Comparison of Phenology and Pathogen Prevalence, Including Infection With the Ehrlichia muris-Like (EML) Agent, of Ixodes Scapularis Removed from Soldiers in the Midwestern and Northeastern United States Over a 15 Year Period (1997-2012)

Background: Since 1997, human-biting ticks submitted to the Department of Defense Human Tick Test Kit Program (HTTKP) of the US Army Public Health Command have been tested for pathogens by PCR. We noted differences in the phenology and infection prevalence among Ixodes scapularis ticks submitted from military installations in different geographic regions. The aim of this study was to characterize these observed differences, comparing the phenology and pathogen infection rates of I. scapularis submitted from soldiers at two sites in the upper Midwest ( Camp Ripley, MN, and Ft. McCoy, WI) and one site in the northeastern US (Ft. Indiantown Gap, PA). Methods: From 1997 through 2012, the HTTKP received 1,981 I. scapularis from the three installations and tested them for Anaplasma phagocytophilum, Babesia microti, Borrelia burgdorferi and the Ehrlichia muris-like (EML) agent using PCR; pathogen presence was confirmed via sequencing or amplification of a second gene target. Pathogen and co-infection prevalence, tick engorgement status, and phenology were compared among installations. Results: Greater rates of A. phagocytophilum and Ba. microti infections were detected in ticks submitted from installations in Minnesota than in Wisconsin or Pennsylvania, and the EML agent was only detected in ticks from Minnesota and Wisconsin. Midwestern ticks were also more likely to be co-infected than those from Pennsylvania. Both adult and nymphal ticks showed evidence of feeding on people, although nymphs were more often submitted engorged. Adult I. scapularis were received more frequently in June from Minnesota than from either of the other sites. Minnesota adult and nymphal peaks overlapped in June, and submissions of adults exceeded nymphs in that month. Conclusions: There were clear differences in I. scapularis phenology, pathogen prevalence and rates of co-infection among the three military installations. Seasonal and temperature differences between the three sites and length of time a population had been established in each region may contribute to the observed differences. The synchrony of adults and nymphs observed in the upper Midwest has implications for pathogen infection prevalence. The EML agent was only detected in Minnesota and Wisconsin, supporting the previous assertion that this pathogen is currently limited to the upper Midwest

Understanding future water challenges in a highly regulated Indian river basin — modelling the impact of climate change on the hydrology of the upper Narmada

The Narmada river basin is a highly regulated catchment in central India, supporting a population of over 16 million people. In such extensively modified hydrological systems, the influence of anthropogenic alterations is often underrepresented or excluded entirely by large-scale hydrological models. The Global Water Availability Assessment (GWAVA) model is applied to the Upper Narmada, with all major dams, water abstractions and irrigation command areas included, which allows for the development of a holistic methodology for the assessment of water resources in the basin. The model is driven with 17 Global Circulation Models (GCMs) from the Coupled Model Intercomparison Project Phase 5 (CMIP5) ensemble to assess the impact of climate change on water resources in the basin for the period 2031–2060. The study finds that the hydrological regime within the basin is likely to intensify over the next half-century as a result of future climate change, causing long-term increases in monsoon season flow across the Upper Narmada. Climate is expected to have little impact on dry season flows, in comparison to water demand intensification over the same period, which may lead to increased water stress in parts of the basin

Provision of artificial shelter on beaches is associated with improved shorebird fledging success

Artificial chick shelters might improve productivity of beach-nesting birds threatened by anthropogenic disturbance. We investigated the efficacy of three different chick shelter designs against four criteria: accessibility to chicks over time, thermal insulation, conspicuousness to beach-goers, and practicality (cost and ease of transport). One design (‘A-frame’) was selected because it offered the greatest thermal insulation, was the least conspicuous, most cost effective, and performed equally well in terms of accessibility. We deployed these artificial shelters on Hooded Plover Thinornis rubricollis territories where broods were present (n 5 11), and compared the behaviour and survival rate of chicks to that at control sites (n 5 10). We were unable to discern any difference in the behaviour of broods when artificial shelters were available. However, the survival rate of chicks to fledging was 71.8% higher where an artificial shelter was provided (n 5 21 broods). This was validated by analysing data from a larger sample of broods monitored as part of an active volunteer-based management programme; shelters conferred a 42.8%increase in survival to fledging (n 5 81 broods). Thus, artificial shelters have the potential to increase survival rates of threatened shorebird chicks, though the mechanisms through which survival is increased require further investigation

