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Introduction: Buprenorphine/naloxone (buprenorphine) has proven to be a life-saving intervention amidst the ongoing opioid epidemic in Canada. Research has shown benefits to initiating buprenorphine from the emergency department (ED) including improved treatment retention, systemic health care savings and fewer drug-related visits to the ED. Despite this, there has been little to no uptake of this evidence-based practice in our department. This qualitative study aimed to determine the local barriers and potential solutions to initiating buprenorphine in the ED and gain an understanding of physician attitudes and behaviours regarding harm reduction care and opioid use disorder management. Methods: ED physicians at a midsize Atlantic hospital were recruited by convenience sampling to participate in semi-structured privately conducted interviews. Audio recordings were transcribed verbatim and de-identified transcripts were uploaded to NVivo 12 plus for concept driven and inductive coding and a hierarchy of open, axial and selective coding was employed. Transcripts were independently reviewed by a local qualitative research expert and themes were compared for similarity to limit bias. Interview saturation was reached after 7 interviews. Results: Emergent themes included a narrow scope of harm reduction care that primarily focused on abstinence-based therapies and a multitude of biases including feelings of deception, fear of diversion, feeling buprenorphine induction was too time consuming for the ED and differentiating patients with opioid use disorder from ‘medically ill’ patients. Several barriers and proposed solutions to initiating buprenorphine from the ED were elicited including lack of training and need for formal education, poor familiarity with buprenorphine, the need for an algorithm and community bridge program and formal supports such as an addictions consult team for the ED. Conclusion: This study elicited several opportunities for improved care for patients with addictions presenting to our ED. Future education will focus on harm reduction care, specifically strategies for managing patients desiring to continue to use substances. Education will focus on addressing the multitude of biases elicited and dispelling common myths. A locally informed buprenorphine pathway will be developed. In future, this study may be used to advocate for improved formal supports for our department including an addictions consult team.
Recognition of the role of infectious agents in a range of both acute and chronic diseases is increasing. One key example is the potential epidemiological and neuropathological association between some cases of schizophrenia with the protozoan Toxoplasma gondii. T. gondii establishes persistent infection within the CNS and can alter host behaviour. Altered dopamine levels have been reported for both T. gondii infection and schizophrenia. Several medications used to treat schizophrenia demonstrate anti-T. gondii properties, and haloperidol, a dopamine antagonist, can prevent the development of T. gondii-altered behaviour in rodents. Furthermore, T. gondii may actually be a source of dopamine, as it encodes a copy of the mammalian enzyme tyrosine hydroxylase, which represents the rate-limiting step in dopamine synthesis.
Using the epidemiologically and clinically applicable rat-T. gondii model, and incorporating a battery of classical and novel non-invasive behavioural and physiological assays, we aim to further elucidate the impact of T. gondii on behaviour and the mechanisms involved.
T. gondii increases the rats’ propensity for predation risk through enhanced activity, visibility and manipulation of their perception of predation risk, turning innate aversion into a ‘suicidal’ feline attraction. There is little indication that T. gondii alters the rats generalized anxiety, nor potential to enhanced predation by non-definitive mammalian host species. Preliminary associative analyses into the relationship between individual behavioural alterations and neurotransmitter and brain cysts localisation profiles will be presented.
Our results provide further evidence for a role of T. gondii in the aetiology of some cases of schizophrenia.
Latent infection with the common intracellular protozoan parasite Toxoplasma gondii has been shown to result in altered behaviour of its host. This behaviour manipulation has been proposed to increase predation of the intermediate host (e.g. rodents and birds) enhancing parasite transmission. Other psychologicalsequalae have also been associated with latent toxoplasmosis including human affective disorders, as human are accidental hosts for Toxoplasma. During cyst stages of the life cycle found in the brain and other tissues, there is a complex interaction between the parasite and the host. Our research is concerned with the possibility that the parasite-induced behavioural changes are mediated by neurotransmitters. Potential factors in neurotransmitter levels include the location of the cyst, the host immune response, and direct parasite products. The cyst is found in many brain regions but elevated numbers have been reported in the hippocampus, amygdala, and nucleus accumbens. The host response involves interferon gamma suppressing growth through tryptophan degradation that could decrease serotonin levels. The parasite could directly manipulate the host brain through altering dopamine levels. We have found a change in dopamine associated with infection. Indeed, the parasite itself encodes the rate-limiting enzyme in dopamine synthesis, tyrosine hydroxylase. Dopamine's role is also supported by finding haloperidol, a dopamine antagonist, blocks manipulation of rodents by Toxoplasma. Our current investigations of alterations in neurotransmitter levels during chronic infection and association with brain cysts will be presented. Our data presents an interesting interplay with the ‘dopamine hypothesis’ that has postulated a link between elevated dopamine and schizophrenia.
