (Micro-Media Systems, Potomac, MD) is a commercially available coagglutination test for the identification of Neisseria gonorrhoeae. We tested 84 strains of Neisseria spp. and Branhamella catarrhalis, including 50 clinical isolates of N. gonorrhoeae. Eighty-six percent (51/59) of N. gonorrhoeae, including 86% (43/50) of clinical isolates of N. gonorrhoeae, were identified correctly in the GonoGen test. In contrast, all N. gonorrhoeae isolates reacted with a fluorescent antibody research reagent composed of monoclonal antibodies. Both reagents were specific for N. gonorrhoeae. Clinical isolates were classified by auxotyping and were serotyped with research monoclonal antibody reagents in coagglutination tests to characterize problem isolates; two auxotype/serovar classes, prototrophic/IA-4 and proline-requiring/IA-4, accounted for 71% (5/7) of GonoGen-negative clinical isolates. Five of the seven isolates that were missed with the first GonoGen lot we tested did react with a second lot of GonoGen reagent. Investigators from different cities in the U.S. have reported different rates of success with GonoGen. Our results indicate that certain N. gonorrhoeae serovars may account for the difference in performance observed with serological tests.