Species Gap. Are we better prepared for zoonotic threat than we were in 1999? Hvae the lessions of the West Nile virus been learned?

The goal of biosurveillance for zoonotic threats is to push the epidemiologic curve to the far left and detect impending disease outbreaks in animals before they spill over into the human population. However, this assumes that all species are under surveillance and that the information is available to public health and national security officials. That is not the case. In both the USA and abroad, governments continue to ignore non-agricultural species that have historically provided early warning of impending human health crises (West Nile virus, plague, tularemia, monkeypox, H3N2 influenza). The majority of funding goes to the public health sector, then to agricultural agencies with little to none on wildlife. This continues in spite of the fact that the majority of recent emerging infectious diseases have originated in wildlife. Dogs, cats, zoo animals, and other urban animal sentinels also continue to be ignored. This is sheer folly. The truth is that we have no way of knowing who or what might serve as sentinels from the next pandemic threat. In 1999, warning of the West Nile virus came from wild crows and zoo flamingos. A few years later, pet prairie dogs and Giant Gambian rats showed signs of monkeypox well in advance of an extensive human outbreak but went undetected due to an entrenched species bias that focuses solely on humans and agricultural species. We must adopt a species neutral approach to biosurveillance. Until this becomes a reality, we will continue to use people as the “index case” for pandemic threats

Nutrient management on intensive dairy farms in the southwest of Ireland

End of Project ReportIntensive grass-based dairy farming relies on high inputs of nutrients that are now regulated under SI 378, 2006 (Good Agricultural Practice for Protection of Waters). This project studied nutrient management practices on twenty-one intensive dairy farms in the south-west of Ireland between 2003 and 2006. Mean stocking rate was 202 kg organic-N/ha deposited by grazing livestock. Overall fertiliser-N use on the farms decreased from 266 to 223 kg N/ha/yr during the study, with the rate of fertiliser-N in the first application each year decreasing from 49 to 33 kg N/ha, while the rate of fertiliser-N applied for first cut silage production also fell from 106 to 96 kg N/ha. These decreases were partly achieved by applying more slurry in springtime and by the introduction of white clover on five of the farms. While the limits on fertiliser-N use under SI 378 were exceeded on ten farms in 2003, the limits were exceeded on only two farms in 2006. Fertiliser-P usage declined from 12.0 to 10.2 kg P/ha/yr, and complied with the limits of SI 378 on thirteen of the farms in 2006. Mean Morgan’s extractable soil P concentration (STP) exceeded 10 mg/l on five farms, while the mean concentration exceeded 8 mg/l on ten farms. Phosphorus management, therefore, was close to that required by SI 378 on most farms. Slurry storage capacity met or exceeded the minimum requirements of SI 378 on eight farms; substantial investment in slurry storage facilities was necessary on thirteen farms. The mean N surplus on the farms declined from 277 to 232 kg N/ha/yr during the study due to a decline in total N input from 335 to 288 kg N/ha/yr over the same period. The mean efficiency of N-use increased from 17.9 to 20.2 %. The large variation in rates of fertiliser-N applied on farms with similar stocking rates suggests potential for further improvements in N use efficiency on some farms. Decreases in nutrient input levels can be partly attributed to increased farmer awareness, due to advice and record keeping from this study and the introduction of SI 378, and the increasing cost of nutrient inputs relative to output prices. In terms of fertiliser N and P use and soil P concentrations, complying with the limits in SI 378 does not require major changes in nutrient management practices on the majority of these intensive dairy farms

The Effect of Kinesiology Tape on Pain and Neck Range of Motion After Cervical Manipulation

