Development of genetic diversity, differentiation and structure over 500 years in four ponderosa pine populations.

Population history plays an important role in shaping contemporary levels of genetic variation and geographic structure. This is especially true in small, isolated range-margin populations, where effects of inbreeding, genetic drift and gene flow may be more pronounced than in large continuous populations. Effects of landscape fragmentation and isolation distance may have implications for persistence of range-margin populations if they are demographic sinks. We studied four small, disjunct populations of ponderosa pine over a 500-year period. We coupled demographic data obtained through dendroecological methods with microsatellite data to discern how and when contemporary levels of allelic diversity, among and within-population levels of differentiation, and geographic structure, arose. Alleles accumulated rapidly following initial colonization, demonstrating proportionally high levels of gene flow into the populations. At population sizes of approximately 100 individuals, allele accumulation saturated. Levels of genetic differentiation among populations (F(ST) and Jost's D(est)) and diversity within populations (F(IS)) remained stable through time. There was no evidence of geographic genetic structure at any time in the populations' history. Proportionally, high gene flow in the early stages of population growth resulted in rapid accumulation of alleles and quickly created relatively homogenous genetic patterns among populations. Our study demonstrates that contemporary levels of genetic diversity were formed quickly and early in population development. How contemporary genetic diversity accumulates over time is a key facet of understanding population growth and development. This is especially relevant given the extent and speed at which species ranges are predicted to shift in the coming century.

Childhood chorea-encephalopathy associated with recent parvovirus B19 infection in two Jamaican children.

This case report highlights the course of two healthy unrelated children with an encephalopathy characterised by dyskinesia, seizures, hemiparesis and behavioural change associated with recent human parvovirus B19 infection. The cases are compared with a previously described case of childhood chorea encephalopathy associated with human parvovirus B19 infection.

Dengue infection in patients presenting with neurological manifestations in a dengue endemic population.

The evaluation of the contribution of neurological dengue in suspected central nervous system (CNS) viral infections is essential to better understand the impact of neurological dengue on morbidity and mortality in dengue endemic regions such as Jamaica. For this study 401 cases of suspected viral CNS infections were investigated for evidence of dengue infection. The frequency of neurological dengue among these CNS cases was found to be 13.5% (54/401). Fifty-three cases were confirmed serologically by haemagglutination inhibition assay (HI) and IgM antibody (ELISA) and the virus was isolated in one case only. Clinical manifestations among dengue positive CNS cases included encephalitis in 51.8% (28/54), meningitis in 33.3% (18/54), seizures in 11.1% (6/54) and acute flaccid paralysis/Guillain-Barré syndrome in 3.7% (2/54). The clinical diagnosis of dengue neurological infection corresponded with laboratory confirmation in 22.2% (12/54) of cases only. Deaths occurred in 3.7% (2/54) of cases and were associated with patients with dengue neurological infection. The high risk of dengue among patients with suspected viral CNS infections in this study supports the need for an increased index of suspicion of dengue in patients presenting with neurological manifestations in dengue endemic countries.

Molecular analysis and implications of neurovirulent circulating vaccine-derived poliovirus in Jamaica. A case report and review of literature.

As the goal to eradicate wild polio virus (WPV) is approached, outbreaks associated with vaccine derived polioviruses (VDPV) with neurovirulent properties have emerged. The relevance for the spread of infection by nonparalytic cVDPV cases, with mutations associated with neurovirulence, is discussed with reference to the molecular analysis of a VDPV isolated from a Jamaican child who presented with aseptic meningitis. Potential risks to the Jamaican community resulting from circulation of cVDPV and critical factors defined by the World Health Organization (WHO) in the global eradication of Polio are analyzed in the context of immunization coverage, and the need to stop all Oral Polio Vaccine (OPV) use once wild polioviruses (WPVs) have been eradicated.

Vitamin D status, body composition and glycemic control in an ambulatory population with diabetes and chronic kidney disease.

