Description of Aegyptianella botuliformis n. sp. (Rickettsiales: Anaplasmataceae) from the helmeted guineafowl, Numida meleagris

Aegyptianella botuliformis n. sp. (Rickettsiales: Anaplasmataceae) isolated from helmeted guineafowls Numida meleagris from the Kruger National Park is described. The rickettsia occurs within a membrane-bound vacuole in the cytoplasm of erythrocytes with up to 8 organisms in a mature inclusion. The initial body resembles that of Aegyptianella pullorum. The tightly packed, sausage-shaped intermediate forms are a distinctive morphological feature, seen as irregular, pleomorphic forms under light microscopy. While more larvae and nymphs of Amblyomma hebraeum and Amblyomma marmoreaum were found on the birds than larvae of an Argas sp., it is believed that the latter are the vectors of A. botuliformis n. sp. In addition to the Kruger National Park, positive blood smears were obtained from guineafowls at other localities in the Transvaal.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat XI Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.Foundation for Research Development.mn201

The prevalence of blood parasites in helmeted guineafowls, Numida meleagris, in the Kruger National Park

Bloodsmears were taken from separate groups of five helmeted guineafowls, Numida meleagris, shot at approximately monthly intervals at Skukuza and near Lower Sabie in the Kruger National Park during the period August 1988 to August 1990. Ninety-eight (86%) of 114 guineafowls had single or multiple infections of Aegyptianella sp., Haemoproteus pratasi, Hepatozoon sp., Leucocytozoon neavei, Plasmodium circumflexum and Trypanosoma numidae. The apparent seasonal prevalence of Aegyptianella sp., H. pratasi and L. neavei, the three most commonly occurring parasites (42%, 49% and 56% of birds infected respectively), is probably dependent on the presence of their respective vectors.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat XI Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.National Parks Board. Foundation for Research Development.mn201

Spatial variability shapes microbial communities of permafrost soils and their reaction to warming

Climate change threatens the Earth’s biggest terrestrial organic carbon reservoir: permafrost soils. With climate warming, frozen soil organic matter may thaw and become available for microbial decomposition and subsequent greenhouse gas emissions. Permafrost soils are extremely heterogenous within the soil profile and between landforms. This heterogeneity in environmental conditions, carbon content and soil organic matter composition, potentially leads to different microbial communities with different responses to warming. The aim of the present study is to (1) elucidate these differences in microbial community compositions and (2) investigate how these communities react to warming. We performed short-term warming experiments with permafrost soil organic matter from northwestern Canada. We compared two sites characterized by different glacial histories (Laurentide Ice Sheet cover during LGM and without glaciation), three landscape types (low-center, flat-center, high-center polygons) and four different soil horizons (organic topsoil layer, mineral topsoil layer, cryoturbated soil layer, and the upper permanently frozen soil layer). We incubated aliquots of all soil samples at 4 °C and at 14 °C for 8 weeks and analyzed microbial community compositions (amplicon sequencing of 16S rRNA gene and ITS1 region) before and after the incubation, comparing them to microbial growth, microbial respiration, microbial biomass and soil organic matter composition. We found distinct bacterial, archaeal and fungal communities for soils of different glaciation history, polygon types and for different soil layers. Communities of low-center polygons differ from high-center and flat-center polygons in bacterial, archaeal and fungal community compositions, while communities of organic soil layers are significantly different from all other horizons. Interestingly, permanently frozen soil layers differ from all other horizons in bacterial and archaeal, but not fungal community composition. The 8-week incubations led to minor shifts in bacterial and archaeal community composition between initial soils and those subjected to 14 °C warming. We also found a strong warming effect on the community compositions in some of the extreme habitats: microbial community compositions of (i) the upper permanently frozen layer and of (ii) low-center polygons differ significantly for incubations at 4 °C and 14 °C. Yet, the lack of a community change in horizons of the active layer suggests that microbes are adapted to fluctuating temperatures due to seasonal thaw events. Our results suggest that warming responses of permafrost soil organic matter, if not frozen or water-saturated, may be predictable by current models. Process changes induced by short-term warming can be rather attributed to changes in microbial physiology than community composition. This work is part of the EU H2020 project “Nunataryuk”

Microbial growth in a warming Arctic: Exploring controls and temperature responses in permafrost soils

