A Bayesian spatiotemporal model for prevalence estimation of a VRE outbreak in a tertiary care hospital.

BACKGROUND: There was a nosocomial outbreak of vancomycin-resistant enterococci (VRE) at the hospital between 1st January 2018 and 31st July 2020. The goals of this study were to describe weekly prevalence, and to identify possible effects of the introduction of selected infection control measures. METHODS: A room-centric analysis of 12 floors (243 rooms) of the main hospital building was undertaken, including data on 37,558 patients over 22,072 person-weeks for the first 2 years of the outbreak (2018-2019). Poisson Bayesian hierarchical models were fitted to estimate prevalence per room and per week, including both spatial and temporal random effects terms. RESULTS: Exploratory data analysis revealed significant variability in prevalence between departments and floors, along with sporadic spatial and temporal clustering during colonization 'flare-ups'. The oncology department experienced slightly higher prevalence over the 104-week study period [adjusted prevalence ratio (aPR) 4.8, 95% confidence interval (CI) 2.6-8.9; P<0.001; compared with general medicine], as did both the cardiac surgery (aPR 3.8, 95% CI 2.0-7.3; P<0.001) and abdominal surgery (aPR 3.7, 95% CI 1.8-7.6; P<0.001) departments. Estimated peak prevalence was reached in July 2018, at which point a number of new infection control measures (including the daily disinfection of rooms and room cleaning with ultraviolet light upon patient discharge) were introduced that resulted in decreasing prevalence (aPR 0.89 per week, 95% CI 0.87-0.91; P<0.001). CONCLUSION: Relatively straightforward but personnel-intensive cleaning with disinfectants and ultraviolet light provided tangible benefits in getting the outbreak under control. Despite additional complexity, Bayesian hierarchical models provide a more flexible platform to study transmission dynamics.

Effect of Planting into a Green Winter Cereal Rye Cover Crop on Growth and Development, Seedling Disease, and Yield of Corn.

Terminating winter cereal rye (Secale cereale L.) cover crops ≥10 days before planting (DBP) corn is recommended to minimize seedling disease and potential yield loss. In Iowa, cold temperatures and frequent precipitation can prevent farmers from following that recommendation and sometimes force them to plant corn while the rye plants are still green, referred to as "planting green" (PG). A field trial was established to evaluate the effect of rye termination shortly before or after corn planting on growth, seedling root disease, and yield of corn. A rye cover crop was terminated 17 and 3 DBP and 6 and 12 days after planting (DAP) corn; corn planted following no rye was included as a control. Rye biomass, C/N ratio, and N accumulation increased when terminated 6 or 12 DAP corn compared with rye terminated 17 or 3 DBP corn. Corn seedlings were taller from the PG treatments. More radicle root rot was observed when rye was terminated 3 DBP, 6 DAP, and 12 DAP corn than for the 17 DBP treatment and the no-rye control. Generally, greater Pythium clade B populations were detected on radicles and seminal roots of corn from the PG treatments. Corn populations, ears, or barren plants were not affected by the treatments. In both years, the no-rye control had the greatest corn yield and the 12 DAP treatment had the lowest yield. Our results suggest that PG increased corn seedling root disease and contributed to reduced corn yield.

Effect of 6-Methoxy-2-Benzoxazolinone (MBOA) on Pythium Species and Corn Seedling Growth and Disease.