Reliable diagnosis of human helminth infection(s) is essential for ongoing disease surveillance and disease elimination. Current WHO-recommended diagnostic assays are unreliable in low-endemic near-elimination settings and typically involve the invasive, onerous and potentially hazardous sampling of bodily fluids such as stool and blood, as well as tissue via biopsy. In contrast, diagnosis by use of non-invasive urine sampling is generally painless, more convenient and low risk. It negates the need for specialist staff, can usually be obtained immediately upon request and is better accepted by patients. In some instances, urine-based diagnostic assays have also been shown to provide a more reliable diagnosis of infection when compared to traditional methods that require alternative and more invasive bodily samples, particularly in low-endemicity settings. Given these relative benefits, we identify and review current research literature to evaluate whether non-invasive urine sampling is currently exploited to its full potential in the development of diagnostic tools for human helminthiases. Though further development, assessment and validation are needed before their routine use in control programmes, low-cost, rapid and reliable assays capable of detecting transrenal helminth-derived antigens and cell-free DNA show excellent promise for future use at the point-of-care in high-, medium- and even low-endemicity elimination settings.
A study was conducted in 2017 and 2018 at the H. Rouse Caffey Rice Research Station near Crowley, LA, to evaluate quizalofop at 120 g ai ha−1 applied independently or in a mixture with clomazone, pendimethalin, clomazone plus pendimethalin, or a prepackaged mixture of clomazone plus pendimethalin when PVLO1 rice reached the two- to three-leaf stage. A second application of quizalofop at 120 g ha−1 was applied 21 d after the initial application. At 7 days after treatment (DAT), antagonism of quizalofop occurred when mixed with clomazone at 334 g ai ha−1, clomazone at 334 g ai ha−1 plus pendimethalin at 810 g ai ha−1, or a prepackaged mixture of clomazone plus pendimethalin at 334 plus 810 g ai ha−1, respectively, when applied to barnyardgrass. At 7 DAT, a neutral interaction occurred with a mixture of quizalofop plus pendimethalin at 810 g ha−1. These data indicate the antagonism of quizalofop was overcome at 14, 28, and 42 DAT with a neutral interaction for barnyardgrass control, 94% to 98%, with all herbicide mixtures evaluated. A neutral interaction occurred for CL-111, CLXL-745, and red rice control when treated with all the herbicide mixtures evaluated across all evaluation dates. Rice yield decreased when not treated with the initial quizalofop application.
We apply two methods to estimate the 21-cm bispectrum from data taken within the Epoch of Reionisation (EoR) project of the Murchison Widefield Array (MWA). Using data acquired with the Phase II compact array allows a direct bispectrum estimate to be undertaken on the multiple redundantly spaced triangles of antenna tiles, as well as an estimate based on data gridded to the uv-plane. The direct and gridded bispectrum estimators are applied to 21 h of high-band (167–197 MHz; z = 6.2–7.5) data from the 2016 and 2017 observing seasons. Analytic predictions for the bispectrum bias and variance for point-source foregrounds are derived. We compare the output of these approaches, the foreground contribution to the signal, and future prospects for measuring the bispectra with redundant and non-redundant arrays. We find that some triangle configurations yield bispectrum estimates that are consistent with the expected noise level after 10 h, while equilateral configurations are strongly foreground-dominated. Careful choice of triangle configurations may be made to reduce foreground bias that hinders power spectrum estimators, and the 21-cm bispectrum may be accessible in less time than the 21-cm power spectrum for some wave modes, with detections in hundreds of hours.
