Evaluation and Determination of the Sensitivity and Specificity of a Treponema Pallidum Dried Blood Spot Method for Serologic Diagnosis of Syphilis

EVALUATION AND DETERMINATION OF THE SENSITIVITY AND SPECIFICITY OF A Treponema pallidum DRIED BLOOD SPOT (DBS) METHOD FOR SEROLOGIC DIAGNOSIS OF SYPHILIS Background: Syphilis is a sexually transmitted infection (STI) caused by Treponema pallidum subspecies pallidum. Syphilis is known as the great imitator due to the similarity of clinical signs and symptoms to other infectious diseases. The primary diagnosis of syphilis relies on clinical findings, including the examination of treponemal lesions, and/or serologic tests. Serologic tests are divided into nontreponemal and treponemal tests. Nontreponemal tests are useful for screening, while treponemal tests are used as confirmatory tests. Methods: A total of 200 serum and DBS specimens collected from patients at the Los Angeles Municipal Sexually Transmitted Disease Clinics were tested by the DBS and enzyme immunoassay (EIA) methods. These samples were sent to the Syphilis Diagnostics Laboratory, Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia for testing. Samples were blindly evaluated by the TREP-SPOTTM DBS and the TREP- SURETM EIA methods for the detection of anti-treponemal IgG- and IgM-class antibodies. Results: The sensitivity of the DBS method was 83% (95% CI, 73.89 - 89.50) and specificity was 100% (95% CI, 95.39 - 100)). The positive predictive value and negative predictive values were 100% (95% CI, 94.48 - 100) and 85% (95% CI, 77.43 - 91.0), respectively. The efficiency of the DBS method was 91.5%. The kappa value for the agreement between the DBS method and EIA assay was 0.83 (95% CI, 0.754 - 0.906). The correlation coefficient (r2) between the anti-treponemal antibody assay results obtained from DBS and serum samples was 0.94. Conclusion: DBS is an optimal choice to be used as a screening tool for the detection of anti-treponemal antibodies for the diagnosis of syphilis. The detection of anti-treponemal antibodies (TREP-SPOTTM DBS EIA) compared favorably to the results of serum-base assay (TREP-SURETM EIA), with an overall concordance of 91.5%. Dried blood spots are technically easier to obtain and are suitable blood samples for primary health care centers

Attitudes et comportements alimentaires des athlètes québécoises pratiquant un sport esthétique à un haut niveau : caractéristiques personnelles et comparaison à un groupe de contrôle

