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Introduction: Epidemiologic and modeling studies suggest that between 45 and 70% of individuals with chronic hepatitis C virus (HCV) infection in Canada remain undiagnosed. The Canadian Association for the Study of the Liver (CASL) recommends one-time screening of baby boomers (1945-1975). Screening programs in the US have shown a very high prevalence of previously undiagnosed HCV among patients seen in the emergency department (ED). We sought to assess the feasibility of implementing a targeted birth-cohort HCV screening program in a Canadian ED setting. Methods: Patients born from 1945 to 1975 presenting to the ED of a downtown Toronto hospital were offered HCV testing. Patients with life-threatening conditions, unable to provide verbal consent in English or intoxication were excluded. Blood samples were collected by finger prick on Dried Blood Spot (DBS) collection cards and tested for anti-HCV antibody with reflex to HCV RNA. Patients with positive HCV RNA were referred to a liver specialist. Results: During a 27-month period (July 2017 - Sept 2019), 8363 patients in the birth cohort presented to the ED during daytime hours. 80% (6714) met eligibility criteria, and 48.4% (3247) were offered testing. Screening was performed by non-medical staff (mean 8/day, median spots on DBS 4). 345 (10.6%) had been previously tested, and 639 (19.7%) declined. 2136 (65.8%) patients underwent testing: median age 58.4 years (40-82), 1117 male (52.3%). Of these, 45 patients (2.1%; 95% CI 1.5%-2.7%) were anti-HCV positive: 32 (76.2%) were HCV RNA positive, 10 (23.8%) negative and 3 not done due to inadequate DBS sample. 26 patients (81.3%) were linked to care and 3 (9.4%) lost to follow-up. HCV prevalence in the ED was significantly higher than the general Canadian population (2.1% vs 0.7%; p < 0.0001) but much lower than reported rates in American EDs (2.1% vs 10.3%; p < 0.0001). Conclusion: Acceptance of HCV screening in the ED birth cohort was high and easily performed using DBS to ensure the majority of positive samples were tested for HCV RNA. Challenges included implementation that limited number of people tested, and linkage to care for HCV positive patients. HCV prevalence among this ED birth cohort was higher than the general population but lower than seen in the ED in the US. This may in part be due to exclusion of individuals with more severe medical issues, refusal by higher risk subgroups, or population and healthcare system differences between countries.
Although interstage mortality for infants with hypoplastic left heart syndrome has declined within the National Pediatric Cardiology Quality Improvement Collaborative, variation across centres persists. It remains unclear whether centres with lower interstage mortality have lower-risk patients or whether differences in care may explain this variation. We examined previously established risk factors across National Pediatric Cardiology Quality Improvement Collaborative centres with lower and higher interstage mortality rates.
Lower-mortality centres were defined as those with >25 consecutive interstage survivors. Higher-mortality centres were defined as those with cumulative interstage mortality rates >10%, which is a collaborative historic baseline rate. Baseline risk factors and perioperative characteristics were compared.
Seven lower-mortality centres were identified (n=331 patients) and had an interstage mortality rate of 2.7%, as compared with 13.3% in the four higher-mortality centres (n=173 patients, p<0.0001). Of all baseline risk factors examined, the only factor that differed between the lower- and higher-mortality centres was postnatal diagnosis (18.4 versus 31.8%, p=0.001). In multivariable analysis, there remained a significant mortality difference between the two groups of centres after adjusting for this variable: adjusted mortality rate was 2.8% in lower-mortality centres compared with 12.6% in higher-mortality centres, p=0.003. Secondary analyses identified multiple differences between groups in perioperative practices and other variables.
Variation in interstage mortality rates between these two groups of centres does not appear to be explained by differences in baseline risk factors. Further study is necessary to evaluate variation in care practices to identify targets for improvement efforts.
Parasites of the genera Plasmodium and Haemoproteus (Apicomplexa: Haemosporida) are a diverse group of pathogens that infect birds nearly worldwide. Despite their ubiquity, the ecological and evolutionary factors that shape the diversity and distribution of these protozoan parasites among avian communities and geographic regions are poorly understood. Based on a survey throughout the Neotropics of the haemosporidian parasites infecting manakins (Pipridae), a family of Passerine birds endemic to this region, we asked whether host relatedness, ecological similarity and geographic proximity structure parasite turnover between manakin species and local manakin assemblages. We used molecular methods to screen 1343 individuals of 30 manakin species for the presence of parasites. We found no significant correlations between manakin parasite lineage turnover and both manakin species turnover and geographic distance. Climate differences, species turnover in the larger bird community and parasite lineage turnover in non-manakin hosts did not correlate with manakin parasite lineage turnover. We also found no evidence that manakin parasite lineage turnover among host species correlates with range overlap and genetic divergence among hosts. Our analyses indicate that host switching (turnover among host species) and dispersal (turnover among locations) of haemosporidian parasites in manakins are not constrained at this scale.
