Measles surveillance in Canada: 2015.

BACKGROUND: Measles has been eliminated in Canada since 1998. Every year, the Public Health Agency of Canada presents epidemiologic evidence to the Pan American Health Organization (PAHO) to verify that measles elimination continues in Canada. OBJECTIVE: To describe measles activity in Canada for 2015 as updated evidence for continued measles elimination status. METHODS: Measles surveillance data were captured by the Canadian Measles and Rubella Surveillance System (CMRSS) and the Measles and Rubella Surveillance (MARS) pilot project and assessed for distribution by demographics and risk factors. Outbreak characteristics were summarized and genotypic and phylogenetic analyses were conducted and described. Surveillance data for 2015 were evaluated against PAHO's essential criteria for measles elimination status. RESULTS: In 2015, the incidence of measles in Canada was 5.5 cases per 1,000,000 population, with 196 cases across four provinces. The majority of cases (87.2%, n=171) were not immunized and both age-specific incidence rates and case counts were highest among those aged 10 to 14 years (29.5 cases per 1,000,000 population, n=55). This was due in large part to a sizeable outbreak in a non-immunizing religious community. Overall, 10.7% (n=21) of cases were hospitalized. Genotype information was available for 100% of measles events (4/4 outbreaks and 6/6 sporadic cases). Canada met or partially met most of PAHO's criteria for verification of measles elimination. CONCLUSION: Although importations and areas of low immunization coverage continue to challenge Canada's elimination status, surveillance data for 2015 provides strong evidence that measles elimination has been maintained.

Measles surveillance in Canada: Trends for 2014.

BACKGROUND: Measles elimination status was achieved in Canada in 1998. The Public Health Agency of Canada compiles evidence for the Pan American Health Organization to confirm that criteria for the verification of measles elimination continue to be met. OBJECTIVE: To describe measles activity in Canada for 2014 in order to support Canada's ongoing measles elimination status. METHODS: Using data captured by the Canadian Measles and Rubella Surveillance System and the Measles and Rubella Surveillance pilot project during 2014, the distribution of measles cases by demographics, immunization status and hospitalization were assessed, outbreak characteristics were summarized and genotypic and phylogenetic analyses were conducted and described. RESULTS: During 2014, 418 measles cases were reported by five provinces and territories for an overall incidence rate of 11.8 cases per 1,000,000 population. Case counts and incidence rates were highest among those five to 14 years of age and the majority of cases were not immunized. Overall, five percent of cases were hospitalized, most frequently the youngest and oldest age groups. Eighteen outbreaks were reported, the largest of which occurred in a non-immunizing religious community in British Columbia. Genotype information was available for 98% of measles events (18/18 outbreaks and 31/32 sporadic cases). Canada continued to meet or partially meet all four of PAHO's criteria for verification of measles elimination. CONCLUSION: Despite significant measles activity in 2014, Canada continues to provide strong evidence that measles elimination status is being maintained.

Measles surveillance in Canada: Trends for 2013.

OBJECTIVE: The objective of this report is to describe measles activity in Canada during 2013, in order to support the documentation and maintenance of measles elimination status. METHODS: A descriptive analysis of measles counts and incidence by age group, immunization history, hospitalization and province/territory, as well as a summary of 2013 outbreaks, was conducted using enhanced measles data captured through the Canadian Measles and Rubella Surveillance System. Genotype information and phylogenetic analysis for 2013 were summarized. RESULTS: In 2013, 83 confirmed measles cases were reported in seven provinces/territories for an incidence rate of 2.4 per 1,000,000 population. Incidence was highest in the youngest age groups (< 1 year, 1 to 4 years). Burden of disease was highest in the youngest age groups and children 10 to 14 years. Three-quarters of cases had been inadequately immunized, and 10% were hospitalized. There were nine measles outbreaks reported in 2013, one of which consisted of 42 cases in a non-immunizing community in Alberta. DISCUSSION: 2013 saw the fifth highest number of reported measles cases since 1998. While we continue to face challenges related to importation and heterogeneous immunization coverage, in 2013 Canada met or partially met all four criteria outlined by the Pan American Health Organization for measles elimination.

