Attitudes, practices and experiences of medical specialists towards email communication with their patients.

BACKGROUND: The medical profession has been slow in embracing email as a means of improving communication with patients. AIMS: To explore the attitudes, practices and experiences of senior medical specialists towards email communication with their patients. METHODS: A cross-sectional qualitative interview of 30 medical staff specialists employed by Canberra Health Services, administered through one-on-one interviews conducted between June and August 2020 (several months into the COVID-19 pandemic). Main outcome measures are the comments extracted from the interviews that were categorised into five domains: (i) integration of email use with patients; (ii) issues addressed through email; (iii) benefits of email communication; (iv) concerns and barriers to email communication; and (v) practice pointers for email use with patients. RESULTS: Regular email correspondence with patients was not widespread. The main benefits identified were improved efficiency and flexibility, especially in the context of managing chronic disease and patient follow up. Participants also identified barriers, including time commitments, privacy and confidentiality, patient expectations and potential for misuse. Most participants were hesitant to endorse email with patients in their practices, citing concerns over the utility and safety of the medium and lack of established protocols and recommendations for email usage. CONCLUSIONS: There is a want and need for comprehensive and accessible professional guidance on email use with patients. Our results indicate opportunities to inform good clinical practice in respect of doctor-patient relationships, clinical workloads and risk management. There is also a need for formal guidelines on emailing with patients. The COVID-19 pandemic has heightened the need for such guidelines.

A natural experiment identifies an impending ecological trap for a neotropical amphibian in response to extreme weather events.

Extreme weather events are predicted to increase as a result of climate change, yet amphibian responses to extreme disturbance events remain understudied, especially in the Neotropics. Recently, an unprecedented windstorm within a protected Costa Rican rainforest opened large light gaps in sites where we have studied behavioral responses of diurnal strawberry poison frogs (Oophaga pumilio) to ultraviolet radiation for nearly two decades. Previous studies demonstrate that O. pumilio selects and defends perches where ultraviolet radiation (UV-B) is relatively low, likely because of the lethal and sublethal effects of UV-B. In this natural experiment, we quantified disturbance to O. pumilio habitat, surveyed for the presence of O. pumilio in both high-disturbance and low-disturbance areas of the forest, and assessed UV-B levels and perch selection behavior in both disturbance levels. Fewer frogs were detected in high-disturbance habitat than in low-disturbance habitat. In general, frogs were found vocalizing at perches in both disturbance levels, and in both cases, in significantly lower UV-B levels relative to ambient adjacent surroundings. However, frogs at perches in high-disturbance areas were exposed to UV-B levels nearly 10 times greater than males at perches in low-disturbance areas. Thus, behavioral avoidance of UV-B may not reduce the risks associated with elevated exposure under these novel conditions, and similarly, if future climate and human-driven land-use change lead to sustained analogous environments.

Parasite dynamics in untreated horses through one calendar year.

BACKGROUND: Horses are host to a plethora of parasites. Knowledge of the seasonality of parasite egg shedding and transmission is important for constructing parasite control programs. However, studies describing these patterns are sparse, and have largely been conducted only in the United Kingdom. This study evaluated strongylid egg shedding patterns and transmission dynamics of Strongylus vulgaris in naturally infected and untreated mares and foals through one calendar year in Kentucky, USA. The study also investigated the existence of a peri-parturient rise (PPR) in strongylid egg counts in foaling mares and collected information about Strongyloides westeri and Parascaris spp. in the foals. METHODS: This study was conducted from January to December 2018. A herd of 18 mares, one stallion, and 14 foals born in 2018 were followed throughout the year. Sera and feces were collected biweekly from all horses, and worm burdens enumerated in 13 foals at necropsy. An S. vulgaris ELISA antibody test was run on all serum samples. Fecal egg counts were determined for all horses, and coproculture and qPCR assay were employed to test for the presence of S. vulgaris in the mature horses. Data were analyzed using the proc glimmix procedure in the SAS 9.4 software program. RESULTS: We found a general lack of seasonality in strongylid egg shedding throughout the year among the mature horses, and no PPR was demonstrated. Shedding of S. vulgaris eggs displayed a higher abundance during the spring, but findings were variable and not statistically significant. Anti-S. vulgaris antibody concentrations did not display significant fluctuations in the mature horses, but evidence of passive transfer of antibodies to the foals was demonstrated, and foals assumed their own production of antibodies starting at approximately 20 weeks of age. Overall, colts shed higher numbers of strongylid, ascarid, and S. westeri eggs than fillies. CONCLUSIONS: This study demonstrated a lack of seasonality in strongylid egg shedding for the study population, which is in stark contrast to previous studies conducted elsewhere. This strongly suggests that more studies should be done investigating these patterns under different climatic conditions.

Substrate-mediated regulation of the arginine transporter of Toxoplasma gondii.

Intracellular parasites, such as the apicomplexan Toxoplasma gondii, are adept at scavenging nutrients from their host. However, there is little understanding of how parasites sense and respond to the changing nutrient environments they encounter during an infection. TgApiAT1, a member of the apicomplexan ApiAT family of amino acid transporters, is the major uptake route for the essential amino acid L-arginine (Arg) in T. gondii. Here, we show that the abundance of TgApiAT1, and hence the rate of uptake of Arg, is regulated by the availability of Arg in the parasite's external environment, increasing in response to decreased [Arg]. Using a luciferase-based 'biosensor' strain of T. gondii, we demonstrate that the expression of TgApiAT1 varies between different organs within the host, indicating that parasites are able to modulate TgApiAT1-dependent uptake of Arg as they encounter different nutrient environments in vivo. Finally, we show that Arg-dependent regulation of TgApiAT1 expression is post-transcriptional, mediated by an upstream open reading frame (uORF) in the TgApiAT1 transcript, and we provide evidence that the peptide encoded by this uORF is critical for mediating regulation. Together, our data reveal the mechanism by which an apicomplexan parasite responds to changes in the availability of a key nutrient.

Amphibian responses in the aftermath of extreme climate events.

Climate change-induced extinctions are estimated to eliminate one in six known species by the end of the century. One major factor that will contribute to these extinctions is extreme climatic events. Here, we show the ecological impacts of recent record warm air temperatures and simultaneous peak drought conditions in California. From 2008-2016, the southern populations of a wide-ranging endemic amphibian (the California newt, Taricha torosa) showed a 20% reduction to mean body condition and significant losses to variation in body condition linked with extreme climate deviations. However, body condition in northern populations remained relatively unaffected during this period. Range-wide population estimates of change to body condition under future climate change scenarios within the next 50 years suggest that northern populations will mirror the loss of body condition recently observed in southern populations. This change is predicated on latter 21st century climate deviations that resemble recent conditions in Southern California. Thus, the ecological consequences of climate change have already occurred across the warmer, drier regions of Southern California, and our results suggest that predicted climate vulnerable regions in the more mesic northern range likely will not provide climate refuge for numerous amphibian communities.