Perkinsus marinus tissue distribution and seasonal variation in oysters Crassostrea virginica from Florida, Virginia and New York

Perkinsus marinus infection intensity was measured in eastern oysters Crassostrea virginica collected in October and December 1993, and March, May, and July 1994 from 3 U.S. sites: Apalachicola Bay (FL), Chesapeake Bay (VA), and Oyster Bay (Mr\u27). Gill, mantle, digestive gland. adductor muscle, hemolymph, and remaining tissue (including gonadal material and rectum) were dissected from 20 oysters from each site at each collection time. Samples were separately diagnosed for P. marin us infections by incubation in Ray\u27s Fluid Thioglycollate Medium (RFTM) and subsequent microscopic quantification of purified enlarged hypnospores. At all sampling times and sites, average P. marinus infection intensity (g wet wt tissue(-1) or ml hemolymph(-1)) was lowest in hemolymph samples, and generally highest in the digestive gland. Perkinsus marinus prevalence was 100% at both FL and NY sites for each of the 5 collection times, and, for the VA site, was less than 100% in only 1 month (May 1994). Seasonal intensity patterns and mean total body burdens differed among the sites. Average body burden was highest in VA during October and progressively declined to a minimum in May. This decline was probably due to mortality of heavily infected oysters and diminution of parasite activity associated with colder temperatures and reduced salinities. Intensities varied little during the months of October and December at both the FL and NY sites. Minimum average intensities were observed in March in FL oysters and May in NY oysters. Relatively high P. marinus infection levels that persisted throughout the winter in NY oysters compared with VA oysters could reflect constant high salinity in Long Island Sound which favors parasite activity, and also rapid decline in temperature in the fall that may have prevented epizootic oyster mortalities

A framework for assessing community adaptation to climate change in a fisheries context

There is a rapidly growing body of scholarship on climate change adaptation in diverse contexts globally. Despite this, climate adaptation at the community level has not received adequate conceptual attention, and a limited number of analytical frameworks are available for assessing place-specific adaptations, particularly in a fisheries context. We use conceptual material from social-ecological systems (SES) resilience and human development resilience to build an integrated framework for evaluating community adaptations to climate change in a fisheries setting. The framework defines resilience as the combined result of coping, adapting, and transforming—recognizing resilience as a system’s capacity and as a process. This understanding of resilience integrates with the three development resilience concepts of resistance, rootedness, and resourcefulness to develop ‘place-based elements’ which refer to collective action, institutions, agency, and indigenous and local knowledge systems. The proposed framework can capture a local setting’s place-specific attributes relating to the well-being of individuals, households, and communities, and the through integration of SES and human development conceptualizations addresses some of the key critiques of the notion of resilience. We have proposed this framework for application in context-specific environments—including fisheries—as a means of assessing community adaptations

Climate change and adaptation to social-ecological change: the case of indigenous people and culture-based fisheries in Sri Lanka

Rural coastal fishery systems in tropical island nations are undergoing rapid change. Using a case study from eastern Sri Lanka, this paper examines the ways in which indigenous Coastal-Vedda fishers experience and respond to such change. We conducted semi-structured interviews (n = 74), focus group discussions (n = 17, 98 participants), and key informant interviews (n = 38) over a 2-year period (2016–2019). The changes that most Coastal-Vedda fishers experience are disturbance from Sri Lankan ethnic war, changes in climate and the frequency and severity of natural disasters, increased frequency of human-elephant conflicts, increasingly unpredictable weather patterns, and transformation of the Coastal-Vedda due to social modernisation. We used a resilience-based conceptual framework focusing on place, human agency, collective action and collaboration, institutions, indigenous and local knowledge systems, and learning to examine fishers’ responses to rapid changes. We identified three community-level adaptive strategies used by the Coastal-Vedda: adaptive institutions with a multi-level institutional structure that facilitates collective action and collaboration, the use of culture-based fisheries (CBF), and diversification of livelihoods. We also recognized four place-specific attributes that shaped community adaptations: cultural identity and worldviews, co-management of CBF, flexibility in choosing adaptive options, and indigenous and local knowledge systems and learning. These adaptive strategies and place-specific attributes provide new insights for scientists, policymakers, and communities in the region, enabling them to more effectively work together to support community adaptation

Investigating The Life Cycle Of Haplosporidium nelsoni (MSX)