Corn yield reduction following a cereal rye cover crop has been attributed to, among other factors, allelochemicals released from decomposing cereal rye residue. The allelopathic effect of 6-methoxy-2-benzoxazolinone (MBOA) was evaluated on corn seedling growth, mycelial growth of seven pathogenic species of Pythium, and root rot of corn seedlings caused by Pythium spp. at 13, 16, and 22 to 23°C (room temperature) using a plate assay. Mycelial growth of all Pythium spp. tested was slower with MBOA at 0.25 mg/ml compared with MBOA at 0.125 and 0.0625 mg/ml and the check (4% V8 juice medium containing neomycin sulfate and chloramphenicol with 0.5% dimethyl sulfoxide). Therefore, no further tests were done with MBOA at 0.25 mg/ml. In general, MBOA reduced corn radicle length and did not cause root rot across all temperatures. However, greater root rot severity in corn was observed on corn seedlings grown in the presence of Pythium lutarium and P. oopapillum on media amended with MBOA compared with the check at all temperatures. Similarly, more root rot caused by P. torulosum and P. spinosum was observed when MBOA was present at 16°C compared with the check with no MBOA. These data suggest that corn seedling disease caused by Pythium spp. could be more severe when corn is planted following a cover crop of winter cereal rye due to the presence of allelochemicals that are released from the cover crop.

Corn stover harvest N and energy budgets in central Iowa.

Harvesting corn stover removes N from the fields, but its effect on subsurface drainage and other N losses is uncertain. We used the Root Zone Water Quality Model (RZWQM) to examine N losses with 0 (NRR) or 50% (RR) corn residue removal within a corn and soybean rotation over a 10-yr period. In general, all simulations used the same pre-plant or post-emergence N fertilizer rate (200 kg ha-1 yr-1). Simulated annual corn yields averaged 10.7 Mg ha-1 for the post emergence applications (NRRpost and RRpost), and 9.5 and 9.4 Mg ha-1 yr-1 for NRRpre and RRpre. Average total N input during corn years was 19.3 kg N ha-1 greater for NRRpre compared to RRpre due to additional N in surface residues, but drainage N loss was only 1.1 kg N ha-1 yr-1 greater for NRRpre. Post-emergence N application with no residue removal (NRRpost) reduced average drainage N loss by 16.5 kg ha-1 yr-1 compared to pre-plant N fertilization (NRRpre). The farm-gate net energy ratio was greatest for RRpost and lowest for NRRpre (14.1 and 10.4 MJ output per MJ input) while greenhouse gas intensity was lowest for RRpost and highest for NRRpre (11.7 and 17.3 g CO2-eq. MJ-1 output). Similar to published studies, the simulations showed little difference in N2O emissions between scenarios, decreased microbial immobilization for RR compared to NRR, and small soil carbon changes over the 10-yr simulation. In contrast to several previous modeling studies, the crop yield and N lost to drain flow were nearly the same between NRR and RR without supplemental N applied to replace N removed with corn stover. These results are important to optimizing the energy and nitrogen budgets associated with corn stover harvest and for developing a sustainable bioenergy industry.

N loss to drain flow and N2O emissions from a corn-soybean rotation with winter rye.

Anthropogenic perturbation of the global nitrogen cycle and its effects on the environment such as hypoxia in coastal regions and increased N2O emissions is of increasing, multi-disciplinary, worldwide concern, and agricultural production is a major contributor. Only limited studies, however, have simultaneously investigated NO3- losses to subsurface drain flow and N2O emissions under corn-soybean production. We used the Root Zone Water Quality Model (RZWQM) to evaluate NO3- losses to drain flow and N2O emissions in a corn-soybean system with a winter rye cover crop (CC) in central Iowa over a nine year period. The observed and simulated average drain flow N concentration reductions from CC were 60% and 54% compared to the no cover crop system (NCC). Average annual April through October cumulative observed and simulated N2O emissions (2004-2010) were 6.7 and 6.0kgN2O-Nha-1yr-1 for NCC, and 6.2 and 7.2kgNha-1 for CC. In contrast to previous research, monthly N2O emissions were generally greatest when N loss to leaching were greatest, mostly because relatively high rainfall occurred during the months fertilizer was applied. N2O emission factors of 0.032 and 0.041 were estimated for NCC and CC using the tested model, which are similar to field results in the region. A local sensitivity analysis suggests that lower soil field capacity affects RZWQM simulations, which includes increased drain flow nitrate concentrations, increased N mineralization, and reduced soil water content. The results suggest that 1) RZWQM is a promising tool to estimate N2O emissions from subsurface drained corn-soybean rotations and to estimate the relative effects of a winter rye cover crop over a nine year period on nitrate loss to drain flow and 2) soil field capacity is an important parameter to model N mineralization and N loss to drain flow.

