Chytrid infections exhibit historical spread and contemporary seasonality in a declining stream-breeding frog.

Species with extensive geographical ranges pose special challenges to assessing drivers of wildlife disease, necessitating collaborative and large-scale analyses. The imperilled foothill yellow-legged frog (Rana boylii) inhabits a wide geographical range and variable conditions in rivers of California and Oregon (USA), and is considered threatened by the pathogen Batrachochytrium dendrobatidis (Bd). To assess drivers of Bd infections over time and space, we compiled over 2000 datapoints from R. boylii museum specimens (collected 1897-2005) and field samples (2005-2021) spanning 9° of latitude. We observed a south-to-north spread of Bd detections beginning in the 1940s and increase in prevalence from the 1940s to 1970s, coinciding with extirpation from southern latitudes. We detected eight high-prevalence geographical clusters through time that span the species' geographical range. Field-sampled male R. boylii exhibited the highest prevalence, and juveniles sampled in autumn exhibited the highest loads. Bd infection risk was highest in lower elevation rain-dominated watersheds, and with cool temperatures and low stream-flow conditions at the end of the dry season. Through a holistic assessment of relationships between infection risk, geographical context and time, we identify the locations and time periods where Bd mitigation and monitoring will be critical for conservation of this imperilled species.

Reaching adults who smoke cigarettes in rural Appalachia: Rationale, design & analysis plan for a mixed-methods study disseminating pharmacy-delivered cessation treatment.

INTRODUCTION: Unlike other U.S. geographical regions, cigarette smoking prevalence remains stagnant in rural Appalachia. One avenue for reaching rural residents with evidence-based smoking cessation treatments could be utilizing community pharmacists. This paper describes the design, rationale, and analysis plan for a mixed-method study that will determine combinations of cessation treatment components that can be integrated within community pharmacies in rural Appalachia. The aim is to quantify the individual and synergistic effects of five highly disseminable and sustainable cessation components in a factorial experiment. METHODS: This sequential, mixed-method research design, based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, will use a randomized controlled trial with a 25 fully crossed factorial design (32 treatment combinations) to test, alone and in combination, the most effective evidence-based cessation components: (1) QuitAid (yes vs. no) (2) tobacco quit line (yes vs. no) (3) SmokefreeTXT (yes vs. no) (4) combination NRT lozenge + NRT patch (vs. NRT patch alone), and (5) eight weeks of NRT (vs. standard four weeks). RESULTS: Logistic regression will model abstinence at six-months, including indicators for the five treatment factors and all two-way interactions between the treatment factors. Demographic and smoking history variables will be considered to assess potential effect modification. Poisson regression will model quit attempts and percent of adherence to treatment components as secondary outcomes. CONCLUSION: This study will provide foundational evidence on how community pharmacies in medically underserved, rural regions can be leveraged to increase utilization of existing evidence-based tobacco cessation resources for treating tobacco dependence. CLINICAL TRIALS: NCT05660525.

Developing logistic regression models using purchase attributes and demographics to predict the probability of purchases of regular and specialty eggs.

Consumers' interest in specialty eggs appears to be growing in Europe and North America. The objective of this research was to develop logistic regression models that utilise purchaser attributes and demographics to predict the probability of a consumer purchasing a specific type of table egg including regular (white and brown), non-caged (free-run, free-range and organic) or nutrient-enhanced eggs. These purchase prediction models, together with the purchasers' attributes, can be used to assess market opportunities of different egg types specifically in British Columbia (BC). An online survey was used to gather data for the models. A total of 702 completed questionnaires were submitted by BC residents. Selected independent variables included in the logistic regression to develop models for different egg types to predict the probability of a consumer purchasing a specific type of table egg. The variables used in the model accounted for 54% and 49% of variances in the purchase of regular and non-caged eggs, respectively. Research results indicate that consumers of different egg types exhibit a set of unique and statistically significant characteristics and/or demographics. For example, consumers of regular eggs were less educated, older, price sensitive, major chain store buyers, and store flyer users, and had lower awareness about different types of eggs and less concern regarding animal welfare issues. However, most of the non-caged egg consumers were less concerned about price, had higher awareness about different types of table eggs, purchased their eggs from local/organic grocery stores, farm gates or farmers markets, and they were more concerned about care and feeding of hens compared to consumers of other eggs types.

