Concordance of Illness Representations: The Key to Improving Care of Medically Unexplained Symptoms

How can effective patient-provider relationships be developed when the underlying cause of the health condition is not well understood and becomes a point of controversy between patient and provider? This problem underlies the difficulty in treating medically unexplained symptoms and syndromes (MUS; e.g., fibromyalgia, chronic fatigue syndrome), which primary care providers consider to be among the most difficult conditions to treat.1 This difficulty extends to the patient-provider relationship which is characterized by discord over MUS.1 In this article, we argue that the key to improving the patient provider relationship is for the patient and provider to develop congruent illness perceptions about MUS

A combined approach for comparative exoproteome analysis of Corynebacterium pseudotuberculosis

Background: Bacterial exported proteins represent key components of the host-pathogen interplay. Hence, we sought to implement a combined approach for characterizing the entire exoproteome of the pathogenic bacterium Corynebacterium pseudotuberculosis, the etiological agent of caseous lymphadenitis (CLA) in sheep and goats. Results: An optimized protocol of three-phase partitioning (TPP) was used to obtain the C. pseudotuberculosis exoproteins, and a newly introduced method of data-independent MS acquisition (LC-MSE) was employed for protein identification and label-free quantification. Additionally, the recently developed tool SurfG+ was used for in silico prediction of sub-cellular localization of the identified proteins. In total, 93 different extracellular proteins of C. pseudotuberculosis were identified with high confidence by this strategy; 44 proteins were commonly identified in two different strains, isolated from distinct hosts, then composing a core C. pseudotuberculosis exoproteome. Analysis with the SurfG+ tool showed that more than 75% (70/93) of the identified proteins could be predicted as containing signals for active exportation. Moreover, evidence could be found for probable non-classical export of most of the remaining proteins. Conclusions: Comparative analyses of the exoproteomes of two C. pseudotuberculosis strains, in addition to comparison with other experimentally determined corynebacterial exoproteomes, were helpful to gain novel insights into the contribution of the exported proteins in the virulence of this bacterium. The results presented here compose the most comprehensive coverage of the exoproteome of a corynebacterial species so far

Quantifying Environmental Limiting Factors on Tree Cover Using Geospatial Data

Environmental limiting factors (ELFs) are the thresholds that determine the maximum or minimum biological response for a given suite of environmental conditions. We asked the following questions: 1) Can we detect ELFs on percent tree cover across the eastern slopes of the Lake Tahoe Basin, NV? 2) How are the ELFs distributed spatially? 3) To what extent are unmeasured environmental factors limiting tree cover? ELFs are difficult to quantify as they require significant sample sizes. We addressed this by using geospatial data over a relatively large spatial extent, where the wall-to-wall sampling ensures the inclusion of rare data points which define the minimum or maximum response to environmental factors. We tested mean temperature, minimum temperature, potential evapotranspiration (PET) and PET minus precipitation (PET-P) as potential limiting factors on percent tree cover. We found that the study area showed system-wide limitations on tree cover, and each of the factors showed evidence of being limiting on tree cover. However, only 1.2% of the total area appeared to be limited by the four (4) environmental factors, suggesting other unmeasured factors are limiting much of the tree cover in the study area. Where sites were near their theoretical maximum, non-forest sites (tree cover \u3c 25%) were primarily limited by cold mean temperatures, open-canopy forest sites (tree cover between 25% and 60%) were primarily limited by evaporative demand, and closed-canopy forests were not limited by any particular environmental factor. The detection of ELFs is necessary in order to fully understand the width of limitations that species experience within their geographic range

Fundraising, celebrations and classroom rewards are substantial sources of unhealthy foods and beverages on public school campuses

Objective: The emphasis in school nutrition policy has been on vending and competitive items. Our study was designed to characterize and quantify the amount and source of other foods and beverages on school campuses. Design: A cross-sectional observational study was conducted using a specially designed objective nutrition observation system. Setting: One low-income school district in southern California with six elementary and two middle schools. Subjects: Data were not collected from individual children. A total of 4033 students, 42 % of whom were Hispanic/Latino, 26 % African American and 21 % non-Hispanic white, were observed across school settings. Results: Data were collected continuously from 9 January 2008 to 16 June 2010. Healthy foods had, per serving, total energy ≤732 kJ (≤175 kcal), total fat content ≤35 %, total saturated fat ≤10 %, sugar less ≤15 g, sodium <200 mg and trans-fat ≤0·5 g. Healthy beverages were only 100 % juice or water, and unflavoured non-fat, 1 %, 2 % milk and soya or rice milk. The system had high inter-rater reliability (r = 0·78 to 0·99), percentage agreement (83 % to 100 %) and test–retest reliability (r = 0·81 to 0·98). Significantly more unhealthy foods and beverages than healthy items were observed on all campuses (P < 0·001). An average of 1·26 (sd 0·46) items per student per week was found with an average of 0·86 (sd 0·34) unhealthy items per child per week. Conclusions: There were substantial amounts of unhealthy foods and beverages brought onto campuses for classroom rewards, celebrations and fundraising that should be targeted for intervention