Background: Biallelic variants in POLR1C are associated with POLR3-related leukodystrophy (POLR3-HLD), or 4H leukodystrophy (Hypomyelination, Hypodontia, Hypogonadotropic Hypogonadism), and Treacher Collins syndrome (TCS). The clinical spectrum of POLR3-HLD caused by variants in this gene has not been described. Methods: A cross-sectional observational study involving 25 centers worldwide was conducted between 2016 and 2018. The clinical, radiologic and molecular features of 23 unreported and previously reported cases of POLR3-HLD caused by POLR1C variants were reviewed. Results: Most participants presented between birth and age 6 years with motor difficulties. Neurological deterioration was seen during childhood, suggesting a more severe phenotype than previously described. The dental, ocular and endocrine features often seen in POLR3-HLD were not invariably present. Five patients (22%) had a combination of hypomyelinating leukodystrophy and abnormal craniofacial development, including one individual with clear TCS features. Several cases did not exhibit all the typical radiologic characteristics of POLR3-HLD. A total of 29 different pathogenic variants in POLR1C were identified, including 13 new disease-causing variants. Conclusions: Based on the largest cohort of patients to date, these results suggest novel characteristics of POLR1C-related disorder, with a spectrum of clinical involvement characterized by hypomyelinating leukodystrophy with or without abnormal craniofacial development reminiscent of TCS.
Background: The classic ketogenic diet is the main non-pharmacological treatment for refractory epilepsy; however, adherence is often challenging. The low glycemic index diet (LGID) is less strict, almost equally effective, and associated with improved adherence. Little is known about the quality of life of children treated with LGID. The objective of this study was to explore changes in the quality of life of children with epilepsy transitioning to the LGID. Methods: Patients on LGID and their parents filled out Pediatric Quality of Life Epilepsy Module questionnaires; one while being on the LGID, and one retrospectively for the time prior to starting the LGID. Results: Data was collected from five children ages 3-13 and their parents. Complete seizure control was seen in two children, >50% seizure reduction in one, and no change in two children. Parental reported quality of life while on the LGID increased with two participants but decreased in all child self reports. Conclusions: Although the LGID led to improved seizure control in three out of five patients, the child-reported quality of life decreased in all children. Larger prospective studies are warranted to reliably assess the impact of the LGID on the quality of life in children with epilepsy.
A study was conducted at the Louisiana State University Agricultural Center’s H. Rouse Caffey Rice Research Station in 2017 and 2018 to evaluate a prepackaged mixture of clomazone plus pendimethalin applied delayed preemergence (DPRE) or POST within an herbicide residual overlay with saflufenacil, clomazone, or quinclorac. POST applications included penoxsulam or halosulfuron in combination with the second residual application. No differences were observed in barnyardgrass control (92% to 98%) at 14 days after treatment (DAT). At 42 DAT, barnyardgrass treated with clomazone plus pendimethalin in combination with either clomazone or quinclorac at either timing was controlled 95% to 96%. However, when saflufenacil was applied PRE, regardless of the POST herbicide or when saflufenacil was applied POST with halosulfuron, barnyardgrass control was reduced to 78% to 81%, compared with 95% to 96% with the control with all other residual combinations. Yellow nutsedge and rice flatsedge control increased when treated with halosulfuron compared with penoxsulam across all evaluation dates. At 28 and 42 DAT, texasweed treated with saflufenacil PRE, regardless of POST applications, was controlled 83% and 87%, respectively, and this was greater control than provided by clomazone or quinclorac applied PRE regardless of POST herbicide program.
We provide the first in situ measurements of antenna element beam shapes of the Murchison Widefield Array. Most current processing pipelines use an assumed beam shape, which can cause absolute and relative flux density errors and polarisation ‘leakage’. Understanding the primary beam is then of paramount importance, especially for sensitive experiments such as a measurement of the 21-cm line from the epoch of reionisation, where the calibration requirements are so extreme that tile to tile beam variations may affect our ability to make a detection. Measuring the primary beam shape from visibilities is challenging, as multiple instrumental, atmospheric, and astrophysical factors contribute to uncertainties in the data. Building on the methods of Neben et al. [Radio Sci., 50, 614], we tap directly into the receiving elements of the telescope before any digitisation or correlation of the signal. Using ORBCOMM satellite passes we are able to produce all-sky maps for four separate tiles in the XX polarisation. We find good agreement with the beam model of Sokolowski et al. [2017, PASA, 34, e062], and clearly observe the effects of a missing dipole from a tile in one of our beam maps. We end by motivating and outlining additional on-site experiments.
We describe the motivation and design details of the ‘Phase II’ upgrade of the Murchison Widefield Array radio telescope. The expansion doubles to 256 the number of antenna tiles deployed in the array. The new antenna tiles enhance the capabilities of the Murchison Widefield Array in several key science areas. Seventy-two of the new tiles are deployed in a regular configuration near the existing array core. These new tiles enhance the surface brightness sensitivity of the array and will improve the ability of the Murchison Widefield Array to estimate the slope of the Epoch of Reionisation power spectrum by a factor of ∼3.5. The remaining 56 tiles are deployed on long baselines, doubling the maximum baseline of the array and improving the array u, v coverage. The improved imaging capabilities will provide an order of magnitude improvement in the noise floor of Murchison Widefield Array continuum images. The upgrade retains all of the features that have underpinned the Murchison Widefield Array’s success (large field of view, snapshot image quality, and pointing agility) and boosts the scientific potential with enhanced imaging capabilities and by enabling new calibration strategies.
