The Bacterial Community in Questing Ticks From Khao Yai National Park in Thailand.

Ticks are known vectors for a variety of pathogens including bacteria, viruses, fungi, and parasites. In this study, bacterial communities were investigated in active life stages of three tick genera (Haemaphysalis, Dermacentor, and Amblyomma) collected from Khao Yai National Park in Thailand. Four hundred and thirty-three questing ticks were selected for pathogen detection individually using real-time PCR assays, and 58 of these were subjected to further metagenomics analysis. A total of 62 ticks were found to be infected with pathogenic bacteria, for a 14.3% prevalence rate, with Amblyomma spp. exhibiting the highest infection rate (20.5%), followed by Haemaphysalis spp. (14.5%) and Dermacentor spp. (8.6%). Rickettsia spp. were the most prevalent bacteria (7.9%) found, followed by Ehrlichia spp. (3.2%), and Anaplasma spp. and Borrelia spp. each with a similar prevalence of 1.6%. Co-infection between pathogenic bacteria was only detected in three Haemaphysalis females, and all co-infections were between Rickettsia spp. and Anaplasmataceae (Ehrlichia spp. or Anaplasma spp.), accounting for 4.6% of infected ticks or 0.7% of all examined questing ticks. The prevalence of the Coxiella-like endosymbiont was also investigated. Of ticks tested, 65.8% were positive for the Coxiella-like endosymbiont, with the highest infection rate in nymphs (86.7%), followed by females (83.4%). Among tick genera, Haemaphysalis exhibited the highest prevalence of infection with the Coxiella-like endosymbiont. Ticks harboring the Coxiella-like endosymbiont were more likely to be infected with Ehrlichia spp. or Rickettsia spp. than those without, with statistical significance for Ehrlichia spp. infection in particular (p-values = 0.003 and 0.917 for Ehrlichia spp. and Rickettsia spp., respectively). Profiling the bacterial community in ticks using metagenomics revealed distinct, predominant bacterial taxa in tick genera. Alpha and beta diversities analyses showed that the bacterial community diversity and composition in Haemaphysalis spp. was significantly different from Amblyomma spp. However, when examining bacterial diversity among tick life stages (larva, nymph, and adult) in Haemaphysalis spp., no significant difference among life stages was detected. These results provide valuable information on the bacterial community composition and co-infection rates in questing ticks in Thailand, with implications for animal and human health.

Field Evaluation of Indoor Thermal Fog and Ultra-Low Volume Applications For Control of Aedes aegypti in Thailand.

Efficacies of a handheld thermal fogger (Patriot™) and a backpack ultra-low volume (ULV) sprayer (Twister™) with combinations of 2 different adulticides (pyrethrin, deltamethrin) and an insect growth regulator (pyriproxyfen) were field-tested and compared for their impact on reducing indoor Aedes aegypti populations in Thailand. The effectiveness of the indoor space sprays was evaluated by sampling the natural Ae. aegypti population in houses and determining their physiological status, by monitoring mortality of sentinel caged mosquitoes (AFRIMS strain) and by assessing larval mortality in laboratory bioassays using water exposed to the spray. A total of 14,742 Ae. aegypti were collected from Biogents Sentinel traps in this study. The combination of ULD® BP-300 (3% pyrethrin) and NyGuard® (10% pyriproxyfen) sprayed either by the Patriot or Twister significantly reduced some Ae. aegypti populations up to 20 days postspray relative to the control clusters. The addition of pyriproxyfen to the adulticide extended how long household mosquito populations were suppressed. In 2 of the 4 products being compared, the Twister resulted in higher mortality of caged mosquitoes compared with the Patriot. However, neither machine was able to achieve high mortality among Ae. aegypti placed in hidden (protected) cages. The larval bioassay results demonstrated that the Twister ULV provided better adult emergence inhibition than the Patriot (thermal fogger), likely due to larger droplet size.

Ixodid ticks associated with feral swine in Texas.

