Transport of Babesia venatorum-infected Ixodes ricinus to Norway by northward migrating passerine birds

<p>Abstract</p> <p>Background</p> <p>Bovine babesiosis is regarded as a limited health problem for Norwegian cows, and the incidence has decreased markedly since the 1930s. Rare cases of babesiosis in splenectomised humans from infection with <it>Babesia divergens </it>and <it>B.venatorum </it>have been described. The objective of this study was to determine whether birds can introduce <it>Babesia</it>-infected ticks. There are between 30 and 85 million passerine birds that migrate to Norway every spring.</p> <p>Methods</p> <p>Passerine birds were examined for ticks at four bird observatories along the southern Norwegian coast during the spring migrations of 2003, 2004 and 2005. The presence of <it>Babesia </it>was detected in the nymphs of <it>Ixodes ricinus </it>by real-time PCR. Positive samples were confirmed using PCR, cloning and phylogenetic analyses.</p> <p>Results</p> <p>Of 512 ticks examined, real-time PCR revealed five to be positive (1.0%). Of these, four generated products that indicated the presence of <it>Babesia </it>spp.; each of these were confirmed to be from <it>Babesia venatorum </it>(EU1). Two of the four <it>B. venatorum</it>-positive ticks were caught from birds having an eastern migratory route (<it>P</it>< 0.001).</p> <p>Conclusions</p> <p>Birds transport millions of ticks across the North Sea, the Skagerrak and the Kattegat every year. Thus, even with the low prevalence of <it>Babesia</it>-infected ticks, a substantial number of infected ticks will be transported into Norway each year. Therefore, there is a continuous risk for introduction of new <it>Babesia </it>spp. into areas where <it>I. ricinus </it>can survive.</p

Highly skewed T-cell receptor V-beta chain repertoire in the bone marrow is associated with response to immunosuppressive drug therapy in children with very severe aplastic anemia

One of the major obstacles of immunosuppressive therapy (IST) in children with severe aplastic anemia (SAA) comes from the often months-long unpredictability of bone-marrow (BM) recovery. In this prospective study in children with newly diagnosed very severe AA (n=10), who were enrolled in the therapy study SAA-BFM 94, we found a dramatically reduced diversity of both CD4+ and CD8+ BM cells, as scored by comprehensive V-beta chain T-cell receptor (TCR) analysis. Strongly skewed TCR V-beta pattern was highly predictive for good or at least partial treatment response (n=6, CD8+ complexity scoring median 35.5, range 24–73). In contrast, IST in patients with rather moderate reduction of TCR V-beta diversity (n=4, CD8+ complexity scoring median 109.5, range 82–124) always failed (P=0.0095). If confirmed in a larger series of patients, TCR V-beta repertoire in BM may help to assign children with SAA up-front either to IST or to allogeneic stem-cell transplantation

Use of granulocyte colony-stimulating factor and risk of relapse in pediatric patients treated for acute myeloid leukemia according to NOPHO-AML 2004 and DB AML-01

Background Supportive-care use of granulocyte colony-stimulating factor (G-CSF) in pediatric acute myeloid leukemia (AML) remains controversial due to a theoretical increased risk of relapse and limited impact on neutropenic complications. We describe the use of G-CSF in patients treated according to NOPHO-AML 2004 and DB AML-01 and investigated associations with relapse. Procedure Patients diagnosed with de novo AML completing the first week of therapy and not treated with hematopoietic stem cell transplantation in the first complete remission were included (n = 367). Information on G-CSF treatment after each course (yes/no) was registered prospectively in the study database and detailed information was gathered retrospectively from each center. Descriptive statistics were used to describe G-CSF use and Cox regression to assess the association between G-CSF and risk of relapse. Results G-CSF as supportive care was given to 128 (35%) patients after 268 (39%) courses, with a large variation between centers (0-93%). The use decreased with time-the country-adjusted odds ratio was 0.8/diagnostic year (95% confidence interval [CI] 0.7-0.9). The median daily dose was 5 mu g/kg (range 3-12 mu g/kg) and the median cumulative dose was 75 mu g/kg (range 7-1460 mu g/kg). Filgrastim was used in 82% of G-CSF administrations and infection was the indication in 44% of G-CSF administrations. G-CSF was associated with increased risk of relapse-the adjusted hazard ratio was 1.5 (95% CI 1.1-2.2). Conclusions G-CSF as supportive care was used in a third of patients, and use decreased with time. Our results indicate that the use of G-CSF may be associated with an increased risk of relapse.Peer reviewe

