The Mycobacterium genus comprises over one-hundred-and-fifty recognised species, the majority of which reside in the environment and many of which can be pathogenic to mammals. Some species of ...environmental mycobacteria may interfere with BCG vaccination efficacy and in tuberculin test interpretation. Examining biogeographic trends in the distribution of members of the mycobacteria across a number of physicochemical and spatial gradients in soil and water environments across Ethiopia using oligotyping identified differential distributions of pathogenic and significant species. The tuberculosis complex was identified in more than 90% of water samples and taxonomic groups implicated in lower BCG vaccine efficiency were core in both soil and water Mycobacterium communities. A reservoir of Mycobacterium bovis was identified in water, with up to 7.3×102 genome equivalents per ml. Elevation, temperature, habitat and vegetation type were important predictors of both soil and water Mycobacterium communities. These results represent the first step in understanding the potential risk of exposure to environmental mycobacteria that may undermine efforts to reduce disease incidence.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The incidence of Mycobacterium bovis, the causative agent of bovine tuberculosis, has been increasing in UK cattle herds resulting in substantial economic losses. The European badger (Meles meles) is ...implicated as a wildlife reservoir of infection. One likely route of transmission to cattle is through exposure to infected badger urine and faeces. The relative importance of the environment in transmission remains unknown, in part due to the lack of information on the distribution and magnitude of environmental reservoirs. Here we identify potential infection hotspots in the badger population and quantify the heterogeneity in bacterial load; with infected badgers shedding between 1 × 10(3)- 4 × 10(5) M. bovis cells g(-1) of faeces, creating a substantial and seasonally variable environmental reservoir. Our findings highlight the potential importance of monitoring environmental reservoirs of M. bovis which may constitute a component of disease spread that is currently overlooked and yet may be responsible for a proportion of transmission amongst badgers and onwards to cattle.
The incidence of Mycobacterium bovis, the causative agent of bovine tuberculosis, in cattle herds in the United Kingdom is increasing, resulting in substantial economic losses. The European badger ...(Meles meles) is implicated as a wildlife reservoir and is the subject of control measures aimed at reducing the incidence of infection in cattle populations. Understanding the epidemiology of M. bovis in badger populations is essential for directing control interventions and understanding disease spread; however, accurate diagnosis in live animals is challenging and currently uses invasive methods. Here we present a noninvasive diagnostic procedure and sampling regimen using field sampling of latrines and detection of M. bovis with quantitative PCR tests, the results of which strongly correlate with the results of immunoassays in the field at the social group level. This method allows M. bovis infections in badger populations to be monitored without trapping and provides additional information on the quantities of bacterial DNA shed. Therefore, our approach may provide valuable insights into the epidemiology of bovine tuberculosis in badger populations and inform disease control interventions.
The herd-level incidence of Mycobacterium bovis has been increasing in the United Kingdom (UK) and Republic or Ireland (RoI) for the past thirty years, resulting in substantial economic and animal ...welfare issues. Failure to control this pathogen in cattle is in part due to European badgers (Meles meles), a wildlife reservoir that are responsible for a proportion of transmission of M. bovis to cattle. Monitoring infection in badger populations is currently limited due to the need to trap badgers, which requires highly trained field staff and is expensive. In addition, although contact with infected badger faeces is a potential transmission route to cattle, very little is known about the extent and variability of the environmental pool of M. bovis shed by badgers. In this project we evaluated the suitability of using environmental badger faeces and a quantitative PCR (qPCR) assay to diagnose and monitor M. bovis in badger populations and described the extent of this environmental pool of potential infection. The first study identified that intensive environmental faecal sampling and analysis with qPCR is at least, if not more, sensitive at diagnosing M. bovis in badger populations than the currently used immunoassays. This study also identified that even within a high prevalence population, the levels of shedding of M. bovis in faeces are highly variable between groups and between seasons, suggesting that there may be heterogeneity in transmission risk throughout the year. Using this non-invasive qPCR method to monitor the first field trial of oral BCG vaccination identified a trend of decreasing levels of M. bovis in faeces with increasing vaccination levels however, these results failed to reach statistical significance, highlighting the importance of adequate sample sizes when implementing this method. Finally, characterisation of the gut and faecal microbiota from animals shedding M. bovis in faeces confirmed that the source of faecal M. bovis is most likely sputum that has been expelled from the lungs, and not from colonisation of the gut. The work presented here suggests that this non-invasive monitoring method can be applied to examine the variable pool of M. bovis over periods of time and large areas, providing an epidemiological tool which has the potential to be implemented to monitor infection in badger populations and disease intervention strategies.