Attempts to decipher the life cycle of Haplosporidium nelsoni began almost immediately after it was identified as the pathogen causing MSX disease in eastern oysters, Crassostrea virginica. But transmission experiments failed and the spore stage, characteristic of haplosporidans, was extremely rare. Researchers concluded that another host was involved: an intermediate host in which part of the life cycle was produced, or-if the oyster was an accidental host-an alternate host that produces infective elements. A later finding that spores were found more often in spat (\u3c 1 y old) than in adults revived the idea of direct transmission between oysters. The new findings and the availability of molecular diagnostics led us to revive life cycle investigations. Over several years, oyster spat were examined for spores and searched for H. nelsoni in potential non-oyster hosts using both histological and polymerase chain reaction (PCR) methodologies. Although spores occurred in a high proportion of spat with advanced infections, it was concluded that they were unlikely to be a principal source of infective elements because naive oysters used as sentinels to assess infection pressure became highly infected even after native oysters developed resistance, and infected spat could no longer be found. A histological survey of zooplankton and small bivalves in Delaware Bay found few recognizable parasites and nothing resembling a haplosporidan. A subsequent PCR study of water, sediment, and macro-invertebrates from Chesapeake, Delaware, and Oyster bays resulted in many positive samples, but in situ hybridization failed to identify any recognizable structures. PCR analysis of potential intermediate hosts for other molluscan pathogens has also resulted in many species yielding positive results but required in situ hybridization to verify infections. It is suggested that any future search for a nonoyster host of H. nelsoni be conducted in a relatively confined system and/or target specific phyla, strategies that have been successful in other life cycle studies. It is noted that candidate phyla could include those known to host haplosporidans and species whose abundance or distribution may have changed in concert with outbreaks of MSX disease in the northeastern United States in recent years

Towards the development of data governance standards for using clinical free-text data in health research: a position paper

Background: Free-text clinical data (such as outpatient letters or nursing notes) represent a vast, untapped source of rich information that, if more accessible for research, would clarify and supplement information coded in structured data fields. Data usually need to be de-identified or anonymised before they can be reused for research, but there is a lack of established guidelines to govern effective de-identification and use of free-text information and avoid damaging data utility as a by-product. / Objective: We set out to work towards data governance standards to integrate with existing frameworks for personal data use, to enable free-text data to be used safely for research for patient/public benefit. / Methods: We outlined (UK) data protection legislation and regulations for context, and conducted a rapid literature review and UK-based case studies to explore data governance models used in working with free-text data. We also engaged with stakeholders including text mining researchers and the general public to explore perceived barriers and solutions in working with clinical free-text. / Results: We propose a set of recommendations, including the need: for authoritative guidance on data governance for the reuse of free-text data; to ensure public transparency in data flows and uses; to treat de-identified free-text as potentially identifiable with use limited to accredited data safe-havens; and, to commit to a culture of continuous improvement to understand the relationships between efficacy of de-identification and re-identification risks, so this can be communicated to all stakeholders. / Conclusions: By drawing together the findings of a combination of activities, our unique study has added new knowledge towards the development of data governance standards for the reuse of clinical free-text data for secondary purposes. Whilst working in accord with existing data governance frameworks, there is a need for further work to take forward the recommendations we have proposed, with commitment and investment, to assure and expand the safe reuse of clinical free-text data for public benefit

Incorporating scale dependence in disease burden estimates:the case of human African trypanosomiasis in Uganda

The WHO has established the disability-adjusted life year (DALY) as a metric for measuring the burden of human disease and injury globally. However, most DALY estimates have been calculated as national totals. We mapped spatial variation in the burden of human African trypanosomiasis (HAT) in Uganda for the years 2000-2009. This represents the first geographically delimited estimation of HAT disease burden at the sub-country scale.Disability-adjusted life-year (DALY) totals for HAT were estimated based on modelled age and mortality distributions, mapped using Geographic Information Systems (GIS) software, and summarised by parish and district. While the national total burden of HAT is low relative to other conditions, high-impact districts in Uganda had DALY rates comparable to the national burden rates for major infectious diseases. The calculated average national DALY rate for 2000-2009 was 486.3 DALYs/100 000 persons/year, whereas three districts afflicted by rhodesiense HAT in southeastern Uganda had burden rates above 5000 DALYs/100 000 persons/year, comparable to national GBD 2004 average burden rates for malaria and HIV/AIDS.These results provide updated and improved estimates of HAT burden across Uganda, taking into account sensitivity to under-reporting. Our results highlight the critical importance of spatial scale in disease burden analyses. National aggregations of disease burden have resulted in an implied bias against highly focal diseases for which geographically targeted interventions may be feasible and cost-effective. This has significant implications for the use of DALY estimates to prioritize disease interventions and inform cost-benefit analyses

