Risk factors for acute toxoplasmosis in England and Wales.

Over 300 cases of acute toxoplasmosis are confirmed by reference testing in England and Wales annually. We conducted a case-control study to identify risk factors for Toxoplasma gondii infection to inform prevention strategies. Twenty-eight cases and 27 seronegative controls participated. We compared their food history and environmental exposures using logistic regression to calculate odds ratios (OR) and 95% confidence intervals in a model controlling for age and sex. Univariable analysis showed that the odds of eating beef (OR 10·7, P < 0·001), poultry (OR 6·4, P = 0·01) or lamb/mutton (OR 4·9, P = 0·01) was higher for cases than controls. After adjustment for potential confounders a strong association between beef and infection remained (OR 5·6, P = 0·01). The small sample size was a significant limitation and larger studies are needed to fully investigate potential risk factors. The study findings emphasize the need to ensure food is thoroughly cooked and handled hygienically, especially for those in vulnerable groups.

The influence of status and the social environment on energy stores in a social fish.

This study explores how muscle and liver energy stores are linked with social status and the social environment in Neolamprologus pulcher, a cooperatively breeding fish that lives in colonies comprised of up to 200 distinct social groups. Subordinate muscle energy stores were positively correlated with the number of neighbouring social groups in the colony, but this pattern was not observed in dominant N. pulcher. Furthermore, liver energy stores were smaller in dominants living at the edge of the colony compared with those living in the colony centre, with no differences among subordinates in liver energy stores. Subordinate N. pulcher may build up large energy stores in the muscles to fuel rapid growth after dispersal, which could occur more frequently in high-density environments. Dominant N. pulcher may use the more easily mobilized energy stores in the liver to fuel daily activities, which could be more energetically demanding on the edge of the colony as a result of the increased predation defence needed on the edge. Overall, this study demonstrates that both subordinate and dominant physiology in N. pulcher varies with characteristics of the social environment. Furthermore, dominant and subordinate energy storage strategies appear to differ due to status-dependent variation in daily activities and variation in the need to prepare for future reproductive or dispersal opportunities.

Consequences of experimental cortisol manipulations on the thermal biology of the checkered puffer (Sphoeroides testudineus) in laboratory and field environments.

Anthropogenic climate change is altering temperature regimes for coastal marine fishes. However, given that temperature changes will not occur in isolation of other stressors, it is necessary to explore the potential consequences of stress on the thermal tolerances and preferences of tropical marine fish in order to understand the thresholds for survival, and predict the associated coastal ecological consequences. In this study, we used exogenous cortisol injections to investigate the effects of a thermal challenge on checkered puffers (Sphoeroides testudineus) as a secondary stressor. There were no significant differences between control and cortisol-treated fish 48h following cortisol treatment for swimming ability (using a chase to exhaustion protocol), blood glucose concentrations or standard metabolic rate. In the lab, control and cortisol-treated puffers were exposed to ambient (29.1±1.5°C), ambient +5°C (heat shock) and ambient -5°C (cold shock) for 4h and to evaluate the consequences of abrupt temperature change on puff performance and blood physiology. Following cold shock, control fish exhibited increases in cortisol levels and weak 'puff' performance. Conversely, fish dosed with cortisol exhibited consistently high cortisol levels independent of thermal treatment, although there was a trend for an attenuated cortisol response in the cortisol-treated fish to the cold shock treatment. A 20-day complementary field study conducted in the puffer's natural habitat, a tidal creek in Eleuthera, The Bahamas, revealed that cortisol-injected fish selected significantly cooler temperatures, measured using accumulated thermal units, when compared to controls. These results, and particularly the discrepancies between consequences documented in the laboratory and the ecological trends observed in the field, highlight the need to establish the link between laboratory and field data to successfully develop management policies and conservation initiatives with regards to anthropogenic climate change.

Use of the Tailored Activities Program to reduce neuropsychiatric behaviors in dementia: an Australian protocol for a randomized trial to evaluate its effectiveness.

