Distribution of Breeding Shorebirds on the Arctic Coastal Plain of Alaska

Available information on the distribution of breeding shorebirds across the Arctic Coastal Plain of Alaska is dated, fragmented, and limited in scope. Herein, we describe the distribution of 19 shorebird species from data gathered at 407 study plots between 1998 and 2004. This information was collected using a single-visit rapid area search technique during territory establishment and early incubation periods, a time when social displays and vocalizations make the birds highly detectable. We describe the presence or absence of each species, as well as overall numbers of species, providing a regional perspective on shorebird distribution. We compare and contrast our shorebird distribution maps to those of prior studies and describe prominent patterns of shorebird distribution. Our examination of how shorebird distribution and numbers of species varied both latitudinally and longitudinally across the Arctic Coastal Plain of Alaska indicated that most shorebird species occur more frequently in the Beaufort Coastal Plain ecoregion (i.e., closer to the coast) than in the Brooks Foothills ecoregion (i.e., farther inland). Furthermore, the occurrence of several species indicated substantial longitudinal directionality. Species richness at surveyed sites was highest in the western portion of the Beaufort Coastal Plain ecoregion. The broad-scale distribution information we present here is valuable for evaluating potential effects of human development and climate change on Arctic-breeding shorebird populations.Les renseignements qui existent en matière de répartition des oiseaux de rivage en reproduction sur la plaine côtière de l’Arctique en Alaska sont anciens, fragmentés et restreints. Ici, nous décrivons la répartition de 19 espèces d’oiseaux de rivage à partir de données recueillies à 407 lieux de recherche entre 1998 et 2004. Cette information a été recueillie grâce à une technique de recherche consistant en une seule visite rapide durant les périodes d’établissement du territoire et de début d’incubation, périodes pendant lesquelles les comportements sociaux et les vocalisations permettent de bien repérer les oiseaux. Nous décrivons la présence ou l’absence de chaque espèce, de même que le nombre général d’espèces, ce qui procure une perspective régionale de la répartition des oiseaux de rivage. Nous comparons et contrastons nos cartes de répartition des oiseaux de rivage à celles d’études antérieures, en plus de décrire les tendances les plus marquées en matière de répartition des oiseaux de rivage. Notre examen de la variation latitudinale et longitudinale en matière de répartition et de nombre d’espèces d’oiseaux de rivage à l’échelle de la plaine côtière arctique de l’Alaska nous a permis de constater que la plupart des espèces d’oiseaux de rivage se manifestaient plus souvent dans la région écologique de la plaine côtière de Beaufort (c’est-à-dire plus proche de la côte) que dans la région écologique des contreforts de Brooks (c’est-à-dire plus à l’intérieur des terres). Par ailleurs, l’occurrence de plusieurs espèces indiquait une directionalité longitudinale substantielle. La richesse des espèces aux sites à l’étude était à son meilleur dans la partie ouest de la région écologique de la plaine côtière de Beaufort. Les renseignements sur la répartition à grande échelle que nous présentons ici jouent un rôle dans l’évaluation des effets éventuels des travaux de mise en valeur par l’être humain et du changement climatique sur les populations d’oiseaux de rivage en reproduction de l’Arctique

Is Streptococcus pyogenes resistant or susceptible to Trimethoprim-Sulfamethoxazole?

Streptococcus pyogenes is commonly believed to be resistant to trimethoprim-sulfamethoxazole (SXT), resulting in reservations about using SXT for skin and soft tissue infections (SSTI) where S. pyogenes is involved. S. pyogenes\u27 in vitro susceptibility to SXT depends on the medium\u27s thymidine content. Thymidine allows S. pyogenes to bypass the sulfur-mediated inhibition of folate metabolism and, historically, has resulted in apparently reduced susceptibility of S. pyogenes to sulfur antibacterials. The low thymidine concentration in Mueller-Hinton agar (MHA) is now regulated. We explored S. pyogenes susceptibility to SXT on various media. Using two sets of 100 clinical S. pyogenes isolates, we tested for susceptibility using SXT Etests on MHA containing defibrinated horse blood and 20 mg/liter β-NAD (MHF), MHA with sheep blood (MHS), MHA alone, MHA with horse blood (MHBA), and MHA with lysed horse blood (MHLHBA). European Committee on Antibacterial Susceptibility Testing (EUCAST) breakpoints defined susceptibility (MIC, ≤1 mg/liter) and resistance (MIC, >2 mg/liter). In study 1, 99% of S. pyogenes isolates were susceptible to SXT on MHA, MHBA, and MHLHBA, with geometric mean MICs of 0.04, 0.04, and 0.05 mg/liter, respectively. In study 2, all 100 S. pyogenes isolates were susceptible to SXT on MHF, MHS, MHA, and MHLHBA with geometric mean MICs of 0.07, 0.16, 0.07, and 0.09 mg/liter, respectively. This study confirms the in vitro susceptibility of S. pyogenes to SXT, providing support for the use of SXT for SSTIs. A clinical trial using SXT for impetigo is ongoing

Improving Delivery of Secondary Prophylaxis for Rheumatic Heart Disease in a High-Burden Setting: Outcome of a Stepped-Wedge, Community, Randomized Trial