BACKGROUND/OBJECTIVES: To determine the interrelationships between body composition, glycemic control and vitamin D status in an ambulatory population with diabetes (DM) and chronic kidney disease (CKD). SUBJECTS/METHODS: Adult (18-80 years) patients (n=60) with DM and stage 1-4 CKD were recruited from the Northern Alberta Renal Program. Outcome variables included body composition (absolute/regional fat (FM)/lean soft tissue/total mass, percent fat/lean/fat-free (FFM) mass), glycemic control (glycated hemoglobin (HbA1c)), vitamin D intake (dietary/supplemental) and vitamin D status (25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D)) measured by validated methodologies. Sarcopenia was determined as an appendicular skeletal mass/height(2) less than 7.26 kg/m(2) (males) and 5.45 kg/m(2) (females). RESULTS: Suboptimal HbA1c (>7%), 25(OH)D (<50 nmol/l) and 1,25(OH)2D (<43 pmol/l) concentrations were present in 57, 8 and 11% of participants. Ten percent of subjects had sarcopenia. Gender/age/DM type, not CKD, significantly influenced regional/whole body composition. Females, older participants and those with type 2 DM had higher %FM. No significant interrelationships between vitamin D status and glycemic control were observed (P>0.05). Serum 25(OH)D concentrations were inversely associated with arm lean soft tissue/FFM/total mass, weight, appendicular skeletal mass, lean soft tissue/height(2), FFM/height(2), appendicular skeletal mass/height(2) and body mass index (P<0.05). Sarcopenia occurred more frequently in patients with 25(OH)D concentrations ⩾100 nmol/l. Regional/whole body %FM was inversely related to 1,25(OH)2D, not 25(OH)D. CONCLUSIONS: Body composition, not glycemic control, is associated with vitamin D status in an ambulatory population of adults with DM and CKD.

The epidemiology of mycotic vulvovaginitis and the use of antifungal agents in suspected mycotic vulvovaginitis and its implications for clinical practice.

Data in the Caribbean documenting the speciation of yeast associated with vulvovaginitis are lacking. The widespread use of antibiotics and increased availability of antimycotic agents, both prescribed and over-the-counter, predisposes both to a change in the epidemiologic patterns and the possible development of secondary resistance among previously susceptible yeast. This study was conducted to evaluate the aetiologic agents associated with mycotic vulvovaginitis and to review the appropriateness of prescribed antifungal therapy. Of 134 positive isolates, the most frequent yeast isolate was C. albicans accounting for 78%, C. tropicalis 10%, Prototheca wickerhamii (P. wickerhamii) 5%, C. glabrata 4%, Cryptococcus albidus (C. albidus) 2% and C. lusitaniae (1%) were also isolated. Of the positive cases, 75% were treated with antifungals, 17% with antibiotics and 8% were not treated. The azole group was the most frequently prescribed antifungal (71%). Of cases with negative yeast cultures, 83% were treated with antifungals. The presence of non-albicans Candida species and other opportunistic fungi is an important finding and combined with the pattern of therapy, represents a major challenge for future empirical therapeutic and prophylactic strategies in the treatment of mycotic vulvovaginitis.

Fractures of the distal part of the fibula with associated disruption of the deltoid ligament. Treatment without repair of the deltoid ligament.

The results in twenty-four patients who were treated for a distal fibular fracture and disruption of the deltoid ligament were studied, using subjective, objective, and radiographic criteria, over a period of at least two years. Nineteen (90 per cent) of the twenty-one patients who were treated without repair of the deltoid ligament had a good or excellent result. All but two of these patients were unrestricted in the ability to walk and run and had no pain during the activities of daily living. No patient had instability of the ankle. At follow-up, the range of motion of the ankle was within 15 degrees of that of the uninjured ankle in 90 per cent of the patients. Only one ankle had radiographic evidence of narrowing of the joint space. The three patients in whom the deltoid ligament was repaired did not have as good a result as the twenty-one patients in whom it was not, but this group was too small to permit valid comparisons. We concluded that exploration of the medial side of the ankle and repair of the deltoid ligament are not necessary unless reduction of the lateral malleolus fails to reduce the talus within the ankle mortise.

Brachial-plexus palsy in the newborn.

Twenty-one patients who had twenty-three brachial-plexus palsies resulting from trauma at birth were studied over a three and one-half year period, between July 1983 and December 1986. The incidence of this group of injuries was 2.5 per 1,000 live births. There were fourteen palsies of the fifth and sixth cervical nerves; eight of the fifth, sixth, and seventh cervical nerves; and one of the entire brachial plexus. Two patients were lost to follow-up shortly after birth. Of the remaining nineteen patients (twenty-one palsies), fifteen (seventeen palsies) had full recovery at an average of three months (range, two weeks to twelve months), and four (four palsies) had residual paralysis of the upper extremity at more than twenty-six months. We concluded that the newborn who has a brachial-plexus palsy has a favorable prognosis for complete recovery.

The effect of semantic and syntactic structure on verbal memory in Alzheimer's disease.

This study examined the ability of 17 patients with Alzheimer's disease and 17 normal-old subjects to recall short sentences that were normal, or had a disruption in either their semantic structure, their syntactic structure, or both their semantic and syntactic structure. Results showed that sentence recall performance was affected similarly in the demented and normal-old subjects by both the syntactic and semantic structure of the sentences. The presence of either type of language structure appeared to allow both normal and demented subjects to organize strings of words into multiword chunks for more efficient memory encoding.

