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Spotted fever group rickettsiae (SFG) are a neglected group of bacteria, belonging to the genus Rickettsia, that represent a large number of new and emerging infectious diseases with a worldwide distribution. The diseases are zoonotic and are transmitted by arthropod vectors, mainly ticks, fleas and mites, to hosts such as wild animals. Domesticated animals and humans are accidental hosts. In Asia, local people in endemic areas as well as travellers to these regions are at high risk of infection. In this review we compare SFG molecular and serological diagnostic methods and discuss their limitations. While there is a large range of molecular diagnostics and serological assays, both approaches have limitations and a positive result is dependent on the timing of sample collection. There is an increasing need for less expensive and easy-to-use diagnostic tests. However, despite many tests being available, their lack of suitability for use in resource-limited regions is of concern, as many require technical expertise, expensive equipment and reagents. In addition, many existing diagnostic tests still require rigorous validation in the regions and populations where these tests may be used, in particular to establish coherent and worthwhile cut-offs. It is likely that the best strategy is to use a real-time quantitative polymerase chain reaction (qPCR) and immunofluorescence assay in tandem. If the specimen is collected early enough in the infection there will be no antibodies but there will be a greater chance of a PCR positive result. Conversely, when there are detectable antibodies it is less likely that there will be a positive PCR result. It is therefore extremely important that a complete medical history is provided especially the number of days of fever prior to sample collection. More effort is required to develop and validate SFG diagnostics and those of other rickettsial infections.
Provision of critical care and resuscitation was not practical during early missions into space. Given likely advancements in commercial spaceflight and increased human presence in low Earth orbit (LEO) in the coming decades, development of these capabilities should be considered as the likelihood of emergent medical evacuation increases.
PubMed, Web of Science, Google Scholar, National Aeronautics and Space Administration (NASA) Technical Server, and Defense Technical Information Center were searched from inception to December 2018. Articles specifically addressing critical care and resuscitation during emergency medical evacuation from LEO were selected. Evidence was graded using Oxford Centre for Evidence-Based Medicine guidelines.
The search resulted in 109 articles included in the review with a total of 2,177 subjects. There were two Level I systematic reviews, 33 Level II prospective studies with 647 subjects, seven Level III retrospective studies with 1,455 subjects, and two Level IV case series with four subjects. There were two Level V case reports and 63 pertinent review articles.
The development of a medical evacuation capability is an important consideration for future missions. This review revealed potential hurdles in the design of a dedicated LEO evacuation spacecraft. The ability to provide critical care and resuscitation during transport is likely to be limited by mass, volume, cost, and re-entry forces. Stabilization and treatment of the patient should be performed prior to departure, if possible, and emphasis should be on a rapid and safe return to Earth for definitive care.
Apolipoprotein E (APOE) E4 is the main genetic risk factor for Alzheimer’s disease (AD). Due to the consistent association, there is interest as to whether E4 influences the risk of other neurodegenerative diseases. Further, there is a constant search for other genetic biomarkers contributing to these phenotypes, such as microtubule-associated protein tau (MAPT) haplotypes. Here, participants from the Ontario Neurodegenerative Disease Research Initiative were genotyped to investigate whether the APOE E4 allele or MAPT H1 haplotype are associated with five neurodegenerative diseases: (1) AD and mild cognitive impairment (MCI), (2) amyotrophic lateral sclerosis, (3) frontotemporal dementia (FTD), (4) Parkinson’s disease, and (5) vascular cognitive impairment.
Genotypes were defined for their respective APOE allele and MAPT haplotype calls for each participant, and logistic regression analyses were performed to identify the associations with the presentations of neurodegenerative diseases.
Our work confirmed the association of the E4 allele with a dose-dependent increased presentation of AD, and an association between the E4 allele alone and MCI; however, the other four diseases were not associated with E4. Further, the APOE E2 allele was associated with decreased presentation of both AD and MCI. No associations were identified between MAPT haplotype and the neurodegenerative disease cohorts; but following subtyping of the FTD cohort, the H1 haplotype was significantly associated with progressive supranuclear palsy.
This is the first study to concurrently analyze the association of APOE isoforms and MAPT haplotypes with five neurodegenerative diseases using consistent enrollment criteria and broad phenotypic analysis.
Working memory (WM) deficits are seen as a core deficit in schizophrenia, implicated in the broad cognitive impairment seen in the illness. Here we examine the impact of WM storage of a single item on the operation of other cognitive systems.
