Vulnerability to relapse during periods of attempted abstinence from cocaine use is hypothesized to result from the rewiring of brain reward circuitries, particularly ventral tegmental area (VTA) ...dopamine neurons. How cocaine exposures act on midbrain dopamine neurons to precipitate addiction-relevant changes in gene expression is unclear. We found that histone H3 glutamine 5 dopaminylation (H3Q5dop) plays a critical role in cocaine-induced transcriptional plasticity in the midbrain. Rats undergoing withdrawal from cocaine showed an accumulation of H3Q5dop in the VTA. By reducing H3Q5dop in the VTA during withdrawal, we reversed cocaine-mediated gene expression changes, attenuated dopamine release in the nucleus accumbens, and reduced cocaine-seeking behavior. These findings establish a neurotransmission-independent role for nuclear dopamine in relapse-related transcriptional plasticity in the VTA.
Developer ducks are ducks being reared for breeding. Like breeder candidate chickens, they are raised with appropriate light and feed programs. A commercial Pekin duck (
) developer flock experienced ...an extraordinary, elevated mortality event at 6 wk of age. Weekly mortality rate that week was 162 ducklings out of a flock of 6420 (2.5%). Mortality jumped to 988 (15.4%) ducklings the next week. On first elevated mortality, six dead ducks from that flock were submitted for diagnostic investigation at Michigan State University Veterinary Diagnostic Laboratory. Myocarditis, pale striping or diffuse pallor of the epicardium, was grossly evident in five of the six submitted ducklings. All of the ducklings had hydropericardium, three had ascites, and three had congested meninges. Histology confirmed myocarditis with myocardial necrosis. Cerebrum and brainstem had lymphocytic vasculitis with rare neuronal necrosis in affected areas, as well as Purkinje cells in the cerebellum. West Nile virus was confirmed by PCR the day after submittal and by immunohistochemistry soon thereafter.
Health workforce needs-based shortages and skill mix imbalances are significant health workforce challenges. Task shifting, defined as delegating tasks to existing or new cadres with either less ...training or narrowly tailored training, is a potential strategy to address these challenges. This study uses an economics perspective to review the skill mix literature to determine its strength of the evidence, identify gaps in the evidence, and to propose a research agenda.
Studies primarily from low-income countries published between 2006 and September 2010 were found using Google Scholar and PubMed. Keywords included terms such as skill mix, task shifting, assistant medical officer, assistant clinical officer, assistant nurse, assistant pharmacist, and community health worker. Thirty-one studies were selected to analyze, based on the strength of evidence.
First, the studies provide substantial evidence that task shifting is an important policy option to help alleviate workforce shortages and skill mix imbalances. For example, in Mozambique, surgically trained assistant medical officers, who were the key providers in district hospitals, produced similar patient outcomes at a significantly lower cost as compared to physician obstetricians and gynaecologists. Second, although task shifting is promising, it can present its own challenges. For example, a study analyzing task shifting in HIV/AIDS in sub-Saharan Africa noted quality and safety concerns, professional and institutional resistance, and the need to sustain motivation and performance. Third, most task shifting studies compare the results of the new cadre with the traditional cadre. Studies also need to compare the new cadre's results to the results from the care that would have been provided--if any care at all--had task shifting not occurred.
Task shifting is a promising policy option to increase the productive efficiency of the delivery of health care services, increasing the number of services provided at a given quality and cost. Future studies should examine the development of new professional cadres that evolve with technology and country-specific labour markets. To strengthen the evidence, skill mix changes need to be evaluated with a rigorous research design to estimate the effect on patient health outcomes, quality of care, and costs.
