Improving Barriers to Timely Colonoscopies: A New Approach to Overcoming Gaps in Medical Care.

This study investigates delays in transitioning from positive noninvasive multitarget stool DNA test results to scheduled diagnostic colonoscopies and identifies strategies aimed at improving patient care. A retrospective review revealed a 53% reduction in the average time from positive multitarget stool DNA test results to ordering colonoscopies postintervention. The findings demonstrate the significance of implementing a new communication system to expedite transitions in health care processes, showcasing its potential to significantly improve efficiency in patient care and health care provider workflows across various clinical testing scenarios. The findings emphasize the transformative impact of this communication system, shedding light on its ability to streamline processes and enhance patient care and staff experience.

A Novel High-Throughput Ex Vivo Ovine Skin Wound Model for Testing Emerging Antibiotics.

The development of antimicrobials is an expensive process with increasingly low success rates, which makes further investment in antimicrobial discovery research less attractive. Antimicrobial drug discovery and subsequent commercialization can be made more lucrative if a fail-fast-and-fail-cheap approach can be implemented within the lead optimization stages where researchers have greater control over drug design and formulation. In this article, the setup of an ex vivo ovine wounded skin model infected with Staphylococcus aureus is described, which is simple, cost-effective, high throughput, and reproducible. The bacterial physiology in the model mimics that during infection as bacterial proliferation is dependent on the pathogen's ability to damage the tissue. The establishment of wound infection is verified by an increase in viable bacterial counts compared to the inoculum. This model can be used as a platform to test the efficacy of emerging antimicrobials in the lead optimization stage. It can be contended that the availability of this model will provide researchers developing antimicrobials with a fail-fast-and-fail-cheap model, which will help increase success rates in subsequent animal trials. The model will also facilitate the reduction and refinement of animal use for research and ultimately enable faster and more cost-effective translation of novel antimicrobials for skin and soft tissue infections to the clinic.

'Remote' behavioural ecology: do megaherbivores consume vegetation in proportion to its presence in the landscape?

Examination of the feeding habits of mammalian species such as the African elephant (Loxodonta africana) that range over large seasonally dynamic areas is exceptionally challenging using field-based methods alone. Although much is known of their feeding preferences from field studies, conclusions, especially in relation to differing habits in wet and dry seasons, are often contradictory. Here, two remote approaches, stable carbon isotope analysis and remote sensing, were combined to investigate dietary changes in relation to tree and grass abundances to better understand elephant dietary choice in the Kruger National Park, South Africa. A composited pair of Landsat Enhanced Thematic Mapper satellite images characterising flushed and senescent vegetation states, typical of wet and dry seasons respectively, were used to generate land-cover maps focusing on the forest to grassland gradient. Stable carbon isotope analysis of elephant faecal samples identified the proportion of C3 (typically browse)/C4 (typically grass) in elephant diets in the 1-2 days prior to faecal deposition. The proportion of surrounding C4 land-cover was extracted using concentric buffers centred on faecal sample locations, and related to the faecal %C4 content. Results indicate that elephants consume C4 vegetation in proportion to its availability in the surrounding area during the dry season, but during the rainy season there was less of a relationship between C4 intake and availability, as elephants targeted grasses in these periods. This study illustrates the utility of coupling isotope and cost-free remote sensing data to conduct complementary landscape analysis at highly-detailed, biologically meaningful resolutions, offering an improved ability to monitor animal behavioural patterns at broad geographical scales. This is increasingly important due to potential impacts of climate change and woody encroachment on broad-scale landscape habitat composition, allowing the tracking of shifts in species utilisation of these changing landscapes in a way impractical using field based methods alone.

Mms21: A Putative SUMO E3 Ligase in Candida albicans That Negatively Regulates Invasiveness and Filamentation, and Is Required for the Genotoxic and Cellular Stress Response.

In the life cycle of the fungal pathogen Candida albicans, the formation of filamentous cells is a differentiation process that is critically involved in host tissue invasion, and in adaptation to host cell and environmental stresses. Here, we have used the Gene Replacement And Conditional Expression library to identify genes controlling invasiveness and filamentation; conditional repression of the library revealed 69 mutants that triggered these processes. Intriguingly, the genes encoding the small ubiquitin-like modifier (SUMO) E3 ligase Mms21, and all other tested members of the sumoylation pathway, were both nonessential and capable of triggering filamentation upon repression, suggesting an important role for sumoylation in controlling filamentation in C. albicans We have investigated Mms21 in detail. Both Mms21 nulls (mms21Δ/Δ) and SP [Siz/Pias (protein inhibitor of activated signal transducer and activator of transcription)] domain (SUMO E3 ligase domain)-deleted mutants displayed invasiveness, filamentation, and abnormal nuclear segregation; filament formation occurred even in the absence of the hyphal transcription factor Efg1. Transcriptional analysis of mms21Δ/Δ showed an increase in expression from two- to eightfold above that of the wild-type for hyphal-specific genes, including ECE1, PGA13, PGA26, HWP1, ALS1, ALS3, SOD4, SOD5, UME6, and HGC1 The Mms21-deleted mutants were unable to recover from DNA-damaging agents like methyl methane sulfonate, hydroxyurea, hydrogen peroxide, and UV radiation, suggesting that the protein is important for genotoxic stress responses. In addition, the mms21Δ/Δ mutant displayed sensitivity to cell wall and thermal stresses, and to different antifungal drugs. All these findings suggest that Mms21 plays important roles in cellular differentiation, DNA damage and cellular stress responses, and in response to antifungal drugs.

