Controlling Legionella pneumophila growth in hot water systems by reducing dissolved oxygen levels.

Legionella pneumophila, the leading cause of Legionnaires' disease in the United States, is found in lakes, ponds, and streams but poses a health risk when it grows in building water systems. The growth of L. pneumophila in hot water systems of healthcare facilities poses a significant risk to patients, staff, and visitors. Hospitals and long-term care facilities account for 76% of reported Legionnaires' disease cases with mortality rates of 25%. Controlling L. pneumophila growth in hot water systems serving healthcare and hospitality buildings is currently achieved primarily by adding oxidizing chemical disinfectants. Chemical oxidants generate disinfection byproducts and can accelerate corrosion of premise plumbing materials and equipment. Alternative control methods that do not generate hazardous disinfection byproducts or accelerate corrosion are needed. L. pneumophila is an obligate aerobe that cannot sustain cellular respiration, amplify, or remain culturable when dissolved oxygen (DO) concentrations are too low (< 0.3 mg/L). An alternative method of controlling L. pneumophila growth by reducing DO levels in a hot water model system using a gas transfer membrane contactor was evaluated. A hot water model system was constructed and inoculated with L. pneumophila at DO concentrations above 0.5 mg/L. Once the model system was colonized, DO levels were incrementally reduced. Water samples were collected each week to evaluate the effect of reducing dissolved oxygen levels when all other conditions favored Legionella amplification. At DO concentrations below 0.3 mg/L, L. pneumophila concentrations were reduced by 1-log over 7 days. Under conditions in the hot water model system, at favorable temperatures and with no residual chlorine disinfectant, L. pneumophila concentrations were reduced by 1-log, indicating growth inhibition by reducing DO levels as the sole control measure. In sections of the model system where DO levels were not lowered L. pneumophila continued to grow. Reducing dissolved oxygen levels in hot water systems of healthcare and other large buildings to control L. pneumophila could also lower the risk of supplemental chemical treatment methods currently in use.

[Innovative 3D imaging]. / Innovative 3D-Bildgebung.

Intraoperative 2D fluoroscopy is often performed for repositioning and implant control. However, this does not always provide the details needed to reliably detect joint steps or incorrect repositioning. Over the last few years, intraoperative 3D imaging has been established and further developed. Multiple studies demonstrate an advantage and better intraoperative control through 3D imaging. Examples are the upper ankle, the proximal tibia and the distal radius; the rates of intraoperative revisions with digital volume tomography (DVT) are between 20-30%. Technical advancements, such as metal artifact reductions, automated plane setting, automated screw detection, and robotic DVT devices, facilitate intraoperative operation, shorten surgical time, and provide improved image quality. By processing the data sets in the form of an immersive, computer-simulated image in terms of "augmented reality" (AR), increased precision can be achieved intraoperatively while reducing radiation exposure. The implementation of these systems is associated with costs, which are offset by cost savings from avoided revisions. Adequate counter-financing is still lacking at the present time. Intraoperative 3D imaging represents an important tool for intraoperative control. The current data situation makes it necessary to address the routine use of 3D procedures, especially in the joint area. The indications are becoming increasingly broader. Technical innovations such as robotics and AR have significantly improved 3D devices in recent years and offer high potential for integration into the OR.

California sea lions interfere with striped marlin hunting behaviour in multi-species predator aggregations.

The open ocean offers a suite of ecological conditions promoting the occurrence of multi-species predator aggregations. These mixed predator aggregations typically hunt large groups of relatively small and highly cohesive prey. However, the mechanisms and functions of these mixed predator aggregations are largely unknown. Even basic knowledge of whether the predator species' interactions are mutualistic, commensal or parasitic is typically missing. Moreover, recordings of attack and capture rates of marine multi-species predator aggregations, which are critical in understanding how and why these interactions have evolved, are almost completely non-existent owing to logistical challenges. Using underwater video, we quantified the attack and capture rates of two high-trophic level marine predators, California sea lions (Zalophus californianus) and striped marlin (Kajikia audax) attacking schools of fishes in the Southern California Current System, offshore the Baja California Peninsula. Recording over 5000 individual attacks across 13 fish schools, which varied in species, size and predator composition, we found that sea lions kleptoparasitized striped marlin hunts and reduced the frequency of marlin attacks and captures via interference competition. We discuss our results in the context of the phenotypic differences between the predator species and implications for a better understanding of multi-species predator aggregations. This article is part of the theme issue 'Mixed-species groups and aggregations: shaping ecological and behavioural patterns and processes'.

