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We describe here a method for determining confidence intervals for a commonly used index of diversity. This approach facilitates the comparison of the genetic population structure of microorganisms isolated from different environments and improves the objective assessment of the discriminatory power of typing techniques.The discrimination of organisms on the basis of variable phenotypic or genetic markers is still the mainstay of quantitative microbial ecology and descriptive epidemiology. To determine the diversity of microorganisms in defined environments (ecosystems) or to identify the reproductive success of disease causing organisms, i.e., the spread of particular strains between hosts, genetic typing techniques are deployed which have the ability to distinguish diverse organisms of the same species. Importantly, when one is comparing the diversity of a single species between different ecosystems or comparing the various typing methods used to resolve such differences, a robust statistical approach is required that allows an objective assessment. To this end, indices of diversity have been defined mathematically that are based on the frequency with which organisms of a particular type occur in a population or can be discriminated by a given typing tool (3, 4, 5). Individuals of a population will belong to one of Z types and will occur with frequencies of 1 . . . Z such that ⌺ ϭ 1. For microorganisms that usually have a very large population size, the genetic diversity () can be described as ϭ 1 -⌺ 2 , which will be the probability that two individuals chosen at random will be of a different type.Inferences on the diversity of the population involve a sampling process. The index of diversity D, as defined by Simpson (5) and lately utilized for the assessment of the discriminatory power of typing techniques (2, 6), is an unbiased estimate of the true diversity of a population based on a sample of n individuals. Simply by chance, different samples will give different results, the difference being due to sample variation and by drawing repeated samples, the precision of the mean estimate for D will improve. If repeated samples of a fixed size n are drawn from the sample population, the values of D will be distributed about with the variance 2 (5): 2 ϭ 4 nwhere j is the frequency n j /n, n j is the number of strains belonging to the jth type, and n is the total number of strains in the sample population. An estimate of the standard deviation of is given by the square root of 2 , and we propose the following as approximate 95% confidence interval (CI):We have applied these equations to determine confidence intervals (i) when assessing the genetic diversity of Staphylococcus aureus isolated from healthy carriers in the community as opposed to hospitalised patients and (ii) when comparing the discriminatory power of macrorestriction analysis by using SmaI restriction patterns with that of RAPD [random(ly) amplified polymorphic DNA] typing.By using the same sampling frame, healthy individuals in the community and in...

Little is known about the amount of cross-transmission, the risk factors for infection, and the relative effectiveness of infection control procedures when methicillin-resistant Staphylococcus aureus (MRSA) infection occurs at highly endemic levels in intensive care units. A cohort study was done to identify exposures associated with cases that likely were the result of cross-transmission (i.e., occurring in clusters and with indistinguishable MRSA macrorestriction profiles). Fitting a simple stochastic model to the ascertained data allowed prediction of the effectiveness of infection control measures. Exposure to relative staff deficit (adjusted rate ratio, 1.05 independent; 95% confidence interval, 1.02-1.09) was the only factor significantly associated with potential transmission (P =.001). It was predicted that a 12% improvement in adherence to hand-hygiene policies might have compensated for staff shortage and prevented transmission during periods of overcrowding, shared care, and high workload but that this would be hard to achieve.

Both the DNA damage response (DDR) and epigenetic mechanisms play key roles in the implementation of senescent phenotypes, but very little is known about how these two mechanisms are integrated to establish senescence-associated gene expression. Here we show that, in senescent cells, the DDR induces proteasomal degradation of G9a and GLP, major histone H3K9 mono- and dimethyltransferases, through Cdc14B- and p21(Waf1/Cip1)-dependent activation of APC/C(Cdh1) ubiquitin ligase, thereby causing a global decrease in H3K9 dimethylation, an epigenetic mark for euchromatic gene silencing. Interestingly, induction of IL-6 and IL-8, major players of the senescence-associated secretory phenotype (SASP), correlated with a decline of H3K9 dimethylation around the respective gene promoters and knockdown of Cdh1 abolished IL-6/IL-8 expression in senescent cells, suggesting that the APC/C(Cdh1)-G9a/GLP axis plays crucial roles in aspects of senescent phenotype. These findings establish a role for APC/C(Cdh1) and reveal how the DDR integrates with epigenetic processes to induce senescence-associated gene expression.

