Jamestown Canyon Virus in Collected Mosquitoes, Maine, United States, 2017-2019.

Jamestown Canyon virus (JCV) is a mosquito-borne arbovirus that circulates in North America. We detected JCV in 4 pools of mosquitoes collected from midcoastal Maine, USA, during 2017-2019. Phylogenetic analysis of a JCV sequence obtained from Aedes cantator mosquitoes clustered within clade A, which also circulates in Connecticut, USA.

Surge in Anaplasmosis Cases in Maine, USA, 2013-2017.

Incidence of human granulocytic anaplasmosis is rising in Maine, USA. This increase may be explained in part by adoption of tick panels as a frequent diagnostic test in persons with febrile illness and in part by range expansion of Ixodes scapularis ticks and zoonotic amplification of Anaplasma phagocytophilum.

Seroprevalence of Borrelia burgdorferi, B. miyamotoi, and Powassan Virus in Residents Bitten by Ixodes Ticks, Maine, USA.

We conducted a serosurvey of 230 persons in Maine, USA, who had been bitten by Ixodes scapularis or I. cookei ticks. We documented seropositivity for Borrelia burgdorferi (13.9%) and B. miyamotoi (2.6%), as well as a single equivocal result (0.4%) for Powassan encephalitis virus.

Fatal Deer Tick Virus Infection in Maine.

Deer tick virus (DTV), a genetic variant (lineage II) of Powassan virus, is a rare cause of encephalitis in North America. We report a fatal case of DTV encephalitis following a documented bite from an Ixodes scapularis tick and the erythema migrans rash associated with Lyme disease.

Update on the Distribution of Aedes japonicus in Maine, 2001-15.

The first confirmed collection of Aedes japonicus in Maine was in Cumberland County in 2001. Since that initial collection, it has been found in 7 of Maine's 16 counties between 2001 and 2015. These collections include the northernmost collection of Ae. japonicus in the eastern USA, from Madawaska in Aroostook County. Though mosquito surveillance is limited in the state, it is evident that Ae. japonicus is more widely distributed in Maine than previously believed although its role in arboviral transmission in the region is unknown.

Human babesiosis, Maine, USA, 1995-2011.

We observed an increase in the ratio of pathogenic Babesia microti to B. odocoilei in adult Ixodes scapularis ticks in Maine. Risk for babesiosis was associated with adult tick abundance, Borrelia burgdorferi infection prevalence, and Lyme disease incidence. Our findings may help track risk and increase the focus on blood supply screening.

Partial trailside Japanese barberry (Ranunculales: Berberidaceae) removal did not reduce the abundance of questing blacklegged ticks (Acari: Ixodidae).

In a nature reserve in southern Maine, we removed invasive Japanese barberry (Berberis thunbergii de Candolle) along sections of forested recreational trails that ran through dense barberry infestations. Barberry thickets provide questing substrate and a protective microclimate for blacklegged ticks (Ixodes scapularis Say), and trail users could brush up against encroaching barberry and acquire ticks. Trailside barberry removal will reduce or eliminate encroaching tick questing substrate and could reduce trailside questing tick abundance by creating a microclimate more hostile to ticks. The same-day cut-and-spray treatment comprised mechanical cutting of barberry clumps (individual plants with numerous ramets) followed immediately by targeted herbicide application to the resulting root crowns. The treatment created trail shoulders to a lateral width of 1-2 m on both sides of 100-m trail sections, with initial treatment in the fall of 2013 and one retreatment in the summer of 2014. Our aim was to remove 90% of barberry clumps to achieve a 50% or better reduction in questing tick abundance on trail shoulders. However, by the fall of 2015, there were only 41% fewer barberry clumps on treated vs. untreated trail sections and there was no reduction in either adults or nymphs. We concluded that our barberry treatment protocol was not sufficiently aggressive since the resulting ecotone habitat on trail shoulders proved suitable for questing I. scapularis. In principle, cutting back barberry along trails should reduce trail user contact with questing deer ticks, but we were unable to demonstrate a reduction in trailside tick abundance.

Effect of a botanical acaricide on Ixodes scapularis (Acari: Ixodidae) and nontarget arthropods.