Bisphenols, but not phthalate esters, modulate gene expression in activated human MAIT cells in vitro.

One route of human exposure to environmental chemicals is oral uptake. This is primarily true for chemicals that may leach from food packaging materials, such as bisphenols and phthalate esters. Upon ingestion, these compounds are transported along the intestinal tract, from where they can be taken up into the blood stream or distributed to mucosal sites. At mucosal sites, mucosal immune cells and in the blood stream peripheral immune cells may be exposed to these chemicals potentially modulating immune cell functions. In the present study, we investigated the impact of three common bisphenols and two phthalate esters on mucosal-associated invariant T (MAIT) cells in vitro, a frequent immune cell type in the intestinal mucosae and peripheral blood of humans. All compounds were non-cytotoxic at the chosen concentrations. MAIT cell activation was only slightly affected as seen by flow cytometric analysis. Phthalate esters did not affect MAIT cell gene expression, while bisphenol-exposure induced significant changes. Transcriptional changes occurred in ∼ 25 % of genes for BPA, ∼ 22 % for BPF and ∼ 8 % for BPS. All bisphenols down-modulated expression of CCND2, CCL20, GZMB and IRF4, indicating an effect on MAIT cell effector function. Further, BPA and BPF showed a high overlap in modulated genes involved in cellular stress response, activation signaling and effector function suggesting that BPF may not be safe substitute for BPA.

[Distortion of the cervical spine : Pathophysiology, diagnostics, treatment and assessment]. / Distorsion der Halswirbelsäule : Pathophysiologie, Diagnostik, Therapie und Begutachtung.

Distortion or whiplash trauma of the cervical spine is an injury pattern associated with motor vehicle collisions and typically occurs after rear impact collisions, but is not limited to this type of collision and accident. The vast majority of these injuries are low-grade injuries according to the Quebec Task Force (QTF) classification, whereby no objective morphological correlates can be determined in clinical and radiological examinations. The prognosis is predominantly favorable and the condition is self-limiting; however, care must be taken with respect to complex courses with chronic pain and the manifestation of neuropsychiatric complaints. Due to the mechanism of the accident this injury pattern is particularly frequent in accidents associated with third party liability insurance claims. The discrepancy between subjective complaints and the presence of objective findings is a particular challenge for the assessment by the medical expert.

Mechanisms of prey division in striped marlin, a marine group hunting predator.

Many terrestrial group-hunters cooperate to kill prey but then compete for their share with dominance being a strong predictor of prey division. In contrast, little is known about prey division in group-hunting marine predators that predominately attack small, evasive prey (e.g. fish schools). We identified individual striped marlin (Kajikia audax) hunting in groups. Groups surrounded prey but individuals took turns attacking. We found that competition for prey access led to an unequal division of prey among the predators, with 50% of the most frequently attacking marlin capturing 70-80% of the fish. Neither aggression, body size nor variation in hunting efficiency explained this skewed prey division. We did find that newly arrived groups of marlin gained on average more access to the prey. This raises the possibility that newly arrived marlin were hungrier and more motivated to feed. However, this result does not necessarily explain the unequal prey division among the predators because the skew in prey captures was found at the level of these groups. Dynamic prey division is probably widespread but under-reported in marine group-hunters and the inability of individuals to monopolize prey until satiation likely reduces the importance of social hierarchies for prey division.

MAIT cell activation is reduced by direct and microbiota-mediated exposure to bisphenols.

Oral uptake is the primary route of human bisphenol exposure, resulting in an exposure of the intestinal microbiota and intestine-associated immune cells. Therefore, we compared the impact of bisphenol A (BPA), bisphenol F (BPF) and bisphenol S (BPS) on (i) intestinal microbiota, (ii) microbiota-mediated immunomodulatory effects and (iii) direct effects on mucosal-associated invariant T (MAIT) cells in vitro. We acutely exposed human fecal microbiota, Bacteroides thetaiotaomicron and Escherichia coli to BPA and its analogues BPF and BPS referring to the European tolerable daily intake (TDI), i.e. 2.3 µg/mL, 28.3 µg/mL and 354.0 µg/mL. Growth and viability of E. coli was most susceptible to BPF, whereas B.thetaiotaomicron and fecal microbiota were affected by BPA > BPF > BPS. At 354.0 µg/mL bisphenols altered microbial diversity in compound-specific manner and modulated microbial metabolism, with BPA already acting on metabolism at 28.3 µg/mL. Microbiota-mediated effects on MAIT cells were observed for the individual bacteria at 354.0 µg/mL only. However, BPA and BPF directly modulated MAIT cell responses at low concentrations, whereby bisphenols at concentrations equivalent for the current TDI had no modulatory effects for microbiota or for MAIT cells. Our findings indicate that acute bisphenol exposure may alter microbial metabolism and impact directly on immune cells.

