First use of whole-genome sequencing to investigate a cluster of Yersinia enterocolitica, Liverpool, United Kingdom, 2017.

PURPOSE: In May 2017 we were notified of a cluster of Yersinia enterocolitica-positive isolates from Liverpool. The purpose of this work was to investigate this cluster of cases and find a possible common source. We combined epidemiological information with whole-genome sequencing (WGS) results, which indicated that these cases were unlikely to be from the same source. This investigation provides evidence that WGS could be used to investigate future clusters of Y. enterocolitica cases. METHODS: A case was defined as a person with a laboratory-confirmed isolate of Y. enterocolitica, sampled in 2017, who is a resident in Liverpool local authority at the time of sampling. Faecal samples were cultured at the local laboratory and presumptive isolates of Yersinia sp. were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Positive isolates were whole-genome sequenced by the reference laboratory. RESULTS: Nine cases were identified, which was significantly greater (P<0.0001) than the average number of cases in this area from the last 10 years. Six cases were female (66.67 %) and the ages of the patients ranged from 20 to 81 (median 54). The sample dates ranged from 29 April to 1 August 2017. The WGS results showed that Y. enterocolitica isolates belonged to different sequence types. CONCLUSION: This was the first time that WGS was used to investigate a cluster of Y. enterocolitica cases; the cases were clustered in time, person and place, but the WGS results indicate that these cases were not from the same source. This result informed the Outbreak Control Team's decision-making and resulted in the investigation being closed.

Integrative Review of Interventions to Promote Breastfeeding in the Late Preterm Infant.

OBJECTIVE: To define the different breastfeeding interventions that promote breastfeeding exclusivity and duration in the late preterm infant and to synthesize findings from the published empirical literature on late preterm infant breastfeeding interventions. DATA SOURCES: The databases CINAHL, Scopus, and PubMed were searched for primary research articles on breastfeeding interventions for late preterm infants. Inclusion criteria included original research studies in which authors examined a breastfeeding intervention or second-line strategy in a sample inclusive of but not necessarily limited to the gestational age range of 34 to 3667 weeks gestation, written in English, and published between 2005 and 2015. STUDY SELECTION: Thirteen articles were identified, including five randomized controlled trials, three quasi-experimental studies, four descriptive studies, and one case study. DATA EXTRACTION: Whittemore and Knafl's methodology guided this integrative review. Data extraction and organization occurred under the following headings: author and year, study design, level of evidence, purpose, sample, setting, results, limitations, recommendations, and intervention. DATA SYNTHESIS: Studies on breastfeeding interventions were synthesized under four concepts within the Late Preterm Conceptual Framework: Physiologic Functional Status, Care Practices, Family Role, and Care Environment. CONCLUSION: Most breastfeeding interventions within this integrative review had positive effects on exclusivity and duration of breastfeeding in the late preterm infant. However, second-line strategies had equivocal effects on exclusivity but had positive effects on duration. The positive effects of breastfeeding interventions on breastfeeding exclusivity and duration are highlighted in our results, and we point to the need for a focus on breastfeeding after the transition home for late preterm infants.

Serum biomarkers of tubal ectopic pregnancy: current candidates and future possibilities.

Ectopic pregnancy remains a considerable cause of maternal morbidity and mortality worldwide. Currently, it is diagnosed using a combination of transvaginal ultrasound and serial serum beta-human chorionic gonadotrophin levels. Diagnosis is often delayed and these tests are time-consuming and costly, both psychologically to the patient and financially to health services. The development of a biomarker that can differentiate a tubal ectopic from an intrauterine implantation is therefore important. In the pre-genomic era, a one-by-one scientific approach has revealed over 20 candidate biomarkers that could be used as a test to diagnose ectopic pregnancy although at present their clinical utility is very limited. These biomarkers cluster into themes: markers of abnormal embryo/trophoblast growth, markers of abnormal corpus luteum function, markers of a growing pregnancy in the Fallopian tube, markers of inflammation and peritoneal irritation, and uterine markers of normal implantation. It is likely that this thematic approach will facilitate the identification of newer biomarkers using microarray technology and inform the development of investigative paradigms using multiple markers at the time of presentation.