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Tuberculosis (TB) and poverty are inextricably linked. Catastrophic costs of TB illness drive TB-affected households into worsening impoverishment and hamper treatment success. The WHO's End TB Strategy recommends social protection for TB-affected households to mitigate financial shock and improve TB outcomes. This scoping review maps the landscape of social protection interventions for people with TB and their households in low- and middle-income countries with high TB burden. A systematic search of Medline, Embase, PubMed, and Web of Science for relevant articles was performed, supplemented with a gray literature search of key databases. Articles were included if they described social protection available to people with TB and TB-affected households in a low- or middle-income country. Data were synthesized in tabular form, and descriptive narrative outlined the successes and challenges of the social protection interventions identified. The search identified 33,360 articles. After abstract screening, 74 articles underwent full text screening, and 49 were included in the final analysis. Forty-three types of social protection were identified, of which 24 were TB specific (i.e., only people with TB were eligible). Varying definitions were used to describe similar social protection interventions, which limited cross-study comparison. Intervention successes included acceptability and increased financial autonomy among recipients. Challenges included delays in intervention delivery and unexpected additional bank transfer fees. A wide range of acceptable social protection interventions are available, with cash transfer schemes predominating. Use of standardized definitions of social protection interventions would facilitate consolidation of evidence and enhance design and implementation in future.

Environmental DNA (eDNA) metabarcoding (parallel sequencing of DNA/RNA for identification of whole communities within a targeted group) is revolutionizing the field of aquatic biomonitoring. To date, most metabarcoding studies aiming to assess the ecological status of aquatic ecosystems have focused on water eDNA and macroinvertebrate bulk samples. However, the eDNA metabarcoding has also been applied to soft sediment samples, mainly for assessing microbial or meiofaunal biota. Compared to classical methodologies based on manual sorting and morphological identification of benthic taxa, eDNA metabarcoding offers potentially important advantages for assessing the environmental quality of sediments. The methods and protocols utilized for sediment eDNA metabarcoding can vary considerably among studies, and standardization efforts are needed to improve their robustness, comparability and use within regulatory frameworks. Here, we review the available information on eDNA metabarcoding applied to sediment samples, with a focus on sampling, preservation, and DNA extraction steps. We discuss challenges specific to sediment eDNA analysis, including the variety of different sources and states of eDNA and its persistence in the sediment. This paper aims to identify good-practice strategies and facilitate method harmonization for routine use of sediment eDNA in future benthic monitoring., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

