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An Outbreak of Streptococcus pyogenes in a Mental Health Facility: Advantage of Well-Timed Whole-Genome Sequencing Over emm Typing
- Sarah M. Bergin, Balamurugan Periaswamy, Timothy Barkham, Hong Choon Chua, Yee Ming Mok, Daniel Shuen Sheng Fung, Alex Hsin Chuan Su, Yen Ling Lee, Ming Lai Ivan Chua, Poh Yong Ng, Wei Jia Wendy Soon, Collins Wenhan Chu, Siyun Lucinda Tan, Mary Meehan, Brenda Sze Peng Ang, Yee Sin Leo, Matthew T. G. Holden, Partha De, Li Yang Hsu, Swaine L. Chen, Paola Florez de Sessions, Kalisvar Marimuthu
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 39 / Issue 7 / July 2018
- Published online by Cambridge University Press:
- 09 May 2018, pp. 852-860
- Print publication:
- July 2018
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- Article
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OBJECTIVE
We report the utility of whole-genome sequencing (WGS) conducted in a clinically relevant time frame (ie, sufficient for guiding management decision), in managing a Streptococcus pyogenes outbreak, and present a comparison of its performance with emm typing.
SETTINGA 2,000-bed tertiary-care psychiatric hospital.
METHODSActive surveillance was conducted to identify new cases of S. pyogenes. WGS guided targeted epidemiological investigations, and infection control measures were implemented. Single-nucleotide polymorphism (SNP)–based genome phylogeny, emm typing, and multilocus sequence typing (MLST) were performed. We compared the ability of WGS and emm typing to correctly identify person-to-person transmission and to guide the management of the outbreak.
RESULTSThe study included 204 patients and 152 staff. We identified 35 patients and 2 staff members with S. pyogenes. WGS revealed polyclonal S. pyogenes infections with 3 genetically distinct phylogenetic clusters (C1–C3). Cluster C1 isolates were all emm type 4, sequence type 915 and had pairwise SNP differences of 0–5, which suggested recent person-to-person transmissions. Epidemiological investigation revealed that cluster C1 was mediated by dermal colonization and transmission of S. pyogenes in a male residential ward. Clusters C2 and C3 were genomically diverse, with pairwise SNP differences of 21–45 and 26–58, and emm 11 and mostly emm120, respectively. Clusters C2 and C3, which may have been considered person-to-person transmissions by emm typing, were shown by WGS to be unlikely by integrating pairwise SNP differences with epidemiology.
CONCLUSIONSWGS had higher resolution than emm typing in identifying clusters with recent and ongoing person-to-person transmissions, which allowed implementation of targeted intervention to control the outbreak.
Infect Control Hosp Epidemiol 2018;852–860
4 - Higher Education in Malaysia: Access, Equity and Quality
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- By Hena Mukherjee, Education consultant and was previously Lead Education Specialist with the World Bank, Jasbir S. Singh, Former Professor, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia, Rozilini M. Fernandez-Chung, Currently Vice-President, HELP University College (Malaysia), and was formerly with the Malaysian Qualifications Agency, T. Marimuthu, Adjunct Professor, School of Education and Cognitive Sciences, Asia e University, Kuala Lumpur, Malaysia, and formerly was Professor, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia
- Edited by Lee Hock Guan
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- Book:
- Education and Globalization in Southeast Asia
- Published by:
- ISEAS–Yusof Ishak Institute
- Published online:
- 12 January 2018
- Print publication:
- 27 September 2017, pp 83-110
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Summary
BACKGROUND
Since independence in 1957, Malaysia has transformed itself from an agrarian to an increasingly industrial and globalized economy. Malaysia was formed in 1963 comprising Malaya, Sabah, Sarawak and Singapore, with the last leaving the group in 1965. In the country of 30-odd million, 62.1 per cent are Malays and other indigenous groups, 21.8 per cent Chinese, 6.5 per cent Indians and 9.6 per cent Others (includes 8.7 per cent non-citizens). Malaya and Singapore were served by the University of Malaya (UM), located in Singapore, until 1957 when a branch campus was established in Kuala Lumpur. In 1962, it split into two entities, University of Malaya and University of Singapore, as befits the two sovereign states.
Formal steps were taken post-independence to develop higher education institutions to provide the high-level skills that the industrializing nation required. These aspirations took particular shape after the civil disturbances of 1969. Higher education in Malaysia expanded exponentially over the last four decades with dramatic improvement in access to public and private higher education institutions (HEIs). The factors contributing to increased access were primarily high secondary enrolment and completion, building on democratization and universalization of the system; an increasingly diversified institutional pattern of universities, colleges, polytechnics and community colleges catering to various levels of achievement; a burgeoning private higher education sector as a result of liberalization policies; and a combination of public and private sources in the financing of HEIs.
This chapter examines current higher education policies and implementation in Malaysia, understanding their historical antecedents in relation to higher education access, equity and quality issues. The issues are analysed within the overall context of the need for well-qualified and highly skilled graduate participation in an increasingly globalized knowledge-based economy with the goal of reaching high income status as envisioned by Vision 2020 (Mohamad 1991). The key challenge is human capital growth. Underlying the discussion is the question: which policies and actions have worked, and which need to be reviewed and adjusted to ensure that the nation's talent pool will match the demands of a high income, knowledge economy?
METHODOLOGY AND DATA
The study draws heavily on government documentation issued by the Ministry of Education (MOE), the Ministry of Higher Education (MOHE), and the Department of Statistics, particularly its Census Reports and Labour Force Surveys. Data provided by officials and politicians to the press have been included.
Temporal patterns of individual and group foraging behaviour in the short-nosed fruit bat, Cynopterus sphinx, in south India
- V. Elangovan, G. Marimuthu, T. H. Kunz
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- Journal:
- Journal of Tropical Ecology / Volume 15 / Issue 5 / September 1999
- Published online by Cambridge University Press:
- 01 September 1999, pp. 681-687
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The short-nosed fruit bat, Cynopterus sphinx, begins to visit fruit-bearing trees about 30 min after sunset. Individual bats often hover near or land on fruits or on nearby branches to remove whole or parts of fruits with their mouth. These bats seldom remain in the fruit-bearing trees to feed, but instead carry fruits to feeding roosts, repeating this behaviour several times throughout the night. Analysis of the temporal distribution of feeding behaviour has revealed two peaks of activity, one in the pre-midnight hours when bats fed mostly on ‘steady state’ fruits, and another during the post-midnight hours when bats fed on ‘big-bang’ fruits. Only solitary bats visited and fed on species with steady state fruiting phenologies, whereas groups of bats regularly visited and fed on species with big-bang fruiting phenologies. Thus, plant species which produce large numbers of fruits appear to promote group foraging during the latter hours of the night. It is suggested that the temporal use of available fruits in south India made it possible for C. sphinx to successfully exploit them, and thereby reduced interference competition with conspecifics.
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