Despite its inclusion in pneumococcal conjugate vaccine 13 (PCV13), Streptococcus pneumoniae serotype 3 remains a major cause of invasive pneumococcal disease in England and Wales. Previous studies have indicated that there are distinct lineages within serotype 3 clonal complex 180 and the clade distributions have shifted in recent years with the emergence of clade II. We undertook whole genome sequencing and genomic analysis of 616 serotype 3 isolates from England and Wales between 2003 and 2018, including invasive and carriage isolates. Our investigations showed that clade II has expanded since 2014 and now represents 50% of serotype 3 invasive pneumococcal disease (IPD) isolates in England and Wales. Genomic analysis of antibiotic resistance and protein antigen genes showed that distinct profiles are present within the clades which could account for the recent emergence of this clade. This investigation highlights the importance and utility of routine whole genome sequencing and its ability to identify new and emerging variation at the single nucleotide level which informs surveillance and will impact future vaccine development.

ResumoO tubo digestivo de Salminus brasiliensis (dourado) mostra adaptações anatômicas ao hábito alimentar carnívoro, ictiófago: esôfago e estômago, em especial a região cecal, apresentam-se consideravelmente distensíveis e o intestino relativamente curto. A grande distensibilidade da parede do intestino anterior deve-se, principalmente, ao padrão da mucosa, que apresenta pregas longitudinais. No intestino anterior, a condução do alimento é facilitada pelo padrão longitudinal das pregas da mucosa. No esôfago e na região pilórica, relacionados com a propulsão do alimento para o órgão seguinte, a túnica muscular é mais desenvolvida do que no restante do tubo digestivo. O esfíncter pilórico regula o fl uxo do alimento para o intestino médio. Em função do padrão da mucosa dos intestinos médio e posterior, em rede, o material em processamento pode permanecer neles retido por um período maior. A área efetiva de absorção intestinal é ampliada em função da estrutura tubular do intestino médio, das pregas da mucosa e dos cecos pilóricos. O tubo digestivo de S. brasiliensis assemelha-se em estrutura ao de outros Salmininae e ao da maioria dos Characiformes ictiófagos como Acestrorhynchus britskii e A. lacustris, embora nestes dois seja encontrada a valva ileorretal; e difere do tubo digestivo de Hoplias malabarius e H. lacerdae, em que o esôfago tem calibre variável, o estômago possui a cárdica mais ampla e o arranjo intestinal é diferente de "N", além da presença da valva ileorretal. relatively short intestine. The great distensibility of the wall of the anterior intestine is due mainly to the pattern of the mucous membrane, which exhibits thick longitudinal folds. In the anterior intestine the transport of the food is facilitated by the longitudinal pattern of the mucous folds. In the esophagus and pyloric region, related to the propulsion of food to the net organ, the muscular tunica is more developed than in the rest of the alimentary tract. The pyloric constriction regulates the food fl ux to the middle intestine. Due to the pattern of mucous membrane of the middle and posterior intestines, in net form, the material being processed can be retained for a greater length of time. The intestinal effective absorption area is amplifi ed due to the tubular structure of the middle intestine, of the mucous intestinal folds, and the pyloric caeca. The alimentary tract of S. brasiliensis is similar in structure to that of other Salmininae and to the majority of the piscivorous Characiformes such as Acestrorhynchus britskii and A. lacustris, although in these two the ileum-rectal valve is found. It also differs from the alimentary tracts of Hoplias malabarius and H. lacerdae, in that the esophagus has variable caliber, the stomach possesses a wider cardia, and the intestinal arrangement is different from "N", besides the presence of the ileum-rectal valve.

Dementia is a challenging chronic illness that affects the patients and their families. Families often perform a full-time, specialised role, which requires expert knowledge and skills. This paper describes the evaluation of proFamilies-dementia (a programme developed to support families that care for a relative with dementia) using an innovative participatory methodology: photovoice, a qualitative method of research that uses photography and voice to access people's experiences. The programme was evaluated in order to identify the positive and negative impacts of the intervention on individuals and families; the advantages and disadvantages of photovoice as a participatory tool were also captured. The sample consisted of six people from five families. Participants identified only positive impacts of the programme, including better emotional management, normalisation of feelings and increased focus on self-care. Photovoice facilitated access to the process of change initiated by proFamilies-dementia, described by a process of going beyond illness, negativity and loneliness.

Multiproblem low‐income families face multiple long‐term problems in contexts deprived of economic resources, and they use various forms of formal and informal support to overcome these problems. This study examines how families coordinate the diverse strategies. A sample of 150 multiproblem, low‐income families was surveyed by means of an interview that comprised three open questions: Which problems do you feel exist in your family? What strategies does your family use to cope with each of these problems? How does your family bring together the different types of support? Main findings suggest that a member of the family (the family manager) coordinates and links informal and formal types of support. Families do not adopt a passive attitude toward problem solving because they activate and manage multiple formal and informal strategies. It is suggested that professionals could promote the coordination between formal and informal strategies without taking away autonomy from the families. © 2009 Wiley Periodicals, Inc.

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