Time Interval Between Cover Crop Termination and Planting Influences Corn Seedling Disease, Plant Growth, and Yield.

Experiments were established in a controlled-growth chamber and in the field to evaluate the effect of the length of time intervals between winter rye cover crop termination and corn planting on corn seedling disease, corn growth, and grain yield in 2014 and 2015. Rye termination dates ranged from 25 days before planting (DBP) to 2 days after planting (DAP) corn in the field and from 21 DBP to 1 DAP in controlled studies. Results were similar in both environments. In general, shorter intervals increased seedling disease and reduced corn emergence, shoot growth, and grain yield of corn following winter rye compared with corn planted 10 or more days after rye termination or without rye. Incidence of Pythium spp. increased with shorter intervals (less than 8 DBP); incidence of Fusarium spp. was not consistent between runs and experiments. In 2014, in the 1-DAP treatment, number of ears and grain yield were reduced (P = 0.05 and 0.02, respectively). In 2015, all termination intervals reduced plant population, number of ears, and yield (P = 0.01), with the 2-DBP treatment causing the biggest decrease. A 10- to 14-day interval between rye termination and corn planting should be followed to improve corn yield following a rye cover crop.

Colonization with resistant microorganisms in patients transferred from abroad: who needs to be screened?

BACKGROUND: While multi-drug resistant organisms (MDRO) are a global phenomenon, there are significant regional differences in terms of prevalence. Traveling to countries with a high MDRO prevalence increases the risk of acquiring such an organism. In this study we determined risk factors for MDRO colonization among patients who returned from a healthcare system in a high-prevalence area (so-called transfer patients). Factors predicting colonization could serve as screening criteria to better target those at highest risk. METHODS: This screening study included adult patients who had been exposed to a healthcare system abroad or in a high-prevalence region in Switzerland over the past six months and presented to our 950-bed tertiary care hospital between January 1, 2012 and December 31, 2013, a 24-month period. Laboratory screening tests focused on Gram-negative MDROs and methicillin-resistant Staphylococcus aureus (MRSA). RESULTS: A total of 235 transfer patients were screened and analyzed, of which 43 (18 %) were positive for an MDRO. Most of them yielded Gram-negative bacteria (42; 98 %), with only a single screening revealing MRSA (2 %); three screenings showed a combination of Gram-negative bacteria and MRSA. For the risk factor analysis we focused on the 42 Gram-negative MDROs. Most of them were ESBL-producing Escherichia coli and Klebsiella pneumoniae while only two were carbapenemase producers. In univariate analysis, factors associated with screening positivity were hospitalization outside of Europe (p < 0.001), surgical procedure in a hospital abroad (p = 0.007), and - on admission to our hospital - active infection (p = 0.002), antibiotic treatment (p = 0.014) and presence of skin lesions (p = 0.001). Only hospitalization outside of Europe (Odds Ratio, OR 3.2 (95 % CI 1.5- 6.8)) and active infection on admission (OR 2.7 (95 % CI 1.07- 6.6)) remained as independent predictors of Gram-negative MDRO colonization. CONCLUSION: Our data suggest that a large proportion of patients (i.e., 82 %) transferred to Switzerland from hospitals in high MDRO prevalence areas are unnecessarily screened for MDRO colonization. Basing our screening strategy on certain criteria (such as presence of skin lesions, active infection, antibiotic treatment, history of a surgical procedure abroad and hospitalization outside of Europe) promises to be a better targeted and more cost-effective strategy.

Low Yield of Methicillin-Resistant Staphylococcus aureus Screening in Hemodialysis Patients: 10 Years' Experience.