We studied 37 healthy controls (HCS) and 43 people with schizophrenia (PSZ). Each trial consisted of a sequence of two potential target stimuli, T1 and T2. T1 was a letter presented for 100 ms. After delays of 100–800 ms, T2 was presented. T2 was a 1 or a 2 and required a speeded response. In one condition, subjects were instructed to ignore T1 but respond to T2. In another condition, they were required to report T1 after making their speeded response to T2 (i.e. to make a speeded T2 response while holding T1 in WM).
PSZ were dramatically slowed at responding to T2 when T1 was held in WM. A repeated measures ANOVA yielded main effects of group, delay, and condition with a group by condition interaction (p's < 0.001). Across delays, the slowing of the T2 response when required to hold T1 in memory, relative to ignoring T1, was nearly 3 times higher in PSZ than HCS (633 v. 219 ms).
Whereas previous studies have focused on reduced storage capacity, the present study found that PSZ are impaired at performing tasks while they are successfully maintaining a single item in WM. This may play a role in the broad cognitive impairment seen in PSZ.
Scholarship on welfare privatization illustrates how the process often curtails and undermines public responsibility for the poor. In this article, I examine how recipients, policy makers, and judges participate in the legal process as a means of challenging and defending privatization. I look at cases of litigation initiated by public housing tenants between 1985 and 2012 to fight the demolition of their homes to explore the changing meaning of public responsibility within a shrinking public sector. My findings show that as legislative and administrative reforms steered courts toward a more flexible understanding of public responsibility, courts gave increasing attention to the economic hardships experienced by the state itself, while downplaying the plight of low-income tenants.
Prion diseases are rare dementias that most commonly occur sporadically, but can be inherited or acquired, and for which there is no cure. We sought to understand which prion disease symptoms are most problematic for carers, to inform the development of outcome measures.
Self-completed questionnaire with follow-up of a subset of participants by structured interview.
A nested study in the UK National Prion Monitoring Cohort, a longitudinal observational study.
Participants and measurements:
71 carers, of people with different prion diseases with a wide range of disease severity, identified 236 of their four most problematic symptoms by questionnaire which were grouped into ten domains. Structured interviews were then done to qualitatively explore these experiences. Eleven family carers of people with prion disease were selected, including those representative of a range of demographics and disease subtypes and those who cared for people with prion disease, living or recently deceased. Interviews were transcribed and formally studied.
The six most problematic symptom domains were: mobility and coordination; mood and behavior; personal care and continence; eating and swallowing; communication; and cognition and memory. The prevalence of these symptoms varied significantly by disease stage and type. A formal analysis of structured interviews to explore these domains is reported.
We make suggestions about how healthcare professionals can focus their support for people with prion disease. Clinical trials that aim to generate evidence regarding therapies that might confer meaningful benefits to carers should consider including outcome measures that monitor the symptomatic domains we have identified as problematic.
This concise guide offers an ideal overview of both the practical and theoretical aspects of foot and ankle surgery for trainees and junior consultants. Easy to read chapters cover all areas of surgery, from examination, imaging, and the biomechanics of the foot and ankle, to specific conditions including amputations and prostheses, deformities, arthritis, cavus and flat foot, sports injuries, Achilles tendon, benign and malignant tumors and heel pain. Fractures and dislocations of the ankle, hind-, mid- and forefoot are also covered, as are the foot in diabetes and pediatrics. Written by a team of international experts, the text is an accessible way to prepare for postgraduate examinations and manage patients successfully.
We applaud the efforts of Cortina, Rabelo, and Holland (2018) in their development of perpetrator predation as a sensitizing concept (see also Cortina, 2017) for future work in workplace aggression and mistreatment (hereafter workplace mistreatment). The importance of being mindful of the manner in which we frame our arguments is both highly relevant and well-articulated by the authors. We further believe that the transfer of focus from that of blaming victims to placing the onus for workplace mistreatment on the actor him/herself is an important idea as our field continues to develop into the 21st century.
A controversy at the 2016 IUCN World Conservation Congress on the topic of closing domestic ivory markets (the 007, or so-called James Bond, motion) has given rise to a debate on IUCN's value proposition. A cross-section of authors who are engaged in IUCN but not employed by the organization, and with diverse perspectives and opinions, here argue for the importance of safeguarding and strengthening the unique technical and convening roles of IUCN, providing examples of what has and has not worked. Recommendations for protecting and enhancing IUCN's contribution to global conservation debates and policy formulation are given.
