Apparent stability masks underlying change in a mule deer herd with unmanaged chronic wasting disease.

The contagious prion disease "chronic wasting disease" (CWD) infects mule deer (Odocoileus hemionus) and related species. Unchecked epidemics raise ecological, socioeconomic, and public health concerns. Prion infection shortens a deer's lifespan, and when prevalence (proportion of adults infected) becomes sufficiently high CWD can affect herd dynamics. Understanding population responses over time is key to forecasting long-term impacts. Here we describe unexpected stability in prevalence and abundance in a mule deer herd where CWD has been left unmanaged. High apparent prevalence (~30%) since at least 2005 likely drove observed changes in the proportion and age distribution of wild-type native prion protein (PRNP) gene homozygotes among deer sampled. Predation by mountain lions (Puma concolor) may be helping keep CWD in check. Despite stable appearances, prion disease nonetheless impairs adult survival and likely resilience in this deer herd, limiting its potential for growth despite refuge from hunter harvest and favorable habitat and winter conditions.

The 10-Item Substance Use Disorder Outcome Scale: Psychometric evaluation.

The current study describes the psychometric properties of a scale (entitled "Substance Use Disorder Outcome Scale-10 items" or 10-Item Substance Use Disorder Outcome Scale) designed for longitudinal studies. Sixteen male veterans attending a substance use disorder recovery clinic were studied over a 2-year period. The attending nurse and physician conducted four, 10-Item Substance Use Disorder Outcome Scale scale ratings, each encompassing a 6-month period, for each participant. Analyses involved scale descriptive results, Cronbach alpha scores, effects of deleting the item on Cronbach alpha scores for the remaining items, and item-to-scale correlations across the four periods, plus three exploratory studies. Scale scores showed skewness p ≤ 1.0 and Cronbach alphas of 0.89 to 0.93. Six of 10 items correlated with total scale scores at 3 or 4 rating periods at p ≤ 0.005. Two items showed p ≤ 0.005 correlations only in the first two periods, and two items showed p ≤ 0.005 correlations only in the last two periods. Exploratory analyses revealed some item convergence over time plus non-significant associations with long-standing demographic and clinical variables. Desirable 10-Item Substance Use Disorder Outcome Scale psychometric properties included normal distribution, excellent Cronbach alphas, and high item-to-score correlations, all of which persisted over time.

Evaluation of prokinetic agents used in the treatment of gastroparesis.

Background/Aim: Hospitalizations due to gastroparesis have increased in the last 20 years with limited advancements in pharmacologic therapy. Although therapy primarily consists of prokinetic agents, little is known about their effects on hospital outcomes. The aim of our study was to determine whether common prokinetic therapies (metoclopramide and erythromycin) improve outcomes in gastroparesis patients. Methods: A retrospective review of adult patients admitted with a primary diagnosis of gastroparesis between 7 January 2011 and 7 January 2014 was conducted. Patients were divided into two groups based on whether they received prokinetic therapy (PRO) during hospitalization or not (NO). Groups were compared to determine length of stay (LOS), 30-day readmission rates, and risk factors affecting these outcomes. Results: Of the 82 patients included in our study, 57 received prokinetic therapy. Mean length of stay (LOS) was 5.8 ± 4.2 days, with a significantly shorter LOS in the NO group (3.7 ± 1.9 vs. 6.7 ± 4.5; p = 0.002). Among patients studied, 30.5% were readmitted within 30 days from discharge with no significant reduction in the PRO group (35.1% PRO vs. 20% NO; p =0.23). Patients with idiopathic gastroparesis had significantly longer LOS (6.9 ± 4.6 vs. 4.2 ± 2.8; p = 0.003). In the PRO group, those who received intravenous (IV) therapy had a significantly shorter LOS (4.9 ± 2.5 IV vs. 8.0 ± 5.3 oral; p = 0.01). Conclusions: Treatment of gastroparesis patients with prokinetic agents did not shorten the LOS nor decrease 30-day readmission rates. In those receiving prokinetics, the IV route was associated with reduced LOS.

Estimating chronic wasting disease effects on mule deer recruitment and population growth.