OBJECTIVE: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in hemodialysis patients and to analyze the cost-effectiveness of our screening approach compared with an alternative strategy. DESIGN Screening study and cost-effectiveness analysis. METHODS: Analysis of twice-yearly MRSA prevalence studies conducted in the hemodialysis unit of a 950-bed tertiary care hospital from January 1, 2004, through December 31, 2013. For this purpose, nasal swab samples were cultured on MRSA screening agar (mannitol-oxacillin biplate). RESULTS: There were 20 mass screenings during the 10-year study period. We identified 415 patients participating in at least 1 screening, with an average of 4.5 screenings per patient. Of 415 screened patients, 15 (3.6%) were found to be MRSA carriers. The first mass screening in 2004 yielded the highest percentage of MRSA (6/101 [6%]). Only 7 subsequent screenings revealed new MRSA carriers, whereas 4 screenings confirmed previously known carriers, and 8 remained negative. None of the carriers developed MRSA bacteremia during the study period. The total cost of our screening approach, that is, screening and isolation costs, was US $93,930. The total cost of an alternative strategy (ie, no mass screening administered) would be equivalent to costs of isolation of index cases and contact tracing was estimated to be US $5,382 (difference, US $88,548). CONCLUSIONS: In an area of low MRSA endemicity (<5%), regular nasal screenings of a high-risk population yielded a low rate of MRSA carriers. Twice-yearly MRSA screening of dialysis patients is unlikely to be cost-effective if MRSA prevalence is low.

Impact of lattice mismatch and stoichiometry on the structure and bandgap of (Fe,Cr)2O3 epitaxial thin films.

The structural properties of phase-pure epitaxial (Fe1-xCrx)2O3 thin films deposited on α-Al2O3(0 0 0 1) substrates by oxygen-plasma-assisted molecular beam epitaxy are investigated across the composition range using x-ray photoelectron spectroscopy, high-resolution x-ray diffraction, scanning transmission electron microscopy and electron energy loss spectroscopy, and non-Rutherford resonant elastic scattering measurements. The films possess a columnar grain structure with uniform mixing of cations on the nanometer scale. Fe-rich films are relaxed and appear to be slightly oxygen-rich, while Cr-rich films remain partially strained to the Al2O3 substrate and are found to be oxygen deficient. A model is proposed to explain the oxygen stoichiometry results based on the energetics of oxygen defect formation and rate of oxygen diffusion in the corundum lattice, and the dependence on the cation composition. Deliberately introducing residual compressive biaxial strain into (Fe1-xCrx)2O3 thin films (x = 0, 0.41, 0.52) by employing a Cr2O3 buffer layer is shown to narrow the optical bandgap, from 1.80(1) eV for relaxed (Fe0.47Cr0.53)2O3 to 1.77(1) eV for partially strained (Fe0.48Cr0.52)2O3. The relationships which are elucidated between epitaxial film structure and optical properties can be applied to bandgap optimization in the (Fe,Cr)2O3 system.

Structural characterization of epitaxial Cr(x)Mo(1-x) alloy thin films.

To develop a model system containing regularly spaced misfit dislocations for studies of the radiation resistance of nanoscale defects, epitaxial thin films of Cr, Mo, and Cr(x)Mo(1-x) alloys were deposited on MgO(001) by molecular beam epitaxy. Film compositions were chosen to vary the lattice mismatch with MgO. The film structure was investigated by x-ray diffraction (XRD), Rutherford backscattering spectrometry (RBS) and scanning transmission electron microscopy (STEM). Epitaxial films with reasonably high crystalline quality and abrupt interfaces were achieved at a relatively low deposition temperature, as confirmed by STEM. However, it was found by XRD and RBS in the channeling geometry that increasing the Mo content of the CrMo alloy films degraded the crystalline quality, despite the improved lattice match with MgO. XRD rocking curve data indicated that regions of different crystalline order may be present within the films with higher Mo content. This is tentatively ascribed to spinodal decomposition into Cr-rich and Mo-rich regions, as predicted by the Cr(x)Mo(1-x) phase diagram.

Band alignment, built-in potential, and the absence of conductivity at the LaCrO3/SrTiO3(001) heterojunction.