Measles molecular epidemiology: What does it tell us and why is it important?

Measles molecular epidemiology was a key component of the verification of elimination of indigenous measles in Canada and is an invaluable tool during public health investigations, both to establish whether connections exist between concurrent measles cases and to indicate possible sources of importations. There are 24 distinct genotypes however the genotype is usually not sufficient to describe the complex molecular epidemiology of measles cases. The exact genetic sequence of the last 450 nucleotides of the nucleoprotein (N) gene (N-450) is used. The measles genome mutates very slowly and so cases within the same chain of transmission usually have identical N-450 sequences. In Canada, the National Microbiology Laboratory (NML) sequences the N-450 and deposits it into the WHO measles sequence database, MeaNS. This database can be used to identify other geographic regions where the measles sequence was detected, supporting or excluding connections. For commonly detected N-450 sequences, MeaNS designates a "sequence variant." Sequence variants are used as the defining characteristic of measles cases with identical sequences and this designation is fundamental to the description of measles molecular epidemiology both locally and globally. As progress is made towards global measles eradication, its genetic diversity decreases and distinct importations of measles from a single reservoir can be difficult to distinguish using current methods. Extending sequencing methods beyond the N-450 is required. While sequencing the entire hemagglutinin (H) gene, which is currently done routinely at the NML, can be helpful, whole genome sequencing will be required for effective molecular surveillance to monitor the sustained elimination of measles in Canada.insert text here.

Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013.

We describe a case of vaccine-associated measles in a two-year-old patient from British Columbia, Canada, in October 2013, who received her first dose of measles-containing vaccine 37 days prior to onset of prodromal symptoms. Identification of this delayed vaccine-associated case occurred in the context of an outbreak investigation of a measles cluster.

Decreased receptivity of pathway connective tissue to sympathetic nerve ingrowth in the developing rat.

Sympathetic axons can form atypical pathways to denervated orbital targets in neonatal rats but not in rats aged 30 or more days. The objective of this study was to determine if connective tissue pathways that carry sympathetic nerves lose their ability to sustain axonal sprouting during the early postnatal period. Regions of periorbital sheath known to contain large numbers of sympathetic axons that travel to distal orbital targets were excised from rats (sympathectomized 3 days previously) on postnatal days 6-7, 14-15, 30-31, and 48-49 and placed in anterior chambers of adult host rats. Tissues were removed 3, 6, or 10 days post-transplant and sympathetic ingrowth was analyzed by catecholamine histofluorescence in whole-mount or cryosectioned specimens. Connective tissue transplants from 6-15-day-old donors showed significant fiber ingrowth by 3 days in oculo, and innervation was maximal by 6 days. In contrast, sprouting into 30-49-day-old tissue was significantly slower, with most transplants lacking fibers at 3 days, and with small numbers of short fibers present at 6 days. We conclude that maturational changes occur in periorbital connective tissue pathways in the early postnatal period which make them less receptive to ingrowth by sympathetic nerves. The findings that connective tissue pathways are better substrates for sympathetic sprouting in the neonatal rat supports the view that developmental changes in these tissues are likely to contribute to the impaired reinnervation of orbital targets by contralateral neurons in juvenile and adult rats.

Learning circles: a strategy for clinical practicum.

The author describes the use of learning circles as a strategy to increase critical-thinking skills. The author describes the origins of the learning circle strategy in experiential and cooperative learning theory, the development of a pilot project using learning circles to explore ethical issues in a clinical course, and student and instructor perceptions of the effectiveness of this strategy.

Presurgical anxiety treated with cognitive behavioral therapy in a 13-year-old female with cleft lip and palate: a psychological case report.

This case report describes presurgical anxiety in a 13-year-old female with complete cleft lip and palate, treatment of the anxiety with cognitive-behavioral therapy and progressive relaxation with biofeedback prior to a septorhinoplasty, and the treatment outcome.

