Initially discovered on plasmids, toxin–antitoxin (TA) systems we

Initially discovered on plasmids, toxin–antitoxin (TA) systems were termed ‘plasmid-addiction’ modules to describe their role in plasmid maintenance through a post-segregational

killing mechanism (Gerdes et al., 1986; Hayes, 2003). TA systems ensure plasmid maintenance in the bacterial host population through the differential stability of the stable toxin and labile antitoxin, both encoded by the plasmid. When present, the plasmid enables the continued expression of antitoxin, which binds to and inactivates the toxin. However, if the plasmid is lost during cell division, the antitoxin protein is rapidly degraded and not replenished, thus releasing the stable toxin to kill the bacterial cell. TA genes are also found on bacterial chromosomes, although their

precise role in this setting is debated (Keren et al., AZD0530 solubility dmso 2004; Buts et al., 2005; Gerdes et al., 2005; Engelberg-Kulka et al., 2006; Szekeres et al., 2007; Nariya & Inouye, 2008). Two of the most well-studied TA systems are MazEF and RelBE encoded by the Escherichia coli chromosome. The MazEF system in E. coli may function as an irreversible mediator of cell death PD0332991 order under stressful conditions (Amitai et al., 2004) or as a modulator of translation to induce a reversible state of bacteriostasis (Pedersen et al., 2002; Christensen et al., 2003). RelBE modulates the stringent response induced by amino acid starvation (Christensen et al., 2001), causing global translation inhibition and leading to bacteriostasis (Pedersen et al., 2002, 2003). Similar to plasmid-encoded systems, chromosomal TA modules derive their intrinsic killing/growth inhibition ability from a shift in the balance towards free toxin (Christensen

FAD et al., 2004). Exploitation of the inherent toxicity of TA systems has been proposed as a novel antibacterial target, as activation of the latent toxin via direct TA complex disruption or some alternative mechanism would result in bacterial cell death (Engelberg-Kulka et al., 2004; DeNap & Hergenrother, 2005; Alonso et al., 2007; Williams & Hergenrother, 2008). However, a prerequisite for the success of this strategy is the identification of clinically important bacteria that would be susceptible to a compound that activates TA systems. Surveys of clinical isolates to determine the prevalence and identity of TA systems could support and guide the development of this strategy by establishing which TA loci are most frequently encountered and would thus serve as the best target candidates. One such survey discovered that TA systems were frequently encoded on plasmids carried by vancomycin-resistant enterorocci (VRE) (Moritz & Hergenrother, 2007). The observation that TA systems are ubiquitous and functional on plasmids in VRE (Moritz & Hergenrother, 2007; Sletvold et al., 2007; Halvorsen et al., 2011) raises the possibility that other pathogenic bacteria may also harbor the genes for TA systems.

, 1997; Henry & Crawford, 2004) Based on data of Troyer et al (

, 1997; Henry & Crawford, 2004). Based on data of Troyer et al. (1998), switching is mediated by frontal regions whereas clustering is mediated by temporal regions. In the light of previous claims about distinct roles of frontal and temporal regions in VF, our results show enhanced engagement of temporal and frontal regions in older compared to younger adults. This finding

seems to reflect the HAROLD pattern for processed based in frontal regions and bilateralisation of activation for SB203580 manufacturer processes based in temporal regions during ageing. This result is convergent with those of the semantic tasks (Hazlett et al., 1998; Wingfield & Grossman, 2006) in which older participants showed greater posterior activation, contrary to what would have been predicted Epacadostat by the PASA. At the same time, the difference between semantic and orthographic VF suggests that neurofunctional reorganization depends on the nature

of the task as well as on the specific strategic process used to maintain the level of performance. Thus, the nature of the task (here an expressive language task) appears determinant for the observed neurofunctional reorganization in aging. In this regard, while patterns of cerebral activations associated with word production during VF tend to be modulated by task demands rather than solely by age, age-related neurofunctional differences are nevertheless exacerbated for other cognitive components involved such as retrieval Idoxuridine strategies. In order to further document the influence of the task on the neurofunctional reorganization in aging there is a need to consider a different task. An example of such a different task is directed visual attention. For this reason, we will now consider the existence of converging evidence for the neurofunctional reorganization principles for a visual attention task in which cognitive load has been varied (Ansado et al.,