Core-level and valence-band x-ray photoemission spectra measured for molecular-beam-epitaxy-grown LaCrO(3)/SrTiO(3)(001) yield band offsets and potential gradients within the LaCrO(3) sufficient to trigger an electronic reconstruction to alleviate the polarity mismatch. Yet, the interface is insulating. Based on first principles calculations, we attribute this unexpected result to interfacial cation mixing combined with charge redistribution within CrO(2) layers, enabled by low-lying d states within LaCrO(3), which suppresses an electronic reconstruction.

Absence of intrinsic ferromagnetic interactions of isolated and paired Co dopant atoms in Zn1-xCoxO with high structural perfection.

We report element specific structural and magnetic investigations on Zn(1-x)Co(x)O epitaxial films using synchrotron radiation. Co dopants exclusively occupy Zn sites as revealed by x-ray linear dichroism having an unprecedented degree of structural perfection. Comparative magnetic field dependent measurements by x-ray magnetic circular dichroism and conventional magnetometry consistently show purely paramagnetic behavior for isolated Co dopant atoms with a magnetic moment of 4.8 (mu B). However, the total magnetization is reduced by approximately 30%, demonstrating that Co-O-Co pairs are antiferromagnetically coupled. We find no sign of intrinsic ferromagnetic interactions for isolated or paired Co dopant atoms in Co:ZnO films.

Rye cover crop and gamagrass strip effects on NO3 concentration and load in tile drainage.

A significant portion of the NO3 from agricultural fields that contaminates surface waters in the Midwest Corn Belt is transported to streams or rivers by subsurface drainage systems or "tiles." Previous research has shown that N fertilizer management alone is not sufficient for reducing NO3 concentrations in subsurface drainage to acceptable levels; therefore, additional approaches need to be devised. We compared two cropping system modifications for NO3 concentration and load in subsurface drainage water for a no-till corn (Zea mays L.)-soybean (Glycine max [L.] Merr.) management system. In one treatment, eastern gamagrass (Tripsacum dactyloides L.) was grown in permanent 3.05-m-wide strips above the tiles. For the second treatment, a rye (Secale cereale L.) winter cover crop was seeded over the entire plot area each year near harvest and chemically killed before planting the following spring. Twelve 30.5x42.7-m subsurface-drained field plots were established in 1999 with an automated system for measuring tile flow and collecting flow-weighted samples. Both treatments and a control were initiated in 2000 and replicated four times. Full establishment of both treatments did not occur until fall 2001 because of dry conditions. Treatment comparisons were conducted from 2002 through 2005. The rye cover crop treatment significantly reduced subsurface drainage water flow-weighted NO3 concentrations and NO3 loads in all 4 yr. The rye cover crop treatment did not significantly reduce cumulative annual drainage. Averaged over 4 yr, the rye cover crop reduced flow-weighted NO3 concentrations by 59% and loads by 61%. The gamagrass strips did not significantly reduce cumulative drainage, the average annual flow-weighted NO3 concentrations, or cumulative NO3 loads averaged over the 4 yr. Rye winter cover crops grown after corn and soybean have the potential to reduce the NO3 concentrations and loads delivered to surface waters by subsurface drainage systems.

Motor abilities and aerobic fitness of obese children.

Obesity is considered to be epidemic worldwide. Stopping further progression interdisciplinary, outpatient intervention therapy programs for obese children have become increasingly important. FITOC (Freiburg Intervention Trial for Obese Children) consists of a combination of organized sports, behavioral therapy and nutritional advice. The effectiveness of the therapy is determined on the basis of anthropometrical and physical performance data. The purpose of this report is to give a differentiated view of the motor abilities of obese children and to describe changes in the course of the therapy program FITOC. Data were collected on n = 49 obese children (BMI > 97th percentile) aged 8 - 12 in a pretest at the beginning and posttest at the end of the intensive phase of the therapy. These data were compared with an age-matched German reference group. Besides the General Sports-Motor Test (Allgemeiner Sportmotorischer Test [AST]), the BMI-SDS values, the body fat mass (FM %) and the aerobic capacity (Watt/kg body weight) were recorded. In the pretest, the running exercise results and the aerobic capacity checked ranged significantly below the values of the reference group. The performance in the coordinative tests of the AST was differentiated. The medicine-ball toss was significantly above average of the reference group. In the posttest, the BMI-SDS values and the body fat mass (% FM) decreased (p < 0.001) and the aerobic capacity improved (p < 0.001). Performance in all motor abilities tests improved and the difference between the strength of the obese children and the strength of the reference group decreased. This study demonstrates that in obese children weight-bearing activities are below average but not all motor abilities.