La pratique d’un sport de type esthétique est aujourd’hui considérée par plusieurs (Sundgot-Borgen & Torstveit, 2004; Thompson & Sherman, 2010) comme un facteur de risque à l’adoption d’attitudes et de comportements alimentaires inappropriés à l’égard de l’alimentation et de l’image corporelle (ACIAI) et ultimement au développement d’un trouble des conduites alimentaires (TCA). Les études actuelles portant sur cette problématique rapportent toutefois des résultats contradictoires. De plus, certains aspects méthodologiques associés notamment à l’hétérogénéité des échantillons limitent la portée interprétative de ces résultats. Afin de pallier les limites actuelles des écrits empiriques, cette thèse a pour but de tracer le portrait de la problématique des désordres alimentaires chez les jeunes athlètes québécoises de haut niveau en sport esthétique. Pour ce faire, un échantillon homogène de 145 adolescentes âgées de 12 à 19 ans a été constitué soit 52 athlètes de haut niveau et 93 non-athlètes. Les sports représentés sont le patinage artistique, la nage synchronisée et le ballet. À partir de cet échantillon, deux études sont réalisées. L’objectif de la première étude est de comparer l’intensité des ACIAI et la prévalence des TCA dans les deux groupes à l’aide de deux questionnaires soit le Eating Disorder Examination Questionnaire (EDE-Q) et le Eating Disorder Inventory-3 (EDI-3). Les résultats obtenus suggèrent qu’il n’y a pas de différence significative entre les athlètes et les non-athlètes de l’échantillon en ce qui a trait à l’intensité des ACIAI et à la prévalence des TCA. La deuxième étude est constituée de deux objectifs. Tout d’abord, comparer les deux groupes relativement aux caractéristiques personnelles suivantes : l’insatisfaction de l’image corporelle (IIC), le sentiment d’efficacité personnelle envers l’alimentation normative (SEP-AN) et l’image corporelle (SEP-IC), le perfectionnisme (P), l’ascétisme (As), la dysrégulation émotionnelle (DÉ) et le déficit intéroceptif (DI). De nature plus exploratoire, le second objectif de cette étude est de décrire et de comparer les caractéristiques personnelles qui sont associées aux ACIAI dans chacun des groupes. Afin de réaliser ces objectifs, deux autres questionnaires ont été utilisés soit le Eating Disorder Recovery Self-efficacy Questionnaire-f (EDRSQ-f) et le Body Shape Questionnaire (BSQ). En somme, les analyses indiquent que les athlètes de l’échantillon présentent des niveaux plus faibles de SEP-AN et de DÉ. Ce faisant, elles auraient moins confiance en leur capacité à maintenir une alimentation normative, mais réguleraient plus efficacement leurs émotions que les adolescentes non-athlètes. Une fois l’âge et l’indice de masse corporelle contrôlés, les résultats démontrent également que le SEP-AN et l’IIC contribuent à prédire dans chaque groupe les ACIAI tels que mesurés par la recherche de minceur. Le SEP-AN a aussi été associé dans les deux groupes à l’intensité des symptômes boulimiques. Les modèles obtenus diffèrent cependant quant aux variables prédictives principales. Chez les athlètes de l’échantillon, l’intensité des conduites boulimiques est associée à la DÉ alors qu’elle est davantage liée au DI chez les adolescentes non sportives. Enfin, en plus de discuter et de comparer l’ensemble de ces résultats aux autres travaux disponibles, les apports distinctifs de la thèse et les principales limites des études sont abordés. Des pistes sont également suggérées afin d’orienter les recherches futures et des implications cliniques sont proposées.The practice of an aesthetic sport is considered by some to be a risk factor for the adoption of inappropriate eating behaviors and attitudes towards food and body image (IEBA) and ultimately the development of an eating disorder (ED). However, the current literature on this issue reports conflicting results. In addition, some methodological flaws related to sample heterogeneity limit the interpretative scope of these results. To overcome the current limitations of the literature, the goal of this thesis is to explore the problematic of eating disorders in young elite athletes in aesthetic sport. To do this, a homogeneous sample of 145 adolescents aged between 12 and 19 years was recruited; 52 high level athletes and 93 non-athletes. The sports represented are figure skating, synchronized swimming and ballet. From this sample, two studies were conducted. The objective of the first study was to compare the intensity of IEBA and the prevalence of ED using the Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Disorder Inventory-3 (EDI-3). The results indicate that there is no significant difference between the groups in regard to the intensity of IEBA and the prevalence of ED. The second study consisted of two goals. First, compare personal characteristics of the two groups. Selected personal characteristics are body image disatisfaction (BID), normative eating self-efficacy NESE), body image self-efficacy (BISE), perfectionism (P), asceticism (As), emotionnal dysregulation (EMD) and interoceptive deficit (ID). The second exploratory objective of this study was to describe and compare the personal characteristics that are associated with IEBA in each group. To achieve these objectives, two other questionnaires were used; the Eating Disorder Recovery Self-efficacy Questionnaire-f (EDRSQ-f) and the Body Shape Questionnaire (BSQ). The analysis indicated that the athletes of the sample have lower levels of NESE and EMD. Once age and body mass index are controlled, the results also showed that the NESE and the BID contribute to the prediction of IEBA (e.s. drive for thinness) in each group. The NESE has also been associated in both groups to the intensity of bulimic symptoms. However, the models differ in the main predictor variables. Among the athletes sample, the intensity of bulimic behaviors was associated with EMD while it was more related to ID in the non athlete group. Finally, in addition to discussing and comparing all these results with the current literature, the distinctive contributions of the thesis and the main limitations of the studies were discussed. Ideas to guide future research and practical clinical implications are also proposed

The Impact of CMS CoP on Kidney Transplant Waiting Times

SRTR program reports provide detailed information on transplant center performance relative to risk-adjusted expected values. Designed to improve outcomes, the behavioral implications of these reports may generate a longer wait time for transplant. UNOS data for 28,839 deceased donor kidney transplants performed during 6/2007- 6/2010 and 79,725 registered patients waiting for a kidney transplant during this time period were merged with SRTR program report data; Patient-specific and transplant center controls were created. An indicator variable was constructed for whether or not a transplant center did not meet the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (CoP) during a patient’s waiting period for a transplant. A censored Cox-proportional hazard model was utilized to investigate the impact of CMS CoP on the length of time until transplant. Data analysis reveals that a transplant center’s failure to meet either the 1-year graft or patient survival rates, according to CMS criteria, is associated with the expected waiting time until transplantation. Further the results suggest that centers may elect to transplant healthier patients and patients for whom they would receive a risk compensation in the SRTR model

A novel phosphoglucomutase-deficient mouse model reveals aberrant glycosylation and early embryonic lethality