2012). Because of its limited computational resources, the human brain must process information selectively. Visual selective attention is the ability to focus perceptual mechanisms on target stimuli by neglecting irrelevant stimuli (Itti et al., 1998). In a recent study, Madden (2007) showed that some aspects of top-down guidance are still operative and may play an important role in older adults’ performance to compensate for the decline in bottom-up visual sensory processes and in executive processing related to task control. This study opened up the possibility of better understanding the nature of the neural mechanisms underlying the neurofunctional reorganization in aging in the context of visual attention tasks. Indeed, as mentioned above, neurofunctional reorganization is thought to occur for many cognitive components or abilities in successful aging to cope with important changes of the brain’s anatomy and physiology in aging (HAROLD, Cabeza, 2002; PASA, Davis et al., 2008).

3 We summarize and review current knowledge on life-threatening j

3 We summarize and review current knowledge on life-threatening jellyfish stings in Thailand, hoping this report will provide a stimulus for improved awareness and management of jellyfish problems throughout Southeast Asia. Two kinds of potentially deadly jellyfish are confirmed in Thai waters: chirodropid box jellyfish and Irukandji box jellyfish (L. Gershwin, unpublished

data). Hundreds of other species of jellyfish are also present but are not considered as life threatening. Chirodropids are large box-shaped jellyfish MK0683 cost (ie, “box jellyfish”) with multiple tentacles arising from each of the four lower corners of the bell. Irukandji are easily distinguished from chirodropids, as their box-shaped body has just a single tentacle at each lower corner. Chironex kill by massive envenomation, causing respiratory arrest or cardiac arrest in systole in as little as 2 to 3 min. Their stings have caused multiple human fatalities throughout the Indo-Pacific, including the Maldives,

southern India, Myanmar, the Malaysian archipelago (east and west coasts), Indonesia, Brunei, Sarawak, Sabah, the Philippines and Solomon Islands, Okinawa (Japan), and Australia (Nakorn, Bioactive Compound Library order personal communication).3-8 At least two confirmed Irukandji deaths have occurred in Australia, probably more, given that the sting leaves little or no mark, and later symptoms resemble acute myocardial infarction (AMI), cerebrovascular accident, or even drowning.9-11 Irukandji syndrome has also been confirmed from Hawaii, Florida, the Caribbean, North Wales (UK), New Guinea, and throughout the tropical Pacific.5,6,9 Chirodropids appear mainly in the summer months in the

northern and southern hemispheres, usually during the local rainy or monsoonal season, and most commonly around sandy beaches near mangrove areas. Their season is longest at the equator, where it can last all year, and reduces moving toward both Tropics. Irukandji are also commonest in the warmer months, although seasonal patterns of some different species9 in Australia have been recorded all months of the year and are probably similar elsewhere.12 Sting case histories were gathered from a variety of sources: PubMed searching keywords “Thailand” and “jellyfish” 3-mercaptopyruvate sulfurtransferase provided four relevant publications; most case histories were obtained through Thai physicians, Divers Alert Network reports, witnesses, media, and e-mail contacts. These reports are certainly a significant underestimation of the true occurrence of fatal or severe stings in Thailand. Diagnoses of “box jellyfish sting” and “Irukandji syndrome” were made by standard acceptance. Chirodropids—causing sudden severe skin pain, obvious severe whip-like skin marks (often on the legs from shallow water), rapid reduction of consciousness, and life-threatening breathing and/or cardiac problems.

The hybridoma medium with l-glutamine, and 10% (v/v) FBC (Biochro

The hybridoma medium with l-glutamine, and 10% (v/v) FBC (Biochrom, AG) plus hypoxanthine–aminopterin–thymidine (HAT) or hypoxanthine–thymidine (HT) (Sigma), was used to select hybrids. Fusions to generate antibody-producing hybridomas GDC-0199 supplier were performed according to standard methods (Köhler & Milstein, 1975). The fusion mixture was then slowly diluted with 25 mL of RPMI 1640 solution. After centrifugation (400 g, 10 min), the cells were resuspended in 75 mL of hybridoma medium with HAT and dispensed in 200-μL aliquots in 6 × 96-well plates (Corning, New York). The hybridoma medium

with HAT was changed after 7 days to hybridoma medium with HT. After 10–14 days of growth in this medium, culture supernatants were tested using an ELISA test, with OPS from S. Dakar

