SUMMARY Real-time PCR has revolutionized the way clinical microbiology laboratories diagnose many human microbial infections. This testing method combines PCR chemistry with fluorescent probe detection of amplified product in the same reaction vessel. In general, both PCR and amplified product detection are completed in an hour or less, which is considerably faster than conventional PCR detection methods. Real-time PCR assays provide sensitivity and specificity equivalent to that of conventional PCR combined with Southern blot analysis, and since amplification and detection steps are performed in the same closed vessel, the risk of releasing amplified nucleic acids into the environment is negligible. The combination of excellent sensitivity and specificity, low contamination risk, and speed has made real-time PCR technology an appealing alternative to culture- or immunoassay-based testing methods for diagnosing many infectious diseases. This review focuses on the application of real-time PCR in the clinical microbiology laboratory.

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Human herpesvirus 6 (HHV-6) infection is common after transplantation; HHV-6 is known to interact with other viruses and induce immunosuppression. Whether HHV-6 plays a role in the occurrence of cytomegalovirus (CMV) infection after transplantation was investigated. In a cohort of 247 liver transplant recipients, HHV-6 seroconversion was identified as a significant risk factor for development of symptomatic CMV infection (P õ .001), including CMV organ involvement (P õ .001), even in the presence of the other significant risk factors: D / /R 0 CMV serologic status (P õ .001) or use of OKT3 after transplantation (P Å .002). Subgroup analysis indicated that HHV-6 seroconversion was significantly associated with symptomatic CMV infection in the D / /R / but not in the D / /R 0 CMV serologic group (P õ .001 and P Å .11, respectively). These results indicate that HHV-6 seroconversion is a marker for CMV disease after transplantation and suggest that additional studies using more sensitive diagnostic techniques are warranted to determine the relationship between HHV-6 and CMV infection after transplantation.

These results suggest that HHV-6 seronegativity before transplantation is a valuable clinical marker that identifies patients at risk for developing fungal infection after transplantation.

Purpose – The purpose of this paper is to advance a framework that identifies three key domains of work and a set of more nuanced considerations and actions within each domain for school leaders seeking to improve school-wide student learning in low-performing schools facing conditions of accountability. Design/methodology/approach – Review of literature. Findings – Drawing from the work of Robinson et al. (2008), the authors identify and discuss a set of nuanced considerations and actions for school leaders seeking to improve school-wide student learning in low-performing schools facing conditions of accountability. These considerations and actions fall into three broad domains of leader work: first, goal setting and planning for goal achievement; second, promoting and participating in teacher learning; and third, planning, coordinating, and evaluating teaching and curriculum. Practical implications – This paper generates implications for school leaders, and school leader developers, school districts, and state departments’ of education. The authors detail two key implications for school districts and/or state departments’ of education as they seek to offer guidance and support to low-performing schools facing conditions of accountability. It also generates a testable framework that can be drawn upon to examine school improvement and the work of school leaders in low-performing schools facing conditions of accountability. Originality/value – The analysis reveals unique challenges and considerations situated within each of the three domains of leader work found by Robinson et al. (2008) to have moderate to strong effects on student outcomes. These issues motivate an assortment of more nuanced leader actions and considerations in each of the three domains of leader work of consequence to student learning. The analysis provides an important accounting of an assortment of nuanced actions and considerations likely to be necessary if leaders are to support the improvement of student learning in these uniquely challenged settings.