Negligible magnetism in excellent structural quality Cr(x)Ti(1-x)O(2) anatase: contrast with high-T(C) ferromagnetism in structurally defective Cr(x)Ti(1-x)O(2).

We reexamine the mechanism of ferromagnetism in doped TiO(2) anatase, using epitaxial Cr:TiO(2) with excellent structural quality as a model system. In contrast to highly oriented but defective Cr:TiO(2) (approximately 0.5 micro(b)/Cr), these structurally superior single crystal films exhibit negligible ferromagnetism. Similar results were obtained for Co:TiO(2). We show for the first time that charge-compensating oxygen vacancies alone, as predicted by F-center mediated exchange, are not sufficient to activate ferromagnetism. Instead, the onset of ferromagnetism correlates with the presence of structural defects.

Expression of the fixR-nifA operon in Bradyrhizobium japonicum depends on a new response regulator, RegR.

Many nitrogen fixation-associated genes in the soybean symbiont Bradyrhizobium japonicum are regulated by the transcriptional activator NifA, whose activity is inhibited by aerobiosis. NifA is encoded in the fixR-nifA operon, which is expressed at a low level under aerobic conditions and induced approximately fivefold under low-oxygen tension. This induction depends on a -24/-12-type promoter (fixRp1) that is recognized by the sigma54 RNA polymerase and activated by NifA. Low-level aerobic expression and part of the anaerobic expression originates from a second promoter (fixRp2) that overlaps with fixRp1 and depends on an upstream DNA region (UAS) located around position -68 (H. Barrios, H. M. Fischer, H. Hennecke, and E. Morett, J. Bacteriol. 177:1760-1765, 1995). A protein binding to the UAS was previously postulated to act as an activator. This protein has now been purified, and the corresponding gene (regR) has been cloned. On the basis of the predicted amino acid sequence, RegR belongs to the family of response regulators of two-component regulatory systems. We identified upstream of the regR gene an additional gene (regS) encoding a putative sensor kinase. A regR mutant was constructed in which neither a specific UAS-binding activity nor fixRp2-dependent transcript formation and fixR'-'lacZ expression was detected in aerobically grown cells. Anaerobic fixR'-'lacZ expression was also decreased in regR mutants to about 10% of the level observed in the wild type. Similarly, regR mutants showed only about 2% residual nitrogen fixation activity, but unlike nodules induced by nifA mutants, the morphology of those nodules was normal, displaying no signs of necrosis. While regR mutants grew only slightly slower in free-living, aerobic conditions, they displayed a strong growth defect under anaerobic conditions. The phenotypic properties of regS mutants differed only marginally, if at all, from those of the wild type, suggesting the existence of a compensating sensor activity in these strains. The newly identified RegR protein may be regarded as a master regulator in the NifA-dependent network controlling nif and fix gene expression in B. japonicum.

Activated CD4+ and CD8+ T-cell subsets in Wegener's granulomatosis.