The herd-level incidence of Mycobacterium bovis has been increasing in the United Kingdom (UK) and Republic or Ireland (RoI) for the past thirty years, resulting in substantial economic and animal ...welfare issues. Failure to control this pathogen in cattle is in part due to European badgers (Meles meles), a wildlife reservoir that are responsible for a proportion of transmission of M. bovis to cattle. Monitoring infection in badger populations is currently limited due to the need to trap badgers, which requires highly trained field staff and is expensive. In addition, although contact with infected badger faeces is a potential transmission route to cattle, very little is known about the extent and variability of the environmental pool of M. bovis shed by badgers. In this project we evaluated the suitability of using environmental badger faeces and a quantitative PCR (qPCR) assay to diagnose and monitor M. bovis in badger populations and described the extent of this environmental pool of potential infection. The first study identified that intensive environmental faecal sampling and analysis with qPCR is at least, if not more, sensitive at diagnosing M. bovis in badger populations than the currently used immunoassays. This study also identified that even within a high prevalence population, the levels of shedding of M. bovis in faeces are highly variable between groups and between seasons, suggesting that there may be heterogeneity in transmission risk throughout the year. Using this non-invasive qPCR method to monitor the first field trial of oral BCG vaccination identified a trend of decreasing levels of M. bovis in faeces with increasing vaccination levels however, these results failed to reach statistical significance, highlighting the importance of adequate sample sizes when implementing this method. Finally, characterisation of the gut and faecal microbiota from animals shedding M. bovis in faeces confirmed that the source of faecal M. bovis is most likely sputum that has been expelled from the lungs, and not from colonisation of the gut. The work presented here suggests that this non-invasive monitoring method can be applied to examine the variable pool of M. bovis over periods of time and large areas, providing an epidemiological tool which has the potential to be implemented to monitor infection in badger populations and disease intervention strategies.
BACKGROUND AND OBJECTIVES
Because of the coronavirus disease 2019 pandemic and recommendations from a range of leaders and organizations, the pediatrics subspecialty 2020 recruitment season was ...entirely virtual. Minimal data exist on the effect of this change to guide future strategies. The aim of this study was to understand the effects of virtual recruitment on pediatric subspecialty programs as perceived by program leaders.
METHODS
This concurrent, triangulation, mixed-methods study used a survey that was developed through an iterative (3 cycles), consensus-building, modified Delphi process and sent to all pediatric subspecialty program directors (PSPDs) between April and May 2021. Descriptive statistics and thematic analysis were used, and a conceptual framework was developed.
RESULTS
Forty-two percent (352 of 840) of PSPDs responded from 16 of the 17 pediatric (94%) subspecialties; 60% felt the virtual interview process was beneficial to their training program. A majority of respondents (72%) reported cost savings were a benefit; additional benefits included greater efficiency of time, more applicants per day, greater faculty involvement, and perceived less time away from residency for applicants. PSPDs reported a more diverse applicant pool. Without an in-person component, PSPDs worried about programs and applicants missing informative, in-person interactions and applicants missing hospital tours and visiting the city. A model based upon theory of change was developed to aid program considerations for future application cycles.
CONCLUSIONS
PSPDs identified several benefits to virtual recruitment, including ease of accommodating increased applicants with a diverse applicant pool and enhanced faculty involvement. Identified limitations included reduced interaction between the applicant and the larger institution/city.
Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological ...momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affects in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess the affect and the number of alcoholic drinks consumed. Results indicate that people are not more likely to drink on days they experience high negative affect but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance consumed more alcohol but not on days they experienced higher negative and positive affects. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. These findings challenge the long-held belief that people drink more alcohol following increase in negative affect. Integrating these findings under different theoretical models and limitations of this field of research, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.
Public Significance Statement
This study meta-analyzed individual participant data from 12,394 individuals across 69 studies in which participants reported their emotional state and alcohol use for multiple days. Contrary to theoretical models of alcohol use, the findings indicated that people are not more likely to drink and do not consume more alcohol on days that they report higher negative affect but are more likely to drink on days that they report higher positive affect.
Most studies on how rising temperatures will impact terrestrial ectotherms have focused on single populations or multiple sympatric species. Addressing the thermal and energetic implications of ...climatic variation on multiple allopatric populations of a species will help us better understand how a species may be impacted by altered climates.