(O281283) and S. Telaviv (O281282). The ELISA test (enzyme-linked immunosorbent assay) was carried out in 96-well plates (C96 Maxisorp, Nunc, Denmark). The plate wells were coated overnight with 10 μL per well antigens (S. Dakar OPS and S. Telaviv OPS) diluted in carbonate buffer (50 mM), pH 9.6, at 4 °C, and tested against serial dilutions of MAb. Antibody binding was detected with peroxidase-conjugated goat anti mouse immunoglobulins (Dako A/S, Denmark) and substrate OPD (Sigma Fast™ OPD) and measured photometrically at 492 nm. For ELISA inhibition, the MAbs in dilution 1 : 20 were preincubated with an inhibitor (LPS and OPS of S. Dakar and S. Telaviv, 20 μg Selumetinib concentration per well) at 4 °C in 96-well plates overnight. Then, the antibodies were transferred to the plate containing the antigens mentioned, and the ELISA test was performed as earlier. Isotyping of MAbs was performed using the test ImmunoPure® Monoclonal Antibody Isotyping Kit I (HRP/ABTS; Pierce). For SDS-PAGE (Laemmli, 1970), an

LPS suspension (1.0 mg mL−1) mixed with a sample buffer (0.1 M Tris–HCl–20 mM EDTA, pH 6.8, containing 8% SDS, 20% glycerol and 0.001% bromophenol blue) was boiled for 20 min, and appropriate portions of LPS were applied to a gel. Electrophoresis was performed in a 15% acrylamide slab gel and 5% acrylamide stacking gel with either a constant current of 30 mA per gel. LPS was detected in the gel by the silver-staining method (Hitchcock & Brown, 1983). The structures of the repeating units of S. Dakar OPS and S. Telaviv OPS are presented in Fig. 1. Salmonella Dakar OPS has a regular structure of pentasaccharide units (Fig. 1a), whereas the S. Telaviv O-polysaccharide has a much more complicated chemical structure (Fig. 1b), with 25% of the main chain β-d-Galp linked in position 3 to a digalactose [α-d-Galp-(13)-α-d-Galp-(1)] branching chain, while terminal Glcp substitutes 55% of the GalpNAc units in position 4. Separation of the water-soluble carbohydrate products on a Bio-Gel P-100 column yielded three fractions of S. Telaviv OPS with different molecular weights: HMW S.

The role of lichen glucans (lichenans, isolichenans, pustulans, n

The role of lichen glucans (lichenans, isolichenans, pustulans, nigerans, lentinan-type glucans and laminarans) in the symbiotic association is not very well understood yet. For lichenin, Honegger & Haisch (2001) demonstrated that this buy NVP-LDE225 (13)(14)-β-glucan is a structural element of the fungal cell wall and has important functions in thalline water relations. Pereyra et al. (2003) also suggested a potential role of pustulan, a partially acetylated β-(16)-glucan, in the retention and storage of water in the thallus. As observed in free-living fungi, where glucans interact with mannoproteins and with each other to form a strong

cell wall, some of the lichen glucans may have the same function. The role of isolichenan in the symbiotic association has not yet been studied. Its absence in the aposymbiotically grown mycobiont suggests that it may not have an importance as a structural element of the fungal cell wall. As it is synthesized

by the mycobiont only in the presence of its symbiotic partner (green alga Trebouxia) in a special microenvironment, which is the lichen thallus, this α-glucan could be considered as a symbiotic product. What triggers this phenomenon and which biological function is exerted by this glucan in the symbiotic relationship is still unknown. In this study, it was also possible to observe that the aposymbiotically grown mycobiont R. complanata produced two more glycans: a Selleckchem Protease Inhibitor Library heteropolysaccharide and a glucan. A comparison of the 13C NMR spectra of Fehling’s Olopatadine supernatants (fraction SF-SK10) from R. peruviana (Cordeiro et al., 2004b, data not shown) and from R. complanata shows that they are similar. This indicated that these glycans were also present in the previously studied R. peruviana mycobiont. Interestingly, these polymers have not been detected in any of

the lichenized Ramalina studied so far (Stuelp et al., 1999; Cordeiro et al., 2003). Finally, lichens have a significant diversity of polysaccharide structures. The symbiotic source of polysaccharides was investigated only for lichens of the genus Ramalina. Further studies with symbionts of other lichens are necessary to verify whether this phenomenon is reproducible among other lichen symbioses, that is whether there are more polysaccharides that are symbiotic products and are not produced in the aposymbiotic state. This research was supported by CNPq foundation, PRONEX-Carboidratos and Fundação Araucária – Brazil. The authors are also grateful to Dr Roman Türk for identification of the lichen species. “
“Streptococcus iniae is a major pathogen of fish, causing considerable economic losses in Israel, the United States and the Far East.

