Identifying children with Cystic Fibrosis in population-scale routinely collected data in Wales

IntroductionThe challenges in identifying a cohort of people with a rare condition can be addressed by routinely collected, population-scale electronic health record (EHR) data, which provide large volumes of data at a national level. This paper describes the challenges of accurately identifying a cohort of children with Cystic Fibrosis (CF) using EHR and their validation against the UK CF Registry.ObjectivesTo establish a proof of principle and provide insight into the merits of linked data in CF research; to identify the benefits of access to multiple data sources, in particular the UK CF Registry data, and to demonstrate the opportunity it represents as a resource for future CF research.MethodsThree EHR data sources were used to identify children with CF born in Wales between 1st January 1998 and 31st August 2015 within the Secure Anonymised Information Linkage (SAIL) Databank. The UK CF Registry was later acquired by SAIL and linked to the EHR cohort to validate the cases and explore the reasons for misclassifications.ResultsWe identified 352 children with CF in the three EHR data sources. This was greater than expected based on historical incidence rates in Wales. Subsequent validation using the UK CF Registry found that 257 (73%) of these were true cases. Approximately 98.7% (156/158) of individuals identified as CF cases in all three EHR data sources were confirmed as true cases; but this was only the case for 19.8% (20/101) of all those identified in just a single data source.ConclusionIdentifying health conditions in EHR data can be challenging, so data quality assurance and validation is important or the merit of the research is undermined. This retrospective review identifies some of the challenges in identifying CF cases and demonstrates the benefits of linking cases across multiple data sources to improve quality

Toxoplasma gondii Infection in the Brain Inhibits Neuronal Degeneration and Learning and Memory Impairments in a Murine Model of Alzheimer's Disease

Immunosuppression is a characteristic feature of Toxoplasma gondii-infected murine hosts. The present study aimed to determine the effect of the immunosuppression induced by T. gondii infection on the pathogenesis and progression of Alzheimer's disease (AD) in Tg2576 AD mice. Mice were infected with a cyst-forming strain (ME49) of T. gondii, and levels of inflammatory mediators (IFN-γ and nitric oxide), anti-inflammatory cytokines (IL-10 and TGF-β), neuronal damage, and β-amyloid plaque deposition were examined in brain tissues and/or in BV-2 microglial cells. In addition, behavioral tests, including the water maze and Y-maze tests, were performed on T. gondii-infected and uninfected Tg2576 mice. Results revealed that whereas the level of IFN-γ was unchanged, the levels of anti-inflammatory cytokines were significantly higher in T. gondii-infected mice than in uninfected mice, and in BV-2 cells treated with T. gondii lysate antigen. Furthermore, nitrite production from primary cultured brain microglial cells and BV-2 cells was reduced by the addition of T. gondii lysate antigen (TLA), and β-amyloid plaque deposition in the cortex and hippocampus of Tg2576 mouse brains was remarkably lower in T. gondii-infected AD mice than in uninfected controls. In addition, water maze and Y-maze test results revealed retarded cognitive capacities in uninfected mice as compared with infected mice. These findings demonstrate the favorable effects of the immunosuppression induced by T. gondii infection on the pathogenesis and progression of AD in Tg2576 mice

Acacia trees on the cultural landscapes of the Red Sea Hills

This paper examines interactions between five pastoral nomadic culture groups of the Egyptian and Sudanese Red Sea Hills and the acacia trees Acacia tortilis (Forssk.) Hayne subsp. tortilis and subsp. raddiana growing in their arid environments. A. tortilis is described as a keystone species both ecologically and culturally: the trees play such critical roles in ecosystems and social groups that their removal would greatly impact both systems. Interviews in the field with the Semitic, Arabic-speaking Ma‘aza and Ababda, and the Cushitic, Beja, Bidhaawyeet-speaking Bishaari, Amar Ar and Hadandawa nomads probed the cultural and ecological contexts of acacias in pastoral nomadism, revealing deep insight into traditional ecological knowledge and traditional perceptions and uses of the trees. The paper describes how this knowledge guides pastoral decision-making, with acacias as a particularly critical component of the pastoral livelihood in both normal and stressful circumstances. A. tortilis is the most important reliable vegetation resource for nomads while also providing fuel and other useful products, ecosystem services for people and animals, and increased biodiversity by providing diverse microhabitats and resources for other species. We describe aspects of kinship, territorial organization, spiritual beliefs and tribal law underlying the significance of trees on the cultural landscape. We discuss environmental and economic challenges to human/tree relationships and to pastoral livelihoods. We challenge views of nomads as agents of ecological destruction, and propose maintenance and restoration of traditional pastoralism as viable alternatives in dryland development

Do pain, anxiety and depression influence quality of life for people with amyotrophic lateral sclerosis/motor neuron disease? A national study reconciling previous conflicting literature

The original version of this article unfortunately contained a mistake. Oliver Hanemann name was incorrect in the in the acknowledgements section of this paper

Toxoplasma gondii and the blood-brain barrier

Infection with the protozoan parasite Toxoplasma gondii is characterized by asymptomatic latent infection in the central nervous system and skeletal muscle tissue in the majority of immunocompentent individuals. Life-threatening reactivation of the infection in immunocompromized patients originates from rupture of Toxoplasma cysts in the brain. While major progress has been made in our understanding of the immunopathogenesis of infection the mechanism(s) of neuroinvasion of the parasite remains poorly understood. The present review presents the current understanding of blood-brain barrier (patho)physiology and the interaction of Toxoplasma gondii with cells of the blood-brain barrier