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are often considered to be the greatest challenge in dementia care, leading to increased healthcare costs, caregiver burden, and placement into care facilities. With potential for pharmacological intervention to exacerbate behaviors or even lead to mortality, the development and rigorous testing of non-pharmacological interventions is vital. A pilot of the Tailored Activities Program (TAP) for reducing problem behaviors in people with dementia was conducted in the United States with promising results. This randomized trial will investigate the effectiveness of TAP for reducing the burden of BPSD on persons with dementia and family caregivers within an Australian population. This trial will also examine the cost-effectiveness and willingness to pay for TAP compared with a control group. METHODS: This randomized trial aims to recruit 180 participant dyads of a person with dementia and their caregivers. Participants will have a diagnosis of dementia, exhibit behaviors as scored by the Neuropsychiatric Inventory, and the caregiver must have at least 7 h per week contact. Participants will be randomly allocated to intervention (TAP) or control (phone-based education sessions) groups, both provided by a trained occupational therapist. Primary outcome measure will be the revised Neuropsychiatric Inventory - Clinician rating scale (NPI-C) to measure BPSD exhibited by the person with dementia. CONCLUSIONS: This trial investigates the effectiveness and cost-effectiveness of TAP within an Australian population. Results will address a significant gap in the current Australian community-support base for people living with dementia and their caregivers.

Therapeutic implications of biomarkers in chronic heart failure.

Understanding of chronic heart failure (HF) has progressed from the concept of a purely hemodynamic disorder to that of a syndrome that results from dysfunction in interconnected molecular pathways. As a result, the focus of research investigations and clinical care has shifted to measurement and modification of maladaptive molecular processes. Accumulating evidence shows that molecular biomarkers provide a window into the pathophysiology of chronic HF and therefore have important therapeutic implications. However, the use of biomarkers in the treatment of HF remains in its infancy. This is partly a result of shortcomings in research studies and a dearth of biomarker-guided clinical trials. In this review, we summarize the potential therapeutic implications of promising biomarkers that uniquely capture the molecular dysfunction that occurs in chronic HF. We discuss the need for strict statistical standards in biomarker studies, provide an overview of biomarker-guided clinical trial design, and discuss the therapeutic potential of a multimarker-based strategy.

Disability in atypical parkinsonian syndromes is more dependent on memory dysfunction than motor symptoms.

BACKGROUND: There is a gap in the systematic description and investigation of functional disability in corticobasal syndrome (CBS) and progressive supranuclear palsy (PSP). Additionally, the relations between disability, apraxia, cognitive and behavioural changes are not well understood in atypical parkinsonian syndromes. METHODS: Fifty patients were included in this study (CBS = 18; PSP = 11), including a subgroup of primary progressive aphasia-nonfluent variant (PPA-nfv = 21) who were used as a control group given the clinic-pathological overlap. Functional disability (basic and instrumental activities of daily living), general cognition and behavioural changes were evaluated at baseline, with a subgroup of patients being reassessed after 16 months. RESULTS: The corticobasal syndrome group had the most marked disability in basic activities in comparison to progressive supranuclear palsy and primary progressive aphasia-nonfluent variant. Longitudinal decline was marked for all three groups. In a linear regression examining factors behind functional disability in CBS and PSP, memory dysfunction emerged as the main factor (48.5%), followed by apraxia (14.9%) and atypical parkinsonian symptoms (9.6%). CONCLUSIONS: Memory dysfunction is the most important factor in functional disability in CBS and PSP, which has to be taken into consideration in disease management, prognosis and planning of services to fully address patients' and families' needs.

Condition dependent intra-individual repeatability of stress-induced cortisol in a freshwater fish.

The glucocorticoid (GC) stress response is thought to be an individual trait associated with behaviour and life history strategies. Studies exploring such relationships typically assume measured hormone values to be repeatable within an individual. However, repeatability of GCs has proven variable in wild animals and underlying reasons remain unknown. We assessed individual repeatability of circulating stress-induced cortisol, the primary GC in teleost fish, and glucose concentrations in a wild teleost fish held under consistent laboratory conditions. We also tested the hypothesis that the magnitude of intra-individual variability in stress-induced cortisol concentrations ("cortisol variability") is influenced by body condition. Wild-caught bluegill sunfish (Lepomis macrochirus) were subjected to repeated standardized stressors and blood sampled (3 times over 6 days) once cortisol concentrations peaked. Various indicators of fish condition, both whole body and physiological, were also measured. Overall, stress-induced circulating cortisol concentrations were repeatable but stress-induced glucose was not. Cortisol variability was related to Fulton's condition factor and size (eviscerated mass) where smaller fish in poor condition exhibited increased cortisol variability. The findings have implications for the interpretation of studies that examine correlates of GC concentrations as they suggest consistency in stress responsiveness is influenced by factors such as size and condition.