Influences of demographic characteristics, attitudes, and preferences of consumers on table egg consumption in British Columbia, Canada.

In addition to regular (white and brown) eggs, alternative types of table eggs (e.g., free-run, free-range, organic) are available in the Canadian market, and their market growth rate has been high during the last decade in British Columbia (BC). The objective of our research was to identify associations between consumers' attitudes, preferences, and demographic characteristics with their consumption of different types of table eggs. An online survey was conducted in June 2009 to gather information from adult BC residents. Sixty-eight percent of the 1,027 randomly selected subjects completed the survey. Our survey indicated that the consumption of cage-free specialty eggs (free-run, free-range, and organic) has strongly increased in BC to 32.9% free-range eggs, 11.93% organic eggs, and 7.6% free-run eggs in 2009 compared with a Print Measurement Bureau consumer survey that showed combined 8% consumption of cage-free specialty eggs in 2007. Results of our survey indicated that, compared with consumers of white regular eggs, consumers of free-range eggs came from smaller households and had a higher education level and income. These consumers indicated that factors of health, nutritional value, environmental issues, and animal welfare were important in egg type selection. Although most consumers rated the specialty eggs as having a higher nutritional value than white regular eggs, price became the most important deciding factor for those consumers who selected white regular eggs. Our findings indicate that increased consumption and increased differentiation exist in the table egg market and this in turn provides support for more research to increase the efficiency of cage-free egg production systems and for better consumer education.

A large patient study confirming that facioscapulohumeral muscular dystrophy (FSHD) disease expression is almost exclusively associated with an FSHD locus located on a 4qA-defined 4qter subtelomere.

Facioscapulohumeral muscular dystrophy (FSHD), an autosomal dominant disorder, represents the third most common human muscular dystrophy. The FSHD disease locus, at chromosome 4q35, is associated with large contractions of the polymorphic repeat sequence array D4Z4. In addition to FSHD disease association with large D4Z4 deletions, a biased interaction with a specific 4qter subtelomeric sequence has been described in patients. Two distinct 4qter subtelomeres, defined as types 4qA and 4qB, have been identified and shown to be equally prevalent in the Caucasian population. In almost all 4q35-linked patients with FSHD, however, disease expression only occurs when large D4Z4 deletions are located on 4qA-defined 4qter subtelomeres. Conversely, large D4Z4 repeat contractions situated on 4qB-defined subtelomeres either are not disease-causing or exhibit a greatly reduced disease penetrance. This study was initiated to confirm this direct FSHD disease association data by measuring the frequency of type 4qA-defined and 4qB-defined subtelomeric sequences in a large cohort of 164 unrelated patients with FSHD from Turkey and the UK, all known to have large D4Z4 deletions. An almost complete association was found between large D4Z4 repeat array deletions located on 4qA-defined 4qter subtelomeres and disease expression in our large FSHD patient cohort. The observed failure of probes 4qA and 4qB to hybridise to two patient-derived DNA samples confirms the presence of an additional rare type of 4qter subtelomeric sequence in humans.

Swallowing therapy--a prospective study on patients with neurogenic dysphagia due to unilateral paresis of the vagal nerve, Avellis' syndrome, Wallenberg's syndrome, posterior fossa tumours and cerebellar hemorrhage.