We tested the effectiveness of the rosemary oil-based insecticide, Eco-Exempt IC2, to control all stages of Ixodes scapularis (Say) in southern Maine. We selected plots in oak-pine forest where I. scapularis is endemic and recorded the abundance of ticks and nontarget arthropods before and after applications of IC2, bifenthrin (a synthetic pyrethroid), and water (reference treatment). Licensed applicators applied high-pressure spray treatments during the summer nymphal and fall adult seasonal peaks. Both acaricides sprayed during the summer nymphal season reduced nymphal I. scapularis/hour to zero. IC2 was as effective as bifenthrin in controlling nymphs through the rest of the nymphal season and also controlled adult ticks 9 mo postspray compared with 16 mo for bifenthrin, and both acaricides reduced larvae through 14 mo postspray. Both acaricides sprayed during the fall adult season reduced adult I. scapularis/hour to zero; IC2 controlled adult ticks 6 mo postspray compared with 1 yr for bifenthrin. Both fall-applied acaricides controlled nymphs 9 mo postspray and reduced larvae up to 10 mo postspray. Impacts on some nontarget arthropods was assessed. Colleoptera, Hymenoptera, and Collembola declined 1 wk postspray in acaricide-treated plots, and in IC2 plots all numbers rebounded by 20 d postspray. For bees and other flower-visiting insects there were no detectable reductions in nests produced, number emerged from nests, or number of foraging visits to flowering plants in IC2 or bifenthrin plots. IC2 was phytotoxic to the leafy portions of select understory plants that appeared to recover by the next growing season.

Strategies of Predictive Schemes and Clinical Diagnosis for Prognosis Using MIMIC-III: A Systematic Review.

The prime purpose of the proposed study is to construct a novel predictive scheme for assisting in the prognosis of criticality using the MIMIC-III dataset. With the adoption of various analytics and advanced computing in the healthcare system, there is an increasing trend toward developing an effective prognostication mechanism. Predictive-based modeling is the best alternative to work in this direction. This paper discusses various scientific contributions using desk research methodology towards the Medical Information Mart for Intensive Care (MIMIC-III). This open-access dataset is meant to help predict patient trajectories for various purposes ranging from mortality forecasting to treatment planning. With a dominant machine learning approach in this perspective, there is a need to discover the effectiveness of existing predictive methods. The resultant outcome of this paper offers an inclusive discussion about various available predictive schemes and clinical diagnoses using MIMIC-III in order to contribute toward better information associated with its strengths and weaknesses. Therefore, the paper provides a clear visualization of existing schemes for clinical diagnosis using a systematic review approach.

Circulating antibody-secreting cells are a biomarker for early diagnosis in patients with Lyme disease.

BACKGROUND: Diagnostic immunoassays for Lyme disease have several limitations including: 1) not all patients seroconvert; 2) seroconversion occurs later than symptom onset; and 3) serum antibody levels remain elevated long after resolution of the infection. INTRODUCTION: MENSA (Medium Enriched for Newly Synthesized Antibodies) is a novel diagnostic fluid that contains antibodies produced in vitro by circulating antibody-secreting cells (ASC). It enables measurement of the active humoral immune response. METHODS: In this observational, case-control study, we developed the MicroB-plex Anti-C6/Anti-pepC10 Immunoassay to measure antibodies specific for the Borrelia burgdorferi peptide antigens C6 and pepC10 and validated it using a CDC serum sample collection. Then we examined serum and MENSA samples from 36 uninfected Control subjects and 12 Newly Diagnosed Lyme Disease Patients. RESULTS: Among the CDC samples, antibodies against C6 and/or pepC10 were detected in all seropositive Lyme patients (8/8), but not in sera from seronegative patients or healthy controls (0/24). Serum antibodies against C6 and pepC10 were detected in one of 36 uninfected control subjects (1/36); none were detected in the corresponding MENSA samples (0/36). In samples from newly diagnosed patients, serum antibodies identified 8/12 patients; MENSA antibodies also detected 8/12 patients. The two measures agreed on six positive individuals and differed on four others. In combination, the serum and MENSA tests identified 10/12 early Lyme patients. Typically, serum antibodies persisted 80 days or longer while MENSA antibodies declined to baseline within 40 days of successful treatment. DISCUSSION: MENSA-based immunoassays present a promising complement to serum immunoassays for diagnosis and tracking therapeutic success in Lyme infections.