There is an active debate regarding whether the ego depletion effect is real. A recent preregistered experiment with the Stroop task as the depleting task and the antisaccade task as the outcome task found a medium-level effect size. In the current research, we conducted a preregistered multilab replication of that experiment. Data from 12 labs across the globe ( N = 1,775) revealed a small and significant ego depletion effect, d = 0.10. After excluding participants who might have responded randomly during the outcome task, the effect size increased to d = 0.16. By adding an informative, unbiased data point to the literature, our findings contribute to clarifying the existence, size, and generality of ego depletion., Competing Interests: Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Nutrient loading is a major threat to estuaries and coastal environments worldwide, therefore, it is critical that we have good monitoring tools to detect early signs of degradation in these ecologically important and vulnerable ecosystems. Traditionally, bottom-dwelling macroinvertebrates have been used for ecological health assessment but recent advances in environmental genomics mean we can now characterize less visible forms of biodiversity, offering a more holistic view of the ecosystem and potentially providing early warning signals of disturbance. We carried out a manipulative nutrient enrichment experiment (0, 150 and 600 g N fertilizer m -2 ) in two estuaries in New Zealand to assess the effects of nutrient loading on benthic communities. After seven months of enrichment, environmental DNA (eDNA) metabarcoding was used to examine the response of eukaryotic (18S rRNA), diatom only (rbcL) and bacterial (16S rRNA) communities. Multivariate analyses demonstrated changes in eukaryotic, diatom and bacterial communities in response to nutrient enrichment at both sites, despite differing environmental conditions. These patterns aligned with changes in macrofaunal communities identified using traditional morphological techniques, confirming concordance between disturbance indicators detected by eDNA and current monitoring approaches. Clear shifts in eukaryotic and bacterial indicator taxa were seen in response to nutrient loading while changes in diatom only communities were more subtle. Community changes were discernible between 0 and 150 g N m -2 treatments, suggesting that estuary health assessment tools could be developed to detect early signs of degradation. Increasing variation in community structure associated with nutrient loading could also be used as an indicator of stress or approaching tipping points. This work represents a first step towards the development of molecular-based estuary monitoring tools, which could provide a more holistic and standardized approach to ecosystem health assessment with faster turn-around times and lower costs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Molecular-based approaches can provide timely biodiversity assessments, showing an immense potential to facilitate decision-making in marine environmental management. However, the uptake of molecular data into environmental policy remains minimal. Here, we showcase a selection of local to global scale studies applying molecular-based methodologies for environmental management at various stages of implementation. Drawing upon lessons learned from these case-studies, we provide a roadmap to facilitate applications of DNA-based methods to marine policies and to overcome the existing challenges. The main impediment identified is the need for standardized protocols to guarantee data comparison across spatial and temporal scales. Adoption of Translational Molecular Ecology - the sustained collaboration between molecular ecologists and stakeholders, will enhance consensus with regards to the objectives, methods, and outcomes of environmental management projects. Establishing a sustained dialogue among stakeholders is key to accelerating the adoption of molecular-based approaches for marine monitoring and assessment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Massive metagenomic sequencing combined with gene prediction methods were previously used to compile the gene catalogue of the ocean and host-associated microbes. Global expeditions conducted over the past 15 years have sampled the ocean to build a catalogue of genes from pelagic microbes. Here we undertook a large sequencing effort of a perturbed Red Sea plankton community to uncover that the rate of gene discovery increases continuously with sequencing effort, with no indication that the retrieved 2.83 million non-redundant (complete) genes predicted from the experiment represented a nearly complete inventory of the genes present in the sampled community (i.e., no evidence of saturation). The underlying reason is the Pareto-like distribution of the abundance of genes in the plankton community, resulting in a very long tail of millions of genes present at remarkably low abundances, which can only be retrieved through massive sequencing. Microbial metagenomic projects retrieve a variable number of unique genes per Tera base-pair (Tbp), with a median value of 14.7 million unique genes per Tbp sequenced across projects. The increase in the rate of gene discovery in microbial metagenomes with sequencing effort implies that there is ample room for new gene discovery in further ocean and holobiont sequencing studies., (© 2020 The Authors. Environmental Microbiology published by Society for Applied Microbiology and John Wiley & Sons Ltd.)

Photosynthetic picoeukaryotes (PPEs) of a size < 3 µm play a crucial role in oceanic primary production. However, little is known of the structure of the PPE community over large spatial scales. Here, we investigated the distribution of various PPE classes along an Atlantic Meridional Transect sampled in boreal autumn 2004 that encompasses a range of ocean provinces (gyres, upwelling, temperate regions), using dot blot hybridization technology targeting plastid 16S rRNA gene amplicons. Two algal classes, Prymnesiophyceae and Chrysophyceae, dominated the PPE community throughout the Atlantic Ocean, over a range of water masses presenting different trophic profiles. However, these classes showed strongly complementary distributions with Chrysophyceae dominating northern temperate waters, the southern gyre and equatorial regions, while prymnesiophytes dominated the northern gyre. Phylogenetic analyses using both plastid and nuclear rRNA genes revealed a high diversity among members of both classes, including sequences contained in lineages with no close cultured counterpart. Other PPE classes were less prevalent along the transect, with members of the Cryptophyceae, Pelagophyceae and Eustigmatophyceae essentially restricted to specific regions. Multivariate statistical analyses revealed strong relationships between the distribution patterns of some of these latter PPE classes and temperature, light intensity and nutrient concentrations. Cryptophyceae, for example, were mostly found in the upwelling region and associated with higher nutrient concentrations. However, the key classes of Prymnesiophyceae and Chrysophyceae were not strongly influenced by the variables measured. Although there appeared to be a positive relationship between Chrysophyceae distribution and light intensity, the complementary distributions of these classes could not be explained by the variables recorded and this requires further explanation., (© 2011 Society for Applied Microbiology and Blackwell Publishing Ltd.)