Ixodid ticks were collected from feral swine in eight Texas ecoregions from 2008-2011. Sixty-two percent of 806 feral swine were infested with one or more of the following species: Amblyomma americanum, A. cajennense, A. maculatum, Dermacentor albipictus, D. halli, D. variabilis, and Ixodes scapularis. Juvenile and adult feral swine of both sexes were found to serve as host to ixodid ticks. Longitudinal surveys of feral swine at four geographic locations show persistent year-round tick infestations of all gender-age classes for tick species common to their respective geographic locations and ecoregions. Amblyomma americanum, A. cajennense, A. maculatum and D. variabilis were collected from 66% of feral swine harvested through an abatement program in seven ecoregions from March to October in 2009. These results indicate westward geographic expansion of D. variabilis. Summary results show feral swine are competent hosts for ixodid species responsible for the transmission of pathogens and diminished well-being in livestock, wildlife, and humans.

A field bioassay to evaluate potential spatial repellents against natural mosquito populations.

A field bioassay evaluating candidate chemicals as aerial repellents was developed and evaluated against natural mosquito populations in Beltsville, MD. The bioassay consisted of an attractive source surrounded by a grid of 16 septa containing a volatile candidate aerial repellent, compared with an attractive source without such a grid. The attractive source was a Centers for Disease Control and Prevention light trap supplemented with carbon dioxide. Significant sources of variation included weather, position, and the differential response of mosquito species. Despite these sources of variation, significant repellent responses were obtained for catnip oil, E,Z-dihydronepetalactone, and DEET.

Evaluation of five trapping systems for the surveillance of gravid mosquitoes in Prince Georges County, Maryland.

Five mosquito trapping systems were evaluated in a large wildlife research center containing extensive and diverse mosquito-breeding habitat. The systems evaluated included Centers for Disease Control (CDC) New Standard Miniature Light traps with and without CO2 (dry ice), CDC gravid traps, partially open 1.8-m3 cages, and Fay-Prince traps baited with CO2. The first 4 trap systems were evaluated for 17 periods, while the Fay-Prince trap was evaluated on 5 trapping dates. Parameters recorded for each species were total catch, percent males, total females, and whether blood-fed/gravid. Fourteen of the 23 species caught yielded over 50 individuals in the 5 trapping systems (range of 71-2,524 specimens per species). Both light and CO2 were powerful attractants for 12 of the 14 commonly caught species. However, for most species, the majority of captured females were nongravid. Gravid traps caught fewer mosquitoes than did light- or CO2-baited traps, but the catch consisted of a higher percentage of gravid females. The open cages caught substantial numbers (>100 individuals) of 5 species, and for 2 species, this was the most productive trap. While light- and CO2-baited traps tended to catch few males or gravid females, the open cages caught an eclectic mixture of males, gravid females, and nongravid females, perhaps representative of the true percentages of each in nature.

Randomized controlled trial of concurrent hepatitis A and B vaccination.

Hepatitis A and B viruses are threats to deployed military forces. The objective of this study was to determine the feasibility of concurrent vaccination against hepatitis A and B viruses. One hundred five healthy persons, 20 to 49 years of age and without serologic markers to hepatitis A or B viruses, were randomized to receive an inactivated hepatitis A vaccine (HEP A; 25 units in 0.5 mL), recombinant hepatitis B vaccine (HEP B; 10 micrograms in 1.0 mL), or both (HEP A & B) concurrently in separate arms. Vaccines were administered intramuscularly at 0, 1, and 6 months. Sera obtained at 1, 2, 6, 7, and 12 months after the first dose were tested for quantitative antibody to hepatitis A virus (anti-HAV) and antibody to hepatitis B surface antigen. Local reactions (e.g., pain) were reported by less than half of the volunteers and were similar at the site of HEP A, whether given alone or concurrently. However, more persons complained of pain (usually mild) at the HEP B site when HEP B was given concurrently with HEP A compared with HEP B alone (43% vs. 15%, 34% vs. 9%, and 42% vs. 15% for doses 1, 2, and 3, respectively; p < 0.05 for each dose). Among persons immunized with HEP A alone or HEP A & B, the proportion with > or = 10 mIU/mL anti-HAV was 83% in both groups 1 month after dose 1 and 100% at months 2, 7, and 12. The geometric mean concentrations of anti-HAV increased from 21 mIU/mL at month 1 to 2,649 and 2,312 mIU/mL in the HEP A and HEP A & B groups, respectively, at month 7. The response to HEP B was similar whether administered alone or concurrently. Antibody responses were similar in those receiving HEP A or HEP B concurrently or alone, but more subjects reported pain (usually mild) at the HEP B site after concurrent vaccination than after HEP B alone. Further work should be conducted to approve HEP A for patients younger than 2 years of age and to develop combined HEP A and HEP B vaccines in the United States.