The role of lichen glucans (lichenans, isolichenans, pustulans, n

The role of lichen glucans (lichenans, isolichenans, pustulans, nigerans, lentinan-type glucans and laminarans) in the symbiotic association is not very well understood yet. For lichenin, Honegger & Haisch (2001) demonstrated that this HDAC inhibitor (13)(14)-β-glucan is a structural element of the fungal cell wall and has important functions in thalline water relations. Pereyra et al. (2003) also suggested a potential role of pustulan, a partially acetylated β-(16)-glucan, in the retention and storage of water in the thallus. As observed in free-living fungi, where glucans interact with mannoproteins and with each other to form a strong

cell wall, some of the lichen glucans may have the same function. The role of isolichenan in the symbiotic association has not yet been studied. Its absence in the aposymbiotically grown mycobiont suggests that it may not have an importance as a structural element of the fungal cell wall. As it is synthesized

by the mycobiont only in the presence of its symbiotic partner (green alga Trebouxia) in a special microenvironment, which is the lichen thallus, this α-glucan could be considered as a symbiotic product. What triggers this phenomenon and which biological function is exerted by this glucan in the symbiotic relationship is still unknown. In this study, it was also possible to observe that the aposymbiotically grown mycobiont R. complanata produced two more glycans: a Bioactive Compound Library price heteropolysaccharide and a glucan. A comparison of the 13C NMR spectra of Fehling’s 3-mercaptopyruvate sulfurtransferase supernatants (fraction SF-SK10) from R. peruviana (Cordeiro et al., 2004b, data not shown) and from R. complanata shows that they are similar. This indicated that these glycans were also present in the previously studied R. peruviana mycobiont. Interestingly, these polymers have not been detected in any of

the lichenized Ramalina studied so far (Stuelp et al., 1999; Cordeiro et al., 2003). Finally, lichens have a significant diversity of polysaccharide structures. The symbiotic source of polysaccharides was investigated only for lichens of the genus Ramalina. Further studies with symbionts of other lichens are necessary to verify whether this phenomenon is reproducible among other lichen symbioses, that is whether there are more polysaccharides that are symbiotic products and are not produced in the aposymbiotic state. This research was supported by CNPq foundation, PRONEX-Carboidratos and Fundação Araucária – Brazil. The authors are also grateful to Dr Roman Türk for identification of the lichen species. “
“Streptococcus iniae is a major pathogen of fish, causing considerable economic losses in Israel, the United States and the Far East.

3c, both clean and infected cells exhibited μ-calpain and m-calpa

3c, both clean and infected cells exhibited μ-calpain and m-calpain

activities. When normalized for protein Daporinad content, the calpain activity in the infected cells was slightly lower than the activity observed in the clean cells, without a significant difference between them [the calpain activity levels in the infected cells were 80±12.2% as compared with the levels in the clean cells (P>0.1; n=3)]. The NDMH lacked any calpain activity (Fig. 3c), consistent with the absence of calpain protein in the mycoplasma shown by immunoblotting (Fig. 3a). The results suggested that under the conditions used here, calpastatin was, to a large extent, separated from calpain in the zymography of the cell extracts of NDMH-infected cells, similar to the separation in the clean cells, allowing calpain caseinolytic activity. To further investigate the effects of mycoplasmal infection on calpain activation and activity, differentiated SH-SY5Y

cells were treated with Ca2+/ionomycin, as described in Materials and methods. μ-Calpain autolysis was enhanced in the Ca2+/ionomycin-treated clean cells, as shown by the appearance of the calpain 76 kDa band, compared with the control clean cells. Little calpain autolysis was observed in the Ca2+/ionomycin-treated infected cells, as shown by the low ratio of the 76 kDa band to the 80 kDa band in these cells, compared with that of the clean cells (Fig. 4a and b). These results suggest that the higher levels of calpastatin in the NDMH-infected cells inhibit Ca2+-promoted calpain activation. Fodrin is a known substrate for calpain, with a fodrin fragment of 150 kDa indicative of caspase and calpain activities, 145 kDa considered find more to be due to calpain activity and 120 kDa considered to be due to caspase activity (Wang, 2000). As shown in Fig. 4c and d, a significantly increased degradation of fodrin to 150/145 kDa fragments was observed in the Ca2+/ionomycin-treated clean cells (211±22% of the levels in the control clean cells); degradation of fodrin to 150/145 kDa bands was inhibited in the

