Trends and gaps in climate change and health research in North America.

The Intergovernmental Panel on Climate Change (IPCC) 5th Assessment Report (2014) assessed the state of climate change and health knowledge, globally through the Human Health: Impacts, Adaptation, and Co-Benefits Chapter and regionally through chapters, such as the North America Chapter. With IPCC's 6th Assessment Report scheduled to be released in 2021-22, we asked: how has climate change and health research in North America advanced since the IPCC's 5th Assessment Report in 2014? Specifically, we systematically identified and examined trends in the extent, range, and nature of climate-health research conducted in North America. We used a scoping review methodology to systematically identify literature and map publication trends. A search string was used to search five academic databases. Two independent reviewers first screened titles and abstracts, and then the full texts of articles for relevance. Research articles and reviews using systematic methods published since 2013 were eligible for inclusion, and no language restrictions were applied. To be included, articles had to measure and link climatic variables or hazards to health outcomes in North America. Relevant articles were analysed using descriptive statistics to explore publication trends. The number of climate-health articles has significantly increased since the last IPCC Assessment Report. Published research about climate change impacts, heat-related mortality and morbidity, and respiratory illness taking place in urban centres and in the USA continue to dominate the North American climate-health literature, reflected by the high proportion of articles published. Important research gaps on previously neglected climate-sensitive health outcomes, however, are beginning to be filled, including climate change impacts on mental health, nutrition, and foodborne disease. We also observed progress in research that included future projections of climate-health risks; however, projection research is still relatively nascent and under-studied for many climate-sensitive health outcomes in North America, and would benefit from considering social and demographic variables in models. Important research disparities in geographical coverage were noted, including research gaps in Canada and Mexico, and in rural and remote regions. Overall, these publication trends suggest an improved understanding of exposure-response relationships and future projections of climate-health risks for many climate-sensitive health outcomes in North America, which is promising and provides an evidence-base to inform the IPCC 6th Assessment Report. Despite these advancements and considering the urgent policy and practice implications, more research is needed to deepen our understanding of climate-sensitive health outcomes, as well as examine new arising issues that have limited evidence-bases. In particular, transdisciplinary and cross-sector research, that includes the social sciences, examining current and future climate-health adaptation, mitigation, and the adaptation-mitigation nexus should become a top priority for research, given the urgent need for this evidence to inform climate change policies, actions, and interventions.

Bifidobacterium breve reduces apoptotic epithelial cell shedding in an exopolysaccharide and MyD88-dependent manner.

Certain members of the microbiota genus Bifidobacterium are known to positively influence host well-being. Importantly, reduced bifidobacterial levels are associated with inflammatory bowel disease (IBD) patients, who also have impaired epithelial barrier function, including elevated rates of apoptotic extrusion of small intestinal epithelial cells (IECs) from villi-a process termed 'cell shedding'. Using a mouse model of pathological cell shedding, we show that mice receiving Bifidobacterium breve UCC2003 exhibit significantly reduced rates of small IEC shedding. Bifidobacterial-induced protection appears to be mediated by a specific bifidobacterial surface exopolysaccharide and interactions with host MyD88 resulting in downregulation of intrinsic and extrinsic apoptotic responses to protect epithelial cells under highly inflammatory conditions. Our results reveal an important and previously undescribed role for B. breve, in positively modulating epithelial cell shedding outcomes via bacterial- and host-dependent factors, supporting the notion that manipulation of the microbiota affects intestinal disease outcomes.

A three-dimensional model of primary bovine endometrium using an electrospun scaffold.

Endometrial stromal and epithelial cell function is typically studied in vitro using standard two-dimensional monocultures, but these cultures fail to reflect the complex three-dimensional (3D) architecture of tissue. A 3D model of bovine endometrium that reflects the architectural arrangement of in vivo tissue would beneficially assist the study of tissue function. An electrospun polyglycolide (PGA) scaffold was selected to grow a 3D model of primary bovine endometrial epithelial and stromal cells, that reflects the architecture of the endometrium for the study of pathophysiology. Electrospun scaffolds were seeded with stromal and epithelial cells, and growth was assessed using histological techniques. Prostaglandin E2 and prostaglandin F2α responsiveness of endometrial scaffold constructs was tested using oxytocin plus arachidonic acid (OT + AA) or lipopolysaccharide (LPS). Stromal and epithelial cells growing on the electrospun scaffold had an architectural arrangement that mimicked whole tissue, deposited fibronectin, had appropriate expression of vimentin and cytokeratin and were responsive to OT + AA and LPS, as measured by prostaglandin accumulation. In conclusion, a functional 3D model of stromal and epithelial cells was developed using a PGA electrospun scaffold which may be used to study endometrial pathophysiology.

