Retrospective Review of 516 Implantations of Option Inferior Vena Cava Filters at a Single Health Care System.

PURPOSE: To retrospectively evaluate the safety, efficacy, and retrievability of Option inferior vena cava (IVC) filters. MATERIALS AND METHODS: All patients (N = 516; 247 women; mean age, 67.1 y ± 15.1; range, 19.5-101.6 y) who received an Option filter between August 2009 and March 2015 at a single health care system were analyzed. RESULTS: The study duration was 68 months, with median clinical follow-up of 7.1 months (range, 1 d to 61.8 mo). During follow-up, 73 of 83 patients (88.0%) underwent successful filter retrieval, 153 died (including three after successful retrieval), and 293 remained alive with filters in situ. Seventeen cases of breakthrough pulmonary embolism (PE) occurred (3.4%). Among 323 patients with direct filter imaging, there were two cases of tilt > 15°, one case of filter deformity, 16 cases of intracaval migration > 2 cm, and no cases of filter fracture. There were six cases of caval occlusion, nine cases of thrombus trapped inside the filter, and 57 cases of limb penetration on computed tomography scans or radiographs of the IVC. Retrieval failures were attributed to filter tilt or tip embedment in the caval wall (n = 4), complete IVC thrombosis (n = 3), thrombus inside the filter (n = 2), or inability to disengage filter legs (n = 1). Recurrent deep vein thrombosis occurred in 34 patients, including 32 with filters in situ and two whose filters had been removed. CONCLUSIONS: Most Option filters were left in situ for permanent indications. Rates of successful retrieval, device-related complications, and breakthrough PE were similar to those associated with other retrievable filters.

The field evaluation of a push-pull system to control malaria vectors in northern Belize, Central America.

BACKGROUND: Campaigns for the continued reduction and eventual elimination of malaria may benefit from new and innovative vector control tools. One novel approach being considered uses a push-pull strategy, whereby spatial repellents are used in combination with outdoor baited traps. The desired effect is the behavioural manipulation of mosquito populations to elicit movement of vectors away from people and into traps. METHODS: Here, a prototype push-pull intervention was evaluated using an experimental hut methodology to test proof-of-principle for the strategy against two natural vector populations, Anopheles albimanus and Anopheles vestitipennis, in Belize, Central America. A Latin square study design was used to compare mosquito entry into experimental huts and outdoor traps across four different experimental conditions: 1) control, with no interventions; 2) pull, utilizing only outdoor traps; 3) push, utilizing only an indoor spatial repellent; and 4) push-pull, utilizing both interventions simultaneously. RESULTS: For An. vestitipennis, the combined use of an indoor repellent and outdoor baited traps reduced average nightly mosquito hut entry by 39% (95% CI: [0.37-0.41]) as compared to control and simultaneously increased the nightly average densities of An. vestitipennis captured in outdoor baited traps by 48% (95% CI: [0.22-0.74]), compared to when no repellent was used. Against An. albimanus, the combined push-pull treatment similarly reduced hut entry, by 54% (95% CI: [0.40-0.68]) as compared to control; however, the presence of a repellent indoors did not affect overall outdoor trap catch densities for this species. Against both anopheline species, the combined intervention did not further reduce mosquito hut entry compared to the use of repellent alone. CONCLUSIONS: The prototype intervention evaluated here clearly demonstrated that push-pull strategies have potential to reduce human-vector interactions inside homes by reducing mosquito entry, and highlighted the possibility for the strategy to simultaneously decrease human-vector interactions outside of homes by increasing baited trap collections. However, the variation in effect on different vectors demonstrates the need to characterize the underlying behavioral ecology of target mosquitoes in order to drive local optimization of the intervention.

A comparison of two commercial mosquito traps for the capture of malaria vectors in northern belize, central america.

To achieve maximum success from any vector control intervention, it is critical to identify the most efficacious tools available. The principal aim of this study was to evaluate the efficacy of 2 commercially available adult mosquito traps for capturing Anopheles albimanus and An. vestitipennis, 2 important malaria vectors in northern Belize, Central America. Additionally, the impact of outdoor baited traps on mosquito entry into experimental huts was assessed. When operated outside of human-occupied experimental huts, the Centers for Disease Control and Prevention (CDC) miniature light trap, baited with human foot odors, captured significantly greater numbers of female An. albimanus per night (5.1 ± 1.9) than the Biogents Sentinel™ trap baited with BG-Lure™ (1.0 ± 0.2). The 2 trap types captured equivalent numbers of female An. vestitipennis per night, 134.3 ± 45.6 in the CDC trap and 129.6 ± 25.4 in the Sentinel trap. When compared to a matched control hut using no intervention, the use of baited CDC light traps outside an experimental hut did not impact the entry of An. vestitipennis into window interception traps, 17.1 ± 1.3 females per hour in experimental huts vs. 17.2 ± 1.4 females per hour in control huts. However, the use of outdoor baited CDC traps did significantly decrease the entry of An. albimanus into window interception traps from 3.5 ± 0.5 females per hour to 1.9 ± 0.2 females per hour. These results support existing knowledge that the underlying ecological and behavioral tendencies of different Anopheles species can influence trap efficacy. Furthermore, these findings will be used to guide trap selection for future push-pull experiments to be conducted at the study site.