Global estimates indicate the oceans are responsible for approximately half of the carbon dioxide fixed on Earth. Organisms < or =5 microm in size dominate open ocean phytoplankton communities in terms of abundance and CO(2) fixation, with the cyanobacterial genera Prochlorococcus and Synechococcus numerically the most abundant and more extensively studied compared with small eukaryotes. However, the contribution of specific taxonomic groups to marine CO(2) fixation is still poorly known. In this study, we show that among the phytoplankton, small eukaryotes contribute significantly to CO(2) fixation (44%) because of their larger cell volume and thereby higher cell-specific CO(2) fixation rates. Within the eukaryotes, two groups, herein called Euk-A and Euk-B, were distinguished based on their flow cytometric signature. Euk-A, the most abundant group, contained cells 1.8+/-0.1 microm in size while Euk-B was the least abundant but cells were larger (2.8+/-0.2 microm). The Euk-B group comprising prymnesiophytes (73+/-13%) belonging largely to lineages with no close cultured counterparts accounted for up to 38% of the total primary production in the subtropical and tropical northeast Atlantic Ocean, suggesting a key role of this group in oceanic CO(2) fixation.

The attenuated Salmonella typhi strain Ty21a is the main constituent of Vivotif, the only attenuated live oral vaccine against typhoid fever. In comparison with antibiotics, the 'magic bullets' which Paul Ehrlich was striving for to treat infectious diseases, this vaccine should be viewed as a 'magic shield', because rather than treating typhoid fever after the infection has started, immunisation with this vaccine strain prevents infection and disease by the induction of specific immune responses. Ty21a is also an attractive carrier for the delivery of heterologous antigens. Recently, we successfully used Ty21a for antigen delivery via the haemolysin secretion system of Escherichia coli, which allows efficient protein secretion from the carrier bacteria., (Copyright 2007 S. Karger AG, Basel.)

Because of high infectivity and significant disease burden, typhoid fever constitutes a major global health problem. Implementation of adequate food handling practices and establishment of safe water supplies are the cornerstone for the development of an effective prevention program. However, vaccination against typhoid fever remains an essential tool for the effective management of this disease. Currently, there are two well tolerated and effective licensed vaccines. One is based on defined subunit virulence (Vi) polysaccharide antigen and can be administered either intramuscularly or subcutaneously and the other is based on the use of live attenuated bacteria for oral administration. The advantages and disadvantages of the various approaches taken in the development of a vaccine against typhoid fever are discussed, along with the potential for future vaccine candidates.

The detection of Helicobacter pylori antigen directly in faecal specimens may offer an alternative non-invasive method for determining the presence of H. pylori infection. This study compared the performance of the Premier Platinum HpSA enzyme immunoassay (HpSA) with histology and CLOtest, a rapid urease test. Of 134 patients undergoing upper gastrointestinal endoscopy, 37 (28%) were H. pylori-positive by histology and CLOtest. Using the HpSA test, H. pylori was detected in 35 H. pylori-positive patients (95% sensitivity) and one H. pylori-negative patient (99% specificity). The positive and negative predictive values for HpSA were 97 and 98%, respectively. HpSA is a rapid, easily performed, non-invasive method for detecting H. pylori.

Staphylococcus schleiferi is a coagulase-negative staphylococcus infrequently reported as a human pathogen. We report a case of prosthetic valve endocarditis attributed to this organism, contrast it to another Staphylococcus species that gives similar clumping factor results (S. lugdunensis), and propose a simple, effective identification scheme for identification of clumping factor-positive staphylococci.

Western Australia (WA) has been able to prevent methicillin-resistant Staphylococcus aureus (MRSA) strains from outside of the state from becoming established in its hospitals. Recently, a single-strain outbreak of MRSA occurred in a WA metropolitan teaching hospital following admission of an infected patient from a remote community. The strain responsible for the outbreak was unrelated to any imported strains and spread rapidly in the hospital. Screening of two remote communities in the region from which the index case came revealed that 42% of the people in one community and 24% in the other carried MRSA. Isolates were typed by resistance pattern, plasmid analysis, contour-clamped homogeneous electric field electrophoresis, bacteriophage pattern, and coagulase gene restriction fragment length polymorphism. It was found that of the people carrying MRSA, 39% in the former community and 17% in the latter community were carrying an MRSA strain which was indistinguishable from the strain that caused the hospital outbreak.