Several lines of evidence argue in favour of an involvement of T cells in the pathogenesis of Wegener's granulomatosis (WG). These include the presence of highly specific IgG autoantibodies to proteinase 3, perivascular T-cell infiltrates and elevated amounts of soluble interleukin-2 (IL-2) receptors in patient's serum. In order to further address this question we evaluated by double immunofluorescence and flow cytometry the expression of several cell surface molecules associated with T-cell activation. As compared to healthy controls (n = 15), the CD4+ subset was significantly diminished, while the percentage of CD8+ T cells was elevated in WG patients (n = 24). Within the CD4+ T-cell subset we found a highly significant increase in activation/memory markers (CD25, CD29, HLA-DR). Within the CD8+ T-cell subset the expression of CD11b, CD29 and CD57 was significantly elevated, while the expression of VD28 was reduced. The use of 10 V beta-, 1 V alpha- and 1 V gamma-specific monoclonal reagents failed to reveal any significant bias in the peripheral T-cell receptor V-gene repertoire of WG patients. There was also no correlation between T-cell activation markers and laboratory parameters [C-reactive protein (CRP), ESR], disease duration or therapy. A significant correlation was found only for the degree of organ involvement and the increase in CD4+ T cells coexpressing HLA-DR, as well as the increase in CD57 expression on CD8+ T cells. In conclusion, both CD4+ and CD8+ T-cell subsets were activated in WG. Cytotoxic CD8+CD57+CD11b+CD28- T cells may directly contribute to damage of vascular endothelium.

One member of a gro-ESL-like chaperonin multigene family in Bradyrhizobium japonicum is co-regulated with symbiotic nitrogen fixation genes.

This report is concerned with the structural characterization and genetic regulation of new bacterial groES and groEL chaperonin genes, and presents two novelties. The first is the discovery that the nitrogen fixing soybean root nodule bacterium, Bradyrhizobium japonicum, unlike all other prokaryotes investigated so far, possesses a multigene family consisting of five very similar, though not identical, groESL-like genes. The second novelty relates to the finding that these five homologues are expressed to different degrees and, in particular, that one family member (namely groESL3) is induced by a mechanism that does not involve the well-known heat shock response. By contrast, the groESL3 genes are co-regulated together with symbiotic nitrogen fixation genes, in that they are activated by the nitrogen fixation regulatory protein NifA at low oxygen conditions and transcribed from a -24/-12 promoter by the sigma 54 RNA polymerase. Two other members of the groESL gene family are apparently expressed constitutively at different levels, and yet another one is strongly induced by high temperature. As an attractive hypothesis it follows that B. japonicum may modulate its cellular contents of GroES- and GroEL-like chaperonins in response to specific environmental conditions and physiological needs.

Mohs micrographic surgery for thin stage I malignant melanoma: rationale for a modern management strategy.

Mohs micrographic surgery is presented as a rational surgical management approach for thin malignant melanoma. Advantages of the Mohs micrographic surgery fresh-tissue technique include tissue conservation, low local recurrence rates, and outpatient reconstruction. It is likely that in the future many physicians and patients will choose Mohs micrographic surgery for the surgical treatment of thin malignant melanoma.

Percutaneous injury during dermatologic surgery.

An anonymous survey was conducted among 100 randomly selected fellows of the American Society for Dermatologic Surgery. Forty-one respondents provided information about their experience with percutaneous injury. Causes of injury during 6278 invasive procedures performed during a 1-month period included suture needlesticks (two injuries), injection needlestick (one), needle recapping (one), scalpel blade (one), skin hook (one), and an injury during the transport of an instrument (one). Dermatologic surgeons were more likely to injure their dominant fingers. Attitudes of dermatologic surgeons were surveyed regarding operating on patients while the physician or assistant was actively infected with human immunodeficiency virus, hepatitis B virus, herpetic whitlow, or paronychia caused by Staphylococcus aureus. Dermatologic surgeons believed that they should be allowed to operate while infected with human immunodeficiency virus (41.5%), hepatitis B virus (40%), herpetic whitlow (25%), and paronychia caused by S. aureus (20%). Few dermatologic surgeons would disclose preoperatively to patients infections present in themselves or in operating team members that were due to human immunodeficiency virus (29.4%), hepatitis B virus (27.8%), herpetic whitlow (28.6%), or paronychia caused by S. aureus (33.3%).