Meticillin was introduced in 1959 to treat infections caused by penicillin-resistant Staphylococcus aureus. In 1961 there were reports from the UK of S aureus isolates that had acquired resistance to meticillin (meticillin-resistant S aureus, MRSA). Similar MRSA isolates were soon found in other European countries, and later from Japan, Australia, and the USA. Today MRSA is a major cause of hospital-acquired infections, and a serious public-health concern. In this forum, we present different perspectives from across the globe to better understand the complexity of the problem, and examine the challenges that individual countries face in trying to control the spread of MRSA.

BackgroundThe use of complementary and alternative medicine (CAM) has been increasing rapidly throughout the world during the past decade. The use of CAM in the general Japanese population has been previously reported to be as high as 76%. This study aims to investigate the patterns of CAM use, perceived effectiveness and disclosure of CAM use to orthodox medical practitioners amongst patients attending typical primary and secondary care clinics in a busy district general hospital in Tokyo, Japan.MethodsThe authors analysed data collected during March 2002 on patients attending general outpatient clinics held at Shiseikai Daini Hospital in Tokyo, Japan. Data was collected by use of self-completed questionnaires distributed to patients in the outpatient clinics waiting area. Statistical analysis was performed using chi-square tests of independence.Results515 adults were approached to participate in this study and the overall response rate was 96% (n = 496). 50% of the patients were using or have used at least 1 CAM therapy within the last 12 months. The 5 most commonly used therapies were massage (n = 106, 43%), vitamins (n = 85, 35%), health foods including dietary supplements (n = 56, 23%), acupressure (n = 51, 21%) and kampo (n = 46, 19%). The majority of CAM users (75%, n = 145) found their CAM treatment to be effective (95% CI = 68–81%). Patients who were more likely to use CAM were females (p = 0.003) and those with a high number of medical conditions (p = < 0.0001). Only a small proportion of patients reported their CAM use to their physician (42%, n = 74). There was no significant difference in CAM use for the different age groups (p = 0.85), education level (p = 0.30) and financial status (p = 0.82).ConclusionPatterns of CAM usage in the sample surveyed was high (50%). Despite this high prevalence rate and presumed acceptance of CAM in Japan, the reporting of CAM use by patients to their physicians was low (42%). It is therefore important that physicians are aware of the possibility that their patients may be using CAM and also increase their knowledge and understanding of these treatments.

The incidence of dry eye disease has increased; the potential for crowdsource data to help identify undiagnosed dry eye in symptomatic individuals remains unknown.OBJECTIVE To assess the characteristics and risk factors associated with diagnosed and undiagnosed symptomatic dry eye using the smartphone app DryEyeRhythm. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study using crowdsourced data was conducted including individuals in Japan who downloaded DryEyeRhythm and completed the entire questionnaire; duplicate users were excluded. DryEyeRhythm was released on November 2, 2016; the study was conducted from November 2, 2016, to January 12, 2018.EXPOSURES DryEyeRhythm data were collected on demographics, medical history, lifestyle, subjective symptoms, and disease-specific symptoms, using the Ocular Surface Disease Index (100-point scale; scores 0-12 indicate normal, healthy eyes; 13-22, mild dry eye; 23-32, moderate dry eye; 33-100, severe dry eye symptoms), and the Zung Self-Rating Depression Scale (total of 20 items, total score ranging from 20-80, with Ն40 highly suggestive of depression). MAIN OUTCOMES AND MEASURESMultivariate-adjusted logistic regression analysis was used to identify risk factors for symptomatic dry eye and to identify risk factors for undiagnosed symptomatic dry eye.RESULTS A total of 21 394 records were identified in our database; 4454 users, included 899 participants (27.3%) with diagnosed and 2395 participants (72.7%) with undiagnosed symptomatic dry eye, completed all questionnaires and their data were analyzed. A total of 2972 participants (66.7%) were women; mean (SD) age was 27.9 (12.6) years. The identified risk factors for symptomatic vs no symptomatic dry eye included younger age (odds ratio [OR], 0.99; 95% CI, 0.987-0.999, P = .02), female sex (OR, 1.99; 95% CI, 1.61-2.46; P < .001), pollinosis (termed hay fever on the questionnaire) (

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