Political preferences in the United States are highly correlated with population density, at national, state, and metropolitan-area scales. Using new data from voter registration records, we assess the extent to which this pattern can be explained by geographic mobility. We find that the revealed preferences of voters who move from one residence to another correlate with partisan affiliation, though voters appear to be sorting on non-political neighborhood attributes that covary with partisan preferences rather than explicitly seeking politically congruent neighbors. But, critically, we demonstrate through a simulation study that the estimated partisan bias in moving choices is on the order of five times too small to sustain the current geographic polarization of preferences. We conclude that location must have some influence on political preference, rather than the other way around, and provide evidence in support of this theory.
In Cameroon, there is a national programme engaged in the control of schistosomiasis and soil-transmitted helminthiasis. In certain locations, the programme is transitioning from morbidity control towards local interruption of parasite transmission. The volcanic crater lake villages of Barombi Mbo and Barombi Kotto are well-known transmission foci and are excellent context-specific locations to assess appropriate disease control interventions. Most recently they have served as exemplars of expanded access to deworming medications and increased environmental surveillance. In this paper, we review infection dynamics through time, beginning with data from 1953, and comment on the short- and long-term success of disease control. We show how intensification of local control is needed to push towards elimination and that further environmental surveillance, with targeted snail control, is needed to consolidate gains in preventive chemotherapy as well as empower local communities to take ownership of interventions.
The current emphasis of schistosomiasis control is placed on preventive chemotherapy using praziquantel. However, reinfection may occur rapidly in the absence of complementary interventions. Recent studies from Senegal suggest that predatory prawns might feed on intermediate host snails and thus impact on schistosomiasis transmission. We designed a study with four repeated cross-sectional surveys pertaining to prawns and snails, coupled with a single cross-sectional parasitological survey among humans. We assessed for potential associations between the presence/density of prawns and snails and correlation with Schistosoma infection in a composite sample of school-aged children and adults. The study was carried out between October 2015 and December 2016 in 24 villages located near the Agnéby and Mé coastal river systems in south-eastern Côte d'Ivoire. At each site, snails and prawns were collected, and in each village, 150 individuals were subjected to stool and urine examination for the diagnosis of Schistosoma mansoni and S. haematobium. We found peaks of relative abundance of intermediate host snails in the villages of the Agnéby River system, while predatory prawns were predominantly recorded in the Mé River system. A negative association was observed between intermediate host snail densities and riverine prawns; however, no pattern was found between this trend in the predator–prey relationship and the prevalence of human schistosomiasis.
Two field studies were conducted in Louisiana to determine the impact of Nealley’s sprangletop on rough rice yield under multiple environments in 2014, 2015, and 2016. The first study evaluated optimal timings of Nealley’s sprangletop removal for optimizing rough rice yields. The second study evaluated the impact of Nealley’s sprangletop densities on rough rice yield. Nealley’s sprangletop was removed with applications of fenoxaprop at 122 g ai ha–1 at 7, 14, 21, 28, 35, and 42 d after emergence (DAE). Nealley’s sprangletop removal at 7 and 14 DAE resulted in higher rough rice yields of 7,880 and 6,960 kg ha–1, respectively, when compared with the rice from the season-long Nealley’s sprangletop competition with a 6,040 kg ha-1 yield. Delaying herbicide application from 7 DAE to 42 DAE resulted in a yield loss of 1,740 kg ha–1. Over the 35-d delay in application, rough rice yield loss from Nealley’s sprangletop interference was equivalent to 50 kg ha–1 d–1. Nealley’s sprangletop densities were established at 1, 3, 7, 13, and 26 plants m–2 by transplanting Nealley’s sprangletop when rice reached the one- to two-leaf stage. At Nealley’s sprangletop densities of 1 to 26 plants m–2, rough rice yields were reduced 10 to 270 kg ha–1, compared with the rice from weed-free plots. Based on regression analysis, Nealley’s sprangletop densities of 1, 35, 70, and 450 plants m–2 reduced rough rice yield 0.14%, 5%, 10%, and 50%, respectively.