Permafrost soils are particularly vulnerable to climate warming. With ~1,500&amp;#160;Gt Carbon&amp;#160;(C), they store a significant proportion of global soil C. Organic matter that was frozen and thus unavailable for microbial decomposition for millennia, is now thawing. How much of this permafrost C is decomposed will be determined by microbial activities and the partitioning of assimilated C to microbial growth (potential C stabilization) or microbial respiration (C loss). Our current knowledge on the controls of microbial growth and respiration in permafrost soils is, however, limited. The objective of this study was to analyze microbial growth and respiration in permafrost soils and to explore soil organic matter composition, microbial community composition and various soil parameters as potential drivers. We collected 81 soil samples from four soil layers (organic, mineral, cryoturbated, permafrost) and three lowland tundra polygon types (low-center, flat-center, high-center) in Arctic Canada. We used pyrolysis-GC-MS fingerprinting to characterize soil organic matter composition and amplicon sequencing (16S, ITS1) to identify archaeal, bacterial, and fungal community composition. Temperature responses (Q10) were analyzed in an 8-week laboratory incubation experiment, subjecting soil aliquots to 4 &amp;#176;C and 14 &amp;#176;C. Microbial growth was determined by 18O-H2O-incorporation into DNA and microbial respiration by gas analysis. Soil organic matter composition differed between soil layers along a gradient of degradation and C content. Organic matter complexity and diversity decreased with the level of decomposition. We found distinct soil organic matter composition for each polygon type, including all soil layers, suggesting different decomposition pathways, induced by differences in vegetation and soil water regime. Anoxic conditions in low-center polygons resulted in more archaea and distinct fungal communities. Microbial community composition differed among all soil layers, with particularly more fungi in organic soils. Microbial mass-specific growth and respiration differed among polygons and soil layers, and both increased with warming. Overall, temperature responses (Q10) were higher for respiration than for growth, implying that microbes are less efficient in using C for growth. Linear mixed effect models revealed that soil organic matter composition and microbial community composition were good predictors for mass-specific growth at field and warmed conditions. Mass-specific respiration was best explained by microbial community composition. Our predictors, however, did not explain the temperature responses. Our results indicate that under warming, microbes allocated more C to respiration, leading to increased greenhouse gas emissions per unit of carbon taken up. We found these results while including all soil layers and polygon types, suggesting these responses to be representative for lowland Arctic ecosystems. Moreover, we could show that organic matter composition and microbial community composition are good predictors for microbial growth and respiration, thus deserving more attention in future studies. This study is part of the EU H2020 project &amp;#8220;Nunataryuk&amp;#8221;.</jats:p

Effect of spinal manipulation on sensorimotor functions in back pain patients: study protocol for a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Low back pain (LBP) is a recognized public health problem, impacting up to 80% of US adults at some point in their lives. Patients with LBP are utilizing integrative health care such as spinal manipulation (SM). SM is the therapeutic application of a load to specific body tissues or structures and can be divided into two broad categories: SM with a high-velocity low-amplitude load, or an impulse "thrust", (HVLA-SM) and SM with a low-velocity variable-amplitude load (LVVA-SM). There is evidence that sensorimotor function in people with LBP is altered. This study evaluates the sensorimotor function in the lumbopelvic region, as measured by postural sway, response to sudden load and repositioning accuracy, following SM to the lumbar and pelvic region when compared to a sham treatment.</p> <p>Methods/Design</p> <p>A total of 219 participants with acute, subacute or chronic low back pain are being recruited from the Quad Cities area located in Iowa and Illinois. They are allocated through a minimization algorithm in a 1:1:1 ratio to receive either 13 HVLA-SM treatments over 6 weeks, 13 LVVA-SM treatments over 6 weeks or 2 weeks of a sham treatment followed by 4 weeks of full spine "doctor's choice" SM. Sensorimotor function tests are performed before and immediately after treatment at baseline, week 2 and week 6. Self-report outcome assessments are also collected. The primary aims of this study are to 1) determine immediate pre to post changes in sensorimotor function as measured by postural sway following delivery of a single HVLA-SM or LVVA-SM treatment when compared to a sham treatment and 2) to determine changes from baseline to 2 weeks (4 treatments) of HVLA-SM or LVVA-SM compared to a sham treatment. Secondary aims include changes in response to sudden loads and lumbar repositioning accuracy at these endpoints, estimating sensorimotor function in the SM groups after 6 weeks of treatment, and exploring if changes in sensorimotor function are associated with changes in self-report outcome assessments.</p> <p>Discussion</p> <p>This study may provide clues to the sensorimotor mechanisms that explain observed functional deficits associated with LBP, as well as the mechanism of action of SM.</p> <p>Trial registration</p> <p>This trial is registered in ClinicalTrials.gov, with the ID number of <a href="http://www.clinicaltrials.gov/ct2/show/NCT00830596">NCT00830596</a>, registered on January 27, 2009. The first participant was allocated on 30 January 2009 and the final participant was allocated on 17 March 2011.</p

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362