Epidemiology of select species of filarial nematodes in free-ranging moose (\u3ci\u3eAlces alces\u3c/i\u3e) of North America

North American moose (Alces alces) are a culturally and economically valued species. Recent population declines raise concern for the survivability of this natural resource. The Minnesota population has experienced the most dramatic decline, with a 60% loss in total numbers since 2006. Nematode parasites, particularly some species of filarids, are important pathogens of moose and could be contributing to morbidity and mortality. This study investigates the eco-epidemiology of two filarial parasites of moose: Rumenfilaria andersoni and Elaeophora schneideri. By surveying cervid species from six U.S. states, we discovered R. andersoni was present in moose from all sample locations with prevalence varying between 20-40%. This suggests R. andersoni is distributed throughout North America. We also observed R. andersoni in white-tailed deer (Odocoileus virginianus) but not elk (Cervus canadensis) or caribou (Rangifer tardanus). Sequence analysis of R. andersoni suggested the existence of two distinct clades. Molecular screening of Minnesota tabanid flies discovered 1.5% harbored R. andersoni, with only Chrysops spp. deerflies containing R. andersoni DNA. This is the first report of R. andersoni in moose and white-tailed deer herds within the contiguous U.S. and the first time horseflies have been implicated as the vector. Molecular surveys for parasitic nematodes in brain tissues from Minnesota moose that died from unknown causes revealed 63% produced 18S sequences closely aligning with E. schneideri, a neurological pathogen of moose previously unreported in Minnesota. Molecular screening of Minnesota tabanid flies revealed E. schneideri was present in the environment and transmission could occur locally. Prevalence ranged between 0-100% per trapping site, with Chrysops spp. and Hybomitra spp. horseflies implicated as vectors. This is the first report of Chrysops spp. serving as a carrier of E. schneideri and the first report of E. schneideri in Minnesota, suggesting E. schneideri is an emerging pathogen in the Minnesota herd. Together these data demonstrate the presence of multiple parasitic nematode species in vulnerable moose populations, yet it is still unclear what the implications are for herd health. Further research is warranted to determine if a link between nematode infections and declining moose populations exists

Physician Executive Leadership: Assessing a Student-Led Approach to Healthcare Leadership Education in Medical School

Poster presented at: 14th Annual AMA Research Symposium in Orlando, Fl Objective: To investigate the effectiveness of Physican Leadership, an open access, student-led healthcare leadership program at Sidney Kimmel Medical College, in preparing to face five key emerging topics in medical practice: healthcare economics, health policy, care and quality and safety, law and medicine, and patient experience. The Problem: Gaps in Medical Education Healthcare in the US continues to evolve, and topics such as health policy, health finance, and patient experience are not central to the practice of medicine. However, the sheer volume of material students are required to learn in the preclinical years makes it challenging to introduce new subjects into traditional medical school curricula. As a result, these topics in healthcare leadership are often left out. Indeed, only 40-50% of medical student report appropriate training in the practice of medicine, including subjects as medical economics, healthcare systems, and managed care.https://jdc.jefferson.edu/pel/1002/thumbnail.jp

Etude de l'interaction entre ADN et apatite analogue au minéral osseux et dentaire : implications pour la préservation de l'ADN ancien, son extraction, son analyse