Purpose: To evaluate a novel two-stage technique to increase yield of bacteria isolated from infected corneal ulcers., Methods: A new blade was designed to remove friable material from infected corneal ulcers. The new blade was used in combination with standard tissue micro-homogenisation equipment in a two-stage technique intended to distribute biopsy samples evenly between relevant agar plates. Patients with presumed-bacterial corneal ulcers underwent sequential corneal sampling using the new two-stage technique and a scalpel blade, used without micro-homogenisation (the order of sampling was varied between two groups). Bacterial isolation rates were compared using the chi-squared test., Results: Twenty-four patients with presumed-bacterial corneal ulcers were studied. The overall positive bacterial isolation rate was 88%, with identical bacterial isolation rates for the new two-stage technique and the scalpel blade (71%). The new technique isolated bacteria from three ulcers that had initially been 'sterile' when sampled with a scalpel blade. Polymicrobial infections were identified in two ulcers with the new blade where only a single organism had been identified using the scalpel blade (not significantly different)., Conclusions: The new two-stage technique shows promise for improving bacterial isolation rates from presumed-bacterial corneal ulcers.

Staphylococcus lugdunensis is being increasingly reported as a pathogen with an outcome resembling that of S. aureus rather than coagulase-negative staphylococci. Recent local isolates exhibited colonial variation that delayed identification and interpretation of clinical significance. Until now previous descriptions have not emphasized colonial variation as an important identifying characteristic of S. lugdunensis.

Methicillin aztreonam mannitol salt agar is a sensitive and reliable solid screening medium for detecting methicillin-resistant Staphylococcus aureus (MRSA). With this medium an incubation period of only 20 h is sufficient to either produce visible colonies of MRSA or to exclude MRSA (no staphylococcal colonies). Coagulase testing (requiring a further 6 h) enables coagulase-positive isolates to be provisionally reported as 'possible MRSA' 26-30 h after the swabs were collected. The medium supports growth of intrinsically resistant staphylococci including low-expression-class MRSA (methicillin minimum inhibitory concentration (MIC) 8-16 mg/L), but methicillin susceptible staphylococci and beta-lactamase hyperproducers are suppressed.

Objective: To determine the usefulness of an indirect immunoflourescence antibody test for antibodies to Bartonella henselae in diagnosing cat scratch disease (CSD)., Design and Setting: Retrospective case survey of 354 patients whose sera were tested for antibodies to B. henselae at Royal Perth Hospital, Perth, and the Institute of Clinical Pathology and Medical Research, Sydney. In 1994; and measurement of the background prevalence of antibodies to B. henselae., Main Outcome Measures: Prevalence of antibodies to B. henselae, odds of a positive titre (> or = 64) in patients with and without specific risk factors for CSD and clinical features of the disease; prevalence of antibodies to B. henselae in randomly selected blood donors., Results: Demographic, clinical and cat contact data were available for 303 patients. Sixty-four (21.1%) had a positive titre, as did 53 of 98 (54%) patients with a history of cat contact and lymphadenopathy. This proportion increased to 62% (38 of 61 patients) in patients with a history of cat scratch or bite and to 90.3% (28 of 31) in those with cat contact, lymphadenopathy and histological evidence of granulomatous lymphadenitis. Patients who developed lymphadenopathy after cat contact were significantly more likely to have a positive titre than those without this history (odds ratio [OR], 20.8; 95% confidence interval [95% Cl], 9.6-46; P < 0.0001). Inclusion of a history of a cat scratch or bite significantly raised the odds of being seropositive (OR, 13.7; 95% Cl, 6.8-28.1; P < 0.0001), and the presence of granulomas on lymph node biopsy further increased the odds (OR, 124.4; 95% Cl, 19.4-1073; P < 0.0001). The prevalence of antibodies to B. henselae in random blood donors in New South Wales was about 5% (five of 102 sera samples)., Conclusions: The immunofluorescence antibody test for B. henselae can be expected to be positive in just over half the patients with clinically suspected CSD, and it has a positive predictive value of 83%. In a significant number of cases the diagnosis cannot be made on the basis of the results of immunofluorescence antibody testing alone and further investigations, including lymph node biopsy, may be required.

We report the first isolation of Bartonella henselae from the blood and fleas of a cat of a patient with cat scratch disease (CSD) in Australia. A 49-year-old man presented with a history that 3 weeks after he had removed fleas from his cat he had developed fever, lethargy and anorexia for 3 days. This was followed by the appearance of axillary lymphadenopathy. There was no history of a bite or scratch and no primary lesion on the skin. Two fine needle aspirates of the axillary lymph node showed granulomatous lymphadenitis with no organisms seen by Warthin-Starry silver staining or electron microscopy. No organism was cultured from the patient's lymph node aspirates or blood cultures processed by lysis centrifugation. However, the polymerase chain reaction (PCR) using p24E and p12B primers gave a 280 bp band indistinguishable from Bartonella henselae when using DNA extracted from the lymph node aspirates and the patient's blood leucocytes. DNA sequencing of the PCR product from the patient's blood showed that the DNA was from Bartonella henselae. The patient's serum had a titre of 1024 in an indirect immunofluorescence antibody test for Bartonella henselae. Bartonella henselae was subsequently cultured from fleas and blood taken from the patient's cat. This case provides evidence that Bartonella henselae is a causative agent of CSD in Australia and supports a possible role for fleas in transmission of the disease.