Reinnervation of denervated iris by transplanted sympathetic ganglia: effect of neuronal age.

Neuronal outgrowth in vivo is aggressive postnatally, but is diminished with increasing age. This may be attributable to intrinsic features of the neuron or its interaction with other components of the developing organism. The purpose of this study was to determine if there is an age-dependent reduction in the intrinsic ability of sympathetic neurons to initiate fiber outgrowth. Superior cervical ganglia from donor rats aged 3-4, 11-12, 27-28 and 45-46 days were removed and transplanted to the anterior chamber of the sympathectomized eye of host rats 85-89 days of age. Ganglia with host irides were removed at 3, 6 and 10 days post-transplant and whole mounts were analysed using catecholamine histofluorescence for maximum sympathetic fiber density, length and initial rate of outgrowth. Fluorescent fibers were present in host irides of donors of all ages and at all post-transplant times. However, maximum fiber density was less for the 3-4-day-old donor ganglia (e.g. 43-71% of 11-46-day-old donor ganglia at 600 microns, 10 days post-transplant). Maximum fiber length was also less in the youngest group (e.g. 35-49% of 11-46-day-old donor ganglia, 10 days post-transplant). Further, the initial rate of outgrowth was decreased for the 3-4-day-old donor ganglia (128 +/- 46 microns/day for the 3-4-day-old ganglia vs 253 +/- 48 microns/day for the 11-12-day-old ganglia, 307 +/- 35 microns/day for the 27-28-day-old ganglia and 260 +/- 22 microns/day for the 45-46-day-old ganglia).(ABSTRACT TRUNCATED AT 250 WORDS)

Autonomic and sensory reinnervation of smooth muscle transplanted to the anterior chamber of the eye: effect of target postnatal age.

The ability of the nervous system to provide target innervation is greatest in early development, but decreases as a function of age. The objective of the present study was to determine if age-related changes occurring within the target tissue contribute to this decline. Periorbital tarsal smooth muscle from donor rats 6, 14, 30, and 48 days postnatal were transplanted to the anterior chamber of the eye of 84- to 90-day-old host rats. The tissue was removed at 3, 6, or 10 days post-transplant and immunostained for presumptive sympathetic nerves (dopamine beta-hydroxylase-immunoreactive, DBH-ir), sensory (calcitonin gene-related peptide-immunoreactive, CGRP-ir) or parasympathetic (vasoactive intestinal polypeptide-immunoreactive, VIP-ir). DBH-ir sympathetic fibers sprouted into target from donors of all ages. However, the rate of ingrowth was most rapid in tissue from 6-day-old donors. In contrast, CGRP-ir sensory fibers showed no age-related differences, but grew more rapidly than sympathetic fibers. However, the innervation density at 10 days was comparable for both types of nerves. No significant VIP-ir parasympathetic ingrowth could be demonstrated at any age. We conclude that smooth muscle target in developing animals can have selective effects on different populations of ingrowing fibers; the rate of sympathetic ingrowth declines with maturity, whereas ingrowth of sensory fibers is not altered.

Effects of argon beam coagulation on split thickness skin graft survival in the swine model.

Argon beam coagulation (ABC) uses argon gas to evacuate blood in an operative field and simultaneously to transport a coagulating electric current to bleeding sites. This allows a 'no touch' method of coagulation which is faster, more precise, and less destructive than conventional electrocautery. The technique has been used to reduce blood loss in liver surgery, trauma surgery and neck dissections. In this study, the effect of ABC treatment of the recipient graft beds on the survival of split thickness skin grafts was assessed in pigs, testing the hypothesis that ABC treatment of the recipient bed would have no adverse effect on skin graft survival. Nine 20 kg mixed breed pigs had split thickness skin grafts raised on each side of the paraspinous area. The graft beds on one side were prepared using ABC and the contralateral side served as controls. The percentage of graft survival on the ABC treated sides was compared to control graft survival on the other side at 12 days postsurgery. Our results confirm the hypothesis that treatment of the recipient bed with ABC does not adversely affect the survival of split thickness skin grafts.