Comparison of experimental hut entrance and exit behavior between Anopheles darlingi from the Cayo District, Belize, and Zungarococha, Peru.

Anopheles darlingi is a major vector for malaria in Central and South America. Behavioral, ecological, genetic, and morphologic variability has been observed across its wide distribution. Recent studies have documented that 2 distinct genotypes exist for An. darlingi: a northern lineage (Belize, Guatemala, Colombia, Venezuela, and Panama) and a southern lineage (Amazonia and southern Brazil). In order to determine if these genotypes exhibited different behavioral traits, entrance and exit movement patterns between 2 field populations of An. darlingi that represented each genotype were evaluated using experimental huts. The Belize population exhibited bimodal entrance, with peak entry occurring between 7:00-8:00 p.m. and 5:00-6:00 a.m. and peak exiting occurring between 7:00-8:00 p.m. The Peru population exhibited unimodal entrance, with peak entry occurring between 10:00-11:00 p.m. and peak exiting occurring between 11:00-12:00 a.m. with a secondary smaller peak at 2:30 a.m. Entrance and exit behavioral patterns were significantly different between the Belize and Peru populations of An. darlingi (log-rank [Mantel-Cox] P < 0.001). Information from the present study will be used in the future to determine if there is a correlation between genotype and host-seeking behavior and can be used in the present for regional vector risk assessment.

First record and demonstration of a southward expansion of Aedes albopictus into Orange Walk Town, Belize, Central America.

The first record of Aedes albopictus in northern Belize was made in Orange Walk Town, Orange Walk District, on November 3, 2011. Aedes spp. larvae were collected during a routine Ministry of Health mosquito survey and reared to adults. Upon emergence, a mixed population of Aedes aegypti (35) and Ae. albopictus (11) was observed (aegypti:albopictus = 3:1). Subsequent larval and adult surveys in Orange Walk and Corozal District, also in northern Belize, have confirmed the presence of Ae. albopictus, thereby indicating the range expansion and establishment of this nuisance biter and potential disease vector in Belize.

The Challenges of Educational Reintegration and the Psychosocial Wellbeing of Returnee Children: Evidence from Latvia.

When emigrant families return-migrate to their homeland, what happens to their school-age children? What challenges do these children face when they switch to a different school system and language? This paper addresses these questions in the context of family return migration to Latvia, based on 40 in-depth interviews with children, their parents and key informants - teachers, school support staff and return-migration coordinators. We find that imaginings of a smooth reintegration into a parental homeland of extended family and friends may not be realised; instead, many children, particularly those of secondary and upper primary-school age, experience the move as a rupture in their lives. School may be fraught with unrealistic expectations on all sides, not helped by poor communication between parents, teachers and support staff. The lack of fluency in the Latvian language is seen by teachers as an obstacle, rather than something to be accepted and worked with. Most teachers are unfamiliar with children from different backgrounds and origins and need training in diversity, tolerance and differentiated learning. This will become increasingly necessary in a country like Latvia, with its ongoing high rates of international migration and return. Our findings show that the educational system and children's experiences of schooling play a crucial role in returnee families' overall reintegration. This raises the importance of return preparedness for the children, including language preparation and awareness of pedagogical and curriculum differences.

Editorial Introduction: The Shifting Geopolitics of Return Migration and Reintegration.

The recent geo-politicisation of return migration warrants deep consideration of the politics of return and reintegration. A focus on geopolitics prefigures the study of reintegration not just as circumstantial to the lives of migrants or the formal strategies of states but also as deeply embedded in the historical socio-cultural and political contexts where it takes place. In introducing a set of papers that explore these links from different angles and based on research from around the world, this article argues that return and reintegration constitute a qualitatively different process from immigration and integration in the receiving countries, first and foremost because the sending state-a key actor in the reintegration process-is in a position of geopolitical power marginality. Indeed, the strategies of all the stakeholders implicated in reintegration are closely linked to the geopolitics of migration governance. In these contexts, migrants' intimate, as well as pragmatic, strategies of reintegration and re-migration are an expression, as well as a trigger, of multi-scale geopolitics. There is a distinct contrast between the emphasis on borders and securitisation in high-income countries and the informality and precarity of the way that migrants have to manage their ontological security in the process of return and reintegration. Reintegration should thus be understood as a process contingent upon different and, often, incongruous legal, political and socio-economic elements, as endorsed and employed by the different stakeholders involved.