Ceropales bipunctata Say (Hymenoptera: Pompilidae) is a cleptoparasitic spider wasp that has declined significantly in parts of its range. New survey work has revealed that the species is common and widespread in dune habitat along the Gulf of Saint Lawrence in New Brunswick, Canada. Its host was determined as Anoplius cleora (Banks) (Hymenoptera: Pompilidae), with Arctosa littoralis (Hentz) (Araneae: Lycosidae) as prey, the first host record for this species. The relative abundance of C. bipunctata in coastal New Brunswick sharply contrasts with a decline in Ontario, Canada, where it was thought to be extirpated. Based on body size, habitat, and locality overlap we postulate that the primary host of C. bipunctata in Ontario and western Québec, Canada, is a different species, Anoplius aethiops (Cresson), with A. atrox (Dahlbom) as a likely secondary host in southwestern Ontario. Both species are closely related to A. cleora and have undergone a decline in eastern Canada. Based on these new findings, we reassess the conservation status of C. bipunctata in Canada.
There is debate about the relative importance of timing of stressful events prenatally and over the life course and risk for subsequent depressive/anxious illness. The aim of this study was to examine the relative roles of prenatal stress and postnatal stress trajectories in predicting depression and anxiety in early adulthood in males and females. Exposure to life stress events was examined in the Western Australian Pregnancy Cohort (Raine) Study during pregnancy and ages 1, 2, 3, 5, 8, 10, 14, and 17 years. At age 20, offspring completed the Depression Anxiety Stress Scale. Prenatal stress and trajectories of stress events from age 1 to 17 were analyzed in linear regression analyses. Five postnatal stress trajectories were identified. In females, medium to high chronic stress exposure or exposure during puberty/adolescence predicted depression and anxiety symptoms while low or reduced stress exposure over the life course did not, after adjustment for relevant confounders. High stress early in pregnancy contributed to male depression/anxiety symptoms independent of postnatal stress trajectory. In females, postnatal stress trajectory was more important than prenatal stress in predicting depression/anxiety symptoms. Interventions focused on reducing and managing stress events around conception/pregnancy and exposure to chronic stress are likely to have beneficial outcomes on rates of depression and anxiety in adults.
Data from a rawinsonde network are used to provide aerological estimates of monthly precipitation minus evaporation (P – E) averaged over the region north of 70° N. Using published climatological estimates of E, area-averaged P is obtained for each month and year as a residual. Using surface temperatures from the rawinsonde network, the fraction of precipitation falling as snow is then estimated. Over the 1974–91 study period, precipitation and snowfall (water equivalent) have annual means of 26.6 and 19.0 cm. respectively. Assuming a representative aged snowpack density of 330 kg m−3 yields a total snow depth of 57.5 cm. The mean annual cycles of both variables display an autumn maximum, but because of the temperature dependency, nearly all precipitation falls as rain during July and August. Composite analyses reveal that increased precipitation for all seasons and increased snowfall for winter and autumn are favored by a “winter-type” circulation pattern, characterized by stronger troughs over the Atlantic and Eurasian sectors of the Arctic, associated with increased cyclonic activity over the Arctic peripheral seas.
A search of recent political science literature and conference presentations shows substantial fascination with the concept of the natural experiment. However, there seems to be a wide array of definitions and applications employed in research that purports to analyze natural experiments. In this introductory essay to the special issue, we attempt to define natural experiments and discuss related issues of research design. In addition, we briefly explore the basic methodological issues around the appropriate analysis of natural experiments and give an overview of different techniques. The overarching theme of this essay and of this issue is to encourage applied researchers to look for natural experiments in their own work and to think more systematically about research design.
Sea turtles host a diverse array of epibionts, yet it is not well understood what factors influence epibiont community composition. To test whether epibiont communities of sea turtles are influenced by the hosts’ nesting or foraging habitats, we characterized the epibiota of leatherback, olive ridley and green turtles nesting at a single location on the Pacific coast of Costa Rica. We also compared the epibiota of these turtles to conspecific populations nesting elsewhere in the East Pacific. If epibiont communities are influenced by nesting habitats, we predicted that sympatrically nesting turtles would have comparable epibiont taxa. Alternatively, if epibiont communities are influenced by foraging habitats, we predicted the diversity of epibiont taxa should reflect the type and diversity of the hosts’ foraging habitats. We identified 18 epibiont taxa from 18 leatherback, 19 olive ridley and six green turtles. Epibiont diversity was low on leatherbacks (four taxa), but higher for olive ridley and green turtles (12 and nine epibiont taxa respectively). The epibiont communities of olive ridley and green turtles were not statistically different, but both were different from leatherbacks. In addition, conspecific sea turtles from other nesting locations hosted more similar epibiont communities than sympatrically nesting, non-conspecifics. We conclude that epibiont diversity of nesting sea turtles is partially linked to the diversity of their foraging habitats. We also conclude that the surface properties of the skin and carapace of these turtles may contribute to the uniqueness of leatherback turtle epibiont communities and the similarities between olive ridley and green turtle epibiont communities.