Consequences of drift and carcass decomposition for estimating sea turtle mortality hotspots

Sea turtle strandings provide important mortality information, yet knowledge of turtle carcass at-sea drift and decomposition characteristics are needed to better understand and manage where these mortalities occur. We used empirical sea turtle carcass decomposition and drift experiments in the Chesapeake Bay, Virginia, USA to estimate probable carcass oceanic drift times and quantify the impact of direct wind forcing on carcass drift. Based on the time period during which free-floating turtle carcasses tethered nearshore were buoyant, we determined that oceanic drift duration of turtle carcasses was highly dependent on water temperature and varied from 2 to 15 days during typical late spring to early fall Bay water conditions. The importance of direct wind forcing for turtle carcass drift was assessed based on track divergence rates from multiple simultaneous deployments of three types of surface drifters: bucket drifters, artificial turtles and turtle carcass drifters. Turtle drift along-wind leeway was found to vary from 1 to 4% of wind speed, representing an added drift velocity of approximately 0.03–0.1 m/s for typical Bay wind conditions. This is comparable to current speeds in the Bay (0.1–0.2 m/s), suggesting wind is important for carcass drift. Estimated carcass drift parameters were integrated into a Chesapeake Bay oceanographic drift model to predict carcass drift to terrestrial stranding locations. Increased drift duration (e.g., due to low temperatures) increases mean distance between expected mortality events and stranding locations, as well as decreases overall likelihood of retention in the Bay. Probable mortality hotspots for the peak month of strandings (June) were identified off coastal southeastern Virginia and within the lower Bay, including the Bay mouth and lower James River. Overall, results support that sea turtle drift time is quite variable, and varies greatly depending on water and air temperature as well as oceanic conditions. Knowledge of these parameters will improve our ability to interpret stranding events around the globe

Risk of Injury in Royal Air Force Training: Does Sex Really Matter?

IntroductionMusculoskeletal injuries are common during military and other occupational physical training programs. Employers have a duty of care to reduce employees’ injury risk, where females tend to be at greater risk than males. However, quantification of principle co-factors influencing the sex–injury association, and their relative importance, remain poorly defined. Injury risk co-factors were investigated during Royal Air Force (RAF) recruit training to inform the strategic prioritization of mitigation strategies.Material and MethodsA cohort of 1,193 (males n = 990 (83%); females n = 203 (17%)) recruits, undertaking Phase-1 military training, were prospectively monitored for injury occurrence. The primary independent variable was sex, and potential confounders (fitness, smoking, anthropometric measures, education attainment) were assessed pre-training. Generalized linear models were used to assess associations between sex and injury.ResultsIn total, 31% of recruits (28% males; 49% females) presented at least one injury during training. Females had a two-fold greater unadjusted risk of injury during training than males (RR = 1.77; 95% CI 1.49–2.10). After anthropometric, lifestyle and education measures were included in the model, the excess risk decreased by 34%, but the associations continued to be statistically significant. In contrast, when aerobic fitness was adjusted, an inverse association was identified; the injury risk was 40% lower in females compared with males (RR = 0.59; 95% CI: 0.42–0.83).ConclusionsPhysical fitness was the most important confounder with respect to differences in males’ and females’ injury risk, rather than sex alone. Mitigation to reduce this risk should, therefore, focus upon physical training, complemented by healthy lifestyle interventions

Water primrose invasion changes successional pathways in an estuarine ecosystem

Invasive species fundamentally change the bio-physical and ecological characteristics of the ecosystems they invade. Rapidly expanding invasive species may facilitate the spread of other invasive species, and successive invasion events may lead to novel species interactions that may push the system beyond its equilibrium state and change successional pathways. Knowing the direction of the invasion front may be useful to predict impacts of invasive species. Water primrose (Ludwigia spp.), one of the invasive floating macrophytes in the Sacramento-San Joaquin River Delta (hereafter, Delta), has increased in cover rapidly over the past three decades likely outcompeting native and non-native species, changing their functional relationships, with cascading effects in the macrophyte communities of the aquatic ecosystem. In this study, we analyze the directionality of water primrose invasion and assess which spaces it occupies, whether it has overcrowded or outcompeted other vegetation communities, and its implications for succession in the Delta. We used imaging spectroscopy data acquired in June of 2004, June of 2008, November of 2014, and October of 2016 for the 2500 km2 of the Delta to map the communities of submerged macrophytes, floating macrophytes, and emergent marsh. We found that water primrose cover increased fourfold in the Delta over the past 13 yr, changing significantly in the central Delta and Liberty Island region from 122 ha in 2004 to 471 ha in 2016. Water primrose expanded first by spreading over open water and submerged macrophytes and, when that habitat was exhausted, primrose invasion switched direction and encroached into emergent marsh. This bilateral expansion to both open water and the marsh is likely to change rates of succession and affect the restoration of the native Delta marshes. Understanding the mechanisms behind the expansion dynamics of this invasive will allow managers to counter its impact on newly established vulnerable marshes.info:eu-repo/semantics/publishedVersio