The glucocorticoid stress response is repeatable between years in a wild teleost fish.

Patterns of glucocorticoid (GC) hormone regulation exhibit considerable inter-individual variation that is often examined relative to individual traits and fitness measures. Although stress-induced GC concentrations are repeatable within an individual in captive populations, this assumption remains untested in wild animals in their natural environment across longer time periods. We assessed the repeatability of baseline and post-stress GC concentrations in a wild teleost fish. Largemouth bass (Micropterus salmoides) were captured and subjected to a standard stress protocol and then stocked into a small research lake. Upon recapture by angling up to 1 year later (n = 26), fish were re-sampled following identical methods. After controlling for a strong effect of water temperature, we confirmed repeatability of post-stress cortisol concentrations despite stress presumed to accompany relocation. We documented no consistency in baseline GC concentrations. This study serves as an important validation for the use of post-stress cortisol concentrations as an individual trait. However, the effect size of repeatability was lower than that found in other taxa. Results also bring forth the reality that environmental variables such as temperature must be considered in studies where these factors can vary, such as when sampling wild animals at liberty.

Bucindolol: new hopes from reviewing past data.

ß-Adrenoceptor antagonists or ß-blockers are a cornerstone of therapy in chronic heart failure (CHF). Bucindolol hydrochloride is a fourth-generation ß-blocker in development for the treatment of CHF. Two trials have been conducted to evaluate its use in CHF, and a third is under way to investigate bucindolol for the reduction of cardiovascular mortality and cardiovascular hospitalizations in a genotype-defined heart failure population. This review aims to summarize the history, pharmacology and clinical trials of bucindolol.

Effect of nesiritide in patients with acute decompensated heart failure.

BACKGROUND: Nesiritide is approved in the United States for early relief of dyspnea in patients with acute heart failure. Previous meta-analyses have raised questions regarding renal toxicity and the mortality associated with this agent. METHODS: We randomly assigned 7141 patients who were hospitalized with acute heart failure to receive either nesiritide or placebo for 24 to 168 hours in addition to standard care. Coprimary end points were the change in dyspnea at 6 and 24 hours, as measured on a 7-point Likert scale, and the composite end point of rehospitalization for heart failure or death within 30 days. RESULTS: Patients randomly assigned to nesiritide, as compared with those assigned to placebo, more frequently reported markedly or moderately improved dyspnea at 6 hours (44.5% vs. 42.1%, P=0.03) and 24 hours (68.2% vs. 66.1%, P=0.007), but the prespecified level for significance (P≤0.005 for both assessments or P≤0.0025 for either) was not met. The rate of rehospitalization for heart failure or death from any cause within 30 days was 9.4% in the nesiritide group versus 10.1% in the placebo group (absolute difference, -0.7 percentage points; 95% confidence interval [CI], -2.1 to 0.7; P=0.31). There were no significant differences in rates of death from any cause at 30 days (3.6% with nesiritide vs. 4.0% with placebo; absolute difference, -0.4 percentage points; 95% CI, -1.3 to 0.5) or rates of worsening renal function, defined by more than a 25% decrease in the estimated glomerular filtration rate (31.4% vs. 29.5%; odds ratio, 1.09; 95% CI, 0.98 to 1.21; P=0.11). CONCLUSIONS: Nesiritide was not associated with an increase or a decrease in the rate of death and rehospitalization and had a small, nonsignificant effect on dyspnea when used in combination with other therapies. It was not associated with a worsening of renal function, but it was associated with an increase in rates of hypotension. On the basis of these results, nesiritide cannot be recommended for routine use in the broad population of patients with acute heart failure. (Funded by Scios; ClinicalTrials.gov number, NCT00475852.).

Using video simulated presence to reduce resistance to care and increase participation of adults with dementia.

BACKGROUND: Cognitive and functional decline in dementia generally impairs performance of basic care activities. Staff assistance during these activities frequently results in confusion, anxiety, and distress, expressed through resistance to care (RTC). METHODS: A single-system ABA withdrawal design (n = 1) evaluated the effect of video-simulated presence (VSP) for decreasing RTC and increasing participation. A family member pre-recorded videos for use during episodes of RTC, in which the family member spoke directly to the participant to encourage participation. RESULTS: Introduction of the VSP significantly reduced RTC during the basic care tasks of feeding and talking medication. This effect was reversed when the intervention was withdrawn. Participation increased following VSP, demonstrating clear trends toward clinical significance. CONCLUSIONS: This person-centered intervention, based on VSP of a family member, provides encouraging results for reducing RTC and increasing participation of adults with dementia in basic care tasks.