Ca2+/ionomycin-treated infected cells (125±3% of the levels in the control clean cells) (Fig. 4c and d). The results suggest that calpain activity, promoted Methamphetamine by increased Ca2+ in the intact clean cells, is inhibited in the infected, calpastatin-overexpressing cells. Contamination of human cell cultures by mycoplasma is frequent, commonly detected in 15–35% of cell cultures, with rates reaching 65–80% in some surveys (Drexler & Uphoff, 2002). Contamination is often undetected, because the culture medium remains clear and the cellular morphological changes may not be obvious. Thus, mycoplasma-induced alterations in cell components, metabolism and regulation of various functions (Drexler & Uphoff, 2002; Rottem, 2003) may not be appreciated, unless specifically studied. Mycoplasma hyorhinis is one of the most common Mycoplasma species that contaminate various cell cultures (Drexler & Uphoff, 2002; Timenetsky et al., 2006).

4%) The most common FTC resistance mutation was M184V (867%) T

4%). The most common FTC resistance mutation was M184V (86.7%). The PrEP drug resistance levels estimated in UK HIV-infectious MSM of 1.6, 0.9 or 4.1%, depending on the definition used, were within the range of values used Estrogen antagonist in simulation studies, which have suggested that circulating PrEP drug resistance will have negligible impact on PrEP efficacy [18]. The decline in PrEP resistance occurred despite an increase in the use of TDF (from 43.4 to 55.9%) and FTC/lamivudine (from 70.3 to 78.1%) between 2005 and 2008 in UK MSM on treatment. Conversely, zidovudine (ZDV) usage, the major driver for the development of TAMs, was found to have decreased

from 31.4 to 11.0%. Our study has a number of limitations. First, all mutations have been regarded as reducing susceptibility to PrEP commensurate with their impact on the efficacy of ART for treatment. However, the impact of mutations on PrEP efficacy is unknown, and Cong et al. [5] speculate that

TDF resistance may have a greater impact than FTC resistance. Furthermore, our TDF-FTC resistance definitions represent a worst-case scenario for PrEP resistance, as it is unlikely that exposure to HIV with only FTC mutations, such as M184V, would result in infection because of the increased sensitivity of TDF [5, 9] and because viruses with both K65R and M184V mutations have been shown [19] to have increased susceptibility to TDF compared with HIV with the K65R mutation alone, so true GBA3 PrEP resistance is likely to be lower selleck chemical than the calculated prevalence.

Secondly, although the methodology used in this paper avoids the overestimation of resistance that is known to occur if only data from ART-experienced patients with resistance tests are used [14], there may be unrecorded covariates (e.g. clinician’s assessment of adherence) which influence which patients are selected for resistance testing and introduce selection bias which cannot be controlled for. Thirdly, despite, in our methodology, the calculated PrEP resistance being adjusted for the reversion of TDR mutations between infection and resistance test, this is still likely to be an underestimate of true PrEP drug resistance. Our methodology assumes that diagnosis occurs 2 years after infection, but the time gap is likely to be larger. Fourthly, transmission risk has been found to be linked to the level of viral load [12], although a meta-analysis [20] found large variations between studies, precluding reliable estimation of a per-act transmission probability for MSM. Therefore, the plasma viral load measurements in this analysis were used to classify individuals as infectious or not infectious and the actual level of viral load has not been taken into account. Finally, simplistic weighting based on estimated population size was used to combine the various diagnosis/treatment groups. Ideally, this should consider the difference in sexual risk behaviours known to exist based on diagnosis status [10, 11].

