Parasitic nematodes simultaneously suppress and benefit from coccidian coinfection in their natural mouse host

Within-host interactions among coinfecting parasites are common and have important consequences for host health and disease dynamics. However, these within-host interactions have traditionally been studied in laboratory mouse models, which often exclude important variation and use unnatural host–parasite combinations. Conversely, the few wild studies of within-host interactions often lack knowledge of parasite exposure and infection history. Here we exposed laboratory-reared wood mice (Apodemus sylvaticus) that were derived from wild-caught animals to two naturally-occurring parasites (nematode: Heligmosomoides polygyrus, coccidia: Eimeria hungaryensis) to investigate the impact of coinfection on parasite infection dynamics, and to determine if the host immune response mediates this interaction. Coinfection led to delayed worm expulsion and prolonged egg shedding in H. polygyrus infections and lower peak E. hungaryensis oocyst burdens. By comparing antibody levels between wild and colony-housed mice, we also found that wild mice had elevated H. polygyrus-IgG1 titres even if currently uninfected with H. polygyrus. Using this unique wild-laboratory system, we demonstrate, for the first time, clear evidence for a reciprocal interaction between these intestinal parasites, and that there is a great discrepancy between antibody levels measured in the wild vs those measured under controlled laboratory conditions in relation to parasite infection and coinfection

Keeping the lights on: the Oakland EcoBlock community electrification and microgrid improves health, comfort and resilience in an urban neighborhood

How can cities efficiently and affordably undergo effective and dramatic decarbonization of buildings and vehicles? Can these strategies promote equity and scale across the urban environment worldwide? The EcoBlock in Oakland, California seeks to answer this urgent environmental, social, and technical question by designing, testing, and deploying community-scale energy and water systems. These innovative systems combine energy and water efficiency and electrification at the building scale with an electrical system that integrates rooftop solar, block-scale storage, electric vehicle (EV) charging, and a smart microgrid that optimizes supply and demand at the block-scale.This paper presents the approach and strategies when moving from design to implementation deploying this novel prototype toward industrializing city-wide, residential microgrids that generate their own clean, renewable power for homes and EVs. Scaling retrofits requires coordination from evaluation, product selection, permitting and installation involving contractors, utilities, consultants and various Authorit(ies) Having Jurisdiction (AHJ). Improvements at homes interconnect with block scale microgrid and EV charging in an existing block and social dynamic. This paper will discuss opportunities and pitfalls to implementing block scale electrification and microgrid to achieve environmental benefits of emission savings and resiliency, utility cost benefits, social benefits of neighborhood network, and comfort and health benefits in each home

Young women’s construction of their post-cancer fertility

Younger women diagnosed with cancer often face compromised fertility as a result of their treatment. However, previous research has adopted a biomedical model of fertility and utilised hypothetico-deductive research methods which have not allowed for full exploration of women's subjectivity. This study explored younger women's construction of their fertility post-cancer, and their discussions of fertility with healthcare professionals, from a social constructionist epistemology. Semi-structured one-to-one interviews were conducted with eight women aged 18-26, across a variety of cancer types. Foucaultian Discourse Analysis identified three subject positions associated with fertility concerns: 'Inadequate woman: Accepting the motherhood mandate'; 'Adequate woman: Resisting the motherhood mandate'; and 'Survival of the fittest: Woman as genetically defective'. Implications of these subject positions included feelings of inadequacy, fear and devastation; feeling undesirable to romantic partners; and concern about passing on cancer-positive genes. In describing healthcare professional interactions, women adopted positions of 'Satisfied patient'; 'Passive recipient patient'; or 'Resisting the passive patient position'. Accounts of inadequate information provision were associated with anger and frustration, whereas feeling adequately informed was associated with satisfaction at making decisions about fertility preservation. These results suggest that fertility is of importance to young women cancer survivors, and that compromised fertility can negatively impact subjectivity

Talking about fertility in the context of cancer : health care professional perspectives

Health care professionals (HCPs) play a key role in providing information and counselling about the implications of cancer for fertility, however, many patients do not receive such information. The aim of this study was to examine the perspectives and practices of Australian HCPs in relation to discussing fertility with cancer patients. A mixed-methods design, comprising of an online survey of 263 HCPs [41.4% nurses; 25.5% doctors; 31% allied health care professionals (AHP)] and qualitative interviews with 49 HCPs, was utilised. HCPs reported that fertility is an important concern for patients and their partners; however, only 50% of doctors and nurses, and 24% of AHPs reported that they always addressed this issue. The primary barriers to discussing fertility were poor patient prognosis; patient gender or age; time constraints; and absence of appropriate resources and materials. Only a minority of HCPs (29%) had undergone training in discussing fertility with cancer patients. The majority wanted further training or education: including nurses (81.8%), AHPs (80.6%) and doctors (55.4%). HCPs agreed that a number of resources would assist them to raise fertility with their patients, including a list of appropriate referral sources, fact sheets, information booklets, a fertility consultation checklist and on-line resources