Complete (1) H and (13) C NMR spectral assignments for the glycoalkaloid dehydrocommersonine.

The normal levels and types of glycoalkaloids found in commercial varieties of potato (Solanum tuberosum) appear to present no hazard to human health. However when wild Solanum species are used in breeding endeavors, new and untested glycoalkaloids may be introduced. Recent studies of domestic crosses with a wild Solanum oplocense accession indicated that the levels of a non-indigenous glycoalkaloid appeared associated with reduced defoliation by the Colorado potato beetle. The non-indigenous glycoalkaloid was isolated from foliage of the wild S. oplocense accession and unambiguously characterized by high-resolution electrospray ionization mass spectrometry and NM analysis as the glycoalkaloid dehydrocommersonine.

Distribution of Triatoma dimidiata sensu lato (Reduviidae: Triatominae) and Risk Factors Associated with Household Invasion in Northern Belize, Central America.

To date, Triatoma dimidiata sensu lato [Reduviidae: Triatominae (Latreille 1811)] remains the sole vector species associated with Chagas disease transmission reported from Belize. Human infection data are limited for Belize and the disease transmission dynamics have not been thoroughly investigated, yet the likelihood of autochthonous transmission is supported by the widespread collection of infected vectors from within local households. Here, we report updated infection rates of the vector population and infestation rates for villages in north and central Belize. Overall, 275 households were enrolled in an ongoing vector surveillance program. Of the 41 insects collected, 25 were PCR positive for T. cruzi, indicating an infection rate as high as 60%. To further characterize the epidemiological risk of human-vector contact, determinants of household invasion were modeled. Local households were surveyed and characterized with respect to over 25 key factors that may be associated with household infestation by T. dimidiata s.l. While final models were not strongly predictive with respect to the risk factors that were surveyed, likely due to the low number of collection observations, the presence of domestic/peri-domestic dogs, nearby light sources, and household structure materials could be the focus of continued risk assessments. In northern Belize, this vector survey lends support to T. dimidiata s.l. inhabiting sylvatic settings as opposed to the classical paradigm of domiciliated vector populations. This designation has strong implications for the local level of human exposure risk which can help guide vector surveillance and control resources.

On migration, geography, and epistemic communities.

This commentary paper starts by questioning the assumption that migration means international migration, and goes on to affirm that migration studies has indeed come of age as a coherent if highly diverse research field. Several emerging epistemic communities are identified: migration and development; gender and migration; lifestyle migration; and youth and student migrations. Finally, I argue that the role of geography in the study of migration has been under-valued.

Characterization of gamma-butyrolactone autoregulatory signaling gene homologs in the angucyclinone polyketide WS5995B producer Streptomyces acidiscabies.

Organisms belonging to the genus Streptomyces produce numerous important secondary metabolites and undergo a sophisticated morphological differentiation program. In many instances these processes are under the control of gamma-butyrolactone (GBL) autoregulatory systems. Streptomyces acidiscabies strain 84.104 produces the secondary metabolite aromatic angucyclinone polyketide WS5995B. In order to explore the role of GBL regulatory circuitry in WS5995B production and morphogenesis in S. acidiscabies, a gene cluster encoding GBL autoregulatory signaling homologs was identified and characterized. Two GBL receptor homologs, sabR and sabS, were found flanking a GBL synthase homolog sabA. Strains carrying mutations in sabS produced elevated levels of WS5995B and displayed conditional morphological defects reminiscent of defects seen in Streptomyces bldA mutants. Notably, sabS possesses a TTA codon predicted to be recognized by tRNA(leu). sabA mutants produced higher levels of WS5995B than the wild-type strain but to a lesser extent than the levels of WS5995B seen in sabS mutants. Purified recombinant SabR and SabS were tested for their abilities to bind predicted AT-rich autoregulatory element (ARE) boxes within the sabRAS region. SabS did not bind any DNA sequences in this region, while SabR bound an ARE box in the region upstream of sabS. Quantitative reverse transcription-PCR analysis revealed higher levels of sabS transcript in sabR mutants than in the wild-type strain, suggesting that sabS expression is repressed by SabR. Based on these data, we propose that the S. acidiscabies sabRAS genes encode components of a signaling pathway which participates in the regulation of WS5995B production and morphogenesis.

