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 Relationship between Sialomucin and Sulfomucin Expression and Hydrogenotrophic Microbes in the Human Colonic Mucosa

The colonic mucus layer is comprised primarily of acidomucins, which provide viscous properties and can be broadly classified into sialomucins or sulfomucins based on the presence of terminating sialic acid or sulfate groups. Differences in acidomucin chemotypes have been observed in diseases such as colorectal cancer and inflammatory bowel disease, and variation in sialo- and sulfomucin content may influence microbial colonization. For example, sulfate derived from sulfomucin degradation may promote the colonization of sulfate-reducing bacteria (SRB), which through sulfate respiration generate the genotoxic gas hydrogen sulfide. Here, paired biopsies from right colon, left colon, and rectum of 20 subjects undergoing routine screening colonoscopies were collected to enable parallel histochemical and microbiological studies. Goblet cell sialo- and sulfomucins in each biopsy were distinguished histochemically and quantified. Quantitative PCR and multivariate analyses were used to examine the abundance of hydrogenotrophic microbial groups and SRB genera relative to acidomucin profiles. Regional variation was observed in sialomucins and sulfomucins with the greatest abundance of each found in the rectum. Mucin composition did not appear to influence the abundance of SRB or other hydrogenotrophic microbiota but correlated with the composition of different SRB genera. A higher sulfomucin proportion correlated with higher quantities of Desulfobacter, Desulfobulbus and Desulfotomaculum, relative to the predominant Desulfovibrio genus. Thus, acidomucin composition may influence bacterial sulfate respiration in the human colon, which may in turn impact mucosal homeostasis. These results stress the need to consider mucus characteristics in the context of studies of the microbiome that target intestinal diseases

Use of the analysis of the volatile faecal metabolome in screening for colorectal cancer

Diagnosis of colorectal cancer is an invasive and expensive colonoscopy, which is usually carried out after a positive screening test. Unfortunately, existing screening tests lack specificity and sensitivity, hence many unnecessary colonoscopies are performed. Here we report on a potential new screening test for colorectal cancer based on the analysis of volatile organic compounds (VOCs) in the headspace of faecal samples. Faecal samples were obtained from subjects who had a positive faecal occult blood sample (FOBT). Subjects subsequently had colonoscopies performed to classify them into low risk (non-cancer) and high risk (colorectal cancer) groups. Volatile organic compounds were analysed by selected ion flow tube mass spectrometry (SIFT-MS) and then data were analysed using both univariate and multivariate statistical methods. Ions most likely from hydrogen sulphide, dimethyl sulphide and dimethyl disulphide are statistically significantly higher in samples from high risk rather than low risk subjects. Results using multivariate methods show that the test gives a correct classification of 75% with 78% specificity and 72% sensitivity on FOBT positive samples, offering a potentially effective alternative to FOBT

Occurrence of Regulated and Emerging Iodinated DBPs in the Shanghai Drinking Water

10.1371/journal.pone.0059677PLoS ONE83

The HIV-1 Transactivator Factor (Tat) Induces Enterocyte Apoptosis through a Redox-Mediated Mechanism

The intestinal mucosa is an important target of human immunodeficiency virus (HIV) infection. HIV virus induces CD4+ T cell loss and epithelial damage which results in increased intestinal permeability. The mechanisms involved in nutrient malabsorption and alterations of intestinal mucosal architecture are unknown. We previously demonstrated that HIV-1 transactivator factor (Tat) induces an enterotoxic effect on intestinal epithelial cells that could be responsible for HIV-associated diarrhea. Since oxidative stress is implicated in the pathogenesis and morbidity of HIV infection, we evaluated whether Tat induces apoptosis of human enterocytes through oxidative stress, and whether the antioxidant N-acetylcysteine (NAC) could prevent it. Caco-2 and HT29 cells or human intestinal mucosa specimens were exposed to Tat alone or combined with NAC. In an in-vitro cell model, Tat increased the generation of reactive oxygen species and decreased antioxidant defenses as judged by a reduction in catalase activity and a reduced (GSH)/oxidized (GSSG) glutathione ratio. Tat also induced cytochrome c release from mitochondria to cytosol, and caspase-3 activation. Rectal dialysis samples from HIV-infected patients were positive for the oxidative stress marker 8-hydroxy-2′-deoxyguanosine. GSH/GSSG imbalance and apoptosis occurred in jejunal specimens from HIV-positive patients at baseline and from HIV-negative specimens exposed to Tat. Experiments with neutralizing anti-Tat antibodies showed that these effects were direct and specific. Pre-treatment with NAC prevented Tat-induced apoptosis and restored the glutathione balance in both the in-vitro and the ex-vivo model. These findings indicate that oxidative stress is one of the mechanism involved in HIV-intestinal disease