Effects of human milk and formula on postprandial glycaemia and insulinaemia.

BACKGROUND/OBJECTIVES: Consumption of formula in place of human milk may produce differences in postprandial glycaemia and insulinaemia that contribute to metabolic programming in the first year of life. The objective of the current study was to determine glycaemic and insulinaemic responses to human milk compared with a typical commercial formula, and then compare 11 other formulas. SUBJECTS/METHODS: On separate mornings in random order, 10 healthy breastfeeding mothers consumed 25 g available carbohydrate portions of their own milk, a formula and reference food (25 g glucose on two occasions). In the second study, 10 different healthy subjects consumed 25 g available carbohydrate portions of 11 different commercial formulas and three reference foods (25 g glucose on three occasions). Fingerpick blood samples were taken at regular intervals over 2 h, and the glycaemic index (GI) and insulin index determined according to a standardised protocol. RESULTS: There were no significant differences in postprandial glycaemia or insulinaemia after human milk vs a typical formula (P = 0.3). Both produced a low GI (mean ± s.e.m.: 38 ± 7 vs 34 ± 7, respectively) and high insulin index (87 ± 14 vs 94 ± 16). The GI and insulin indices of the other formulas ranged from 18 ± 3 to 67 ± 6 and 53 ± 9 to 209 ± 33, respectively. CONCLUSIONS: Human milk and a typical formula elicit similar postprandial glycaemic and insulinaemic responses, but there is a wide range of responses to other formulas.

Disruption of heterotypic community development by Porphyromonas gingivalis with small molecule inhibitors.

Porphyromonas gingivalis is one of the main etiological organisms in periodontal disease. On oral surfaces P. gingivalis is a component of multispecies biofilm communities and can modify the pathogenic potential of the community as a whole. Accumulation of P. gingivalis in communities is facilitated by interspecies binding and communication with the antecedent colonizer Streptococcus gordonii. In this study we screened a library of small molecules to identify structures that could serve as lead compounds for the development of inhibitors of P. gingivalis community development. Three small molecules were identified that effectively inhibited accumulation of P. gingivalis on a substratum of S. gordonii. The structures of the small molecules are derived from the marine alkaloids oroidin and bromoageliferin and contain a 2-aminoimidazole or 2-aminobenzimidazole moiety. The most active compounds reduced expression of mfa1 and fimA in P. gingivalis, genes encoding the minor and major fimbrial subunits, respectively. These fimbrial adhesins are necessary for P. gingivalis co-adhesion with S. gordonii. These results demonstrate the potential for a small molecular inhibitor-based approach to the prevention of diseases associated with P. gingivalis.

Regulon controlled by the GppX hybrid two component system in Porphyromonas gingivalis.

The periodontal pathogen Porphyromonas gingivalis experiences a number of environmental conditions in the oral cavity, and must monitor and respond to a variety of environmental cues. However, the organism possesses only five full two-component systems, one of which is the hybrid system GppX. To investigate the regulon controlled by GppX we performed RNA-Seq on a ΔGppX mutant. Fifty-three genes were upregulated and 37 genes were downregulated in the ΔGppX mutant. Pathway analyses revealed no systemic function for GppX under nutrient-replete conditions; however, over 40% of the differentially abundant genes were annotated as encoding hypothetical proteins indicating a novel role for GppX. Abundance of small RNA was, in general, not affected by the absence of GppX. To further define the role of GppX with respect to regulation of a hypothetical protein observed with the greatest significant relative abundance change relative to a wild-type control, PGN_0151, we constructed a series of strains in which the ΔgppX mutation was complemented with a GppX protein containing specific domain and phosphotransfer mutations. The transmembrane domains, the DNA-binding domain and the phosphotransfer residues were all required for regulation of PGN_0151. In addition, binding of GppX to the PGN_0151 promoter regions was confirmed by an electrophoretic mobility shift assay. Both the ΔGppX mutant and a ΔPGN_0151 mutant were deficient in monospecies biofilm formation, suggesting a role for the GppX-PGN_0151 regulon in colonization and survival of the organism.

Microbial interactions in building of communities.