Background: Annually, 30%–50% of adults will experience some form of debilitating neck pain. One approach to treating neck pain is cervical manipulation. This treatment modality has, at times, been reported to result in a short-term increase in pain, which in turn has been linked to reduced neck range of motion (ROM). Elastic therapeutic tape (ETT) has been shown to reduce musculoskeletal pain, although limited research has been conducted to determine if ETT can mitigate pain and facilitate neck ROM following cervical manipulation. Purpose: The purpose of this study is to compare the pain and neck ROM among patients with acute neck pain who do and do not receive ETT following cervical manipulation. Methods: A convenience sample of 50 patients between 18 and 64 years of age presented with acute noncomplicated neck pain was recruited from an outpatient chiropractic clinic. Patients were randomly assigned to 2 groups. In the tape group (n = 27), ETT was applied to their neck immediately following cervical manipulation for neck pain. In the control group (n = 23), cervical manipulation was performed with no application of ETT following the procedure. Pain and neck ROM were recorded at the following 3 different intervals: pre-cervical manipulation (T1), within 5 minutes of cervical manipulation (T2), and 24–48 hours after manipulation (T3). In total, 6 cervical ROM values were recorded with dual inclinometers. Pain was measured by asking of each patient to rate their neck pain using the numeric pain rating scale from 0 to 10. Results: The tape group demonstrated a significant decline (P \u3c 0.00) in pain between T1 (x = 6.15) and T2 (x = 5.37) and between T1 and T3 (x = 4.89). The control group did not report significant changes in their pain over the duration of the study. Neither group reported any significant change in any measure of neck ROM over the duration of the study. Clinical Relevance: Results from this study support the use of ETT to reduce pain immediately and 24–48 hours following cervical manipulation among patients presenting with acute neck pain

One Health: Addressing the Challenges of Global Health and Food Security panel

This panel will provided an expert-centered overview of operational, policy, and critical decision-making threats, opportunities, and strengths that shape the effectiveness of health and food protection and security locally, nationally, and transnationally. Perspectives addressed proactive, trans-operational, commercializable, and innovative R&D approaches to these objectives. WARNING: The presentation by Dr. Stephen Barnes entitled "Lessons learned from combat casualty care" contains graphic images of wounds sustained in combat. Viewer discretion is strongly advised

Burning Cold: Involvement of TRPA1 in Noxious Cold Sensation

Soon after its discovery ten years ago, the ion channel TRPA1 was proposed as a sensor of noxious cold. Evidence for its activation by painfully cold temperatures (below ~15° C) has been mixed, however. Some groups found that cold elicits a nonselective conductance in cells expressing TRPA1; others found no activation, or argued that activation is an indirect effect of elevated $Ca^{ 2+}$ . Sensory cells from the trigeminal and dorsal root ganglia that are activated by cold were sometimes correlated with those cells expressing TRPA1; other times not. Mice lacking TRPA1 showed behavioral defi cits for some assays of painful cold sensation, but not others. New evidence tends to support direct activation of TRPA1 by cold, and the slow and relatively weak activation of TRPA1 by cold helps reconcile some confl icting studies

Sustainable Harvesting of Tropical Rainforests: Reply to Keto, Scott and Olsen

This paper refutes the Keto et al. proposition that the Queensland selection logging system is neither ecologically nor economically sustainable. The key requirements of this system are: (1) that logging guidelines are sympathetic to the silvicultural characteristics of the forest, ensuring adequate regeneration of commercial species and discouraging invasion by weeds; (2) tree-marking by trained staff specifies trees to be retained, trees to be removed and the direction of felling to ensure minimal damage to the residual stand; (3) logging equipment is appropriate and driven by trained operators to ensure minimal damage and soil disturbance, compaction and erosion; (4) prescriptions ensure that adequate stream buffers and steep slopes are excluded from logging; (5) sufficient areas for scientific reference, feature protection and recreation are identified and excluded from logging; and (6) that deficiencies in an evolving system are recognized and remedied, leading to an improved system. Many studies of the effects of logging in these forests have been published and collectively provide a unique demonstration of one possible approach to sustainable timber harvesting

The family Carditidae (Bivalvia) in the early Danian of Patagonia (Argentina)