In-hospital costs (for both in-patient and day-care admissions) w

In-hospital costs (for both in-patient and day-care admissions) were based on the DRG system in use in Italy since 1994, in which disease groups Copanlisib chemical structure are defined according to the hospital discharge form data. Costs

of out-patient consultations and examinations (laboratory and clinical imaging) were calculated based on the official standard costs assigned by the Italian Ministry of Health. According to an agreement between the Italian Ministry of Health and all pharmaceutical companies, hospitals pay half price for antiretroviral drugs, instead of the full cost paid by the public in Italy. All costs in this analysis were annualized and expressed in nominal terms for the year in which they were incurred. Costs incurred by patients (e.g. costs of travel to hospital services or costs of additional services incurred by staying at home), intangible costs (e.g. stress and anxiety) and indirect costs to society (e.g. loss of productivity) were INCB018424 clinical trial not estimated, as they did not affect the comparison of medical sector burden between chronic diseases, which was the main objective of the study. For the

same reasons, the cost analysis did not take into consideration the inflation rate, which the Italian National Institute of Statistics confirmed to be 2.1% on average at the time of our study. The criteria for the identification of HIV-infected persons were as follows: a diagnosis of HIV infection based on serological testing; For an HIV-infected person to be considered as having a concomitant chronic disease, they had to satisfy at least one of the above criteria for that chronic disease. HIV-infected persons who were at any time on antiretroviral treatment during the year were classified as ‘on antiretroviral treatment’. A verification procedure to assess the sensitivity of the BLHA database for detecting HIV-infected patients was performed through cross-checking of patients registered in the databases Thalidomide of the following institutions operating

in the Province: the Institute of Infectious and Tropical Diseases, the Clinic for Sexually Transmitted Diseases, Methadone Dispensing Units, and Primary Health Care Services for HIV Patients. Death certificates were also reviewed. Cross-checking verified that the BLHA database missed only 4% of patients registered in the other available databases. Starting from 2004, all newly identified cases were considered as ‘incident’ cases, by which we mean ‘newly diagnosed’ rather than ‘newly infected’. To calculate a denominator for the annual prevalence and incidence, we used an estimate of the mid-year average number of people who received services from the Brescia Local Health Authority during a calendar year.

In-hospital costs (for both in-patient and day-care admissions) w

In-hospital costs (for both in-patient and day-care admissions) were based on the DRG system in use in Italy since 1994, in which disease groups Roscovitine concentration are defined according to the hospital discharge form data. Costs

of out-patient consultations and examinations (laboratory and clinical imaging) were calculated based on the official standard costs assigned by the Italian Ministry of Health. According to an agreement between the Italian Ministry of Health and all pharmaceutical companies, hospitals pay half price for antiretroviral drugs, instead of the full cost paid by the public in Italy. All costs in this analysis were annualized and expressed in nominal terms for the year in which they were incurred. Costs incurred by patients (e.g. costs of travel to hospital services or costs of additional services incurred by staying at home), intangible costs (e.g. stress and anxiety) and indirect costs to society (e.g. loss of productivity) were Metabolism inhibitor not estimated, as they did not affect the comparison of medical sector burden between chronic diseases, which was the main objective of the study. For the

same reasons, the cost analysis did not take into consideration the inflation rate, which the Italian National Institute of Statistics confirmed to be 2.1% on average at the time of our study. The criteria for the identification of HIV-infected persons were as follows: a diagnosis of HIV infection based on serological testing; For an HIV-infected person to be considered as having a concomitant chronic disease, they had to satisfy at least one of the above criteria for that chronic disease. HIV-infected persons who were at any time on antiretroviral treatment during the year were classified as ‘on antiretroviral treatment’. A verification procedure to assess the sensitivity of the BLHA database for detecting HIV-infected patients was performed through cross-checking of patients registered in the databases to of the following institutions operating

in the Province: the Institute of Infectious and Tropical Diseases, the Clinic for Sexually Transmitted Diseases, Methadone Dispensing Units, and Primary Health Care Services for HIV Patients. Death certificates were also reviewed. Cross-checking verified that the BLHA database missed only 4% of patients registered in the other available databases. Starting from 2004, all newly identified cases were considered as ‘incident’ cases, by which we mean ‘newly diagnosed’ rather than ‘newly infected’. To calculate a denominator for the annual prevalence and incidence, we used an estimate of the mid-year average number of people who received services from the Brescia Local Health Authority during a calendar year.