Effects of the maleless mutation on X and autosomal gene expression in Drosophila melanogaster.

The mutational effect of the maleless (mle) gene in Drosophila has been reexamined. Earlier work had suggested that mle along with other male-lethal genes was responsible for hypertranscription of the X chromosome in males to bring about dosage compensation. Prompted by studies on dosage sensitive regulatory genes, we tested for effects of mlets on the phenotypes of 16 X or autosomal mutations in adult escapers of lethality. In third instar larvae, prior to the major lethal phase of mle, we examined activities of 6 X or autosomally encoded enzymes, steady state mRNA levels of 15 X-linked or autosomal genes and transcripts from two large genomic segments derived from either the X or from chromosome 2 and present in yeast artificial chromosomes. In contrast to the previously hypothesized role, we detected pronounced effects of mle on the expression of both X-linked and autosomal loci such that a large proportion of the tested genes were increased in expression, while only two X-linked loci were reduced. The most prevalent consequence was an increase of autosomal gene expression, which can explain previously observed reduced X:autosome transcription ratios. These observations suggest that if mle plays a role in the discrimination of the X and the autosomes, it may do so by modification of the effects of dosage sensitive regulatory genes.

Facial Impairment Scales for Clefts.

The purpose of this paper is to present the Facial Impairment Scales for Clefts. The Facial Impairment Scales for Clefts consist of four, 24-photograph, empirically derived scales of severity of cleft impairment. They were developed (1) to serve as research tools in single and multicenter studies of the surgical, psychosocial, and integrated treatment outcomes of facial clefts and (2) to assist in clinical assessment staging of the aesthetic severity of cleft impairment. Study 1 was conducted to extend the generalizability of the Facial Impairment Scales for Clefts to other groups of raters, including plastic surgeons. Reliability of scale ratings between children (n = 54) and plastic surgeons (n = 23) was examined. Rank orders of photographic subjects by severity of cleft impairment by children were highly correlated with ranks given by plastic surgeons. Study 2 in this series was conducted to assess if new photographs could be reliably fitted to scales. One-hundred and thirty-four medical student raters were able to scale new photographs reliably to the standard measures. These findings suggest that the Facial Impairment Scales for Clefts have sufficient reliability and validity for use in studies of severity of facial impairment.

Comparison of rapid versus slow tissue expansion on skin-flap viability.

The effect of rapid versus slow tissue expansion on random-pattern skin-flap survival lengths was evaluated in two groups of pigs. Each group (group 1--slow; group 2--rapid) was further evaluated for the effect that delay (A), delay plus expansion (B), expansion only (C), and acute flap elevation (D) had on flap length viability. Intergroup and intragroup comparisons were made. In the slowly expanded group, significantly greater flap length viabilities were demonstrated in the slow expansion flaps as compared with the delay plus expander flaps and the delayed flaps, respectively. In the rapidly expanded group, the flap length viabilities of flaps C, B, and A were statistically equal. However, the flap length viability of the rapidly expanded flaps was statistically equal to that of the slowly expanded flaps (C1 = C2). The effect tissue expansion has on improving flap length viability as compared with the delay phenomenon may be related to the combination of a delay effect plus increased nutrient flow density that slow expansion produces. This combined metabolic enhancement is preserved with rapid tissue expansion.

Clefting and psychosocial adjustment. Influence of facial aesthetics.

This article briefly reviewed the research literature on the psychosocial correlates of facial clefts and described a program of research to study the relationship between severity of cleft impairment and psychosocial adjustment. In the past 40 years, there has been increasing recognition and research literature on the psychologic implications of facial clefts to patients and their families. Advances in both the knowledge base and the science of the psychologic correlates of facial clefts have been made. Children with clefts are not at greater risk for psychopathology than are individuals without clefts; however, they are at significant risk for social competence problems relating to development of friendships, progress in school, and participation in organizations. Problems with social competence have a negative effect on development. The ability of all children to make friends and to be liked by others is considered by most parents, teachers, and child development specialists to be a major developmental milestone. Not having friends and social withdrawal can cause parents or teachers to refer noncleft children to mental health professionals and is a predictor of impaired adult social competence and mental health. Studies of adults with clefts are consistent with studies of adults without clefts. Adults with repaired clefts are less likely to marry than are their noncleft siblings, and they have more problems with social withdrawal. Because facial attractiveness is well-known to affect peer acceptance, we hypothesized that the severity of the cleft deformity may have a significant impact on social competence. Consequently, we undertook a program of research to examine this question.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital nonprogressive myopathy with Möbius and Robin sequence--the Carey-Fineman-Ziter syndrome: a confirmatory report.