Patient Preferences for Follow-up After Recent Excision of a Localized Melanoma

Importance The standard model of follow-up posttreatment of localized melanoma relies on clinician detection of recurrent or new melanoma, through routinely scheduled clinics (clinician-led surveillance). An alternative model is to increase reliance on patient detection of melanoma, with fewer scheduled visits and increased support for patients’ skin self-examination (SSE) (eg, using smartphone apps to instruct, prompt and record SSE, and facilitate teledermatology; patient-led surveillance). Objective To determine the proportion of adults treated for localized melanoma who prefer the standard scheduled visit frequency (as per Australian guideline recommendations) or fewer scheduled visits (adapted from the Melanoma Follow-up [MELFO] study of reduced follow-up). Design, Setting, and Participants This survey study used a telephone interview for surveillance following excision of localized melanoma at an Australian specialist center. We invited a random sample of 400 patients who had completed treatment for localized melanoma in 2014 to participate. They were asked about their preferences for scheduled follow-up, and experience of follow-up in the past 12 months. Those with a recurrent or new primary melanoma diagnosed by the time of interview (0.8-1.7 years since first diagnosis) were asked about how it was first detected and treated. SSE practices were also assessed. Main Outcomes and Measures Proportion preferring standard vs fewer scheduled clinic visits, median delay between detection and treatment of recurrent or new primary melanoma, and SSE practices. Results Of the 262 people who agreed to be interviewed, the mean (SD) age was 64.3 (14.3) years, and 93 (36%) were women. Among the 230 people who did not have a recurrent or new primary melanoma, 149 vs 81 preferred the standard vs fewer scheduled clinic visits option (70% vs 30% after adjusting for sampling frame). Factors independently associated with preferring fewer visits were a higher disease stage, melanoma on a limb, living with others, not having private health insurance, and seeing a specialist for another chronic condition. The median delay between first detection and treatment of recurrent or new primary melanoma was 7 and 3 weeks, respectively. Only 8% missed a scheduled visit, while 40% did not perform SSE or did so at greater than 3-month intervals. Conclusions and Relevance Some patients with melanoma may prefer fewer scheduled visits, if they are supported to do SSE and there is rapid clinical review of anything causing concern (patient-led surveillance)

Ruisasi 1 and the earliest evidence of mass-produced ceramics in Caution Bay (Port Moresby region), Papua New Guinea

The history of pottery use along the south coast of Papua New Guinea spans from Lapita times, here dated to 2900–2600 cal BP, through to mass production of pottery associated with a number of ethnographically-known interaction (and exchange) networks. Understanding the antecedents and developmental histories of these interaction networks is of considerable importance to archaeological research from local to western Pacific geographical scales. The archaeological site of Ruisasi 1 located at Caution Bay near Port Moresby provides new insights into scales of pottery production before the development of the regional Motu hiri exchange system within the past 500 years. Here faunal remains indicate occupation by marine specialists who exploited a diverse range of local marine environments. Nearly 20,000 ceramic sherds are present in Square A, mostly from a 26 cm thick ‘pottery midden’. A minimum of 45 red slip/plainware vessels based on conjoined sets of sherds plus two vessels with incised decoration are present; the maximum number of clay vessels based on Fabric Types is 155. The globular red slip/plainware pots have highly standardized shapes and sizes, consistent with mass pottery production. The concentration of sherds from these pots within the pottery midden reflects short-duration depositional events within the period of village life c. 1630–1220 cal BP. Whether or not the pots were made locally or imported is the subject of ongoing research. Whatever the case, Ruisasi 1 raises the possibility of mass pottery production possibly linked to a regional interaction network pre-dating the hiri

Periscope Proteins are variable length regulators of bacterial cell surface interactions

Changes at the cell surface enable bacteria to survive in dynamic environments, such as diverse niches of the human host. Here, we reveal “Periscope Proteins” as a widespread mechanism of bacterial surface alteration mediated through protein length variation. Tandem arrays of highly similar folded domains can form an elongated rod-like structure; thus, variation in the number of domains determines how far an N-terminal host ligand binding domain projects from the cell surface. Supported by newly available long-read genome sequencing data, we propose that this class could contain over 50 distinct proteins, including those implicated in host colonization and biofilm formation by human pathogens. In large multidomain proteins, sequence divergence between adjacent domains appears to reduce interdomain misfolding. Periscope Proteins break this “rule,” suggesting that their length variability plays an important role in regulating bacterial interactions with host surfaces, other bacteria, and the immune system

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Colorectal cancer incidences in Lynch syndrome: a comparison of results from the prospective lynch syndrome database and the international mismatch repair consortium

Objective To compare colorectal cancer (CRC) incidences in carriers of pathogenic variants of the MMR genes in the PLSD and IMRC cohorts, of which only the former included mandatory colonoscopy surveillance for all participants. Methods CRC incidences were calculated in an intervention group comprising a cohort of confirmed carriers of pathogenic or likely pathogenic variants in mismatch repair genes (path_MMR) followed prospectively by the Prospective Lynch Syndrome Database (PLSD). All had colonoscopy surveillance, with polypectomy when polyps were identified. Comparison was made with a retrospective cohort reported by the International Mismatch Repair Consortium (IMRC). This comprised confirmed and inferred path_MMR carriers who were first- or second-degree relatives of Lynch syndrome probands. Results In the PLSD, 8,153 subjects had follow-up colonoscopy surveillance for a total of 67,604 years and 578 carriers had CRC diagnosed. Average cumulative incidences of CRC in path_MLH1 carriers at 70 years of age were 52% in males and 41% in females; for path_MSH2 50% and 39%; for path_MSH6 13% and 17% and for path_PMS2 11% and 8%. In contrast, in the IMRC cohort, corresponding cumulative incidences were 40% and 27%; 34% and 23%; 16% and 8% and 7% and 6%. Comparing just the European carriers in the two series gave similar findings. Numbers in the PLSD series did not allow comparisons of carriers from other continents separately. Cumulative incidences at 25 years were < 1% in all retrospective groups. Conclusions Prospectively observed CRC incidences (PLSD) in path_MLH1 and path_MSH2 carriers undergoing colonoscopy surveillance and polypectomy were higher than in the retrospective (IMRC) series, and were not reduced in path_MSH6 carriers. These findings were the opposite to those expected. CRC point incidence before 50 years of age was reduced in path_PMS2 carriers subjected to colonoscopy, but not significantly so