Intensive ¢sh production worldwide has increased the risk of infectious diseases. However, before any infection can be established, pathogens must penetrate the primary barrier. In ¢sh, the three major routes of infection are the skin, gills and gastrointestinal (GI) tract. The GI tract is essentially a muscular tube lined by a mucous membrane of columnar epithelial cells that exhibit a regional variation in structure and function. In the last two decades, our understanding of the endocytosis and translocation of bacteria across this mucosa, and the sorts of cell damage caused by pathogenic bacteria, has increased. Electron microscopy has made a valuable contribution to this knowledge. In the ¢sh-farming industry, severe economic losses are caused by furunculosis (agent, Aeromonas salmonicida spp. salmonicida) and vibriosis [agent, Vibrio (Listonella) anguillarum]. This article provides an overview of the GI tract of ¢sh from an electron microscopical perspective focusing on cellular damage (speci¢c attack on tight junctions and desmosomes) caused by pathogenic bacteria, and interactions between the 'good' intestinal bacteria [e.g. lactic acid bacteria (LAB)] and pathogens. Using di¡erent in vitro methods, several studies have demonstrated that co-incubation of Atlantic salmon (Salmo salar L.) foregut (proximal intestine) with LAB and pathogens can have bene¢cial e¡ects, the cell damage caused by the pathogens being prevented, to some extent, by the LAB. However, there is uncertainty over whether or not similar e¡ects are observed in other species such as Atlantic cod (Gadus morhua L.). When discussing cellular damage in the GI tract of ¢sh caused by pathogenic bacteria, several important questions arise including: (1) Do di¡erent pathogenic bacteria use di¡erent mechanisms to infect the gut? (2) Does the gradual development of the GI tract from larva to adult a¡ect infection? (3) Are there di¡erent infection patterns between di¡erent ¢sh species? The present article addresses these and other questions. Ã Intestinal sac.wAs only 13 autochthonous bacterial strains were isolated one can not draw a general conclusion.zUssing chamber.PC, pyloric cacea; FG, foregut; MG, midgut; HG, hindgut; HGC, hindgut chamber; NI, not investigated.Lactic acid bacteria vs. pathogens in the gastrointestinal tract of ¢sh E RingÖ et al.

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Based on a study of changes of the Danish budget institutions, the paper explores how a centralization cascade may look like, and discusses the consequences thereof. The paper identifies a centralization cascade, as the Ministry of Finance acquires increased power and greater control over the line ministries. Consequently, line ministries enhance their control over their agencies, which is followed by enhanced internal management and control within agencies. The changes imply both functional and dysfunctional consequences as well as the appearance of a range of trade-offs between the different functions of a budget.Mads Bøge Kristiansen, PhD, is an Associate Professor

ObjectivesTo assess the feasibility of using video recordings of neonatal resuscitation (NR) to evaluate the quality of care in a low-resource district hospital.DesignProspective observational feasibility study.SettingChake-Chake Hospital, a district hospital in Pemba, Tanzania, in April and May 2019.ParticipantsAll delivering women and their newborns were eligible for participation.Main outcome measuresMotion-triggered cameras were mounted on resuscitation tables and provided recordings that were analysed for quality of care indicators based on the national NR algorithm. Assessment of feasibility was conducted using Bowen’s 8-point framework for feasibility studies.Results91% (126 of 139) of women and 96% (24 of 26) of health workers were comfortable or very comfortable with the video recordings. Of 139 newborns, 8 underwent resuscitation with bag and mask ventilation. In resuscitations, heat loss prevention measures were not performed in half of the cases (four of eight), clearing the airway was not performed correctly in five of eight cases, and all newborns were suctioned vigorously and repeatedly, even when not indicated. In a quarter (two of eight) of cases, the newborn’s head was not positioned correctly. Additionally, two of the eight newborns needing ventilation were not ventilated within the first minute of life. In none of the eight cases did ventilation appear to be performed effectively.ConclusionsIt proved feasible to use video recordings to assess quality of care during NR in a low-resource setting, and the method was considered acceptable for the delivering women and health workers. Recordings of eight resuscitations all demonstrated deviations from NR guidelines.