Negative regulation of filamentous growth in Candida albicans by Dig1p.

Transcriptional regulation involves both positive and negative regulatory elements. The Dig1 negative regulators are part of a fungal-specific module that includes a transcription factor (a Ste12 family member) and a Dig1 family member. In Saccharomyces cerevisiae, the post-genome-duplication Dig1/Dig2 proteins regulate MAP kinase controlled signalling pathways involved in mating and filamentous growth. We have identified the single Dig1 orthologue in the fungal pathogen Candida albicans. Genetic studies and transcriptional profiling experiments show that this single protein is implicated in the regulation of MAP kinase-controlled processes involved in mating, filamentous growth and biofilm formation, and also influences cAMP-regulated processes. This suggests that the multiple cellular roles of the Dig1 protein are ancestral and predate the sub-functionalization apparent in S. cerevisiae after the genome duplication. Intriguingly, even though loss of Dig1 function in C. albicans enhances filamentous growth and biofilm formation, colonization of the murine gastrointestinal tract is reduced in the mutant. The complexity of the processes influenced by Dig1 in C. albicans, and the observation that Dig1 is one of the few regulatory proteins that were retained in the duplicated state after the whole genome duplication event in yeast, emphasizes the important role of these negative regulators in fungal transcriptional control.

Clathrin- and Arp2/3-independent endocytosis in the fungal pathogen Candida albicans.

UNLABELLED: Clathrin-mediated endocytosis (CME) is conserved among eukaryotes and has been extensively analyzed at a molecular level. Here, we present an analysis of CME in the human fungal pathogen Candida albicans that shows the same modular structure as those in other fungi and mammalian cells. Intriguingly, C. albicans is perfectly viable in the absence of Arp2/3, an essential component of CME in other systems. In C. albicans, Arp2/3 function remains essential for CME as all 15 proteins tested that participate in CME, including clathrin, lose their characteristic dynamics observed in wild-type (WT) cells. However, since arp2/3 cells are still able to endocytose lipids and fluid-phase markers, but not the Ste2 and Mup1 plasma membrane proteins, there must be an alternate clathrin-independent pathway we term Arp2/3-independent endocytosis (AIE). Characterization of AIE shows that endocytosis in arp2 mutants relies on actin cables and other Arp2/3-independent actin structures, as inhibition of actin functions prevented cargo uptake in arp2/3 mutants. Transmission electron microscopy (TEM) showed that arp2/3 mutants still formed invaginating tubules, cell structures whose proper functions are believed to heavily rely on Arp2/3. Finally, Prk1 and Sjl2, two proteins involved in patch disassembly during CME, were not correctly localized to sites of endocytosis in arp2 mutants, implying a role of Arp2/3 in CME patch disassembly. Overall, C. albicans contains an alternative endocytic pathway (AIE) that relies on actin cable function to permit clathrin-independent endocytosis (CIE) and provides a system to further explore alternate endocytic routes that likely exist in fungal species. IMPORTANCE: There is a well-established process of endocytosis that is generally used by eukaryotic cells termed clathrin-mediated endocytosis (CME). Although the details are somewhat different between lower and higher eukaryotes, CME appears to be the dominant endocytic process in all eukaryotes. While fungi such as Saccharomyces cerevisiae have proven excellent models for dissecting the molecular details of endocytosis, loss of CME is so detrimental that it has been difficult to study alternate pathways functioning in its absence. Although the fungal pathogen Candida albicans has a CME pathway that functions similarly to that of S. cerevisiae, inactivation of this pathway does not compromise growth of yeast-form C. albicans. In these cells, lipids and fluid-phase molecules are still endocytosed in an actin-dependent manner, but membrane proteins are not. Thus, C. albicans provides a powerful model for the analysis of CME-independent endocytosis in lower eukaryotes.

The mating projections of Saccharomyces cerevisiae and Candida albicans show key characteristics of hyphal growth.

Fungi can grow in a variety of growth forms: yeast, pseudohyphae and hyphae. The human fungal pathogen Candida albicans can grow in all three of these forms. In this fungus, hyphal growth is distinguished by the presence of a Spitzenkörper-like structure at the hyphal tip and a band of septin bars around the base of newly evaginated germ tubes. The budding yeast Saccharomyces cerevisiae grows as yeast and pseudohyphae, but is not normally considered to show hyphal growth. We show here that in mating projections of both C. albicans and S. cerevisiae a Spitzenkörper-like structure is present at the growing tip and a band of septin bars is present at the base. Furthermore, in S. cerevisiae mating projections, Spa2 and Bni1 form a cap to the 3-dimensional ball of FM4-64 staining, exactly as previously observed in C. albicans hyphae, suggesting that the putative Spitzenkörper may be a distinct structure from the polarisome. Taken together this work shows that mating projections of both S. cerevisiae and C. albicans show the key characteristics of hyphal growth.