Cerebrospinal fluid proteome of patients with acute Lyme disease.

During acute Lyme disease, bacteria can disseminate to the central nervous system (CNS), leading to the development of meningitis and other neurologic symptoms. Here we have analyzed pooled cerebrospinal fluid (CSF) allowing a deep view into the proteome for patients diagnosed with early disseminated Lyme disease and CSF inflammation. Additionally, we analyzed individual patient samples and quantified differences in protein abundance employing label-free quantitative mass spectrometry-based methods. We identified 108 proteins that differ significantly in abundance in patients with acute Lyme disease from controls. Comparison between infected patients and control subjects revealed differences in proteins in the CSF associated with cell death localized to brain synapses and others that likely originate from brain parenchyma.

Emergence of Ixodes scapularis (Acari: Ixodidae) in a Small Mammal Population in a Coastal Oak-Pine Forest, Maine, USA.

In the United States, surveillance has been key to tracking spatiotemporal emergence of blacklegged ticks [Ixodes scapularis Say (Ixodida:Ixodidae)] and their pathogens such as Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner (Spirochaetales: Spirochaetaceae), the agent of Lyme disease. On the Holt Research Forest in midcoastal Maine, collection of feeding ticks from live-trapped small mammal hosts allowed us to track the emergence and establishment of I. scapularis, 1989-2019. From 1989-1995, we collected only I. angustus Neumann (Ixodida: Ixodidae)(vole tick), Dermacentor variabilis Say (Ixodida: Ixodidae) (American dog tick), and I. marxi Banks (Ixodida: Ixodidae) (squirrel tick) from seven species of small mammals. The most abundant tick host was the white-footed mouse [Peromyscus leucopus Rafinesque (Rodentia:Cricetidae)] followed by the red-backed vole (Myodes gapperi Vigors (Rodentia: Cricetidae)). Emergence of I. scapularis was signaled via the appearance of subadult I. scapularis in 1996. Emergence of B. burgdorferi was signaled through its appearance in I. scapularis feeding on mice in 2005. There was a substantial increase in I. scapularis prevalence (proportion of hosts parasitized) and burdens (ticks/host) on white-footed mice and red-backed voles in 2007. The ~11-yr time-to-establishment for I. scapularis was consistent with that seen in other studies. White-footed mice comprised 65.9% of all captures and hosted 94.1% of the total I. scapularis burden. The white-footed mouse population fluctuated interannually, but did not trend up as did I. scapularis prevalence and burdens. There were concurrent declines in I. angustus and D. variabilis. We discuss these results in the broader context of regional I. scapularis range expansion.

Use of Cervid Serosurveys to Monitor Eastern Equine Encephalitis Virus Activity in Northern New England, United States, 2009-2017.

Vertebrate surveillance for eastern equine encephalitis virus (EEEV) activity usually focuses on three types of vertebrates: horses, passerine birds, and sentinel chicken flocks. However, there is a variety of wild vertebrates that are exposed to EEEV infections and can be used to track EEEV activity. In 2009, we initiated a pilot study in northern New England, United States, to evaluate the effectiveness of using wild cervids (free-ranging white-tailed deer and moose) as spatial sentinels for EEEV activity. In Maine, New Hampshire, and Vermont during 2009-2017, we collected blood samples from hunter-harvested cervids at tagging stations and obtained harvest location information from hunters. U.S. Centers for Disease Control and Prevention processed the samples for EEEV antibodies using plaque reduction neutralization tests (PRNTs). We detected EEEV antibodies in 6 to 17% of cervid samples in the different states and mapped cervid EEEV seropositivity in northern New England. EEEV antibody-positive cervids were the first detections of EEEV activity in the state of Vermont, in northern Maine, and northern New Hampshire. Our key result was the detection of the antibodies in areas far outside the extent of documented wild bird, mosquito, human case, or veterinary case reports of EEEV activity in Maine, New Hampshire, and Vermont. These findings showed that cervid (deer and moose) serosurveys can be used to characterize the geographic extent of EEEV activity, especially in areas with low EEEV activity or with little or no EEEV surveillance. Cervid EEEV serosurveys can be a useful tool for mapping EEEV activity in areas of North America in addition to northern New England.