An elastic net penalized small area model combining unit- and area-level data for regional hypertension prevalence estimation.

Hypertension is a highly prevalent cardiovascular disease. It marks a considerable cost factor to many national health systems. Despite its prevalence, regional disease distributions are often unknown and must be estimated from survey data. However, health surveys frequently lack in regional observations due to limited resources. Obtained prevalence estimates suffer from unacceptably large sampling variances and are not reliable. Small area estimation solves this problem by linking auxiliary data from multiple regions in suitable regression models. Typically, either unit- or area-level observations are considered for this purpose. But with respect to hypertension, both levels should be used. Hypertension has characteristic comorbidities and is strongly related to lifestyle features, which are unit-level information. It is also correlated with socioeconomic indicators that are usually measured on the area-level. But the level combination is challenging as it requires multi-level model parameter estimation from small samples. We use a multi-level small area model with level-specific penalization to overcome this issue. Model parameter estimation is performed via stochastic coordinate gradient descent. A jackknife estimator of the mean squared error is presented. The methodology is applied to combine health survey data and administrative records to estimate regional hypertension prevalence in Germany.

'TB or not TB': the conundrum of pre-European contact tuberculosis in the Pacific.

Tuberculosis (TB) is a major global health threat, infecting one-third of the world's population. Despite this prominence, the age, origin and spread of the disease have been topics of contentious debate. Molecular studies suggest that Mycobacterium tuberculosis 'sensu stricto', the most common strain of TB infecting humans today, originated in Africa and from there spread into Europe and Asia. The M. tuberculosis strains most commonly found across the Pacific and the Americas today are most closely related to European strains, supporting a hypothesis that the disease only reached these regions relatively recently via European sailors or settlers. However, this hypothesis is inconsistent with palaeopathological evidence of TB-like lesions in human remains from across the Pacific that predate European contact. Similarly, genetic evidence from pre-European South American mummies challenges the notion of a European introduction of the disease into the Pacific. Here, we review the complex evidence for the age and origin of TB in the Pacific, and discuss key gaps in our knowledge and how these may be addressed. This article is part of the theme issue 'Insights into health and disease from ancient biomolecules'.

Oil gland and oil pores in billfishes: in search of a function.

Billfishes are well known for their distinctive elongated rostra, i.e. bills. The functional significance of billfish rostra has been frequently discussed and the recent discovery of an oil gland (glandula oleofera) at the base of the rostrum in swordfish, Xiphias gladius, has added an interesting facet to this discussion regarding the potential co-evolution of gland and rostra. Here, we investigated the oil gland and oil pores (through which the oil is brought to the skin surface) of four billfish species - swordfish, Atlantic blue marlin (Makaira nigricans), Indo-Pacific sailfish (Istiophorus platypterus) and striped marlin (Kajikia audax) - and provide detailed evidence for the presence of an oil gland in the last three. All four species had a high density of oil pores on the forehead which is consistent with the hypothesis of hydrodynamic benefits of the oil. The extension of the pores onto the front half of the rostrum in sailfish and striped marlin, but not in swordfish or blue marlin, suggests that the oil may have additional functions. One such function could be linked to the antibacterial and anti-inflammatory properties of the oil. However, the available evidence on predatory rostrum use (and hence the likelihood of tissue damage) is only partly consistent with the extension of pores on rostra across species. We conclude that the oil gland probably serves multiple, non-mutually exclusive functions. More detailed information on rostrum use in blue marlin and swordfish is needed to better link behavioural and morphological data with the aim of accomplishing a full comparative analysis.