Biomechanical variables associated with Achilles tendinopathy in runners.

OBJECTIVE: The aim of this study was to investigate the kinetics, kinematics and muscle activity in runners with Achilles tendinopathy. DESIGN: Case-control study. SETTING: Biomechanics laboratory. PARTICIPANTS: 21 runners free from injury and 21 runners with Achilles tendinopathy performed 10 running trials with standardised running shoes. Injured runners were diagnosed clinically according to established diagnostic criteria. Uninjured runners had been injury-free for at least 2 years. MAIN OUTCOME MEASUREMENTS: During each trial, kinetic and lower limb kinematic data were measured using a strain gauge force plate and six infrared cameras respectively. Electromyographic (EMG) data from six muscles (tibialis anterior (TA), peroneus longus (PE), lateral gastrocnemius (LG), rectus femoris (RF), biceps femoris (BF) and gluteus medius (GM)) were measured with a telemetric EMG system. RESULTS: Knee range of motion (heel strike to midstance) was significantly lower in injured runners than in uninjured runners. Similarly, preactivation (integrated EMG (IEMG) in 100 ms before heel strike) of TA was lower for injured runners than uninjured runners. RF and GM IEMG activity 100 ms after heel strike was also lower in the injured group. However, impact forces were not different between the two groups. CONCLUSION: Altered knee kinematics and reduced muscle activity are associated with Achilles tendinopathy in runners. Rehabilitation exercises or other mechanisms (e.g. footwear) that affect kinematics and muscle activity may therefore be beneficial in the treatment of runners with Achilles tendinopathy.

Genetic variants of microsomal epoxide hydrolase and glutamate-cysteine ligase in COPD.

The genetic factors that contribute to the development of chronic obstructive pulmonary disease (COPD) are poorly understood. Many candidate genes have been proposed, including enzymes that protect the lung against oxidative stress, such as microsomal epoxide hydrolase (EPHX1) and glutamate-cysteine ligase (GCL). To date, most reported findings have been for EPHX1, particularly in relation to functional variants associated with fast and slow metabolism of epoxide intermediates. The present study aimed to identify any association of variation in these genes with COPD susceptibility or severity. In total, 1,017 white COPD patients and 912 nondiseased age and sex matched smoking controls were genotyped for six single nucleotide polymorphisms (SNPs) in EPHX1 (including the fast and slow variants and associated haplotypes), and eight SNPs in the two genes encoding GCL. GCL is a rate-limiting enzyme in the synthesis of glutathione, a major contributor to anti-oxidant protection in the lung. No association of variation was found in EPHX1 or GCL with susceptibility to COPD or disease severity. This is the largest reported study to date and is well powered to detect associations that have been previously suggested. The current data indicate that these genetic variants are unlikely to be related to susceptibility or disease severity in white chronic obstructive pulmonary disease patients.

Rhesus monkey rhadinovirus: a model for the study of KSHV.

Rhesus monkey rhadinovirus (RRV) is one of the closest phylogenetic relatives to the human pathogen Kaposi sarcoma-associated herpesvirus (KSHV)-a gamma-2 herpesvirus and the etiologic agent of three malignancies associated with immunosuppression. In contrast to KSHV, RRV displays robust lytic-phase growth in culture, replicating to high titer, and therefore holds promise as an effective model for studying primate gammaherpesvirus lytic gene transcription as well as virion structure, assembly, and proteomics. More recently, investigators have devised complementary latent systems of RRV infection, thereby also enabling the characterization of the more restricted latent transcriptional program. Another benefit of working with RRV as a primate gammaherpesvirus model is that its efficient lytic growth makes genetic manipulation easier than that in its human counterpart. Exploiting this quality, laboratories have already begun to generate mutant RRV, setting the stage for future work investigating the function of individual viral genes. Finally, rhesus macaques support experimental infection with RRV, providing a natural in vivo model of infection, while similar nonhuman systems have remained resistant to prolonged KSHV infection. Recently, dual infection with RRV and a strain of simian immunodeficiency virus (SIV) has led to a lymphoproliferative disorder (LPD) reminiscent of multicentric Castleman disease (MCD)--a clinical manifestation of KSHV infection in a subset of immunosuppressed patients. RRV, in short, shows a high degree of homology with KSHV yet is more amenable to experimental manipulation both in vitro and in vivo. Taken together, these qualities ensure its current position as one of the most relevant viral models of KSHV biology and infection.