Implementation of routine outcome measurement in child and adolescent mental health services in the United Kingdom: a critical perspective

The aim of this commentary is to provide an overview of clinical outcome measures that are currently recommended for use in UK Child and Adolescent Mental Health Services (CAMHS), focusing on measures that are applicable across a wide range of conditions with established validity and reliability, or innovative in their design. We also provide an overview of the barriers and drivers to the use of Routine Outcome Measurement (ROM) in clinical practice

The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle

Background: Routine outcome measurement (ROM) is important for assessing the clinical effectiveness of health services and for monitoring patient outcomes. Within Child and Adolescent Mental Health Services (CAMHS) in the UK the adoption of ROM in CAMHS has been supported by both national and local initiatives (such as government strategies, local commissioning policy, and research). Methods: With the aim of assessing how these policies and initiatives may have influenced the uptake of ROM within two different CAMHS we report the findings of two case-note audits: a baseline audit conducted in January 2011 and a re-audit conducted two years later in December 2012-February 2013. Results: The findings show an increase in both the single and repeated use of outcome measures from the time of the original audit, with repeated use (baseline and follow-up) of the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) scale increasing from 10% to 50% of cases. Re-audited case-notes contained more combined use of different outcome measures, with greater consensus on which measures to use. Outcome measures that were applicable across a wide range of clinical conditions were more likely to be used than symptom-specific measures, and measures that were completed by the clinician were found more often than measures completed by the service user. Conclusions: The findings show a substantial improvement in the use of outcome measures within CAMHS. These increases in use were found across different service organisations which were subject to different types of local service priorities and drivers

Spatial and temporal occurrence of killer whale ecotypes off the outer coast of Washington State, USA

Three killer whale Orcinus orca ecotypes inhabit the northeastern Pacific: residents, transients, and offshores. To investigate intraspecific differences in spatial and temporal occur - rence off the outer coast of Washington State, USA, 2 long-term acoustic recorders were deployed from July 2004 to August 2013: one off the continental shelf in Quinault Canyon (QC) and the other on the shelf, off Cape Elizabeth (CE). Acoustic encounters containing pulsed calls were analyzed for call types attributable to specific ecotypes, as no calls are shared between ecotypes. Both sites showed killer whale presence year-round, although site CE had a higher number of days with encounters overall. Transients were the most common ecotype at both sites and were encountered mainly during the spring and early summer. Residents were encountered primarily at site CE and showed potential seasonal segregation between the 2 resident communities, with northern residents present mainly during summer and early fall when southern residents were not encountered. Offshore encounters were higher at site QC, with little evidence for seasonality. Spatial and temporal variability of residents and transients matches the distribution of their prey and can potentially be used for further inferences about prey preferences for different transient groups

Lack of insurance coverage and urgent care use for asthma: A retrospective cohort study

BACKGROUND: Asthma is a common chronic disease with profound impacts upon individuals and the US health care system. Inadequate health care coverage has been associated with more frequent and severe exacerbations of the disease. We examined the relationship between adequacy of health care coverage and use of emergent care of adults with asthma. METHODS: The 2001 Behavioral Risk Factor Surveillance System was the source of data on adults with current asthma. Bivariate and multiple logistic regression analysis modeled identifiable factors in predicting urgent or emergent care. RESULTS: Key variables included demographics and information on self-reported gaps in health care coverage. The primary outcome was emergency room or urgent care visits for worsening of asthma symptoms. Of 16,234 subjects nationally with current asthma, 2,195 from eight states had valid responses to a supplemental module asking about emergency room use or urgent care visits because of asthma. Thirty four percent of these individuals required such care in the previous year. Having an interruption in health care coverage in the past year was associated with an increased risk of needed urgent or emergent care (crude Odds Ratio [OR] 1.48, 95% confidence intervals [CI]1.03, 2.1). The association was not statistically significant in the adjusted multivariate model including race/ethnicity, employment status, gender, age, education and the ability to identify a primary physician (adjusted OR 1.2, 95% CI 0.8, 1.8). CONCLUSION: This study provides population-level, generalizable evidence of increased risk of exacerbations of asthma in adults and (1) their demographic characteristics, and (2) continuous adequate health care coverage