Ce mémoire contribue à l'exploration des mécanismes physico-chimiques qui sous-tendent la préservation post mortem de l'ADN ancien au sein de restes squelettiques dans un contexte anthropologique ou médico-légal. Nous avons étudié le rôle potentiellement joué par la matrice minérale, composée d'apatite phosphocalcique, au sein d'un système complexe. Cette complexité provient tant des propriétés intrinsèques du tissu que de l'influence de paramètres dits " environnementaux " (température, pH, force ionique, activités enzymatiques) dans la préservation de l'ADN. Trois volets d'exploration ont été retenus. Une étude in situ a été réalisée via la caractérisation physico-chimique de spécimens osseux et dentaires anciens utilisés comme substrats d'ADN. Nos résultats contribuent à l'identification d'indicateurs physico-chimiques de la diagénèse, tels que la quantité de matière organique résiduelle, l'état de maturation de l'apatite, ou encore la taille de cristallites. L'exploration in vitro de processus d'adsorption/désorption d'ADN sur une apatite biomimétique de synthèse préalablement caractérisée a été initiée, permettant des essais de modélisation des interactions physico-chimiques observées. Nos données corroborent l'hypothèse d'une conservation exceptionnelle de l'ADN dans le temps par le biais d'une adsorption sur l'apatite, avancée empiriquement par de nombreux paléogénéticiens. Sous un angle plus appliqué, un kit de purification d'ADN, utilisé pour l'ADN ancien, a été caractérisé afin de mieux comprendre l'affinité de l'ADN pour des surfaces inorganiques et identifier les éventuels paramètres influençant le rendement et la qualité des extraits d'ADN ancien.This thesis contributes to explore the physico-chemical mechanisms underlying the preservation of ancient DNA within skeletal remains, arising from anthropological or forensic contexts. The complexity of such systems is not only related to the intrinsic features of hard tissues, but also to the effect of environmental parameters (temperature, pH, ionic strength, microbiological activity). In particular, we focused on the potential key role played by the mineral matrix, composed of calcium phosphate apatite. We addressed this topic from three viewpoints. First, an in situ study was achieved by means of physico-chemical characterization of bone and tooth remains, previously used as DNA substrates. Our results contribute to identify diagenetic indicators, such as the amount of residual organic matter, the maturation state of the apatite phase, or else mean crystallite dimensions. Next, we initiated a study of DNA adsorption/desorption processes on synthetic biomimetic apatite, pointing to the existence of strong physico-chemical interactions, that we have attempted to model. Our data substantiate the empirical hypothesis often alleged by paleogenetics researchers - but not experimentally demonstrated - explaining the exceptional preservation of DNA over time thanks to an adsorption phenomenon onto apatite within hard tissues. From a more applied perspective, the components of a DNA purification kit, used for ancient DNA, have been examined from a physico-chemical point of view with the goal to better understand DNA affinity toward inorganic surfaces and identify key parameters which may allow improving the yield and the quality of ancient DNA extracts

Long-term quality of life after en-bloc vertebrectomy: 25 patients followed up for 9 years

AbstractObjectiveAssess quality-of-life results in patients who have undergone extensive curative surgery for spinal tumor and compare them to the general population in France.IntroductionLife expectancy is not the only criterion to assess the outcomes after massive tumor resections. Residual quality of life is also crucial. An indication for major surgery for spinal tumor should take the patient's long-term functional status into account, but the literature is limited on this question.Materials and methodsTwenty-five living patients from a group of 120 operated were assessed, all of whom were operated on by the same surgeon between 1984 and 2007. The mean follow-up was 9 years (range, 3–25 years). The mean age at surgery was 49 years. The patients completed different functional and quality-of-life questionnaires: the Oswestry Disability Index version 2 (ODI), the PROLO, the Karnofsky Index of performance status (KI), the Eastern Cooperative Oncology Group performance status (ECOG), the Short Form-36 Health Survey (SF-36), and the EuroQol-5 Dimensions (EQ5D). In addition, each patient was clinically and radiographically evaluated. Subgroups were identified considering the number of levels resected and histology. Their results on the SF-36 were compared with the results from the general population in France.ResultsThe mean PCS (physical component summary of the SF-36) was 52.4, the MCS (mental component summary, the psychological component of the SF-36) was 47.7, the ODI was 18.2, the PROLO was 7, the ECOG was 1, and the KI was 80%. The resections at three levels were associated with worse results in terms of quality of life, but overall, the results were similar to the French general population data for all categories of the SF-36.ConclusionAppropriate indications for massive spinal resection give good oncological and functional results. Although the expected life expectancy justifies this aggressive surgery, postoperative quality of life shows that it can also be successful on a functional level.Level of evidenceLevel IV; retrospective clinical study

Tetratrichomonas and Trichomonas spp.-Associated Disease in Free-Ranging Common Eiders (Somateria mollissima) from Wellfleet Bay, MA and Description of ITS1 Region Genotypes

During an outbreak of Wellfleet Bay virus (WFBV) in common eiders (Somateria mollissima) from the Cape Cod region of Massachusetts, several birds were diagnosed with trichomonosis consisting of multiple trichomonad species. Six birds were examined, with trichomonads found in ceca in four birds and associated typhlitis in three of these four birds. PCR and DNA sequencing utilizing trichomonad-specific primers targeting the ITS1 region of the ribosomal DNA (rDNA) revealed the presence of Tetratrichomonas gallinarum in the gastrointestinal tracts of five birds and Trichomonas spp. in the livers of two birds, one of which had a dual Te. gallinarum-Trichomonas gallinae infection. Sequence analysis revealed no variation between Te. gallinarum sequences whereas the ITS1 sequences obtained from the other Trichomonas spp. demonstrated the presence of multiple genotypes. One sequence had 100% identity to a Trichomonas sp. previously isolated from a Cooper\u27s hawk (Accipiter cooperii) and the other sequence was 100% identical to a previously described Tr. gallinae isolate obtained from a Pacific Coast band-tailed pigeon (Patagioenas fasciata monilis). These findings suggest Te. gallinarum and other Trichomonas spp. possibly contributed to morbidity and mortality in this species. Furthermore, to the authors\u27 knowledge, this is the first report of trichomonad-associated disease in a free-ranging sea duck