Recently, we evaluated a 27-month-old boy with congenital generalized nonspecific myopathy, Möbius sequence, Robin sequence, and failure to thrive. We think the child has the same entity described by Carey, Fineman, and Ziter in 1982 [J Pediatr 101:353-364] and as such represents only the third example of this unusual syndrome. Review of the large number of conditions in which the Robin sequence occurs supports heterogeneity. Our case strengthens the Möbius-Robin association and further defines the Carey-Fineman-Ziter syndrome as a viable entity. It is most likely inherited as an autosomal recessive trait.

Combined effects of severity of cleft impairment and facial attractiveness on social perception: an experimental study.

Children and adolescents provided their impressions of stimulus faces that systematically varied in attractiveness and severity of cleft impairment. The results indicated that facial attractiveness is a consistent characteristic of cleft-impaired faces. However, facial attractiveness did not moderate the negative impact of cleft impairment on social perception. Reduced severity of impairment did moderate the negativity of social perception. The implications of these findings for our understanding of the effects of cleft impairment on social perceptions are discussed.

The effect of instruction on burn prevention in eighth-grade students in preparation for babysitting.

New parents quickly discover that the greatest resource for child care at the least cost are teenage babysitters. These sitters assume the responsibility for burn prevention of young children. This study tested the effect of a burn prevention presentation on pre- and posttest scores of eighth-grade students (N = 119) from five sections of a science class. Students were between the ages of 12 and 14 years and 99 of them (83.2%) were babysitters. Multiple analysis of variance was calculated, and differences were seen between information regarding burns from hot bath water, cigarette lighters, and baby bottles that were heated in microwave ovens; however, the differences were not significant. This study concluded that eighth-grade students learned burn prevention before they entered the eighth grade but that there is a need to update these babysitters on burn prevention and new hazards such as cigarette lighters and microwave ovens.

Dosage compensation of the copia retrotransposon in Drosophila melanogaster.

Dosage compensation in Drosophila has been studied at the steady state RNA level for several single-copy genes; however, an important point is addressed by analyzing a repetitive, transposable element for dosage compensation. The two issues of gene-specific cis control and genomic position can be studied by determining the extent of dosage compensation of a transposable element at different chromosomal locations. To determine whether the multicopy copia transposable element can dosage compensate, we used the X-linked white-apricot (wa) mutation in which a copia element is present. The extent of dosage compensation was determined for the white and copia promoters in larvae and adults in two different genomic locations of the wa allele. We conclude that copia is able to dosage compensate, and that the white promoter and the copia promoter are not coordinate in their dosage compensation abilities when assayed under these various conditions. Thus, two transcriptional units, one within the other, both of which are able to dosage compensate, do so differently in response to developmental stage and genomic position.

Development of scales of severity of facial cleft impairment.

The reliability and validity of human judgments in rating the severity of cleft-related facial impairment were examined in this series of studies. The goal of the research was to develop scales for rating the severity of facial cleft impairment using psychophysical methods for measuring human judgment. The principle findings were: (1) Four photographic categorized scales with high inter-group reliability and satisfactory content and construct validity were developed; (2) Raters used objective stimulus characteristics of the face to scale impairment; (3) Ratings of facial attractiveness decreased as the severity of impairment increases; (4) Full face ratings of the severity of impairment correlated highly with ratings of the same photographs cropped below the eyes. The implications of these findings for clinical and research application are discussed.