Chronic wasting disease (CWD), a prion disease of mule deer (Odocoileus hemionus), accelerates mortality and in so doing has the potential to influence population dynamics. Although effects on mule deer survival are clear, how CWD affects recruitment is less certain. We studied how prion infection influenced the number of offspring raised to weaning per adult (≥2 yr old) female mule deer and subsequently the estimated growth rate (λ) of an infected deer herd. Infected and presumably uninfected radio-collared female deer were observed with their fawns in late summer (August-September) during three consecutive years (2006-2008) in the Table Mesa area of Boulder, Colorado, USA. We counted the number of fawns accompanying each female, then used a fully Bayesian model to estimate recruitment by infected and uninfected females and the effect of the disease on λ. On average, infected females weaned 0.95 fawns (95% credible interval=0.56-1.43) whereas uninfected females weaned 1.34 fawns (95% credible interval=1.09-1.61); the probability that uninfected females weaned more fawns than infected females was 0.93). We used estimates of prevalence to weight recruitment and survival parameters in the transition matrix of a three-age, single-sex matrix model and then used the matrix to calculate effects of CWD on λ. When effects of CWD on both survival and recruitment were included, the modeled λ was 0.97 (95% credible interval = 0.82-1.09). Effects of disease on λ were mediated almost entirely by elevated mortality of infected animals. We conclude that although CWD may affect mule deer recruitment, these effects seem to be sufficiently small that they can be omitted in estimating the influences of CWD on population growth rate.

Lions and prions and deer demise.

BACKGROUND: Contagious prion diseases--scrapie of sheep and chronic wasting disease of several species in the deer family--give rise to epidemics that seem capable of compromising host population viability. Despite this prospect, the ecological consequences of prion disease epidemics in natural populations have received little consideration. METHODOLOGY/PRINCIPAL FINDINGS: Using a cohort study design, we found that prion infection dramatically lowered survival of free-ranging adult (>2-year-old) mule deer (Odocoileus hemionus): estimated average life expectancy was 5.2 additional years for uninfected deer but only 1.6 additional years for infected deer. Prion infection also increased nearly fourfold the rate of mountain lions (Puma concolor) preying on deer, suggesting that epidemics may alter predator-prey dynamics by facilitating hunting success. Despite selective predation, about one fourth of the adult deer we sampled were infected. High prevalence and low survival of infected deer provided a plausible explanation for the marked decline in this deer population since the 1980s. CONCLUSION: Remarkably high infection rates sustained in the face of intense predation show that even seemingly complete ecosystems may offer little resistance to the spread and persistence of contagious prion diseases. Moreover, the depression of infected populations may lead to local imbalances in food webs and nutrient cycling in ecosystems in which deer are important herbivores.

Inadequate skill of healthcare professionals in using asthma inhalation devices.

Inadequate skill in the use of asthma inhalation devices by healthcare professionals has been well documented over the past 25 years. We performed a PubMed search of the English literature for studies regarding skill by physicians, medical students, pharmacists, nurses, and respiratory therapists in using asthma inhalation devices. This review summarizes 20 studies that were identified. Results of these studies consistently showed lack of skill in using metered-dose inhalers, spacers, and dry powder inhalers by a majority of healthcare professionals. National and international guidelines for asthma management include detailed patient education as an essential component of care, yet a large percentage of healthcare professionals are not competent in using inhalation devices. Practical solutions to this problem are needed to enhance the care of asthma patients.

Infant Temperament: An Evaluation of Children with Down Syndrome.

The current study investigated differences in the development of temperament for normally developing infants and infants with Down Syndrome (DS). DS has been described as the most prevalent cause for mental retardation, and its effects on the central nervous system may also influence the development of temperament. Parents of 3 to 12 month-old normally developing infants and infants with DS completed the Infant Behavior Questionnaire-Revised (IBQ-R). Results indicated that parents of infants with DS described their children as exhibiting higher levels of temperament dimensions associated with Orienting/Regulating Capacity, and lower levels of attributes collectively referred to as Negative Affectivity, relative to comparison children. Specifically, infants with DS were reported to exhibit lower levels of Distress to Limitations, higher levels of Low Intensity Pleasure, Duration of Orienting, Falling Reactivity, and Cuddliness/Affiliation. No significant differences were found between IBQ-R factor intercorrelations for children with DS and normatively developing infants.