Flow cytometric characterization of freshwater crayfish hemocytes for the examination of physiological status in wild and captive animals

Enumeration of invertebrate hemocytes is a potentially powerful tool for the determination of physiological effects of extrinsic stressors, such as hypoxia, disease, and toxicant exposure. A detailed flow cytometric method of broad application was developed for the objective characterization and enumeration of the hemocytes of New Zealand freshwater crayfish Paranephrops planifrons for the purpose of physiological health assessment. Hemocyte populations were isolated by flow cytometric sorting based on differential light scatter properties followed by morphological characterization via light microscopy and software image analysis. Cells were identified as hyaline, semigranular, and granular hemocytes based on established invertebrate hemocyte classification. A characteristic decrease in nuclear size, an increase in granularity between the hyaline and granular cells, and the eccentric location of nuclei in granular cells were also observed. The granulocyte subpopulations were observed to possess varying degrees of granularity. The developed methodology was used to perform total and differential hemocyte counts from three lake populations and between wild and captive crayfish specimens. Differences in total and differential hemocyte counts were not observed among the wild populations. However, specimens held in captivity for 14 d exhibited a significant 63% reduction in total hemocyte count, whereas the relative hemocyte proportions remained the same. These results demonstrate the utility of this method for the investigation of subacute stressor effects in selected decapod crustaceans

Type 2 Innate Lymphoid Cells in Allergic Disease.

Type II innate lymphoid cells (ILC2) are a novel population of lineage-negative cells that produce high levels of Th2 cytokines IL-5 and IL-13. ILC2 are found in human respiratory and gastrointestinal tissue as well as in skin. Studies from mouse models of asthma and atopic dermatitis suggest a role for ILC2 in promoting allergic inflammation. The epithelial cytokines IL-25, IL-33, and TSLP, as well as the lipid mediator leukotriene D4, have been shown to potently activate ILC2 under specific conditions and supporting the notion that many separate pathways in allergic disease may result in stimulation of ILC2. Ongoing investigations are required to better characterize the relative contribution of ILC2 in allergic inflammation as well as mechanisms by which other cell types including conventional T cells regulate ILC2 survival, proliferation, and cytokine production. Importantly, therapeutic strategies to target ILC2 may reduce allergic inflammation in afflicted individuals. This review summarizes the development, surface marker profile, cytokine production, and upstream regulation of ILC2, and focuses on the role of ILC2 in common allergic diseases

Improving diabetes care and management in Torres Strait remote primary health care settings

Background: Torres Strait Islanders (TSI) have the highest prevalence of Type 2 diabetes in Australia with about a third of the adult population affected; the incidence of Type 2 diabetes and other co-morbid conditions are also extremely high at around 3%. A review in 2005 noted that newer diabetes cases were younger, more obese and had poorer glycaemic control compared to 6 years previously. Clinicians report anecdotally that many patients are prescribed insulin therapy; however, it is unknown if patients are collecting their medication from local primary health care centres. Diabetes is associated with significant depression, which can result in poorer clinical outcomes, including increased mortality. Little is known about the prevalence of depression among TSI adults with diabetes. Models of chronic disease management in the Torres Strait region remains an ongoing discussion that supports better self-management of diabetes amongst patients. Study Aims: The overall aim of this thesis is to provide epidemiological evidence to support the development of community level interventions to address the most important risk factors associated with the health of Torres Strait Islanders with Type 2 diabetes. 1. Review patient level factors on behavioural aspects of diabetes management and care including psychological insulin resistance and depression. 2. Review health service factors that impact on diabetes management and care. Methods / Design: Study 1: 29/197 adults with poorly controlled diabetes who have refused insulin treatment, were interviewed using validated instruments Insulin Treatment Appraisal Scale (ITAS) and Barriers to Insulin Treatment Questionnaire (BITQ). Study 2: A descriptive cross-sectional survey in 2013 and 2014, Interviews with 188/197 adults with diabetes in five remote Torres Strait Islands using the Patient Health Questionnaire (PHQ)-9. Study 3: A Retrospective clustered cohort study of the impact of the intervention on care processes, intermediate clinical outcomes in 285 adults with known diabetes. At baseline 197 participants from five remote Torres Strait Island communities (mostly the Eastern group of Islands) consented to be enrolled in the survey. A further 88 records from the western group of islands were audited from 2012 - 2015 and serves as a comparator group. Target population: Adults diagnosed with Type 2 diabetes located in the remote Island communities of the Torres Strait region with primary health care services provided by Queensland Health. Results: Study 1: Thirty- four percent (n=197) had poor glycaemic control. Compared to those with HbA1c 8.5% and taking insulin (n=37), the 29 insulinnaïve participants were more obese, more likely to smoke and drink alcohol, have lower mean HbA1c and fewer years with diabetes. Among the insulinnaïve group, those reporting higher 'barriers' (BITQ scores) were older and with lower formal education than those reporting fewer barriers. TSI participants consistently scored low on 'knowledge' items in the ITAS, especially those which would guide insulin initiation (insulin improves glucose control and prevents complications). Study 2: Ninety – five percent (n=197) completed PHQ-9 interviews. The median PHQ-9 score was 5.5 (IQR 0-7); 42% of respondents scored 0-4 (noneminimal), 46% scored 5-9 (mild) and 12% scored10+ (moderate –severe). Mean Hba1c was 8.3% (67.4 mmol). HbA1c was not related to PHQ-9 scores (β=0.20, Ρ = 0.323), however exercise in hours (β =0.34, Ρ < 0.001) and screen time in hours (β = 0.11, Ρ < 0.001) were significant predictors of depression after adjusting for other study variables. Study 3: At baseline, overall (n=285), 61% were women, 75% were aged over 50, 67% were obese (Body Mass Index (BMI), higher in the comparator group), 65% were poorly controlled (Hba1c>8.5%) and 18% were smokers (lower in comparator group). At baseline (2012) GP management plans (GPMP) and team care arrangements (TCA) were more likely to be completed in the eastern group 93% vs. 39% with 90% referred to a dietician, diabetes educator or podiatrist. However, in 2015 a decrease in the GPMP from 93% vs. 20% in the eastern group. It appeared that participants in the eastern group had better glycaemic control than those in the western group (34% had hba1c> 8.5% compared to 39% in the eastern group) and this difference persisted through to 2015. Conclusion: Improving patient level factors on behavioural characteristics of diabetes care requires better communication between service providers and clients, taking consideration of local cultural contexts and beliefs. Simple health promotion activities could improve mental health and general well-being in this population. Understanding patient behaviour can assist service providers to deliver appropriate service delivery that involves clients' input. Overall, patients with Type 2 diabetes are hesitant to commence insulin therapy, mild depression scores were evident that do not appear to have an effect on glycaemic control. However, care planning, referrals, and other clinical measures important to diabetes care, and actual numbers of consultations appeared to decline dramatically between 2012 and 2015 in all sites. This suggests that a more systematic approach to population-level diabetes care is required

Improving Access to Snowmobiling Safety Information

Snowmobiling is a common activity for rural people in areas like the North Country of New York state. There are inherent risks associated with an activity like snowmobiling, and a primary care office is a location at which patients and their families can be informed of recommendations from professional associations, state laws regarding the activity, and recommendations on safer practices and safety courses that are available. I modified an informational flyer that caters to patients in the Plattsburgh area of New York to try to encourage safer snowmobiling, especially for children