The Role of the Environment in Fostering Independence: Conceptual and Methodological Issues in Developing an Instrument.

Although rehabilitation professionals are increasingly aware that environments can support or interfere with an individual's ability to function, environmental factors are not emphasized in assessment and intervention planning across rehabilitation disciplines. Conceptual and methodological issues related to creating a measure for assessing the rehabilitation environment, in either institutional or home settings, as it relates to fostering an individual's independence are presented. Reflecting a multidimensional conceptual base, the Environment-Independence Interaction Scale has subscales for temporal, physical, social, and cultural dimensions of the environment. The measure is primarily intended for research in evaluating effects of various rehabilitation environments on selected outcomes.

Test-retest reliability of three aphasia tests: performance of non-brain-damaged older adults.

This study was designed to assess the test-retest reliability of three aphasia tests. The Auditory Comprehension Test for Sentences (ACTS), the Boston Naming Test (BNT), and the Reading Comprehension Battery for Aphasia (RCBA) were administered on two separate occasions to 31 non-brain-damaged adults aged 50 to 76 years. The results showed acceptable score stability for all three aphasia tests. Sixty-eight percent of the time, older non-brain-damaged adults would be expected to score within 4.0% or less of the total number of test items on repeated testing.

The validity of reading comprehension therapy materials.

This study examines the degree to which reading comprehension therapy materials measure reading comprehension. Thirty-six non-brain-damaged adults (18 females, 18 males) ranging in age from 55 to 75 years participated. They answered written multiple-choice questions from aphasia therapy workbooks before and after reading the paragraphs (n = 40) to which the questions related. Results showed that for each of four sets of workbook materials, subjects answered an average of 24% to 49% more of the questions after reading the paragraphs relative to the number they answered before reading the paragraphs. For questions that could not be answered using one's prior knowledge, subjects were more dependent on having to read the paragraph in order to answer the questions correctly. Based on binomial probabilities, at least half of the questions from 32/40 paragraphs were answered correctly at greater than chance levels without reading the related paragraph.

Chikungunya in Jamaica: Public health effects and clinical features in children / Chikungunya en Jamaica ­ Efectos en la Salud Pública y Características Clínicas en Niños

Chikungunya virus (CHIKV) entered the Caribbean for the first time in 2013 and Jamaica experienced its maiden epidemic with Chikungunya Fever in 2014. We aimed to describe the public health effects and describe the clinical features in children and adolescents in Jamaica. METHODS: This study reviewed the public health effects of the illness in Jamaica by reviewing available data sources and the clinical features in 210 children and adolescents meeting the case definition at two hospitals, Bustamante Hospital for Children and University Hospital of the West Indies between August 23 and October 31, 2014 by chart review. Descriptive analyses and comparisons between groups using the Mann-Whitney U test were performed with SPSS version 22. RESULTS: The majority of households were affected by the illness which caused widespread absenteeism from school and work, loss of productivity and economic losses estimated at 60 billion dollars. The health sector was impacted by increased numbers seen in clinics and emergency departments, increased need for bed space and pharmaceuticals. Ninety-nine per cent of the children were febrile with a median maximal temperature of 102.4 F. Ninety-three per cent had household contacts of 0­20 persons. In addition to fever, maculopapular rash and joint pains, infants six months and younger presented with irritability and groaning (p = 0.00) and those between six months and six years presented with febrile seizures (p = 0.00). Neurologic involvement was noted in 24%. Apart from anaemia, few had other laboratory derangements. Few had severe organ dysfunction and there were no deaths. CONCLUSION: The Chikungunya Fever epidemic had significant public health and economic impact in Jamaica. In children, there were characteristic presentations in neonates and young infants and in children six months to six years. Neurologic involvement was common but other organ dysfunction was rare. These findings underscore the need to prevent further epidemics and the quest for a vaccine.(AU)