Objective: To assess the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Western Australia., Design: Retrospective review of statutory notification data., Setting: Western Australia (WA), 1993., Outcome Measures: Notification rates, antibiotic resistance patterns and classification of isolates as imported or WA MRSA strains on the basis of antibiotic susceptibility., Results: There were 204 notifications of MRSA, 78% of which were classified as WA MRSA. Three outbreaks of MRSA infection and colonisation occurred in separate WA hospitals. Notification rates per 100,000 were highest in the rural regions: the Kimberley (86.32), Goldfields (62.47), Mid West (37.21) and Pilbara (27.38) regions; and lowest in the metropolitan regions (5.52). All MRSA isolates were susceptible to vancomycin. Most imported strains were susceptible to amikacin, bacitracin, chloramphenicol, framycetin, fusidic acid and novobiocin, but only 23% to gentamicin. WA MRSA strains remained predominantly susceptible to all antibiotics tested, except beta-lactams, erythromycin and tetracycline, but a few strains resistant to rifampicin (1%) and fusidic acid (3%) appeared in the second half of 1993., Conclusions: The epidemiology of MRSA in WA is changing rapidly, with increases in both the numbers of notifications and the proportion from country regions. A new strain of MRSA (WA MRSA) that is less resistant to antibiotics than imported MRSA has emerged and is threatening the State's success in preventing establishment of MRSA in its hospitals.

Six mupirocin-resistant Staphylococcus aureus were isolated from patients living in the northern part of Western Australia (WA). They were all resistant to methicillin, tetracycline, trimethoprim and cadmium and harboured similar 41.4 kb plasmids. Transfer and curing experiments with one of the isolates, WBG7569, demonstrated that the 41.4 kb plasmid encoded resistance to mupirocin, tetracycline, trimethoprim and cadmium. The isolates were compared by pulsed-field gel electrophoresis with methicillin-resistant S. aureus (MRSA) previously isolated from the Kimberley region in the northern-most part of WA (WA MRSA). The mupirocin-resistant isolates were found to be closely related to WA MRSA suggesting that they were WA MRSA which had acquired a new multiple-resistance plasmid encoding high-level mupirocin resistance.

Methicillin-resistant Staphylococcus aureus (MRSA) obtained from patients who had not been hospitalized outside Western Australia (WA) were studied for antimicrobial resistance and plasmid content and by pulsed-field gel electrophoresis. They were found to be of several types, none of which appeared to be related to MRSA which have been previously studied. It appears that new MRSA strains have emerged in communities in the far north of WA and are being isolated at an increasing frequency in Perth hospitals 2000 km south.

Cytotoxicity of faecal extracts was demonstrated in 47 of 88 children (54%) referred for microbiological investigation of stools. Cytotoxic Clostridium difficile and vertotoxigenic Escherichia coli (VTEC) were the pathogens identified most commonly but cytotoxicity was also found in association with Campylobacter jejuni, Salmonella spp, Shigella sonnei, Giardia lamblia, rotavirus, adenovirus and poliovirus type 1 which had been acquired by oral immunization. In two patients, one of whom had cystic fibrosis, cytotoxicity of faecal extracts was associated with isolation of Pseudomonas aeruginosa. In five of 13 patients with diarrhoea and cytotoxic C. difficile, other pathogens were also present, in agreement with the view that C. difficile are more readily recovered when the intestinal flora have been altered by colonization with other micro-organisms. There was no correlation between previous treatment with antibiotics and isolation of C. difficile. Cytotoxicity neutralized by antitoxin, usually to C. sordellii, is used to detect cytotoxic C. difficile. We suggest that cytotoxicity not neutralized in this way should be an indication for further investigation of stools for the presence of other pathogens such as VTEC or viruses.

