Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats.

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development's (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security.

Does the Use of Psychotropic Medication Adversely Affect the Outcomes of Hip Arthroscopy?

BACKGROUND: Over the past decade, the use of psychotropic medications (PTMs) in the United States has doubled, and currently 20% of adults are taking 1 or more of these antidepressant, antianxiety, antipsychotic, or mood-altering medications. To date, however, the incidence of PTM use in patients undergoing hip arthroscopy and the results of hip arthroscopy in these patients have not been reported. PURPOSE: To determine the prevalence of PTM use in patients undergoing hip arthroscopy and to compare the outcomes of patients taking PTMs versus those of patients not taking PTMs. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Medical records of 880 consecutive patients who underwent hip arthroscopy performed by the senior author were reviewed and data were collected, including the number and types of PTMs that these patients were taking at the time of their hip arthroscopy. All hips were assessed with the Byrd modified Harris Hip Score (mHHS) preoperatively; 709 patients (81%) had scores obtained at 12 months and 669 patients (76%) at 24 months after surgery. Demographic data and mHHS of patients taking psychotropic medications (PTM group) were compared with those of patients not taking PTMs (NPTM group). RESULTS: Four hundred twenty-two (48%) of the 880 patients studied were taking PTMs at the time of their hip arthroscopy; significant differences between the PTM and NPTM groups were average age (48 vs 35 years, respectively), and the high percentage of females (53%) and low percentage of males (38%) in the PTM group. Preoperative scores for the PTM and NPTM groups were similar (41 vs 42 points, respectively), but postoperative scores of the PTM group were significantly lower at 6 months (72 vs 89 points), 12 months (77 vs 91 points), and 24 months (79 vs 88 points) after surgery ( P = .01). In contrast, the scores of the subgroups of PTM and NPTM adolescents obtained at 3 months (92.5 vs 88.9 points), 6 months (92.1 vs 90.3 points), 12 months (89.5 vs 92.1 points), and 24 months (90.3 vs 90.1 points) after surgery did not significantly differ. CONCLUSION: The incidence of PTM use in this series of patients with hip arthroscopy was triple that reported for US adults (48% vs 17%, respectively) and adolescents (23% vs 6.3%), and the PTM group had significantly lower 12- and 24-month mHHS results than the NPTM group. These results suggest that (1) patients undergoing hip arthroscopy who are taking PTMs are at significantly higher risk for poor outcomes and (2) their use of PTMs should be identified and addressed before proceeding with hip arthroscopy.

Hospital-based enhanced surveillance for West Nile virus neuroinvasive disease.

Accurate data on the incidence of West Nile virus (WNV) disease are important for directing public health education and control activities. The objective of this project was to assess the underdiagnosis of WNV neuroinvasive disease through laboratory testing of patients with suspected viral meningitis or encephalitis at selected hospitals serving WNV-endemic regions in three states. Of the 279 patients with cerebrospinal fluid (CSF) specimens tested for WNV immunoglobulin M (IgM) antibodies, 258 (92%) were negative, 19 (7%) were positive, and two (1%) had equivocal results. Overall, 63% (12/19) of patients with WNV IgM-positive CSF had WNV IgM testing ordered by their attending physician. Seven (37%) cases would not have been identified as probable WNV infections without the further testing conducted through this project. These findings indicate that over a third of WNV infections in patients with clinically compatible neurological illness might be undiagnosed due to either lack of testing or inappropriate testing, leading to substantial underestimates of WNV neuroinvasive disease burden. Efforts should be made to educate healthcare providers and laboratorians about the local epidemiology of arboviral diseases and the optimal tests to be used in different clinical situations.

Cervical spinal cord injury after thoracic spinal instrumentation: a case series.

STUDY DESIGN: Retrospective case report of 2 cases. OBJECTIVE: To describe 2 cases of cervical spinal cord injury/vascular insult after posterior instrumentation of thoracic/thoracolumbar scoliosis. SUMMARY OF BACKGROUND DATA: Spinal cord injury is an uncommon but well-documented complication associated with spinal deformity surgery. The midthoracic spinal cord is most vulnerable to these presumed vascular insults. Injuries above the level of instrumentation are rare. METHODS: In this report, we review the clinical histories of 2 adolescent females undergoing posterior spinal fusion with subsequent cervical spinal cord injuries. RESULTS: In both cases, intraoperative cervical alignment appeared neutral and all hardware appeared appropriately positioned. Spinal cord monitoring demonstrated changes in 1 patient but not in the other. With time, both patients improved clinically. CONCLUSION: Cervical spinal cord injuries may occur after distal deformity correction.

Completeness of West Nile virus testing in patients with meningitis and encephalitis during an outbreak in Arizona, USA.

Accurate data on West Nile virus (WNV) cases help guide public health education and control activities, and impact regional WNV blood product screening procedures. During an outbreak of WNV disease in Arizona, records from patients with meningitis or encephalitis were reviewed to determine the proportion tested for WNV. Of 60 patients identified with meningitis or encephalitis, 24 (40%) were tested for WNV. Only 12 (28%) of 43 patients aged <50 years were tested for WNV compared to 12 (71%) of 17 patients aged ≥50 years (P<0·01). Patients with clinical signs of weakness or paralysis, elevated CSF protein, admitted to an inpatient facility, or discharged to a rehabilitation facility were also more likely to have WNV testing performed. The lack of testing in younger age groups and in those with less severe disease probably resulted in substantial underestimates of WNV neuroinvasive disease burden.

Exocytosis precedes and predicts the increase in growth in oscillating pollen tubes.