Establishment of a community is considered to be essential for microbial growth and survival in the human oral cavity. Biofilm communities have increased resilience to physical forces, antimicrobial agents and nutritional variations. Specific cell-to-cell adherence processes, mediated by adhesin-receptor pairings on respective microbial surfaces, are able to direct community development. These interactions co-localize species in mutually beneficial relationships, such as streptococci, veillonellae, Porphyromonas gingivalis and Candida albicans. In transition from the planktonic mode of growth to a biofilm community, microorganisms undergo major transcriptional and proteomic changes. These occur in response to sensing of diffusible signals, such as autoinducer molecules, and to contact with host tissues or other microbial cells. Underpinning many of these processes are intracellular phosphorylation events that regulate a large number of microbial interactions relevant to community formation and development.

Optimized sample preparation for high-resolution AFM characterization of fixed human cells.

Atomic force microscopy enables the simultaneous acquisition of high-resolution topographical and biophysical data allowing integrated analysis of cell surfaces during development and pathogenesis, and, critically, can link molecular and biophysical events. Here we used atomic force microscopy to analyse endometrial epithelial cells and neuronally differentiated P19 cells. Optimized reproducible sample preparation techniques enabled micro- and nanoscale multi-parameter analysis. Comparative analysis using atomic force microscopy and scanning electron microscopy demonstrated the utility of atomic force microscopy for examining tissue morphology, and its ability to generate data allowing differentiation of cells from different origins to be monitored. At low resolution atomic force microscopy produced topographic data complementary to scanning electron microscopy images, whilst at high resolution atomic force microscopy captured novel cell surface structural detail for both epithelial and neuronal cell types. Analysis of surface roughness provided biophysical data which enabled qualitative and quantitative differences between samples to be measured. This study provides an important optimization of sample preparation enabling more generalized atomic force microscopy utilization for cellular analysis required for advanced cell surface morphological studies.

Club-based and non-club-based physiotherapists' views on the psychological content of their practice when treating sports injuries.

The aim of the present study was to explore whether there were any differences in the psychological content of practice between club-contracted and non-club-contracted physiotherapists when treating sports injuries. Eighty-seven certified physiotherapists (non-club contracted N = 42, club contracted N = 45) from the United Kingdom completed a modified version of the Athletic Training and Sport Psychology Questionnaire (ATSPQ). Results revealed significant between-group differences in psychological skills use and the importance of psychological skills knowledge. Non-club-contracted physiotherapists reported a higher use of improving social support and higher-order psychological skills (e.g., reducing depression, stress, and anxiety) and rated knowledge of these psychological skills to be more important whilst club-contracted physiotherapists reported a higher use of short-term goal settings. These findings suggest that non-club-based physiotherapists may approach the treatment of injured athletes in a different way to their club-based counterparts. Results suggest athletes treated outside of the club system may experience a different recovery process.

Application of atomic force microscopy to the study of natural and model soil particles.

The structure and surface chemistry of soil particles has extensive impact on many bulk scale properties and processes of soil systems and consequently the environments that they support. There are a number of physiochemical mechanisms that operate at the nanoscale which affect the soil's capability to maintain native vegetation and crops; this includes soil hydrophobicity and the soil's capacity to hold water and nutrients. The present study used atomic force microscopy in a novel approach to provide unique insight into the nanoscale properties of natural soil particles that control the physiochemical interaction of material within the soil column. There have been few atomic force microscopy studies of soil, perhaps a reflection of the heterogeneous nature of the system. The present study adopted an imaging and force measurement research strategy that accounted for the heterogeneity and used model systems to aid interpretation. The surface roughness of natural soil particles increased with depth in the soil column a consequence of the attachment of organic material within the crevices of the soil particles. The roughness root mean square calculated from ten 25 microm(2) images for five different soil particles from a Netherlands soil was 53.0 nm, 68.0 nm, 92.2 nm and 106.4 nm for the respective soil depths of 0-10 cm, 10-20 cm, 20-30 cm and 30-40 cm. A novel analysis method of atomic force microscopy phase images based on phase angle distribution across a surface was used to interpret the nanoscale distribution of organic material attached to natural and model soil particles. Phase angle distributions obtained from phase images of model surfaces were found to be bimodal, indicating multiple layers of material, which changed with the concentration of adsorbed humic acid. Phase angle distributions obtained from phase images of natural soil particles indicated a trend of decreasing surface coverage with increasing depth in the soil column. This was consistent with previous macroscopic determination of the proportions of organic material chemically extracted from bulk samples of the soils from which specimen particles were drawn. Interaction forces were measured between atomic force microscopy cantilever tips (Si(3)N(4)) and natural soil and model surfaces. Adhesion forces at humic acid free specimen surfaces (Av. 20.0 nN), which are primarily hydrophilic and whose interactions are subject to a significant contribution from the capillary forces, were found to be larger than those of specimen surfaces with adsorbed humic acid (Av. 6.5 nN). This suggests that adsorbed humic acid increased surface hydrophobicity. The magnitude and distribution of adhesion forces between atomic force microscopy tips and the natural particle surfaces was affected by both local surface roughness and the presence of adsorbed organic material. The present study has correlated nanoscale measurements with established macroscale methods of soil study. Thus, the research demonstrates that atomic force microscopy is an important addition to soil science that permits a multiscale analysis of the multifactorial phenomena of soil hydrophobicity and wetting.

