We evaluated the Prodesse ProFlu-1 real-time reverse transcription-PCR multiplex assay with the SmartCycler instrument for the detection of human respiratory syncytial virus (RSV) and influenza A and B viruses in comparison to conventional cell culture and antigen immunoassays with the BD Directigen A؉B and Binax NOW RSV assays over two successive respiratory virus seasons. Ninety-two percent of the 361 specimens tested were nasopharyngeal aspirates obtained from individual patients, of which 119 were positive for RSV and 59 were positive for influenza virus. The median age of the patients whose specimens were positive for RSV and influenza virus were 6.3 months and 42.4 years, respectively. The specificity of all of the methods tested was >99%, and the individual sensitivities of NOW RSV, RSV culture, Directigen A؉B, influenza virus culture, and the Proflu-1 PCR for influenza/RSV were 82% (95% confidence interval [CI], 73 to 88), 57% (95% CI, 44 to 69), 59% (95% CI, 44 to 72), 54% (95% CI, 38 to 69), and 98% (95% CI, 93 to 100)/95% (95% CI, 85 to 99), respectively. In a clinical setting where viral isolation is performed to confirm rapid antigen immunoassay results for these common respiratory viruses, one-step real-time reverse transcriptase PCR testing can be a more sensitive and timely confirmatory method.Human respiratory syncytial virus (RSV) and influenza A and B viruses are respiratory pathogens associated with substantial morbidity and mortality annually (43). Virtually all children become infected with RSV within 2 years after birth, and 1% require hospitalization (15). Although the importance of RSV as a cause of pneumonia and brochiolitis in young children is well recognized (21), the most serious morbidity and highest mortality associated with both RSV and influenza virus circulation occurs disproportionately among elderly persons (43). The first-line tests used to detect these virus infections in many hospitals are antigen-based immunoassays. It has been demonstrated that antigen immunoassays have exceedingly poor sensitivity in detecting RSV and influenza virus infections in the elderly, seriously limiting their utility for detecting and confirming institutional or community outbreaks (7,13,38). This study was intended to evaluate the performance of viral isolation in cell culture, one-step real-time multiplex reverse transcription-PCR (RT-PCR), and antigen immunoassays for the detection of influenza virus and RSV in respiratory specimens from adults and children during two respiratory virus seasons. MATERIALS AND METHODS Specimens.Upper respiratory tract specimens were collected from 353 individual symptomatic patients during two successive winter respiratory virus seasons encompassing

A more complete understanding of meningococcal disease has been hampered by lack of an appropriate animal model. We subjected 5-day-old guinea pigs, rats, and mice to intranasal challenge with meningococci and we measured rates of bacteremia as a marker of mucosal invasion. After a single intranasal instillation of 10(7) serotype 2 meningococci, positive blood cultures were found in 0% of guinea pigs, 16% of rats, and 39% of mice, and so mice were used for further studies. Death occurred in 4% of mice and was associated with a purulent leptomeningitis and ventriculitis. Forty percent of mice had nasopharyngeal colonization which increased to 65% with repeated injections. Carrier strains were avirulent, a nonserotype 2 disease strain had low invasiveness, and serotype 2 strains were most virulent. Iron dextran increased rates of bacteremia after challenge with serotype 2 strains. Adult animals were not susceptible to bacteremia after intranasal challenge. The neonatal mouse model fulfills most of the criteria for an appropriate experimental model of meningococcal disease.

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For collaborative patient-centered practice models to develop, improved collaboration in the workplace is needed. In this project we aimed to create a model of continuing professional development (CPD) using a case based approach that would allow the exchange of information between primary health care providers in the community. Over 60 participants from community care sectors including physicians, nurses and administrators participated in a planning group and two consultation workshops. Using participatory action research methods, themes contributing to and inhibiting communication, collaboration and coordination of care in the community were identified. Recommendations for solutions were prioritized and implemented. Evaluations suggest that the case scenario and consultation approach successfully focused participants to address relevant local issues to improve collaboration among community providers.