Long-term inpatient disease burden in the Adult Life after Childhood Cancer in Scandinavia (ALiCCS) study : A cohort study of 21,297 childhood cancer survivors

Background Survivors of childhood cancer are at increased risk for a wide range of late effects. However, no large population-based studies have included the whole range of somatic diagnoses including subgroup diagnoses and all main types of childhood cancers. Therefore, we aimed to provide the most detailed overview of the long-term risk of hospitalisation in survivors of childhood cancer. Methods and findings From the national cancer registers of Denmark, Finland, Iceland, and Sweden, we identified 21,297 5-year survivors of childhood cancer diagnosed with cancer before the age of 20 years in the periods 1943-2008 in Denmark, 1971-2008 in Finland, 1955-2008 in Iceland, and 1958-2008 in Sweden. We randomly selected 152,231 population comparison individuals matched by age, sex, year, and country (or municipality in Sweden) from the national population registers. Using a cohort design, study participants were followed in the national hospital registers in Denmark, 1977-2010; Finland, 1975-2012; Iceland, 1999-2008; and Sweden, 1968-2009. Disease-specific hospitalisation rates in survivors and comparison individuals were used to calculate survivors' standardised hospitalisation rate ratios (RRs), absolute excess risks (AERs), and standardised bed day ratios (SBDRs) based on length of stay in hospital. We adjusted for sex, age, and year by indirect standardisation. During 336,554 person-years of follow-up (mean: 16 years; range: 0-42 years), childhood cancer survivors experienced 21,325 first hospitalisations for diseases in one or more of 120 disease categories (cancer recurrence not included), when 10,999 were expected, yielding an overall RR of 1.94 (95% confidence interval [95% CI] 1.91-1.97). The AER was 3,068 (2,980-3,156) per 100,000 person-years, meaning that for each additional year of follow-up, an average of 3 of 100 survivors were hospitalised for a new excess disease beyond the background rates. Approximately 50% of the excess hospitalisations were for diseases of the nervous system (19.1% of all excess hospitalisations), endocrine system (11.1%), digestive organs (10.5%), and respiratory system (10.0%). Survivors of all types of childhood cancer were at increased, persistent risk for subsequent hospitalisation, the highest risks being those of survivors of neuroblastoma (RR: 2.6 [2.4-2.8]; n = 876), hepatic tumours (RR: 2.5 [2.0-3.1]; n = 92), central nervous system tumours (RR: 2.4 [2.3-2.5]; n = 6,175), and Hodgkin lymphoma (RR: 2.4 [2.3-2.5]; n = 2,027). Survivors spent on average five times as many days in hospital as comparison individuals (SBDR: 4.96 [4.94-4.98]; n = 422,218). The analyses of bed days in hospital included new primary cancers and recurrences. Of the total 422,218 days survivors spent in hospital, 47% (197,596 bed days) were for new primary cancers and recurrences. Our study is likely to underestimate the absolute overall disease burden experienced by survivors, as less severe late effects are missed if they are treated sufficiently in the outpatient setting or in the primary health care system. Conclusions Childhood cancer survivors were at increased long-term risk for diseases requiring inpatient treatment even decades after their initial cancer. Health care providers who do not work in the area of late effects, especially those in primary health care, should be aware of this highly challenged group of patients in order to avoid or postpone hospitalisations by prevention, early detection, and appropriate treatments.Peer reviewe

Can standardized patients replace physicians as OSCE examiners?