100 Ma sweat bee nests: Early and rapid co-diversification of crown bees and flowering plants.

100 Ma sweat bee nests reported herein are the oldest evidence of crown bees. A new phylogeny for short-tongued bees, calibrated with these nests dated with 40Ar/39Ar, attests for the first time for a late Albian rapid diversification of bees along with angiosperms. Such hypothesis lacked paleontological support until this study. The new ichnospecies Cellicalichnus krausei, which was found along with wasp trace fossils and new beetle trace fossils in the Castillo Formation of Patagonia, represents typical Halictini nests composed of sessile cells that are attached to main tunnels. According to geological, paleosol, paleobotanical, and ichnological data, bees, and angiosperms cohabited in an inland and dry environment comparable to an open dry woodland or savanna, under warm-temperate and semiarid-subhumid climate, in the Southern Hemisphere by the Albian.

Linking hunting weaponry to attack strategies in sailfish and striped marlin.

Linking morphological differences in foraging adaptations to prey choice and feeding strategies has provided major evolutionary insights across taxa. Here, we combine behavioural and morphological approaches to explore and compare the role of the rostrum (bill) and micro-teeth in the feeding behaviour of sailfish (Istiophorus platypterus) and striped marlin (Kajikia audax) when attacking schooling sardine prey. Behavioural results from high-speed videos showed that sailfish and striped marlin both regularly made rostrum contact with prey but displayed distinct strategies. Marlin used high-speed dashes, breaking schools apart, often contacting prey incidentally or tapping at isolated prey with their rostra; while sailfish used their rostra more frequently and tended to use a slower, less disruptive approach with more horizontal rostral slashes on cohesive prey schools. Capture success per attack was similar between species, but striped marlin had higher capture rates per minute. The rostra of both species are covered with micro-teeth, and micro-CT imaging showed that species did not differ in average micro-tooth length, but sailfish had a higher density of micro-teeth on the dorsal and ventral sides of their rostra and a higher amount of micro-teeth regrowth, suggesting a greater amount of rostrum use is associated with more investment in micro-teeth. Our analysis shows that the rostra of billfish are used in distinct ways and we discuss our results in the broader context of relationships between morphological and behavioural feeding adaptations across species.

Updated European Consensus Statement on diagnosis and treatment of adult ADHD.

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.

Are Tidal Salt Marshes Exposed to Nutrient Pollution more Vulnerable to Sea Level Rise?

Over the past four decades, Long Island, NY, USA, has lost coastal wetlands at a rate of 4% per decade due to submergence. In this study, we examined relationships between the rate of tidal salt marsh loss and environmental factors, including marsh elevation, tidal range, and wastewater exposure through analysis of stable isotope ratios of marsh soils and biota. Our goal was to identify factors that increase vulnerability of marshes to sea level rise, with a specific emphasis on the potential role of poor water quality in hastening marsh loss. Our results suggest that wastewater exposure may accelerate loss of intertidal marsh, but does not negatively impact high tidal marsh resilience to sea level rise. And while marsh elevation and tidal range were statistically significant predictors of marsh loss, they similarly displayed opposite relationships among marsh zones. This study suggests that different functional zones of coastal salt marshes may not respond similarly to global change factors, and that elevation may be an important factor mediating eutrophication effects to coastal salt marshes.

How to detect high-performing individuals and groups: Decision similarity predicts accuracy.

Distinguishing between high- and low-performing individuals and groups is of prime importance in a wide range of high-stakes contexts. While this is straightforward when accurate records of past performance exist, these records are unavailable in most real-world contexts. Focusing on the class of binary decision problems, we use a combined theoretical and empirical approach to develop and test a approach to this important problem. First, we use a general mathematical argument and numerical simulations to show that the similarity of an individual's decisions to others is a powerful predictor of that individual's decision accuracy. Second, testing this prediction with several large datasets on breast and skin cancer diagnostics, geopolitical forecasting, and a general knowledge task, we find that decision similarity robustly permits the identification of high-performing individuals and groups. Our findings offer a simple, yet broadly applicable, heuristic for improving real-world decision-making systems.

Artificial Light at Night Affects Emergence from a Refuge and Space Use in Guppies.

Artificial light at night (ALAN) is a major form of anthropogenic pollution. ALAN is well known to affect different behaviours during nighttime, when changes in light conditions often have immediate consequences for the trade-offs individuals experience. How ALAN affects daytime behaviours, however, has received far less attention. Here we studied how ALAN affected daytime personality traits and learning ability. We exposed Trinidadian guppies, Poecilia reticulata, for 10 weeks to different ALAN levels: bright light (24 hrs bright light, ~5,000 lx), dim light (12 hrs bright light; 12 hrs dim light, ~0.5 lx) and control (12 hrs bright light; 12 hrs dark). Afterwards, we tested how the treatments affected diurnal emergence from a refuge, space use, activity, sociability and the ability to memorize the location of companion fish. Individuals exposed to the light treatments (both dim and bright light) emerged quicker from a refuge and fish from the bright light treatment spent relatively more time in the open area of the arena. ALAN did not affect any of the other behaviours, although memory could not be tested since fish did not learn the companions' location. Our results demonstrate that ALAN, next to affecting nocturnal behaviours, can also affect key diurnal behavioural processes, associated with risk-taking.