Greenhouse trials were conducted to determine Hooker's evening primrose transplant tolerance to POST-applied herbicides. Herbicide treatments consisted of glyphosate at 1.68 kg ae ha−1, glufosinate at 0.84 kg ai ha−1, fenoxaprop at 0.10 kg ai ha−1, fluazifop at 0.45 kg ai ha−1 + a nonionic surfactant (NIS) at 0.25% v/v, sulfosulfuron at 0.06 kg ai ha−1 + NIS at 0.25% v/v, quinclorac at 0.42 kg ae ha−1 + methylated seed oil (MSO) at 0.5% v/v, mesotrione at 0.21 kg ai ha−1, and the combination of quinclorac + mecoprop + dicamba at 0.42 + 0.21 + 0.06 kg ae ha−1 + MSO at 0.5% v/v. Fluazifop (14%) and fenoxaprop (19%) treatments did not result in any significant phytotoxicity 7 d after treatment (DAT) compared with the nontreated check. Hooker's evening primrose exhibited 26 to 37% phytotoxicity in response to quinclorac, glyphosate, or sulfosulfuron 7 DAT. Phytotoxicity ≥ 50% was observed for mesotrione, glufosinate, and the combination of quinclorac + mecoprop + dicamba 7 DAT. Phytotoxicity increased for all treatments 28 DAT. Fluazifop (21%) was the only treatment that did not exhibit phytotoxicity symptoms different from the nontreated check 28 DAT. Hooker's evening primrose exhibited 31 to 40% phytotoxicity with applications of fenoxaprop, glyphosate, or glufosinate 28 DAT. Phytotoxicity was ≥ 58% with all other treatments 28 DAT. Fluazifop exhibited similar above-ground (12.4 g) and below-ground (16.4 g) biomass as the nontreated check (10.8 and 14.7 g, respectively) 28 DAT. All other treatments resulted in 1.6 to 5 g of above-ground biomass and 0.8 to 4.3 g of below-ground biomass 28 DAT. Fluazifop (24.3) and fenoxaprop (18.8) applications resulted in a plant growth index (PGI) that was not significantly different from the nontreated check (24.7) 28 DAT. A PGI ≤ 16.2 was observed for all other treatments 28 DAT.
We investigate whether musculoskeletal anatomy and three-dimensional (3-D) body proportions were modified during the evolution of large (>6000 kg) body size in Allosauroidea (Dinosauria: Theropoda). Three adaptations for maintaining locomotor performance at large body size, related to muscle leverage, mass, and body proportions, are tested and all are unsupported in this analysis. Predictions from 3-D musculoskeletal models of medium-sized (Allosaurus) and large-bodied (Acrocanthosaurus) allosauroids suggest that muscle leverage scaled close to isometry, well below the positive allometry required to compensate for declining muscle cross-sectional area with increasing body size. Regression analyses on a larger allosauroid data set finds slight positive allometry in the moment arms of major hip extensors, but isometry is included within confidence limits. Contrary to other recent studies of large-bodied theropod clades, we found no compelling evidence for significant positive allometry in muscle mass between exemplar medium- and large-bodied allosauroids. Indeed, despite the uncertainty in quantitative soft tissue reconstruction, we find strong evidence for negative allometry in the caudofemoralis longus muscle, the single largest hip extensor in non-avian theropods. Finally, we found significant inter-study variability in center-of-mass predictions for allosauroids, but overall observe that consistently proportioned soft tissue reconstructions produced similar predictions across the group, providing no support for a caudal shift in the center of mass in larger taxa that might otherwise reduce demands on hip extensor muscles during stance. Our data set provides further quantitative support to studies that argue for a significant decline in locomotor performance with increasing body size in non-avian theropods. However, although key pelvic limb synapomorphies of derived allosauroids (e.g., dorsomedially inclined femoral head) evolved at intermediate body sizes, they may nonetheless have improved mass support.
Patients with schizophrenia and their first-degree relatives exhibit both abnormally diminished and increased neural activation during cognitive tasks. In particular, excessive task-related activity is often observed when tasks are easy, suggesting that inefficient cerebral recruitment may be a marker of vulnerability for schizophrenia. This hypothesis might best be tested using a very easy task, thus avoiding confounding by individual differences in task difficulty.