We used eight years of thermal and behavioral data collected from four populations of Pacific rattlesnakes (Crotalus oreganus) living in climatically distinct habitat types (inland and coastal) to determine the field‐active and laboratory‐preferred body temperatures, thermoregulatory metrics, and maintenance energetic requirements of snakes from each population.
Physical models showed that thermal quality was best at coastal sites, but inland snakes thermoregulated more accurately despite being in more thermally constrained environments. Projected increases of 1 and 2°C in ambient temperature result in an increase in overall thermal quality at both coastal and inland sites.
Population differences in modeled standard metabolic rate estimates were driven by body size and not field‐active body temperature, with inland snakes requiring 1.6× more food annually than coastal snakes.
All snakes thermoregulated with high accuracy, suggesting that small increases in ambient temperature are unlikely to impact the maintenance energetic requirements of individual snakes and that some species of large‐bodied reptiles may be robust to modest thermal perturbations under conservative climate change predictions.
We used long‐term thermal data collected from four populations of Pacific rattlesnakes (Crotalus oreganus) to determine and compare thermoregulatory metrics and maintenance energetic requirements of snakes living in climatically distinct habitats (coastal and inland). Thermal quality was best at coastal sites, but inland snakes thermoregulated more accurately despite being in more thermally constrained environments. Population differences in standard metabolic rate estimates were driven by body size rather than body temperature, with inland snakes requiring 1.6× more food annually than coastal snakes.
The year 2020 has seen the emergence of a global pandemic as a result of the disease COVID-19. This report reviews knowledge of the transmission of COVID-19 indoors, examines the evidence for ...mitigating measures, and considers the implications for wintertime with a focus on ventilation.
ACC/AHA Task Force on Performance Measures Paul A. Heidenreich, MD, MS, FACC, FAHA, Chair Nancy M. Albert, PhD, CCNS, CCRN, FAHA Paul S. Chan, MD, MSc, FACC Lesley H. Curtis, PhD T. Bruce Ferguson, ...Jr, MD, FACC Gregg C. Fonarow, MD, FACC, FAHA P. Michael Ho, MD, PhD, FACC, FAHA Corrine Jurgens, PhD, RN, ANP-BC, FAHA Sean O'Brien, PhD Andrea M. Russo, MD, FACC Randal J. Thomas, MD, MS, FAACVPR, FACC, FAHA Henry H. Ting, MD, MBA, FACC, FAHA Paul D. Varosy, MD, FACC Table of Contents Preface2134 Structure and Membership of the Writing Committee2134 Disclosure of Relationships With Industry2134 The Need for Shared Accountability2135 Shared Accountability and PMs2136 General Overview2136 Examples of Shared-Accountability Measures2136 Longitudinal Process Adherence2136 Intermediate Patient Outcome Metrics--Reaching Target Goals (Blood Pressure, Hemoglobin A1c)2137 Example of Shared Accountability for Clinical Events and Patient Outcomes2137 Methodological Challenges2138 Accountability and Attribution2138 Potential Levels of Aggregation2138 Defining Patient Attribution2138 Defining Parties Responsible for a PM2138 Defining Assessment Periods for PMs2139 Issues Relating to Patient Adherence and Self-Care2139 Defining Adherence and Self-Care2139 Challenges With Handling Patient Treatment Refusals2139 Adjusting for Patient Case Mix2140 Psychosocial Factors Impacting Patient Case Mix2140 Factors Impeding or Facilitating the Adoption of Shared-Accountability PMs2140 Health Information Systems2140 Payment Reforms, Healthcare Ownership, and ACOs2140 Special Issues Relating to Patient Accountability Metrics2140 Patient PM and Accountability2140 Patient Financial Incentives and Unintended Consequences2141 Conclusion and Key Recommendations2141 References2143 Appendix 1 Author Relationships With Industry and Other Entities (Relevant)2144 Appendix 2 Reviewer Relationships With Industry and Other Entities (Relevant)2145 Preface Structure and Membership of the Writing Committee Members of the Writing Committee included experienced clinicians and specialists in cardiology, cardiac rehabilitation, quality improvement, outcomes research, epidemiology, and performance measures (PMs) methodology, as well as patient advocates. Because the Writing Committee is defining general principles, rather than making specific PM recommendations, members' relationships with pharmaceutical and device companies were not considered relevant to the topic.
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