To determine which type of egg-laying hen housing was best for the chickens, the workers in those housing systems, the environment, and society based on food safety and affordability, a combined ...research project involving egg suppliers, food manufacturers, food service representatives, and food retailers, as well as research institutions and nongovernmental organizations, was performed. This study reports the hen health and welfare portion based upon veterinary health inspections and compared mortality rates, skeletal abnormalities, causes of death determined by necropsy, and titers to infectious bronchitis and Newcastle disease viruses. Birds were housed on a preexisting Midwest layer complex, which consisted of conventional cages (CC). New houses were built adjacent to the CC house where enriched colony cages (EC) and an aviary system (AV) were installed. Two flock cycles from housing to 78 wk of age were followed. Total mortality was greatest for AV, while CC and EC birds were similar. Keel bone fractures were greatest for AV, next greatest for EC, and least for CC birds. Other skeletal abnormalities were greatest for AV birds. Birds dying from being caught in the structure, pick out, and persecution was most frequent for AV and next most frequent for EC, but nonexistent with CC birds. Infectious pododermatitis (bumblefoot) was most frequent for AV, next most frequent for EC, and essentially nonexistent for CC birds. There was little to no effect on antibody titers based upon housing type. Based upon these findings, it appears that EC housing is better for the health and welfare of egg-laying chickens than CC or AV housing.
In a large population of animals, it is normal to have some die each day from causes not related to disease, which is often referred to as natural causes. In poultry production, this phenomenon is ...commonly referred to as daily mortality. In egg-producing chickens, many of the natural causes of death are associated with making an egg. The causes of normal mortality in commercial egg-laying chicken flocks have been described very little to date. A commercial chicken egg farm, housing approximately two million single-comb white leghorn chickens (Gallus gallus domesticus) in 16 egg-producing flocks, was visited on a monthly basis to monitor bird health, body conditioning, skeletal integrity, and causes of daily mortality in an attempt to provide early detection of health abnormalities. A representative sample of daily mortality from each flock was necropsied to determine the cause of death. Reported herein is a summary of visits for a period of 38 mo from June 2011 to July 2014. The top 15 causes of normal mortality, in rank order of prevalence, were determined to be the following: egg yolk peritonitis, hypocalcemia, gout, self-induced molt, salpingitis, caught by spur, intussusception or volvulus (twisted intestine), cannibalism (pick out), tracheal plug, septicemia, fatty liver syndrome, internal layer, layer hepatitis, persecution, and prolapsed vent. Other causes noted were hyperthermia (during summer), trauma, coccidiosis, ovarian neoplasia, being egg bound, urolithiasis, peritonitis (not egg yolk induced), leg fracture, caught in the structure, tumor (other than ovarian origin), wing fracture, exsanguination, and cardiomyopathy.
To estimate the shortage of mental health professionals in low- and middle-income countries (LMICs).
We used data from the World Health Organization's Assessment Instrument for Mental Health Systems ...(WHO-AIMS) from 58 LMICs, country-specific information on the burden of various mental disorders and a hypothetical core service delivery package to estimate how many psychiatrists, nurses and psychosocial care providers would be needed to provide mental health care to the total population of the countries studied. We focused on the following eight problems, to which WHO has attached priority: depression, schizophrenia, psychoses other than schizophrenia, suicide, epilepsy, dementia, disorders related to the use of alcohol and illicit drugs, and paediatric mental disorders.
All low-income countries and 59% of the middle-income countries in our sample were found to have far fewer professionals than they need to deliver a core set of mental health interventions. The 58 LMICs sampled would need to increase their total mental health workforce by 239,000 full-time equivalent professionals to address the current shortage.
Country-specific policies are needed to overcome the large shortage of mental health-care staff and services throughout LMICs.
Private equity (PE) firms have been acquiring physician practices at an increasing rate, raising concerns about such firms' penetration at the physician level into local markets and the impact on ...health care quality and prices. However, limited knowledge exists about the extent of PE firms' control in local markets. By linking data on PE acquisitions to physician data and using full-time-equivalent physicians as the base of assessment, we estimated the local market share of each PE firm within ten physician specialties at the Metropolitan Statistical Area (MSA) level. PE-acquired physician practice sites increased from 816 across 119 MSAs in 2012 to 5,779 across 307 MSAs in 2021. Single PE firms had significant market share, exceeding 30 percent in 108 MSA specialty markets and exceeding 50 percent in 50 of those markets. The findings raise concerns about competition and call for closer scrutiny by the Federal Trade Commission, state regulators, and policy makers.