Eighteen people with schizophrenia, 18 unaffected full siblings of patients with schizophrenia and 26 healthy controls performed an easy auditory target-detection task in a 3-T magnetic resonance imaging (MRI) scanner. Groups were matched for accuracy on the task. Blood oxygen level-dependent (BOLD) responses to non-target stimuli in participants with vulnerability for schizophrenia (siblings and patients) were compared with those of healthy controls, and those of patients with those of unaffected siblings. BOLD responses to targets were compared with baseline, across groups.
Subjects with vulnerability for schizophrenia showed significant hyperactivation to non-targets in brain areas activated by targets in all groups, in addition to reduced deactivation to non-targets in areas suppressed by targets in all groups. Siblings showed greater activation than patients to non-targets in the medial frontal cortex. Patients exhibited significantly longer reaction times (RTs) than unaffected siblings and healthy controls.
Inefficient cerebral recruitment is a vulnerability marker for schizophrenia, marked by reduced suppression of brain areas normally deactivated in response to task stimuli, and increased activation of areas normally activated in response to task stimuli. Moreover, siblings show additional activation in the medial frontal cortex that may be protective.
The crustose lichen Lecanora conizaeoides has declined markedly around London with progressively diminishing sulphur dioxide pollution of the air since the 1960s. To identify the immediate causes of its decline, we applied S in the form of bisulphite (0·2 & 2 mM) and sulphate (2 mM), and N as nitrate (2 mM) to relict colonies of the lichen on beech trunks in a plantation in Windsor Forest. Growth of the lichen was monitored by estimating changes in percentage cover. By the end of a 25-month period of two-weekly treatments, all the chemical treatments had resulted in significant decreases in cover of L. conizaeoides compared to distilled water controls, with the 2 mM bisulphite causing the greatest loss. Bark surface pH was also lowered by the chemical treatments, but most by the 2 mM bisulphite applications. Similar results were obtained in two laboratory experiments where the nutrient applications were repeated under a controlled environment and thallus area monitored photographically. No evidence was obtained to support the hypothesis that growth of L. conizaeoides is stimulated by an elevated sulphur supply. We conclude that the disappearance of the lichen is linked to gradual increase in bark pH caused by the combined effects of a marked reduction in SO2 emissions and rising emissions of NH3.
Isoenzyme-based studies have identified 3 taxa/species/‘phylogenetic complexes’ as agents of visceral leishmaniasis in Sudan: L. donovani, L. infantum and “L. archibaldi”. However, these observations remain controversial. A new chitinase gene phylogeny was constructed in which stocks of all 3 putative species isolated in Sudan formed a monophyletic clade. In order to construct a more robust classification of the L. donovani complex, a panel of 16 microsatellite markers was used to describe 39 stocks of these 3 species. All “L. donovani complex” stocks from Sudan were again found to form a single monophyletic clade. L. donovani ss stocks from India and Kenya were found to form 2 region-specific clades. The partial sequence of the glutamate oxaloacetate transaminase (GOT) gene of 17 L. donovani complex stocks was obtained. A single nucleotide polymorphism in the GOT gene appeared to underlie the isoenzyme classification. It was concluded that isoenzyme-based identification is unsafe for stocks isolated in L. donovani endemic areas and identified as L. infantum. It was also concluded that the name L. archibaldi is invalid and that only a single visceralizing species, Leishmania donovani, is found in East Africa.
Low seed set is a serious problem in seed orchards of lodgepole pine (Pinus contorta var. latifolia Engelmann) in the southern interior of British Columbia. We tested the hypothesis that Leptoglossus occidentalis Heidemann is responsible for the low seed set. Cones enclosed in insect exclusion bags as part of a pollination experiment produced significantly more filled seeds per cone than cones that were not bagged. In a separate bagging experiment, cones that were enclosed with a L. occidentalis female and her progeny produced only about one filled seed per cone, compared with about 28 seeds in bagged control cones. Changes in microclimate associated with the use of bags did not appear to be responsible for the observed increase in seed set in bagged cones. Leptoglossus occidentalis was also excluded from trees using the insecticide fenvalerate. Cones on fenvalerate-treated trees produced > 11 filled seeds per cone, whereas water-treated (control) cones produced < 1.7 filled seeds. These data suggest that L. occidentalis should be considered a serious pest in lodgepole pine seed orchards.