Epidemiology of the lymphatic-dwelling filarioid nematode Rumenfilaria andersoni in free-ranging moose (Alces alces) and other cervids of North America

Background: Moose (Alces alces) are a culturally and economically valued species in Minnesota, where the northeast population has decreased by 60 % since 2006. The cause of the decline is currently unclear; however, parasites, predation, and climate change have all been implicated. Nematode parasites are important pathogens in North American moose, potentially causing severe disease and mortality. Recent spread of Rumenfilaria andersoni, a filarioid nematode of moose, has been documented in Finnish cervids; however, little is known about the epidemiology of this parasite in North America. Methods: To investigate the prevalence and distribution of R. andersoni, 584 blood samples were collected from live-captured and dead animals and screened microscopically for the presence of microfilariae using a modified Knott's test. Microfilariae were identified based on morphological characteristics. A subset of Knott's-positive animals was subjected to polymerase chain reaction (PCR) with filarioid-specific primers targeting the first internal transcribed spacer region (ITS-1) of the rRNA gene cluster. Results: Rumenfilaria microfilariae were present in 20.5 % of Minnesota moose (n = 352), with slight fluctuations observed over four years. Minnesota white-tailed deer (Odocoileus virginianus) (n = 2) and moose (n = 44) from Alaska, Montana, Washington, Maine, and New Hampshire also harbored R. andersoni, suggesting this parasite occurs widely throughout North American moose herds, and white-tailed deer can serve as a patent host. Sequence analysis of cervid blood (moose, n = 15; white-tailed deer, n = 1) confirmed the identity of R. andersoni and revealed the existence of two distinct clades. Genetic comparisons of R. andersoni isolates from North America and semi-domesticated Finnish reindeer found the two groups to be closely related, supporting previous hypotheses that R. andersoni was recently introduced into Finland by the importation of deer from the United States. Conclusions: To the best of our knowledge these observations represent the first report of R. andersoni within the contiguous United States and reveal this nematode as a common parasite of North American moose and white-tailed deer. Although the implications of R. andersoni infection on moose health is unclear, increased awareness of this parasite will help prevent unintentional introduction of R. andersoni into naive populations via the translocation of wild and captive cervids.Peer reviewe

Emergence of the arterial worm Elaeophora schneideri in moose (Alces alces) and tabanid fly vectors in northeastern Minnesota, USA

Background Moose (Alces alces) are a culturally and economically valued species in Minnesota. However, the moose population has experienced a sudden, marked decline in their range, including extirpation in the northwest and a 66% decline in the last decade in the northeast portions of the state. Although the exact cause of this decline is unclear, parasitic metastrongylid and filarioid nematode infections are known causes of morbidity and mortality in moose across North America. Methods To determine if these parasitic nematodes could be contributing to the Minnesota moose population decline, we molecularly examined banked tissues obtained from moose that died of known and unknown causes for the presence of nematode DNA. Extracted brain DNA of 34 individual moose was amplified utilizing primers targeting the 18S rRNA gene and internal transcribed spacer regions of nematodes. Results DNA sequencing revealed that PCR products obtained from 15 (44.1%) of the moose were 99% identical to Parelaphostrongylus tenuis, a metastrongylid known to cause neurological disease and death. Additionally, brain tissue from 20 (58.8%) individuals yielded sequences that most closely aligned with Elaeophora schneideri, a parasite associated with neurological impairment but previously unreported in Minnesota. Setaria yehi, a common filarioid parasite of deer, was also detected in the brain tissue of 5 (14.7%) moose. Molecular screening of 618 captured tabanid flies from four trapping sites revealed E. schneideri was present (6%) in the Minnesota environment and transmission could occur locally. Prevalence rates among the flies ranged between 0–100% per trapping site, with Chrysops spp. and Hybomitra spp. implicated as the vectors. Conclusions Ultimately, these data confirm that P. tenuis is widespread in the Minnesota moose population and raises the question of the significance of E. schneideri as a contributing factor to morbidity and mortality in moose