Multi-tissue analysis of oxygen isotopes in wild rhesus macaques (Macaca mulatta).

Oxygen isotopes in animal tissues are directly related to body water composition and thus the environment. Accurate measurement of animal tissue δ(18)O provides information about local climate, an animal's geographical origin and subsequent movements, with wide applications in palaeobiology and forensic science. The genesis and evolution of tissue-based oxygen isotopes within species and within individuals are complex. We present the first data, for non-human primates, rhesus macaques (Macaca mulatta), on the relationship between oxygen isotope sources in bio-apatite (PO(4) and PCO(3)) and hair taken from six sample sites in Asia, ranging from western India to northern Vietnam. The range of values is similar within each tissue type, with good correlation between tissues (r = 0.791 to 0.908), allowing cross-tissue extrapolations. This is important when the availability of suitable tissues is limited. Biological interpretation of the small data set is difficult: macaque diets are eclectic, and the samples are from various locations. However, factors such as overall climate, precipitation quantity and source, and altitude are clearly influencing the results for each discrete geographical grouping. Future work could be aimed at assessing δ(18)O tissue associations for other species as the relationships appear to be species-specific.

Modern macaque dietary heterogeneity assessed using stable isotope analysis of hair and bone.

Dietary variability might have been a major factor in the dispersal and subsequent persistence of the genus Macaca in both tropical and temperate areas. Macaques are found from northern Africa to Japan, yet there have been few systematic attempts to compare diets between different modern populations. Here we have taken a direct approach and sampled museum-curated tissues (hair and bone) of Macaca mulatta (rhesus macaques) for carbon and nitrogen stable isotope dietary analyses. Samples from India, Vietnam, and Burma (Myanmar) were taken, representing both tropical and temperate populations. The delta(13)C values obtained from hair show that the temperate macaques, particularly those from Uttar Pradesh, have a delta(13)C signature that indicates at least some use of C(4) resources, while the tropical individuals have a C(3)-based diet. However, delta(13)C values from bone bioapatite indicate a C(3)-based diet for all specimens and they do not show the C(4) usage seen in the hair of some animals, possibly because bone represents a much longer turnover period than that of hair. The results of delta(15)N analyses grouped animals by geographic region of origin, which may be related to local soil nitrogen values. The greatest variation in delta(15)N values was seen in the specimens from Burma, which may be partly due to seasonality, as specimens were collected at different times of year. We also investigated the relationship between the hair, bone collagen, and bone bioapatite delta(13)C results, and found that they are highly correlated, and that one tissue can be used to extrapolate results for another. However, our results also suggest that hair may pick up discrete feeding traces (such as seasonal usage), which are lost when only bone collagen and bioapatite are examined. This has important implications for dietary reconstructions of archaeological and paleontological populations.

Theropithecus and 'Out of Africa' dispersal in the Plio-Pleistocene.

Theropithecus oswaldi was one of the most widely distributed Plio-Pleistocene primates, found in southern, East, and North Africa, as well as in Spain, India, and possibly Italy. Such a large geographic range for a single primate species is highly unusual. Here, the nature and timing of its dispersal is examined using the Stepping Out cellular automata model. A hypothetical dispersal of T. darti is also modelled to assess whether the late Pliocene might have been a more favorable period for Afro-Eurasian dispersal than the early Pleistocene. Stepping Out draws on climatic and biome reconstruction to provide the paleovegetative and climatic background necessary for the simulations, and model parameters for T. oswaldi and T. darti were set a priori on the basis of their fossil records and paleobiologies. The simulations indicate that T. darti could have readily left Africa in the Pliocene, and that it swiftly reaches Asia. A European T. darti colonization was less certain and less rapid. The simulated T. oswaldi dispersal out of Africa was slower, but nonetheless T. oswaldi arrived at Mirzapur within the time period indicated by the fossil record. Using the a priori parameters, T. oswaldi did not arrive at the European sites of Cueva Victoria and Pirro Nord. It cannot be discounted, therefore, that some of the European fossils are a result of an earlier T. darti dispersal. The simulations also showed that in order for Theropithecus to reach Europe, it needed to be tolerant of a relatively wide range of habitats. In addition, our finding that Asian colonization was more rapid and more probable parallels the information from the hominin fossil record, in which the fossils from Asia predate those from Europe by several hundred thousand years.

Learning to nurse: reflections on bathing a patient.

The reflective process allows nurses to view their practice by bringing their theoretical knowledge and nursing practice closer together. In this article, a nursing student describes different methods of reflection and applies them to her experience of bathing a patient. Issues of bathing, preparation and the conflicts with time management are explored, demonstrating the benefits of reflection as a tool for learning.