How Climate Effects the Tick Vector of Lyme Disease: A Critical and Systematic Review of the Literature

Background Lyme disease (LD) is a common vector-borne disease in North America. Understanding the causes behind inter-annual fluctuations of LD incidence can help warn healthcare providers of upcoming outbreaks. Objective Identifying what specific climate variables affects the vector, Ixodes scapularis ticks, and ultimately LD incidence. Methods A systematic review was carried out to understand how climate variables affect the tick population variables that are related to LD. Results Twenty-one studies met the inclusion criteria. Risk of bias was generally rated “low” or “probably low” and quality of evidence was rated “moderate”. Strength of evidence was assessed for tick abundance, a proxy for LD. The relationship with climatic moisture was rated as “sufficient”, but was rated “inadequate” for temperature and temperature+moisture. A positive, moderate-strong relationship between prior climatic moisture and tick abundance (r=0.82; r2=0.56–0.64) was observed in 50% of studies. The relationship was observed in 75% of nymph-only abundance studies. While relationships were observed between tick abundance and temperature (70% of studies, r=(-0.89)–0.93; r2=(-0.56)–0.34) and temperature+moisture (38% of studies, 75% negative relationships), direction and magnitude could not be determined. Conclusion Higher climatic moisture (yearly or 0.5–2 years prior) increases tick abundance and, by proxy, LD incidence. Nymph-only abundance studies, a more accurate proxy, was more likely to show this relationship. Climate change is predicted to increase precipitation in Northeast US/Canada, which appears likely to increase LD incidence

(VIDEO) Characterizing the Exposome: Critical Analysis of Exposome-Wide Association Studies

Purpose: The exposome is a conceptual framework of all exposures encountered by an individual in his or her lifetime. Studying the exposome is thereby a monumental feat that may require extensive research, conceptualization, and proof-of-concept analyses. Researchers have begun studying the exposome by developing exposome- and environment-wide association studies (EWAS). Since EWAS is such a novel technique, this critical analysis of existing EWAS in the literature sought to determine whether the studies utilized common research methods, how the data were analyzed, and whether the analyses were similar. The analysis also sought to explore ways in which these studies could inform study of the exposome. Methods: The ProQuest Environmental Science Collection was queried for articles conducting exposome-wide association studies and environment-wide association studies. Only research articles were accepted for further analysis. These articles were examined following epidemiological study critical analysis guidelines. Results: Five research articles were returned through literature review. Methods analysis determined that the studies conducted similar regression analyses of extensive exposure variables with a single health outcome as the dependent variable. One study utilized an animal model and primarily studied metabolites, thereby supporting the concept that metabolomics may play a supporting role in study of the exposome. All studies utilized validation procedures and examined results using a false discovery rate. Conclusions: The EWAS articles examined in this critical analysis conducted extensive validation procedures to successfully demonstrate the statistical significance of large-scale linear and logistic regression. These procedures will likely make EWAS a valuable resource in future exposome studies

(VIDEO) Barriers to Implementing Advance Care Planning in the Healthcare Setting

Objectives: Current barriers to implementing Advanced Care Planning (ACP) will be examined as applied to the healthcare system. Methods: A literature review was performed looking at the current practices of ACP (e.g. filling out advanced directives (AD), Medical Orders for Life Sustaining Treatment (MOLST)/ Physician Orders for Life Sustaining Treatment (POLST), etc.), physician comfort level with having end-of-life discussion (EOL), successful/unsuccessful interventions to increase ACP/EOL discussions among health care providers (HCP), and the current political environment with respect to physicians’ ability to implement ACP/EOL discussions. Cochrane, Pubmed, and Google Scholar were searched for papers written in English after 2000 in the United States In order to be eligible, the studies were required to discuss educational interventions, patient/physician barriers, and/or political barriers surround ACP/EOL discussions. Results: Seventeen articles were identified to meet the inclusion criteria and are included in this review. Barriers identified by both the physician and the patient were: lack of time, lack of awareness, lack of comfort, and lack of a systematic approach. Educational interventions for health care providers somewhat improved comfort levels. The introduction of the Medicare Reimbursement had a substantial impact on increasing the amount of ACP/EOL conversations reported. Conclusions: Although there is some evidence that educational interventions aimed at health care providers improves the providers’ knowledge, self-efficacy, and communication with regards to ACP, health-system and political barriers remain to impact ACP implementation. Medicare reimbursement not only allows physicians to be paid for their time facilitating these discussion, but legitimizes its need. It is recommended that a systematic approach to ACP, throughout the course of the patient’s life, will improve implementation rates and physician/patient comfort levels with ACP/EOL discussions