The first systematic analysis of the Danian carditids of Patagonia is presented, which includes four genera—one new genus and the first records of three other genera in South America. They consist of Claibornicardia paleopatagonica (Ihering, 1903), a widely distributed species occuring in the Jagüel, Roca and Salamanca formations (Neuquén, Río Negro and Chubut Provinces); Rotundicardia Heaslip, 1968, represented by the new species R. mariobrosorum n. sp., which is restricted to the Roca Formation (Río Negro Province); Cardites feruglioi (Petersen, 1846) (Roca and Lefipán formations, Río Negro and Chubut Provinces); and by Kalelia new genus, which includes K. burmeisteri (Böhm, 1903) from the Salamanca and Roca formations (Río Negro and Chubut Provinces), which is related to the Paris Basin species K. multicostata (Lamarck, 1806) n. comb. and K. pectuncularis (Lamarck, 1806) n. comb. ‘Venericardia’ iheringi (Böhm, 1903), a species known only from internal molds, is described and regarded as a carditid with uncertain affinities. The presence of Claibornicardia, Rotundicardia, and Cardites in Patagonia constitutes the most ancient record of these genera and confirms biogeographical connections previously established between the Danian Argentinian and North American/European fossil faunas.Fil: Perez, Damián. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales ; ArgentinaFil: del Río, Claudia Julia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales ; Argentin

Care and communication between health professionals and patients affected by severe or chronic illness in community care settings: a qualitative study of care at the end of life

Background: Advance care planning (ACP) enables patients to consider, discuss and, if they wish, document their wishes and preferences for future care, including decisions to refuse treatment, in the event that they lose capacity to make decisions for themselves. ACP is a key component of UK health policy to improve the experience of death and dying for patients and their families. There is limited evidence about how patients and health professionals understand ACP, or when and how this is initiated. It is evident that many people find discussion of and planning for end of life care difficult, and tend to avoid the topic. Aim: To investigate how patients, their relatives and health professionals initiate and experience discussion of ACP and the outcomes of advance discussions in shaping care at the end of life. Design and data collection: Qualitative study with two workstreams: (1) interviews with 37 health professionals (general practitioners, specialist nurses and community nurses) about their experiences of ACP; and (2) longitudinal case studies of 21 patients with 6-month follow-up. Cases included a patient and, where possible, a nominated key relative and/or health professional as well as a review of medical records. Complete case triads were obtained for 11 patients. Four cases comprised the patient alone, where respondents were unable or unwilling to nominate either a family member or a professional carer they wished to include in the study. Patients were identified as likely to be within the last 6 months of life. Ninety-seven interviews were completed in total. Setting: General practices and community care settings in the East Midlands of England. Findings: The study found ACP to be uncommon and focused primarily on specific documented tasks involving decisions about preferred place of death and cardiopulmonary resuscitation, supporting earlier research. There was no evidence of ACP in nearly half (9 of 21) of patient cases. Professionals reported ACP discussions to be challenging. It was difficult to recognise when patients had entered the last year of life, or to identify their readiness to consider future planning. Patients often did not wish to do so before they had become gravely ill. Consequently, ACP discussions tended to be reactive, rather than pre-emptive, occurring in response to critical events or evidence of marked deterioration. ACP discussions intersected two parallel strands of planning: professional organisation and co-ordination of care; and the practical and emotional preparatory work that patients and families undertook to prepare themselves for death. Reference to ACP as a means of guiding decisions for patients who had lost capacity was rare. Conclusions: Advance care planning remains uncommon, is often limited to documentation of a few key decisions, is reported to be challenging by many health professionals, is not welcomed by a substantial number of patients and tends to be postponed until death is clearly imminent. Current implementation largely ignores the purpose of ACP as a means of extending personal autonomy in the event of lost capacity. Future work: Attention should be paid to public attitudes to death and dying (including those of culturally diverse and ethnic minority groups), place of death, resuscitation and the value of anticipatory planning. In addition the experiences and needs of two under-researched groups should be explored: the frail elderly, including those who manage complex comorbid conditions, unrecognised as vulnerable cases; and those patients affected by stigmatised conditions, such as substance abuse or serious mental illness who fail to engage constructively with services and are not recognised as suitable referrals for palliative and end of life care. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707