In April 1982, a patient infected with methicillin-resistant Staphylococcus aureus (MRSA) was transferred to the Royal Perth Hospital from the Royal Darwin Hospital. Within three months, 19 patients and four staff members had become infected or colonized with MRSA. The outbreak was terminated only after all colonized inpatients were transferred to a separate isolation unit. After the outbreak, all new patients and new employees who had been in hospitals outside Western Australia in the previous 12 months were screened. From June 1, 1982, to June 30, 1984, 28 of the 649 patients (4.3%) screened on admission to the Royal Perth Hospital were found to be harbouring MRSA. During the same period only one of the 468 persons (0.2%) screened on application for employment at the Hospital was found to be colonized with MRSA. Since the policy of screening new patients and staff from hospitals outside Western Australia was introduced, no serious outbreak of MRSA has occurred.

99 spinal cord injured patients who were initially managed by intermittent catheterisation have been followed up for an average of 36 months (6 to 81 months) since their discharge from hospital. The urological results in this group of patients have been compared with those of 2 series in which indwelling catheters were used in the initial period. It appears that initial bladder management by intermittent catheterisation allows a higher percentage of patients to become catheter-free and gives a lower incidence of urological complications. The average incidence of re-infection of the urinary tracts and the condition of the upper tracts compares favourably with those reported after management by indwelling catheterisation.

The Royal Free Hospital in London has experienced the spread of a phage 85 methicillin-resistant Staphylococcus aureus (MRSA). An analysis of a sample has demonstrated that the plasmids carried by these strains, and the type and location of their drug-resistance determinants, are similar to those of MRSA strains which have been causing problems in some Australian hospitals.

The isolates from an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) at Royal Perth Hospital (RPH) during a 3 month period in 1982 have been compared genetically with MRSAs isolated at the same hospital during 1969-1973. The 1982 isolates are genetically similar to isolates from eastern Australia and appear to have been introduced by a patient transferred from a hospital in another Australian state. Methicillin-resistant Staph. aureus isolated during 1969-1973 were genetically distinguishable from the 1982 isolates but were similar to strains reported from elsewhere in the world during these years. This indicates that the MRSA strains currently prevalent in Australia are either a new type or are related to previous MRSAs but have undergone considerable genetic change. These results give further support to suggestions that the strains of MRSA currently being isolated in Australian hospitals have special properties which have facilitated their spread.

The antimicrobial activity of urine collected from adult male paraplegics ingesting methenamine mandelate (MM) was evaluated. The in vitro bacterial growth in urine from these patients was inhibited when the free formaldehyde (HCHO) concentration was 10 to 22 microgram per ml. When the HCHO concentration was in the region of 28 microgram per ml or greater, bactericidal effect became apparent. Urine containing 1323 microgram of MM per ml with a pH of 5.9 when freshly voided had sufficient HCHO to be bacteriostatic. Urine containing at least 1740 microgram of MM per ml with a pH of 5.1 or less when freshly voided was bactericidal. The latter concentration of MM in urine was usually achieved when the patient ingested 4 g of MM per day in divided doses and the intake of fluid was not excessive. Under some circumstances an individual receiving MM without an additional acidifying agent may produce urine with a pH low enough to release sufficient HCHO to exert a useful antibacterial effect. However, supplementary acidification with ammonium chloride produced marked lowering of the urinary pH in all patients receiving MM, resulting in bactericidal levels of HCHO.

The in-vitro activity of ticarcillin was found to be greater than that of carbenicillin against 97 out of 100 strains of Pseudomonas aeruginosa which were recently isolated from clinical specimens at the Royal Perth Hospital complex. These results indicate that ticarcillin should be considered for use in place of carbenicillin for treating infections caused by P. aeruginosa.

Strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated in the Royal Perth Hospital (RPH) in Western Australia have been analysed genetically and three main types were characterized: (i) strains similar to those isolated in Europe before 1973. These strains caused small outbreaks in the RPH during the period 1966-1974, but have not been isolated in recent years, except from one patient with reactivation of osteomyelitis after 16 years; (ii) strains of the type prevalent in eastern and northern Australia, one of which caused a difficult-to-control outbreak in the RPH in 1982. Strains of this type have previously been isolated only from patients who had been in hospitals in eastern and northern Australia, but recently were isolated also from other patients--which indicates that this type of MRSA is now present in the Western Australian community; and (iii) strains, which are genetically different from either of the above two types, were isolated from patients who had been in hospitals in Southeast Asia, but have not yet caused an outbreak in the RPH.