Effect of bodychecking on injury rates among minor ice hockey players

BACKGROUND: In 2002, Hockey Canada changed the age classifications for minor ice hockey. Previously, 10- and 11-year-old children played at the Atom level (no bodychecking), and 12- and 13-year-old children played at the Peewee level (bodychecking allowed). After the policy change, 11-year-old players were placed in the Peewee division with 12-year-old players; the Atom division included 9- and 10-year-old players. The objective of this study was to examine the effect that the policy change had on injuries to 11-year-old players and compare this information with injury trends among 10- and 12-year-old players. METHODS: The study location was the Capital Health region, which serves the greater Edmonton area in Alberta. Capital Health maintains a database of all emergency department visits in the region. A search of the database identified 10-, 11- and 12-year-old players admitted to 7 emergency departments with hockey-related injuries during the 2 years before and the 2 years after the policy change. We also conducted a chart review for the 11-year-old players, extracting detailed information on the nature and circumstances of their injuries for the same period. RESULTS: The rate of injuries sustained by 11-year-old children playing at the Peewee level (with bodychecking) increased significantly compared with the rate among 11-year-0ld players at the Atom level (rate ratio [RR] 1.9, 95% confidence interval [CI] 1.4–2.4). The rate of severe injuries was more than 2 times greater among 11-year-old Peewee players than among 11-year-old Atom players (RR 2.4, 95% CI 1.6–3.6). Injury rates among the 10-year-old players (bodychecking never allowed) and the 12-year-old players (bodychecking always allowed) changed little over the study period. INTERPRETATION: The introduction of bodychecking to 11-year-old players was associated with a large increase in injury rates. From a public health perspective, the age at which bodychecking is introduced in minor hockey should be raised

How Safe Are Common Analgesics for the Treatment of Acute Pain for Children? A Systematic Review

Background. Fear of adverse events and occurrence of side effects are commonly cited by families and physicians as obstructive to appropriate use of pain medication in children. We examined evidence comparing the safety profiles of three groups of oral medications, acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, to manage acute nonsurgical pain in children (ud_less_than18 years) treated in ambulatory settings. Methods. A comprehensive search was performed to July 2015, including review of national data registries. Two reviewers screened articles for inclusion, assessed methodological quality, and extracted data. Risks (incidence rates) were pooled using a random effects model. Results. Forty-four studies were included; 23 reported on adverse events. Based on limited current evidence, acetaminophen, ibuprofen, and opioids have similar nausea and vomiting profiles. Opioids have the greatest risk of central nervous system adverse events. Dual therapy with a nonopioid/opioid combination resulted in a lower risk of adverse events than opioids alone. Conclusions. Ibuprofen and acetaminophen have similar reported adverse effects and notably less adverse events than opioids. Dual therapy with a nonopioid/opioid combination confers a protective effect for adverse events over opioids alone. This research highlights challenges in assessing medication safety, including lack of more detailed information in registry data, and inconsistent reporting in trials.Peer Reviewe

A retrospective observational study of Lyme neuroborreliosis in the southwest of England

BackgroundLyme disease is endemic in the UK with a high incidence in southwest England. Neurological symptoms are the most common complication.AimTo review the clinical manifestations and management of Lyme neuroborreliosis in Southwest England.Design and settingSix hospitals in Hampshire participated in this retrospective, observational study.MethodsPatients with neurological symptoms and a positive screening ELISA followed by confirmatory immunoblots between January 2015 and December 2017 were contacted and a questionnaire completed. Information gathered included demographics, tick exposure, symptoms, sequelae, investigations and treatment.ResultsSeventy-two patients were included; 71% initially presented to their GP, 26% were children, a preceding tick bite was reported in 24% and erythema migrans in 36%. The most common symptom was unilateral facial nerve palsy. Central nervous system manifestations were uncommon. Only 13 patients had a lumbar puncture. All patients received effective antibiotics, apart from 2 who were not treated but recovered fully. Treatment duration varied with 55% of patients receiving either a shorter or longer duration than recommended by the EFNS and BIA during the study period. Patients given longer courses did not report fewer sequelae. Complete resolution was reported in 72%. The remainder complained mainly of subjective symptoms.ConclusionsMost patients were diagnosed and managed on clinical grounds and did not undergo invasive investigations. Patients were given effective antibiotics although the difference in duration was marked; recent NICE guidelines recommending 3 weeks of antibiotics may help standardise this. The majority improved with no sequelae. This is the largest UK study focusing exclusively on neuroborreliosis with particular emphasis on management and outcome