Patients with phosphoglucomutase (PGM1) deficiency, a congenital disorder of glycosylation (CDG) suffer from multiple disease phenotypes. Midline cleft defects are present at birth. Overtime, additional clinical phenotypes, which include severe hypoglycemia, hepatopathy, growth retardation, hormonal deficiencies, hemostatic anomalies, frequently lethal, early-onset of dilated cardiomyopathy and myopathy emerge, reflecting the central roles of the enzyme in (glycogen) metabolism and glycosylation. To delineate the pathophysiology of the tissue-specific disease phenotypes, we constructed a constitutive Pgm2 (mouse ortholog of human PGM1)-knockout (KO) mouse model using CRISPR-Cas9 technology. After multiple crosses between heterozygous parents, we were unable to identify homozygous life births in 78 newborn pups (P = 1.59897E-06), suggesting an embryonic lethality phenotype in the homozygotes. Ultrasound studies of the course of pregnancy confirmed Pgm2-deficient pups succumb before E9.5. Oral galactose supplementation (9 mg/mL drinking water) did not rescue the lethality. Biochemical studies of tissues and skin fibroblasts harvested from heterozygous animals confirmed reduced Pgm2 enzyme activity and abundance, but no change in glycogen content. However, glycomics analyses in serum revealed an abnormal glycosylation pattern in the Pgm2(+/-) animals, similar to that seen in PGM1-CDG

Development of exchange lists for M editerranean and H ealthy E ating D iets: implementation in an intervention trial

Background There has been little research published on the adaptation of diabetic exchange list diet approaches for the design of intervention diets in health research despite their clinical utility. The exchange list approach can provide clear and precise guidance on multiple dietary changes simultaneously. The present study aimed to develop exchange list diets for M editerranean and H ealthy E ating, and to evaluate adherence, dietary intakes and markers of health risks with each counselling approach in 120 subjects at increased risk for developing colon cancer. Methods A randomised clinical trial was implemented in the USA involving telephone counselling. The M editerranean diet had 10 dietary goals targeting increases in mono‐unsaturated fats, n ‐3 fats, whole grains and the amount and variety of fruits and vegetables. The Healthy Eating diet had five dietary goals that were based on the US H ealthy P eople 2010 recommendations. Results Dietary compliance was similar in both diet arms, with 82–88% of goals being met at 6 months, although subjects took more time to achieve the M editerranean goals than the H ealthy E ating goals. The relatively modest fruit and vegetable goals in the Healthy Eating arm were exceeded, resulting in fruit and vegetable intakes of approximately eight servings per day in each arm after 6 months. A significant ( P  < 0.05) weight loss and a decrease in serum C ‐reactive protein concentrations were observed in the overweight/obese subgroup of subjects in the M editerranean arm in the absence of weight loss goals. Conclusions Counselling for the M editerranean diet may be useful for both improving diet quality and for achieving a modest weight loss in overweight or obese individuals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108685/1/jhn12158.pd

101 Dothideomycetes genomes: A test case for predicting lifestyles and emergence of pathogens.

Dothideomycetes is the largest class of kingdom Fungi and comprises an incredible diversity of lifestyles, many of which have evolved multiple times. Plant pathogens represent a major ecological niche of the class Dothideomycetes and they are known to infect most major food crops and feedstocks for biomass and biofuel production. Studying the ecology and evolution of Dothideomycetes has significant implications for our fundamental understanding of fungal evolution, their adaptation to stress and host specificity, and practical implications with regard to the effects of climate change and on the food, feed, and livestock elements of the agro-economy. In this study, we present the first large-scale, whole-genome comparison of 101 Dothideomycetes introducing 55 newly sequenced species. The availability of whole-genome data produced a high-confidence phylogeny leading to reclassification of 25 organisms, provided a clearer picture of the relationships among the various families, and indicated that pathogenicity evolved multiple times within this class. We also identified gene family expansions and contractions across the Dothideomycetes phylogeny linked to ecological niches providing insights into genome evolution and adaptation across this group. Using machine-learning methods we classified fungi into lifestyle classes with &gt;95&nbsp;% accuracy and identified a small number of gene families that positively correlated with these distinctions. This can become a valuable tool for genome-based prediction of species lifestyle, especially for rarely seen and poorly studied species

Symplasmic transport and phloem loading in gymnosperm leaves

Despite more than 130 years of research, phloem loading is far from being understood in gymnosperms. In part this is due to the special architecture of their leaves. They differ from angiosperm leaves among others by having a transfusion tissue between bundle sheath and the axial vascular elements. This article reviews the somewhat inaccessible and/or neglected literature and identifies the key points for pre-phloem transport and loading of photoassimilates. The pre-phloem pathway of assimilates is structurally characterized by a high number of plasmodesmata between all cell types starting in the mesophyll and continuing via bundle sheath, transfusion parenchyma, Strasburger cells up to the sieve elements. Occurrence of median cavities and branching indicates that primary plasmodesmata get secondarily modified and multiplied during expansion growth. Only functional tests can elucidate whether this symplasmic pathway is indeed continuous for assimilates, and if phloem loading in gymnosperms is comparable with the symplasmic loading mode in many angiosperm trees. In contrast to angiosperms, the bundle sheath has properties of an endodermis and is equipped with Casparian strips or other wall modifications that form a domain border for any apoplasmic transport. It constitutes a key point of control for nutrient transport, where the opposing flow of mineral nutrients and photoassimilates has to be accommodated in each single cell, bringing to mind the principle of a revolving door. The review lists a number of experiments needed to elucidate the mode of phloem loading in gymnosperms