Antecedentes: El virus de Chikungunya (CHIKV) entró en el Caribe por primera vez en 2013, y Jamaica experimentó su primera epidemia de fiebre de Chikungunya en 2014. Nos propusimos como objetivo describir sus efectos en la salud pública y describir sus características clínicas en niños y adolescentes en Jamaica. Métodos: Este estudio examinó los efectos de la enfermedad en la salud pública en Jamaica. El examen se realizó mediante la revisión de fuentes de datos disponibles y las características clínicas en 210 niños y adolescentes que cumplían con la definición del caso en dos hospitales ­ Hospital Pediátrico Bustamante y el Hospital Universitario de West Indies ­ entre el 23 de agosto y 31 de octubre de 201, según las historias clínicas. Se realizaron análisis descriptivos y comparaciones entre los grupos usando la prueba U de Mann-Whitney y la versión 22 de SPSS Resultados: La mayoría de los hogares fueron afectados por la enfermedad, que causó un ausentismo generalizado en escuelas y trabajos, pérdida de productividad, y pérdidas económicas estimadas en 60 billones de dólares. El sector de la salud fue afectado por un aumento del número de personas atendidas en clínicas y departamentos de urgencias, y una mayor necesidad de camas en los hospitales y productos farmacéuticos. Noventa y nueve por ciento de los niños presentaron un estado febril con una temperatura mediana máxima de 102.4 F. Un noventa y tres por ciento tuvo contactos domésticos de personas de 0­20. Además de fiebre, erupciones maculopapulares y dolores en las articulaciones, los niños de seis meses o menos edad, presentaron irritabilidad y quejidos (p = 0.00), y aquellos entre seis meses y seis años de edad presentaron convulsiones febriles (p = 0.00). Se observó compromiso neurológico en el 24%. Aparte de anemia, algunos tenían otros trastornos de laboratorio. Otros presentaban una disfunción orgánica severa y no hubo muertes. Conclusión: La epidemia de fiebre de Chikungunya tuvo un impacto significativo tanto en la salud pública como en la economía de Jamaica. Los niños presentaron manifestaciones características, observadas tanto en recién nacidos y bebés pequeños como en niños de seis meses a seis años. El compromiso neurológico fue común, pero cualquiera otra disfunción orgánica fue rara. Estos hallazgos subrayan la necesidad de hacer más por evitar las epidemias y buscar la solución de una vacuna.(AU)

Surgery for involutional entropion.

Surgery for involutional entropion must correct horizontal eyelid laxity, vertical laxity, and overriding of the tarsus by the infra-tarsal tissues. The surgery should give lasting functional and pleasing cosmetic results. These goals are achieved with: 1) a blepharoplasty incision and reflection of a skin-muscle flap; 2) excision of a wedge of eyelid tissue at the lateral canthus; 3) barrier sutures or tuck of the retractors; 4) reattachment of the lid to the lateral orbital rim; and 5) excision of excess skin.

A new probe for silicone intubation of the lacrimal drainage system.

A new probe is described for silicone intubation of the lacrimal drainage system. The probe is a 1-mm hollow, malleable stainless steel tube. The leading end is rounded and smooth. Silicone tubing is fitted inside the trailing end of the probe, which is swaged over the tubing. The complete instrument consists of two such probes attached to each end of a 30-cm length of silicone tubing. Because the silicone is swaged onto the probe, the possibility of slippage of the tubing from the probe is eliminated.

Transparency of one-handed Amer-Ind hand signals to nonfamiliar viewers.

Thirty non-brain-damaged adults viewed 104 videotaped Amer-Ind hand signals. The majority of these hand signals were produced with one hand; 60 originally one-handed gestures and 31 left-hand adaptations of two-handed gestures were included in the data analyses. Nineteen subjects were between the ages of 20 and 30 years (younger group), and 11 subjects were between the ages of 50 and 69 years (older group). After viewing each hand signal twice in succession, the subjects wrote at least one word for that signal's meaning. The mean percentage of one-handed signals correctly identified was 48.2%; these signals varied widely in transparency (0% to 100%). The left-hand adaptations were significantly lower in transparency than the originally one-handed signals. The younger and older subjects did not differ in the mean percentage of one-handed signals they identified correctly (49.0% and 46.4%, respectively). However, some individual hand signals were easier for the younger subjects to identify; the opposite was also true.

Late quaternary extinction of a tree species in eastern North America.

Widespread species- and genus-level extinctions of mammals in North America and Europe occurred during the last deglaciation [16,000-9,000 yr B.P. (by (14)C)], a period of rapid and often abrupt climatic and vegetational change. These extinctions are variously ascribed to environmental change and overkill by human hunters. By contrast, plant extinctions since the Middle Pleistocene are undocumented, suggesting that plant species have been able to respond to environmental changes of the past several glacial/interglacial cycles by migration. We provide evidence from morphological studies of fossil cones and anatomical studies of fossil needles that a now-extinct species of spruce (Picea critchfieldii sp. nov.) was widespread in eastern North America during the Last Glacial Maximum. P. critchfieldii was dominant in vegetation of the Lower Mississippi Valley, and extended at least as far east as western Georgia. P. critchfieldii disappeared during the last deglaciation, and its extinction is not directly attributable to human activities. Similarly widespread plant species may be at risk of extinction in the face of future climate change.