Genospecies diversity of Lyme disease spirochetes in rodent reservoirs.

To determine whether particular Borrelia burgdorferi s.l. genospecies associate solely with rodent reservoir hosts, we compared the genospecies prevalence in questing nymphal Ixodes ticks with that in xenodiagnostic ticks that had fed as larvae on rodents captured in the same site. No genospecies was more prevalent in rodent-fed ticks than in questing ticks. The three main spirochete genospecies, therefore, share common rodent hosts

RE: "Trends in 'Deaths of Despair' Among Working-Aged White and Black Americans, 1990-2017"

In a recent article by Tilstra et al., the authors characterize mortality rates from suicide, drug use, and alcohol use stratified by sex and race, with the goal of comparing non-Hispanic Black and non-Hispanic White death rates related to these “deaths of despair.” We commend the authors for this important work. The authors used data from the National Vital Statistics System and US Census to assess cause-specific mortality trends stratified by race and sex and found parallels in mortality trends for Black and White adults with respect to the opioid epidemic and the Great Recession. The authors did not observe period or cohort increases in suicide for Black men and women, stating that this finding warrants further study. Measurement error could underlie some of the unexpected trends the authors identified. One potential source of error is differential misclassification of suicide by race in the US National Center for Vital Statistics data. The authors cite a study that found the odds of suicide misclassification as “undetermined intent” was twice as high in Black populations compared with White populations. Additionally, the National Center of Health Statistics found evidence that deaths are overreported differentially in White and Black populations (overestimates of 1% and 5%, respectively), which may be related to historical undercounting of certain populations, including Black and Hispanic populations, in the Census denominator of the mortality rate

Cerebrospinal fluid findings in adults with acute Lyme neuroborreliosis

Presence of BB-specific antibodies in the cerebrospinal fluid (CSF) with evidence of their intrathecal production in conjunction with the white cell count in the CSF and typical clinical symptoms is the traditional diagnostic gold standard of Lyme neuroborreliosis (LNB). Few data are available on the CSF lactate concentration in European adults with the diagnosis of acute LNB. The objective of the study was to investigate the CSF changes during acute LNB. Routine CSF parameters [leukocyte count, protein, lactate and albumin concentrations, CSF/serum quotients of albumin (QAlb), IgG, IgA and IgM, and oligoclonal IgG bands] and the Borrelia burgdorferi (BB)-specific antibody index were retrospectively studied in relation to the clinical presentation in patients diagnosed with acute LNB. A total of 118 patients with LNB were categorized into the following groups according to their symptoms at presentation; group 1: polyradiculoneuritis (Bannwarth’s syndrome), group 2: isolated facial palsy and group 3: predominantly meningitic course of the disease. In addition to the CSF of patients with acute LNB, CSF of 19 patients with viral meningitis (VM) and 3 with neurolues (NL) were analyzed. There were 97 patients classified with definite LNB, and 21 as probable LNB. Neck stiffness and fever were reported by 15.3% of patients. Most of these patients were younger than 50 years. Polyradiculoneuritis was frequently found in patients older than 50 years. Lymphopleocytosis was found in all patients. Only 5 patients had a CSF lactate ≥3.5 mmol/l, and the mean CSF lactate level was not elevated (2.1 ± 0.6 mmol/l). The patients with definite LNB had significantly higher lactate levels than patients with probable LNB. Elevated lactate levels were accompanied by fever and headache. In the Reiber nomograms, intrathecal immunoglobulin synthesis was found for IgM in 70.2% followed by IgG in 19.5%. Isoelectric focussing detected an intrathecal IgG synthesis in 83 patients (70.3%). Elevated BB AIs in the CSF were found in 97 patients (82.2%). Patients with VM showed lower CSF protein concentration and CSF/serum quotients of albumin than LNB patients. In acute LNB, all patients had elevated cerebrospinal fluid (CSF) leukocyte counts. In contrast to infections by other bacteria, CSF lactate was lower than 3.5 mmol/l in all but 5 patients. The CSF findings did not differ between polyradiculoneuritis, facial palsy, and meningitis. The CSF in LNB patients strongly differed from CSF in VM patients with respect to protein concentration and the CSF/serum albumin quotient

Renewable Energy Deployment in the Federal Sector

To reduce energy costs and help protect the environment, the U.S. Department of Energy's (DOE's) Federal Energy Management Program (FEMP) assists Federal agencies in becoming more energy efficient and using more renewable energy. FEMP's renewable energy program has identified three technology pathways to this goal: (1) purchasing and installing cost-effective renewable energy technologies at Federal sites; (2) purchasing a portion of Federal facilities' electricity from renewable power sources; and (3) incorporating the principles of low-energy design in new construction. To support these pathways, FEMP has also identified three overarching actions that need to be taken: (1) partnering with others to develop clear messages about renewable energy that resonate with the public; (2) coordinating agency programs to leverage resources and emphasize renewables; and (3) securing commitments and support from Federal leadership. This paper describes FEMP's progress in each pathway and supporting action and includes examples of recent Federal projects