Challenges of including dietitians, nurses, occupational therapists, and pharmacists in the Federal Credentialing Program.

Credentialing and recredentialing of federal health care providers involves hundreds of hours of labor and associated costs. This article presents the history of credentialing and efforts to expand the Federal Credentialing Program to include dietitians, nurses, occupational therapists, and pharmacists and discusses barriers to this possible expansion. Representatives from federal and civilian health care service delivery agencies and credentialing and licensure bodies will gather to establish common credentialing information for these professions. Discussing barriers to these efforts will help to ensure success. In addition, a more efficient and streamlined system could easily be adopted by the civilian sector for these professions.

Retraining physicians for primary care. A study of physician perspectives and program development.

OBJECTIVE: To determine the number and kinds of programs that medical schools and managed care organizations offer or plan to offer to retrain physician specialists to practice primary care medicine and to discover physicians' attitudes toward such retraining. DESIGN: A survey was mailed in 1994 to all 126 medical schools and the 19 largest US managed care organizations to collect detailed information about existing and potential retraining programs. Physicians' attitudes toward retraining were elicited from participants in 3 geographically diverse focus groups. Selected specialists were polled through the national survey of the American Medical Association's Socioeconomic Monitoring System to ascertain the demand for retraining. RESULTS: The majority of institutions contacted perceived a need for retraining, but few programs had been established. Programs being "considered" varied widely in duration, class size, target audience, accreditation, and projected training settings. Although unenthusiastic about retraining, physicians preferred programs that would expand their patient base, maintain the practice population, be inexpensive and close to home, and provide hands-on training in the eventual practice environment. Physicians also preferred a goal-oriented, part-time retraining program in a large group practice or managed care setting that would allow them to practice their specialty while retraining. Few planned or existing programs incorporate many of these features. The most likely candidates for retraining are subspecialty physicians who currently provide some primary care and are employed by a medical plan. CONCLUSIONS: Despite efforts by those who perceive that a need for more generalist physicians is stimulating interest in retraining specialists and subspecialists to provide primary medical care, physician interest and program availability remain low, and programs under development are not being designed to attract those who may seek retraining. This situation is probably fortuitous, because changed perceptions about the adequacy of the generalist physician workforce since the beginning of this study have diminished the call for retraining.

Gastroenterology workforce modeling.

OBJECTIVE: To examine the current supply and distribution of gastroenterologists and project future supply under various scenarios to provide a paradigm for workforce reform. DESIGN: An analysis of current practices and distribution of gastroenterologists and a demographic model, using the 1992 gastroenterology workforce as a baseline. MAIN OUTCOME MEASURE: Comparison of current supply, distribution, and practice profiles with past data and future projections, using analyses of data from the 1993 Area Resource File, 1992 Medicare Part B file, age- and sex-specific death and retirement rates from the Bureau of Health Professions, managed care staffing patterns, the National Survey of Internal Medicine Manpower, and the Bureau of the Census. RESULTS: Rapid growth in the number of US gastroenterologists has resulted in a gastroenterologist-to-population ratio double that used on average by health maintenance organizations. In addition, the work profile of gastroenterologists is shared significantly by primary care physicians and other specialists, with the exception of a few specific and uncommon procedures. CONCLUSIONS: Empirical evidence suggests that, even in the absence of detailed models to describe the desired supply/need balance for gastroenterology, the US health care system and clinicians may benefit from a reduction in gastroenterology training programs. The Gastroenterology Leadership Council endorsed a goal of 25% to 50% reduction in trainee numbers over 5 years, and recent National Resident Matching Program data indicate that a voluntary downsizing process is in full force. This study illustrates a paradigm for workforce planning that could be useful for other medical specialties.