Multitarget test for emerging Lyme disease and anaplasmosis in a serosurvey of dogs, Maine, USA.

To determine if the range of deer ticks in Maine had expanded, we conducted a multitarget serosurvey of domestic dogs (Canis lupus familiaris) in 2007. An extension of exposure to Borrelia burgdorferi to the northern border and local transmission of Anaplasma phagocytophilum throughout southern areas was found.

Real-Time Tracking of Human Neck Postures and Movements.

Improper neck postures and movements are the major causes of human neck-related musculoskeletal disorders. To monitor, quantify, analyze, and detect the movements, remote and non-invasive based methods are being developed for prevention and rehabilitation. The purpose of this research is to provide a digital platform for analyzing the impact of human neck movements on the neck musculoskeletal system. The secondary objective is to design a rehabilitation monitoring system that brings accountability in the treatment prescribed, which is shown in the use-case model. To record neck movements effectively, a Smart Neckband integrated with the Inertial Measurement Unit (IMU) was designed. The initial task was to find a suitable position to locate the sensors embedded in the Smart Neckband. IMU-based real-world kinematic data were captured from eight research subjects and were used to extract kinetic data from the OpenSim simulation platform. A Random Forest algorithm was trained using the kinetic data to predict the neck movements. The results obtained correlated with the novel idea proposed in this paper of using the hyoid muscles to accurately detect neck postures and movements. The innovative approach of integrating kinematic data and kinetic data for analyzing neck postures and movements has been successfully demonstrated through the efficient application in a rehabilitation use case with about 95% accuracy. This research study presents a robust digital platform for the integration of kinematic and kinetic data that has enabled the design of a context-aware neckband for the support in the treatment of neck musculoskeletal disorders.

Support for deer herd reduction on offshore Islands of Maine, U.S.A.

Over the past three decades, citizens of Maine in the northeastern United States have experienced increasing blacklegged tick (Ixodes scapularis) abundance and rising incidence of Lyme and other tick-borne diseases. White-tailed deer (Odocoileus virginianus) overabundance has been considered one cause of the high incidence of tick-borne diseases on offshore islands of New England. Most of Maine's 15 offshore, unbridged island communities have a history of concern about ticks, Lyme disease, and white-tailed deer overabundance, but have been challenged to keep deer numbers down through hunting or culls. This history has led to perennial, often divisive community debates about whether and how to reduce the size of their deer herds. In 2016 we conducted a convenience sample survey of year-round and summer residents of Maine's offshore islands to quantify the level of concern about Lyme disease, and assess the motivations and level of support for deer herd reduction. Among respondents, 84 % agreed Lyme disease was a problem on their island and 61 % supported deer herd reduction. Agreement that Lyme disease was a problem was associated with having acquired tick-borne disease as well as with tick bites without disease. Respondents ranked deer overabundance as a top cause of tick abundance and tick-borne disease and supported deer herd reduction as an approach to reduce the risk of Lyme disease. Other problems associated with deer overabundance (vehicle collisions, damage to landscaping, and damage to forests) also motivated support for deer reduction. Approval of doe permits, an expanded archery season, and sharpshooting as reduction methods was greater than an expanded firearms season. Respondents felt responsibility for tick control fell to the town for the most part, and recognized that multiple factors have contributed to the tick problem in Maine, not just deer.

A Generalized Additive Model Correlating Blacklegged Ticks With White-Tailed Deer Density, Temperature, and Humidity in Maine, USA, 1990-2013.