BACKGROUND: To reduce inter-rater variability in evaluations and the demand on physician time, standardized patients (SP) are being used as examiners in OSCEs. There is concern that SP have insufficient training to provide valid evaluation of student competence and/or provide feedback on clinical skills. It is also unknown if SP ratings predict student competence in other areas. The objectives of this study were: to examine student attitudes towards SP examiners; to compare SP and physician evaluations of competence; and to compare predictive validity of these scores, using performance on the multiple choice questions examination (MCQE) as the outcome variable. METHODS: This was a cross-sectional study of third-year medical students undergoing an OSCE during the Internal Medicine clerkship rotation. Fifty-two students rotated through 8 stations (6 physician, 2 SP examiners). Statistical tests used were Pearson's correlation coefficient, two-sample t-test, effect size calculation, and multiple linear regression. RESULTS: Most students reported that SP stations were less stressful, that SP were as good as physicians in giving feedback, and that SP were sufficiently trained to judge clinical skills. SP scored students higher than physicians (mean 90.4% +/- 8.9 vs. 82.2% +/- 3.7, d = 1.5, p < 0.001) and there was a weak correlation between the SP and physician scores (coefficient 0.4, p = 0.003). Physician scores were predictive of summative MCQE scores (regression coefficient = 0.88 [0.15, 1.61], P = 0.019) but there was no relationship between SP scores and summative MCQE scores (regression coefficient = -0.23, P = 0.133). CONCLUSION: These results suggest that SP examiners are acceptable to medical students, SP rate students higher than physicians and, unlike physician scores, SP scores are not related to other measures of competence

Multivariate statistical analysis of net diatom species distributions in the Southwestern Atlantic and Indian Ocean

Vertical net haul diatom assemblages from near South Georgia, and from between Africa and Antarctica, were examined and compared. Variation among South Georgia stations was examined by principal component, cluster and canonical discriminant analyses. Diatom distributions provide evidence for at least two distinct water masses. The region north of the island is characterized by neritic, temperate diatoms and by an assemblage with low species diversity. The region south of the island is characterized by oceanic, antarctic species and relatively high species diversity. The regions are most distinct to the west of the island, intergrading east of the island. Within the north-south division, five station groupings were detected on the basis of distribution of dominant net diatoms. By comparing classical species ecological categorizations to results of principal component analysis, a “neritic-oceanic” factor was identified from net diatom distributions. This factor was common to both areas in spite of the fact that Biscoe and Agulhas collections were from different seasons.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46982/1/300_2004_Article_BF00446041.pd

Characteristics and outcome in patients with central nervous system involvement treated in European pediatric acute myeloid leukemia study groups

Background: There is no consensus on the treatment for pediatric patients with acute myeloid leukemia and initial central nervous system (CNS) involvement. Methods: To evaluate different CNS-directed treatment options (intrathecal [IT] therapy, CNS irradiation, hematopoietic stem cell transplantation [HSCT]), 261 patients (excluding acute promyelocytic leukemia) with initial CNS involvement treated in trials with similar intensive chemotherapy by four cooperative European study groups (1998–2013) were studied and compared with CNS-negative patients from the Berlin–Frankfurt–Münster group. Results: Patient characteristics in the different study groups were comparable. Young age, high white blood cell count, extramedullary involvement other than the CNS, monoblastic morphology, and inv(16) were associated with CNS involvement (each P &lt; 0.0001). There were no major differences in outcome between the study groups. The cumulative incidence of relapse (CIR) regarding the CNS was higher in initially CNS-positive versus initially CNS-negative patients (all: 8 ± 2% vs. 3 ± 1%, P(Gray) = 0.001; isolated: 4 ± 1% vs. 1 ± 0%, P(Gray) = 0.03). However, global outcome of the CNS-positive cohort (overall survival, 64 ± 3%; event-free survival 48 ± 3%; and CIR 33% ± 3%) did not differ significantly from CNS-negative patients. Risk groups defined by cytogenetics were of likewise prognostic significance in CNS-positive and -negative patients. CNS treatment with cranial irradiation was not superior compared to IT therapy and systemic chemotherapy (± HSCT). Conclusion: Although CNS relapses occurred more frequently in initially CNS-positive patients, their global outcome was similar as in CNS-negative patients. Intensified IT therapy was heterogeneous; however, at least eight applications, preferably with triple IT chemotherapy, seem to be appropriate to accompany dose-intensive systemic chemotherapy