Synthesis and NMR characteristics of N-acetyl-4-nitro, N-acetyl-5-nitro, N-acetyl-6-nitro and N-acetyl-7-nitrotryptophan methyl esters.

N-acetyl-4-nitrotryptophan methyl ester (2), N-acetyl-5-nitrotryptophan methyl ester (3), N-acetyl-6-nitrotryptophan methyl ester (4) and N-acetyl-7-nitrotryptophan methyl ester (5) were synthesized through a modified malonic ester reaction of the appropriate nitrogramine analogs followed by methylation with BF(3)-methanol. Assignments of the (1)H and (13)C NMR chemical shifts were made using a combination of (1)H-(1)H COSY, (1)H-(13)C HETCOR and (1)H-(13)C selective INEPT experiments.

"Left Like Stones in the Middle of the Road": Narratives of Aging Alone and Coping Strategies in Rural Albania and Bulgaria.

OBJECTIVES: We explore and compare older adults' lived experiences and coping strategies in two postcommunist countries-Albania and Bulgaria. Wholesale youth outmigration and economic and institutional regional decline have led to decaying rural areas where older adults become "abandoned." Aging alone, as couples or widowed, they are socially marginalized and in constant search for coping mechanisms which enable them to survive. METHODS: We adopt a social-psychology theoretical framework which distinguishes between problem-focused and emotion-focused coping. Data include 28 in-depth interviews with older residents and participant observation in selected rural areas of the two countries. RESULTS: In both countries, rural social isolation is expressed as a lack of close family ties-mainly due to the removal through outmigration of children and grandchildren-and detachment from society at large. The most prevalent coping mechanism consists of practical and emotional support from non-kin ties, especially neighbors. Remittances help to resolve material needs, especially in Albania, where most rural young people migrate abroad. In both settings, a range of emotion-focused coping strategies were identified, including perceptions of decreased needs, lowered expectations about relationships, and satisfaction at the achievements of the younger generations. DISCUSSION: Similarities between research findings in Albania and Bulgaria reflect their shared political and institutional history. Although few, differences relate to a combination of contrasting migration and cultural patterns. In both settings problem- and emotion-focused adaptive strategies are overlapping, and successful aging efforts seem to be of a communal rather than an individualistic nature.

Use of remote sensing and geographic information systems to predict locations of Anopheles darlingi-positive breeding sites within the Sibun River in Belize, Central America.

Previous studies have identified several anopheline species integral to the transmission of malaria in Belize. The highly efficient vector, Anopheles darlingi Root, is currently considered the most important. The preferred larval habitat of An. darlingi has been described as floating detritus patches, which are commonly associated with overhanging spiny bamboo, Guadua longifolia (E. Fourn.), along river margins. The objectives of this study were to use remote sensing and geographic information system (GIS) tools to 1) define the landscape features (i.e., river curvature, land cover, and house locations) associated with An. darlingi-positive breeding habitats and 2) determine the association between cleared land cover and the growth of spiny bamboo. A systematic survey was conducted in which all detritus patches of at least 1 m2 were sampled, mapped using GPS, and characterized by cause of habitat lodging. Bamboo stretches growing along the river margins also were mapped. Spatial analyses of satellite imagery found no associations between river characteristics or land cover with positive An. darlingi habitats. In addition, there was no significant difference in cleared versus forested land cover in relation to the presence or absence of bamboo. Results indicate that the average distance from homes to negative habitats was significantly greater than from positive detritus mats. Based on the land cover and river characteristics used, our results do not support the use of remote sensing as a predictive tool to locate specific areas within rivers positive for An. darlingi habitats.

Biting patterns and seasonal densities of Anopheles mosquitoes in the Cayo District, Belize, Central America with emphasis on Anopheles darlingi.