We examined exocytosis during oscillatory growth in lily (Lilium formosanum and Lilium longiflorum) and tobacco (Nicotiana tabacum) pollen tubes using three markers: (1) changes in cell wall thickness by Nomarski differential interference contrast (DIC), (2) changes in apical cell wall fluorescence in cells stained with propidium iodide (PI), and (3) changes in apical wall fluorescence in cells expressing tobacco pectin methyl esterase fused to green fluorescent protein (PME-GFP). Using PI fluorescence, we quantified oscillatory changes in the amount of wall material from both lily and tobacco pollen tubes. Measurement of wall thickness by DIC was only possible with lily due to limitations of microscope resolution. PME-GFP, a direct marker for exocytosis, only provides information in tobacco because its expression in lily causes growth inhibition and cell death. We show that exocytosis in pollen tubes oscillates and leads the increase in growth rate; the mean phase difference between exocytosis and growth is -98 degrees +/- 3 degrees in lily and -124 degrees +/- 4 degrees in tobacco. Statistical analyses reveal that the anticipatory increase in wall material predicts, to a high degree, the rate and extent of the subsequent growth surge. Exocytosis emerges as a prime candidate for the initiation and regulation of oscillatory pollen tube growth.

NAD(P)H oscillates in pollen tubes and is correlated with tip growth.

The location and changes in NAD(P)H have been monitored during oscillatory growth in pollen tubes of lily (Lilium formosanum) using the endogenous fluorescence of the reduced coenzyme (excitation, 360 nm; emission, >400 nm). The strongest signal resides 20 to 40 microm behind the apex where mitochondria (stained with Mitotracker Green) accumulate. Measurements at 3-s intervals reveal that NAD(P)H-dependent fluorescence oscillates during oscillatory growth. Cross-correlation analysis indicates that the peaks follow growth maxima by 7 to 11 s or 77 degrees to 116 degrees, whereas the troughs anticipate growth maxima by 5 to 10 s or 54 degrees to 107 degrees. We have focused on the troughs because they anticipate growth and are as strongly correlated with growth as the peaks. Analysis of the signal in 10-microm increments along the length of the tube indicates that the troughs are most advanced in the extreme apex. However, this signal moves basipetally as a wave, being in phase with growth rate oscillations at 50 to 60 microm from the apex. We suggest that the changes in fluorescence are due to an oscillation between the reduced (peaks) and oxidized (troughs) states of the coenzyme and that an increase in the oxidized state [NAD(P)(+)] may be coupled to the synthesis of ATP. We also show that diphenyleneiodonium, an inhibitor of NAD(P)H dehydrogenases, causes an increase in fluorescence and a decrease in tube growth. Finally, staining with 5-(and-6)-chloromethyl-2',7'-dichlorohydrofluorescein acetate indicates that reactive oxygen species are most abundant in the region where mitochondria accumulate and where NAD(P)H fluorescence is maximal.

Profilin inhibits pollen tube growth through actin-binding, but not poly-L-proline-binding.

Previously, we have shown that excess profilin inhibits pollen tube growth at significantly lower concentrations than it blocks cytoplasmic streaming. To elucidate the mechanism by which profilin achieves this function, we have employed mutant profilins from Schizosaccharomyces pombe [J. Lu and T.D. Pollard (2001) Mol Biol Cell 12:1161-1175], which have defects in actin-binding, ability to inhibit polymerization, and poly- l-proline (PLP)-binding. Using Lilium longiflorum L. pollen and S. pombe profilins as wild-type (wt) standards, mutant profilins have been injected into pollen tubes of Lilium, and examined for their effects on growth rate and cell morphology. Our results show that mutant Y5D (68% actin-binding; 1.1% PLP-binding) is indistinguishable from wt-standard profilins. However mutant K81F (2.7% actin-binding; 77% PLP-binding) and especially mutant K67E (<1% actin-binding; 100% PLP-binding) are significantly less effective than wt-standard profilins in their ability to inhibit pollen tube growth. PLP also inhibits pollen tube growth. However, PLP is not different from K67E/PLP combined, which has no actin-binding, suggesting that PLP does not function by binding to profilin. In addition, there are differences in the morphology and F-actin organization in cells injected with PLP versus wt-profilin. Whereas wt-profilin causes a fragmentation and marked reduction in the amount of F-actin [L. Vidali et al. (2001) Mol Biol Cell 12:2534-2545], PLP generates an extensive disorganization without any apparent reduction in the amount of F-actin. We conclude that along with actin-binding activity of profilin, PLP-containing proteins also participate in the growth control process, and can do so independently of binding to profilin.

Effect of aging on horizontal smooth pursuit.

Quantitative infrared oculographic study of horizontal pursuit in young and elderly normal subjects showed significantly lower smooth pursuit velocities in the elderly when tracking triangular waveform targets of 20 degrees amplitude at velocities of 10 degrees/sec and over. Latencies for initiation of smooth eye movements were significantly prolonged in older subjects. The reduced velocity responses of the pursuit system indicate that the diagnosis of abnormal pursuit must be qualified by the age of the patient. Smooth pursuit is an age-dependent motor system.

The ocular tilt reaction. A paroxysmal dyskinesia associated with elliptical nystagmus.

The ocular tilt reaction, a synkinesis of ocular torsion, skew deviation, and head tilting, was a paroxysmal disorder in a patient with multiple sclerosis. In this distinctive pattern of eye and head motion, the 12 o'clock corneal meridians of both eyes are rotated conjugately in the direction of the lower skewed eye and the head is inclined laterally in the same direction. Paroxysmal activation of brain stem otolithic vestibular projections is proposed responsible for the dyskinesia. Coincident attacks of vertical and horizontal low amplitude pendular oscillation of the eyes produced elliptical nystagmus. This ocular motor disorder was treated effectively with carbamazepine.