Sarcoidosis and MIF gene polymorphism: a case-control study in an Irish population.

Macrophage migration inhibitory factor is a key pro-inflammatory mediator. A 5-CATT repeat functional polymorphism within the promoter of the gene was previously associated with the lowest promoter activity. It was hypothesised that patients exhibiting a 5-CATT allele would have a less aggressive inflammatory response with an associated less severe clinical phenotype in sarcoidosis. Irish Caucasian sarcoidosis patients (n = 173) followed up for 1-39 yrs and a control group (n = 166) were genotyped for the CATT repeat polymorphism. Disease severity at the time of diagnosis and at the time of elaboration of the present study was assessed by the presence of thoracic and extrathoracic symptoms, erythema nodosum, radiographic interstitial changes (chest radiograph score equal to stage II or greater, or high-resolution computed tomography confirmed), pulmonary function tests, steroid use, erythrocyte sedimentation rate, C-reactive protein and angiotensin-converting enzyme levels. In the Irish population studied, no evidence was found of a significant association between either sarcoidosis susceptibility and disease severity and the 5-CATT repeat functional polymorphism in the macrophage migration inhibitory gene. The present study found no significant association between the 5-CATT repeat macrophage migration inhibitory factor gene polymorphism and sarcoidosis, and did not support the overriding role for macrophage migration inhibitory factor in driving sarcoidosis pathogenesis.

Estimation of selected heavy metals and arsenic in PM10 aerosols in the ambient air of the Greater Athens Area, Greece.

Aerosol samples of PM(10) were collected during summer and winter 2003 at two different sites in the Messogia Basin northeast of Athens, to demonstrate the variations of heavy metals in PM(10) and examine their relationship with both gaseous pollutants and meteorological parameters. Estimated heavy metals during the experimental campaign were mercury (Hg), cadmium (Cd), lead (Pb), nickel (Ni) and arsenic (As). The average heavy metal concentrations for the first site (Spata) constituted 0.66-14.7ng/m(3) for the summer period and 0.14-19.5ng/m(3) for the winter period. At the second site (Koropi), the corresponding values varied between 0.89 and 13.3ng/m(3) and 0.16 and 24.7ng/m(3), respectively. PM(10) Hg, PM(10) Cd and PM(10) Ni contents showed regular daily variations, with higher mass percentages during the summer, indicating differences in local PM(10) sources for each season. On the contrary, PM(10) Pb presented higher mass percentages during the winter. Examination of the relationship between heavy metals and meteorological parameters indicated a higher correlation with temperature and relative humidity, especially for Pb. In addition, most of the heavy metals (apart from Hg) presented an expected correlation with nitrate oxides (NO(x)), PM(10) and ozone (O(3)). Higher correlations with both meteorological parameters and gaseous pollutants were observed during the winter experimental campaign. Maximum heavy metal concentrations at both sites were observed during days with NE or NNE prevailing winds during the summer campaign, while the winter period was characterized with maximums during days with W or WNW prevailing winds.

Chorioamnionitis increases matrix metalloproteinase-8 concentrations in bronchoalveolar lavage fluid from preterm babies.

OBJECTIVE: To determine the effects of chorioamnionitis and antenatal corticosteroids on matrix metalloproteinase-8 (MMP-8) concentrations in bronchoalveolar lavage (BAL) fluid from preterm babies in the first week of life. DESIGN: Prospective observational study. SETTING: Regional neonatal intensive care unit. PATIENTS: Thirty five ventilated preterm babies < 33 weeks gestation, seven of whom were born after chorioamnionitis, which was diagnosed histologically as the presence of inflammatory cells in the chorioamnionic plate. METHODS: MMP-8 was measured by enzyme linked immunosorbent assay (ELISA) in 90 serial BAL samples taken during the first six postnatal days. The median MMP-8 concentration for each baby was calculated. RESULTS: Median MMP-8 concentrations were higher in the chorioamnionitis group than in those without (43 v 5 ng/ml). Partial or complete courses of antenatal corticosteroids had no effect on MMP-8 concentrations. CONCLUSIONS: Higher concentrations of MMP-8 are found in BAL fluid from preterm babies from pregnancies complicated by chorioamnionitis. This type I collagenase may contribute to the lung injury that occurs in some babies with respiratory distress syndrome.