Predicting final disposition after stroke using the Orpington Prognostic Score.

BACKGROUND: Prediction of outcome after stroke is important for triage decisions, prognostic estimates for family and for appropriate resource utilization. Prognostication must be timely and simply applied. Several scales have shown good prognostic value. In Calgary, the Orpington Prognostic Score (OPS) has been used to predict outcome as an aid to rehabilitation triage. However, the OPS has not been assessed at one week for predictive capability. METHODS: Among patients admitted to a sub-acute stroke unit, OPS from the first week were examined to determine if any correlation existed between final disposition after rehabilitation and first week score. The predictive validity of the OPS at one week was compared to National Institute of Health Stroke Scale (NIHSS) score at 24 hours using logistic regression and receiver operator characteristics analysis. The primary outcome was final disposition after discharge from the stroke unit if the patient went directly home, or died, or from the inpatient rehabilitation unit. RESULTS: The first week OPS was highly predictive of final disposition. However, no major advantage in using the first week OPS was observed when compared to 24h NIHSS score. Both scales were equally predictive of final disposition of stroke patients, post rehabilitation. CONCLUSIONS: The first week OPS can be used to predict final outcome. The NIHSS at 24h provides the same prognostic information.

Influence of harvest date and light integral on the development of strawberry flavour compounds.

Strawberries cv. Elsanta were grown in peat bags in a glasshouse and subjected to three shading levels (0%, 25%, 47%) for 2 weeks, commencing 1 week prior to first fruit ripening. Fruit was harvested at five intervals and analysed using Atmospheric Pressure Chemical Ionization (APCI) and direct liquid-mass spectrometry techniques. Thirteen volatiles implicated in strawberry flavour and three non-volatiles, sucrose, glucose and citric acid, were measured. Highly significant differences in volatile and non-volatile concentrations existed between harvest dates. Shading had a significant effect on hexanal, hexenal, ethyl methyl butyrate, and methyl butyrate concentrations at some harvests. In general, at each harvest the higher the level of shading the lower the level of the volatile in the fruit. Sucrose concentration showed a decrease throughout the harvest period, whereas glucose and citric acid showed less clear trends. Shading had a significant effect on glucose and sucrose concentrations. Some possible reasons for the variability in strawberry flavour are discussed.

Improving the time to diagnosis after an abnormal screening mammogram.

INTRODUCTION: Five community-specific interventions to reduce the time to diagnosis after an abnormal breast screen have been evaluated. METHODS: Subjects with abnormal screening mammograms in 1998 were assessed through five community pilot projects (N = 1137) and a control random sample assessed elsewhere in BC (N = 1053). The number, types, dates and physician costs of breast-related interventions after an abnormal screen were compared between pilots and control. RESULTS: The median time to diagnosis for women without a biopsy was reduced from 23 days to 7 days (p = 0.001) in the pilot with facilitated referral to diagnosis. The median time to diagnosis for women with a biopsy was reduced from 57 days to 22-43 days in the pilots. Median physician costs per subject were lower (p = 0.02) in pilots that more frequently used core biopsy to obtain a diagnosis. CONCLUSIONS: Process changes can improve the time to diagnosis after an abnormal breast screen, with similar or lower physician costs per subject. Facilitating the referral process had the greatest impact.

Evidence of delays in transferring patients with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus to long-term-care facilities.

This retrospective case-control study examined whether there was a difference in length of time awaiting long-term-care placement for patients identified as having methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus compared to controls. Thirty-nine patients with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus waited for placement an average of 61 days longer than controls (P<.0002). The average number of requests for placement was 2.5 compared to 1.7 for controls (P=.015).