Retrospective studies have suggested that older adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) have better survival rates when treated using a pediatric ALL regimen ...administered by pediatric treatment teams. To address the feasibility and efficacy of using a pediatric treatment regimen for AYA patients with newly diagnosed ALL administered by adult treatment teams, we performed a prospective study, CALGB 10403, with doses and schedule identical to those in the Children's Oncology Group study AALL0232. From 2007 to 2012, 318 patients were enrolled; 295 were eligible and evaluable for response. Median age was 24 years (range, 17-39 years). Use of the pediatric regimen was safe; overall treatment-related mortality was 3%, and there were only 2 postremission deaths. Median event-free survival (EFS) was 78.1 months (95% confidence interval CI, 41.8 to not reached), more than double the historical control of 30 months (95% CI, 22-38 months); 3-year EFS was 59% (95% CI, 54%-65%). Median overall survival (OS) was not reached. Estimated 3-year OS was 73% (95% CI, 68%-78%). Pretreatment risk factors associated with worse treatment outcomes included obesity and presence of the Philadelphia-like gene expression signature. Use of a pediatric regimen for AYAs with ALL up to age 40 years was feasible and effective, resulting in improved survival rates compared with historical controls. CALGB 10403 can be considered a new treatment standard upon which to build for improving survival for AYAs with ALL. This trial was registered at www.clinicaltrials.gov as #NCT00558519.
•Using an intensive pediatric regimen for AYAs with ALL is feasible.•High rates of EFS and OS were seen compared with historical controls.
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A sudden drop in egg production in commercial poultry flocks can be economically devastating, and rapid identification of the cause often requires a combined effort between the producer, ...veterinarian, and pathologist. In September 2019, a 35-wk-old commercial Pekin breeder duck flock in Indiana suffered a drop in egg production from 1700 to 1000 eggs daily (41.2% drop). Again, in September 2021, three Pekin breeder duck flocks aged 32, 58, and 62 wk from the same company suffered a similar drop in egg production, with a mild increase in weekly mortality of 1.0% to 2.5%. In 2019 and in 2021, birds from affected flocks were submitted to the Veterinary Diagnostic Laboratory at Michigan State University for postmortem examination. Common gross examination findings included flaccid, shrunken, or atrophied ova (all hens), pododermatitis, airsacculitis, hepatomegaly, splenomegaly, ascites, and pallor of the left ventricle. Histopathologic examination of cerebrum, cerebellum, and brainstem revealed mild lymphocytic perivascular cuffing, vasculitis, and gliosis, suggesting viral encephalitis. In the heart, there was mild multifocal cardiomyocyte necrosis, mineralization, and infiltration by lymphocytes and macrophages. PCR for Newcastle disease virus, avian influenza virus, eastern equine encephalitis virus, and West Nile virus (WNV) was performed. Brain and heart samples were positive for WNV by PCR, and WNV antigen was detected in the cerebellum by immunohistochemistry. This is the first report to associate WNV infection with a drop in egg production in waterfowl, which are known to be important reservoir species for WNV and, as such, are generally asymptomatic.
A flock of 50,000 28-day-old broiler breeder chickens experienced an elevated mortality event. Chickens from that flock, five pullets and six cockerels, were submitted for diagnostic investigation. ...Necropsy revealed bacterial septicemia with fibrinous polyserositis in the majority of the birds while two cockerels had coccidial typhlitis. Because sulfadimethoxine was not available at the time, sulfaquinoxaline (SQ) was prescribed at label dosage with water treatment for 2 days, followed by 3 days of no medication, followed by 2 days of medication. The mortality rose dramatically 9 days after the last treatment. Lesions at that time consisted of skin discoloration, subcutaneous petechiation, and enlarged pale kidneys. Mortality remained elevated for 14 days. Analysis of blood, kidney, and liver revealed elevated levels of SQ. Recalculation of dosage, water consumption, amount of drug administered, remaining drug stock, and concentration of supplied SQ were analyzed and determined to be as predicted.
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