Geographical range expansions of blacklegged tick [Ixodes scapularis Say (Acari: Ixodidae)] populations over time in the United States have been attributed to a mosaic of factors including 20th century reforestation followed by suburbanization, burgeoning populations of the white-tailed deer [Odocoileus virginianus Zimmerman (Artiodactyla: Cervidae)], and, at the northern edge of I. scapularis' range, climate change. Maine, a high Lyme disease incidence state, has been experiencing warmer and shorter winter seasons, and relatively more so in its northern tier. Maine served as a case study to investigate the interacting impacts of deer and seasonal climatology on the spatial and temporal distribution of I. scapularis. A passive tick surveillance dataset indexed abundance of I. scapularis nymphs for the state, 1990-2013. With Maine's wildlife management districts as the spatial unit, we used a generalized additive model to assess linear and nonlinear relationships between I. scapularis nymph abundance and predictors. Nymph submission rate increased with increasing deer densities up to ~5 deer/km2 (13 deer/mi2), but beyond this threshold did not vary with deer density. This corroborated the idea of a saturating relationship between I. scapularis and deer density. Nymphs also were associated with warmer minimum winter temperatures, earlier degree-day accumulation, and higher relative humidity. However, nymph abundance only increased with warmer winters and degree-day accumulation where deer density exceeded ~2 deer/km2 (~6/mi2). Anticipated increases in I. scapularis in the northern tier could be partially mitigated through deer herd management.

Trial of a minimal-risk botanical compound to control the vector tick of Lyme disease.

We compared the application of IC2, a minimal-risk (25B) botanical compound containing 10% rosemary oil, with bifenthrin, a commonly used synthetic compound, and with water for the control of Ixodes scapularis Say (= Ixodes dammini Spielman, Clifford, Piesman & Corwin), on tick-infested grids in Maine, in an area where Lyme disease is established and other tick-borne diseases are emerging. High-pressure sprays of IC2, bifenthrin, and water were applied during the peak nymphal (July) and adult (October) seasons of the vector tick. No ticks could be dragged on the IC2 grids within 2 wk of the July spray, and few adult ticks were found in October or the following April. Similarly, no adult ticks could be dragged 1.5 wk after the October IC2 spray, and few the following April. No ticks were found on the bifenthrin grids after either spray through the following April, whereas substantial numbers of ticks remained throughout on the grids sprayed with water. Thus, IC2 appears to be an effective, minimum-risk acaricide to control the vector tick of Lyme disease.

Eastern Equine Encephalitis Virus Seroprevalence in Maine Cervids, 2012-2017.

Eastern equine encephalitis virus (EEEV) first emerged in Maine in the early 2000s and resulted in an epizootic outbreak in 2009. Since 2009, serum samples from cervids throughout Maine have been collected and assessed for the presence of neutralizing antibodies to EEEV to assess EEEV activity throughout the state. We tested 1,119 Odocoileus virginianus (white-tailed deer) and 982 Alces americanus (moose) serum samples collected at tagging stations during the hunting seasons from 2012 to 2017 throughout the state of Maine. Odocoileus virginianus from all 16 counties were EEEV seropositive, whereas A. americanus were seropositive in the northwestern counties of Aroostook, Somerset, Piscataquis, and Franklin counties. Seroprevalence in O. virginianus ranged from 6.6% to 21.2% and in A. americanus from 6.6% to 10.1%. Data from this report in conjunction with findings previously reported from 2009 to 2011 indicate that EEEV is endemic throughout Maine.

Decoupling of Blacklegged Tick Abundance and Lyme Disease Incidence in Southern Maine, USA.

Lyme disease is caused by the bacterial spirochete Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt, and Brenner (Spirocheatales: Spirochaetaceae) which is transmitted through the bite of an infected blacklegged tick Ixodes scapularis Say (Ixodida: Ixodidae). Maine, USA, is a high Lyme disease incidence state, with rising incidence of Lyme disease and other tick-borne illnesses associated with increasing I. scapularis abundance and northward range expansion. Members of the public submitted ticks to a tick identification program (1990-2013). From these passive surveillance data, we characterized temporal trends in I. scapularis submission rate (an index of abundance), comparing Maine's northern tier (seven counties) versus southern tier (nine counties). In the northern tier, the I. scapularis submission rate increased throughout the duration of the time series, suggesting I. scapularis was emergent but not established. By contrast, in the southern tier, submission rate increased initially but leveled off after 10-14 yr, suggesting I. scapularis was established by the mid-2000s. Active (field) surveillance data from a site in the southern tier-bird tick burdens and questing adult tick collections-corroborated this leveling pattern. Lyme disease incidence and I. scapularis submission rate were temporally correlated in the northern but not southern tier. This suggested a decoupling of reported disease incidence and entomological risk.