Workshop on pediatric AIDS rehabilitation: a summary.

The workshop offered the following recommendations for research on pediatric AIDS: (1) investigating cross-cutting issues such as pain and/or QOL; (2) identifying effective service delivery and associated cultural considerations; (3) promoting data sharing and standardized instruments; and (4) examining affected body systems.

Language and development in FG syndrome with callosal agenesis.

The FG syndrome is characterized by unusual facies, sudden infant death, developmental delay, and abnormalities of the cardiac, gastrointestinal, and central nervous systems. No longitudinal data on development in surviving patients are currently available. Serial evaluations of a patient with FG syndrome, whose sole central nervous system anomaly was agenesis of the corpus callosum, showed a consistent pattern over time. Specific language impairments in syntactic and pragmatic-semantic areas are emerging. These findings represent the first detailed data on which expectations for children with the FG syndrome can be based. The findings also fit theoretical constructs on the function of the corpus callosum and may therefore be generalized to provide expectations for other patients with isolated agenesis of the corpus callosum. Given the information gained from this case, it is clear that language intervention/consultation should be a pivotal service for such children, and that the speech-language pathologist should play a role in the development of an integrated educational services plan.

A clinico-epidemiological study of epidemic typhus in Africa.

Epidemic, louse-borne typhus persists in the rugged, mountainous areas of Ethiopia and much of northeastern and central Africa as well as in the rural highlands of Central and South America, where the conditions of living favor the harboring of body lice and where antibiotic treatment and effective louse-control measures are unavailable. The historical significance and current epidemiology of typhus, including the reservoir of Rickettsia prowazekii in flying squirrels in the United States, are reviewed, and the clinical presentation, laboratory findings, and hospital course in the cases of 60 patients admitted with epidemic, louse-borne typhus to the St. Paul's Hospital in Addis Ababa, Ethiopia, are described. Treatment of this disease with oral doxycycline, tetracycline, or chloramphenicol prevents complications and results in prompt resolution of symptoms.

Black English in a Mississippi prison population.

Nine linguistic features unique to Black English were examined in the speech of 87 Black and 77 White inmates of a Mississippi prison population. The purpose of the study was to determine whether Black inmates could be distinguished from White inmates by their use of the present progressive, final stops, distributive be, remote aspect been, noun plurals, third person singular present tense, possessives, consonant clusters, and the copula. Results showed that use of eight of the nine features accurately predicted the ethnicity of the subjects. Only remote aspect been failed to identify ethnic differences. Identification of dialect variation among minority populations and more specifically among prison populations is an important step toward providing effective remediation programs.

Hormonal influence on language development in physically advanced children.

Sex differences in language performance have long been noted, with females more verbal and males superior in visual-spatial tasks. Two theories seek to explain the differences in language function. Waber (1976, Science, 193, 572-574) suggests that these sex differences are secondary to differences in bilateral language function related to the faster maturation rate in girls. Geschwind and Galaburda (1985, Archives of Neurology, 42,(I), 428-459; (II), 521-552; (III), 634-654) on the other hand posit an intimate interrelationship of sex hormones, the immune system, and laterality as influencing the ultimate asymmetry of the nervous system, which in turn could account for such differences. In the present study, language function was examined in patients with accelerated maturation caused by conditions with sex hormone elevation (idiopathic precocious puberty and congenital adrenal hyperplasia). The degree of maturational advancement was similar between the two groups. However, significant language performance differences were noted between androgen- vs. estrogen-exposed patients, regardless of genetic sex or diagnosis of the patient, indicating a hormonal effect on language development over time. These data support Geschwind and Galaburda's multifactorial theory for the origin of sex differences in language performance, and argue against Waber's maturational hypothesis.

Goldenhar's syndrome: a case study.

Goldenhar's Syndrome, a rare symptom complex involving craniofacial and vertebral malformations, is reviewed and a detailed case history of a 19-mo-old exhibiting the syndrome is described. This multiple-problem child exhibited a 6-mo deficit in communication skills at 12 mo of age. After 6 mo of participation in a multidisciplinary early intervention program, including speech-language therapy, the child exhibits normal language although he has articulation problems consistent with his craniofacial defects.