Future Contingents and the Logic of Temporal Omniscience

At least since Aristotle’s famous 'sea-battle' passages in On Interpretation 9, some substantial minority of philosophers has been attracted to the doctrine of the open future--the doctrine that future contingent statements are not true. But, prima facie, such views seem inconsistent with the following intuition: if something has happened, then (looking back) it was the case that it would happen. How can it be that, looking forwards, it isn’t true that there will be a sea battle, while also being true that, looking backwards, it was the case that there would be a sea battle? This tension forms, in large part, what might be called the problem of future contingents. A dominant trend in temporal logic and semantic theorizing about future contingents seeks to validate both intuitions. Theorists in this tradition--including some interpretations of Aristotle, but paradigmatically, Thomason (1970), as well as more recent developments in Belnap, et. al (2001) and MacFarlane (2003, 2014)--have argued that the apparent tension between the intuitions is in fact merely apparent. In short, such theorists seek to maintain both of the following two theses: (i) the open future: Future contingents are not true, and (ii) retro-closure: From the fact that something is true, it follows that it was the case that it would be true. It is well-known that reflection on the problem of future contingents has in many ways been inspired by importantly parallel issues regarding divine foreknowledge and indeterminism. In this paper, we take up this perspective, and ask what accepting both the open future and retro-closure predicts about omniscience. When we theorize about a perfect knower, we are theorizing about what an ideal agent ought to believe. Our contention is that there isn’t an acceptable view of ideally rational belief given the assumptions of the open future and retro-closure, and thus this casts doubt on the conjunction of those assumptions

A high-resolution diatom-based Middle and Late Holocene environmental history of the Little Belt region, Baltic Sea

The large‐scale shifts in the salinity of the Baltic Sea over the Holocene are well understood and have been comprehensively documented using sedimentary proxy records. More recent work has focused on understanding how past salinity fluctuations have affected other ecological parameters (e.g. primary productivity, nutrient content) of the Baltic basin, and salinity changes over key events and over short time scales are still not well understood. The International Ocean Drilling Program Expedition 347 cored the Baltic basin in order to collect basin‐wide environmental records through a glacial–interglacial cycle. Site M0059 is located in the Little Belt between the Baltic Sea and the Atlantic Ocean. A composite splice section from Site M0059 was analysed at a decadal resolution to study changes in salinity, nutrient conditions and other surface water column parameters based on changes in diatom assemblages and on quantitative diatom‐based salinity inferences. A mesotrophic slightly brackish assemblage is seen in the lowermost analysed depths, corresponding to 7800–7500 cal. a BP . An increase in salinity and nutrient content of the water column leads into a meso‐eutrophic brackish phase. The observed salinity increase is rapid, lasting from 7500 to 7150 cal. a BP . Subsequently, the Little Belt becomes oligotrophic and is dominated by tychopelagic diatoms from c . 7100 to c . 3900 cal. a BP . This interval contains some of the highest salinities observed followed by diatom assemblages similar to those of the Northern Atlantic Ocean, composed primarily of cosmopolitan open ocean marine diatoms. A return to tychopelagic productivity is seen from 3850 to 980 cal. a BP . Anthropogenic eutrophication is detected in the last 300 years of the record, which intensifies in the uppermost sediments. These results represent the first decadally resolved record in the region and provide new insight into the transition to a brackish basin and subsequent ecological development.The large-scale shifts in the salinity of the Baltic Sea over the Holocene are well understood and have been comprehensively documented using sedimentary proxy records. More recent work has focused on understanding how past salinity fluctuations have affected other ecological parameters (e.g. primary productivity, nutrient content) of the Baltic basin, and salinity changes over key events and over short time scales are still not well understood. The International Ocean Drilling Program Expedition 347 cored the Baltic basin in order to collect basin-wide environmental records through a glacial-interglacial cycle. Site M0059 is located in the Little Belt between the Baltic Sea and the Atlantic Ocean. A composite splice section from Site M0059 was analysed at a decadal resolution to study changes in salinity, nutrient conditions and other surface water column parameters based on changes in diatom assemblages and on quantitative diatom-based salinity inferences. A mesotrophic slightly brackish assemblage is seen in the lowermost analysed depths, corresponding to 7800-7500 cal. a BP. An increase in salinity and nutrient content of the water column leads into a meso-eutrophic brackish phase. The observed salinity increase is rapid, lasting from 7500 to 7150 cal. a BP. Subsequently, the Little Belt becomes oligotrophic and is dominated by tychopelagic diatoms from c. 7100 to c. 3900 cal. a BP. This interval contains some of the highest salinities observed followed by diatom assemblages similar to those of the Northern Atlantic Ocean, composed primarily of cosmopolitan open oceanmarine diatoms. A return to tychopelagic productivity is seen from 3850 to 980 cal. a BP. Anthropogenic eutrophication is detected in the last 300 years of the record, which intensifies in the uppermost sediments. These results represent the first decadally resolved record in the region and provide new insight into the transition to a brackish basin and subsequent ecological development.Peer reviewe