Cognitive and Behavioral Effects of Nitrogen Dioxide Exposure in Primary School Children: A Systematic Review

A systematic literature review was conducted to identify relevant studies evaluating the relationship between nitrogen dioxide emissions and cognitive and behavioral health in children. Eight studies were identified, reviewed, and analyzed according to specific inclusion criteria. The results of the review show that there is strong evidence for an inverse relationship between nitrogen dioxide exposure and cognitive and behavioral health in primary school children. However, further research is needed to confirm the observed associations between nitrogen dioxide exposure and cognitive and behavioral health

Improving global influenza surveillance: trends of A(H5N1) virus in Africa and Asia

<p>Abstract</p> <p>Background</p> <p>Highly pathogenic avian influenza A(H5N1) viruses are an important health problem in many Asian and African countries. The current increase in human cases demonstrates that influenza A(H5N1) is still a significant global pandemic threat. Many health organizations have recognized the need for new strategies to improve influenza global surveillance. Specifically, the World Health Organization through the global technical consultation for influenza surveillance have called for a detailed picture of the current limitations, especially at the nation level, to evaluate, standardize and strength reporting systems. The main goal of our study is to demonstrate the value of genetic surveillance as part of a strategic surveillance plan. As a proof of concept, we evaluated the current situation of influenza A(H5N1) in Asian and Africa.</p> <p>Results</p> <p>Our analysis revealed a power-law distribution in the number of sequences of A(H5N1) viruses analyzed and/or reported to influenza surveillance networks. The majority of the Asian and African countries at great risk of A(H5N1) infections have very few (approximately three orders of magnitude) sequenced A(H5N1) viruses (e.g. hemagglutinin genes). This suggests that countries under pandemic alert for avian influenza A(H5N1) have very limited participation (e.g. data generation, genetic analysis and data share) in avian influenza A(H5N1) surveillance. More important, this study demonstrates the usefulness of influenza genetic surveillance to detect emerging pandemic threat viruses.</p> <p>Conclusions</p> <p>Our study reveals that some countries suffering from human cases of avian influenza have limited participation (e.g. genetic surveillance or data share) with global surveillance networks. Also, we demonstrate that the implementation of genetic surveillance programs could increase and strengthen worldwide epidemic and pandemic preparedness. We hope that this work promotes new discussions between policy makers and health surveillance organizations to improve current methodologies and regulations.</p

On the Cellular Basis of Hydrogen Sulfide Toxicity

170 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2008.Hydrogen sulfide (H2S) produced by colonic sulfate-reducing bacteria represents an insult to the intestinal epithelium potentially contributing to chronic disorders that are dependent on gene-environment interactions. Clinical and epidemiologic studies reveal either persistent sulfate-reducing bacteria colonization or higher H2S concentrations in the gut or feces of patients suffering from ulcerative colitis and/or colorectal cancer. However, there is not a satisfactory mechanistic model able to explain these circumstantial observations. In these studies, we first examined the chronic cytotoxicity of sulfide using a microplate assay and genotoxicity using the single-cell gel electrophoresis (SCGE; comet assay) in Chinese hamster ovary (CHO) and HT-29 cl.16E cells. Sulfide showed chronic cytotoxicity in CHO cells with a %C1/2 of 368.57 Mmol/L. Sulfide was genotoxic for both cell lines but this effect was observed only when DNA repair was inhibited. The HT-29 cl.16E colonocyte cell line was less sensitive to sulfide than CHO cells. Furthermore when naked nuclei were directly treated with sulfide, DNA damage was observed at concentrations two orders of magnitude lower than previously observed with intact cells. This damage was effectively quenched by co-treatment with butylhydroxyanisole. Sulfide treatment also increased the number of oxidized bases recognized by formamidopyrimidine [fapy]-DNA glycosylase. These results confirmed the genotoxicity of sulfide and suggested that sulfide-induced genotoxicity is mediated by free radicals. Consequently we sought to define the early (30 min) and late (4 h) response of human non-transformed intestinal epithelial cells (FHs 74 Int) to a genotoxic---but not cytotoxic---concentration of sulfide (500 muM Na2S) using pathway specific quantitative RT-PCR arrays. Significant changes in gene expression were predominantly observed at 4 h, including PTGS2 (Cox-2; 7.9 fold upregulation), and IL-1A (interleukin 1 alpha; 5.2 fold downregulation). Functional pathway analysis indicated that sulfide modulates cell cycle progression and triggers both an inflammatory and DNA repair response. Together, these observations stress the possible role of sulfide as an insult in the intestinal environment that, given a predisposing genetic background, may lead to genomic instability or the cumulative mutations found in adenomatous polyps leading to colorectal cancer.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD

Analysis of Policy Barriers to Emergency Medical Service Involvement in Hospice Care

Purpose The life expectancy in the United States is longer than ever before. However, as the Baby Boom generation ages and people die increasingly slow deaths from chronic conditions, there will be a growing need for partnerships and programs to ensure end of life patients get the care they need in the setting that they want. One partnership in particular that has a growing following is that between hospice agencies and the Emergency Medical Services. This paper will examine potential policies at the Federal, State, and systemic levels that hinder or prevent EMS agencies from participating in hospice services. Methods A review of literature was conducted. Academic literature from after 1974 – the date of the first American hospice agency – and grey literature from after 2007 were considered. SCOPUS, CINAHL, and the Himmelfarb Library database were queried with various combinations of MeSH terms. Those results were then screened by date and content for relevance. A variety of government agencies and relevant NGOs were also searched for applicable content. Results Significant barriers to EMS involvement in hospice services exist at the Federal and State levels. At the Federal level, there is a major problem with reimbursement for both EMS and Hospice services with regards to this type of care. The Drug Enforcement Administration also has policy barriers written into the Controlled Substances Act, but there is legislation waiting for the President’s signature that may reverse these barriers. Additional barriers exist on a state by state basis, but these were more difficult to determine, and searching for each independently proved challenging. Conclusion Significant barriers to EMS involvement in Hospice care exist at Federal and State levels. Because some states allow for EMS agencies to provide home health services without transport, and because the major barriers to the federal controlled substance issue is expected to resolve soon, there is an opportunity for further research into EMS / hospice collaboration efficacy given the correct policy conditions. There is also an opportunity to explore novel reimbursement structures and criteria to support these programs and benefit the patient population they serve

Climate-Driven Models of Valley Fever Incidence: A Systematic Review

Background: Valley Fever incidence has risen dramatically in the Southwest United States over the past two decades. Current hypotheses of Valley Fever infection implicate dust as a vector and climate as an influencing factor on seasonal and annual disease incidence. Climate-driven models have aided the understanding of other infectious disease such as meningococcal meningitis and Rift Valley Fever. Objectives: To evaluate model design of climate-driven models predicting Valley Fever incidence by through the framework of a systematic review. Methods: We conducted a systematic literature review using both the PRISMA and Navigation guides. Web of Science, Pubmed, Embase, ProQuest, and Scopus were searched for all articles published in English after 1997 pertaining to climate and Valley Fever. Only studies utilizing county, state, and national level exposure and case information from the Southwest United States were included in this review. Results: Eight studies modeling Valley Fever incidence by climate variables were identified and reviewed. Exploratory analysis revealed bimodal peaks in both incidence and precipitation throughout the study areas. Adjusting for disease incubation and grouping incident cases by season provided the best estimate of a case’s exposure window. Detrending annual incident case data increases model sensitivity as recent linear increases in incidence cannot be explained solely by climate. Seasonal incidence terms and seasonal climate parameters provided the most accurate and precise model results, with a maximum full model R2 of 0.8. Discussion: Application of climate-driven Valley Fever models in public health can enhance preventative and diagnostic measures. Use of large exposure windows or seasons improves model accuracy and accounts for the varied nature of disease report dates

(VIDEO) Is using a bicycle as method for transportation contributing to your mental health? A critical analysis on the effects of physical activity in individuals suffering from depression and anxiety

**This submission has been withdrawn by request of the author.*