BACKGROUND: No studies exist dealing with the outcome of dysphagic patients with posterior fossa (IV. ventricle) tumours (PFT) or cerebellar hemorrhage (CH), and the outcome of patients with Wallenberg's syndrome (WS) after functional swallowing therapy (FST) has so far not been studied in detail. Patients and methods. 208 patients with neurogenic dysphagia (ND) who were consecutively admitted for functional swallowing therapy (FST) over a 3 year period to our hospital were examined clinically, by use of a videofluoroscopic swallowing study (VFSS) and/or fibreoptic evaluation of swallowing (FEES). The most frequent etiology was stroke (48%), followed by CNS tumours (13%). In the present study we defined three groups. Group 1 comprised 8 patients with PFT or CH. Group 2 consisted of 27 patients with WS, which was the leading cause among patients with non-hemispheric stroke. Since in WS a vagal nerve paresis due to affection of the Nucleus ambiguus occurs, 8 patients with Avellis' syndrome or unilateral paresis of the vagal nerve served as controls and were defined as group 3. Findings. In the three groups, functional feeding status showed significant improvement after FST comprising methods of restitution, compensation and adaptation, each of which were applied in more than 80% of patients. Outcome was, however, significantly worse in group 1 as compared to group 2 and in group 2 as compared to group 3. Dysfunction of the upper esophageal sphincter and reflex triggering were significantly more severely disturbed in groups 1 and 2 as compared to group 3. Group 1 showed significantly more severe disturbances of the oral phase as compared to groups 2 and 3. After FST, more than 50% (5/8) of group 1 and 30% (8/27) of WS patients (group 2) were dependent on tube feeding, whereas all patients of group 3 were full-oral feeders. Interpretation. This is the first study dealing with the outcome of dysphagic patients with PFT or CH. Based on our results it can be assumed that in these patients pressure is exerted on both dorsomedial central pattern generators (DMCPGs) for swallowing in a posterior-anterior direction. Due to the importance of the DMCPGs for swallowing, bilateral (and often MRI-invisible) lesions seem to be very harmful. For a better understanding of the pathomechanism responsible for ND in patients with PFT or CH, modern imaging methods such as proton magnetic resonance spectroscopy should be used for studying metabolic changes in the dorsal medulla in the future. Since the outcome of patients with WS with regard to dependence of tube feeding was not associated with the site or size of the lesion, it may due to the individual asymmetry of the swallowing-dominant forebrain hemisphere - depend on the side of the medullary infarction.

The localization of central pattern generators for swallowing in humans--a clinical-anatomical study on patients with unilateral paresis of the vagal nerve, Avellis' syndrome, Wallenberg's syndrome, posterior fossa tumours and cerebellar hemorrhage.

BACKGROUND: Our understanding of brainstem swallowing centers is mainly based on experimental animals. In order to solve this problem also in humans, a clinical-anatomical study on dysphagic patients with different lesion patterns was performed. PATIENTS AND METHODS: We studied 43 consecutively admitted dysphagic patients with unilateral paresis of the vagal nerve (PVN), Avellis' syndrome (AS), Wallenberg's syndrome (WS), posterior fossa tumour (PFT) or cerebellar hemorrhage (CH) with regard to clinical and anatomical aspects. FINDINGS: There was a continuum with regard to functional outcome from neurogenic dysphagia (ND): Patients with PFT or CH had a significantly worse outcome than patients with WS; the outcome of WS patients was significantly worse than that of patients with PVN or AS. In AS only the Nucleus ambiguus (NA) and its surrounding reticular formation (RF) were affected. In all patients with WS, the infarctions of the dorsolateral medulla were situated in the rostral third of the medulla and affected the NA and the Nucleus tractus solitarii (NTS) with their surrounding RF. In patients with PFT and CH, the NTS and its surrounding RF were affected on both sides. The overlap area of WS and PFT lesions is situated in the NTS and the surrounding RF, especially in its Nucleus parvocellularis. INTERPRETATION: Our results point to the fact, that in humans the dorsomedial central pattern generators (CPGs) for swallowing are situated in the rostral part of the dorsal medulla oblongata near the NTS/surrounding RF (especially Nucleus parvocellularis) and that the dorsomedial CPGs are superior to the ventrolateral CPGs (near the NA/surrounding RF) with regard to their swallowing-relevance. Furthermore, we hypothesize that due to the individual asymmetry of the swallowing-dominant forebrain hemisphere - the outcome from ND in WS depends on the side of the medullary infarction.

Motor cortex excitability in patients with migraine with aura and hemiplegic migraine.