Generating Rasch-based activity of daily living measures from the Spinal Cord Injury Longitudinal Aging Study.

STUDY DESIGN: Retrospective Longitudinal Study. OBJECTIVES: (1) To determine whether the Spinal Cord Injury Activities of Daily Living (SCI_ADL) measure shows adequate item-level and precision psychometrics; (2) to investigate whether the SCI_ADL measure effectively detects ADL changes across time; (3) to describe self-care task(s) participants can and cannot do across time. SETTING: Two Midwestern hospitals and 1 Southeastern specialty hospital in 1993. METHODS: All participants were adults with traumatic SCI of at least 1-year duration at enrollment. We used 20-year (1993-2013) retrospective longitudinal data and categorized participants into three injury levels: C1-C4 (cervical; n=50), C5-C8 (n=126) and T1-S5 (thoracic, lumbar and sacral; n=168). We first examined psychometrics of the SCI_ADL with factor and Rasch analyses; then we investigated longitudinal change of SCI_ADL scores at three time points over 20 years (1993, 2003 and 2013) using generalized linear mixed modeling and post hoc analyses. RESULTS: The SCI_ADL measure demonstrated unidimensionality, person strata of 2.9, high Cronbach's α (0.93) and fair person reliability (0.76). T1-S5 had the highest measures, following C5-C8 and C1-C4 at three time points (P<0.05). The C1-C4 and T1-S5 groups showed significant decreases from 2003 to 2013; however, none of the three groups showed significant differences from 1993 to 2003 (P<0.05). CONCLUSIONS: The SCI_ADL measure could detect longitudinal ADL changes of the population with SCI across time. The C1-C4 group decreased the most in ADLs, indicating higher need of long-term services and rehabilitation.

New primate locality from the early Miocene of Patagonia, Argentina.

OBJECTIVES: The purpose of this work is to present a new primate locality with evidence that increases the knowledge on the radiation of the extinct platyrrhine primates. MATERIALS AND METHODS: We studied the new specimen and compared it to specimens identified as Mazzonicebus almendrae. RESULTS: The new first and second molars were comparable to Mazzonicebus almendrae in all morphological details, allowing us to allocate the new specimen to M. almendrae and add comments on morphological variation in this species regarding the orientation of the labial cristae and development of the anterolingual cingulum. This new maxilla also present the first known M3 for the species. DISCUSSION: The new specimen increases our knowledge of the extinct platyrrhines from Patagonia. Their age and geographical distribution ranges from early to middle Miocene in an area between 40° to 47° of southern latitude.

Rasch measurement properties of the Pain Medication Questionnaire in persons with spinal cord injury.

STUDY DESIGN: Secondary analysis of cross-sectional population-based self-report data. OBJECTIVE: To determine how well the Pain Medication Questionnaire (PMQ) measures risk of pain medication misuse and its precision in separating individuals with spinal cord injury (SCI) into meaningful classification categories. SETTING: Academic medical center in Southeastern United States. METHODS: Data were collected from a population-based registry of SCI (n=971). Eligible participants included adults with traumatic SCI with residual effects who were at least 1 year post injury and 18 years of age and who had PMQ data in which they reported active use of pain medication at the time of the study (n=745). RESULTS: Most items (23/26) of the PMQ contributed to a single unidimensional construct. Rasch analysis results revealed that the rating scale, majority of persons (>93%), and majority of items (20/23) fit the Rasch measurement model. The PMQ demonstrated adequate reliability (person reliability =0.67) and separated persons into two strata-those likely to misuse pain medication and those with low liklihood of misusing pain medication. CONCLUSIONS: Findings offer a deeper understanding of the measurement properties of the PMQ as a precursor for widespread population-based studies to elucidate the incidence of pain medication misuse in persons with SCI. Results also have important research and clinical implications for commonly used PMQ total score cut-offs, which may misclassify an individual's risk of pain medication misuse.