The present study utilized an experimental hut to conduct human-baited landing collections for characterizing the all-night biting patterns and seasonal densities of adult Anopheles darlingi in the centrally located Cayo District of Belize, Central America. A total of 25 all-night collections (i.e., sunset to sunrise) were conducted from January 2002 to May 2003, capturing a total of 18,878 An. darlingi females. Anopheles darlingi exhibited a bimodal nightly biting pattern with one predominate peak occurring three h after sunset and a smaller peak occurring one h prior to sunrise. Biting females were collected throughout the night in higher densities indoors (9,611) than outside (9,267) the experimental hut (O:I=1.00:1.04). Seasonal adult collections show An. darlingi densities were highest during the transitional months between the end of the wet and beginning of the dry season (January) and the end of the dry season and beginning of the wet season (May). A total of 2,010 An. darlingi females was captured in 31 two-h, human-baited landing collections performed from January to October 2002. Anopheles darlingi monthly population densities were found to have no significant associations with high or low temperatures, precipitation, or river level. However, qualitative data examination indicates an inverse relationship between river level and An. darlingi adult collections suggesting a disturbance of larval habitats. All-night biting and seasonal distribution patterns for other anopheline species are also described. None of the adult specimens collected throughout the entire study tested positive for Plasmodium spp. infection using the VecTest rapid diagnostic kit.

Characterization of cross-linked hydroxycinnamic acid amides isolated from potato common scab lesions.

Four feruloyl amides, N-trans-feruloyloctopamine (1), N-cis-feruloyloctopamine (2), N-trans-feruloyltyramine (3), N-cis-feruloyltyramine (4), a cross-linked N-trans-feruloyltyramine dimer (5), and a cross-linked N-cis-feruloyltyramine dimer (6) were isolated from potato common scab lesions. The compounds were purified by TLC and characterized by a combination of (1)H and (13)C NMR spectroscopic techniques. The presence of an accompanying minor complex of cross-linked dimers containing both feruloyltyramines and feruloyloctopamines was also demonstrated. This is the first characterization of cross-linked hydroxycinnamic acid amides associated with wound healing in potato (Solanum tuberosum) tubers.

More chemistry of the thaxtomin phytotoxins.

Chemical and biochemical studies indicated the possible involvement of N-acetyltryptophan and 4-nitrotryptophan as intermediates in biosynthesis of the thaxtomin phytotoxins. A search for other potential pathways indirectly resulted in the identification of three unusual thaxtomin analogues derived from the o-thaxtomin A isomer. Investigations to resolve the identity of a previously described thaxtomin A di-glucoside were not supportive of the proposed structure.

Occurrence of Turnip Scab Caused by Phytotoxin-Producing Streptomyces spp.

Turnips (Brassica rapa L var. rapifera) purchased from a New Brunswick supermarket in the winter of 2003 contained discernable corky scab-like lesions on their surfaces. The turnips were surface-disinfested with a warm-water rinse, and microorganisms from excised lesions were isolated with methodologies developed for the specific isolation of Streptomyces spp. (1). Nine isolates morphologically characteristic of Streptomyces scabies strains (2) were subsequently examined for pathogenicity on potato mini-tubers and production of the scab phytotoxin, thaxtomin A (1). Four of the nine isolates proved pathogenic on potato mini-tubers. When grown on an oatmeal broth medium, only the pathogenic isolates generated thin-layer chromatographic detectable quantities of the requisite phytotoxin, thaxtomin A (1). Previous greenhouse studies have demonstrated the ability of pathogenic Streptomyces spp. isolated from scab lesions on potatoes to infect turnips (2). To our knowledge, this is the first investigation to confirm the presence of thaxtomin A producing isolates on field-grown turnips. References: (1) R. R. King et al. Am. Potato J. 68:675, 1991. (2) R. Loria et al. Plant Dis. 81:836, 1997.

Comparison of life table attributes from newly established colonies of Anopheles albimanus and Anopheles vestitipennis in northern Belize.

A life table study was conducted for recently established colonies of Anopheles albimanus and Anopheles vestitipennis in Belize, Central America. The colonies were reared in the northern Orange Walk District under uncontrolled environmental conditions (29-32 degrees C, 87-90% RH, and 13:11 L:D photoperiod). The mean time of larval development for An. albimanus was 10.8 days for males and 11.7 days for females. Mean times for An. vestitipennis larval development were 11.3 days for males and 13.5 days for females. Anopheles albimanus exhibited a 92% survival rate from egg hatch to adult emergence, while that of An. vestitipennis was 82%. Neither species showed a sex ratio that was significantly different from 1:1. Adult male An. albimanus lived for an average of 13.6 days, while the females lived for an average of 21.2 days. The An. vestitipennis adult males lived for a mean of 14.8 days, while the females lived considerably longer with a mean of 25.6 days. The reproductive rate and age of mean cohort reproduction were calculated as 287 and 11.3 days for An. albimanus and 302 and 13.4 days for An. vestitipennis. The r/B and B/D ratios of 0.13 and 1.15, respectively, for An. albimanus and 0.1 and 1.1, respectively, for An. vestitipennis indicate that these species have a low potential for colonization.