The lack of availability of a suitable animal model has limited understanding of the pathophysiology of meningococcal disease. We have utilized a neonatal mouse model in which atraumatic intranasal inoculation of meningococci results in nasopharyngeal colonization and ultimately bacteremia. Using this model, we compared the virulence of seven encapsulated meningococcal carrier strains with eight meningococcal strains which were isolated from cerebrospinal fluid or blood of patients (disease strains). Intraperitoneal (IP) iron dextran was given to some animals to enhance meningococcal virulence. After IP iron, carrier strains were still poorly invasive with rates of bacteremia ranging from 0 to 15% (mean = 3%), whereas disease-associated strains were significantly more invasive and caused bacteremia in 31-64% of animals (mean = 39%). Without iron injections, nasopharyngeal colonization rates were similar (36 versus 30%, P greater than 0.1) for case and carrier strains. IP iron dextran significantly enhanced rates of colonization and bacteremia caused by the disease strains only. We have, therefore, shown that the relative virulence of meningococcal strains for humans is maintained in this experimental model.

A nmore complete understanding of meningococcal disease has been hampered by the lack of an appropriate animal model. Previous models have utilized injections of meningococci, which precludes the study of nasopharyngeal colonization and invasion. We have developed a model for meningococcal disease in which litters of 5-day-old mice are challenged intranasally with 107 viable meningococci. Bacteremia is monitored by jugular venous blood cultures, and cerebrospinal fluid is sanlpled by cisternal punctures. Human diseaseassociated and carrier strains were compared; nasopharyngeal colonization was similar for these bacteria, but the case-associated strains were much more frequently invasive and caused bacteremia. Twenty-one percent of bacteremic animals had meningitis. There was an age-related susceptibility to infection which correlated inversely with the levels of serum complement. Prein'ection of iron dextran increased the number of animals which were bacteremic, the concentration of bacteria in blood, and nasopharyngeal colonization. Noncapsular variants of virulent meningococci did not colonize nasopharyngeal tissue in vivo, and they were not invasive. This neonatal mouse model mimics meningococcal disease as seen in humans and may be useful in studying the initial events in the pathogenesis of meningococcal disease.

The literature shows that students typically use either a surface approach to learning, in which the emphasis is on memorization of facts, or a deep approach to learning, in which learning for understanding is the primary focus. This paper describes how computer technology, specifically the use of a multimedia CD-ROM, was integrated into a microbiology curriculum as part of the transition from focusing on facts to fostering learning for understanding. Evaluation of the changes in approaches to learning over the course of the term showed a statistically significant shift in a deep approach to learning, as measured by the Study Process Questionnaire. Additional data collected showed that the use of computer technology supported this shift by providing students with the opportunity to apply what they had learned in class to order tests and interpret the test results in relation to specific patient-focused case studies. The extent of the impact, however, varied among different groups of students in the class. For example, students who were recent high school graduates did not show a statistically significant increase in deep learning scores over the course of the term and did not perform as well in the course. The results also showed that a surface approach to learning was an important aspect of learning for understanding, although only those students who were able to combine a surface with a deep approach to learning were successfully able to learn for understanding. Implications of this finding for the future use of computer technology and learning for understanding are considered.

The literature shows that students typically use either a surface approach to learning, in which the emphasis is on memorization of facts, or a deep approach to learning, in which learning for understanding is the primary focus. This paper describes how computer technology, specifically the use of a multimedia CD-ROM, was integrated into a microbiology curriculum as part of the transition from focusing on facts to fostering learning for understanding. Evaluation of the changes in approaches to learning over the course of the term showed a statistically significant shift in a deep approach to learning, as measured by the Study Process Questionnaire. Additional data collected showed that the use of computer technology supported this shift by providing students with the opportunity to apply what they had learned in class to order tests and interpret the test results in relation to specific patient-focused case studies. The extent of the impact, however, varied among different groups of students in the class. For example, students who were recent high school graduates did not show a statistically significant increase in deep learning scores over the course of the term and did not perform as well in the course. The results also showed that a surface approach to learning was an important aspect of learning for understanding, although only those students who were able to combine a surface with a deep approach to learning were successfully able to learn for understanding. Implications of this finding for the future use of computer technology and learning for understanding are considered.