BACKGROUND Health system strengthening is needed to improve delivery of secondary prophylaxis against rheumatic heart disease. METHODS AND RESULTS We undertook a stepped-wedge, randomized trial in northern Australia. Five pairs of Indigenous community clinics entered the study at 3-month steps. Study phases comprised a 12 month baseline phase, 3 month transition phase, 12 month intensive phase and a 3- to 12-month maintenance phase. Clinics received a multicomponent intervention supporting activities to improve penicillin delivery, aligned with the chronic care model, with continuous quality-improvement feedback on adherence. The primary outcome was the proportion receiving ≥80% of scheduled penicillin injections. Secondary outcomes included "days at risk" of acute rheumatic fever recurrence related to late penicillin and acute rheumatic fever recurrence rates. Overall, 304 patients requiring prophylaxis were eligible. The proportion receiving ≥80% of scheduled injections during baseline was 141 of 304 (46%)-higher than anticipated. No effect attributable to the study was evident: in the intensive phase, 126 of 304 (41%) received ≥80% of scheduled injections (odds ratio compared with baseline: 0.78; 95% confidence interval, 0.54-1.11). There was modest improvement in the maintenance phase among high-adhering patients (43% received ≥90% of injections versus 30% [baseline] and 28% [intensive], P<0.001). Also, the proportion of days at risk in the whole cohort decreased in the maintenance phase (0.28 versus 0.32 [baseline] and 0.34 [intensive], P=0.001). Acute rheumatic fever recurrence rates did not differ between study sites during the intensive phase and the whole jurisdiction (3.0 versus 3.5 recurrences per 100 patient-years, P=0.65). CONCLUSIONS This strategy did not improve adherence to rheumatic heart disease secondary prophylaxis within the study time frame. Longer term primary care strengthening strategies are needed. CLINICAL TRIAL REGISTRATION URL: www.anzctr.org.au. Unique identifier: ACTRN12613000223730

Loop Evolution Observed with AIA and Hi-C

In the past decade, the evolution of EUV loops has been used to infer the loop substructure. With the recent launch of High Resolution Coronal Imager (Hi-C), this inference can be validated. In this presentation we discuss the first results of loop analysis comparing AIA and Hi-C data. In the past decade, the evolution of EUV loops has been used to infer the loop substructure. With the recent launch of High Resolution Coronal Imager (Hi-C), this inference can be validated. In this presentation we discuss the first results of loop analysis comparing AIA and Hi-C data

An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial

Objective To evaluate the clinical efficacy of an established programme of occupational therapy in maintaining functional activity and reducing further health risks from inactivity in care home residents living with stroke sequelae. Design Pragmatic, parallel group, cluster randomised controlled trial. Setting 228 care homes (>10 beds each), both with and without the provision of nursing care, local to 11 trial administrative centres across the United Kingdom. Participants 1042 care home residents with a history of stroke or transient ischaemic attack, including those with language and cognitive impairments, not receiving end of life care. 114 homes (n=568 residents, 64% from homes providing nursing care) were allocated to the intervention arm and 114 homes (n=474 residents, 65% from homes providing nursing care) to standard care (control arm). Participating care homes were randomised between May 2010 and March 2012. Intervention Targeted three month programme of occupational therapy, delivered by qualified occupational therapists and assistants, involving patient centred goal setting, education of care home staff, and adaptations to the environment. Main outcome measures Primary outcome at the participant level: scores on the Barthel index of activities of daily living at three months post-randomisation. Secondary outcome measures at the participant level: Barthel index scores at six and 12 months post-randomisation, and scores on the Rivermead mobility index, geriatric depression scale-15, and EuroQol EQ-5D-3L questionnaire, at all time points. Results 64% of the participants were women and 93% were white, with a mean age of 82.9 years. Baseline characteristics were similar between groups for all measures, personal characteristics, and diagnostic tests. Overall, 2538 occupational therapy visits were made to 498 participants in the intervention arm (mean 5.1 visits per participant). No adverse events attributable to the intervention were recorded. 162 (11%) died before the primary outcome time point, and 313 (30%) died over the 12 months of the trial. The primary outcome measure did not differ significantly between the treatment arms. The adjusted mean difference in Barthel index score at three months was 0.19 points higher in the intervention arm (95% confidence interval −0.33 to 0.70, P=0.48). Secondary outcome measures also showed no significant differences at all time points. Conclusions This large phase III study provided no evidence of benefit for the provision of a routine occupational therapy service, including staff training, for care home residents living with stroke related disabilities. The established three month individualised course of occupational therapy targeting stroke related disabilities did not have an impact on measures of functional activity, mobility, mood, or health related quality of life, at all observational time points. Providing and targeting ameliorative care in this clinically complex population requires alternative strategies

Toll-like receptor 2-modulating pectin-polymers in alginate-based microcapsules attenuate immune responses and support islet-xenograft survival

Encapsulation of pancreatic islets in alginate-microcapsules is used to reduce or avoid the application of life-long immunosuppression in preventing rejection. Long-term graft function, however, is limited due to varying degrees of host tissue responses against the capsules. Major graft-longevity limiting responses include inflammatory responses provoked by biomaterials and islet-derived danger-associated molecular patterns (DAMPs). This paper reports on a novel strategy for engineering alginate microcapsules presenting immunomodulatory polymer pectin with varying degrees of methyl-esterification (DM) to reduce these host tissue responses. DM18-pectin/alginate microcapsules show a significant decrease of DAMP-induced Toll-Like Receptor-2 mediated immune activation in vitro, and reduce peri-capsular fibrosis in vivo in mice compared to higher DM-pectin/alginate microcapsules and conventional alginate microcapsules. By testing efficacy of DM18-pectin/alginate microcapsules in vivo, we demonstrate that low-DM pectin support long-term survival of xenotransplanted rat islets in diabetic mice. This study provides a novel strategy to attenuate host responses by creating immunomodulatory capsule surfaces that attenuate activation of specific pro-inflammatory immune receptors locally at the transplantation site