We studied the excitability of the motor cortex using transcranial magnetic stimulation (TMS) in 12 patients with migraine with aura (MA) and nine patients with familial hemiplegic migraine (FHM). Motor thresholds at rest, the duration of the cortical and peripheral silent period and intracortical inhibition and facilitation using paired-pulse TMS at intervals of 2 to 15 ms were measured with patients free of attacks for at least 48 h. In contrast to previous reports we could not find any significant differences between patient groups and compared to controls (n=17) in the parameters tested. The results suggest that there are no interictal changes of excitability of the motor cortex in migraine. This study does not support the concept of general cortical hyperexcitability in migraine secondary to a genetic predisposition or a structural alteration of inhibitory interneurones in the cortex due to repeated parenchymal insults during attacks.

Tuberculosis: an old disease with a new face.

Tuberculosis (TB) is a disease that was considered essentially eradicated until a few years ago. Many health care providers in the United States, entering their professions during the time that TB was considered conquered, received little training about the means to control and prevent the spread of TB. Efforts once targeted towards the control and prevention of TB have been directed to other areas, while cases of TB have increased. Today health care providers see increased numbers of persons with TB, along with increasing numbers of persons with TB disease that is proving resistant to many of the drugs that previously were used to successfully treat TB. As health care providers, nurses must be able to properly assess the risks that patients face from TB exposure, and the risks that nurses face when caring for TB patients. The primary means of slowing the spread of TB involves early diagnosis, proper treatment and proper isolation of persons suspected of having TB. The goal of this article is to discuss the basic pathophysiology of TB infection and disease, means of spread of TB, risk factors associated with TB, signs and symptoms of TB and basic nursing care of patients with TB, emphasizing the care that patients with both renal disease and TB require.

New insights on Goodpasture's syndrome.

Goodpasture's Syndrome is a rare illness that is often difficult to diagnose because of the large number of disease entities that can produce similar symptoms. With the discovery of antiglomerular basement membrane antibodies and antineutrophil cytoplasmic autoantibodies, plus the means to readily test for them, it is now possible to make an accurate and more rapid diagnosis of Goodpasture's Syndrome than has been possible in the past. Characteristics of Goodpasture's Syndrome include diffuse pulmonary hemorrhage, interstitial lung disease, anemia, and glomerulonephritis. Because of the potential for life-threatening and rapidly progressive pulmonary hemorrhage, renal failure, or both, early and accurate diagnosis and treatment are imperative. Since the possibility of preserving renal function is minute if the renal disease is far advanced at the time of diagnosis, early intervention is crucial. Nursing care centered around the actual and potential problems that these patients experience is vital for preserving life and function.

Nephrotic syndrome: pathophysiology and treatment.

Nephrotic syndrome refers to the symptoms caused by renal injury in which large amounts of protein are lost in the urine. Common manifestations of the syndrome are proteinuria, edema, hypoalbuminemia, hyperlipidemia, and hypercoagulability. Recent research has presented findings that contradict some of the accepted theories regarding the pathophysiology of some symptoms of the syndrome. Accurate understanding of these pathophysiological mechanisms underlying the symptoms seen in nephrotic syndrome is necessary for caregivers to determine the appropriate treatment for these patients.

Policies and practices used for the safe handling of antineoplastic drugs.

There is increasing evidence that exposure to antineoplastic drugs in the workplace has definite, measurable effects on health care workers. The literature supports the theory that use of proper protective practices and equipment while handling antineoplastic drugs will provide adequate protection from the effects of these agents. Many of the hospitals, physicians' offices, and health care agencies surveyed did not have comprehensive policies outlining safe practices and procedures when handling antineoplastic drugs. Use of gloves was the only consistently used method of self protection in any facility that responded to the survey. In spite of the known potential dangers associated with exposure to these drugs, the literature supports the theory that many health care workers still do not use available protective equipment and procedures. Research is imperative to determine the exact long term effects of exposure to antineoplastic drugs by health care workers and to develop ways to ensure proper, consistent use of safety measures.